role ofa ntibioticp rophylaxis forc lean td c p rocedu res · role ofa ntibioticp rophylaxis forc...
TRANSCRIPT
![Page 1: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/1.jpg)
Role of A ntibiotic P rophylaxis forC leanTD C P roced u res
Loay Salman, MD MBA
C hief:D ivision of N ephrologyand H ypertension
The Thomas O rdwayD istingu ished P rofessorof M edicineA lbanyM edicalC ollege,A lbany,N Y
13thA nnu alA S D IN S cientific M eeting–Febru ary,20 17
![Page 2: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/2.jpg)
What is the Concern?
U S R DS -1999
![Page 3: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/3.jpg)
Antibiotic prophylaxis for minimallyinvasive interventional procedures
•Zegal et al in 1998 sent a questionnaire regarding antibioticprophylactic usage to 2,039 members of the Society ofCardiovascular and Interventional Radiology (SCVIR).
Conclusion:
Indications for antibiotic prophylaxis are not clear tointerventionalists for a large number of vascular andnonvascular interventional procedures.
Zegaletal,JVasc Interv Radiol.1 998
![Page 4: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/4.jpg)
Procedure related infection
Procedure related infection:
No consensus on definition.
Any documented infection at the procedure site or bloodstream that occur within 72 hours after the procedure.
Rate:
There is no data about dialysis access proceduresinfection rate.
SalmanL ,A sifA :SID . 2009
![Page 5: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/5.jpg)
SalmanL ,A sifA :SID . 2009
![Page 6: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/6.jpg)
JVascIntervR adiol2016;27:339– 343
Conclusions:The odds ratio of infection was 0.85 with antibiotic use but one was contained within theconfidence interval suggesting no significant difference in infection rate when antibioticswere used.
![Page 7: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/7.jpg)
Recommendation
•Intravenous Antibiotic ProphylaxisRandomized controlled trials indicate that catheter-related infections andsepsis are reduced when prophylactic intravenous antibiotics areadministered to high-risk immunosuppressed cancer patients or neonates(C ategoryA 2evidence).
The literature is insufficient to evaluate outcomes associated with theroutine use of intravenous antibiotics (C ategory D evidence).
•Recommendations for Intravenous Antibiotic ProphylaxisFor immunocompromised patients and high-risk neonates, administerintravenous antibiotic prophylaxis on a case-by-case basis. Intravenousantibiotic prophylaxis should not be administered routinely.
P racticeGuidelinesforCentralVenousAccess:A R eportby theAmerican Society of Anesthesiologists T askForceonCentralVenousAccess
Anesthesiology3 2012,Vol.116,539-573
![Page 8: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/8.jpg)
Recommendation
P ractice Gu ideline forA d u ltA ntibiotic P rophylaxis d u ringVascu larand InterventionalRadiologyP roced u res
JVasc Interv Radiol20 1 0 ;21 :1 611 –1 630
![Page 9: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/9.jpg)
Recommendation
GuidelinesfortheP reventionofIntravascularCatheter-R elatedInfections,2011www.cdc.gov
![Page 10: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/10.jpg)
What are the concerns ofAntibiotic use?
![Page 11: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/11.jpg)
Concerns with routine use of antibiotics!
• Antibiotic resistance:• Mutation.• Transfer of resistance-encoding genetic material from one bacteria to another.• Increased number of susceptible host (i.e. immunocompromised).• Not following infection control practices.• M isu se oroveru se of antibiotics.
A cta P harmacolSin24,20 0 3
• Multi-drug-resistant organisms:• Methicilin-resistant Staphylococci (MRSA)• Vancomycin-resistant Enterococci (VRE)• Extended-spectrum beta-lactamase (ESBL)
There is clear evidence that infections with those organisms are diagnosed more frequentlyas compared with the past.
A m JInfectC ontrol28,20 0 0
![Page 12: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/12.jpg)
•Antibiotic side effects:• Large prospective study reported that only 3.2% demonstrated
true penicillin allergy of which 0.2% were anaphylactic innature.
InternationalRheu matic FeverGrou p.L ancet1 991
• Another large prospective study reported that the rate of sideeffects is 22%.
C how etal,B rJA naesth97,20 0 6
•Antibiotic financial burden!
Concerns with routine use of antibiotics!
![Page 13: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/13.jpg)
Important!
I. Peritoneal Dialysis Catheter Placement:
Prophylactic antibiotic use is recommended!
•Cefazolin•Vancomycin
Gadallahetal.A m JKidney D is,20 0 0Keane etal.P eritD ialInt.1 996;1 6(6):557
W ikdahletal.N ephrolD ialTransplant.1 997;1 2(1 ):1 57D ombros etal.N ephrolD ialTransplant.20 0 5;20 Su ppl9:ix3
II. Accidentally extruded Catheters
III. High risk patients
![Page 14: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/14.jpg)
If Antibiotic is given!
•Timing: 30 – 60 minutes
van Kasteren et al. Clin Infect Dis. 2007;44(7):921Steinberg et al. Ann Surg. 2009 Jul;250(1):10-6
Bratzler et al. Surg Infect (Larchmt). 2013 Feb;14(1):73-156. Epub 2013 Mar 5
•Number of doses
C .J.Strachan,B M J1,1 977B owden etal.,A m JSu rg152,1 986
C lassen etal.,N EnglJM ed 326,1 992Goldmann e tal.JThorac C ardiovasc Su rg.1 977;73(3):470
H arbarthetal.C ircu lation.20 0 0 ;1 0 1 (25):291 6
![Page 15: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/15.jpg)
Procedure Sterility!
![Page 16: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/16.jpg)
Procedure Sterility!
Barrier PrecautionsUse maximal sterile barrier precautions, including theuse of a cap, mask, sterile gown, sterile gloves, and asterile full body drape, for the insertion of CVCs,PICCs, or guidewire exchange. Category IB
20 11 Gu idelines forthe P revention of Intravascu larC atheter-Related Infections
www.cdc.gov
![Page 17: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/17.jpg)
Procedure Sterility!
Skin PreparationPrepare clean skin with a >0.5% chlorhexidinepreparation with alcohol before central venouscatheter and peripheral arterial catheter insertion andduring dressing changes. If there is a contraindicationto chlorhexidine, tincture of iodine, an iodophor, or70% alcohol can be used as alternatives. Category IA
20 11 Gu idelines forthe P revention of Intravascu larC atheter-Related Infections
www.cdc.gov
![Page 18: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/18.jpg)
Tu u lietal.N EnglJM ed.20 1 6Feb 1 8;374(7):647-55
A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery
![Page 19: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/19.jpg)
D arou iche etal.N EnglJM ed.20 1 0 Jan 7;362(1 ):1 8-26
Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis
![Page 20: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/20.jpg)
•Chlorhexidine gluconate:• It is a bactericidal agent, its uptake by bacteria and yeast is rapid and
maximum effect was attained within 20s.
H u go etal,P harmacol.1 964,1 965,1 966
• Chlorhexidine crosses the cell wall presumably by passive diffusionleading to damage to the delicate semipermeable membrane andsubsequently leakage of intracellular constituents.
• At low concentrations it has bacteriostatic effect and at highconcentrations it is bactericidal.
• Chlorhexidine has long lasting effect (>6 hours).
M cD onnellG,Ru ssellA D .C lin M icrobiolRev,1 999
Procedure Sterility!
Skin Preparation
![Page 21: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/21.jpg)
•Iodophors, such as povidone-iodine:• Iodine rapidly penetrates into microorganisms and attacks key groups of
proteins which culminate in cell death.
• Their activity is much shorter than that of chlorhexidine gluconate.
• It can be inactivated by blood or serum proteins. That’s why once appliedto the skin they should be allowed to completely dry in order to maximizetheir antimicrobial action.
A ly R,M aibachH I.A m JInfectC ontrol,1 988
Gentry etal.Su rgery 98(1 ),1 985
•Alcohol:• Little is known about the exact mode of action of alcohol but it is generally believed
that they cause membrane damage and rapid denaturation of proteins.
• It is believed that it has germicidal activity against bacteria, fungi, and viruses.
• The effectiveness of pure alcohol solutions is limited by their lack of any residualactivity and their flammability.
M cD onnellG,Ru ssellA D .C lin M icrobiolRev ,1 999
Procedure Sterility!
Skin Preparation
![Page 22: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/22.jpg)
There is no firm evidence that one type of hand antisepsis isbetter than another in reducing SSIs.C hlorhexidine glu conate scru bs may red u ce the nu mberof C FUs on hands compared withpovidone iodine scru bs;however,the clinicalrelevance of this su rrogate ou tcome is u nclear.A lcoholru bs withadditionalantiseptic ingredients may red u ce C FUs compared withaqu eou sscru bs.W ithregard to du ration of hand antisepsis,a 3minu te initialscru b red u ced C FUs onthe hand compared witha 2minu te scru b,bu tthis was very low qu ality evidence,and findingsabou ta longerinitialscru b and su bsequ entscru b d u rations are notconsistent.Itis u nclearwhethernailpicks and bru shes have a differentialimpacton the nu mberof C FUs remainingon the hand.Generally,almostallevidence available to inform decisions abou thandantisepsis approaches thatwere explored here were informed by low orvery low qu alityevidence.
Tanneretal.C ochrane D atabase S ystRev.20 1 6Jan 22;(1 ):C D 0 0 4288.
Procedure Sterility!
Hand Sanitization
![Page 23: Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res · Role ofA ntibioticP rophylaxis forC lean TD C P rocedu res Loay Salman, MD MBA C hief:D ivision of N ephrologyand H ypertension](https://reader030.vdocuments.co/reader030/viewer/2022040615/5f0dff2e7e708231d43d1c13/html5/thumbnails/23.jpg)
Thankyou !