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Guideline for Prevention of Surgical Site Infection, 1999

Table 4

Operations, Likely Surgical Site Infection (Ssi) Pathogens, And References On Use Of Antimicrobial Prophylaxis*
Operations Likely Pathogens†‡ References
Placement of all grafts, prostheses, or implants Staphylococcus aureus; coagulase-negative staphylococci 269,282-284,290
Cardiac S. aureus; coagulase-negative staphylococci 251-253,462,463
Neurosurgery S. aureus; coagulase-negative staphylococci 241,249,258,259,261,464,465
Breast S. aureus; coagulase-negative staphylococci 242,248


Limited data; however, commonly used in procedures such as anterior segment resection, vitrectomy, and scleral buckles

S. aureus; coagulase-negative staphylococci; streptococci; gram-negative bacilli 466


Total joint replacement
Closed fractures/use of nails, bone plates,
other internal fixation devices
Functional repair without implant/device

S. aureus; coagulase-negative staphylococci; gram-negative bacilli 60,243-246,254,255,467-473

Noncardiac thoracic

Thoracic (lobectomy, pneumonectomy, wedge resection, other noncardiac mediastinal procedures)
Closed tube thoracostomy

S. aureus; coagulase-negative staphylococci Streptococcus pneumoniae; gram-negative bacilli 240,247,474,475
Vascular S. aureus; coagulase-negative staphylococci 250,463,476,477
Appendectomy Gram-negative bacilli; anaerobes 263,452,478
Biliary tract Gram-negative bacilli; anaerobes 260,262,479-484
Colorectal Gram-negative bacilli; anaerobes 200,239,256,287-289,485-490
Gastroduodenal Gram-negative bacilli; streptococci; oropharyngeal
anaerobes (e.g., peptostreptococci)
Head and neck (major procedures with incision through oropharyngeal mucosa) S. aureus; streptococci; oropharyngeal anaerobes (e.g., peptostreptococci) 494-497
Obstetric and gynecologic Gram-negative bacilli; enterococci; group B streptococci; anaerobes 270-280,435
May not be beneficial if urine is sterile
Gram-negative bacilli 267

* Refer to "Antimicrobial prophylaxis in surgery," The Medical Letter, 1997,266 for current recommendations of antimicrobial agents and doses.
† Likely pathogens from both endogenous and exogenous sources.
‡ Staphylococci will be associated with SSI following all types of operations.


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