Administration Of Prophylactic Antibiotics Research Articles

Antibiotic prophylaxis and (pre-)dental implant surgery

Recent literature indicates that in a healthy patient, who has sufficient bone volume to allow implant placement, it is justified to refrain from prophylactic administration of antibiotics. The patient should, however, rinse with chlorhexidine digluconate 1 day prior to treatment and at least 1 week postoperatively. In the case of an immune-compromised patient, a single antibiotic gift is indicated 1 hour before the procedure (2 grams of amoxicillin orally or 2 grams of cefazoline intravenously). In the case of a healthy patient, antibiotic (AB) prophylaxis is also indicated if autologous bone, a bone filler or membranes are applied. Although AB prophylaxis is not necessary when harvesting extraoral bone grafts, it is indicated because the harvested bone is applied intraorally in the same treatment session. The question whether postoperative administration of antibiotics is still needed remains open.

3046 C. diff Infections During Induction Chemotherapy

INTRODUCTION: Patient with acute myeloid leukemia (AML) are at increased risk of developing Clostridium difficile (C. Diff) colitis due to routine use of prophylactic antibiotics, the use of chemotherapy and neutropenia. These factors also add additional challenges to successful treatment. We report a case of fulminant C. Diff pancolitis to highlight these challenges. CASE DESCRIPTION/METHODS: 65 year old male was found to have pancytopenia on routine blood work at primary care office after experiencing 15 pound weight loss over 1 month. He had a history of rheumatoid arthritis that was well controlled on medications and had no other symptoms. His initial CBC showed a WBC 0.4 k/mm3, Hgb 6.9 g/dL, & platelets 8 k/mm3. A subsequent bone marrow biopsy showed 50% myeloblast, flow cytometry and genetic testing showed normal cytogenetics with intermediate risk & (-) FLT 3 mutation. Patient underwent 7 + 3 induction & a 5 + 2 reinduction after day 14 bone marrow showed residual disease. Patient was placed on prophylactic voriconazole, acyclovir & Levaquin but still developed fevers during neutropenic nadir. Blood cultures showed polymicrobial sepsis from a GI source (with growth of Gemella haemolysans & Rothia mucilaginosa). He developed diarrhea & NAAT tested positive for C. Diff. An abdominal X ray showed dilated large bowel loops with ileus a subsequent CT scan confirmed pancolitis (Figures 1 and 2). Patient developed septic shock. He initially responded to fluid resuscitation and was started on oral vancomycin and IV flagyl. After 4 days patient had a PEA arrest and was transferred to ICU after ROSC. Patient passed away soon after as patient family opted for comfort measures. DISCUSSION: Patients with acute myeloid leukemia (AML) are immunocompromised with neutropenia either due to their disease or from the effects of their chemotherapy regimen. Neutropenic patients are at risk for life threatening infections & administration of prophylactic antibiotics is common practice for induction chemotherapy. Many chemotherapy agents have antimicrobial activity altering the gut biome. Research has shown cancer patients have decreased response to therapy, increased time to resolution of diarrhea, and increased relapse rates to C. Diff associated diarrhea. The key is to diagnose & treat early. Severe disease should be distinguished early. The 2018 IDSA guidelines recommends use of algorithms and criteria to aid in this process (Figure 3). Further research is needed to outline the optimum approach to treatment in this patient group.

878 Prophylactic Antibiotic Administration in EUS-Guided Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

INTRODUCTION: EUS guided fine needle aspiration (FNA) of pancreatic cystic lesions (PCL) has become the standard diagnostic modality for pancreatic cysts. Current American Society of Gastrointestinal Endoscopy (ASGE) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines recommended the use of periprocedural prophylactic antibiotics (PA), although data is equivocal. Our aim was to perform a systematic review and meta-analysis to evaluate the efficacy of PA in preventing cyst infection during EUS-guided aspiration of PCL and assess the rate of complications related to antibiotic use. METHODS: We included studies evaluating the outcomes of using PA in EUS-guided FNA of PCL. We searched PubMed, Embase, and Google Scholar through April 2019. Eligible studies were searched for variables of interest including infection of PCL and antibiotic-related complications. All statistical analyses were performed using the R Programming Language. Pooled rates of variables were reported as Relative risks (RR) with 95% confidence interval and heterogeneity was reported as I2 statistics. RESULTS: A total of 9 retrospective studies were eligible and included in the analysis. 6 studies compared the use of PA to no antibiotics while the other 3 did not have a comparison group. There were 1183 subjects in the antibiotic group and 579 subjects in the non-antibiotic group. Duration of antibiotics varied from a single intraprocedural dose to 3-5 days following the procedure. Multiple antibiotic regimens were used including ceftriaxone, quinolones, amoxicillin, and piperacillin/tazobactam. There was no statistically significant difference in the rate of cyst infection between patients receiving PA and those who did not (RR = 0.6, 0.21-1.75; I2 = 0%) (Figure 1). 1.2% of patients receiving PA developed adverse events related to antibiotic use. In addition, there was no difference among subgroups when stratifying subjects by single dose and 3-5 days of antibiotics (P = 0.619) (Figure 2). CONCLUSION: The incidence of infectious complications after EUS-guided FNA of PCL appears very low and the use of PA did not substantially reduce the risk. Antibiotic use is not free of adverse events. Further randomized controlled trials are needed to evaluate the appropriateness of current recommendations.

Adherence to American Society of Health‐System Pharmacists guidelines for antibiotic prophylaxis in thoracic surgery: a prospective observational study

AbstractBackgroundSurgical antibiotic prophylaxis (SAP) decreases the incidence of surgical site infections. However, inappropriate use of prophylactic antibiotics may lead to antibiotic resistance, prolonged hospital stay and adverse drug reactions.AimThis prospective study aimed to assess the concordance of prophylactic antibiotic administration for thoracic operations in Iran with American Society of Health‐System Pharmacists (ASHP) guidelines.MethodsThe appropriateness of SAP administration in 222 thoracic operations was assessed in a respiratory referral centre over a period of 4 months. Demographic, clinical and SAP data were recorded from patient files. ASHP guidelines were used to evaluate the appropriateness of prophylactic antibiotic administration.ResultsCefazolin was correctly prescribed for approximately 70% of patients who required antibiotic prophylaxis. SAP was administered at the correct time (within 60 min before surgery) for 71.6% of surgeries. Intraoperative doses were correctly given in 27.7% of prolonged procedures. In 86.7% of surgeries, antibiotic administration was continued for more than 24 h after surgery (based on a physician's opinion or recent microbiological cultures).ConclusionThe results suggest a relatively low rate of consistency between SAP administration and ASHP guidelines in Iran. A long duration of antibiotic administration after operations is an important finding, which should be considered and re‐evaluated by thoracic surgeons in Iran.

Measuring Healthcare-Associated Infection Outcomes: Enhanced Surveillance to Include Process Adherence for Quality Improvement.

To prevent healthcare-associated infections, there are a range of clinical practices that should be followed. For example, appropriate administration of prophylactic antibiotics [process] is essential to reduce risks of surgical site infections post-operatively [outcome]. Monitoring adherence to these processes provides insights into potential causes of infection. The Victorian Healthcare Associated Infection Surveillance System (VICNISS) captures process data in the same system as outcome data, thereby providing integrated data to support quality improvement within healthcare and reduce the burden of healthcare-associated infections.

Risk factors for febrile neutropenia in neoadjuvant docetaxel, cisplatin, and 5-fluorouracil chemotherapy for esophageal cancer.

The aim of the present study was to evaluate the incidence and explore the risk factors of febrile neutropenia (FN) in patients with esophageal cancer receiving neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy in real-world settings. We retrospectively reviewed clinical data of 128 consecutive patients with esophageal cancer. Specifically, these patients underwent neoadjuvant DCF chemotherapy with prophylactic antibiotic administration at our institution between July 2009 and January 2015. Two FN-related endpoints were set as follows: definite FN (dFN) defined as grade 4 neutropenia at the onset of fever and clinically suspected FN (csFN), which included both patients with dFN and patients without grade 4 neutropenia but with deteriorating grade 3 neutropenia at the onset of fever who were clinically diagnosed with FN for which they underwent treatment. The risk factors for dFN and csFN were evaluated based on patients' characteristics. A total of 72 (56.3%) patients developed grade 3 or grade 4 neutropenia and 26 (20.3%) developed csFN including 14 (10.9%) with dFN. Multivariate analysis revealed that older age (OR 3.57, CI 1.27-10.1, P = 0.016) and living alone (OR 5.17, 95% CI 1.26-21.3, P = 0.023) were statistically significant risk factors for csFN development. As to dFN, no statistically significant risk factors were identified. Older age and living alone are significant risk factors for developing FN, and thus, particularly for patients with risk factors for FN, G-CSF should be considered instead of prophylactic antibiotics with careful observation.

Health-related quality of life of patients treated with chemoradiotherapy plus or minus prophylactic antibiotics to reduce the number of pneumonias for locally advanced head and neck cancer, the PANTAP study

ObjectivesThe recent PANTAP trial showed that administration of prophylactic antibiotics in locally advanced head and neck carcinoma (LAHNC) patients treated with chemoradiotherapy reduced fever, hospitalization and costs. The current study describes the effect of prophylactic antibiotics on health-related quality of life (HRQoL), another secondary endpoint of the trial. Materials and methodsIn this multicenter randomized trial, LAHNC patients treated with chemoradiotherapy received prophylactic antibiotics or standard care. HRQoL was assessed at baseline (before chemoradiotherapy), day 28 of chemoradiotherapy (one day before starting prophylactic antibiotics), the final day of radiotherapy, and 3.5 months after the end of chemoradiotherapy, using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC H&N35 module, and the Performance Status Scale for Head & Neck cancer patients (PSS-HN). ResultsNinety-five patients were randomized: 48 patients were allocated to the standard group and 47 patients to the prophylaxis group. Thirty-four patients in the standard group (70.8%) and 28 patients in the prophylaxis group (59.6%) completed the questionnaires at baseline and at follow-up. No significant differences in HRQoL were found at baseline and at day 28. At the end of radiotherapy, the prophylaxis group performed better on almost all functional subscales of the EORTC QLQ-C30 and reported less symptoms. At the end of follow up, almost no differences were seen between the two treatment groups. ConclusionProphylactic antibiotics during chemoradiotherapy for LAHNC patients improved HRQoL at the end of the radiotherapy, however no differences were found 3.5 months after the end of chemoradiotherapy.

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

What Prophylactic Antibiotic (Type, Dose and Route of Administration) Should Be Administered Perioperatively for Patients Undergoing Total Ankle Arthroplasty (TAA)?

The administration of prophylactic antibiotics before total ankle arthroplasty (TAA) potentially reduces the incidence of surgical site infection (SSI) and/or periprosthetic joint infection (PJI). Weight-based (of at least 2 g) cefazolin administered intravenously within 60 minutes before the procedure can be an adequate choice for antibiotic prophylaxis. If the patient has a beta-lactam anaphylaxis, we recommend an appropriate alternative antibiotic effective against Staphylococcus. It is unclear whether prophylaxis should be given as a single dose or as multiple doses. Strong. Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

Short communication: Effects of porcine plasma or combined sodium butyrate and Bacillus subtilis on growth and health of grain-fed veal calves

The objective of this study was to evaluate the effects of incorporating 2 commonly used additives or spray-dried porcine plasma in calf milk replacer (CMR) on calf performance and health. Male Holstein calves (n = 158) transported from auction barns and local dairy farms were randomly assigned to receive 1 of 3 decoquinate-containing CMR for the first 49 d of the experiment: all milk protein and no additives (CONT); 15% of crude protein (CP) replaced with spray-dried porcine plasma, no additives (PLM); or all milk protein and an added combination of sodium butyrate (rate 1.4 kg of butyric acid/Mt) and Bacillus subtilis (1.28 million cfu/g of feed; BB). All milk replacers were formulated to contain 26% CP and 17% fat, 2.4% Lys, and 0.8% Met, and were bucket-fed at daily feeding rates of 520 g during wk 1 and 2, 650 g during wk 3, and 900 g during wk 4 and 5, in a total of 4, 5, and 6 L of solution, respectively. Calves were offered texturized calf starter (18% CP) upon arrival until wk 3 and transitioned to a corn and pellet ration with 2% straw (18.1% CP). No prophylactic administration of antibiotics occurred. All calves were gradually weaned over a 2-wk period. Calves were individually housed until weaned and then housed in groups of 5 in a mechanically ventilated facility in southwestern Ontario, Canada. Fecal scores, treatments administered (antibiotic or supportive therapy), and mortalities were recorded daily. Body weight was measured using a digital scale at arrival and at 14, 49, 56, and 78 d after arrival. No differences were found among the groups with respect to growth, feed efficiency, or incidence of diarrhea or respiratory infection treatment. Calves supplemented with BB had a greater hazard of mortality over the growing period compared with CONT. An interaction was found between the BB group and the level of total serum protein, with the BB group having a lower proportion of days with a fecal score of 3 when the calves had a higher total serum protein level. Calves fed PLM had a lower proportion of d with a fecal score of 3 relative to CONT but no difference in the proportion of d with a fecal score of 2 or higher. This study found that the addition of spray-dried plasma in CMR reduced diarrhea severity; however, supplementing BB was associated with a higher hazard of calf mortality and had a varying response on fecal score.

Protocol for a comparison study of 1-day (single dose) versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial.

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2 nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day (single dose) cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry ( UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1 st 2017.

Protocol for a comparison study of 1-day (single dose) versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2 nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day (single dose) cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry ( UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1 st 2017.

Evaluation of administration of prophylactic antibiotics in mesh repair of inguinal hernia

Background: The benefit of use of prophylactic antibiotic in mesh inguinal hernia repair needs evaluation in view of emergence of resistant micro-organisms with indiscriminate use of antibiotics and also to avoid unnecessary expenditure.Methods: 100 patients of primary inguinal hernia, fulfilling inclusion criteria, were recruited in a prospective, randomized, double blind study where single dose of prophylactic antibiotic half hour prior to mesh repair surgery was administered to 50 patients in study group and routine antibiotics to remaining 50 in control group. Follow up was done for any evidence of infection till one month after the surgery.Results: The incidence of infection in both the groups was analyzed. Prophylactic antibiotic group reported to have an infection rate of 12% as compared to 10% in control group Incidence of infection in both groups was 2% at time of discharge and 0% after one week, at the time of suture removal. Two week after discharge 6% in study and 4% in control groups had infection. After one month of surgery, incidence of infection was 4% in both prophylactic antibiotic group and control group. None of the patients required mesh removal and results was statistically similar in both groups.Conclusions: The use of prophylactic antibiotic in our study was seen to be as effective as routine preoperative and postoperative antibiotics and should be recommended as it reduces the cost burden to the patient significantly and also prevents development of bacterial resistance to drugs.

Are postoperative prophylactic antibiotics in closed reduction of nasal bone fracture valuable?: prospective study of 30 cases.

BackgroundProphylactic antibiotic administration after surgery for a nasal bone fracture is performed due to concerns about infection-related complications, such as, toxic shock syndrome. To evaluate the validity and efficacy of antibiotic use, we compared the results obtained and the bacterial profiles of nasal packing materials in patients that underwent closed reduction for a nasal bone fracture with or without prophylactic antibiotic administration.MethodsThirty consecutive patients with a nasal bone fracture, but without an open wound, that underwent closed reduction during March to August 2017 were included in the present study. Fifteen of these 30 patients were randomly assigned to a control group, members of were administered postoperative intravenous antibiotics once at the day of surgery and then oral antibiotics for 4 days. The other 15 patients were assigned to an experimental group and not administered any antibiotic postoperatively. Antibiotic ointment was not applied to nasal packing in either group. Nasal packing was removed on postoperative day 4 in all cases. Removed nasal gauze packings were culture tested and strains identified in the two groups were compared.ResultsBacterial strain types cultured from packings were similar in the experimental and control groups and no patient showed signs of clinically significant infection.ConclusionThe findings of this study suggest postoperative prophylactic antibiotic use is not clinically required after closed reduction of a nasal bone fracture. Furthermore, the non-use of postoperative antibiotics is biologically beneficial, as it reduces the occurrence of resistant strains and medical costs, and is more convenient for patients.

The Influence of Maternal-Foetal Parameters on Concentrations of Zonulin and Calprotectin in the Blood and Stool of Healthy Newborns during the First Seven Days of Life. An Observational Prospective Cohort Study.

Background: It can be hypothetically assumed that maternal and perinatal factors influence the intestinal barrier. Methods: The study was conducted with 100 healthy, full-term newborns breastfed in the first week of life, with similar analyses for their mothers. Zonulin and calprotectin levels were used as intestinal permeability markers. Results: The median (range) zonulin concentrations (ng/mL) were in mothers: serum, 21.39 (6.39–57.54); stool, 82.23 (42.52–225.74); and newborns: serum cord blood, 11.14 (5.82–52.34); meconium, 54.15 (1.36–700.65); and stool at age seven days, 114.41 (29.38–593.72). Calprotectin median (range) concentrations (µg/mL) in mothers were: stool, 74.79 (3.89–211.77); and newborns: meconium, 154.76 (6.93–8884.11); and stool at age seven days 139.12 (11.89–627.35). The use of antibiotics during pregnancy resulted in higher zonulin concentrations in umbilical-cord serum and calprotectin concentrations in newborn stool at seven days, while antibiotic therapy during labour resulted in higher zonulin concentrations in the stool of newborns at seven days. Zonulin concentrations in the stool of newborns (at seven days) who were born via caesarean section were higher compared to with vaginal birth. With further analyses, caesarean section was found to have a greater effect on zonulin concentrations than prophylactic administration of antibiotics in the perinatal period. Pregnancy mass gain >18 kg was associated with higher calprotectin concentrations in maternal stool. Body Mass Index (BMI) increase >5.7 during pregnancy was associated with decreased zonulin concentrations in maternal stool and increased calprotectin concentrations in stool of mothers and newborns at seven days. There was also a negative correlation between higher BMI increase in pregnancy and maternal zonulin stool concentrations and a positive correlation between BMI increase in pregnancy and maternal calprotectin stool concentrations. Conclusion: Maternal-foetal factors such as caesarean section, antibiotic therapy during pregnancy, as well as change in mother’s BMI during pregnancy may increase intestinal permeability in newborns. Changes in body mass during pregnancy can also affect intestinal permeability in mothers. However, health consequences associated with increased intestinal permeability during the first days of life are unknown. Additionally, before the zonulin and calprotectin tests can be adopted as universal diagnostic applications to assess increased intestinal permeability, validation of these tests is necessary.

Influence of prophylactic antibiotic duration on postoperative pneumonia following pulmonary lobectomy for non-small cell lung cancer.

Although postoperative pneumonia after radical surgery for non-small cell lung cancer (NSCLC) carries a mortality risk, the duration of postoperative prophylactic antibiotics against pneumonia has not been elucidated. This study aimed to evaluate the influence of the duration of prophylactic antibiotics on postoperative pneumonia following radical surgery for NSCLC in patients who received antibiotics intraoperatively (short period) and in those who received antibiotics both intraoperatively and postoperatively (long period). A total of 477 patients who underwent radical lobectomy for NSCLC were analyzed retrospectively. Propensity score analysis generated two matched pairs of 152 patients in both the short and long period groups. After propensity score matching, the incidence of postoperative pneumonia following pulmonary lobectomy was significantly less in the long period group than in the short period group (3.9% vs. 16.4%, P<0.001). On logistic regression analysis, short period of prophylactic antibiotic administration was the independent risk factor for postoperative pneumonia (odds ratio: 6.82, P<0.001). Prophylactic antibiotic administration in both the intraoperative and postoperative periods reduced the incidence of pneumonia after pulmonary lobectomy for NSCLC.

Analysis of Risk Factors for Multiantibiotic-Resistant Infections Among Surgical Patients at a Children's Hospital.

Background: To identify the potential risk factors for multiantibiotic-resistant infections and provide sufficient evidence for multiantibiotic resistance prevention and control.Materials and Methods: We conducted a retrospective study of all patients in pediatric orthopedics, pediatric heart surgery, and pediatric general surgery at a level 3, grade A children's hospital from January to December 2016. The clinical laboratory information monitoring system and the medical record system were used to collect patient information regarding age, surgery type, preoperative length of stay, admission season, incision type, preoperative infection, intraoperative blood loss, postoperative use of invasive equipment, duration of catheter drainage, and timepoint of intraoperative prophylactic antibiotics administration. We used logistic univariate and multivariate regression analysis to analyze the potential risk factors for multiantibiotic-resistant infections among pediatric surgical patients. SPSS 21.0 and Excel software packages were used for the statistical analysis.Results: In total, 2,973 patients met the inclusion criteria: 1,247 patients in pediatric orthopedics, 1,089 patients in pediatric heart surgery, and 637 patients in pediatric general surgery. At the end of the study, 113 patients were multiantibiotic-resistant infection cases; the rate of multiantibiotic-resistant infections was 3.80%, and the detection rate was 84.79%. Multivariate analysis indicated that the multiantibiotic-resistant infection cases were influenced by age, department, admission season, incision type, preoperative infection, and duration of catheter drainage.Conclusions: Age, department, admission season, incision type, preoperative infection, and duration of catheter drainage may provide possible evidence for prevention and control strategies of multiantibiotic-resistant infections.

Knowledge of antibiotics and antimicrobial resistance amongst final year dental students of Polish medical schools-A cross-sectional study.

Antimicrobial resistance has been one of the biggest global concerns. Dentists constitute an important group of antibiotic prescribers, and it was shown that their therapeutic decisions are not always rational. In this paper, we present knowledge of antibiotics prescription rules and antimicrobial resistance amongst graduating dentistry students from all dentistry faculties of medical universities in Poland, who will soon join the group of antibiotics prescribers. A questionnaire consisting of 28 questions was developed. The survey was conducted in May-June 2015. The study group comprised a total of 752 students. About 54% expressed the opinion that dentists overprescribe antibiotics. One-tenth thought that they can be used for the treatment of flu (7%) and common cold (11%). Respondents pointed to amoxicillin (46%) and clindamycin (44%) as the first-choice treatment of dentoalveolar abscess, if medically indicated. More than half of the students (58%) suggested using doxycycline and metronidazole in aggressive periodontitis in an individual allergic to penicillin. The vast majority of students (97%) indicated that penicillins and cephalosporins were suitable for treatment of dental infections in pregnant women. The majority of participants (82%) said that rheumatic disease, chronic immunosuppression, chronic kidney failure and a history of infective endocarditis required a prophylactic administration of antibiotics before or during endodontic treatment. The research showed variable levels of understanding of antibiotics use amongst dental students in medical universities in Poland. Our results emphasise the need to educate dental students further regarding antibiotics and risks related to antibiotic misuse, especially in dental practice.

Protocol for a comparison study of 1-day versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry (UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1st 2017.

Pre-operative anti-microbial administration for prevention of post-operative infections in patients with open cholecystectomy and laparoscopic cholecystectomy

Background: Prophylactic antibiotics are used in many elective surgeries by the surgeons to prevent postoperative wound infections. The present study was done with the aim to find out the efficacy of antibiotics to reduce the bacterial load.Methods: This prospective study was done in KPC Medical College from January 2015-December 2015. A total number of 56 patients with symptomatic gall stone disease were included in the study. Of them, 36 patients underwent laparoscopic cholecystectomy (group A) and 20 patients underwent open cholecystectomy (group B). 18 cases who underwent laparoscopic procedure and 10 cases who underwent open procedures were given preoperative antibiotics while the other half did not receive preoperative antibiotics. Postoperative wound infection was analysed by wound swab culture.Results: Female preponderance was seen in the study (M:F-1:7). Majority of them belongs to 21-30years of age. Postoperatively wound infection was seen in 6 cases in group A and in 4 cases in group B and the difference was statistically significant (p&lt;0.05). The positive rate of bacteria by wound swab culture was higher in NPTG cases in both group A (n=7) and group B (n=4) and the difference was statistically significant among two groups. No complications and mortality were reported in the study.Conclusions: This study document that administration of prophylactic antibiotics before cholecystectomy will reduces the incidence of postoperative wound infections.