Perioperative Pathogens-Slides

Slides
Pdf Summary
This presentation by Drs. Edie Shen and Barbara Slawski covers key aspects of perioperative infections and considerations, focusing on endocarditis prophylaxis, COVID-19, HIV, surgical site infection (SSI) prevention, immunosuppressants, and postoperative fever.

<strong>Endocarditis Prophylaxis:</strong> Guidelines have shifted, now recommending prophylaxis only for high-risk patients (e.g., prosthetic valves, prior endocarditis) undergoing dental procedures involving manipulation of gingival tissue. Antibiotic regimens favor amoxicillin; clindamycin is no longer recommended due to serious reactions.

<strong>COVID-19 and Surgery:</strong> Early pandemic data showed high perioperative risk and mortality with recent COVID infection. More recent studies reveal decreased risk over time and with vaccination. Surgery is generally delayed at least 2 weeks after infection, with risk assessment extending up to 7 weeks, especially if symptoms persist. Patient-specific factors, severity, vaccination, and surgery complexity guide timing.

<strong>Surgical Site Infection Prevention:</strong> SSIs occur in 2-5% of surgeries and constitute a significant proportion of hospital infections. Key prevention includes optimization of medical conditions such as diabetes, smoking cessation, avoiding unnecessary transfusions, careful medication management, and avoiding shaving (which increases SSI risk). MRSA/MSSA screening and targeted decolonization prior to orthopedic and cardiac surgery can reduce Staphylococcus aureus infections, although overall SSI reduction data are mixed.

<strong>Immunosuppressants:</strong> The PUCCINI study suggests preoperative TNF inhibitor use does not markedly increase SSI risk. Surgical timing relative to biologic medications must balance infection risk versus disease flare, with guidelines recommending temporary holding of some immunosuppressants before surgery and restarting 1-2 weeks postoperatively.

<strong>HIV and Surgery:</strong> Controlled HIV infection with undetectable viral load reduces perioperative risk. Continuation of antiretroviral therapy through the perioperative period is critical to prevent resistance and maintain viral suppression. Close management of drug interactions and awareness of potential side effects like QT prolongation is important.

<strong>Postoperative Fever:</strong> The 5 “W’s” (Wind, Water, Wound, Walking, Wonder drug) remain central to differential diagnosis, with timing after surgery guiding likely etiologies. Early fever is rarely due to atelectasis. A systematic approach including history, physical exam, and selective diagnostics is advocated.

Overall, this comprehensive overview highlights individualized risk assessment, updated guidelines, and multidisciplinary coordination to optimize perioperative infectious outcomes.

Contact: edieshen@uw.edu, bslawski@mcw.edu
Keywords
perioperative infections
endocarditis prophylaxis
COVID-19 and surgery
surgical site infection prevention
immunosuppressants
postoperative fever
HIV and surgery
antibiotic regimens
MRSA/MSSA screening
perioperative risk assessment