Duration Of Antibiotic Prophylaxis Research Articles

Perioperative antibiotic prophylaxis in implant breast reconstruction

Implant infection is the most common and serious complication in implant-based breast reconstruction. To prevent infection, many surgeons have adopted a perioperative antibiotic prophylaxis regimen for managing patients. However, there has been considerable debate regarding the duration of antibiotic prophylaxis. After reading this article, plastic surgeons should manage their patients with an understanding of the evidence supporting perioperative antibiotic prophylaxis.

Perioperative Antibiotic Prophylaxis Duration in Patients Undergoing Cystectomy With Urinary Diversion

Perioperative antibiotic prophylaxis (PAP) reduces the incidence of surgical site infections (SSIs). Guidelines recommend 24 hours or less of PAP for cystectomy with urinary diversion; however, evidence specifying optimal PAP duration for this surgery is lacking, and prolonged administration of PAP is common practice. To establish noninferiority of 24-hour PAP vs extended-duration PAP in preventing SSIs within 90 days after cystectomy with urinary diversion. This single-center, noninferiority randomized clinical trial was performed from April 18, 2018, to August 18, 2022, in patients aged older than 18 years undergoing elective open cystectomy with urinary diversion. Exclusion criteria were contraindications to administered drugs and inability to follow study procedures. PAP administered for 24 hours (24-hour PAP group) vs PAP until all catheters and stents were removed (extended PAP group). The primary end point was the rate of SSI, and the secondary end points included all-cause mortality, both within 90 days after surgery. Noninferiority of the 24-hour PAP treatment was assessed by comparing the 90% CI (corresponding to a significance level of α = .05) with the predefined noninferiority margin of 10%. A total of 95 patients were randomly assigned to the 24-hour PAP group (median [IQR] age, 69.3 [63.1-76.8] years; 66 males [69.5%]) and 98 to the extended PAP group (median [IQR] age, 69.5 [60.8-75.5] years; 68 males [69.4%]). Patients in the 24-hour PAP group received PAP for a median of 1 day (IQR, 1-1 day), and patients in the extended PAP group received PAP for a median of 8 days (IQR, 7-10 days). No significant differences in SSIs occurring within 90 days were found (24-hour PAP group, 8 patients [8.4%]; extended PAP group, 12 patients [12.2%]; P = .53). The risk difference for 90-day cumulative SSI incidence was -3.8% (90% CI, -11.1% to 3.4%), establishing noninferiority of 24-hour PAP vs extended PAP to prevent SSI. Mortality was not significantly different between groups. The findings of this randomized clinical trial demonstrate noninferiority of 24-hour PAP vs extended-duration PAP in preventing SSIs within 90 days after cystectomy with urinary diversion and may contribute to antibiotic stewardship efforts in urology. ClinicalTrials.gov Identifier: NCT03305627.

Antibiotic prophylaxis practice in gastrointestinal surgery in five hospitals in southern Benin

BackgroundBenin’s healthcare system is characterized by a lack of local guidelines for surgical antibiotic prophylaxis (SAP), which is essential to prevent surgical site infection. AimTo audit compliance for SAP practices in gastrointestinal surgery. MethodsData were prospectively collected from gastrointestinal surgery departments in five hospitals. Over a four month period, SAP was assessed using five conventional criteria (indication, choice of antibiotic, dosage, timing, and duration of administration) among patients admitted for Altemeier class 1 or 2 procedures. Three guidelines were used as reference: World Health Organization (WHO), American Society of Health-System Pharmacists (ASHP)and French Society of Anaesthesia and Intensive Care Medicine (SFAR). FindingsOf 68 surgical interventions, overall compliance with WHO, ASHP, and SFAR was observed in zero (0.0%), one case (1.5%) and two cases (2.9%), respectively. Compliance with indication varied according to the guidelines: 65 (95.6%) were compliant with WHO and ASHP and 47 cases (69.11%) with SFAR. Among compliant cases, the antibiotics administered were rarely selected according to guidelines: WHO, 2 (2.9%) and ASHP, 2 (2.9%), and SFAR, 3 (4.4%). Drug dosage compliance varied from 20 (29.4%) (SFAR) to 49 (72.0%) (ASHP). Timings were respected in 47 (69.1%; WHO), 45 (66.2%; ASHP) and 9 cases (13.2%; SFAR). The number of cases compliant with antibiotic prophylaxis duration were 13 (19.1%; WHO), 17 (25.0%; ASHP) and 16 (23.5%; SFAR). ConclusionThe SAP compliance rate in gastrointestinal surgery based on the five conventional criteria was very low. SAP guidelines must be implemented appropriately for local bacteriological epidemiology.

Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting.

Surgical site infection (SSI), albeit infrequent, drastically impacts the quality of care. This article endeavors to investigate the predictive factors of SSIs following surgical interventions that involve the gastrointestinal (GI) tract within a single institution in a resource-limited setting. Over seven years from June 2015 to June 2022, patients who underwent GI surgery and developed SSI were retrospectively matched with an unaffected case-control cohort of patients. Standardized techniques for wound culture, laboratory evaluation of bacterial isolates, and antibiotic susceptibility tests were employed. Logistic regression analysis was utilized to investigate the predictive factors associated with 30-day postoperative SSI occurrence. A total of 525 patients who underwent GI surgical procedures were included, among whom, 86 (16.4%) developed SSI and the majority of SSIs were superficial (74.4%). Escherichia coli was the most commonly isolated bacterium (54.4%), and a high percentage of multidrug-resistant organisms were observed (63.8%). In multivariate Cox regression analysis, illiteracy (Odds ratio [OR]:40.31; 95% confidence interval [CI]: 9.54-170.26), smoking (OR: 21.15; 95% CI: 4.63-96.67), diabetes (OR: 5.07; 95% CI: 2.27-11.35), leukocytosis (OR: 2.62; 95% CI: 1.24-5.53), hypoalbuminemia (OR: 3.70; 95% CI: 1.35-10.16), contaminated and dirty wounds (OR: 6.51; 95% CI:1.62-26.09), longer operation duration (OR: 1.02; 95% CI: 1.01-1.03), emergency operations (OR: 12.58; 95% CI: 2.91-54.30), and extending antibiotic prophylaxis duration (OR: 3.01; 95% CI: 1.28-7.10) were the independent risk factors for SSI (all p < 0.05). This study highlights significant predictors of SSI, including illiteracy, smoking, diabetes, leukocytosis, hypoalbuminemia, contaminated and dirty wounds, longer operative time, emergency operations, and extending antibiotic prophylaxis duration. Identifying these risk factors can help surgeons adopt appropriate measures to reduce postoperative SSI and improve the quality of surgical care, especially in a resource-limited setting with no obvious and strict policy for reducing SSI.

Membrane stripping in group B streptococcus carriers does not impede adequate intrapartum antibiotic prophylaxis: a retrospective study.

Membrane stripping in group B streptococcus (GBS) carriers poses an increased risk of inadequate antibiotic prophylaxis, potentially due to accelerated labor, thereby potentially impacting the management of GBS colonization during delivery. We compared the adequacy of intrapartum antibiotic prophylaxis between pregnant women colonized with GBS, who underwent membrane stripping and those who did not. The study aimed to determine whether the performance of membrane stripping, by potentially shortening labor duration, increases the risk of inadequate antibiotic prophylaxis dispensation. A retrospective cohort study was conducted on GBS screen-positive women with a full-term singleton pregnancy in cephalic presentation, who were eligible for vaginal delivery. The exposed group consisted of women who underwent membrane stripping, while the unexposed group consisted of women who did not undergo membrane stripping. The primary outcome was defined as inadequate duration of antibiotic prophylaxis during labor, wherein less than 4 h of beta-lactam antibiotics were administered prior to delivery. Neonatal outcome was compared between the groups. This retrospective cohort study comprised 1,609 women, with 129 in the exposed group (stripping group) and 1,480 in the unexposed group (no stripping group). Adequate intrapartum antibiotic prophylaxis was received by 64.3% (83/129) of the exposed group, compared to 46.9% (694/1,480) of the unexposed group (p = 0.003). Membrane stripping was associated with increased odds of receiving adequate prophylaxis (OR 1.897, 95% CI 1.185-3.037, p = 0.008). After excluding women who presented to the labor ward in active labor and delivered in less than 4 h, both the exposed and unexposed groups had similarly high rates of adequate intrapartum antibiotic prophylaxis (87.5% vs. 85.8%, respectively). No significant difference was observed in adverse neonatal outcomes between the groups. The provision of membrane stripping did not impede adequate intrapartum antibiotic prophylaxis and was correlated with a higher rate of sufficient prophylaxis in comparison to non-swept patients. These observations suggest that membrane stripping can be considered a safe option for ensuring adequate antibiotic prophylaxis in women colonized with GBS.

Perioperative antibiotic prophylaxis in the setting of cochlear implantation: a retrospective analysis of 700 cases

PurposePostoperative wound infections after cochlear implantation are rare but sometimes serious and can lead to explantation. Therefore, perioperative antibiotic administration is often recommended. However, in clinical practice, the type and duration of antibiotic prophylaxis varies between different centers. The aim of this study was to investigate the role of perioperative antibiotic prophylaxis in preventing postoperative complications.Methods700 patients who underwent cochlear implantation between 2007 and 2019 were retrospectively evaluated with regard to wound infections within the first 28 postoperative days. These were classified into major and minor complications. Data were analyzed using the IBM statistical program SPSS.ResultsIn 670 out of 700 patients the type and duration of perioperative antibiotic administration could be reconstructed from the records. Of these 67 patients (10%) received antibiotics as a single shot, 158 patients (23.6%) were treated with antibiotics for a period of 48 h, and 445 patients (66.4%) received prolonged antibiotic therapy for more than 72 h. In total 64 patients (9.5%) showed abnormalities in wound assessment within the first 28 postoperative days after implantation. Major infections (1.6%) were detected in 11 patients. Overall, there was no statistically significant difference in wound infection rates between the group receiving single-shot antibiosis and the group receiving 48 h prophylaxis or antibiotic treatment > 72 h (p = 0.46).ConclusionPatients receiving an antibiotic single shot do not appear to be at significantly increased risk for postoperative wound infections compared with patients with prolonged antibiotic treatment. Continuation of data collection across centers seems reasonable.

Antibiotics for UTI Prevention After Intradetrusor OnabotulinumtoxinA Injections.

Urinary tract infections (UTIs) occur in 8.6% to 48.1% of patients after intradetrusor onabotulinumtoxinA injections. The objective of this study was to evaluate both choice and duration of antibiotic prophylaxis on the incidence of UTI within 30 days after in-office onabotulinumtoxinA injections. We included a single-site, retrospective cohort of 305 patients with overactive bladder or bladder pain syndrome receiving postprocedure prophylactic antibiotics for in-office, 100-unit intradetrusor onabotulinumtoxinA injections from 2019 to 2023. Categories of antibiotic prophylaxis compared included (1) nitrofurantoin 100 mg twice daily for 3 days, (2) nitrofurantoin 100 mg twice daily for 5 days, (3) trimethoprim-sulfamethoxazole 160 mg/800 mg twice daily for 3 days, and (4) "other regimens." Primary outcome was incidence of UTI within 30 days. Variables were compared via χ2 test. Crude/adjusted odds were estimated using binary logistic regression. Incidence of UTI was 10.4% for 3-day nitrofurantoin, 20.5% for 5-day nitrofurantoin, 7.4% for 3-day trimethoprim-sulfamethoxazole, and 25.7% among "other regimens" (P = 0.023). Differences among primary regimens were substantial but not statistically significant: 3-day trimethoprim-sulfamethoxazole had 31% lower odds of UTI versus 3-day nitrofurantoin (odds ratio [OR], 0.689; P = 0.518). Compared with 3-day nitrofurantoin regimen, the 5-day nitrofurantoin regimen had twice the odds of UTI (OR, 2.22; P = 0.088). Those receiving "other regimens" had nearly 3 times the odds of UTI (OR, 2.98; P = 0.018). Results were similar adjusting for age and race. Overall urinary retention rate was 1.97%. Prophylactic antibiotic choice and duration of treatment potentially affect UTI incidence after in-office, intradetrusor onabotulinumtoxinA injections. Nitrofurantoin and trimethoprim-sulfamethoxazole for 3 days have the lowest UTI incidence.

Effect of Perioperative Prophylactic Intravenous Antibiotic Use in Immediate Implant-Based Breast Reconstruction: A Retrospective Matched Cohort Study.

Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection ( p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.

Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting

Background Surgical site infection (SSI), albeit infrequent, drastically impacts the quality of care. This article endeavors to investigate the predictive factors of SSIs following surgical interventions that involve the gastrointestinal (GI) tract within a single institution in a resource-limited setting. Methods Over seven years from June 2015 to June 2022, patients who underwent GI surgery and developed SSI were retrospectively matched with an unaffected case-control cohort of patients. Standardized techniques for wound culture, laboratory evaluation of bacterial isolates, and antibiotic susceptibility tests were employed. Logistic regression analysis was utilized to investigate the predictive factors associated with 30-day postoperative SSI occurrence. Results A total of 525 patients who underwent GI surgical procedures were included, among whom, 86 (16.4%) developed SSI and the majority of SSIs were superficial (74.4%). Escherichia coli was the most commonly isolated bacterium (54.4%), and a high percentage of multidrug-resistant organisms were observed (63.8%). In multivariate Cox regression analysis, illiteracy (Odds ratio [OR]:40.31; 95% confidence interval [CI]: 9.54-170.26), smoking (OR: 21.15; 95% CI: 4.63-96.67), diabetes (OR: 5.07; 95% CI: 2.27-11.35), leukocytosis (OR: 2.62; 95% CI: 1.24-5.53), hypoalbuminemia (OR: 3.70; 95% CI: 1.35-10.16), contaminated and dirty wounds (OR: 6.51; 95% CI:1.62-26.09), longer operation duration (OR: 1.02; 95% CI: 1.01-1.03), emergency operations (OR: 12.58; 95% CI: 2.91-54.30), and extending antibiotic prophylaxis duration (OR: 3.01; 95% CI: 1.28-7.10) were the independent risk factors for SSI (all p &lt; 0.05). Conclusions This study highlights significant predictors of SSI, including illiteracy, smoking, diabetes, leukocytosis, hypoalbuminemia, contaminated and dirty wounds, longer operative time, emergency operations, and extending antibiotic prophylaxis duration. Identifying these risk factors can help surgeons adopt appropriate measures to reduce postoperative SSI and improve the quality of surgical care, especially in a resource-limited setting with no obvious and strict policy for reducing SSI.

FACTORS CONTRIBUTING TO THE RISK OF SURGICAL SITE INFECTION AND SEPSIS FOLLOWING RECONSTRUCTIVE FLAP SURGERY

Introduction: Reconstructive flap surgery, vital for addressing defects in diverse body regions, is employed in post-cancer and traumatic wound reconstruction, yielding favorable outcomes. While minor complications are well-documented, systemic complications, particularly sepsis, remain underexplored. This systematic review fills the gap by investigating sepsis incidence and associated risk factors in reconstructive flap surgery, aiming to enhance understanding, prevent complications, and improve patient care. Method: The researchers in this study followed the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to ensure that their work met the required standards. This was done to ensure the precision and reliability of the conclusions derived from the research. Result: Our search produced 14 results. After looking at the titles and summaries, we found several papers that fit our criteria. At first, we excluded few articles because they were written in review and case report style. But after reading the full papers carefully, we included five papers in our final analysis. These papers included retrospective review study and retrospective studies. Conclusion: Postoperative sepsis and surgical site infections (SSIs) are significant challenges in reconstructive flap surgery, with a 2.1% sepsis incidence and identified risk factors including comorbidities, BMI, and ASA Score. Sepsis elevates 30-day mortality risk almost fivefold, emphasizing the need for preventive measures. Our study underscores the impact equivalence of SSIs and Major Postoperative Infections (MPIs) and recommends a 72-hour antibiotic prophylaxis duration in head and neck free flap surgery. Notably, preoperative recipient site infection in lower extremity tissue transfer influences graft outcomes, and longer operating time consistently predicts SSIs, necessitating strategic planning and comprehensive comorbidity management. Prospective studies are crucial for refining predictors and optimizing patient care in reconstructive flap surgery.

A feasibility survey to inform trial design investigating surgical site infection prevention in vascular surgery

Introduction: Current surgical site infection (SSI) prevention guidance indicates low-quality evidence supporting many of their recommendations. Subsequently, there is substantial variation in practice and often implementation of unsubstantiated interventions. There is therefore a need to rapidly evaluate best practices to prevent SSI. This survey aimed to evaluate current practice in the prevention of SSI and equipoise regarding potential interventions to reduce SSI rates in major lower limb amputation (MLLA) and groin incisions. Methods: A cross-sectional national survey was developed from current international guidelines to prevent SSI, following CHERRIES and CROSS checklists. A study steering committee directed internal validation prior to dissemination via single stage sampling of the membership of the Vascular Society of Great Britain and Ireland. Results: The survey received 58 responses from clinicians across 38 NHS trusts. Most respondents were consultant vascular surgeons (91%; 53/58). Preoperatively, there was variable practice in the use of preoperative bathing, surgical site preparation, antibiotic prophylaxis duration and the use of incise drapes for both MLLA and groin incisions. Intraoperatively there was little consensus for wound irrigation, drain insertion, changing gloves and instruments prior to skin closure, skin closure technique, and the use of dressings for both MLLA and groin incisions. The majority of respondents were willing to randomise patients to most interventions. Nearly three-quarters (72%; 42/58) of respondents agreed or strongly agreed that a combined outcome measure of SSI and wound dehiscence would be the ideal primary outcome in a trial investigating SSI prevention in MLLA. Conclusions: Despite significant heterogeneity in practice to prevent SSI, the majority of surgeons surveyed showed they would be willing to randomise to interventions in a randomised controlled trial. This key finding is important in the design of future studies.

1459. Association of Antibiotic Prophylaxis Duration and Length of Stay in Patients Undergoing Coronary Artery Bypass Graft Procedure

Abstract Background Antibiotic prophylaxis in surgery is a standard measure to reduce the risk of microbial contamination following an incision. For most surgeries, a single dose of antibiotics is generally required. However, in patients undergoing coronary artery bypass graft (CABG) procedure, antibiotics have been administered for ≥ 24 hours as data on the optimal duration is not sufficient. We aimed to correlate the duration of antibiotic prophylaxis in patients undergoing CABG with length of hospital stay (LOS). Methods We conducted a retrospective cohort study comparing LOS of patients undergoing CABG who received antibiotic prophylaxis for ≥ 24 hours (extended course group) and those who received it for &amp;lt; 24 hours (short course group). Inclusion criteria were adults who had undergone CABG between 01/09/2015 –01/03/2019 in a cardiology and cardiothoracic surgery hospital. Exclusion criteria were immunocompromised patients, in-hospital mortality and patients with a pre-existing infection. The primary outcome was LOS and we also explored other variables that may predict LOS. Effects were adjusted for confounders using a multivariate linear regression model. Results A total of 855 patients were identified. After exclusion, 840 were included in the analysis of which 425 (50.6%) received antibiotics for ≥ 24 hours and 415 (49.4%) received them for &amp;lt; 24 hours. The median LOS was 12.2 [IQR 11.0] days in the extended course group and 8.4 [IQR 8.8] days in the short course group, with a difference of 3.8 days (95% CI: 1.8-5.7), p-value &amp;lt; 0.001. However, after adjusting for potential confounders the difference was no longer significant, 1.7 days (95% CI: -0.23-3.7), p-value 0.083. Independent predictors of length of stay were, male gender, presence of chronic kidney disease, American Society of Anesthesiologists class, priority of the surgery and history of infection in the last 90 days. Conclusion There is no statistically significant difference in LOS between short and extended antibiotic prophylaxis course in patients undergoing CABG procedure. Future work should explore the cost-effectiveness of short versus extended course antibiotic prophylaxis. Disclosures All Authors: No reported disclosures

Lumbar fusion through the anterolateral mini-approach: comparison of anterior interbody (OLIF-AF) and percutaneous pedicle (OLIF-PF) fixations in the surgical treatment of single-level stenosis

Objective. To perform comparative analysis of the clinical efficacy and safety of indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach (OLIF) with anterolateral (OLIF-AF) and posterior percutaneous (OLIF-PF) screw fixations in the surgical treatment of single-segment lumbar stenosis.Material and Methods. A retrospective comparative analysis of treatment of 88 patients aged 29 to 72 years with single-level lumbar stenosis was carried out. Posterior instrumental fixation (OLIF-PF) was performed in 60 cases, and anterolateral (OLIF-AF) – in 28.Results. The compared groups did not statistically significantly differ from each other in terms of age, gender, body mass index, clinical picture and duration of symptoms before surgery, assessment of neurological status according to the Zurich Claudication Questionnaire (ZCQ), preoperative diagnosis, localization of stenosis, pain assessment in the back and leg before surgery according to a digital rating scale, physical status (ASA), health assessment (SF-12, ODI), follow-up period, as well as smoking and the presence of comorbidities (p &gt; 0.05). In the OLIF-AF group, compared to the OLIF-PF group, a statistically significant advantage was found in terms of blood loss, duration of surgery and anesthesia, the level of radiological exposure, duration of patient’s hospitalization and hospital stay in the postoperative period, as well as the duration of antibiotic prophylaxis and intraoperative volume of infusions (p &lt; 0.05). Despite earlier discharge and less use of local anesthesia (35.7 % vs 73.3 %; p = 0.001), patients in the OLIF-AF group had statistically significantly lower level of back pain on the day of discharge (3.0 vs 3.5; p = 0.034) and were less likely to need opioids (3.6 % vs 31.7 %; p = 0.003). With regard to complications and adverse events, there were no statistically significant differences during dynamic follow-up period from 3 to 50 months in both groups (17.9 % vs 28.3 %; p = 0.290), including depending on the timing of complications (early or late). In addition, no statistically significant differences were found for neurological, infectious, gastrointestinal, urological, or implant-related complications (p &gt; 0.05).Conclusions. Indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach in combination with OLIF-AF is an effective and safe technique for the surgical treatment of single-segment lumbar stenosis. This method allows to reduce the invasiveness of surgery and severity of the pain syndrome and to create conditions for enhanced recovery after surgery. Further multicenter randomized trials are needed to comprehensively evaluate long-term outcomes.

Prospective Randomized Trial of Antibiotic Prophylaxis Duration for Percutaneous Nephrolithotomy in Low-Risk Patients.

Introduction and Objective: Postoperative infection and sepsis account for the most common complications following percutaneous nephrolithotomy (PCNL), as high as 14% in low-risk patients. Although the American Urological Association (AUA) recommends perioperative antibiotics for 24 hours or less for PCNL, practice patterns vary regarding duration of antibiotic therapy. We aimed to compare the efficacy of 24-hour antibiotic coverage vs short-course protocol of antibiotic prophylaxis for PCNL. Materials and Methods: Low-risk patients with a sterile preoperative urine culture undergoing PCNL were prospectively randomized to antibiotics for up to 24 hours after procedure (24Hr) or continued until external urinary catheters were removed (CR) study groups. Patients were given a first generation cephalosporin, or ciprofloxacin in patients with penicillin allergy. Exclusion criteria included age <18 years, receiving antibiotics immediately before the procedure, history of urosepsis, presence of indwelling catheter >1 week, multistage procedure, immunosuppression, pregnancy, multiple antibiotic allergies, and patients who are breastfeeding. Results: Ninety-eight patients were randomized to either 24Hr (n = 49) or CR (n = 49). Mean duration of antibiotic administration was 20.6 and 34.0 hours in the 24Hr and CR groups (p = 0.04), respectively. Age, comorbidities, stone size, operative time, number of punctures, dilations, and proportion of "tubeless" procedures were similar between groups. There were no differences in febrile episodes, rates of systemic inflammatory response syndrome, bacteremia, or culture-proven postoperative urinary tract infection between the 24Hr and CR groups. Overall complication rates were similar between groups. In a subgroup analysis which excluded "tubeless" patients (24 and 29 patients in 24Hr and CR groups, respectively), no differences were seen in postoperative outcomes. Conclusions: In a randomized, prospective study, we found that a 24-hour protocol for antibiotic prophylaxis is not associated with increased risk of infection-related events compared to giving antibiotics until external catheters are removed in patients with low infectious risk undergoing PCNL. Clinicaltrials.gov: NCT02579161.

Prolonged antibiotic prophylaxis after pancreatoduodenectomy: systematic review and meta-analysis.

Previous studies have reported conflicting results of prolonged antibiotic prophylaxis on infectious complications after pancreatoduodenectomy. This study evaluated the effect of prolonged antibiotics on surgical-site infections (SSIs) after pancreatoduodenectomy. A systematic review and meta-analysis was undertaken of SSIs in patients with perioperative (within 24 h) versus prolonged antibiotic (over 24 h) prophylaxis after pancreatoduodenectomy. SSIs were classified as organ/space infections or superficial SSI within 30 days after surgery. ORs were calculated using a Mantel-Haenszel fixed-effect model. Ten studies were included in the qualitative analysis, of which 8 reporting on 1170 patients were included in the quantitative analysis. The duration of prolonged antibiotic prophylaxis varied between 2 and 10 days after surgery. Four studies reporting on 782 patients showed comparable organ/space infection rates in patients receiving perioperative and prolonged antibiotics (OR 1.35, 95 per cent c.i. 0.94 to 1.93). However, among patients with preoperative biliary drainage (5 studies reporting on 577 patients), organ/space infection rates were lower with prolonged compared with perioperative antibiotics (OR 2.09, 1.43 to 3.07). Three studies (633 patients) demonstrated comparable superficial SSI rates between patients receiving perioperative versus prolonged prophylaxis (OR 1.54, 0.97 to 2.44), as well as in patients with preoperative biliary drainage in 4 studies reporting on 431 patients (OR 1.60, 0.89 to 2.88). Prolonged antibiotic prophylaxis is associated with fewer organ/space infection in patients who undergo preoperative biliary drainage. However, the optimal duration of antibiotic prophylaxis after pancreatoduodenectomy remains to be determined and warrants confirmation in an RCT.

Identification of predictive factors for surgical site infections in gastrointestinal surgeries: A retrospective cross-sectional study in a resource-limited setting

Background: Surgical site infection (SSI), albeit infrequent, drastically impact the quality of care. This article endeavors to investigate the predictive factors of SSIs following surgical interventions that involve the gastrointestinal (GI) tract within a single institution in a resource-limited setting. Methods: Over seven years from June 2015 to Oct 2022, patients who underwent GI surgery and developed SSI were retrospectively matched with an unaffected case-control cohort of patients. Standardized techniques for wound culture, laboratory evaluation of bacterial isolates, and antibiotic susceptibility tests were employed. Logistic regression analysis was utilized to investigate the predictive factors associated with 30-day postoperative SSI. Results: A total of 525 patients who underwent GI surgical procedures were included, among whom, 79 (15%) developed SSI. The majority of SSIs were superficial (67.10%), Escherichia coli was the most commonly isolated bacterium (54.4%), and a high percentage of multidrug-resistant organisms were observed (63.8%). In multivariate Cox regression analysis, illiteracy (Odds ratio [OR]:40.31; 95% confidence interval [CI]: 9.54-170.26), smoking (OR: 21.15; 95% CI: 4.63-96.67), diabetes (OR: 5.07; 95% CI: 2.27-11.35), leukocytosis (OR: 2.62; 95% CI: 1.24-5.53), hypoalbuminemia (OR: 3.70; 95% CI: 1.35-10.16), contaminated and dirty wounds (OR: 6.51; 95% CI:1.62-26.09), longer operative time (OR: 1.02; 95% CI: 1.01-1.03), emergency operations (OR: 12.58; 95% CI: 2.91-54.30), and extending antibiotic prophylaxis duration (OR: 3.01; 95% CI: 1.28-7.10) were the independent risk factors for SSI (all p &lt; 0.05). Conclusions: This study highlights significant predictors of SSI, including illiteracy, smoking, diabetes, leukocytosis, hypoalbuminemia, contaminated and dirty wounds, longer operative time, emergency operations, and extending antibiotic prophylaxis duration. Identifying these risk factors can help surgeons adopt appropriate measures to reduce postoperative SSI and improve the quality of surgical care, especially in a resource-limited setting with no obvious and strict policy for reducing SSI.

AB015. SOH23ABS_169. Surgical prophylactic antibiotics: compliance with local and AMRIC guidelines

Background: Antimicrobial prophylaxis is a critical step in preventing surgical site infection. The Antimicrobial Resistance and Infection Control committee (AMRIC) position statement summarises current guidelines on the maximum recommended duration of antibiotic prophylaxis for each surgical speciality. Our aim is to audit the use of prophylactic antibiotics by the breast surgery unit at one teaching hospital in Ireland against local and AMRIC guidelines.

MP32-06 EARLY STENT REMOVAL AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP32-06 EARLY STENT REMOVAL AFTER RADICAL CYSTECTOMY Jessica Wenzel, Solange Bassale, Paul Jones, Eric Robinson, Sudhir Isharwal, Christopher Amling, Kamran Sajadi, and Jen Jane Liu Jessica WenzelJessica Wenzel More articles by this author , Solange BassaleSolange Bassale More articles by this author , Paul JonesPaul Jones More articles by this author , Eric RobinsonEric Robinson More articles by this author , Sudhir IsharwalSudhir Isharwal More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Kamran SajadiKamran Sajadi More articles by this author , and Jen Jane LiuJen Jane Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extended antibiotic prophylaxis after radical cystectomy (RC) reduces urinary tract infections (UTI) and urosepsis. Optimal duration of prophylaxis remains unknown as ureteral stents are associated with an increased risk of UTI. Similarly, the optimal duration and benefit of ureteral stents is unknown, with trends toward removing stents earlier or foregoing them altogether. Our protocol after RC previously consisted of ureteral stent duration of at least 14 days and 30 days of antibiotic prophylaxis postoperatively. To reduce stent duration and antibiotic exposure, we changed our protocol in 2020 to remove stents prior to discharge and stop antibiotic prophylaxis earlier (14d). We assessed rates of UTI and urine leak in our cohort of patients undergoing RC during this change. METHODS: We performed a retrospective chart review of all patients who underwent radical cystectomy for bladder cancer at our institution between 2016-2022(OHSU IRB approved). Patients were stratified into early or late stent removal ( <14 or >14 days post-operatively). The primary outcomes were incidence of UTI (defined as positive urine culture requiring antibiotic treatment) and urine leak, as measured by postoperative drain creatinine measurement greater than twice serum creatinine Statisical analysis was performed using Wilcoxon test and chi-square analysis. RESULTS: Of 221 patients with evaluable data, 33% of patients had early and 67% had late stent removal. Mean day of stent removal was 8.0 versus 19.9 in the early versus late group. Antibiotic exposure was lower in the early stent removal group (10 vs 21 days, p≤0.05). There was no difference in rate of postoperative UTI when comparing early versus late stent removal (10.8% vs 10.2%, p=0.9). Similarly, there was no difference in rate of urine leak when comparing early versus late stent removal (0% vs 1.3%, p=0.31). Readmission rates were similar for early versus late stent removal (7 vs 12%, p=0.3). CONCLUSIONS: Earlier stent removal and reduced duration of antibiotic prophylaxis after RC does not result in an increased rate of UTI or urine leak. Decreasing ureteral stent duration reduces postoperative antibiotic exposure without increasing adverse outcomes in patients undergoing RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e442 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Wenzel More articles by this author Solange Bassale More articles by this author Paul Jones More articles by this author Eric Robinson More articles by this author Sudhir Isharwal More articles by this author Christopher Amling More articles by this author Kamran Sajadi More articles by this author Jen Jane Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P2-07-02: Effects of different duration of prophylactic antibiotic use on unplanned reoperation in breast cancer patients undergoing implant-based breast reconstruction: A retrospective study with overlap weighting analysis

Abstract Background: Some special consensus recommended the duration of perioperative antibiotic prophylaxis was within 24 hours postoperatively in breast cancer undergoing postmastectomy implant breast reconstruction. However, surgeons in practice favored to prolong the duration. The aim of this study was to estimate the effects of duration of antibiotics on major adverse outcomes in real clinical practice setting with diverse population using overlap weighting model. Methods: In this retrospective study, patients with breast cancer undergoing breast implant reconstructions were collected in Fudan University Shanghai Cancer Center from 1 January 2008 to 31 December 2021. Cases were divided into two groups according to the duration of perioperative antibiotic prophylaxis: short-term group (≤ 24 hours) and long-term group (&amp;gt;24 and≤48 hours). The primary outcomes were unplanned reoperations and complication-related unplanned reoperations. Unplanned reoperation was defined as debridement, expander removal without prosthesis implantation, expander removal and expander implantation, prosthesis removal and prosthesis implantation, prosthesis removal, prosthesis removal and expander implantation. By reviewing the patients’ detailed medical history, all unplanned reoperations were divided into non-complication-related unplanned reoperations and complication-related unplanned reoperations. Non-complication-related unplanned reoperations included: patients voluntarily gave up continuing reconstruction, suspected recurrence of cancer, changed reconstruction methods, unsatisfactory appearance, and unknown reasons. Complication-related unplanned reoperations included: infection, exposure of prosthesis or expander, poor wound healing, rupture of expander, necrosis of skin flap, bleeding. The secondary outcomes were infections that required intervention. It was defined as both met with white blood cells elevation and physician antibiotic prescription during outpatient follow-up. To adjust confounders, propensity score overlap weighting was used, and subgroup analysis and sensitive test were conducted to demonstrate the robustness of results. A P value less than 0.05 was considered statistically significant. Results: In 4367 cases of unilateral implant reconstructions, 4128 (95%) were included in this study. Among them, 1689 were expander implantation, 1124 were prosthesis implantation and 1315 were expander removal and prosthetic implantation. At inclusion, only 283 cases (6.9%) received antibiotics prophylaxis ≤24 hours, 3090 cases (74.9%) with duration &amp;gt;24 and≤48 hours, and 755 cases (18.3%) with duration &amp;gt;48 hours. Of them, 230 cases (5.6%) underwent unplanned reoperation, including 131 (3.2%) complication-related unplanned reoperations, and 99 (2.4%) non-complication-related unplanned reoperations. And there were 110 cases (2.7%) with infections that required intervention. In unweighted or weighted data set, short-term antibiotic use did not significantly increase the risk of adverse outcomes, including unplanned reoperation, complication-related unplanned reoperation, and infection required intervention, compared with long-term antibiotic use with or without patients with duration more than 48 hours. Most subgroup analysis showed no evidence of heterogeneity of the effects of duration of antibiotic use on adverse outcomes. Conclusion: In clinical setting with diverse population, prolong antibiotic prophylaxis with more than 24 hours is not necessary to reduce major adverse outcomes, even in some critical conditions. Appropriating and accessible prophylactic initiatives should be developed and implemented with shorten the duration of antibiotic prophylaxis and minimized adverse outcomes. Key words: perioperative antibiotic prophylaxis, breast cancer, postmastectomy implant reconstruction, unplanned reoperation Citation Format: Zeqing Li, Jiajian Chen, Shuang Hao, A-Yong Cao, Xiaoyan Huang, Zhiming Shao, Jiong Wu. Effects of different duration of prophylactic antibiotic use on unplanned reoperation in breast cancer patients undergoing implant-based breast reconstruction: A retrospective study with overlap weighting analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-07-02.

Duration of Antibiotic Prophylaxis for Ballistic Fractures to the Extremities.

In the U.S. there are thousands of ballistic firearm injuries to the extremities and subsequent infections, yearly. There is a lack of consensus regarding the ideal duration of antibiotic treatment to prevent infection of these wounds. Our study investigated infection rate among ballistic extremity fracture patients based on antibiotic prophylaxis duration, operative management, wound severity, and fracture location. Retrospective chart review of ballistic extremity fracture patients from a single trauma center from 01/01/2010 to 12/31/2020. Of 1611 fracture cases screened, 193 met our inclusion criteria. Infection rate was significantly higher among patients who received antibiotic prophylaxis for ≥48hours (19.4%) compared to those who received antibiotics for <48 hours (4.4%) (Chi2 = 9.89, P = .001). This trend continued among patients who underwent operative management (P < .001), patients with articular ballistic fractures (P = .014), patients with non-articular ballistic fractures (P = .03), and patients with ballistic fractures to the lower extremities (P = .003). There was no difference in the rate of infection between patients who received ≥48hours or <48hours of antibiotic prophylaxis among patients with Gustilo-Anderson grade I, grade II, or grade III injuries, patients with ballistic fracture to the upper extremities, and patients who did not undergo operative management. Across all analyses in the present study, there was not a single correlation between antibiotic prophylaxis duration for ≥48hours and lower rates of subsequent infection. For patients with ballistic fractures to the extremities, prophylactic antibiotic administration for ≥48hours is unwarranted.