Infant with Congenital Diaphragmatic Hernia, Pre and Post-operative Care — Antibiotic Prophylaxis — Clinical Pathway: Inpatient and ICU

Infant with Congenital Diaphragmatic Hernia Clinical Pathway, Pre and Post-operative Care — Inpatient and ICU

Perioperative Antibiotic Prophylaxis

General Information

  • The need for perioperative antibiotic prophylaxis is based on the type of procedure and whether or not the patient is receiving scheduled antibiotic treatment (e.g., not prophylaxis) to continue through the procedure
  • If patient requires Vancomycin, see Vancomycin special considerations.
  • The first dose of preoperative antibiotics should be completed by bolus or intravenous infusion no earlier than 60 minutes before incision.
  • For CHOP N/IICU only: Order all antibiotics to the N/IICU and send them with the patient to the OR.
General Information About Perioperative Antibiotics Perioperative Antibiotic Prophylaxis Guidelines
Perioperative Antibiotic Recommendations Antibiotic Prophylaxis by Surgical Procedure
Non-OR Procedural Units IR Cath Lab Antibiotic Recommendations Antibiotic Prophylaxis for Non-operating Room Procedural Units
Dosing Recommendations Dosing for Perioperative Prophylactic Antibiotic Therapy
Receiving Antibiotic Treatment (e.g., Not Prophylaxis) to Continue Through Surgical Procedure
  • Ensure the antibiotic regimen covers likely surgical site infection pathogens. Contact Antimicrobial Stewardship or Infectious Diseases with questions.
  • Current dosing intervals should be maintained throughout the procedure.
  • Do not give an additional dose of scheduled antibiotics before incision to prevent overdosing.
Postoperative Antibiotics
  • Antibiotic prophylaxis after wound closure is rarely indicated
    (See Postoperative Antibiotic Prophylaxis)
  • If continuing antibiotics post-op, order and time (or re-time) from last dose given in the OR and continue for no more than 24 hours for most procedures

Subacute Bacterial Endocarditis (SBE) Prophylaxis

For patients undergoing surgery who are at high risk of SBE, please refer to CHOP Recommendations for Pre-procedural Antibiotic Prophylaxis for Subacute Bacterial Endocarditis (SBE).

Vancomycin Special Considerations

Vancomycin   Indicated if history of colonization or infection with methicillin-resistant Staphylococcus aureus (MRSA)
  • Order vancomycin the day before procedure so that it arrives at inpatient unit before transfer to OR
  • ID approval is not required for perioperative prophylaxis; select the pre-approved indication, “Perioperative prophylaxis (24 hours) Please change duration to reflect 24-hour approval when ordering.
  • Coordinate timing of Vancomycin administration:
    • Transferring to PACU: PACU charge nurse
    • Direct to OR: OR charge nurse
  • Review nursing administration and implications
  • Order pre-medication if history of vancomycin infusion reaction (formerly known as “red man syndrome”).
  • Once medication is spiked or primed, it must start within one hour
  • Note:
    Rapid IV administration (over < 60 minutes) may cause adverse reactions. Due to concomitant administration of anesthesia, care must be taken while administering vancomycin infusion around the time of anesthesia induction.