Case 5: Does this patient need an antibiotic before surgery?

Preoperative Care of Patients with Kidney Disease
Author: V. Dimov, M.D., Department of General Internal Medicine, Cleveland Clinic

56 yo male with DM2, HTN, hyperlipidemia, ESRD on hemodialysis (HD) is here for preoperative evaluation for colon surgery. He had a synthetic graft placed for HD access 3 months ago.

Does he need an antibiotic before surgery?

Yes. Antibiotic prophylaxis using the standard endocarditis regimen is recommended for several months after the placement of a synthetic vascular access graft. This implies even to minor procedures like dental cleaning.

The guidelines for antibiotic prophylaxis for GI endoscopy recommend prophylaxis before high risk endoscopy procedures for up to the first year after placement of a synthetic vascular graft.

The goal is to avoid bacterial seeding of the graft before epithelilization takes place.

Summary

Antibiotic prophylaxis is recommended for several months after the placement of a synthetic graft.

References

Guidelines for antibiotic prophylaxis for gastrointestinal (GI) endoscopy. Hirota WK, Petersen K, Baron TH, Goldstein JL, Jacobson BC, Leighton JA, Mallery JS, Waring JP, Fanelli RD, Wheeler-Harbough J, Faigel DO. Gastrointest Endosc 2003 Oct;58(4):475-82. National Guideline Clearinghouse.
Preoperative Care of Patients with Kidney Disease. Mahesh Krishnan, M.D., M.P.H. Am Fam Physician 2002;66:1471-6.
Perioperative Management of the Patient With Chronic Renal Failure. Kenneth E Otah, MD, MSc, Moro O Salifu, MD, MPH, Eseroghene Otah, MD. eMedicine.com, last accessed 3/7/06, eMedicine.com/med/topic3166.htm.

Image source: National Institutes of Health, public domain.

Created: 5/31/06
Updated: 8/06/06

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