The Harms of Postoperative Antibiotic ProphylaxisA Teachable Moment

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JAMA Internal Medicine

May 1, 2022

Teachable Moment

Article Information and Disclosures

Sheliza Halani, MD¹;

Mark McIntyre, PharmD, RPh²;

Alon Vaisman, MD, MAS^1,3

Author Affiliations

¹Department of Medicine, University of Toronto, Toronto, Ontario, Canada
²Antimicrobial Stewardship Program, Sinai Health – University Health Network, Toronto, Ontario, Canada
³Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada

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A man in his 70s with a medical history of coronary artery disease presented to the emergency department with fever and chills. The patient underwent a metatarsophalangeal arthrodesis for toe clawing 3 days prior and had been discharged the same day with a 14-day course of cephalexin for postoperative surgical site infection (SSI) prophylaxis. He presented on postoperative day 3 with frequent watery stools and abdominal pain. Admission vital signs were notable for a temperature of 39.4° C and blood pressure of 125/65 mm Hg.

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Article Information

Corresponding Author: Alon Vaisman, MD, MAS, 8PMB 104 200 Elizabeth St, Toronto General Hospital M5G 2C4 (alon.vaisman@uhn.ca).

Published Online: March 28, 2022. doi:10.1001/jamainternmed.2022.0413

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

Additional Information: Dr Halani is an internal medicine resident, Dr Vaisman is an infectious diseases staff physician, and Dr McIntyre is an infectious disease pharmacist. Drs Vaisman and Halani were involved in case preparation. Drs Halani, Vaisman, and McIntyre were involved in the literature search, manuscript preparation, and editing and revising the manuscript. All authors contributed to the preparation of this article.

References

Branch-Elliman W , O’Brien W , Strymish J , Itani K , Wyatt C , Gupta K . Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg. 2019;154(7):590-598. doi:10.1001/jamasurg.2019.0569 PubMed Google Scholar Crossref

Berríos-Torres SI , Umscheid CA , Bratzler DW , et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection. JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 PubMed Google Scholar Crossref

Allegranzi B , Zayed B , Bischoff P , et al; WHO Guidelines Development Group. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288-e303. doi:10.1016/S1473-3099(16)30402-9 PubMed Google Scholar Crossref

Ierano C , Thursky K , Marshall C , et al. Appropriateness of surgical antimicrobial prophylaxis practices in Australia. JAMA Netw Open. 2019;2(11):e1915003. doi:10.1001/jamanetworkopen.2019.15003 PubMed Google Scholar Crossref

Puig-Asensio M , Perencevich EN , Livorsi DJ . Prolonged postprocedural antimicrobial use: a survey of the Society for Healthcare Epidemiology of America Research Network. Infect Control Hosp Epidemiol. 2019;40(11):1281-1283. doi:10.1017/ice.2019.242 PubMed Google Scholar Crossref

The Harms of Postoperative Antibiotic ProphylaxisA Teachable Moment

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