General Notes

Antibiotics should be given within 60 minutes prior to surgical incision. Vancomycin and fluoroquinolone infusion should begin within 120 minutes before surgical incision due to the prolonged infusion time required for these drugs.

If patient already on antibiotics, prophylactic doses should still be given prior to surgery at times outline above. If patient already on vancomycin or gentamicin, consult pharmacist to assess need for prophylactic dose.

For prolonged operative procedures (lasting greater than 4 hours) or procedures with excessive blood loss (over 1500 mL), see redosing intervals. The redosing interval is defined as the time from initiation of preoperative dose, not the time of 1st incision.

General risk factors for surgical site infection:

• Extremes of age

• Nutritional status

• Obesity

• Diabetes mellitus

• Tobacco use

• Coexistent remote body-site infections

• Altered immune response

• Corticosteroid therapy

• Recent surgical procedure

• Length of preoperative hospitalization

• Colonization with microorganisms

• Immunocompromised

For patients known to be colonized with MRSA, it is reasonable to add a single pre-operative dose of Vancomycin 20 mg/kg to the recommended agents.