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Appendix: Institutional guideline recommendations for surgical procedures
Definitions:
• Timing: for beta-lactams and aminoglycosides, infusion started 0-60 minutes prior to incision; for fluoroquinolones, infusion started 0-120 minutes prior to incision; for vancomycin, infusion started 0-120 minutes prior to incision or completed 0-60 minutes prior to incision
• High risk for MRSA: History of MRSA infection or colonization; on chronic hemodialysis; hospitalization for >48 hrs within 90 days; current hospitalization >72 hours; surgery involving placement of prosthetic material
• Severe beta-lactam allergy: anaphylaxis, angioedema, difficulty breathing, urticaria, hives, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and skin sloughing
| |Preferred regimen without severe |Preferred regimen with severe |High risk for MRSA without severe |High risk for MRSA with severe |
| |beta-lactam allergy (not high-risk for |beta-lactam allergy (not high-risk for |beta-lactam allergy |beta-lactam allergy |
| |MRSA) |MRSA) | | |
|Coronary artery |See recommendations for high-risk for |See recommendations for high-risk for |Cefazolin + Vancomycin |Vancomycin + Gentamicin |
|bypass graft and other cardiac |MRSA |MRSA | | |
|procedures | | | |OR if eGFR ................
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