Choice Of Antibiotic Prophylaxis Research Articles

Evaluation of Blood and Biliary Drainage Cultures and Mortality after Percutaneous Transhepatic Biliary Drainage Procedure

Introduction: Bacteremia and bile duct infection following percutaneous transhepatic biliary drainage (PTBD) are severe complications. Thus, the aim of this study was to investigate the risk factors of mortality and to evaluate the differences between blood and biliary drainage culture positive patients after PTBD. Materials and Methods: This is a retrospective study of 90 patients without any signs of infection prior to the PTBD procedures. Of these patients, we further divided them into three groups based on culture results: 1) first group was only bacteremic, 2) second group was only bile drainage culture-positive, and 3) third group was both bacteremic and bile drainage culture-positive. We compared clinical and laboratory parameters between these three groups and also evaluated the culture results in a high-resistance setting. Results: There were 90 patients who developed bacteremia, bile duct infections or both. In the laboratory findings, bacteremic patients showed significantly higher serum level of alanine aminotransferase (ALT) (p=0.001). Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were found to be the independent risk factors for 30-day mortality after PTBD. (p=0.01, p=0.01, and p=0.04, respectively). Gram-negative organisms were present in 71.2% of the cases; Escherichia coli was the most common species (28.1%) followed by Enterococcus faecium (18.1%), Klebsiella pneumoniae (15.8%) and Pseudomonas aeruginosa (9.9%). 51 (41.8%) of the cultured gram-negative bacteria were extended spectrum beta-lactamases positive and carbapenem resistance was found in 27 (15.8%) isolates. Conclusion: Elevated ALT level was only difference between three groups. Therefore, bacteremic and bile culture positive patients should be treated with the same care. Elevated neutrophil counts, lipase levels and carbapenem-resistant isolates were the independent risk factors for mortality. Finally, the choice of antibiotic prophylaxis should be reviewed according to the antimicrobial resistance profiles.

Prevalence of Multidrug-Resistant Organisms in Patients Undergoing Free Flap Reconstruction.

The purpose of this study is to evaluate the relationship between antibiotic prophylaxis and prevalence of multidrug-resistant organisms (MDRO) in patients undergoing head and neck cancer reconstruction. Retrospective Chart Review. Retrospective review of patients who underwent head and neck free flap reconstruction at our institution between 2009 to 2016. Of the 145 patients that underwent head and neck tumor removal surgery using free tissue flaps to cover the defect and therafter received antibiotic prophylaxis, 30 (20.7%) developed postoperative surgical site (n = 17, 55.7%) or distant (n = 13, 43.4%) infections. Seven had a multidrug-resistant infection, the most common with Methicillin-Resistant Staphylococcus aureus (MRSA). There was no significant relationship between antibiotic spectrum or duration to the development of postoperative infections or MDRO. Pseudomonas and MRSA infections were low overall with only one multidrug-resistant Pseudomonas infection. The choice of antibiotic prophylaxis should cover organisms these patients are at highest risk for including anaerobes and Gram-negative organisms. A shorter duration of antibiotic prophylaxis should be considered given no increased risk of postoperative infection nor MDRO. Finally, one must be aware of the potential threat of multidrug-resistant Pseudomonas and MRSA amongst this vulnerable population and identity these with culture driven treatment. 4 Laryngoscope, 131:E1881-E1887, 2021.

Microbiological profile of nosocomial infections following cardiac arrest: Insights from the targeted temperature management (TTM) trial

AimsInfectious complications frequently occur in intensive care unit patients admitted after out-of-hospital cardiac arrest. There is debate on the effects of temperature management on the incidence of infections, as well as on the efficacy and choice of antibiotic prophylaxis. In this substudy of the targeted temperature management (TTM) trial, we describe the microbiological profile of infectious complications in patients with cardiac arrest and examined the impact of TTM at 33 °C compared to TTM at 36 °C. Furthermore we aimed to determine the association between antibiotic prophylaxis and the incidence of infections. MethodsThis is a posthoc analysis of the TTM cohort. Microbiological data was retrospectively collected for the first 14-days of ICU-admission. Logistic regression was used to determine the relationship between antibiotic prophylaxis and pneumonia adjusted for mortality. ResultsOf 696 patients included in this analysis, 158 (23%) developed pneumonia and 28 (4%) had bacteremia with a clinically relevant pathogen. Staphylococcus aureus was the most common pathogen isolated in patients with pneumonia (23%) and in patients with bacteremia (24%). Gram-negative pathogens were most common overall. TTM did not have an impact on the microbiological profile. The use of antibiotic prophylaxis was significantly associated with a reduced risk of infection (OR 0.59, 95%CI 0.43-0.79, p = 0.0005). This association remained significant after correcting for confounders (OR 0.64, 95%CI 0.46-0.90; p = 0.01). The association is not present in a model after correction for clustering within centers (aOR 0.55, 95%CI 0.20–1.47, p = 0.22). Adjustment for mortality did not influence the outcome. ConclusionGram-negative pathogens are the most common causes of nosocomial infections following cardiac arrest. TTM does not impact the microbiological profile. It remains unclear whether patients in ICUs using antibiotic prophylaxis have a reduced risk of pneumonia and bacteremia that is unrelated to center effects.

Utility of wound cultures in the management of open globe injuries: a 5-year retrospective review

BackgroundEndophthalmitis after open globe injury can be devastating to vision recovery. As treatment of endophthalmitis is often empiric, some surgeons may obtain cultures at presentation of trauma in anticipation of later infection. This study examines the usefulness of wound cultures obtained during globe repair.ResultsInstitutional Review Board approval was obtained. Medical records were retrospectively reviewed, with 168 open globes included. Cultures of the wound site had been taken in all cases included in this study. Wound cultures were positive in 63% of cases but were not used for clinical decision-making for any patient in this study. Two patients had evidence of endophthalmitis at presentation, with results of vitreous culture matching those from the wound. No patient later developed endophthalmitis after open globe repair.ConclusionsDespite a high rate of wound contamination, few cases of endophthalmitis (1.2%) were seen in this series. In no case did the results of wound culture impact choice of antibiotic prophylaxis or treatment. Cultures obtained at the time of open globe repair were not cost effective in the subsequent management of the injury.

448. Impact of Doxycycline Prophylaxis on Skin and Soft-Tissue Infection Incidence in Naval Special Warfare Trainees

BackgroundSkin and soft-tissue infections (SSTIs) are a common complication of military training. Naval Special Warfare (NSW) training requires prolonged periods of extreme physical exertion and unique environmental exposures, including extended immersion in ocean water. A centerpiece of SEAL training is referred to as “Hell Week” (HW), a colloquial term to reflect the intense physical obstacles and exposure to extreme environmental conditions endured by candidates. Due to such environmental exposures, NSW trainees are at increased risk for SSTI due to uncommon organisms. A prior outbreak of Shewanella SSTI and bacteremia among NSW trainees led to the initiation of prophylactic doxycycline 100 mg daily during and for 7 days after HW to attempt to reduce this risk. The efficacy of this intervention is undetermined.MethodsDoxycycline prophylaxis was initiated in August 2015. We conducted a retrospective analysis of SSTI incidence presenting for medical attention among NSW trainees from April 2013 to November 2018, using case records collected prospectively at the Naval Special Warfare Center. The incidence of SSTI was calculated based on the size of a given class and the number of affected trainees. SSTI cases were then divided and analyzed as occurring during vs. after HW.ResultsThe pre-intervention cohort consisted of 1626 NSW trainees. A total of 76 trainees developed SSTI, with 20 cases during HW and 56 cases in the post-HW period. In the post-intervention cohort, 2022 trainees experienced a total of 81 cases of SSTI during HW and 83 in the post-HW period. 45% of all SSTI cases occurred in the months of June, July, and August. The incidence of cellulitis between the pre- and post-intervention cohorts during HW was 2% and 4%, respectively, and 5% and 6.4% in the post-HW period. There were no hospitalizations for invasive gram-negative infections following the initiation of doxycycline prophylaxis.ConclusionDoxycycline prophylaxis does not appear to reduce the incidence of SSTI but may reduce the incidence of certain severe infections. The choice of antibiotic prophylaxis and dosing may require further investigation. Seasonality of SSTI among NSW trainees is an unexpected finding and may provide valuable information for the prevention of future illness. Disclosures All authors: No reported disclosures.

Clinicobacteriological study of chronic dacryocystitis in Egypt

BackgroundEmpirical antibiotic treatment is a common practice to manage chronic dacryocystitis in many healthcare settings in spite of the probability for changing in the types of microbial isolates.The aims of this study were to find out the current clinicomicrobiological profile of adult cases with chronic dacryocystitis and to determine the antibiogram of the isolated organisms to the commonly prescribed antibiotics.ResultsOf the 25 samples obtained, 15 (60%) yielded a positive culture, 12 (48%) showed single bacterial isolate while 3 (12%) had mixed (two types) bacterial isolates.A total of 18 different strains of microorganisms were obtained from 25 cases, with 12/18 (66.7%) Gram-positive, 5/18 (27.7%) Gram-negative isolates, and 1/18 (5.5%) was fungal isolate. Coagulase-negative staphylococci were the most frequently found Gram-positive bacteria (22.2%), while Klebsiella species was the predominant of Gram-negative bacteria (16.6%). The majority of the isolated bacterial strains were sensitive to gatifloxacin (88%) and amikacin (88%) while the main resistance of the bacterial isolates, recovered from chronic dacryocystitis, was to cephalexin (59%).ConclusionThere is a continuous possibility of changing the type of pathogens responsible for dacryocystitis as well as their susceptibility to antibiotics. Microbiological study with microbial culture and antibiotic sensitivity test has to be done to all cases of chronic dacryocystitis for a better choice of antibiotic prophylaxis and treatment options, and to guard against the emergence of more drug-resistant strains.

Interventions to avoid pulmonary complications after lung cancer resection.

Surgical resection of lung cancer is the preferred treatment for early-stage disease in medically fit patients. The rates of postoperative pulmonary complications (PPCs) such as pneumonia, empyema and atelectasis are as high as 10% in contemporary series. A review of the literature was performed to identify the best evidence supporting interventions to identify, prevent and treat PPCs. The use of patient risk scores, appropriate choice of antibiotic prophylaxis, intraoperative ventilatory strategies, chest physiotherapy, sputum management and non-invasive ventilatory support were specifically discussed, as was the relevant supporting data. Recommendations to guide best practice and inform future research questions are outlined.

Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study.

Antibiotic prophylaxis is commonly used in head and neck oncologic surgery, due to the clean-contaminated nature of these procedures. There is a wide variety in the use of prophylactic antibiotics regarding the duration of application and the choice of agent. The purpose of this study was to determine whether short-term or long-term antibiotic prophylaxis has an impact on the development of head and neck surgical wound infection (SWI). Retrospective chart review was carried out in 418 clean-contaminated head and neck surgical oncology cases at our department. More than 50 variables including tumour type and stage, type of surgical treatment, co-morbidities, duration and choice of antibiotic prophylaxis, and the incidence of SWI were analysed. Following descriptive data analysis, Chi square test by Pearson and Fisher's exact test were used for statistical evaluation. Fifty-eight of the 418 patients (13.9%) developed SWI. Patients with advanced disease and tracheotomy showed a significantly higher rate of SWI than those with early stage disease and without tracheotomy (p=0.012 and p=0.00017, respectively). However, there was no significant difference between the SWI rates in the short term and long term treatment groups (14.6 and 13.2%, respectively; p=0.689). Diabetes and body weight were not found to be risk factors for SWI. Long-term antibiotic prophylaxis was not associated with a decrease in SWI in the entire cohort of patients undergoing clean-contaminated major head and neck oncologic surgery. Our data confirmed the extent of surgery and tracheotomy as being risk factors for postoperative SWI.

Impact of choice of antibiotic prophylaxis on colorectal surgical site infection in Bangkok Hospital

Impact of choice of antibiotic prophylaxis on colorectal surgical site infection in Bangkok Hospital

Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures?

In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible. This was a retrospective case-control study on patients hospitalized from 2004 to 2009. We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of ten days. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was three days and the median delay between trauma and surgery was one day. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome. We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis.

Choice of Intravenous Antibiotic Prophylaxis for Colorectal Surgery Does Matter

The Surgical Care Improvement Program endorses mandatory compliance with approved intravenous prophylactic antibiotics; however, oral antibiotics are optional. We hypothesized that surgical site infection (SSI) rates may vary depending on the choice of antibiotic prophylaxis. A retrospective cohort study of elective colorectal procedures using Veterans Affairs Surgical Quality Improvement Program (VASQIP) and SSI outcomes data was linked to the Office of Informatics and Analytics (OIA) and Pharmacy Benefits Management (PBM) antibiotic data from 2005 to 2009. Surgical site infection rates by type of IV antibiotic agent alone (IV) or in combination with oral antibiotic (IV + OA) were determined. Generalized estimating equations were used to examine the association between type of antibiotic prophylaxis and SSI for the entire cohort and stratified by use of oral antibiotics. After 5,750 elective colorectal procedures, 709 SSIs (12.3%) developed within 30 days. Oral antibiotic + IV (n = 2,426) had a lower SSI rate than IV alone (n = 3,324) (6.3% vs 16.7%, p < 0.0001). There was a significant difference in the SSI rate based on type of preoperative IV antibiotic given (p ≤ 0.0001). Generalized estimating equations adjusting for significant covariates of age, body mass index, procedure work relative value units, and operation duration demonstrated an independent protective effect of oral antibiotics (odds ratio [OR] 0.37, 95% CI 0.29 to 0.46), as well as increased rates of SSI associated with ampicillin/sulbactam (OR 2.21, 95% CI 1.37 to 3.56) and second generation cephalosporins (cefoxitin, OR 2.50, 95% CI 1.83 to 3.42; cefotetan, OR 2.70, 95% CI 1.72 to 4.22) when compared with first generation cephalosporin/metronidazole. The choice of IV antibiotic was related to the SSI rate; however, oral antibiotics were associated with reduced SSI rate for every antibiotic class.

Choice of Antibiotic Prophylaxis for Colorectal Surgery Does Matter

Choice of Antibiotic Prophylaxis for Colorectal Surgery Does Matter

Posttraumatic Bacterial Infections in Extremities before and after Osteosynthesis in Small Animals

Posttraumatic Bacterial Infections in Extremities before and after Osteosynthesis in Small Animals

The value of oral antibiotic prophylaxis in biliary tract surgery

In this study the relationship between the presence or absence of organisms in bile or on closing wound swabs and the subsequent development of wound sepsis was confirmed. There was no significant difference in the incidence of septic complications among three treatment groups in which cefuroxime (iv) and ciprofloxacin (iv or oral) were administered. Consideration of costs attributable to the choice of antibiotic prophylaxis suggests that oral ciprofloxacin in biliary tract surgery may offer significant advantages.