Efficacy Of Perioperative Antibiotic Prophylaxis Research Articles

Efficacy of perioperative antibiotic prophylaxis in elective soft-tissue-only wrist arthroscopy

Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results.

Perioperative antibiotic prophylaxis in open tracheostomy: A preliminary randomized controlled trial

BackgroundThe efficacy of perioperative antibiotic prophylaxis for prevention of wound infection in open tracheostomy has been minimally studied and remains controversial. MethodsA preliminary double-blind, randomized, placebo-controlled trial was conducted. A total of 159 patients who underwent open tracheostomy were enrolled, and 88 patients were excluded because of lack of desire to participate in research, emergency condition, administration of other antibiotics, immunocompromise, or cervical skin infection. The remainings were randomly assigned to an antibiotic group or a control group. Another 11 patients were excluded after the randomization due to intraoperative contamination, death from the underlying disease, receiving other antibiotics, or lost to the follow-up. A total of 30 patients in each group were qualified for analysis. In the antibiotic group, clindamycin was intravenously administered 30 min before the incision and every 8 h after the operation for 24 h. In the control group, an equal volume of sterile saline was administered. ResultsWound infection developed in 2 patients (6.7%) in the antibiotic group and 7 patients (23.3%) in the control group (p = 0.08). In multivariate analysis, smoking and previous neck irradiation were the significant risk factors for wound infection (p = 0.042 and 0.019, respectively). The mean length of hospital stay after tracheostomy in patients with and without wound infection were 17 ± 2 days and 4 ± 2 days, respectively (p = 0.013). ConclusionThe result of this preliminary study reveals that antibiotic prophylaxis reduced tracheostomy wound infection rate from 23.3% to 6.7% although it was not statistically significant. However, wound infection may lead to serious complications and prolonged postoperative length of hospital stay, and therefore proper perioperative antibiotics should be considered in patients who are not receiving other antibiotics, and particularly in patients with risk factors for wound infection.

Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis.

The primary aim of the present study was to determine the incidence of infections following arthroscopic rotator cuff repair in a single department over a 10-year period. Secondary goals included the evaluation of potential risk factors for infections and to investigate the efficacy of perioperative antibiotic prophylaxis in the reduction of infectious complications. A retrospective evaluation of 3294 all-arthroscopic rotator cuff repairs performed between 2004 and 2014 at a single institution was conducted to determine the rate of infection in all-arthroscopic rotator cuff repairs. Detailed data including demographics, co-morbidities, initial surgical procedure, time from index surgery to infection, clinical presentation, isolated pathogens, and subsequent treatment were recorded of patients with infections. Univariate logistic regression was performed, and a multivariate model was developed to identify variables that were predictive of infections following arthroscopic rotator cuff repair. The rate of infection was 8.5/1000 in whom rotator cuff repairs were performed (95% CI 0.58-1.23%) during the study period. The most commonly identified pathogen was Staphylococcus epidermidis (n=11, 39.3%), followed by Propionibacterium acnes (n=8, 28.6%) and Staphylococcus aureus (n=2, 7.1%). Patients presented at our institution with signs of infection an average of 28.9±14.7days after the index surgery. The leading symptom that was present in all patients was diffuse or localized shoulder pain, followed by local signs of infection in 19 (67.9%), secretion in 14 (50%), and fever in 9 (32.1%) patients, respectively. Univariate and multivariate analyses identified the male gender, age over 60, and duration of surgery over 90min as predictive factors for infection. Administration of perioperative antibiotic prophylaxis was an independent mitigating factor for postoperative infection and reduced the infection rate from 1.54% (95% CI 0.98-2.30%) to 0.28% (95% CI 0.10-0.67%). The overall incidence of infection was 8.5/1000 arthroscopic rotator cuff repairs over a 10-year period. Gender, age, and length of surgery were identified as predictive factors for infection. The administration of perioperative antibiotic prophylaxis significantly reduced the overall risk of infection and is therefore recommended in all-arthroscopic rotator cuff repairs. However, current prophylactic treatment strategies were not equally efficient for all types of pathogens. Retrospective comparative study, Level III.

Retrospective health-care associated infection surveillance in oral and maxillofacial reconstructive microsurgery.

In polymorbid or anaemic patients who receive preoperative radiotherapy or undergo long duration surgery involving potentially infectious sites, perioperative antibiotic prophylaxis (PAP) that is effective against normal oral bacterial flora is mandatory and plays an important role in preventing postoperative infection. In a four-year retrospective analysis, the incidence, outcome, and the efficacy of PAP were evaluated in patients treated at the Department of Oral and Maxillofacial Surgery and Otorhinolaryngology at Kecskemét Hospital. The results were compared with data from the literature to determine if the use of PAP was adequate at the Department.During the study period (between 01/09/2007 and 31/01/2011) 108 patients were evaluated. The mean duration of prophylactic antibiotic treatment was 8.3 ± 5.2 days, with cefotaxime+metronidazole being the most commonly used combination. Surgical site infection occurred in 8 patients (7.5%) in the clean-contaminated category.Our results showed that the perioperative antibiotic prophylaxis administered at our Department was efficient and effective against the oral bacterial flora of patients. Its use is recommended in head and neck microsurgery. To avoid development of antibiotic resistance and to reduce costs, it seems that the duration of antibiotic regimen for primary surgery can be reduced from 8.3 ± 5.2 days to 3 days.

Wirksamkeit und Verträglichkeit zweier Zephalosporine in der perioperativen Antibiotikaprophylaxe bei abdominalen und vaginalen Hysterektomien und gynäkologischen Laparotomien

Ziel der vorliegenden Untersuchung war es, die Wirksamkeit und Verträglichkeit zweier Zephalosporine in der perioperativen Antibiotikaprophylaxe bei Patientinnen, die einer abdominalen oder vaginalen Hysterektomie oder einer gynäkologischen Laparotomie unterzogen wurden, zu testen, um die Rate postoperativer Störungen der Wundheilung zu verringern. Insgesamt wurden 199 Patientinnen prospektiv in zwei Gruppen randomisiert. Die erste Gruppe (n = 100) erhielt perioperativ 1 g Cefotiam (Spizef^®) und 0,5 g Metronidazol (Clont^®) intravenös 30 min vor der Operation, während die zweite Gruppe (n = 99) 2 g Cefoxitin (Mefoxitin^®) intravenös erhielt, ebenfalls 30 min vor der Operation. Die Wirksamkeit der Prophylaxe wurde sowohl klinisch als auch aufgrund von laborchemischen Parametern objektiviert. Bei 97 Patientinnen (97%) der Cefotiam-Gruppe und bei 94 Patientinnen (94%) der Cefoxitin-Gruppe traten keine Wundheilungsstörungen auf. Keine postoperativen systemischen Infektionen wurden bei 81% der Cefotiam-Gruppe und 85% der Cefoxitin-Gruppe beobachtet. 98% der Patientinnen der Cefotiam-Gruppe und 97% der Patientinnen der Cefoxitin-Gruppe wiesen eine sehr gute bzw. gute Verträglichkeit der Medikation auf. In beiden Gruppen traten, durch die Antibiotikaprophylaxe bedingt, jeweils nur bei 3 Patientinnen Übelkeit bzw. Erbrechen auf. Die Untersuchung ergab im gesamten Kollektiv sehr niedrige Infektionsraten. Cefotiam in niedriger Dosierung und Metronidazol waren genauso wirksam wie Cefoxitin. Zephalosporine der zweiten Generation in Kombination mit Metronidazol können daher als sehr wirksame und nebenwirkungsarme Antibiotika bei der Prophylaxe lokaler Infektionen angesehen werden.

Ceftriaxone (single dose) versus cefoxitin (multiple doses): success and failure of antibiotic prophylaxis in 1052 cesarean sections

The efficacy of perioperative antibiotic prophylaxis in cesarean section with a single dose of ceftriaxone, a long-acting cephalosporin not widely used for prophylaxis, was tested. Ceftriaxone as a single dose of 1 g i.v. versus three doses of cefoxitin 1 g i.v. respectively were used in a prospective, randomized, controlled study consisting of 1052 patients undergoing cesarean section. Postoperative infection rate as measured by fever, endometritis and wound infection was 6.5% with ceftriaxone and 6.4% with cefoxitin. Urinary tract infections were significantly more frequent in the cefoxitin than in the ceftriaxone group (17.8% vs. 9.7%, p < 0.001). Enterococci and Escherichia coli accounted for urinary tract infections 1.86-, respectively, 4.3-fold more frequently with cefoxitin than with ceftriaxone. The time of hospitalization in patients with urinary tract infections was significantly lower with ceftriaxone than with cefoxitin (11 vs. 12 days, p < 0.05). The tolerance in both groups was equally satisfactory. A single dose of ceftriaxone, which is simple, reliable (compliance), well tolerated, inexpensive (fewer urinary tract infections and therefore fewer treatment costs than with cefoxitin) and safe (no overgrowth of pathogens) in our opinion is the antibiotic regimen of choice for prophylaxis in cesarean section in the described circumstances.

Prevention of graft infection by bonding of gentamycin to Dacron prostheses

To increase the efficacy of perioperative antibiotic prophylaxis in vascular surgery an experimental study including topical application of the gentamicin derivative EMD 46/217 and fibrin sealant as antibiotic carrier to Dacron prostheses was initiated. In vitro treatment of Dacron with gentamicin and fibrin was followed by constant antibiotic release for 3 weeks. In a subsequent animal study Dacron grafts were implanted in the aorta of 10 pigs after direct contamination with Staphylococcus aureus solution. One graft was pretreated with the antibiotic/fibrin compound, a second with the antibiotic alone. Grafts 3 (no pretreatment) and 4 (fibrin alone) served as controls. After 1 week the grafts and their corresponding implantation sites were excised for measurement of antibiotic content and for culture. The antibiotic content of grafts with the antibiotic/fibrin compound was 25.0 ± 7.2 μg/gm wet weight, whereas Dacron pretreated with the antibiotic alone contained no measurable drug amounts except for one specimen (0.5 μg/gm) (antibiotic/fibrin vs antibiotic, p < .0005). The corresponding implantation sites to antibiotic/fibrin grafts contained 1.07 ± 0.54 μg/gm antibiotic, whereas in only 2/10 implantation sites of antibiotic grafts low antibiotic levels were found (0.05 and 0.2 μg/gm) (antibiotic/fibrin vs antibiotic, p < 0.005). All control grafts and 9/10 antibiotic grafts were infected. By contrast, only five were contaminated, and 5 of 10 remained sterile after culture (antibiotic/fibrin vs antibiotic, p < 0.05). This finding correlates with the antibiotic content in the Dacron. It is concluded that pretreatment of prosthetic Dacron grafts with the antibiotic/fibrin compound results in binding of sufficient amounts of antibiotic for at least 1 week. This procedure can serve as a prophylactic tool against perioperative vascular graft infection. (J Vasc Surg 1992; 15:187–93.)

Prevention of graft infection by bonding of gentamycin to Dacron prostheses.

To increase the efficacy of perioperative antibiotic prophylaxis in vascular surgery an experimental study including topical application of the gentamicin derivative EMD 46/217 and fibrin sealant as antibiotic carrier to Dacron prostheses was initiated. In vitro treatment of Dacron with gentamicin and fibrin was followed by constant antibiotic release for 3 weeks. In a subsequent animal study Dacron grafts were implanted in the aorta of 10 pigs after direct contamination with Staphylococcus aureus solution. One graft was pretreated with the antibiotic/fibrin compound, a second with the antibiotic alone. Grafts 3 (no pretreatment) and 4 (fibrin alone) served as controls. After 1 week the grafts and their corresponding implantation sites were excised for measurement of antibiotic content and for culture. The antibiotic content of grafts with the antibiotic/fibrin compound was 25.0 +/- 7.2 micrograms/gm wet weight, whereas Dacron pretreated with the antibiotic alone contained no measurable drug amounts except for one specimen (0.5 microgram/gm) (antibiotic/fibrin vs antibiotic, p less than .0005). The corresponding implantation sites to antibiotic/fibrin grafts contained 1.07 +/- 0.54 microgram/gm antibiotic, whereas in only 2/10 implantation sites of antibiotic grafts low antibiotic levels were found (0.05 and 0.2 microgram/gm) (antibiotic/fibrin vs antibiotic, p less than 0.005). All control grafts and 9/10 antibiotic grafts were infected. By contrast, only five were contaminated, and 5 of 10 remained sterile after culture (antibiotic/fibrin vs antibiotic, p less than 0.05). This finding correlates with the antibiotic content in the Dacron. It is concluded that pretreatment of prosthetic Dacron grafts with the antibiotic/fibrin compound results in binding of sufficient amounts of antibiotic for at least 1 week.(ABSTRACT TRUNCATED AT 250 WORDS)

Perioperative Antibiotic Prophylaxis for Herniorrhaphy and Breast Surgery

We assessed the efficacy of perioperative antibiotic prophylaxis for surgery in a randomized, double-blind trial of 1218 patients undergoing herniorrhaphy or surgery involving the breast, including excision of a breast mass, mastectomy, reduction mammoplasty, and axillary-node dissection. The prophylactic regimen was a single dose of cefonicid (1 g intravenously) administered approximately half an hour before surgery. The patients were followed up for four to six weeks after surgery. Blinding was maintained until the last patient completed the follow-up and all diagnoses of infection had been made. The patients who received prophylaxis had 48 percent fewer probable or definite infections than those who did not (Mantel-Haenszel risk ratio, 0.52; 95 percent confidence interval, 0.32 to 0.84; P = 0.01). For patients undergoing a procedure involving the breast, infection occurred in 6.6 percent of the cefonicid recipients (20 of 303) and 12.2 percent of the placebo recipients (37 of 303); for those undergoing herniorrhaphy, infection occurred in 2.3 percent of the cefonicid recipients (7 of 301) and 4.2 percent of the placebo recipients (13 of 311). There were comparable reductions in the numbers of definite wound infections (Mantel-Haenszel risk ratio, 0.49), wounds that drained pus (risk ratio, 0.43), Staphylococcus aureus wound isolates (risk ratio, 0.49), and urinary tract infections (risk ratio, 0.40). There were also comparable reductions in the need for postoperative antibiotic therapy, non-routine visits to a physician for problems involving wound healing, incision and drainage procedures, and readmission because of problems with wound healing. We conclude that perioperative antibiotic prophylaxis with cefonicid is useful for herniorrhaphy and certain types of breast surgery.