Parenteral Antibiotic Prophylaxis Research Articles

Current state of the issue of antibiotic prophylaxis and antibiotic therapy in colorectal surgery. Literature review

The article presents a modern view on the problem of antibiotic prophylaxis and antibiotic therapy in colorectal surgery. This study reflects the key microbiological aspects of drug selection and algorithms for parenteral and oral antibiotic prophylaxis. The section of antibiotic therapy contains relevant information about the initial empirical therapy and the de-escalation principles, including the aspect of antibiotic resistance.

Commentary to ‘Is parenteral antibiotic prophylaxis associated with fewer infectious complications stented, distal hypospadias repair?’

In this report, Doersch and co-authors address the controversy of the use of antibiotics for hypospadias repair [ [1] Doersch K. Logvinenko T. Nelson C. Is parenteral antibiotic prophylaxis associated with fewer infectious complications stented, distal hypospadias repair?. J Pediatr Urol. 2022; 18: 759-763 Google Scholar ]. The two reasons to consider antibiotic prophylaxis during hypospadias repair are to reduce wound infections and symptomatic urine infections associated with a catheter. Both of these are quite uncommon, as shown in this study reporting only a single infectious complication in 100 boys undergoing distal repairs without preoperative parenteral antibiotics, and no infections in those not receiving postoperative antibiotics. Is parenteral antibiotic prophylaxis associated with fewer infectious complications in stented, distal hypospadias repair?Journal of Pediatric UrologyVol. 18Issue 6PreviewJudicious use of antibiotics for surgical prophylaxis is important for reducing antimicrobial resistance while preventing infectious surgical complications. In the setting of pediatric distal hypospadias repairs, it is unclear if antibiotic surgical prophylaxis is beneficial. Full-Text PDF

Is parenteral antibiotic prophylaxis associated with fewer infectious complications in stented, distal hypospadias repair?

Judicious use of antibiotics for surgical prophylaxis is important for reducing antimicrobial resistance while preventing infectious surgical complications. In the setting of pediatric distal hypospadias repairs, it is unclear if antibiotic surgical prophylaxis is beneficial. The purpose of this study was to compare rates of infectious complications in pediatric subjects undergoing distal hypospadias repair who received any peri-operative antibiotics to those who did not. This was a review of a retrospective cohort from a database of individuals undergoing hypospadias repairs evaluating whether they received peri-operative or post-operative antibiotic prophylaxis and determining the rate of infectious complications in those who did compared to those who did not receive antibiotic prophylaxis. Infectious complications were defined as surgical site infection (SSI) or urinary tract infection (UTI). There was no significant difference in infectious complication rates between individuals who received peri-operative parenteral antibiotic prophylaxis and those who did not. All subjects with infectious complications received post-operative oral antibiotic prophylaxis. There was one instance of C. difficile infection in a subject who received peri-operative parenteral antibiotics. Reducing antibiotic utilization without increasing infectious surgical complications is important in safely reducing antimicrobial resistance. In this study of pediatric distal hypospadias repair, peri-operative antibiotics did not demonstrate a clear benefit and post-operative oral antibiotics demonstrated no benefit in preventing infectious complications. Other studies evaluating peri- and post-operative antibiotics for pediatric hypospadias repair have also failed to demonstrate a benefit for antibiotics in preventing infections. Practitioners should reconsider the use of antibiotics in this setting. Routine antibiotic prophylaxis does not appear beneficial for preventing infectious complications following uncomplicated, stented pediatric distal hypospadias repairs.

Oral and Parenteral vs. Parenteral Antibiotic Prophylaxis for Patients Undergoing Laparoscopic Colorectal Resection: An Intervention Review with Meta-Analysis.

This study aims to systematically assess the efficacy of parenteral and oral antibiotic prophylaxis compared to parenteral-only prophylaxis for the prevention of surgical site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer resection. Published and unpublished randomized clinical trials comparing the use of oral and parenteral prophylactic antibiotics vs. parenteral-only antibiotics in patients undergoing laparoscopic colorectal surgery were collected searching electronic databases (MEDLINE, CENTRAL, EMBASE, SCIENCE CITATION INDEX EXPANDED) without limits of date, language, or any other search filter. The outcomes included SSIs and other infectious and noninfectious postoperative complications. Risk of bias was assessed using the Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2). A total of six studies involving 2252 patients were finally included, with 1126 cases in the oral and parenteral group and 1126 cases in the parenteral-only group. Meta-analysis results showed a statistically significant reduction of SSIs (OR 0.54, 95% CI 0.40 to 0.72; p < 0.0001) and anastomotic leakage (OR 0.55, 95% CI 0.33 to 0.91; p = 0.02) in the group of patients receiving oral antibiotics in addition to intravenous (IV) antibiotics compared to IV alone. Our meta-analysis shows that a combination of oral antibiotics and intravenous antibiotics significantly lowers the incidence of SSI compared with intravenous antibiotics alone.

1146 Use of Prophylactic Oral Antibiotics in Preventing Postoperative Surgical Site Infections in Elective Colorectal Surgery – A Review

Abstract Aim To prevent postoperative surgical site infections (SSIs), prophylactic oral antibiotics (OA) administration in combination with mechanical bowel preparation (MBP) and prophylactic parenteral (IV) antibiotics have been a preoperative procedure in elective colorectal surgery. Hence, the aim of this article is to review the effectiveness of prophylactic OA in preventing SSIs in elective colorectal surgery. Method PubMed and Scopus databases were searched. Search criteria included keywords such as antibiotic prophylaxis, oral antibiotic prophylaxis, parenteral antibiotic prophylaxis, postoperative surgical site infection and colorectal surgery. Selection criteria included any randomised controlled trials (RCTs) which investigated the effectiveness of prophylactic OA, with or without prophylactic IV antibiotics in preventing SSIs in elective colorectal surgery in adult population, published from the years 2010 onwards. Only full text studies and papers published in English language were chosen. Results Ten RCTs were included in this study. Studies indicated that OA alone could significantly reduce the risk of postoperative SSIs (p &amp;lt; 0.05). Further analysis of these studies showed that in the presence of IV antibiotic prophylaxis, there is an even greater reduction in the risk of SSIs (P &amp;lt; 0.05). However, an article by Hjalmarsson et al. showed that there was a significantly greater rate of incisional SSIs in prophylactic OA group in comparison to prophylactic IV antibiotics group (P &amp;lt; 0.022). Conclusions These studies indicate that OA in combination with IV antibiotic prophylaxis is superior to either IV antibiotic prophylaxis or OA prophylaxis respectively. Hence, it is advisable to administer a combined OA and IV antibiotic prophylaxis in elective colorectal surgery.

Selective digestive decontamination, a seemingly effective regimen with individual benefit or a flawed concept with population harm?

Selective digestive decontamination (SDD) regimens, variously constituted with topical antibiotic prophylaxis (TAP) and protocolized parenteral antibiotic prophylaxis (PPAP), appear highly effective for preventing ICU-acquired infections but only within randomized concurrent control trials (RCCT’s). Confusingly, SDD is also a concept which, if true, implies population benefit. The SDD concept can finally be reified in humans using the broad accumulated evidence base, including studies of TAP and PPAP that used non-concurrent controls (NCC), as a natural experiment. However, this test implicates overall population harm with higher event rates associated with SDD use within the ICU context.

Structural equation modeling the \u201ccontrol of gut overgrowth\u201d in the prevention of ICU-acquired Gram-negative infection

BackgroundConceptually, the “control of gut overgrowth” (COGO) is key in mediating prevention against infection with Gram-negative bacilli by topical antibiotic prophylaxis, a common constituent of selective digestive decontamination (SDD) regimens. However, the relative importance of the other SDD components, enteral and protocolized parenteral antibiotic prophylaxis, versus other methods of infection prevention and versus other contextual exposures cannot be resolved within individual studies.MethodsSeven candidate generalized structural equation models founded on COGO concepts were confronted with Pseudomonas and Acinetobacter bacteremia as well as ventilator-associated pneumonia data derived from > 200 infection prevention studies. The following group-level exposures were included in the models: use and mode of antibiotic prophylaxis, anti-septic and non-decontamination methods of infection prevention; proportion receiving mechanical ventilation; trauma ICU; mean length of ICU stay; and concurrency versus non-concurrency of topical antibiotic prophylaxis study control groups.ResultsIn modeling Pseudomonas and Acinetobacter gut overgrowth as latent variables, anti-septic interventions had the strongest negative effect against Pseudomonas gut overgrowth but no intervention was significantly negative against Acinetobacter gut overgrowth. Strikingly, protocolized parenteral antibiotic prophylaxis and concurrency each have positive effects in the model, enteral antibiotic prophylaxis is neutral, and Acinetobacter bacteremia incidences are high within topical antibiotic prophylaxis studies, moreso with protocolized parenteral antibiotic prophylaxis exposure. Paradoxically, topical antibiotic prophylaxis (moreso with protocolized parenteral antibiotic prophylaxis) appears to provide the strongest summary prevention effects against overall bacteremia and overall VAP.ConclusionsStructural equation modeling of published Gram-negative bacillus infection data enables a test of the COGO concept. Paradoxically, Acinetobacter and Pseudomonas bacteremia incidences are unusually high among studies of topical antibiotic prophylaxis.

Oral + Parenteral Antibiotic Prophylaxis in Colonic Surgery With Mechanical Bowel Preparation vs. no Mechanical Bowel Preparation.

Oral + Parenteral Antibiotic Prophylaxis in Colonic Surgery With Mechanical Bowel Preparation vs. no Mechanical Bowel Preparation.

Studies of selective digestive decontamination as a natural experiment to evaluate topical antibiotic prophylaxis and cephalosporin use as population-level risk factors for enterococcal bacteraemia among ICU patients.

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) regimens appear protective against ICU-acquired overall bacteraemia. These regimens can be factorized as topical antibiotic prophylaxis (TAP) with (SDD) or without (SOD) protocolized parenteral antibiotic prophylaxis (PPAP) using cephalosporins. Both TAP and cephalosporins are risk factors for enterococcal colonization although their impact on enterococcal bacteraemia within studies of SDD/SOD remains unclear. To benchmark the enterococcal bacteraemia incidence within component (control and intervention) groups of SDD/SOD studies among ICU patients versus studies without intervention (observational groups). The literature was searched for SDD/SOD studies reporting enterococcal bacteraemia incidence data. In addition, component groups of studies of various non-antibiotic interventions served to provide additional points of reference. The mean incidence per 100 patients (and 95% CI) for enterococcal bacteraemia among 19 SDD/SOD studies was equally increased among concurrent control (2.1; 1.0%-4.7%) and intervention (2.3; 2.0%-2.7%) groups versus the benchmark incidence (0.8; 0.6%-1.2%) derived from 16 observational study groups and also versus 9 component groups from non-antibiotic studies. These higher incidences remained apparent (P < 0.02) in a meta-regression model adjusting for groupwide factors such as PPAP use, mechanical ventilation proportion, group mean length of stay >7 days and publication year. The incidences of enterococcal bacteraemia within both concurrent control and intervention groups of SDD/SOD studies are unusually high compared with the literature-derived benchmark. The impact of parenteral cephalosporin used as PPAP additional to TAP on enterococcal bacteraemia incidence was indeterminate in this analysis.

Prelabour rupture of membranes (PROM) at term: prognostic factors and neonatal consequences

La rupture prématurée des membranes (RPM) à terme survient dans 5 à 10% des grossesses. Elle rend compte d'une part importante de morbidité et de mortalité néonatales. Le but de cette étude est de déterminer les facteurs pronostiques maternels et obstétricaux ainsi que le devenir des nouveau-nés à terme issus d'une grossesse compliquée de rupture prématurée des membranes ayant été hospitalisés au service ou gérés à la consultation externe. Etude rétrospective, analysant toutes les observations de nouveau-nés à terme issus de grossesses compliquées de RPM, enregistrées au service de néonatologie de l'hôpital d'enfants de Rabat entre le 1er janvier et le 31 juillet 2014. Au cours de la période d'étude nous avons colligé 144 cas de RPM isolée sur un total de 2400 naissances vivantes (NV) soit une prévalence de 6% NV, répartis comme suit : 06 cas de RPM (4%) entre 6 et 12 heures, 14 cas (9,7%) entre 12 et 18 heures, 28 cas (19,4%) entre 18 et 24 heures et 96 cas (66,6%) supérieure à 24 heures. La majorité de nos parturientes étaient dans la tranche d'âge de 25 à 35ans avec un taux de 52%. Une chorioamniotite associée a été retenue dans 8,3% des cas. Les parturientes ont été mises sous antibiothérapie prophylactique par voie orale ou parentérale dans 28% des cas, avec un liquide amniotique clair dans 81% des cas. Le diagnostic d'IMF probable a été retenu dans 46 cas dont 65.2 % dans le sous groupesupérieur à 18 h versus respectivement 26% et 8,7% dans les sous groupe 12 à 18 h et inférieur à 12 h. A l'admission, on a noté une prédominance masculine avec 58,3%, les nouveau-nés étaient asymptomatiques dans 76% des cas et ils présentaient une détresse respiratoire dans 42,8% des cas, un ictère dans 31,45% des cas, une fièvre dans 14,2% des cas et des signes de souffrance neurologique dans 11,5% des cas. Tous les nouveau-nés hospitalisés, soit dans 72% des cas, ont été mis sous antibiothérapie pendant une durée allant de 5 à 10 jours avec une durée d'hospitalisation moyenne de 2,44jours. Ce travail souligne le risque important d'IMF associé à une RPM même à terme. Ce risque est d'autant plus important que la rupture est supérieure à 24 heures de temps. Dans la majorité des cas le liquide amniotique est clair et les nouveau-nés sont asymptomatiques à l'admission, ce qui laisse la mise sous antibiothérapie automatiquement de ces nouveau-nés un sujet encore très discutable.

Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01).

The incidence of surgical site infection (SSI) is reportedly lower in laparoscopic colorectal surgery than in open surgery, but data on the difference in SSI incidence between colon and rectal laparoscopic surgeries are limited. The incidence and risk factors for SSI, and the effect of oral antibiotics in colon and rectal laparoscopic surgeries, were investigated as a sub-analysis of the JMTO-PREV-07-01 (a multicenter, randomized, controlled trial of oral/parenteral vs. parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery). A total of 582 elective laparoscopic colorectal resections, comprising 376 colon surgeries and 206 rectal surgeries, were registered. The incidence of SSI in rectal surgery was significantly higher than in colon surgery (14 vs. 8.2%, P=0.041). Although the incidence of incisional SSI was almost identical (7%) between the surgeries, the incidence of organ/space SSI in rectal surgery was significantly higher than in colon surgery (6.3 vs. 1.1%, P=0.0006). The lack of oral antibiotics was significantly associated with the development of SSI in colon surgery. Male sex, stage IV cancer, and abdominoperineal resection were significantly associated with SSI in rectal surgery. The combination of oral and parenteral antibiotics significantly reduced the overall incidence of SSI in colon surgery (relative risk 0.41, 95% confidence interval 0.19-0.86). The incidence of SSI in laparoscopic rectal surgery was higher than in colon surgery because of the higher incidence of organ/space SSI in rectal surgery. The risk factors for SSIs and the effect of oral antibiotics differed between these two procedures.

Antimicrobial Formulation and Delivery in the Prevention of Surgical Site Infection.

A number of adjunct antimicrobial measures have been studied in an attempt to reduce surgical site infection (SSI) rates. In addition to parenteral antibiotic prophylaxis, these measures include oral antibiotics in bowel preparation for colorectal surgery, antiseptic/antimicrobial irrigation, antimicrobial sutures, local antibiotics, skin incision antibacterial sealants, and antimicrobial dressings. It is the purpose of this review to study the evidence behind each of these measures and to evaluate relevant data for recommendations in each area. A systematic review of the literature through PubMed was performed. Need for adequate dosing and re-dosing of intravenous peri-operative antibiotics, duration of antibiotic usage past wound closure, and the use of antibiotic bowel preparation in colorectal surgery are well defined in the published literature. However, data on local antimicrobial measures remain controversial. Proper dosing and re-dosing of prophylactic intravenous antibiotics should become standard practice. Continuation of intravenous antibiotic prophylaxis beyond wound closure is unnecessary in clean cases and remains controversial in clean-contaminated and complex cases. Oral antibiotic bowel preparation is an important adjunct to intravenous antibiotic prophylaxis in colorectal surgery. The use of topical antimicrobial and antiseptic agents such as antibacterial irrigations, local antimicrobial application, antimicrobial-coated sutures, antibacterial wound sealants, and antimicrobial impregnated dressings in the prevention of SSI is questionable.

Efficacy of topical antibiotic administration on the inhibition of perioperative oral bacterial growth in oral cancer patients: a preliminary study

Parenteral antibiotic prophylaxis is the current standard of therapy in clean-contaminated oral cancer surgery. Nevertheless, the incidence of surgical site infection (SSI) in oral oncological surgery is relatively high, especially in major surgery with reconstruction and tracheotomy. The aims of this study were to investigate the perioperative condition related to microorganisms in the oral cavity and to examine the efficacy of the topical administration of tetracycline in reducing the number of bacteria in the oropharyngeal fluid during intubation. The number of oral bacteria was measured during intubation in patients undergoing major oral cancer surgery. The efficacy of the topical administration of tetracycline or povidone iodine gel in reducing the bacteria was then investigated. Bacteria in the oropharyngeal fluid grew from 106CFU/ml to 108CFU/ml during the 3h after intubation (CFU, colony-forming units). When tetracycline was applied to the dorsum of the tongue, oral bacteria decreased immediately to 105CFU/ml, and the number of bacteria in the oropharyngeal fluid was maintained below 107CFU/ml for 7h. The concentration of tetracycline in the oropharyngeal fluid was extremely high for several hours after topical administration. The topical administration of tetracycline could reduce oral bacteria in patients undergoing clean-contaminated oral cancer surgery. This method is expected to be effective in the prevention of SSI.

Role of risk-based approach in the prevention of vertical transmission of neonatal sepsis

Vertical transmission of infections remains a common cause of neonatal morbidity and mortality worldwide. We studied the risk-based approach in preventing the vertical transmission of neonatal sepsis. A prospective case control study of 154 pregnant women with risk factors for vertical transmission of infections (subjects) and 154 pregnant women without the risk factors (control) at University of Ilorin Teaching Hospital, Ilorin from 1st July to 31st December, 2010. After counseling and consent taking, all participants had active management of labour and all subjects had parenteral intrapartum antibiotic prophylaxis with Ampicillin. There was postnatal evaluation of all babies for signs of neonatal sepsis followed by blood culture and treatment of culture positive babies. The outcome measures were signs and symptoms of neonatal sepsis, neonatal positive blood culture and maternal postpartum morbidity. Neonatal sepsis occurred in 16 babies (subjects=11, control=5); three babies had Early Onset Group B Streptococcal Disease (EOGBSD) (subjects=2, control=1; P=0.501) while 13 had non Group B Streptococcal (GBS) infections (subjects=9, control=4; P=0.113); onset of signs and symptoms was < 24hrs in all cases, incidence of EOGBSD were 12.9/1000 (subjects) and 6.5/1000 (controls). Subjects whose babies had sepsis had multiple risk factors; one dose of antibiotics and antibiotics to delivery interval < 2hours. There was no sepsis in babies of mothers who had adequate antibiotic prophylaxis. There was no maternal or neonatal death but 17.5% of subjects had maternal postpartum morbidities. The risk-based approach is a practicable alternative in preventing vertical transmission of neonatal sepsis if antibiotic prophylaxis is adequate before delivery.

Conservative Management of Uterine Artery Pseudoaneurysm Rupture with Rectal Fistula after Laparoscopic Myomectomy and Review of the Literature

Late uterine hemorrhage caused by uterine artery pseudoaneurysm is a rare but life-threatening complication after uterine surgery. The association of uterine pseudoanerysm rupture causing rectal fistula has not been reported in literature as well as its management. Herein we report a case of massive late uterine bleeding and rectal bleeding after laparoscopic myomectomy. A 43 year old Caucasian nulliparous woman underwent laparoscopic excision of 8 cm posterior intramural myoma. One month later she developed acute abdominal pain and proctorrhagia. A Computer Tomography scan (CT) demonstrated a 10 cm pelvic hematoma. The transvaginal ultrasound (TVU) showed 1 cm aneurism of the uterine artery. Transarterial angiography confirmed the ruptured uterine artery pseudoaneurysm that was successfully embolized. Repeated colonoscopy showed a rectal fistula. Total parenteral nutrition (TPN) and antibiotic prophylaxis were started. During the following month the intensity and frequency of proctorrhagia gradually declined. After four week of TPN colonoscopy confirmed a complete fistula healing. Oral feeding was gradually reintroduced. Two months later an ultrasound scan showed a complete resolution of the pelvic hematoma. To the best of our knowledge this the first described association of two rare complications: a pseudoaneurysm rupture and the subsequent rectal laceration successfully treated with embolization and conservative management.

Topical antibiotics as a major contextual hazard toward bacteremia within selective digestive decontamination studies: a meta-analysis

BackgroundAmong methods for preventing pneumonia and possibly also bacteremia in intensive care unit (ICU) patients, Selective Digestive Decontamination (SDD) appears most effective within randomized concurrent controlled trials (RCCT’s) although more recent trials have been cluster randomized. However, of the SDD components, whether protocolized parenteral antibiotic prophylaxis (PPAP) is required, and whether the topical antibiotic actually presents a contextual hazard, remain unresolved. The objective here is to compare the bacteremia rates and patterns of isolates in SDD-RCCT’s versus the broader evidence base.MethodsBacteremia incidence proportion data were extracted from component (control and intervention) groups decanted from studies investigating antibiotic (SDD) or non-antibiotic methods of VAP prevention and summarized using random effects meta-analysis of study and group level data. A reference category of groups derived from purely observational studies without any prevention method under study provided a benchmark incidence.ResultsWithin SDD RCCTs, the mean bacteremia incidence among concurrent component groups not exposed to PPAP (27 control; 17.1%; 13.1-22.1% and 12 intervention groups; 16.2%; 9.1-27.3%) is double that of the benchmark bacteremia incidence derived from 39 benchmark groups (8.3; 6.8-10.2%) and also 20 control groups from studies of non-antibiotic methods (7.1%; 4.8 – 10.5). There is a selective increase in coagulase negative staphylococci (CNS) but not in Pseudomonas aeruginosa among bacteremia isolates within control groups of SDD-RCCT’s versus benchmark groups with data available.ConclusionsThe topical antibiotic component of SDD presents a major contextual hazard toward bacteremia against which the PPAP component partially mitigates.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0714-x) contains supplementary material, which is available to authorized users.

Risk Factors Affecting the Incidence of Infection after Orthopaedic Surgery: The Role of Chemoprophylaxis

The incidence of surgical site infection and urinary tract infection following orthopaedic procedures has diminished in recent years due to modern antimicrobial prophylaxis. We conducted a case-control study (100 cases, 100 controls) in order to evaluate the risk factors associated with infection after orthopaedic procedures. The following risk factors were defined: gender, age, comorbidities [rheumatoid arthritis, diabetes mellitus, obesity (> 30 kg/m2), peripheral vessel disease], pre- and post-operative glucose levels, pre-operative and post-operative length of stay (days), duration (days) of urinary catheterization, type of parenteral antibiotic prophylaxis (cefotaxime or vancomycin), time of surgery (elective or scheduled), American Society of Anesthesiologists (ASA) Score (0-3), type of surgery (fracture osteosynthesis, joint replacement, spinal surgery, other), and the type of anesthesia administered (general, epidural, spinal). Urinary tract infection was the most frequent post-surgical infection (71 out of 100 cases) followed by surgical site infection (15 out of 100 cases). Using the multivariable logistic regression model, we found out that only the type of chemoprophylaxis was statistically significant risk factor (p < 0.001) associated with post-surgical infection. More specifically, the use of vancomycin instead of cephalosporin is associated with a lower risk of infection.

Intestinal failure and home parenteral nutrition: Implications for oral health and dental care

Background disease processes, medication and therapies in people with intestinal failure receiving home parenteral nutrition may affect their oral health. To inform oral health advice for this group a study of their oral health status was carried out. Fifty-two HPN outpatients recruited from specialised nutrition clinics at a national referral centre listed their medical and medication history, perceived oral health and dental treatment experience in a structured interview and underwent an oral health examination. Findings were compared with 2009 UK Adult Dental Health Survey data, using one-sample t tests. Oral health of the HPN cohort was poorer than the UK norm; patients had more decay (p<0.001), fewer teeth (p<0.001) and fewer sound and untreated teeth (p=0.023) despite similar dental attendance. Hyperphagia, sip feeds, oral rehydration fluids and polypharmacy (in 96%) are identifiable risk factors for caries, xerostomia (in 81%) and thus oral infection risk (including oral candidiasis). Patients were experiencing current problems (60%) and psychological discomfort (56%) from poor oral health. The patient pathway does not include oral health information. Dental teams should be aware of the management and prevention of HPN related complications with bisphosphonates, anticoagulant therapy, and parenteral antibiotic prophylaxis. HPN patients may benefit from increased awareness of their oral health risk factors.

Closed hip and long bone fractures The regimen effectiveness of antibiotic prophylaxis in surgical fixation

A metaanalysis of 22 randomized controlled trials found evidence to support parenteral antibiotic prophylaxis regimens for patients undergoing surgical fixation of closed hip and long bone fractures. Preoperative parenteral antibiotic doses (single or combined with multiple postoperative doses) resulted in decreased risk of deep, superficial, and urinary tract infections compared with no antibiotic. Single doses of short acting agents may be less effective than multiple doses of the same agent in decreasing the risk of any of the infections evaluated. By contrast, there was no significant difference in infection risk between a single dose of a long acting agent and multiple doses of other agents with shorter half lives. No significant differences were found when multiple dose regimens were compared or when administration routes (oral versus parenteral) were compared.

Risk Factors for Infection After Knee Arthroplasty

Clinical studies have revealed a number of important risk factors for postoperative infection following total knee arthroplasty. Because of the small numbers of cases in those studies, there is a risk of obtaining false-negative results in statistical analyses. The purpose of the present study was to determine the risk factors for infection following primary and revision knee replacement in a large register-based series. A total of 43,149 primary and revision knee arthroplasties, registered in the Finnish Arthroplasty Register, were followed for a median of three years. The Finnish Arthroplasty Register and the Finnish Hospital Discharge Register were searched for surgical interventions that were performed for the treatment of deep postoperative infections. Cox regression analysis with any reoperation performed for the treatment of infection as the end point was performed to determine the risk factors for this adverse outcome. Three hundred and eighty-seven reoperations were performed because of infection. Both partial and complete revision total knee arthroplasty increased the risk of infection as compared with the risk following primary knee replacement. Male patients, patients with seropositive rheumatoid arthritis or with a previous fracture around the knee, and patients with constrained and hinged prostheses had increased rates of infection after primary arthroplasty. Wound-related complications increased the risk of deep infection. The rate of septic failure was lower after unicondylar than after total condylar primary knee arthroplasty, but the difference was not significant. The combination of parenteral antibiotic prophylaxis and prosthetic fixation with antibiotic-impregnated cement protected against septic failure, especially after revision knee arthroplasty. Following revision total knee arthroplasty, diagnosis and prosthesis type had no effect, but previous revision for the treatment of infection and wound-healing problems predisposed to repeat revision for the treatment of infection. There was an increased risk of deep postoperative infection in male patients and in patients with rheumatoid arthritis or a fracture around the knee as the underlying diagnosis for knee replacement. The results of the present study suggest that the infection rate is similar after partial revision and complete revision total knee arthroplasties. Combining intravenous antibiotic prophylaxis with antibiotic-impregnated cement seems advisable in revision arthroplasty.