Antibiotics For Prevention Of Surgical Site Infection Research Articles

Perioperative antimicrobial prophylaxis in surgery and adherence to guidelines

Introduction: Surgical Antimicrobial Prophylaxis (SAP) lowers post-operative surgical site infection (SSI) if used with American Society of Health-System Pharmacists (ASHP) guidelines. Objective: The present study was carried out with the aim to assess the rational use of antibiotics for prevention of SSI and to look for adherence to ASHP guidelines. Materials and Method: This was a prospective study done in 228 patients in surgical ward/ICU who received antibiotics for surgical prophylaxis. Results: There was unnecessary SAP pre-operatively in 22.80 % respondents. Post-operatively 10.08 % patients received single antibiotic, 79.39% received two, 14.91% received three, one received four antimicrobials. Antibiotics were used for procedures where antibiotic prophylaxis is not indicated There was appropriate antimicrobial selection in 31.58% surgeries .Appropriate initial time of SAP was in 87.72% surgeries .Route, dose, dose interval were appropriate in all surgeries. The duration of prophylaxis was consistent with the guideline recommendation in 47.37% patients. SSI developed in 3.5% cases. Patients were discharged without complications. Conclusion: Utilization of antimicrobials for surgical prophylaxis are not in accordance with standard treatment guidelines. There was overuse of antimicrobials .Costly and branded drugs were used. Effective educational intervention, development of local guidelines / protocols can help to overcome this. Keywords: Antimicrobial, surgical prophylaxis, ASHP guidelines, surgical site infection

Adherence to Guideline-Based Antibiotic Prophylaxis in Gynecology among Alabama Providers.

Surgical site infection (SSI) is a preventable cause of postoperative morbidity. The appropriate use of perioperative antibiotics for prevention of SSIs is a well-established quality metric. Little is known about the adherence to guidelines-based antibiotic prophylaxis among Alabama obstetricians and gynecologists. Our aims were to determine their adherence to guidelines-based antibiotic prophylaxis and identify the factors that are predictive of nonadherence. Online, self-administered survey of Alabama obstetricians and gynecologists. Providers reported not providing the indicated antibiotics and/or giving nonindicated antibiotics in almost all surgical scenarios. The exceptions included hysterectomies, in which almost all (96%) providers routinely gave indicated antibiotics. No providers reported giving antibiotics during intrauterine device placement or endometrial biopsies, which is appropriate. The only factor predictive of inappropriate antibiotic use was the absence of a standing antibiotic protocol. Alabama gynecologic surgeons can and should improve their compliance with guidelines-based antibiotic prophylaxis. More research is needed to determine which interventions would improve adherence in this provider population; our study suggests that the implementation of a standing antibiotic protocol may be a reasonable first step.

A comparative study of single dose preoperative antibiotic prophylaxis versus five-day conventional postoperative antibiotic therapy in patient undergoing elective surgical procedure

Background: Surgical site infections (SSIs) increase overall mortality and morbidity and increase the length of hospital stay and overall costs. With the fear of developing wound infection after surgery, author used to administer antibiotics for a period of 7-10days even in clean and clean-contaminated cases. This study aimed to fill that lacunae and there by aid the gradual shift away from over reliance on antibiotics in prevention of SSI, so author can prevent rapid development of resistance against antibiotics, prolonged hospital stays, and drug induced complication.Methods: This facility based prospective study was carried out over a period of 1year involving 102 patients between the age group of 20-70years. All the patients in study group were given a single dose of 1gm (150mg/kg) of injection cefotaxime, 30minute before skin incision. All the cases in the control group received injection cefotaxime 1gm (150mg/kg) I.V. BD for five days.Results: Data in the form of age, sex, type of surgery, post-operative fever, severity of pain and swelling at site of incision, duration of post-operative hospital stay, cost of treatment were noted in prescribed format and statistical analysis was done.Conclusions: Single dose antibiotic prophylaxis is sufficient for clean and clean contaminated surgeries because there was no difference found in SSI either using single dose pre-operative antibiotic prophylaxis or using five days conventional post-operative antibiotic therapy with the added advantage of significant reduction in hospital stay and savings in resources.

The effectiveness of i.v. cefuroxime prophylaxisof surgical site infection after elective inguinal hernia repair with mesh: A retrospective observational study.

The efficacy of routine antibiotic prophylaxis for prevention of surgical site infection (SSI) after elective inguinal hernia repair with a mesh patch remains uncertain. The authors of a recent Cochrane meta-analysis based on 17 randomized trials were unable to draw a definitive conclusion on this subject. The purpose of this study was to determine the effectiveness of prophylactic antibiotics for prevention of SSI after elective inguinal hernia repair with meshand the risk factors for SSI. All low-risk patients who underwent elective inguinal hernia repair with mesh at our institution between 2010 and 2015 were enrolled in this study, with the exception of patients with recurrent hernias or immunosuppressive diseases. All patients received a single intravenous (i.v.) injection of cefuroxime (1.5g)within 2 h prior to surgery at the discretion of the surgeon. SSI was defined using criteria of the Centers for Disease Control and Prevention. The variables which could influence the rate of SSI were analyzed by multivariate analysis to determine the independent risk factors for SSI. Among the 605 patients who underwent elective inguinal hernia repair with mesh during the study period, 553 were eligible for enrolment in the study. Of these, 331 received a single dose of cefuroxime preoperatively. The overall SSI rate was 5.4%; 9.4% of those patients who did not receive preoperative antibiotic prophylaxis developed SSI versus 2.8% of those who did receive prophylaxis (P = 0.001). All infections were superficial. Factors independently associated with SSI were advanced age, smoking and preoperative stay. The incidence of SSI among low-risk patients who did and did not receive preoperative antibiotic prophylaxis after elective inguinal hernia repair with mesh differed significantly, particularly among patients of advanced age, smokers and patients with a prolonged preoperative stay in the hospital.