Antibiotic Prophylaxis Guidelines Research Articles

Infective Endocarditis in North Africa and the Middle East, 1990‒2019: Updates from the Global Burden of Disease Study 2019.

Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI). The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website. Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five. This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures.

Antibiotic Prophylaxis and Infective Endocarditis Incidence Following Invasive Dental Procedures

The association between antibiotic prophylaxis and infective endocarditis after invasive dental procedures is still unclear. Indications for antibiotic prophylaxis were restricted by guidelines beginning in 2007. To systematically review and analyze existing evidence on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures. PubMed, Cochrane-CENTRAL, Scopus, Web of Science, Proquest, Embase, Dentistry and Oral Sciences Source, and ClinicalTrials.gov were systematically searched from inception to May 2023. Studies on the association between antibiotic prophylaxis and infective endocarditis following invasive dental procedures or time-trend analyses of infective endocarditis incidence before and after current antibiotic prophylaxis guidelines were included. Study quality was evaluated using structured tools. Data were extracted by independent observers. A pooled relative risk (RR) of developing infective endocarditis following invasive dental procedures in individuals who were receiving antibiotic prophylaxis vs those who were not was computed by random-effects meta-analysis. The outcome of interest was the incidence of infective endocarditis following invasive dental procedures in relation to antibiotic prophylaxis. Of 11 217 records identified, 30 were included (1 152 345 infective endocarditis cases). Of them, 8 (including 12 substudies) were either case-control/crossover or cohort studies or self-controlled case series, while 22 were time-trend studies; all were of good quality. Eight of the 12 substudies with case-control/crossover, cohort, or self-controlled case series designs performed a formal statistical analysis; 5 supported a protective role of antibiotic prophylaxis, especially among individuals at high risk, while 3 did not. By meta-analysis, antibiotic prophylaxis was associated with a significantly lower risk of infective endocarditis after invasive dental procedures in individuals at high risk (pooled RR, 0.41; 95% CI, 0.29-0.57; P for heterogeneity = .51; I2, 0%). Nineteen of the 22 time-trend studies performed a formal pre-post statistical analysis; 9 found no significant changes in infective endocarditis incidence, 7 demonstrated a significant increase for the overall population or subpopulations (individuals at high and moderate risk, streptococcus-infective endocarditis, and viridans group streptococci-infective endocarditis), whereas 3 found a significant decrease for the overall population and among oral streptococcus-infective endocarditis. While results from time-trend studies were inconsistent, data from case-control/crossover, cohort, and self-controlled case series studies showed that use of antibiotic prophylaxis is associated with reduced risk of infective endocarditis following invasive dental procedures in individuals at high risk, while no association was proven for those at low/unknown risk, thereby supporting current American Heart Association and European Society of Cardiology recommendations. Currently, there is insufficient data to support any benefit of antibiotic prophylaxis in individuals at moderate risk.

The impact of american urological association antibiotic prophylaxis guidelines at the time of sacral neuromodulation implantation on rates of infection

The impact of american urological association antibiotic prophylaxis guidelines at the time of sacral neuromodulation implantation on rates of infection

Performance of a Large Language Model in the Generation of Clinical Guidelines for Antibiotic Prophylaxis in Spine Surgery.

Large language models, such as chat generative pre-trained transformer (ChatGPT), have great potential for streamlining medical processes and assisting physicians in clinical decision-making. This study aimed to assess the potential of ChatGPT's 2 models (GPT-3.5 and GPT-4.0) to support clinical decision-making by comparing its responses for antibiotic prophylaxis in spine surgery to accepted clinical guidelines. ChatGPT models were prompted with questions from the North American Spine Society (NASS) Evidence-based Clinical Guidelines for Multidisciplinary Spine Care for Antibiotic Prophylaxis in Spine Surgery (2013). Its responses were then compared and assessed for accuracy. Of the 16 NASS guideline questions concerning antibiotic prophylaxis, 10 responses (62.5%) were accurate in ChatGPT's GPT-3.5 model and 13 (81%) were accurate in GPT-4.0. Twenty-five percent of GPT-3.5 answers were deemed as overly confident while 62.5% of GPT-4.0 answers directly used the NASS guideline as evidence for its response. ChatGPT demonstrated an impressive ability to accurately answer clinical questions. GPT-3.5 model's performance was limited by its tendency to give overly confident responses and its inability to identify the most significant elements in its responses. GPT-4.0 model's responses had higher accuracy and cited the NASS guideline as direct evidence many times. While GPT-4.0 is still far from perfect, it has shown an exceptional ability to extract the most relevant research available compared to GPT-3.5. Thus, while ChatGPT has shown far-reaching potential, scrutiny should still be exercised regarding its clinical use at this time.

Knowledge and Attitude Toward Antibiotic Prescription Among Dental Students and Interns at Multiple Universities in Saudi Arabia.

Dental students in Saudi Arabia are authorized to write prescriptions for antibiotics during practical training. Adverse side effects and resistance could result from inappropriate prescription. Accordingly, there is a need to evaluate the knowledge of dental students regarding guidelines and applications of antibiotic prescription. To assess the knowledge and attitude toward guidelines and applications of antibiotic prescription among dental students and interns at multiple universities in Saudi Arabia. A cross-sectional study was conducted among dental students in their final clinical years (4th to 6th year) and dental interns. The study data were collected using a valid and reliable structured questionnaire comprising three domains: 1) demographic characteristics, 2) knowledge, and 3) attitude toward antibiotic prescription for dental and systemic conditions. The data were analyzed and presented as frequency percentages, and the chi-square test was used to compare the knowledge and attitude items between the dental students and interns. The statistical significance level was set at p ≤ 0.05. A total of 248 participants (women: 55.6%, men: 44.4%) were included in the study. Approximately 21.8% were 4th year students; 17.7%, 5th year students; 12.9%, 6th year students; and 47.6%, interns. For most items, the knowledge level was relatively high, and the attitude was generally positive among the participants. Approximately, 87.1% had good knowledge about current guidelines for antibiotic prophylaxis, 83.9% about antibiotic prescription, and 95.2% about antibiotic resistance. The interns showed significantly higher knowledge levels and favorable attitude, particularly for guidelines and applications of antibiotic prescription and correct use of antibiotics for oral cases, than did the students. Amoxicillin was the most frequently prescribed antibiotic among the participants. The interns and 6th-year students demonstrated a relatively high knowledge level and positive attitude toward appropriate antibiotic prescriptions. However, deficiencies were observed among the students in their early clinical years, particularly for systemic conditions. These findings highlight the importance of implementing educational campaigns and providing guidelines to promote the appropriate use of antibiotics among dental students in their final clinical years.

Contemporary Prophylactic Antibiotic Practices and Adjunct Therapies in Autologous Fat Grafting Procedures: A Survey of The Aesthetic Society Members

Abstract Background Autologous fat grafting (AFG) is a widely used surgical technique that involves extracting a patient's own adipose tissue and transferring it to different areas of the body. This practice is still evolving. Guidelines for antibiotic prophylaxis and use of adjuncts in plastic surgery are currently limited, with a notable absence of standardized guidelines for AFG. Objectives In this survey, we assess contemporary antibiotic practices and adjuncts in AFG procedures. Methods A 52-question survey was emailed to 3106 active members of The Aesthetic Society. Two hundred and ninety-three responses were recorded, representing a 9% response rate. Results We analyzed 288 responses. The most common AFG procedures were facial (38%), gluteal (34%), and breast (27%) augmentation. Preoperative antibiotics were used by 84.0% overall, with rates of 74.3%, 88.0%, and 92.7% in face, breast, and gluteal AFG, respectively. Lipoaspirate–antibiotic mixing was reported by 19.8%, mainly during gluteal AFG (46.9%), and less so in face (2.8%) and breast (8%) AFG. Notably, 46.9% of surgeons administered prolonged prophylaxis for 72 h or more. Tranexamic acid was utilized by 39.9% of the surveyed surgeons. Platelet-rich plasma was used by 5.6%. Doppler ultrasound was incorporated by 16.7% in AFG, with 21.5% in gluteal AFG, 14% in the face, and 19% in breast procedures. Conclusions In this survey, we offer insights into antibiotic practices and adjunct therapies in AFG, especially intraoperative antibiotic mixing. Practices among members of The Aesthetic Society vary from guidelines. It is crucial to standardize practices and conduct further research to pave the way for evidence-based guidelines in AFG. Level of Evidence: 5

Effectiveness of integrated prophylactic antibiotics prescription in patients undergoing radiofrequency and microwave ablation of liver tumors: a retrospective cohort study

An institutionalised in-house antibiotic prophylaxis (AP) guideline was developed in May 2019 to standardize AP prescription. This retrospective cohort study evaluated the effectiveness and clinical outcomes of the newly launched AP guideline on patients undergoing radiofrequency (RFA) and microwave (MWA) ablation of the liver from November 2018 to March 2020. Patients without high risk of biliary tree contamination were recommended a single dose of 2g IV cefazolin (or 600mg IV clindamycin in cases of beta-lactam allergy). Univariate analysis was conducted to evaluate the clinical outcomes.
 
 The study included 87 patients who underwent 93 procedures consisting of 18 RFAs and 75 MWAs for liver tumours. Concordance with AP guidelines improved significantly (38.5% vs. 87.0%; p<0.001). There were no ablation-related infections and mortality within 30 days post-ablation, and post-procedural nausea and vomiting were significantly reduced (15.4% vs. 1.9%; p=0.020). No significant difference in post-procedural fever (7.7% vs. 5.6%; p-value=0.693), chest and/or abdominal pain (5.1% vs. 7.4%; p=1.000) were noted.
 
 The newly implemented in-house antibiotic prophylaxis guideline streamlined AP prescribing in patients undergoing RFA and MWA. Additional research is needed to determine the effects on infection and mortality in patients with high-risk factors such as bile duct stents, sphincterotomies, and biliary-enteric anastomoses.

EGS P13 Adherence to Guidelines for Post-Splenectomy Patients in a Primary Care Practice in North West England

Abstract Background Splenectomy is indicated in haematological, oncological disorders and occasionally during emergency (trauma) surgery. Given the spleens role in the immunological response, overwhelming infection remains an area of concern for post-splenectomy patients with low prevalence (0.1-0.5%) but high mortality (∼50%). Strep pneumoniae, H influenzae Type B and Neisseria meningitidis are common bacterial perpetrators. At present, Public Health England and the British Society for Haematology recommends regular influenza, pneumococcal and meningococcal vaccinations for patients with asplenia or hyposplenism. They should also be on lifelong prophylactic antibiotics. This audit aimed to assess the adherence to vaccination and antibiotic prophylaxis guidelines for post-splenectomy patients. Methods 19 patients post splenectomy patients were identified at a primary care practice in North West England. Data was retrospectively collected from the last 10 years with two researchers manually searching through their GP records. Parameters collected included both compliance and timeliness with vaccinations and antibiotic prophylaxis as per national guidance. Where there was a deviation from the guidance, the records were again searched to identify any cause. Results 109/162 (67.3%) ‘vaccination opportunities’ for the recommended yearly influenza vaccination were successfully delivered. 17/19 (89.4%) patients had no documented initial pneumococcal vaccination at time of splenectomy. 23/162 (14.2%) influenza and 22/37 (56.4%) pneumococcal vaccination opportunities were missed with no documentation explaining why. Only 1 patient received the recommended MenACWY/MenB vaccination at diagnosis, 5 received delayed vaccinations and 13/19 (68.4%) patients received no meningitis vaccination. 7/19 (37%) patients were not on prophylactic antibiotics as recommended with no documented explanation. 2 of those patients were issued one-off antibiotic prescriptions and 1 had their prescription stopped due to non-compliance. Conclusions Significant improvement is needed with regards to antibiotic prophylaxis, pneumococcal and meningococcal vaccinations with over 50% of vaccinations being missed. Poor documentation and a shift to electronic health records are possible factors that have affected data collection, particularly as a significant number of the splenectomies performed were prior to 2000. Recommendations include routine reviews for asplenic patients, encouragement for opportunistic vaccination and increasing awareness of the risks of post-splenectomy sepsis and the benefits of vaccinations. Future scope could include looking at the same guidelines for other hyposplenic/asplenic conditions.

Antibiotic Utilization and Prophylaxis in Paediatric Cardiac Surgery: A Retrospective Observational Study at a Rural Tertiary Care Hospital in India.

Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.

699 Audit of Post-Splenectomy Patients in Primary Care

Abstract Aim To describe the demographics of a large general practices post-splenectomy patient population (including sex, age, and indication for splenectomy), and audit of cohort's care against national immunisation and antibiotic prophylaxis guidelines. Method All adult patients registered with the practice who had undergone surgical splenectomy were included. Included patients’ medical records were reviewed and data including sex; age; date and indication of splenectomy; immunisation history; and drug history were collected. Results Fifteen of approximately 13,000 registered patients were coded for having previously undergone surgical splenectomy. The main indications included trauma; haematological disease; major intra-abdominal resection. Patient cohort were of an older patient population (mean age 69) having undergone splenectomy several years previously (mean 39 years ago). Three patients had outstanding pneumococcal vaccine in the past five years, however there was 100% compliance with annual influenza vaccine. All patients had received a minimum of two COVID vaccinations. Variation in prescribed phenoxymethylpenicillin dose, with two patients on incorrect antibiotic prophylaxis, and four patients without antibiotic prophylaxis. Conclusions Despite our small patient cohort, this audit highlighted variation and deficiencies in patient care, and has led to a recall of patients with outstanding pneumococcal vaccination and review of antibiotic prophylaxis offered to patients. Additionally, there is no national recommendation that post-splenectomy patients should be offered an annual COVID booster. We recommend that this is reviewed urgently by public health officials due to an increased risk of secondary pneumococcal infection with COVID infection, which may be life-threatening.

Utilization of Prophylactic Antibiotics for Cardiac Patients Undergoing Dental Procedures in Saudi Arabia: A Retrospective Study.

This study aimed to determine the characteristics of antibiotic prophylaxis (AP) utilization and the level of adherence of King Saud University Medical City (KSUMC) staff to the latest American Heart Association (AHA) guidelines for AP for infective endocarditis (IE) in cardiac patients undergoing dental procedures. The study was conducted as a retrospective cohort study to investigate the relationship between AP in dental procedures and cardiac patients admitted in the surgical wards of KSUMC between 2015 and 2021. All cardiac patients who underwent dental procedures were included in the study. We excluded patients with long-term or concurrent antibiotic use for other indications. Overall, 170 (69.4%) cardiac patients received AP before undergoing a dental procedure. The most common comorbidities were hypertension (39.1%) and diabetes (34.2%). Most of the low-risk (69.4%) and moderate-risk (70.5%) patients received AP, despite the guideline's recommendation to limit AP to high-risk patients only. Moreover, only 53.8% of high-risk patients were prescribed AP. In total, 95.9% of the 170 patients who received AP did so without following the recommendations. Only one patient developed IE during the 1-year follow-up. Tooth extraction was the only significant predictor of AP prescription in our study (P = 0.001; OR: 3.73; 95% CI; 1.678-8.298). There was an exceeding level of inconsistency (95.9%) in AP utilization by cardiac patients in our sample compared with the recommendations of the latest AHA guidelines.

A survey of Asian Eye Institutions on perioperative antibiotic prophylaxis in cataract surgery

PurposeTo determine current institutional practice patterns for the use of perioperative antibiotics and other measures to prevent infection after cataract surgery in Asia.MethodsAn online survey-based study of leading eye institutions in China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam was conducted. The survey was administered to 26 representative key opinion leaders from prominent tertiary eye institutions that are also national academic teaching institutions in Asia. Survey responses were collated and anonymized during analysis.ResultsAll surveyed institutions used povidone iodine for the preoperative antiseptic preparation of the eye, with notable variations in the concentration of povidone iodine used for conjunctival sac instillation. Preoperative topical antibiotics were prescribed by 61.5% and 69.2% of institutions in low-risk and high-risk cases, respectively. Regarding the use of intra-operative antibiotics, 60.0% and 66.7% of institutions administered intracameral antibiotics in low-risk and high-risk patients, respectively. Postoperative topical antibiotics use patterns were generally very similar in low-risk and high-risk patients. Over half of the institutions (52.2% and 68.0% in low-risk and high-risk patients, respectively) also indicated prolonged postoperative use of topical antibiotics (> 2 weeks). Not all surveyed institutions had established policies/protocols for perioperative antibiotic use in cataract surgery, endophthalmitis surveillance, and/or a monitoring program for emerging antimicrobial resistance.ConclusionThere are variations in antimicrobial prophylaxis approaches to preoperative, intra-operative and postoperative regimens in cataract surgery in Asia. More evidence-based research is needed to support the development of detailed guidelines for perioperative antibiotic prophylaxis to reduce postoperative infections.

The use of antibiotic prophylaxis in patients undergoing urologic procedures in an academic hospital Surabaya: A retrospective study.

Prophylactic antibiotics in urological procedures are essential to prevent postoperative infections. A different approach in selecting antibiotic prophylaxis according to the type of procedure is needed. A retrospective study was carried out at an academic hospital in Surabaya, Indonesia, by collecting medical records of patients who underwent urologic procedures within 2019- 2020, including microbiological data. One hundred seventy-nine urological procedures were assessed. Antibiotic prophylaxis was administered in the clean-contaminated and clean procedures (93.2% and 6.8%, respectively). Ceftriaxone was commonly used (69.3%), single-dose, one day before the surgery. Gram-negative bacteria were widely found in the urinary culture of patients (75.2%). E. coli, K. pneumoniae, and P. aeruginosa were dominating with low susceptibility to cephalosporins. ESBL-producing bacteria were E. coli (64%) and K. pneumoniae (89%). The 3rd generation cephalosporins (ceftriaxone) are mostly used in urological procedures despite the low susceptibility against this antibiotic in cultured E coli, P. aeruginosa, and K. pneumonia. The aminoglycosides have relatively good activity and have been suggested in several guidelines for urologic procedures, such as prostate and urinary tract stone procedures. It is crucial to consider the incision site, type of procedure, and bacterial profile in the hospital to propose antibiotic prophylaxis guidelines.

O172 Room for improvement: a multi-centre audit of our current compliance with surgical antibiotic prophylaxis guidelines in Ireland

Abstract Introduction In 2017, a national point prevalence study in Ireland showed low compliance with Surgical Antibiotic Prophylaxis (SAP) duration, with 70% of prescriptions exceeding recommended duration. We hypothesise that there has been little improvement since then and we aim to define our compliance issues more broadly than duration alone. Methods To assess compliance with SAP guidelines at a locally, a multi-site audit was conducted over a 14-day period in July 2022. Data was collected at one major, public hospital and one private hospital, both in the Dublin region. Procedures performed in an operating theatre from all surgical specialties were audited. Results A total of 303 procedures were audited across both sites with 165 public and 138 private included. Overall, compliance with local SAP guidance, according to indication, duration and agent was present in 72 patients (23.7%). Performance in both centres was similar (22% public versus 26% private). Of patients in whom SAP was indicated, all 182 (100%) received it. 91 patients (30%), had no indication for SAP. 19 patients (21.1%) still received SAP despite having no indication. Antibiotic duration surpassed 48 h in 58 (25%) procedures, with 40 (17.5%) receiving antibiotic prophylaxis for more than 6 days. Compliance with appropriate agent recommendation was 43.5%. Conclusion Compliance with SAP guidance is low. Despite contrasting work processes in public versus private settings, compliance with SAP guidelines are similar. Work is currently underway to identify barriers to compliance in order to implement quality improvement initiatives and to address this.

Auto-Substitutions to Optimize Perioperative Antimicrobial Prophylaxis: Pre-Post Intervention Study.

Appropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology-Head and Neck Surgery (OHNS). The objective of the study is to achieve 90% compliance with evidence-based perioperative antibiotic prophylaxis guidelines among elective surgical procedures in OHNS. The pre-intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019-2020) whereas the post-intervention group comprised patients undergoing elective procedures during the 8 months following the implementation (October 2020-May 2021). The 4 Es of knowledge translation and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self-reported perception of following evidence-based guidelines. Compliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall compliance improved from 38.8% pre-intervention to 59.0% post-intervention (p < 0.001). Agent compliance did not improve from pre- to post-intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence-based antimicrobial prophylaxis guidelines. Compliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compliance. Future interventions will target agent compliance and selected procedures with lower compliance rates. 3 Laryngoscope, 133:3403-3408, 2023.

Bacterial Contamination of Open Fractures: Pathogens and Antibiotic Resistance Patterns in East China.

Bacterial contamination of soft tissue in open fractures leads to high infection rates. Pathogens and their resistance against therapeutic agents change with time and vary in different regions. The purpose of this study was to characterize the bacterial spectrum present in open fractures and analyze the bacterial resistance to antibiotic agents based on five trauma centers in East China. A retrospective multicenter cohort study was conducted in six major trauma centers in East China from January 2015 to December 2017. Patients who sustained open fractures of the lower extremities were included. The data collected included the mechanism of injury, the Gustilo-Anderson classification, the isolated pathogens and their resistance against therapeutic agents, as well as the prophylactic antibiotics administered. In total, 1348 patients were included in our study, all of whom received antibiotic prophylaxis (cefotiam or cefuroxime) during the first debridement at the emergency room. Wound cultures were taken in 1187 patients (85.8%); the results showed that the positive rate of open fracture was 54.8% (651/1187), and 59% of the bacterial detections occurred in grade III fractures. Most pathogens (72.7%) were sensitive to prophylactic antibiotics, according to the EAST guideline. Quinolones and cotrimoxazole showed the lowest rates of resistance. The updated EAST guidelines for antibiotic prophylaxis in open fracture (2011) have been proven to be adequate for a large portion of patients, and we would like to suggest additional Gram-negative coverage for patients with grade II open fractures based on the results obtained in this setting in East China.

Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals.

Surgical site infections (SSI) can be as high in gynecology and obstetrics surgeries compared to other areas. Antimicrobial prophylaxis is an effective tool in the prevention of SSIs; however, it is often not adequately administered, so this study aimed to understand the compliance and factors associated with the use of the clinical practice guidelines for antibiotic prophylaxis in gynecological surgeries in two hospitals in the city of Huanuco, Peru. An analytical cross-sectional study of all gynecologic surgeries performed during 2019 was performed. Compliance was determined based on the antibiotic chosen, dose, administration time, redosing, and prophylaxis duration. Age, hospital of origin, presence of comorbidities, surgery performed, as well as its duration, types of surgery, and anesthesia were considered as related factors. We collected 529 medical records of patients undergoing gynecological surgery with a median age of 33 years. The prophylactic antibiotic was correctly indicated in 55.5% of cases, and the dose was correct in 31.2%. Total compliance with the five variables evaluated was only 3.9%. Cefazolin was the most commonly used antibiotic. Low compliance with the institutional clinical practice guidelines for antibiotic prophylaxis was identified, showing that antimicrobial prophylaxis in the hospitals studied was inadequate.

Are self-reported anthropometric data reliable enough to meet antibiotic prophylaxis guidelines in orthopedic surgery?

BackgroundSurgical site infection is a serious complication in orthopedic surgery. The use of antibiotic prophylaxis (AP) combined with other prevention strategies has been shown to reduce this risk to 1% for hip arthroplasty and 2% for knee arthroplasty. The French Society of Anesthesia and Intensive Care Medicine (SFAR) recommends doubling the dose when the patient's weight is greater than or equal to 100 kg, and the body mass index (BMI) is greater than or equal to 35 kg/m2. Similarly, patients with a BMIgreater than40 kg/m2 orlesser than18 kg/m2 are ineligible for surgery in our hospital. Self-reported anthropometric measurements are commonly used in clinical practice to calculate BMI, but their validity has not been assessed in the orthopedic literature. Therefore, we conducted a study comparing self-reported with systematically measured values and observed the impact these differences may have on perioperative AP regimens and contra-indications to surgery. HypothesisThe hypothesis of our study was that self-reported anthropometric values differed from those measured during preoperative orthopedic consultations. Materials and methodsThis single-center retrospective study with prospective data collection was conducted between October and November 2018. The patient-reported anthropometric data were first collected and then directly measured by an orthopedic nurse. Weight was measured with a precision of 500 g and height was measured with a precision of 1 cm. ResultsA total of 370 patients (259 women and 111 men) with a median age of 67 years (17–90) were enrolled. The data analysis found significant differences between the self-reported and measured height [166 cm (147–191) vs. 164 cm (141–191) (p<0.0001)], weight [72.9 kg (38–149) vs. 73.1 kg (36–140) (p<0.0005)] and BMI [26.3 (16.2–46.4) vs. 27 (16–48.2) (p<0.0001)]. Of these patients, 119 (32%) reported an accurate height, 137 (37%) an accurate weight, and 54 (15%) an accurate BMI. None of the patients had two accurate measurements. The maximum underestimation was 18 kg for weight, 9 cm for height, and 6.15 kg/m2 for BMI. The maximum overestimation was 28 kg for weight, 10 cm for height, and 7.2 kg/m2 for BMI. The verification of the anthropometric measurements identified another 17 patients who had contra-indications to surgery (12 with a BMI>40 kg/m2 and 5 with a BMI<18 kg/m2) and who would not have been detected based on the self-reported values. ConclusionsAlthough patients underestimated their weight and overestimated their height in our study, these had no impact on the perioperative AP regimens. However, this misreporting failed to detect potential contraindications to surgery. Level of evidenceIV; retrospective study with prospective data collection and no control group.

Microbiologic and Clinical Description of Postoperative Central Nervous System Infection After Endoscopic Endonasal Surgery

Consensus guidelines for antibiotic prophylaxis in endoscopic endonasal surgery (EES) have not been developed. The study objective was to define the microbiologic and clinical characteristics of post-EES central nervous system (CNS) infections. This was a single-center retrospective study of patients >18 years of age who underwent EES between January 2010 and July 2021 at a high-volume skull base center. Patients with confirmed CNS infection within 30 days of EES were included. During the study period, the standard prophylaxis regimen was ceftriaxone 2 g every 12 hours for 48 hours. For patients with a documented penicillin allergy, vancomycin plus aztreonam was recommended. In total, 2440 EES procedures were performed on 2005 patients; the CNS infection rate was 1.8% (37/2005). CNS infections were more common among patients with a history of previous EES (6.5%; 20/307) compared with those who did not (1%; 17/1698; P < 0.001). The median time from EES to CNS infection was 12 (6-19) days. Thirty-two percent (12/37) of CNS infections were polymicrobic, which was more common among patients without previous EES (52.9%; 9/17) compared with those with previous EES (15%; 3/20; P= 0.03). Across all cases, Staphylococcus aureus (n= 10) and Pseudomonas aeruginosa (n= 8) were commonly isolated pathogens. Among those with confirmed methicillin-resistant Staphylococcus aureus (MRSA) nares colonization before EES, 75% (3/4) developed MRSA CNS infections compared with 6.1% (2/33) of noncolonized patients (P= 0.005). CNS infection after EES is rare and causative pathogens vary. Further studies are needed to identify the impact of MRSA nares screening on antimicrobial prophylaxis before EES.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.

Antibiotics for Dental Implant Surgery: Extracting Available Evidence, Risks, Benefits, and Insights to Consider.