Surgical site infection Management Suture removal and wound drainage Perform suture removal plus incision and drainage in patients with SSI. B Antibiotic therapy Indications Q Does the patient have erythema and induration extending > 5 cm from the wound edge? Q Does the patient have fever (temperature > 38.5 C)? Q Is the patient tachycardic (HR > 110 beats/minute)? Q Does the patient have a WBC count > 12,000/mm ? No to all Avoid using routine adjunctive systemic antimicrobial therapy in patients without systemic signs of infection. D Yes to any Consider administering systemic antimicrobial therapy in conjunction with incision and drainage in patients with SSIs associated with a significant systemic response, such as: erythema and induration extending > 5 cm from the wound edge fever > 38.5 C HR > 110 bpm WBC > 12,000 cells/ L. C Administer a brief course of systemic antimicrobial therapy in patients with SSIs following clean operations on the trunk, head and neck, or extremities, if systemic signs of infection are present. B Antibiotic therapy Choice of agent Q Does the patient have nasal MRSA colonization? Q Has the patient had prior MRSA infection? Q Has the patient recently been hospitalized? Q Has the patient recently received antibiotics? Yes to any Administer vancomycin, linezolid, daptomycin, telavancin, or ceftaroline in patients at high risk of MRSA, such as patients with nasal MRSA colonization, prior MRSA infection, recent hospitalization, or recent antibiotics. B No to all Administer a first-generation cephalosporin, or antistaphylococcal penicillin to cover methicillin-susceptible S. aureus in patients without risk factors for MRSA infection. B Antibiotic therapy Choice of agent Q Does the patient have a surgical site infection following an operation on the axilla, gastrointestinal tract, perineum, or female genital tract? Yes Administer an antibiotic agent active against Gram-negative bacteria and anaerobes (such as a cephalosporin or a fluoroquinolone) in combination with metronidazole for infections following operations on the axilla, gastrointestinal tract, perineum, or female genital tract. B No Continue management as clinically indicated.