Administration Of Prophylactic Antibiotics Research Articles

Antibiotic Prophylaxis to Prevent Obesity-Related Induction Complications in Nulliparae at Term: a pilot randomized controlled trial

Women with obesity are at increased risk of complications during and after labor and delivery, including puerperal infection and cesarean delivery. As labor induction has become increasingly common, it is crucial to find ways to decrease complication rates in this high-risk population. This study aimed to explore the effect of prophylactic antibiotics during labor induction of nulliparous women with obesity on the rates of cesarean delivery and puerperal infection and to estimate the parameters needed to calculate the sample size for a larger, multicenter trial. In this randomized, placebo-controlled pilot trial, nulliparous patients with a body mass index of ≥30 kg/m2 were randomized to either prophylactic antibiotics (500 mg azithromycin for 1 dose and 2 g cefazolin every 8 hours for up to 3 doses) or placebo, administered starting at the beginning of labor induction. The exclusion criteria were known fetal anomaly, fetal demise, multifetal gestation, ruptured membranes >12 hours, infection requiring antibiotics at the start of labor induction, and/or allergy to azithromycin or beta-lactam antibiotics. The co-primary outcomes were rates of puerperal infection (composite of chorioamnionitis, endometritis, and/or cesarean delivery wound infection) and cesarean delivery. Participants were followed up for 30 days after delivery, and maternal and neonatal demographic and outcome data were collected. Proportions and 95% confidence limits were calculated for each of these outcomes. From January 2019 to May 2021, 101 patients were randomized in the class III stratum (1 patient who was randomized ultimately did not undergo labor induction). From February 2020 to May 2021, 38 and 47 patients were randomized to class I and II strata, respectively (to assess the effect of obesity class on the outcomes expected to be influenced by antibiotic prophylaxis). In the antibiotics and placebo groups, the rates of cesarean delivery were 29.0% (95% confidence interval, 19.8-38.3) and 39.8% (95% confidence interval, 29.8-49.7), respectively, and puerperal infection occurred in 8.6% (95% confidence interval, 2.9-14.3) and 9.7% (95% confidence interval, 3.7-15.7), respectively. In the subgroup with class III obesity, in the antibiotics and placebo groups, the rates of cesarean delivery were 33.3% (95% confidence interval, 20.4-47.9) and 46.0% (95% confidence interval, 32.2-59.8), respectively, and puerperal infection occurred in 7.8% (95% confidence interval, 0.5-15.2) and 10.0% (95% confidence interval, 1.7-18.3), respectively. Note that this pilot study was not powered to detect differences of this magnitude but rather to estimate parameters. The administration of prophylactic antibiotics during labor induction of nulliparous patients with obesity resulted in a 27% lower cesarean delivery rate overall and a 28% lower rate in patients with class III obesity. A larger trial is warranted to evaluate these differences.

Fetal and Newborn Management of Cloacal Malformations.

Cloaca is a rare, complex malformation encompassing the genitourinary and anorectal tract of the female in which these tracts fail to separate in utero, resulting in a single perineal orifice. Prenatal sonography detects a few cases with findings such as renal and urinary tract malformations, intraluminal calcifications, dilated bowel, ambiguous genitalia, a cystic pelvic mass, or identification of other associated anomalies prompting further imaging. Multi-disciplinary collaboration between neonatology, pediatric surgery, urology, and gynecology is paramount to achieving safe outcomes. Perinatal evaluation and management may include treatment of cardiopulmonary and renal anomalies, administration of prophylactic antibiotics, ensuring egress of urine and evaluation of hydronephrosis, drainage of a hydrocolpos, and creation of a colostomy for stool diversion. Additional imaging of the spinal cord and sacrum are obtained to plan possible neurosurgical intervention as well as prognostication of future bladder and bowel control. Endoscopic evaluation and cloacagram, followed by primary reconstruction, are performed by a multidisciplinary team outside of the neonatal period. Long-term multidisciplinary follow-up is essential given the increased rates of renal disease, neuropathic bladder, tethered cord syndrome, and stooling issues. Patients and families will also require support through the functional and psychosocial changes in puberty, adolescence, and young adulthood.

Adherence to recommendations for antibiotic prophylaxis before cesarean section: a survey of anesthesiologists in Vinnytsia region

Annotation. Surgical wound infection is the most common complication after a caesarean section. The frequency of this complication is 3-15%, and it causes maternal mortality in 3% of cases. The work aims to analyze the compliance of the appointment of antibiotic prophylaxis by anesthesiologists in the Vinnytsia region according to the current protocols for women who give birth by caesarean section. We conducted a multicenter regional survey among 21 medical institutions with the participation of 69 anesthesiologists who provide care to obstetric patients in Vinnytsia and Vinnytsia region. In addition to general information on the number of inpatient/ward deliveries, the number of cesarean births, and the urgency of surgery, the e-questionnaire included questions about the choice of antibiotic prophylaxis drug (s) for women who give birth by caesarean section and timing of its conduction. The obtained results reflect the practice of 21/23 (91.3%) obstetric hospitals and departments in the city of Vinnytsia and Vinnytsia region. The results of our study show that most often respondents carry out antibiotic prophylaxis with ceftriaxone 27/67 (40.3%), ampicillin and cefazolin – 18/67 (26.9%). Data analysis was performed using the statistical package “SPSS 20” (SPSS Inc.) version 21.0.0 for Windows. To find the differences in frequencies, we used the method of determining χ2 (Pearson), determined the odds ratio (Odds Ratio) and relative risk (Relative Risk). It was found out that among anesthesiologists who provide care to obstetric patients, 59.7% prescribe antimicrobials in accordance with current guidelines, 64.1% follow the recommended timing of antibiotic prophylaxis - 30-60 minutes before the skin incision, and 2.4% of respondents do not prescribe prophylactic administration of antibiotics for women who give birth by caesarean section. The prospect of further research is the development and implementation of a clear unified strategy for the prevention of infection of the surgical wound in Vinnytsia and Vinnytsia region.

Association between the duration of antibiotic prophylaxis and surgical site infection after orthognathic surgery in Japan

PurposeThis study aimed to evaluate the risk factors for surgical site infection (SSI) after orthognathic surgery, focusing on the duration of prophylactic antibiotic administration in Japan. Study DesignThe study included 181 patients who underwent orthognathic surgery at the Department of Oral and Maxillofacial Surgery of Yamagata University Hospital between 2012 and 2021. The clinical parameters of SSI were retrospectively investigated using patient charts. Logistic regression analysis was used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for risk factors for SSI after orthognathic surgery. ResultsNineteen patients (10.5%) were complicated with SSI. Male sex (OR, 3.638; 95% CI, 1.316–10.058) and an antibiotic prophylaxis duration ≤3 days (OR, 12.718; 95% CI, 1.639–98.673) were independent risk factors for SSI after orthognathic surgery. ConclusionExtended-term antibiotic prophylaxis was more effective for prevention of SSI after orthognathic surgery than short-term in this study.

Antibiotic prophylaxis for preventing bacterial endocarditis following dental procedures.

Infective endocarditis is a severe infection arising in the lining of the chambers of the heart. It can be caused by fungi, but most often is caused by bacteria. Many dental procedures cause bacteraemia, which could lead to bacterial endocarditis in a small proportion of people. The incidence of bacterial endocarditis is low, but it has a high mortality rate. Guidelines in many countries have recommended that antibiotics be administered to people at high risk of endocarditis prior to invasive dental procedures. However, guidance by the National Institute for Health and Care Excellence (NICE) in England and Wales states that antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures. This is an update of a review that we first conducted in 2004 and last updated in 2013. Primary objective To determine whether prophylactic antibiotic administration, compared to no antibiotic administration or placebo, before invasive dental procedures in people at risk or at high risk of bacterial endocarditis, influences mortality, serious illness or the incidence of endocarditis. Secondary objectives To determine whether the effect of dental antibiotic prophylaxis differs in people with different cardiac conditions predisposing them to increased risk of endocarditis, and in people undergoing different high risk dental procedures. Harms Had we foundno evidence from randomised controlled trials or cohort studies on whether prophylactic antibiotics affected mortality or serious illness, and we had found evidence from these or case-control studies suggesting that prophylaxis with antibiotics reduced the incidence of endocarditis, then we would also have assessed whether the harms of prophylaxis with single antibiotic doses, such as with penicillin (amoxicillin 2 g or 3 g) before invasive dental procedures, compared with no antibiotic or placebo, equalled the benefits in prevention of endocarditis in people at high risk of this disease. An information specialist searched four bibliographic databases up to 10 May 2021 and used additional search methods to identify published, unpublished and ongoing studies SELECTION CRITERIA: Due to the low incidence of bacterial endocarditis, we anticipated that few if any trials would be located. For this reason, we included cohort and case-control studies with suitably matched control or comparison groups. The intervention was antibiotic prophylaxis, compared to no antibiotic prophylaxis or placebo, before a dental procedure in people with an increased risk of bacterial endocarditis. Cohort studies would need to follow at-risk individuals and assess outcomes following any invasive dental procedures, grouping participants according to whether or not they had received prophylaxis. Case-control studies would need to match people who had developed endocarditis after undergoing an invasive dental procedure (and who were known to be at increased risk before undergoing the procedure) with those at similar risk who had not developed endocarditis. Our outcomes of interest were mortality or serious adverse events requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse effects of the antibiotics; and the cost of antibiotic provision compared to that of caring for patients who developed endocarditis. Two review authors independently screened search records, selected studies for inclusion, assessed the risk of bias in the included study and extracted data from the included study. As an author team, we judged the certainty of the evidence identified for the main comparison and key outcomes using GRADE criteria. We presented the main results in a summary of findings table. Our new search did not find any new studies for inclusion since the last version of the review in 2013. No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included in the previous versions of the review, but one case-control study met the inclusion criteria. The trial authors collected information on 48 people who had contracted bacterial endocarditis over a specific two-year period and had undergone a medical or dental procedure with an indication for prophylaxis within the past 180 days. These people were matched to a similar group of people who had not contracted bacterial endocarditis. All study participants had undergone an invasive medical or dental procedure. The two groups were compared to establish whether those who had received preventive antibiotics (penicillin) were less likely to have developed endocarditis. The authors found no significant effect of penicillin prophylaxis on the incidence of endocarditis. No data on other outcomes were reported. The level of certainty we have about the evidence is very low. There remains no clear evidence about whether antibiotic prophylaxis is effective or ineffective against bacterial endocarditis in at-risk people who are about to undergo an invasive dental procedure. We cannot determine whether the potential harms and costs of antibiotic administration outweigh any beneficial effect. Ethically, practitioners should discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.

Intraosseous Regional Administration of Prophylactic Antibiotics in Total Knee Arthroplasty.

Prosthetic joint infection (PJI) after total knee arthroplasty is a devastating complication. With the development of antibiotic resistance, a safe and effective means of delivering antibiotic prophylaxis is needed. Intraosseous regional antibiotics (IORA) achieve higher local concentrations of antibiotics with fewer systemic side effects. Previous studies have proven the safety of IORA, whereas animal models have proven it to be more effective than intravenous antibiotics for preventing infection following surgery. Recently, large-scale retrospective studies have also demonstrated lower PJI rates following TKA when IORA is used when compared to routine intravenous prophylaxis. In this article, we propose an evidence-based method for the administration of intraosseous antibiotics in TKA, cover the up-to-date data supporting its use, and explore future directions for additional research.

The expected advantage of administering prophylactic antibiotics using target‐ concentration controlled infusion: Development of a new pharmacokinetic model of cefazolin

The aim of this study was to explore the utility of target-concentration controlled infusion (TCI) as a prophylactic antibiotic administration method based on the results of a population pharmacokinetic model of cefazolin. In patients undergoing elective gastric surgery, 2g of cefazolin was dissolved in 50 mL of saline and administered for 10min prior to skin incision. Arterial blood samples were obtained at preset intervals to measure the total and free plasma concentrations of cefazolin. Population pharmacokinetic analysis was performed using non-linear mixed-effects modelling. To evaluate the effectiveness of the TCI method, stochastic simulation was performed based on the model construction results. In total, 360 total and 360 free plasma concentration measurements from 40 patients were used to characterise the pharmacokinetics of cefazolin. The changes in the total concentration of cefazolin over time were well-explained by the three-compartment mammillary model. Fat-free mass and estimated glomerular filtration rate were significant covariates. The probability of target attainment (PTA) to reach the target 100% fraction of time that the free plasma concentration of cefazolin was maintained above its minimal inhibitory concentration (fT > MIC) at MIC of 4mg/L was also notably higher in the TCI method (90.7%) than in the standard method (17.0%). When cefazolin is administered by the TCI method, patient-tailored antibiotic dosing may be possible. The potential benefits of administering prophylactic antibiotics by the TCI method were observed. Further research is warranted to confirm the effectiveness of the TCI method.

PD42-09 DO PROPHYLACTIC ANTIBIOTICS REDUCE URINARY TRACT INFECTIONS FOLLOWING ROBOT-ASSISTED RADICAL CYSTECTOMY? A RANDOMIZED CONTROL TRIAL

You have accessJournal of UrologyCME1 May 2022PD42-09 DO PROPHYLACTIC ANTIBIOTICS REDUCE URINARY TRACT INFECTIONS FOLLOWING ROBOT-ASSISTED RADICAL CYSTECTOMY? A RANDOMIZED CONTROL TRIAL Holly Houenstein, Yousuf Ramahi, Ayat A. Shah, Philippa Doherty, Kristopher Attwood, Zhe Jing, Qiang Li, Ahmed A. Hussein, and Khurshid A. Guru Holly HouensteinHolly Houenstein More articles by this author , Yousuf RamahiYousuf Ramahi More articles by this author , Ayat A. ShahAyat A. Shah More articles by this author , Philippa DohertyPhilippa Doherty More articles by this author , Kristopher AttwoodKristopher Attwood More articles by this author , Zhe JingZhe Jing More articles by this author , Qiang LiQiang Li More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002603.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infectious complications are the most common following radical cystectomy, mostly occurring within 30 days of surgery. We sought to investigate the utility of prophylactic antibiotics to reduce urinary tract infections in the early postoperative period after Robot-Assisted Radical Cystectomy (RARC). METHODS: A prospective randomized controlled trial (RCT) was performed to investigate the safety and efficacy of prophylactic antibiotics in reducing urinary tract infections (UTI) after RARC (NCT04502095). UTI was defined as the presence of a positive urine culture (≥105 cfu/mL with no more than 2 organisms) and ≤1 documented urinary symptom(s). Patients were randomized in a ration 1:1 to receive prophylactic antibiotics (800/160mg trimethoprim-sulfamethoxazole or 100 mg Nitrofurantonin) for 30 days, versus current standard of care (no postoperative antibiotics). Compliance of treatment group was defined as administration of antibiotic for ≥15 days. Data were analyzed for adverse events and development of UTI within for 30 and 90 days following RARC. RESULTS: 43 patients were enrolled (22 in the treatment arm and 21 controls). Final cohort comprised 36 patients (15 in treatment arm and 21 controls) with a median follow up time of 3 months (IQR 1.5-7.3). No patient in the treatment group developed UTIs within 90 days of RARC compared to 7 patients (33%) in the control group (p=0.03). Patients in the treatment group had lower 30-day (67% vs 76%, p=0.71), 90-day complications (73% vs 81%, p=0.70), 30-day (7% vs 14%, p=0.63), 90-day high-grade complications (7% vs 29%, p=0.20) and 30-day (13% vs 29%, p=0.42) and 90-day readmissions (13% vs 33%, p=0.25), but did not reach statistical significance. Patients in the treatment group experienced lower overall infectious complications within 90 days of RARC (13% vs 48%, p=0.04) (Table 1). Two (13%) patients in the treatment group experienced adverse events, one patient with Clavien-Dindo grade 2 event (Clostridium Difficile colitis), and one patient with both grade 3 (AKI) and grade 4 events (hyperkalemia). Patients with adverse events received trimethoprim-sulfamethoxazole. CONCLUSIONS: The administration of 30-day prophylactic antibiotics after RARC was significantly associated with decreased 90-day UTIs and infectious complications after RARC. Source of Funding: The Roswell Park Alliance Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e698 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Holly Houenstein More articles by this author Yousuf Ramahi More articles by this author Ayat A. Shah More articles by this author Philippa Doherty More articles by this author Kristopher Attwood More articles by this author Zhe Jing More articles by this author Qiang Li More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD06-07 REAL-WORLD URINARY TRACT INFECTION RATES AND ANTIBIOTIC PRACTICE WITH URETHRAL INJECTION OF POLYACRYLAMIDE HYDROGEL (BULKAMID®)

You have accessJournal of UrologyCME1 May 2022PD06-07 REAL-WORLD URINARY TRACT INFECTION RATES AND ANTIBIOTIC PRACTICE WITH URETHRAL INJECTION OF POLYACRYLAMIDE HYDROGEL (BULKAMID®) Shreeya Popat, Justina Tam, Hannah Koenig, Alvaro Lucioni, Kathleen Kobashi, and Una Lee Shreeya PopatShreeya Popat More articles by this author , Justina TamJustina Tam More articles by this author , Hannah KoenigHannah Koenig More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Kathleen KobashiKathleen Kobashi More articles by this author , and Una LeeUna Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002525.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Polyacrylamide hydrogel (PAHG) (Bulkamid®) is a transurethral bulking agent that has demonstrated safety, efficacy, and durability in the treatment of stress urinary incontinence in women. Initial clinical trials report a post-procedure urinary tract infection (UTI) rate of 3.5%. While manufacturer information recommends pre-procedure antibiotics, the American Urological Association best practice statement is uncertain about antibiotic prophylaxis, and real-world practice is varied. Therefore, we report a single institution’s experience with UTI following PAHG urethral bulking. METHODS: Charts of patients who underwent PAHG urethral bulking from May 2020 to March 2021 were retrospectively reviewed. Demographic characteristics were collected, along with pre-procedure urinalyses (UA) and if prophylactic antibiotics were administered. In addition, charts were reviewed for post-procedure UTI. UTI was defined by prescription of antibiotics for UTI symptoms within 14 days of the procedure. Statistical analysis examining significant differences between groups that did and did not have post-procedure UTI was performed using Fisher’s exact test. RESULTS: During the study period, 103 women underwent PAHG for urethral bulking by 3 FPMRS surgeons at a single institution. 72 (69.9%) received pre-procedure prophylactic antibiotics. On pre-operative UA, 93 (88.3%) were positive for leukocyte esterase, 23 (22.3%) for blood, and only 1 was positive for nitrites. Only 3 of these samples resulted in a positive urine culture. Eleven of the 103 (10.7%) patients were prescribed antibiotics within 14 days of PAHG urethral bulking for a UTI. Of the 3 patients with incidentally positive urine cultures prior to the procedure, only one developed UTI symptoms and was treated with antibiotics. Presence of blood or nitrites on pre-procedure UA was not significantly related with post-procedure UTI. However, leukocyte esterase positivity was significantly related with post-procedure UTI (p = 0.03). Limitations include that this was a retrospective study and therefore not powered to determine UTI rate. CONCLUSIONS: In this cohort of real-world practice of PAHG urethral bulking, the incidence of UTI was 10.7%. Administration of prophylactic antibiotics varied and was not associated with lower rates of post-procedure UTIs. Although leukocyte esterase on pre-procedure urinalyses correlated with post-procedure UTIs on this initial analysis, more studies are needed to meaningfully guide clinical practice. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e95 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shreeya Popat More articles by this author Justina Tam More articles by this author Hannah Koenig More articles by this author Alvaro Lucioni More articles by this author Kathleen Kobashi More articles by this author Una Lee More articles by this author Expand All Advertisement PDF DownloadLoading ...

Antibiotic Prophylaxis and Empirical Antibiotic Therapy in Primary Arthroplasty and Periprosthetic Joint Infections: Current Practice and Need for Therapy Optimization.

The aim of the present work was to survey the situation of healthcare regarding the use of prophylactic and empirical antibiotics in primary arthroplasty and treatment of periprosthetic joint infections (PJI). For this purpose, a survey was conducted at German university and occupational accident hospitals. Survey data was compared to previously published data on the antimicrobial regimes of PJI (n=81) patients (n=81) treated in our department between 2017 and 2020. A homogeneous picture emerged for the prophylactic administration of antibiotics in the context of primary arthroplasty. In 93.2% (elective) and 88.6% (fracture treatment) of the hospitals, first or second generation cephalosporins were administered perioperatively for infection prophylaxis in primary hip arthroplasty. The empirical antibiotic treatment of PJIs showed a clearly inhomogeneous therapeutic picture. Monotherapy with an aminopenicillin plus a beta-lactamase inhibitor is used most frequently (38.7%); first and second generation cephalosporins are used second most frequently as monotherapy (18.2%). In light of the global problem of antibiotic multi-resistance, clinical use of antibiotics has to be reasonable and effective. The present results highlight the further need to improve awareness and following existing guidelines in the administration of empirical antibiotic therapy in PJI.

Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

Ureteral stents are commonly used during pyeloplasty to ensure drainage and anastomotic healing. Antibiotic prophylaxis is often used due to concerns for urinary tract infection (UTI). Although many surgeons prescribe prophylactic antibiotics following pyeloplasty, practices vary widely due to lack of clear evidence-based guidelines. We hypothesize that the rate of stent UTI does not significantly vary between children who receive antibiotics and those who do not. We reviewed the medical records of 741 patients undergoing pyeloplasty between January 2010 and July 2018 across seven institutions. Exclusion criteria were: age older than 22 years, no stent placed, externalized stents used, and incomplete records. Surgical approach, age, antibiotic use, stent duration, Foley duration, and urine culture results were recorded. Patients were categorized into two groups, those younger than four years of age and those four years and older as proxy for likely diaper use. Univariate logistic regression was conducted to identify variables associated with UTI. Multivariable backward stepwise logistic regression was used to identify the best model with Akaike information criterion as model selection criteria. The selected model was used to calculate odds ratios and 95% confidence intervals summarizing the association between prophylactic antibiotics and stent UTI while controlling for age, gender, and intra-operative urine cultures. 672 patients were included; 338 received antibiotic prophylaxis and 334 did not. These groups differed in mean age (3.91 vs. 6.91 years, P<.001), mean stent duration (38.5 vs. 35.32 days, P<.001), and surgical approach (53.25% vs. 32.04% open vs. laparoscopic, P<.001). The incidence of stent UTI was low overall (7.59%) and similar in both groups: 31/338 (9.17%) in the prophylaxis group and 20/334 (5.99%) in the non-prophylaxis group (P=.119). Although female gender, likely diaper use, and positive intra-operative urine culture were each associated with significantly higher odds of stent UTI, prophylactic antibiotic use was not associated with significant reduction in stent UTI in any of these groups. Surgical approach, stent duration, and Foley duration were not associated with stent UTI. Incidence of stent UTI is low overall following pyeloplasty. Prophylactic antibiotics are not associated with lower rates of stent UTI following pyeloplasty even after controlling for risk factors of female gender, likely diaper use, and positive intra-operative urine culture. Routine administration of prophylactic antibiotics after pyeloplasty does not appear to be beneficial, and may be best reserved for those with multiple risk factors for UTI.

Adverse effects due to changes in the composition of the intestinal microbiota as result of the administration of antibiotics during the perinatal period

Antibiotic administration commonly induces allergic reactions, dysmicrobism and microbial resistance, but long-term effects due to changes in gut microbiota composition are difficult to assess. This paper aims to identify in the literature adverse effects induced by changes in gut microbiota composition after perinatal administration of antibiotics. Antibiotic administration during pregnancy is a predisposing factor for the development of bronchial asthma, eczema, or allergic rhinitis in children, but does not support the hypothesis as being a risk factor for childhood obesity/overweight. The effect on the newborn’s microbiota of prophylactic administration of antibiotics during caesarean section is controversial. Postnatal treatments with antibiotics frequently causes intestinal dysmicrobism, the most severe form being necrotizing enterocolitis, especially among premature infants, but effects on the changes in body weight are controversial. Early administration of broad-spectrum antibiotics, particularly macrolides and cephalosporins, is strongly associated with the development of bronchial asthma at age 5 years. Recently, altered auditory processing and changes in recognition memory were described in newborn exposed to antibiotics in the absence of infection. More studies are needed to clarify the association between the type of antibiotic, the frequency, respectively period (both prenatal and intrapartum) of administration and long-term effects.

Evaluation of the Status of Prophylactic Administration of Antibiotics in Surgery Department of Shahid Sadoughi Hospital of Yazd City in 2018

Introduction: surgical site infection is one of the most important causes of mortality and morbidity: use of the prophylactic antibiotic is one of the effective methods for its prevention, the present study aimed to investigate the status of prophylactic administration of antibiotics in Surgery Department of Shahid Sadoughi Hospital of Yazd City in 2018.&#x0D; Methods: this descriptive cross-sectional study was performed on 600 patients from General Surgery Department of Shahid Sadoughi Hospital of Yazd City in 2018. Data were collected by questionnaire. Selection of the prophylactic antibiotic (pa), the dosage, time, type and the route of antibiotic administration were compared with ASHP ( American Society of Health System Pharmacistis) and -Clinical Medicine Strategy of Using Preventive Antibiotics in Surgeries (Iranian guideline). Data were analyzed by SPSS version 16 software.&#x0D; Results: Mean age of the patients was 35.02 ±19.12 years. Regarding the use or non-use of antibiotics 85.2%, the route of administration 85.2%, the dose of the drug 64.7% were in accordance with the instructions. The time of drug prescription was in accordance with the national instructions in 72.3% of cases and in accordance with ASHP in 72.8% of cases. The most inconsistency with ASHP and Iranian guideline was seen in the type of the antibiotic that was in accordance with ASHP and Iranian guideline in 50.7% and 48.8%, respectively. The overall appropriateness of PA was found in 50.7% and 48.8% cases according to ASHP and Iranian guideline, respectively. &#x0D; Conclusion: In the recent study, the most inconsistency with ASHP and Iranian guideline was seen in the type of prescription antibiotic.

327 Prophylactic Antibiotics Do Not Prevent CNS Infection in Civilian Gunshot Wounds to the Head

INTRODUCTION: Civilian gunshot wounds to the head (GSWH) are an ongoing epidemic in the US, with incidence rising each year. They are frequently devastating, with case fatality rates approaching 91%, accounting for fatalities occurring in the hospital and at the scene of injury. Although military GSWH are robust, data and management guidelines for civilian GSWH is relatively lacking. Specifically, the administration of prophylactic antibiotics in GSWH patients remains controversial. Prior studies indicate the incidence of intracranial infection after civilian GSWH to be as high as 25%, with significant impact on morbidity and mortality. METHODS: We retrospectively reviewed survivable GSWH at our level 1 trauma center between 2012-2017. Patients were assessed for CNS infection, and categorized with regard to the use of prophylactic antibiotics, length of stay, GCS at presentation, bullet trajectory, and demographics. RESULTS: 236 patients sustained survivable GSWH. 12/236 (5.1%) patients developed CNS infection following GSWH, and 3/12 (25%) of those patients had not received prophylactic antibiotics. Of the 133 patients who received prophylactic antibiotics, 10 (7.5%) subsequently developed CNS infection. Infection was diagnosed more commonly in patients who received antibiotics, but this was not statistically significant (p = 0.138). Bullet trajectories through the paranasal sinuses or oropharynx were significantly more likely to result in CNS infection (OR 3.04, p = 0.0624). Patients who underwent decompressive surgery and patients who underwent invasive ICP monitoring had significantly higher odds of developing CNS infections (OR 17.7, p = 0.00616; OR = 0.24, p = 0.048). CONCLUSION: Decompressive surgery, invasive ICP monitoring, and bullet trajectory were statistically significant factors associated with development of CNS infection following GSWH. Prophylactic antibiotics did not reduce the incidence of CNS infection, and may have increased the risk of infection.

First documented outbreak of arthritis caused by Kingella kingae in a Spanish childcare center

BackgroundRecently, Kingella kingae (K. kingae) has been described as the most common agent of skeletal system infections in children 6 months-2 years of age. More exceptional is the clinical presentation in clusters of invasive K. kingae infections. We describe the investigation of the first outbreak of 3 cases of arthritis caused by K. kingae documented in Spain detected in a daycare center in Roses, Girona. Patients and methodsIn December of 2015 surveillance throat swabs obtained from all attendees from the same class of the index daycare center were assessed to study the prevalence of K. kingae colonization. The sample was composed of 9 toddlers (range: 16–23 months of age). Investigation was performed by culture and K. kingae-specific RT-PCR. Combined amoxicillin-rifampicin prophylaxis was offered to all attendees who were colonized by K. kingae. Following antimicrobial prophylaxis, a new throat swab was taken to confirm bacterial eradication. ResultsK. kingae was detected by RT-PCR throat swabs in the 3 index cases and 5 of the 6 daycare attendees. Cultures were negative in all cases. After administration of prophylactic antibiotics, 3 toddlers were still positive for K. kingae-specific RT-PCR. ConclusionsClusters of invasive K. kingae infections can occur in daycare facilities and closed communities. Increased awareness and use of sensitive detection methods are needed to identify and adequately investigate outbreaks of K. kingae disease. In our experience, the administration of prophylactic antibiotics could result in partial eradication of colonization. No further cases of disease were detected after prophylaxis.

Implementing the Golden Hour Protocol to Improve the Clinical Outcomes in Preterm Infants

Purpose: Since premature infants are sensitive to the changes in blood glucose levels and body temperature, maintaining these parameters is important to avoid the risk of infections. The authors implemented the Golden Hour protocol (GHP) that aims to close the final incubator within one hour of birth by implementing early treatment steps for premature infants after birth, such as maintaining body temperature, securing airway, and rapidly administering glucose fluid and prophylactic antibiotics by securing breathing and rapid blood vessels. This study investigated the effect of GHP application on the short- and long-term clinical outcomes.Methods: We retrospectively analyzed the medical records between 2017 and 2018 before GHP application and between 2019 and 2020 after GHP application in preterm infants aged 24 weeks or older and those aged less than 33 weeks who were admitted to the neonatal intensive care unit.Results: Overall, 117 GHP patients and 81 patients without GHP were compared and analyzed. Peripheral vascularization time and prophylactic antibiotic administration time were shortened in the GHP-treated group (&lt;i&gt;P&lt;/i&gt;=0.007 and &lt;i&gt;P&lt;/i&gt;=0.008). In the short-term results, the GHP-treated group showed reduced hypothermia upon arrival at the neonatal intensive care unit (&lt;i&gt;P&lt;/i&gt;=0.002), and the blood glucose level at 1 hour of hospitalization was higher (&lt;i&gt;P&lt;/i&gt;=0.012). Furthermore, the incidence of neonatal necrotizing enteritis decreased (&lt;i&gt;P&lt;/i&gt;=0.043). As a long-term result, the incidence of BPD was reduced (&lt;i&gt;P&lt;/i&gt;=0.004).Conclusion: We confirmed that applying GHP improved short- and long-term clinical outcomes in premature infants aged &lt;33 weeks age of gestation, and we expect to improve the treatment quality by actively using it for postnatal treatment.

Does routine administration of prophylactic antibiotics to newborns delivered through meconium-stained fluid improve neonatal outcomes?

Barnes, Carson MD; Beyer, Caroline MD; Bloecher, Patrick MD; Carlson, Chelsea MD Author Information

Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Background: The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. Methods: This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. Results: Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; p = 0.03) and complications (OR: 0.48; p = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; p = 0.24), mortality (OR: 0.69; p = 0.17), extrapancreatic infection (OR: 0.64, p = 0.54), pulmonary infection (OR: 1.23; p = 0.69), blood infection (OR: 0.60; p = 0.35), urinary tract infection (OR: 0.97; p = 0.97), pancreatic pseudocyst (OR: 0.59; p = 0.28), fluid collection (OR: 0.91; p = 0.76), organ failure (OR: 0.63; p = 0.19), acute respiratory distress syndrome (OR: 0.80; p = 0.61), surgical intervention (OR: 0.97; p = 0.93), dialysis (OR: 2.34; p = 0.57), use of respirator or ventilator (OR: 1.90; p = 0.40), intensive care unit treatment (OR: 2.97; p = 0.18), and additional antibiotics (OR: 0.59; p = 0.28) between the experimental and control groups. Conclusions: It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

Cholangiocarcinoma With Sepsis Associated With Percutaneous Transhepatic Biliary Drainage (PTBD)

Percutaneous transhepatic biliary drainage (PTBD) can be an alternative palliative treatment in resectable cholangiocarcinoma. One of the most common complications of PTBD is infection, with a prevalence of 3.6 – 67.4% in patients undergoing PTBD procedure, with mortality rate of 0.05-7%. We report a case of a 46-year old male with a history of fever 14 days after undergoing PTBD procedure. Physical examination revealed tachycardia, tachypnea, febris, jaundice, and decreased urine output. Laboratory results revealed hypochromic-microcytic anemia, leukocytosis, decreased renal function, elevated liver enzymes, obstructive icterus, hypoalbuminemia, and hyperkalemia. Blood and gall culture revealed a growth of Eschericia coli. The patient was given fluid resuscitation and antibiotic suitable to microbial sensitivity test, and treatment of acute kidney injury and hyperkalemia, including hemodialysis. The patient’s general condition improved after ten days of care, and was discharged on the twentieth day. Cholangitis is one of the most infectious complications following PTBD procedure. The prevalence of sepsis in biliary drainage procedures was reported 2.5-2.7%, with enteral bacteria gram-negative bacilli being the most common pathogen found in blood and bile. The administration of prophylactic antibiotics was not proven to decrease prevalence of infection. Bacterial translocation via portal vein due to loss of mucosal integrity in the intestines may contribute to bacteremia following PTBD procedure.

Comparison of Use and Non-Use of Prophylactic Antibiotics for Severe Acute Pancreatitis. Randomized Clinical Trial. Preliminary Report

Introduction: Acute pancreatitis is a frequent disease in Chile, with mortality rate of 10-30%. Prophylactic antibiotics administration has been part of severe acute pancreatitis treatment for theoretical prevention of infectious complications and mortality reduction. Yet the available evidence is controversial. The aim of this article is to demonstrate that prophylactic antibiotics do not reduce complications, need for intensive care unit bed or mortality in severe acute pancreatitis.