From: Logan Whitfield
Sent: Wednesday, December 19, 2018 7:30:08 AM
Subject: ANCEF (Cefazolin) Available Post-Op Exception Update

Good Morning Everyone,

We have an addition to the list of exceptions for post-operative antibiotics. Currently the policy for automatic discontinuation of post-operative antibiotics is as follows:
For all clean/clean-contaminated procedures where cefazolin, clindamycin, or vancomycin are listed on current pre/post-op orders, all post-op antibiotic orders will automatically be discontinued due to no supportive literature/guidelines. Exceptions where no automatic change will be made include:
      a.Post-op orders with 'until drain removed' in neurosurgery patients
      b.For CV surgery post-op orders ≤ 48 hours
      c.Joint replacement post-op orders ≤ 24 hours
      d.Colorectal surgery post-op orders
      e.Post-op orders for Implantation of spinal cord stimulator, generator, and lead wires ≤ 24 hours

In addition to the above exceptions, 24 hours of post-operative antibiotics post breast implant will be included. Below is the email from yesterday in its entirety with the new addition for your use as needed. Please contact the Antimicrobial Management Team with any questions you may have.


Begin Email:

Good Morning Everyone

ANCEF (Cefazolin) is once again available for use in active infections as well as for pre-operative prophylaxis. However, continued supply will remain uncertain for the coming months.  As of this morning, all pre-op/pre-procedural areas should have their Pyxis stations restocked. Cefazolin will be supplied from sterile processing otherwise. Please ensure your respective floors/units are informed as appropriate ensuring understanding of the following:

  1.Patients can once again receive cefazolin as the preferred pre-op prophylaxis in those without beta –lactam allergies.
  2.For any active infections cefazolin can again be ordered for treatment.

The following changes not related to the supply of cefazolin will REMAIN in effect based on the consensus of the Medical Executive Committee and Pharmacy and Therapeutics Committee:

  3.For all clean/clean-contaminated procedures where cefazolin, clindamycin, or vancomycin are listed on current pre/post-op orders, all post-op antibiotic orders will automatically be discontinued due to no supportive literature/guidelines. Exceptions where no automatic change will be made include:
      a.Post-op orders with 'until drain removed' in neurosurgery patients
      b.For CV surgery post-op orders ≤ 48 hours
      c.Joint replacement post-op orders ≤ 24 hours
      d.Colorectal surgery post-op orders
      e.Post-op orders for Implantation of spinal cord stimulator, generator, and lead wires ≤ 24 hours
  4.The surgery department will not utilize vancomycin or cefazolin in irrigation solutions.
  5.Pre-op antibiotic orders for cefazolin, vancomycin, or clindamycin will be automatically discontinued for percutaneous procedures involving venous puncture (e.g., tunneled lines, drain placements, etc.).
  6.If intra-op wound infection or spillage of bile/bowel contents is discovered, then antibiotics need to be customized by the practitioner.

Thank You,

Philip Logan Whitfield, PharmD
PGY2 Infectious Disease Pharmacy Resident