Duration Of Antibiotic Prophylaxis Research Articles

Short Versus Extended Antibiotic Prophylaxis for Maxillary Sinus Floor Augmentation Via a Lateral Window Approach: A Randomized Controlled Trial.

The purpose of this randomized controlled trial was to compare the surgical site infection rate with short (24 hours) vs extended (7 days) antibiotic prophylaxis for maxillary sinus floor augmentation surgery. Eighty-five patients who were candidates for unilateral or bilateral maxillary sinus floor augmentation surgery were randomly assigned to short or extended antibiotic prophylaxis. Patients were evaluated on days 7, 14, 30, 60, and 180 after surgery for symptoms and signs of infection. The primary study endpoint was the development of surgical site infection up to day 180 postoperatively. Patients underwent a total of 117 maxillary sinus floor augmentation surgeries, 62 in the short prophylaxis arm and 55 in the extended prophylaxis arm. Fifty-three patients (62%) had unilateral surgery, and 32 (38%) had bilateral surgery. Three patients developed a surgical site infection by 180 days postsurgery (overall rate, 2.6%): one patient (1.6%) in the 24-hour arm and two (3.6%) in the extended prophylaxis arm. All three patients received antibiotic treatment, and the infections resolved entirely. A low rate of surgical site infection was observed after maxillary sinus floor augmentation, and there was no apparent advantage to extended (7 days) vs short (24 hours) duration of antibiotic prophylaxis. The findings do not support the use of extended postprocedural chemoprophylaxis for patients undergoing maxillary sinus floor augmentation.

MP25-16 IMPACT OF DURATION OF ANTIBIOTIC PROPHYLAXIS ON UTI RATE AFTER ONABOTULINUMTOXINA INJECTION

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021MP25-16 IMPACT OF DURATION OF ANTIBIOTIC PROPHYLAXIS ON UTI RATE AFTER ONABOTULINUMTOXINA INJECTION Sarah Martin, Jacqueline Zillioux, Neil Kocher, Raymond Rackley, Sandip Vasavada, Howard Goldman, Katie Propst, Eiftu Haile, and Emily Slopnick Sarah MartinSarah Martin More articles by this author , Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Neil KocherNeil Kocher More articles by this author , Raymond RackleyRaymond Rackley More articles by this author , Sandip VasavadaSandip Vasavada More articles by this author , Howard GoldmanHoward Goldman More articles by this author , Katie PropstKatie Propst More articles by this author , Eiftu HaileEiftu Haile More articles by this author , and Emily SlopnickEmily Slopnick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002022.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are currently no specific guidelines on antibiotic prophylaxis for intravesical OnabotulinumtoxinA (BTX) injection, despite high risk of post-procedural urinary tract infection (UTI). Our objective was to assess the impact of duration of antibiotic prophylaxis on rate of UTI within 30 days of BTX injection. METHODS: A retrospective chart review was performed of patients who received office BTX injection from 2014-2020 with FPMRS providers at a single academic institution. UTI rates within 30 days of BTX were compared between three prophylaxis regimens: no antibiotic, a single dose, or a multiple day course of any antibiotic. UTI was defined as new lower urinary tract symptoms treated either empirically or associated with a positive urine culture. Patients on daily antibiotic prophylaxis for recurrent UTI were excluded. Association of UTI with units of BTX, BMI, history of diabetes, immunosuppresion, neurogenic bladder or recurrent UTI and incidence of new post-procedure urinary retention were also investigated. Statistical analysis was performed with univariate and subsequent multivariable logistic regression analysis to assess for possible confounding factors. RESULTS: A total of 180 patients and 560 cycles of BTX injections were included: 173 (96%) were women with mean age 62.9 years (range 20-95; SD 12.6). The majority received 100U (65%) for a non-neurogenic diagnosis (67%). Overall rates of UTI and urinary retention within 30 days were 11% and 6%, respectively. No antibiotic prophylaxis was given to 79 (14%) patients, 343 (61%) received a single dose, and 138 (25%) received a multiple day regimen (3-7 days). On univariate analysis, UTI incidence was lower with administration of any antibiotic prophylaxis as compared to none: single dose 7.6% vs. 25.3% (OR 0.24, p<0.001), multiple dose 11.0% vs. 25.3% (OR 0.36, p=0.007). There was no difference in UTI rates between single and multiple dose antibiotic regimens (p=0.233). On multivariable logistic regression, use of any antibiotic prophylaxis was associated with a lower incidence of UTI (single OR 0.32, p=0.002; multiple OR 0.42, p=0.042), with no difference between single and multiple dose regimens (p=0.068). History of recurrent UTI (OR 2.3, p=0.024) and de novo post-procedure retention (OR 3.9, p=0.002) were predictors of UTI. CONCLUSIONS: Use of antibiotic prophylaxis for office intravesical BTX injection is associated with a significantly lower incidence of UTI compared to no antibiotic. Importantly, a multiple day regimen was not more effective than a single dose of antibiotics in preventing UTI. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e459-e460 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Martin More articles by this author Jacqueline Zillioux More articles by this author Neil Kocher More articles by this author Raymond Rackley More articles by this author Sandip Vasavada More articles by this author Howard Goldman More articles by this author Katie Propst More articles by this author Eiftu Haile More articles by this author Emily Slopnick More articles by this author Expand All Advertisement PDF downloadLoading ...

PIN3 Impact of Antimicrobial Stewardship Interventions on Compliance with Surgical Antibiotic Prophylaxis: A Systematic Review

There is paucity of data describing the effectiveness of antimicrobial stewardship in improving compliance with surgical antibiotic prophylaxis. This review evaluated the impact of antimicrobial stewardship interventions on compliance with surgical antibiotic prophylaxis measures, surgical site infection and economic outcome. PubMed, Scopus, Science Direct, and Google Scholar databases were searched to identify eligible studies that reported the impact of antimicrobial stewardship on compliance with surgical antibiotic prophylaxis and/or antibiotic utilization, surgical site infections from 2000 to 2017. Fourteen studies were selected; eight (57%) uncontrolled before-and-after studies, and two each randomized trial, interrupted time series and controlled before-and-after studies. Clinician education, organizational changes and audit and feedback were the most common stewardship interventions. Stewardship interventions improved compliance with antibiotic selection (1% - 90%); timing of first dose (5% - 96%); intra-operative re-dosing (28% - 53%); and total compliance (19% - 44%). Duration of antibiotic prophylaxis had the least improvement (7% - 25%) after stewardship interventions. Generally, studies with low baseline compliance rate showed greater improvements after stewardship interventions. Stewardship interventions reduced antibiotic utilization (20% - 35% Defined Daily Dose/100 procedures), surgical site infections (0.8% - 5.6%), and the costs of antibiotic prophylaxis per procedure ($ 2.5 - $ 345). Participation of stakeholders in antimicrobial stewardship program was vital for the success of the interventions. Low quality evidence shows that stewardship interventions improve compliance with surgical antibiotic prophylaxis measures, and reduced antibiotic utilization, surgical site infections and cost of surgical antibiotic prophylaxis.

Efficacy of 1 versus 3 days of intravenous amikacin as a prophylaxis for patients undergoing transurethral resection of the prostate: A prospective randomized trial.

Introduction:There are no uniform guidelines on the duration of antibiotic prophylaxis for transurethral resection of the prostate (TURP). The objective of this study was to evaluate the efficacy of 1 day versus 3 days of intravenous amikacin as prophylaxis, before TURP.Materials and Methods:In this prospective randomized control trial, patients with sterile preoperative urine culture were randomized to receive either 1 day (Group A) or 3 days (Group B) of intravenous (IV) amikacin. All patients had their catheter removed on the 3rd day and a midstream urine culture was obtained on the 4th day. The follow-up was scheduled at 1 week and at 1 month. The rate of bacteriuria on the 4th postoperative day was analyzed as the primary outcome. The secondary outcomes included symptomatic urinary tract infection (UTI), its risk factors, and other complications at 1 month.Results:Of the 338 patients randomized, 314 patients were evaluable until day 7 and 307 until 1 month. Bacteriuria rate at day 4 (Group A: 8.8% [95% confidence interval (CI): 4.2–13.2]; Group B: 4.4% [95% CI: 1.2%–7.7%], P = 0.124, Fisher's exact test) was similar in both the groups. At 1 month, the rate of symptomatic UTI was also similar in both the groups (3.5% [95% CI: 0.8–6.9] vs. 1.7% [95% CI: 0.2–4.2], P = 0.344, Fisher's exact test). Bacteriuria (colony-forming unit, >104/ml) at day 4 was a significant risk factor for developing symptomatic UTI (P = 0.006). Antibiotic resistance was higher in Group B (P = 0.002) (Group A: 7.1% [95% CI: 6.3–20] vs. Group B: [71%, CI: 38–104], P = 0.0021, Fisher's exact test).Conclusion:One day is possibly noninferior to 3 days of IV amikacin as prophylaxis in patients undergoing TURP with respect to bacteriuria and symptomatic UTI, with an added advantage of lower antibiotic resistance.

575. Effectiveness of Short vs Long Course Perioperative Antibiotics in Lung Transplant Recipients with Donor Positive Respiratory Cultures

BackgroundLung transplant recipients are at increased risk for infection in the early post-operative phase. Perioperative antibiotic (POA) practices are variable among transplant centers with sparse data regarding optimal antibiotic prophylaxis duration. This study aimed to evaluate the efficacy of short course (SC) (≤10 days) vs long course (LC) (≥11 days) POA in lung transplant patients.MethodsThis was a single-center, retrospective study of non-cystic fibrosis first time lung transplant recipients with donor positive cultures between Aug 2013 and Sept 2019. Patients who died within 14 days of transplant were excluded. Data collected included baseline characteristics, donor and recipient cultures, POA, and hospitalization details. The primary outcome was 30-day recipient freedom from donor-derived respiratory bacterial infection. Secondary outcomes included development of Clostridioides difficile infection (CDI), cumulative time on ventilator, post-op time to extubation, in-hospital all-cause mortality, and 30-day development of POA resistance. Descriptive statistics were used for analysis. Continuous variables were compared using the Wilcoxon rank sum test while categorical variables were compared using the chi-square or Fisher’s exact test. Statistical significance was defined as p< 0.05.ResultsA total of 147 patients were included (58 SC vs 89 LC). Median POA duration in the SC group was 6.5 days vs 13 days in the LC group (p< 0.0001). The primary outcome of 30-day freedom from donor-derived respiratory infection was present in 56 (97%) patients in the SC vs. 85 (96%) patients in the LC group (p= 1). There was no difference in development of CDI (p = 0.4), mortality (p = 1), or resistant organisms (p=0.28) while cumulative ventilator time and time to post-op extubation were longer in the LC group (p = 0.002 & 0.007, respectively). Methicillin-sensitive Staphylococcus aureus was the most common organism isolated from donors in the SC (23, 40%) and LC (48, 54%) groups.ConclusionAmong lung transplant recipients with positive donor cultures, short course POA was as effective as long course in preventing donor-derived bacterial pneumonia. Further studies are needed to assess heterogeneity in POA practices and optimal duration among transplant centers.Disclosures Brian C. Keller, MD, PhD, CareDx, Inc. (Grant/Research Support) Bryan A. Whitson, MD, PhD, Abbott Laboratories (Consultant)TransMedics OCS (Other Financial or Material Support, Serves on the Clinical Events Committee)

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.

Evaluation of Surgical Site Infections After Change in Surgical Prophylaxis in VAD Patients

Background: In October 2013, the University of Maryland Medical Center established a formal antibiotic prophylaxis protocol for patients undergoing ventricular assist device (VAD) placement, replacing a previous system of various broad-spectrum antibiotic combinations typically for prolonged durations based on surgeon preference. This new protocol consisted of a standardized regimen of 72 hours of vancomycin and ceftriaxone after the procedure. The objective of this project was to evaluate the rate of surgical site infection (SSI) related to VAD placement to ensure that implementing the new protocol did not cause an increase in SSI rates. Methods: The study was a retrospective cohort study of patients who had undergone VAD placement before the protocol change (January 1, 2011, to October 1, 2013) and after the change (October 1, 2013, to November 15, 2015). The primary outcomes was the difference in SSI rate before and after the protocol change using CDC NHSN definitions. Pertinent data points of interest included reason for VAD placement, duration/type of antibiotics used, delayed sternal closure, SSI, characterization of infection (bloodstream, driveline, or pocket), organism identified on culture and mortality at 30 days and 1 year. SSI rates were assessed using the Fischer exact test, and descriptive statistics were used for other outcome variables. Results: In total, 75 patients were included before the protocol and 46 after the protocol change. Overall, 27% and 17% of patients were on therapeutic antibiotics prior to the VAD placement, respectively (P = 0.23). Also, 8 (6.6%) patients in the preintervention group had an SSI compared to 1 patient (0.8%) in the postintervention group (P = .15). Adherence to the protocol was suboptimal, with 27% of patients in the postintervention group receiving non–protocol-adherent antibiotics and 65% of patients receiving antibiotics &gt;96 hours postoperatively. When evaluating the patients collectively, SSI rates were the same when antibiotics were discontinued &lt;72 hours postoperatively versus when antibiotics were continued beyond 72 hours postoperatively or were not given at all postoperatively (3.1% vs 10.7% vs 0%; P = .24). SSI rates were also no different among patients who received cefazolin monotherapy (0%), vancomycin and ceftriaxone (2.7%), vancomycin and piperacillin tazobactam (2%), and other antibiotic combinations (7.7%) for surgical prophylaxis (P = 0.1). Conclusions: No change in SSI rates was noted after a protocol change narrowing the spectrum and duration of antibiotic prophylaxis was implemented. Evaluation of optimal surgical prophylaxis in this patient population is difficult due to low event rates and frequent therapeutic indications for antibiotics outside the standard prophylaxis. Despite these challenges, this study supports the safety of studying SSI prophylaxis reduction in the VAD population. Further studies are reasonable and warranted.Funding: NoneDisclosures: None

Antibiotic Prophylaxis for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis.

Infectious complications following prostate biopsy are increasing and fluoroquinolone prophylaxis has recently been banned by the European Commission. In this systematic review we summarize the evidence for different antibiotic prophylaxis regimens. We searched MEDLINE®, Embase® and Cochrane Database for randomized controlled trials (inception to October 2019) assessing antimicrobial interventions in prostate biopsy. Primary outcome was infectious complications. Exclusion criteria were simultaneous interfering interventions. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the certainty of evidence. Protocol was registered with PROSPERO (CRD42015026354). Overall 59 randomized controlled trials (14,153 participants) and 7 different antimicrobial interventions were included. Antibiotic prophylaxis reduced infectious complications compared to no prophylaxis (RR 0.56, 95% CI 0.40-0.77, p=0.0005, I2=15%, participants 1,753, studies 11). A short-term prophylaxis (single shot to 3 days) was inferior to a long-term prophylaxis (1 to 7 days) with fluoroquinolone (RR 1.89, 95% CI 1.37-2.61, p=0.0001, I2=0%, participants 3,999, studies 17). Fosfomycin trometamol was an alternative to fluoroquinolone with reduced rates of infectious complications (RR 0.49, 95 CI 0.27-0.87, p=0.02, I2=54%, participants 1,239, studies 3). Empiric prophylaxis was inferior to targeted prophylaxis (RR 1.81, 95% CI 1.28-2.55, p=0.0008, I2=48%, participants 1,511, studies 6). Standard prophylaxis was inferior to augmented prophylaxis (using multiple rather than single agent) using a fixed model (RR 2.10, 95% CI 1.53-2.88, p <0.0001, I2=71%, participants 2,597, studies 9), but not using a random model (p=0.07). No difference was observed in infectious complications based on route or timing of antimicrobial prophylaxis. The certainty of evidence was rated as low/very low. In countries where fluoroquinolones are allowed as antibiotic prophylaxis, a minimum of a full 1-day administration as well as targeted therapy in case of fluoroquinolone resistance is recommended. In countries with a ban on fluoroquinolones, fosfomycin is a good alternative, as is augmented prophylaxis, although no established standard combination exists to date.

Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients

Background and purpose — The optimal type and duration of antibiotic prophylaxis for primary arthroplasty of the hip and knee are subject to debate. We compared the risk of complete revision (obtained by a 1- or 2-stage procedure) for periprosthetic joint infection (PJI) after primary total hip or knee arthroplasty between patients receiving a single dose of prophylactic antibiotics and patients receiving multiple doses of antibiotics for prevention of PJI. Patients and methods — A cohort of 130,712 primary total hip and 111,467 knee arthroplasties performed between 2011 and 2015 in the Netherlands was analyzed. We linked data from the Dutch arthroplasty register to a survey collected across all Dutch institutions on hospital-level antibiotic prophylaxis policy. We used restricted cubic spline Poisson models adjusted for hospital clustering to compare the risk of revision for infection according to type and duration of antibiotic prophylaxis received. Results — For total hip arthroplasties, the rates of revision for infection were 31/10,000 person-years (95% CI 28–35), 39 (25–59), and 23 (15–34) in the groups that received multiple doses of cefazolin, multiple doses of cefuroxime, and a single dose of cefazolin, respectively. The rates for knee arthroplasties were 27/10,000 person-years (95% CI 24–31), 40 (24–62), and 24 (16–36). Similar risk of complete revision for infection among antibiotic prophylaxis regimens was found when adjusting for confounders. Interpretation — In a large observational cohort we found no apparent association between the type or duration of antibiotic prophylaxis and the risk of complete revision for infection. This does question whether there is any advantage to the use of prolonged antibiotic prophylaxis beyond a single dose.

Retrospective analysis of risk factors for deep infection in lower limb Gustilo\u2013Anderson type III fractures

BackgroundOpen fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo–Anderson (G–A) type III fractures.Materials and methodsThis retrospective study investigated patients who underwent surgical procedures for lower limb G–A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G–A type III fractures (77 G–A type IIIA fractures and 37 G–A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G–A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure.ResultsEighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G–A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01).ConclusionEarly flaps rather than skin grafting should be used to cover G–A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures.Level of evidenceLevel IV retrospective observational study.

Single dose versus 24\u2009h antibiotic prophylaxis in reduction mammaplasty: study protocol for a randomized controlled trial

BackgroundReduction mammaplasty is among the most commonly performed procedures in plastic surgery. Antibiotics are widely prescribed, on an empirical basis, to prevent surgical site infections. However, there is a lack of evidence to support its use. This trial aims to compare the influence of the use of prophylatic antibiotics as a single dose or for 24 h on surgical site infection rates following reduction mammaplasty.MethodsRandomized trial of non-inferiority, with two parallel groups. A total of 146 breast hypertrophy patients, with reduction mammaplasty already scheduled, will be enrolled. Patients will be randomly allocated to the placebo group that will receive antibiotics only at the anesthesia induction (n = 73) or to the antibiotics group that will receive antibiotics at the anesthesia induction and for 24 h (n = 73). None of the patients will receive antibiotics after hospital discharge. Patients will be followed-up weekly, for 30 days, regarding surgical site infection. The Centers for Disease Control and Prevention criteria will be applied. A statistical analysis of the data will be performed.DiscussionPrevious studies have demonstrated a decrease in infection rates after reduction mammaplasty when antibiotic prophylaxis was used, compared to the use of no antibiotics. However, the duration of antibiotic prophylaxis remains a point to be clarified. This study will test the hypothesis that maintaining the use of antibiotics for 24 h does not reduce infection rates compared to the use of a single preoperative dose.Trial registrationClinicaltrials.gov NCT04079686. Registered on September 6, 2019.

Is Cutibacterium acnes early surgical site infection rate related to the duration of antibiotic prophylaxis in adolescent idiopathic scoliosis surgery?

Cutibacterium acnes(C. acnes) is a gram-positive anaerobic bacillus located in pilosebaceous glands, usually responsible for late postoperative surgical site infections (SSI). A recent study performed in our institution highlighted an unexpected emergence of C. acnesearly SSI. One potential explanation was the change of the perioperative antibioprophylaxis (ATB) protocol, which switched from 48h postoperative cefamandole to intraoperative only cefazoline. The aim of this study was therefore to investigate the influence of the ATB duration on the occurrence of C. acnesearly SSI, by comparing the incidence rates during 3 consecutive ATB protocols. Between January 2007 and September 2017, all patients who underwent posterior fusion for AIS were retrospectively reviewed. Early C. acnes SSI were reported and compared between 3 periods, during which the ATB protocols were modified. January 2007-February 2012: Intraoperative Cefamandole continued 48h (protocol 1) March 2012-August 2016: Single shot of intraoperative Cefazoline (protocol 2) September 2016-September 2017: Intraoperative Cefazoline continued 48h (protocol 3). Fifty-three early SSI (7.2%) were reported among the 732 posterior AIS fusions included. Globalincidence of C. acnesinfection was 2.9%. The incidence of C. acnes in early SSI increased from 0 to 4.9% between protocol 1 and 2, but was reduced to 1.7% with protocol 3. Early C acnes SSIcan be explained by the difficulty to eradicate this pathogen with current skin preparation procedures and some Beta-lactam antibiotics tolerance. Longer duration antibioprophylaxis is preferable to prevent from early C. acnes SSI.

Duration of Intrapartum Antibiotic Prophylaxis for Group B Streptococcus [06A

INTRODUCTION: Intrapartum vertical transmission of group B streptococcus (GBS) occurs in approximately 50% of vaginal births without antibiotic prophylaxis. This prospective cohort study aimed to determine if &lt;4 hours duration of intrapartum antibiotic prophylaxis (IAP) before delivery reduces GBS vertical transmission rates. METHODS: 1354 GBS positive parturients presented to Yale New Haven Hospital between 10/1/2009 and 3/28/2012. Of eligible patients ≥37 weeks with singleton gestations in labor (n=1111), 316 were invited after IRB approval to participate and 240 completed the study. Maternal characteristics, labor course, delivery and neonatal outcomes were obtained. Of 240 maternal-infant dyads, 69 received &lt;4 hours of IAP and 158 received ≥4 hours. Nine did not receive IAP. Infant oropharyngeal and rectal swabs were collected after 24 hours to detect mucosal GBS colonization. RESULTS: Rates of GBS transmission were equivalent in those receiving less than and greater than 4 hours of prophylaxis before delivery, respectively (1.5 vs 1.2%; P=1.0). No significant differences in GBS transmission were observed between those with and without risk factors for early neonatal GBS disease. No cases of GBS vertical transmission occurred in those who received IAP prior to membrane rupture versus 3 (3.9%) cases of transmission (P=.036) among those who received IAP after membrane rupture. CONCLUSION: GBS vertical transmission rates among individuals who received IAP &lt;4 hours were equivalent to those receiving IAP ≥4 hours before delivery. Antibiotic prophylaxis duration may be less relevant than membrane rupture timing in vertical transmission and deserves further exploration to optimize newborn monitoring protocols after delivery in maternal GBS colonization.

Abstract 88: Do Postoperative Prophylactic Antibiotics Reduce Highly Virulent Infections? An Analysis Of 660 Tissue Expander Breast Reconstructions

Purpose: Many surgeons are reluctant to discontinue prophylactic antibiotics after 24 hours in tissue expander breast reconstruction (TEBR) due to increased risk of surgical site infection (SSI). There is currently no consensus regarding antibiotic prophylaxis duration in TEBR. In addition, there remains a lack of research investigating microorganisms involved in SSI across various perioperative antibiotic protocols. The purpose of this study was to examine how two different prophylactic antibiotic regimens impacted the bacterial profiles of SSI and rate of implant loss after TEBR. Methods: A single institution retrospective review was performed of immediate TEBRs between 2001-2018. Demographics, chemotherapy/radiation, prophylactic antibiotic regimen and SSI cultures were analyzed. SSIs requiring hospitalization before stage 2 were included. Outpatient managed SSIs were excluded. Highly virulent organisms were defined as ESKAPE pathogens (Enterococcus faecium, Staphylococcus Aureus, Klebsiella Pneumoniae, Acinetobacter baumannii, Pseudomonas Aeruginosa, Enterobacter species) based on literature. Implant loss was defined as removal of TE without immediate replacement. Results: Of 660 TEBRs, 85 (12.9%) developed an SSI prior to stage 2. Fifty-six (65.9%) previously received <24 hours perioperative prophylactic IV antibiotics and oral antibiotics after discharge (Group 1) and 29 (34.1%) were given <24 hours prophylactic IV antibiotics only (Group 2). There was no significant difference in demographics (i.e. BMI, age, smoking status, preoperative chemotherapy/radiation) or inpatient treatment of the SSI (Oral/IV antibiotics) between the two groups. In Group 1, 64% (n=36) developed culture positive SSIs, compared to 83% (n=24) in Group 2. Staphylococcus Aureus was the most common bacteria in both groups. Group 2 demonstrated a significantly increased incidence of gram-positive organisms (46.4% vs 72.4%, p=0.022) and Staphylococcus Aureus (21.4% vs 55.2%, p=0.002). However, there was no significant difference in overall highly virulent (p=0.168), gram-negative (p=0.416), or total isolated organisms (p=0.192) between groups. Interestingly, Group 1 demonstrated an increase in Pseudomonas Aeruginosa SSIs, (14.3% vs 3.4%, p=0.124) but this finding did not reach significance. Implant loss between Groups 1 and 2 (62.5% vs. 62.1%, p=0.969) respectively, was nearly identical. Conclusion: Our study demonstrates that despite differences in bacterial profiles between the two antibiotic protocols, prolonged postoperative antibiotic use did not provide additional protection against overall highly virulent infections. In addition, the implant loss rate between the two groups was similar. Antibiotic stewardship guidelines against the overuse of prolonged prophylactic regimens should be considered. Further analysis regarding timing of SSIs and antibiotic treatment is warranted.

Benefits, Drawbacks and Precautions of Performing Laparoscopy and Laparotomy in Management of Benign Adnexal Masses in Pregnant Women; A Comparative Study

Surgical management strategies of benign ovarian cysts diagnosed during pregnancy include cyst resection, ovarian excision, or salpingo-oophrectomy but the best surgical procedure is still controversial. Using laparoscopic assisted methods has been extensively used in management of many gynecologic related diseases in non-pregnant women. Previously, performing laparoscopic surgeries for management of benign ovarian cysts during pregnancy was limited to only case reports, case series and retrospective studies. Aim of the study was to compare between laparoscopic and conventional open surgery for management of benign adnexal cysts in pregnant women, regarding; pregnancy outcome, benefits and drawbacks on mother and fetus, operative and perioperative details. Patients and methods We included 80 pregnant females with benign ovarian cysts who were eligible for the study, splitting them in to 2 cohorts each group contain 40 patients the first cohort underwent laparoscopic excision of the ovarian cyst and the second cohort underwent conventional laparotomy for management of the ovarian cysts. Results We found statistically significant differences between both studied groups regarding the overall costs of the operation as; anesthesia, surgery, and materials costs and in comparison with laparotomy, the laparoscopy related costs associated were higher (p &lt; 0.001). We found that duration of post-operative hospital staying was shorter in laparoscopy group than laparotomy group (p &lt; 0.001). The rate and duration of antibiotic prophylaxis was lower in laparoscopy group than laparotomy group (p &lt; 0.001). The rate of wound healing was higher in the laparoscopy group. The postoperative fever rate and degree of maximum temperature was less in laparoscopy group than laparotomy group (p = 0.005). Conclusion We concluded that performing laparoscopic assisted surgical procedure for excision of benign ovarian cystic masses in pregnant women lead to less blood loss, shorter hospitalization better wound healing with no increased risks of fetal or maternal complications than laparotomy. Although laparoscopy has higher costs but it was more accepted by the patients as it is minimally invasive.

Benefits, Drawbacks and Precautions of Performing Laparoscopy and Laparotomy in Management of Benign Adnexal Masses in Pregnant Women; A Comparative Study

Surgical management strategies of benign ovarian cysts diagnosed during pregnancy include cyst resection, ovarian excision, or salpingo-oophrectomy but the best surgical procedure is still controversial. Using laparoscopic assisted methods has been extensively used in management of many gynecologic related diseases in non-pregnant women. Previously, performing laparoscopic surgeries for management of benign ovarian cysts during pregnancy was limited to only case reports, case series and retrospective studies. Aim of the study was to compare between laparoscopic and conventional open surgery for management of benign adnexal cysts in pregnant women, regarding; pregnancy outcome, benefits and drawbacks on mother and fetus, operative and perioperative details. Patients and methods We included 80 pregnant females with benign ovarian cysts who were eligible for the study, splitting them in to 2 cohorts each group contain 40 patients the first cohort underwent laparoscopic excision of the ovarian cyst and the second cohort underwent conventional laparotomy for management of the ovarian cysts. Results We found statistically significant differences between both studied groups regarding the overall costs of the operation as; anesthesia, surgery, and materials costs and in comparison with laparotomy, the laparoscopy related costs associated were higher (p &lt; 0.001). We found that duration of post-operative hospital staying was shorter in laparoscopy group than laparotomy group (p &lt; 0.001). The rate and duration of antibiotic prophylaxis was lower in laparoscopy group than laparotomy group (p &lt; 0.001). The rate of wound healing was higher in the laparoscopy group. The postoperative fever rate and degree of maximum temperature was less in laparoscopy group than laparotomy group (p = 0.005). Conclusion We concluded that performing laparoscopic assisted surgical procedure for excision of benign ovarian cystic masses in pregnant women lead to less blood loss, shorter hospitalization better wound healing with no increased risks of fetal or maternal complications than laparotomy. Although laparoscopy has higher costs but it was more accepted by the patients as it is minimally invasive.

Do Postoperative Prophylactic Antibiotics Reduce Highly Virulent Infections?: An Analysis of 660 Tissue Expander Breast Reconstructions.

Many surgeons are reluctant to discontinue prophylactic antibiotics after 24 hours in tissue expander breast reconstruction (TEBR) because of fear of increased risk of surgical site infection (SSI). Currently, there is no consensus regarding antibiotic prophylaxis duration in TEBR. In addition, there remains a lack of research investigating microorganisms involved in SSI across various perioperative antibiotic protocols. The purpose of this study was to examine how 2 different prophylactic antibiotic regimens impacted the bacterial profiles of SSI and rate of implant loss after TEBR. A single-institution retrospective review of immediate TEBRs between 2001 and 2018 was performed. Surgical site infections requiring hospitalization before stage 2 were included. Highly virulent organisms were defined as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species). Implant loss was defined as removal of tissue expander without immediate replacement. Of 660 TEBRs, 85 (12.9%) developed an SSI requiring hospitalization before stage 2. Fifty-six (65.9%) received less than 24 hours of perioperative intravenous antibiotics and oral antibiotics after discharge (group 1), and 29 (34.1%) received less than 24 hours of intravenous antibiotics only (group 2). There was no significant difference in demographics, preoperative chemotherapy/radiation, acellular dermal matrix usage, or treatment of SSI between groups. In group 1, 64% (n = 36) developed culture positive SSIs, compared with 83% (n = 24) in group 2 (P = 0.076). Staphylococcus aureus was the most common bacteria in both groups. Group 2 demonstrated a significantly increased incidence of gram-positive organisms (46.4% vs 72.4%, P = 0.022) and S. aureus (21.4% vs 55.2%, P = 0.002). However, there was no significant difference in overall highly virulent (P = 0.168), gram-negative (P = 0.416), or total isolated organisms (P = 0.192). Implant loss between groups 1 and 2 (62.5% vs 62.1%, P = 0.969) respectively, was nearly identical. Our study demonstrates that, despite differences in bacterial profiles between 2 antibiotic protocols, prolonged postoperative antibiotic use did not protect against overall highly virulent infections or implant loss. Antibiotic stewardship guidelines against the overuse of prolonged prophylactic regimens should be considered. Further analysis regarding timing of SSIs and antibiotic treatment is warranted.

Multi-Center Prospective Study of Restrictive Post-Operative Antibiotic Treatment of Children with Complicated Appendicitis.

Background: No consensus has been reached regarding the most advantageous duration of antibiotic prophylaxis to decrease post-operative infection complications of appendectomy for acute complex appendicitis. This study aimed to determine the efficacy of short-term antibiotic treatment on post-operative complications in children with complex appendicitis. Methods: A multi-center, parallel group, randomized study was conducted in patients younger than 14 years of age with complicated appendicitis at three hospitals in China. The qualified patients were randomized prospectively to either the restrictive 72-hour short-term antibiotic strategy or the standard antibiotic usage. A comparison of the complications within 24 months, including infectious complications and long-term results, were conducted between the two groups. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR), number ChiCTR1900023941 and is complete. Results: A shorter duration of antibiotic treatment had no effect on intestinal function recovery, antibiotic-associated diarrhea, and health-care-associated Clostridium difficile infection and infectious complication, including intra-abdominal abscess development (17.9% vs. 18.0%, p = 0.52). Furthermore, no substantial difference for re-admission requirement and re-operation were found between the two treatment strategies. A sizeable decrease in total duration of hospitalization (p < 0.001) and average total antibiotic duration (p < 0.001) were observed for the restrictive antibiotic strategy group. Conclusion: In complicated appendicitis, the restrictive antibiotic usage was equivalent to standard antibiotic usage in terms of short- and long-term outcomes, but with shorter hospital stays and fewer antibiotic agents.

Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden

Background: The risk of infection after transrectal ultrasound (TRUS)-guided prostate biopsies is increasing. The aim of the study was to assess the use of antibiotic prophylaxis for prostate biopsy in Sweden. Methods: All public and private urology clinics reporting to the National Prostate Cancer Register of Sweden received a survey on TRUS-biopsy prophylaxis. Results: Of the 84 clinics surveyed, 76 replied (90%). If no risk factors for infection were present, a single dose of ciprofloxacin 750 mg was used by 50 clinics (66%). Multiple doses of ciprofloxacin 500 or 750 mg (n=14; 18%) or a single dose of trimethoprim-sulfamethoxazole 160/800 mg (n=7; 9%) were other common prophylaxes. Most clinics gave the prophylaxes immediately before the biopsy (n=41; 54%). Urine dipstick was used by 30 clinics (39%) and rectal enema by six (8%). In patients with high risk of infection, the survey mirrors a large variety of regiments used. Conclusions: The preference to use a single dose of ciprofloxacin 750 mg is in accordance with the Swedish national guidelines for patients with a low risk of infection. Better compliance to the guideline recommendation to use a urine dipstick would probably increase the number of patients classified as having an increased risk of infection. Being classified as a high-risk patient should lead to an extended duration of antibiotic prophylaxis, however, the variety of regimens used in the high-risk group reflects an inability to treat these patients in a standardized fashion and also highlights a need for more clear-cut guidelines. Pre-biopsy identification of high-risk patients is an important issue to tackle for the urologic clinics in order to reduce the number of infections.

Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden.

Background: The risk of infection after transrectal ultrasound (TRUS)-guided prostate biopsies is increasing. The aim of the study was to assess the use of antibiotic prophylaxis for prostate biopsy in Sweden. Methods: All public and private urology clinics reporting to the National Prostate Cancer Register of Sweden received a survey on TRUS-biopsy prophylaxis. Results: Of the 84 clinics surveyed, 76 replied (90%). If no risk factors for infection were present, a single dose of ciprofloxacin 750 mg was used by 50 clinics (66%). Multiple doses of ciprofloxacin 500 or 750 mg (n=14; 18%) or a single dose of trimethoprim-sulfamethoxazole 160/800 mg (n=7; 9%) were other common prophylaxes. Most clinics gave the prophylaxes immediately before the biopsy (n=41; 54%). Urine dipstick was used by 30 clinics (39%) and rectal enema by six (8%). In patients with high risk of infection, the survey mirrors a large variety of regiments used. Conclusions: The preference to use a single dose of ciprofloxacin 750 mg is in accordance with the Swedish national guidelines for patients with a low risk of infection. Better compliance to the guideline recommendation to use a urine dipstick would probably increase the number of patients classified as having an increased risk of infection. Being classified as a high-risk patient should lead to an extended duration of antibiotic prophylaxis, however, the variety of regimens used in the high-risk group reflects an inability to treat these patients in a standardized fashion and also highlights a need for more clear-cut guidelines. Pre-biopsy identification of high-risk patients is an important issue to tackle for the urologic clinics in order to reduce the number of infections.