Which ABX to discontinue?

[Sparda29]

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Patient comes in from the nursing home to have surgery for ruptured quadricep tendon due to a fall. In the nursing home, the patient was already being treated for sepsis with Zosyn 3.375 IVPB q8h and Vancomycin 1gm q12h.

Orthopedics sees the patient, they have surgery to repair the ruptured tendon, and all meds are reordered, except they also order Ancef 2 grams q8h x 3 doses. Apparently, Ancef is the drug of choice post surgery for SCIP patients.

Isn't there no need to start Ancef since Vancomycin and Zosyn would provide sufficient coverage???

 

[npage148]

Did a p2 ask you this?

 

[Sparda29]

Did a p2 ask you this?

No. PGY2 ortho resident though. I'm trying to convince him to ditch the Ancef.

 

[Praziquantel86]

Why is the patient being treated for "sepsis" at a nursing home in the first place? And are there any signs/symptoms of infection? I don't think a tendon rupture qualifies.

I'd recommend reading the surgical prophylaxis guidelines with a focus on two questions - (1) what is the optimal prophylactic choice for a clean surgical site and (2) what is the optimal duration of surgical prophylaxis.

The answers to all of those questions should lead you to the correct choice for this patient.

 

[Sparda29]

Why is the patient being treated for "sepsis" at a nursing home in the first place? And are there any signs/symptoms of infection? I don't think a tendon rupture qualifies.

I'd recommend reading the surgical prophylaxis guidelines with a focus on two questions - (1) what is the optimal prophylactic choice for a clean surgical site and (2) what is the optimal duration of surgical prophylaxis.

The answers to all of those questions should lead you to the correct choice for this patient.

Read the profile wrong. Patient lives at a nursing home and developed sepsis and was admitted to the hospital. She suffered a fall at the hospital and ruptured a tendon as a result of the fall and was transferred into the orthopedics unit for surgical repair of the ruptured tendon.

Optimal prophylactic choice for this patient is Ancef 2 grams q8h x 3 doses, or Vancomycin 1 gram q12h x 2 doses if PCN allergic. Patient is not PCN allergic, but they are already being treated with Vancomycin 1 gram q12h, so why not just D/C the Ancef and you're already being covered by the existing Vancomycin order?

 

[awval999]

You are correct, they do not need the Ancef.

The patient meets Core Measures--- they are excluded because the patient came in with a documented pre-existing condition; Sepsis and have been on antibiotics for >24 hours pre-surgery.

 

[lisinopril]

D/c ancef...no need.

 

[VCU07]

Read the profile wrong. Patient lives at a nursing home and developed sepsis and was admitted to the hospital. She suffered a fall at the hospital and ruptured a tendon as a result of the fall and was transferred into the orthopedics unit for surgical repair of the ruptured tendon.

Optimal prophylactic choice for this patient is Ancef 2 grams q8h x 3 doses, or Vancomycin 1 gram q12h x 2 doses if PCN allergic. Patient is not PCN allergic, but they are already being treated with Vancomycin 1 gram q12h, so why not just D/C the Ancef and you're already being covered by the existing Vancomycin order?

Ancef has better activity vs strep although both would be sufficient if this is for scip.

 

[redxiii1313]

Read the profile wrong. Patient lives at a nursing home and developed sepsis and was admitted to the hospital. She suffered a fall at the hospital and ruptured a tendon as a result of the fall and was transferred into the orthopedics unit for surgical repair of the ruptured tendon.

Optimal prophylactic choice for this patient is Ancef 2 grams q8h x 3 doses, or Vancomycin 1 gram q12h x 2 doses if PCN allergic. Patient is not PCN allergic, but they are already being treated with Vancomycin 1 gram q12h, so why not just D/C the Ancef and you're already being covered by the existing Vancomycin order?

you mentioned that pt is on zosyn. lol, pretty sure pt isn't allergic to penicillins. you're already covering the pt with two big cannons (aka vanco + zosyn). no need to add on a small gun (cefazolin) to the regimen