Would you like email updates of new search results? Discussion will provide agreement across the surgical team as to the final wound class as well as a restatement and/or amplification of the AP required. 55 Recent modifications to the NNIS risk index include a history of preoperative chemotherapy (OR=1.94), or groin incisions (OR=4.65). If giving Vancomycin or Clindamycin,administration may be within 2 Ann Transl Med 2017; 5: 100. Solis-Tellez H, Mondragon-Pinzon EE, Ramirez-Marino M, et al: Epidemiologic analysis: prophylaxis and multidrug-resistance in surgery. 2013. Berrios-Torres SI: Evidence-based update to the U.S. centers for disease control and prevention and healthcare infection control practices advisory committee guideline for the prevention of surgical site infection: developmental process. Hepatobiliary Surg Nutr. Deborah J. Lightner, MD; Mayo Clinic; Kevin Wymer, MD; Mayo Clinic; Joyce Sanchez, MD; Medical College of Wisconsin; Louis Kavoussi, MD; Northwell Health, Table I: Hostrelated factors affecting SSI risk a[pdf] Table II: Proposed Procedureassociated Risk Probabilty of SSI c,d,e,f [pdf] Table III: Recommended Definitions for a Surgical Site Infection (SSI), Hospital Acquired Infection (HAI), and Periprocedural Urinary Tract Infections (UTI) b,c,d[pdf] Table IV: Wound Classifications k [pdf] Table V: Recommended antimicrobial prophylaxis for urologic procedures [pdf] Table VI: End of Case Assesment of Wound Class f [pdf]. 15 It is known that the achievement of therapeutic levels of cefazolin and cefepime are significantly delayed in the morbidly obese patients undergoing bariatric surgery. Tanner J, Norrie P, and Melen K: Preoperative hair removal to reduce surgical site infection. This patient population is at high risk of fungemia, with a higher likelihood of morbidity and mortality if targeted antifungals are not used at the time of relief of obstruction. Mangram AJ, Horan TC, Pearson ML, et al: Guideline for prevention of surgical site infection, 1999. Int Urol Nephrol 2017; 49: 1311. 17 Lastly, it is unlikely that high volume data on SSI and the impact of AP will be available in the near term for most urologic procedures; SSI are currently reported for inpatient hospital procedures, and most urology cases are increasingly performed as 23-hour stays or less. Sandini M, Mattavelli I, Nespoli L, et al: Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement. We recommend against use of post-operative antibiotic agents in patients undergoing laparoscopic cholecystectomy for mild or moderate acute cholecystitis. As examples, if purulence is discovered at the time of a routine stent exchange, then cultures should be obtained and the antimicrobial agent(s) continued until the culture results are known. 149 The quality of the evidence was variable, with a high risk of selection and attrition bias in most studies reviewed. Emerg Med J 2014; 7: 576. Implicit in risk reduction is the understanding of the baseline risk. Assimos D, Krambeck A, Miller NL, et al: S Surgical management of stones: american urological association/endourological society guideline, part II. The procedures themselves may be classified into low-risk, intermediate-risk, and high-risk probability for an associated SSI (Table II). Putnam LR, Chang CM, Rogers NB, et al: Adherence to surgical antibiotic prophylaxis remains a challenge despite multifaceted interventions. Alternatives include first- or second-generation cephalosporins, amoxicillin/clavulanate, or an aminoglycoside ampicillin. While reducing contamination through either microperforations or frank perforations, double-gloving does not appear to confer a reduction in SSI, 123,124 although many surgeons continue this practice to reduce their own exposure. During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL, and normothermia should be maintained in all patients. Keywords: Bakken JS, Borody T, Brandt LJ, et al: Treating clostridium difficile infection with fecal microbiota transplantation. J Urol 2017; 198: 297. Using a process of iterative consensus, all authors voted to accept or reject each recommendation. Standardized definitions for SSI, sepsis, and post-procedural UTI (see Table III) should be used for reporting by the surgeon, who is the most accurate observer of the wound class and of any subsequent infectious complications.