Peri-op TOC
12. INFECTIOUS DISEASE CONCERNS
HIV and AIDS
*Asymptomatic HIV infection does not appear to significantly increase surgical
morbidity/mortality; however, the clinical sequellae of advanced HIV disease
and AIDS clearly leads to a higher rate of postoperative complications and
death. Postoperative mortality among AIDS patients is influenced more by
the progression of underlying opportunistic infections and malignancies than
by surgical complications.
SPECIFIC CONCERNS:
-
Hematologic parameters-platelets, white blood cells, and red blood cells
can all be affected by HIV disease. Postoperative bacterial and wound infection
risk correlates with the absolute neutrophil count (ANC) just as in non-HIV
infected individuals, and the indications for GCSF administration are essentially
the same. Thrombocytopenia and anemia are also common findings in advanced
disease.
-
Nutrition-poor nutritional status is an indicator of high surgical risk.
-
Immunologic status-this also correlates with surgical risk. One study documented
the combination of low serum albumin (under 2.5 gm) and a history of
opportunistic infection was associated with decreased survival after surgery.
The correlation between CD4 count and surgical morbidity/mortality is still
unclear, however.
-
Adrenal insufficiency-more prevalent in patients with HIV disease than in
non-HIV infected individuals, although still not a common condition. Underlying
adrenal insufficiency may be unmasked postoperatively, particularly in patients
with advanced disease.
-
Chronic medications-may be interrupted in the immediate perioperative period.
Peri-op TOC
EMPIRICAL IV ANTIBIOTIC REGIMENS FOR
COMMON SURGICAL INFECTIONS
CELLULITIS (uncomplicated):
Ancef 1gm q8h or Clindamycin 900mg q8h
DIABETIC/ ISCHEMIC FOOT INFECTION (*amputation risk):
Unasyn 3gm q6h (+ Gentamicin) or Ceftazidime 1gm q8h and Clindamycin 900mg
q8h (+ Gentamicin)
MASTITIS (with abscess drainage):
Clindamycin 300mg q6h or Ancef 1gm q8h and Flagyl 500mg q8h
PERITONITIS/ INTRA-ABDOMINAL INFECTION
(including appendicitis, cholecystitis, cholangitis, perforated
bowel, diverticulitis):
*multiple regimens
-
· Ampicillin 2gm q6h and Flagyl 500mg q8h and Gentamicin SDDA or
-
· Ceftazidime 1gm q8h and Flagyl 500mg q8h or
-
· Clindamycin 900mg q8h and Gentamicin SDDA or
-
· Ceftazidime 1gm q8 and Clindamycin 900mg q8 or
-
· Clindamycin 900mg q8h and Cipro 400mg q12h (IV Cipro is a restricted
antibiotic)
HOSPITAL-ACQUIRED PNEUMONIA:
-
Ceftazidime 1gm q8h and Clindamycin 900mg q8h (+ Gentamicin)
-
or Piperacillin 3gm q6h and Gentamicin SDDA
(SDDA = Single Day Dosing Aminoglycoside)
Peri-op TOC