Discontinuation Of Antibiotic Prophylaxis Research Articles

Infectious diseases: what's new in 2023

The year 2023 saw the publication of several studies in various areas of infectious diseases. The administration of corticosteroids decreased mortality in severe community-acquired pneumonia. Administration of doxycycline post-exposure prophylaxis reduced the risk of bacterial sexually transmitted infections at the risk of resistance selection. An herbal preparation decreased mortality in sepsis. A meta-analysis concludes that oseltamivir does not significantly reduce the risk of hospitalisation for influenza. Discontinuation of antibiotic prophylaxis during dental procedures in Sweden did not increase the incidence of viridans group Streptococcus endocarditis. Several studies have led to the introduction of RSV (Respiratory Syncytial Virus (RSV) vaccination. 2023 also saw the resurgence of invasive Group A Streptococcal infections, of which clinicians must be wary.

Practice of antibiotic prophylaxis in patients undergoing mastectomy without immediate reconstruction: A survey of breast surgeons in Pakistan.

e13519 Background: Incidence of surgical site infections after breast surgery range from 0.8-26%. Though preoperative antibiotic prophylaxis (AP) is widely used, international and national guidelines lack focus on post-operative antibiotic prophylaxis (PAP). This survey of surgeons in Pakistan reports surgeon preference for AP in cases of mastectomy without immediate reconstruction but with indwelling drains. Methods: An anonymous, online, validated 16-item survey, exploring peri-operative antibiotic choices and prescribing practices was disseminated to a working-group of 30 leading breast surgeons in Pakistan. Descriptive statistics were performed using Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 25 (response rate: 83.3%) members responded, with the majority being fellowship-trained breast surgeons/surgical oncologists (68%) and having > 10 years’ experience (60%). For mastectomy without reconstruction, though most (76%) reported routine use of pre-operative AP, there was considerable variation in post-operative AP. 36% reported no further AP after a single dose of pre-operative AP, 24% continued AP for 24 hours in high-risk patients only, while 24% continued AP for 24 hours in all patients. 12% continued post-operative AP in all patients for 7 days, while 4% reported continuing post-operative AP for the duration of indwelling drains. Antibiotic choice for peri-operative AP also varied. 56% used cephalosporins, 24% used penicillin, and the remaining 20% reported that their choice varied across patients. Conclusions: There is widespread variation in surgeon comfort with discontinuation of AP after the first pre-operative dose in patients undergoing mastectomy without immediate reconstruction but with indwelling drains. Large randomized controlled trials are necessary to develop guidelines to ensure uniformity and evidence-based post-operative AP.

Complications following local anaesthetic transperineal prostate biopsies without antibiotic prophylaxis: An institution’s experience

Objectives: This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis. Patients and methods: A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB ( n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB ( n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records. Results: Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%. Conclusion: The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB. Level of evidence: Level 2b.

Antibiotic prophylaxis in gynecological surgery. A literature review

Gynecological surgical procedures are associated with significant morbidity, and a major impact on the quality of life. The antibiotic prophylaxis should minimize the risk of postoperative infections complications, preventing in the same time the adverse effects of long-term antibiotic usage. The aim of this paper is to detail the current recommendations for antibiotic prophylaxis in gynecological surgical procedures performed by open abdominal or laparoscopic approach. We have performed a review of the English language literature from the PubMed/Medline database using the following search details: (“Antibiotic Prophylaxis”[Mesh]) AND “Gynecologic Surgical Procedures”[Mesh]. We used the similar articles function to find additional secondary resources. Antibiotic prophylaxis should not be performed in elective laparoscopic gynecological procedures without the opening of the uterus or vagina. During hysterectomy for benign or malignant disease, the first dose of antibiotic prophylaxis should be infused one hour prior to skin incision, excepting Vancomycin and Fluoroquinolone that should be started two hours before. The antibiotic should be repeated if the duration of the surgery lasts more than two half-lives of the drug or the intraoperative bleeding is greater than 1500 mL. The antibiotic prophylaxis should be discontinued within the first 24 hours after surgery. Timely administration of adequate antibiotics and a meticulous surgical technique are mandatory for effectively decreasing the risk of postoperative infectious complications. Thorough adherence to international recommendations for antibiotic prophylaxis discontinuation within 24 hours should minimize the adverse events of antibiotic usage.

Reduction or discontinuation of antibiotic prophylaxis in vascular access surgery, tendon sheath incision and PD catheter placement.

Immune response in dialysis patients is suppressed and these patients are susceptible to bacterial infections. Therefore, minimal use of antibiotics in dialysis patients is recommended to avoid generating drug-resistant bacteria. However, minor surgeries including vascular access surgery, tendon sheath incision and peritoneal dialysis (PD) catheter placement are inevitable in dialysis patients and evidence-based recommendations on the judicious use of antibiotics are not currently available for these procedures. In this study, the optimal antibiotic prophylaxis for minor surgeries was evaluated. This is a retrospective study. In dialysis patients at Kawashima Hospital, a three-step reduction of antibiotic use was performed in 651 cases of arteriovenous fistula (AVF) and tendon sheath incision surgeries from July 2009 through October 2012. Moreover, general surgical guidelines-recommended dose of preoperative antibiotics only were used in 532 cases of arteriovenous graft (AVG) and PD catheter placement from January 2010 through October 2012. The surgical site was observed for 2 weeks after the surgery. In only one case of AVF surgery, redness of the skin around the stitches was noticed 5 days after the surgery, which was healed with antibiotics taken orally for 3 days. Neither AVG nor PD catheter placement demonstrated any infection at the surgical site during the 2-week observation period. Even in dialysis patients, neither pre- nor postoperative antibiotics are necessary for AVF and tendon sheath incision surgeries. AVG and PD catheter placement surgeries require only a small amount of antibiotics preoperatively.

Quality of Life in Children with Spina Bifida: A Cross-Sectional Evaluation of 102 Patients and their Parents

Background: In the so-called SPIN UTI study on 176 patients with spina bifida and clean intermittent cathererization (CIC) we have studied the influence of antibiotic prophylaxis (AP) on the number of yearly urinary tract infections (UTIs) and bacterial resistance to commonly used antibiotics. We have proven that stopping AP increased the number of yearly UTIs only slightly and clinically irrelevant patients would have to take AP for two years to prevent one extra non-febrile, non-scarring UTI, We have also shown that bacterial resistance improved over time when AP was stopped. In this article we study the influence of the recommended discontinuation of AP on Health Related Quality of Life (HRQL) in spina bifida. Methods: Participating children aged 4-16 years and their parents were asked to fill out the validated KINDL-R questionnaire, combined with specific spina bifida questions. Scores in study participants were compared with healthy controls. Also, the impact of AP, gender, level of spinal lesion, hydrocephalus, methods of catheterization and defecation, mobility and level of schooling on HRQL was evaluated. Results: One hundred and two of the 133 eligible children (77%) filled out the KINDL-R. Patients and their parents had significantly lower HRQL scores than healthy controls (p<0.001). Parents had significantly lower scores than their children, especially in the psychological domains. Severity of co-morbidity was not associated with differences in HRQL. There were no differences between children who continued and stopped AP. Conclusions: HRQL scores are lower in spina bifida patients compared to healthy children. Parents have even lower scores, especially in the psychological domains. Stopping antibiotic prophylaxis does not adversely affect HRQL, and should therefore be pursued to improve bacterial resistance patterns in spina bifida patients.

Efficiency and Effectiveness of Using Nonmedical Staff During an Urgent Mass Prophylaxis Response

Using a simulated anthrax scenario, the Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to its internal population. This closed POD had developed and exercised its mass prophylaxis plan in conjunction with the local health department twice before, and the department was interested in assessing the impact of having no onsite department involvement. Two sessions were conducted as part of the overall exercise. In session 1, agency staff ran POD operations with no department involvement. During session 2, department staff provided an hour-long training session and oversaw POD operations. Mean throughput and accuracy rates of the 2 sessions were then compared to a previous health department public POD exercise staffed by department personnel and medical volunteers. The closed POD would be able to process the entire internal population in an estimated mean time of 23.9 hours. The accuracy rates for dispensing the correct medication during session 1 was 84.7% and 92.4% during session 2 (p=0.0012). Overall accuracy was significantly higher in a previous local health department public POD exercise (88.6% vs. 96.9%, p < 0.0001), as was pediatric dosing accuracy (p < 0.0001). We concluded that nonmedical closed PODs are a valuable strategy during a public health emergency that requires large segments of a population to receive medication rapidly. They must be activated judiciously, however, as their use may increase adverse events and potentially result in discontinuation of antibiotic prophylaxis should people choose not to finish the course. Local health department training and oversight reduce errors but may not always be available.