** Prompt surgery consult and consider Infectious Diseases consult
| Involvement of Specific Body Area | Surgical service to Consult |
|---|---|
| Dental origin with no airway involvement / compromise | Oromaxillofacial Surgery |
| Dental origin with airway involvement /compromise | ENT – Head & Neck Surgery |
| Head and neck | ENT |
| Face | Plastics |
| Hands | Plastics |
| Lower extremity | Orthopedic surgery |
| Trunk (thorax and abdominal wall) | General surgery |
| External genitalia (male) | Urology |
| Female genital organs | Gynecology |
Common Pathogens
Common pathogens include group A streptococci (GAS)** or mixed infections caused by anaerobes and gram negative bacilli
Consider polymicrobial coverage in particular in clinical settings below:
- Surgical procedures involving bowel or penetrating abdominal trauma
- Decubitus ulcer or a perianal abscess
- IV drug users (consider adding vancomycin for empiric MRSA coverage)
- Spread from a Bartholin abscess or a minor vulvovaginal infection
Empiric or Mixed Aerobic / Anaerobic Organisms
Consider addition of IV vancomycin in patients at risk for MRSA infections
Piperacillin-tazobactam IV q8h + clindamycin* 600-900mg IV q8h (can discontinue clindamycin if it is non-GAS infection)
OR if resistant gram negatives are suspected:
Meropenem 500mg IV q6h + clindamycin 600-900mg IV q8h
Confirmed Group A Streptococci **
Penicillin G 4 MU IV q4h + clindamycin 600-900 IV q8h (reassess clindamycin when hemodynamically stable)
OR
In patients with non-severe allergy to penicillin (i.e. absence of anaphylaxis)
Ceftriaxone 2g IV q24h + clindamycin 600-900mg IV q8h (reassess clindamycin when hemodynamically stable)
IVIG
Consider intravenous immune globulin (IVIG) 1g/kg on day 1, then 0.5g/kg on days 2 and 3 (obtained from Blood Blank). Alternate dosing strategy is 0.15g/kg/day x 5 days.
Please refer to the Ontario Regional Blood Coordinating Network for more information on use of IVIG.
** invasive GAS infection, including streptococcal toxic shock syndrome, necrotizing fasciitis, and meningitis, contact Infection Control Practitioner or Infectious Disease Physician for further details.