Spectrum: Local Antimicrobial Stewardship, for Island Health

Post Operative IAI

Refers to a health-care associated infection within 30 days of an intra-abdominal operative procedure or within 90 days if prosthetic material is implanted

Diagnostic Pearls

Urgent surgical consultation

Screen for MRSA and CPO as per Island Health ARO screening questionnaire

Blood cultures recommended unless SIRS is absent

Empiric Therapy

Mild-moderate

Those who do not meet criteria for severe infection but may have:

  • SIRS (two or more of: Temperature >38°C or <36°C; Heart rate >90/min; Respiratory rate >20/min; White blood cell count >12,000/mm3 or <4,000mm3)

  • Co-morbidities (e.g. diabetes, advanced age)

Severe

Requiring ICU admission, or

Sepsis (life-threatening organ dysfunction e.g. hypotension, acute renal failure, caused by dysregulated host response to infection)

Microbiology

Usual Organisms

Enterobacteriaceae (E. coli, Klebsiella)

Enteric anaerobes (B. fragilis, Clorstridium)

Skin flora, particularly MSSA

Possible Organisms

MRSA

Coagulase-Negative Staphylococci

ESBLs

AmpC producing organisms or "SPICE" bacteria