Postprocedural Antibiotics Research Articles

A novel sacral neuromodulation protocol is associated with reduction in removal for device infection.

Sacral neuromodulation (SNM) has been established as an effective third-line therapy for non-obstructive urinary retention and urinary urgency-frequency syndrome. Device infection, ranging from 2-10%, is a severe complication usually necessitating device explanation. This study sought to demonstrate an infection protocol founded upon established device implantation risk factors and novel approaches to reduce the incidence of device infection, while maintaining good antibiotic stewardship following best practice statements. A single-surgeon protocol was enacted from 2013 to 2022. Preoperatively, nasal swabs were cultured from each patient. If positive for methicillin-resistant Staphylococcus aureus or methicillin-sensitive Staphylococcus aureus, preoperative treatment with intranasal mupirocin was employed. Preoperative cefazolin was administered in patients with negative cultures or MSSA-positive. All protocol patients were given chlorhexidine wipes before surgery and prepped with a chlorhexidine scrub followed by alcohol/iodine paint. Post-procedural antibiotics were not given. Pre-protocol patients from 2011 to 2013 served as controls. Pre-protocol (n=87) patients had a significantly higher rate of device infection compared to protocol patients (n=444) in both the percentage of patients experiencing device infection (4.6% vs 0.9%, p=0.01) and percentage of procedures associated with device infection (2.9% vs 0.5%, p<0.05). A successful culture of the nares was achieved in 91.4% of protocol patients, with 11.6% MRSA-positive. Risk ratio for infection of pre-protocol/protocol patients was 0.19 (0.05-0.77) with odds ratio 5.1 (1.3-20.0). Utilization of a novel SNM infection protocol tailored to a patient's preoperative MRSA colonization is associated with a reduction in the overall incidence of explant for device infection while avoiding prolonged postoperative antibiotic regimens. The study was initiated prior to January 18, 2017 and does not meet the definition of an applicable clinical trial (ACT) as defined in section 402 (J) of the US PHS Act.

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.

Engaging patients in antimicrobial stewardship: co-designed educational tool to improve periprocedural care through de-implementation of guideline-discordant antimicrobial use.

Effective de-implementation models often include replacement of an ineffective practice with an alternative. We co-developed patient education materials as a replacement strategy for inappropriate post-procedural antibiotics in cardiac device procedures. Lessons learned and developed materials may be used to promote infection prevention in other periprocedural settings.

Is antibiotic prophylaxis necessary after endoscopic ultrasound-guided fine-needle aspiration of pancreatic cysts?

Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics. We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and postprocedural antibiotic prophylaxis, and adverse events were retrospectively extracted. A total of 470 EUS-FNA procedures were performed by experienced endosonographers for the evaluation of PCLs in 448 patients, 58.7% of whom were women. The mean age was 66.3±12.8 years. The mean cyst size was 25.7±16.9 mm. Postprocedural antibiotics were administered in 274 cases (POSTAB+ group, 58.3%) but not in 196 cases (POSTAB- group, 41.7%). None of the patients in either group developed systemic or localized infection within the 30-day follow-up period. Procedure-related adverse events included mild abdominal pain (8 patients), intra-abdominal hematoma (1 patient), mild pancreatitis (1 patient), and perforation (1 patient). One additional case of pancreatitis was recorded; however, the patient also underwent endoscopic retrograde cholangiopancreatography. The incidence of infection after EUS-FNA of PCLs is negligible. Routine use of postprocedural antibiotics does not add a significant benefit.

Post-procedural Antibiotic Use and Associated Outcomes After Common Urologic Procedures Across a National Healthcare System

ObjectiveTo quantify the benefits and harms of post-procedural antibiotic use after common urologic procedures. Materials and MethodsThis retrospective cohort study included patients who underwent an endoscopic urologic procedure (transurethral resection of bladder tumor, transurethral resection of prostate, or ureteroscopy) within the Veterans Health Administration between January 1, 2017 and June 30, 2021. A post-procedural antibiotic was any qualifying antibiotic prescribed for administration on the day after the procedure. Guidelines generally do not recommend post-procedural antibiotics for surgical prophylaxis. Outcomes included unplanned return visits and Clostridioides difficile infection within 30 days. Log-binomial models with risk-adjustment were used to measure the association between post-procedural antibiotic use and outcomes. Hospital-level observed-to-expected (O:E) ratios were constructed to compare post-procedural antibiotic use. ResultsThere were 74,629 qualifying procedures across 105 hospitals; 27,422 (36.7%) received post-procedural antibiotics (median 3 days, IQR 3-6). An unplanned return visit occurred in 20.2% of patients who received post-procedural antibiotics vs 17.2% who did not (adjusted RR 1.032, 95% CI 0.999-1.066). C. difficile infection was diagnosed in 0.27% vs 0.10% in those who received and did not receive post-procedural antibiotics (adjusted RR 1.67, 95% CI 1.13-2.45). The O:E ratio for post-procedural antibiotic use ranged from 0.46 among hospitals in the lowest-use quartile to 1.93 in the highest-use quartile. ConclusionPost-procedural antibiotics were frequently prescribed after urologic procedures with large inter-facility variability even after adjusting for case-mix differences. Post-procedural antibiotic use was associated with increased risk for C. difficile infection but not fewer unplanned return visits. Efforts to reduce guideline-discordant use of post-procedural antibiotics are needed.

The effects of avoiding extended antimicrobial drain prophylaxis on Clostridioides difficile and postprocedural infection rates: a 5-year retrospective.

Postprocedural infection is a consequential complication of neurosurgical intervention. Periprocedural antimicrobial prophylaxis is routinely administered to prevent infection, and in some cases, continued for extended periods while surgical drains remain in place. However, there is little evidence that extended antimicrobial administration is necessary to reduce postprocedural infection, and extended antimicrobials can be associated with harm, such as Clostridioides difficile infection. The authors sought to evaluate whether shortening the duration of postprocedural antimicrobial prophylaxis would decrease the incidence of C. difficile infection without increasing the incidence of postprocedural infection. In this retrospective study, two general neurosurgical cohorts were examined. In one cohort, postoperative antimicrobial prophylaxis was limited to 24 hours; in the other, some patients received extended postoperative antimicrobial prophylaxis while surgical drains or external ventricular drains (EVDs) remained in place. Rates of infection with C. difficile as well as postprocedural infection after surgery and EVD placement were compared. Seven thousand two hundred four patients undergoing 8586 surgical procedures and 413 EVD placements were reviewed. The incidence of C. difficile infection decreased significantly from 0.5% per procedural encounter to 0.07% with the discontinuation of extended postprocedural antibiotics within 90 days of a procedure. Rates of postprocedural infection and EVD infection did not significantly change. Results were similar in subgroups of patients with closed suction drains as well as cranial and spine subgroups. Discontinuation of extended antimicrobial prophylaxis was associated with a significant decrease in the incidence of C. difficile infection without a concomitant change in postprocedural infections or EVD-associated infection. This study provides evidence in support of specialtfy-wide discontinuation of extended postoperative antimicrobial prophylaxis, even in the presence of closed suction drains.

Antibiotic-prescribing practices and associated outcomes after common urologic procedures in an integrated healthcare system

Background: Many urologists continue antibiotics after common urologic procedure beyond the timeframes recommended by professional guidelines. In this study, we sought to evaluate the association between postprocedural antibiotic use and patient outcomes. Methods: We identified all patients who underwent 1 of 3 urologic procedures (transurethral resection of bladder tumor [TURBT], transurethral resection of prostate [TURP], and ureteroscopy) within the Veterans’ Health Administration (VHA) between January 1, 2017, and June 30, 2021. A postprocedural antibiotic was any antibiotic potentially used for a urinary tract–related indication that was prescribed for administration after the day of the procedure. Outcomes were captured within 30 days of the procedure and included (1) return visits, defined as any emergency department or urgent care encounter or hospital readmission, and (2) Clostridium difficile infection (CDI), defined as a positive test for C. difficile and the prescription of an anti-CDI antibiotic. We used log-binomial models with risk adjustment to determine the association between postprocedural antibiotic use and outcomes. We constructed hospital-level observed-to-expected ratios for postprocedural antibiotic use, and we used these models to calculate the probability of each patient receiving postprocedural antibiotics. Results: Overall, we identified 74,629 patients; 98% were male; the mean age was 70 years (SD, 10). Among them, 50% underwent TURBT, 28% underwent TURP, and 23% underwent ureteroscopy. A postprocedural antibiotic was prescribed to 25,738 (35%) cases for a median duration of 3 days (IQR, 3–6). Return visits occurred in 13,489 patients (18%), and CDI occurred in 104 patients (0.1%). Patients exposed to postprocedural antibiotics had 16% more return visits (RR, 1.16; 95% CI, 1.13–1.20) and more than twice as much CDI (RR, 2.22; 95% CI, 1.51–3.26) than patients not exposed to postprocedural antibiotics. In log-binomial risk-adjusted analysis, the risk of return visits did not differ between the 2 groups (RR, 1.00; 95% CI, 0.97–1.04) but the risk of CDI was higher in patients who received post-procedural antibiotics (RR, 1.87; 95% CI, 1.00–3.51). Hospitals (n = 105) varied widely in their observed-to-expected ratios for prescribing postprocedural antibiotics, and the frequency of return visits was similar regardless of the frequency at which postprocedural antibiotics were prescribed (Table 1). Conclusions: Postprocedural antibiotics were prescribed beyond recommended intervals after more than one-third of common urologic procedures, with a large degree of variability across hospitals. The use of postprocedural antibiotics was not associated with fewer return visits but was associated with a nonsignificant increase in CDI risk. Efforts to reduce postprocedural antibiotics are needed.Funding: YesDisclosures: This work was funded, in part, by the Merck Investigator Studies Program. This work was also supported by a Career Development Award (DJL) from the VA Health Services Research and Development Service (CDA 16-204) and by the Iowa City VA Health Care System, Department of Pharmacy Services.

Postoperative Oral Antibiotic Use and Infection-Related Complications After Spinal Cord Stimulator Surgery

ObjectivesSpinal cord stimulation (SCS) is considered a minimally invasive and reversible neuromodulation therapy for various chronic pain disorders. The rates of infection following SCS surgery reported in the literature range from 2.8% to 10%. Several studies indicated no potential benefit of postoperative antibiotics (beyond 24 hours) on subsequent device infection. This study aimed to understand the characteristics of postoperative antibiotic prescriptions and subsequent infections following SCS surgery. Materials and MethodsThe study was a retrospective cohort using the IBM® MarketScan® Commercial and Medicare Supplemental Databases from 2013 to 2018. Adult patients undergoing SCS surgical procedures with at least 90 days of follow-up were identified using Current Procedural Terminology (CPT®) codes. Postprocedural oral antibiotics within 14 days and preprocedural corticosteroid use within seven days were identified using National Drug Codes (NDC). Administrative claims were analyzed to understand the characteristics of prescribed postoperative antibiotics. Infection-related complications within 90 days were identified using administrative codes. ResultsA total of 18,105 patients (age 55.5 ± 13.1 years, 40.2% male) underwent SCS surgery during the study period. Postprocedural oral antibiotics and preprocedural steroids were prescribed for 35.3% and 2.6%, respectively, for SCS surgery patients. The most commonly used postprocedural antibiotics were cephalexin (55.4%) and sulfamethoxazole-trimethoprim (10.6%). The most common duration of antibiotic prescriptions was seven, ten, and five days in our study, from most to least common duration. Superficial surgical site infection (SSI), deep SSI, device infection, or any infection within 90 days occurred in 2.9%, 1.0%, 1.8%, and 4%, respectively, of the patients undergoing SCS surgery. ConclusionsProspective studies are needed to understand the reasons for noncompliance with expert consensus recommendations on postoperative antibiotic use beyond 24 hours of SCS surgery. Neuromodulation team members should play an important role in antibiotic stewardship.

Cardiac implantable electronic device infection: prevalence and risk factors

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of CIED implantation procedures has increased dramatically in recent decades due to population aging and expansion of indications. At the same time, the number of CIED-associated complications has increased too. Infection is a very important and heavy complication of CIED implantation, which significantly increases mortality and morbidity. Aim and objectives This study aimed to estimate the risk of CIED-infection in a group of patients who received an aggressive scheme of postprocedural antibiotic therapy and compare with the risk of infection in another group, where a mild antibiotic therapy scheme was used. The study objectives were to assess the incidence and prevalence of CIED-related infection in patients operated in a tertiary cardiovascular center, as well as identify infection-related risk factors. Methods A retrospective, observational, cross-sectional study was performed. The study sample included 355 patients, who underwent CIED-related procedure in a single center between 01.12.2017 and 30.07.2020. Two antibiotic prophylaxis and wound follow-up protocols (mild and aggressive) were used. In this study, we compared the effectiveness of both methods to prevent a CIED related infection. Patient’s demographic data, clinical features, comorbidities, the device and procedure-related information were also assessed for having a relationship with CIED infection rate. Data entry and statistical analyses were performed with SPSS version 23 software. Binomial logistic regression analyses were performed for adjusted analyses. Results The prevalence of infection was 3.5% in the group with mild scheme and 1.13% in the group with the aggressive scheme. The difference in two subgroups was not significant (p = 0,149). In the whole sample the prevalence of infection was 1,69%. According to this study severe renal failure with glomerular filtration rate (GFR)&amp;lt;30 mL/min (OR = 32.6, CI = 2.5-420.8, p = 0.008), chronic obstructive pulmonary disease (OR = 8.2, CI = 1.4-47.6, p = 0.019), and thyroid disfunction (OR = 7.065, CI = 1.2-40.6, p = 0.028) were found as significant predictors for having CIED infection. In participants who underwent a reimplantation and in those with postoperative hematoma the odds of having infection was respectively 6.2 fold (CI = 1.086-35.5, p = 0.04) and 48.8 fold (CI = 8.4-285.9, p = 0.028) higher, compared to patients with primary implantation and absence of hematoma. Age of participants with CIED-infection (mean age = 52.5 ) was younger compared to patients without infection (mean age = 61.2, p = 0.039). Conclusion According to our study the risk of infection in our center is comparable to recorded prevalence in other countries. There is no statistically significant difference on CIED infection between mild and aggressive antibiotic therapy schemes. Recommendations The routine use of aggressive antibiotic therapy is not justified and carries a risk of microbial resistance, as well as additional healthcare costs.

Systematic Review of the Management of Ureteroarterial Fistulas After Ileal Conduit Urinary Diversion.

OBJECTIVE. No studies or guidelines exist to direct management of ureteroarterial fistula (UAF) after ileal conduit urinary diversion in which the possible risks and complications associated with stent-graft infection from the conduit flora must be reconciled with those of open surgical repair. This study seeks to characterize the clinical presentation, pathogenesis, and optimal diagnostic and therapeutic management of this entity through a systematic review of the literature. MATERIALS AND METHODS. A systematic search of the English-language literature using the PubMed, Scopus, and ScienceDirect databases was performed: 264 abstracts were identified. From those abstracts, 32 studies comprising 40 patients with 43 UAFs were selected for analysis. Data points including demographics, clinical presentation, UAF specifications, procedural details, postprocedural complications, and clinical outcomes were reviewed. RESULTS. Predisposing factors included female sex, chronic ureteral stent placement, and past surgical intervention and irradiation for pelvic malignancy. Fistulization was overwhelmingly unilateral (95.0% of patients) and included the common iliac artery (90.7% of UAFs). Combined endovascular and endoureteral modalities presented similar outcomes compared with surgical approaches in terms of UAF-related mortality (7.1% vs 13.3%, respectively) and complication rates (28.6% vs 26.7%) during a similar median follow-up period (9.5 vs 14.0 months). Endovascular stent-graft infections were present in 14.3% of cases and represented a leading indication for reintervention after endovascular management (50.0%). CONCLUSION. Short- and intermediate-term outcomes of combined endovascular and endoureteral techniques compare favorably with those of surgical approaches in the treatment of UAF after ileal conduit urinary diversion. Although there is a relatively low stent-graft infection rate, close follow-up within the first year after the procedure is required given the propensity of complications to develop during this window. The use of postprocedural antibiotics is uncertain but is likely prudent.

Outcomes after successful fallopian tube recanalization: A single institution experience: Observational Retrospective study

PurposeTo determine outcomes after successful fallopian tube recanalization (FTR) in women who suffer infertility with documented tubal occlusion on hysterosalpingogram. MethodsA retrospective review of consecutive successful FTR procedures from January 2010 to December 2016 was performed. 53 women who had hysterosalpingogram confirmed unilateral or bilateral tubal occlusion from a single tertiary academic medical center and successful FTR were eligible for inclusion. 35 (66.0%) patients had follow up at 12 months after FTR, with 13 conceiving within 1 year of the procedure. Data was collected from the medical record. Complication, conception, and take-home-baby (THB) rates were recorded. The average age of patients was 32.3 years (range 26–42 years). All patients received peri- and post-procedure antibiotics. The study was conducted with institutional IRB approval. ResultsAverage follow-up after FTR was 1335 days. All patients tolerated the procedure well with no immediate complications. One patient had a urinary tract infection a week after FTR. 13 (37.1%) became pregnant after FTR. Of these women, 2 had ectopic pregnancies and 2 patients had spontaneous abortions. The THB rate after FTR for all patients was 25.7%. The THB rate in women who became pregnant after FTR was 69.2%. Of those women who did not become pregnant after FTR, 19 (84.6%) went to assisted reproductive techniques, and of those, 8 (42.1%) became pregnant. ConclusionInfertility affects 8.4% of U.S. women, with tubal disease a major causative factor. In our study, successful FTR led to pregnancy in over a third of the patients with the majority giving birth to healthy babies. Given the success of obtaining pregnancy in combination with a low complication rate, FTR is a viable option in women who suffer from tubal infertility.

334. Treatment Duration of Antibiotics for Sacral Osteomyelitis After Skin Flap Procedure

BackgroundPatients with spinal cord injuries frequently develop sacral osteomyelitis. Optimal treatment often involves intravenous antibiotics and skin flap closure of the ulcer; however, best practices for the duration of antibiotic therapy pre- and post-procedure are unknown.MethodsThis was a retrospective, cohort study of spinal cord injury patients at the VA St. Louis undergoing a skin flap procedure from 1 October 2014 to 31 March 2019. Patients aged 18 to 89 years with a documented spinal cord injury and receiving treatment for sacral osteomyelitis with antibiotics and skin flap placement were considered for inclusion. The primary outcome was to determine if there was a difference in antibiotic treatment duration, both pre-procedure and post-procedure, between those that failed combination therapy and those patients for which the treatment was successful. Treatment failure was defined as documentation of no resolution of sacral osteomyelitis after treatment, re-initiation of antibiotics for sacral osteomyelitis of the same area, documented flap break-down, or an unplanned flap-related procedure within 1 year of completion of antibiotic therapy.ResultsTwelve patients were identified for inclusion. Baseline characteristics were similar between groups; 5/8 patients successfully treated received vancomycin, compared to 4/4 patients that failed therapy. Overall, 75% (8/12) had a successful treatment outcome at 12 months. In qualifying patients, average days of pre-procedure and post-procedure antibiotics were similar between patients who achieved success and those who failed (45.5 vs. 44.3 days pre-procedure, respectively (p >0.05) and 39 vs. 43 days post-procedure (p >0.05), respectively). When evaluated by weeks of therapy, no statistically significant differences were noted in treatment success rates between those treated for less than 6 weeks versus those treated for longer (66.6% [2/3] vs. 63.6% [6/9], p >0.05).ConclusionNo difference in pre- or post-flap procedure antibiotic duration was observed in patients who failed therapy compared to those who were successfully treated.Disclosures All Authors: No reported disclosures

Intratonsillar Abscess: Case Series of a Rare Entity

Intratonsillar abscess (ITA) is a rarely reported clinical entity in both children and adults. Despite its rarity ITA should be considered in the differential diagnosis of Peritonsillar abscess and Tonsillitis. CT scan is useful to confirm the presence of an ITA. The following case series summarizes three cases of intratonsillar abscess that presented to our centre and their management. The primary treatment modality involved needle aspiration with post-procedural antibiotics.

Evaluation of the Effect of Routine Antibiotic Administration after Uterine Artery Embolization on Infection Rates

PurposeTo evaluate the effect of routine administration of post-procedural antibiotics following elective uterine artery embolization (UAE) on infectious complication rates. Materials and MethodsThe charts of patients who underwent UAE between January 2013 and September 2019 were retrospectively reviewed. Prior to January 15, 2016, all patients received post-procedural antibiotics with 500 mg of ciprofloxacin twice a day orally for 5 days. After January 15, 2016, none of the patients received post-procedural antibiotics. All patients in both groups received pre-procedural intravenous antibiotics. The post-procedural antibiotics group included 217 patients (age, 44.7 ± 6 years); the no-antibiotics group included 158 patients (age, 45.4 ± 5.6 years). Patients in the no-antibiotics group had a significantly higher rate of diabetes mellitus (P = .03) but fewer cases of adenomyosis (P = .048). Otherwise, demographic and fibroid characteristics were similar between the groups. ResultsSix infectious complications (6/375, 1.6%) were recorded. No statistically significant difference (P = .66) was observed in the number of infections between the post-procedural antibiotics group (4/217, 1.8%) and the no-antibiotics group (2/158, 1.3%). Three of the 6 infectious complications presented with malodorous vaginal discharge (3/375, 0.8%) and received nominal therapy. The 3 remaining complications (0.8%) were considered major and included 2 patients (0.5%) who underwent hysterectomy and 1 patient (0.3%) who underwent myomectomy. The major infection rate was 0.9% (2/217) in the post-procedural antibiotics group and 0.7% (1/158) in the no-antibiotics group (P = 1). There were no 90-day post-procedural mortalities. ConclusionsDiscontinuation of routine post-procedural antibiotics with ciprofloxacin after elective UAE did not result in increased rates of infectious complications within the first 90 days post procedure.

3:27 PM Abstract No. 102 Infectious complications and postprocedural antibiotics following initial percutaneous biliary drainage for patients with endoscopically placed stents

To evaluate the risk of cholangitis and role of postprocedural antibiotics for patients with endoscopic biliary stents (EBS) undergoing initial percutaneous biliary cholangiography and drainage (PTC). Retrospective review identified all adult patients undergoing initial PTC without preprocedural evidence of cholangitis over an 18-month period at a large academic center. Cholangitis was defined as fever ≥ 38.5°C within 24 hours of the PTC. Clinical characteristics between patients with and without EBS were compared using chi-squared. 64 patients with a mean age of 62 were included; all patients received preprocedural prophylactic antibiotics. 60 (94%) patients presented with biliary obstruction and 4 (6%) with biliary leak. 45 patients (70%) had a history of endoscopic retrograde cholangiopancreatography (ERCP), 23 (36%) had EBS, and 28 (44%) had a surgical bilioenteric anastomosis. Overall, 9 patients (14%) became cholangitic with one patient developing septic shock. Patients with EBS were more likely to develop cholangitis compared to both the entire cohort (7/23 vs. 2/41, P = 0.005) and patients with history of ERCP alone (7/23 vs. 1/19, P = 0.02). 22 (34.4%) patients were placed on postprocedural empiric antibiotics (i.e., antibiotics without clinical evidence of cholangitis) by their primary team. 6 patients with EBS were placed on empiric post procedure antibiotics and none developed cholangitis, whereas 7 of the 17 (41.2%) not placed on empiric antibiotics developed cholangitis (P = 0.059). These results suggest that patients with EBS may be at high-risk for developing cholangitis after initial PTC beyond the risk conferred to patients with previous ERCP. This may be due to the presence of an indwelling foreign body. The role of routine postprocedural empiric antibiotics for this patient group needs further investigation given the high morbidity associated with cholangitis.

3:27 PM Abstract No. 168 Postprocedural antibiotics do not significantly affect rates of endometritis after uterine fibroid embolizationa

3:27 PM Abstract No. 168 Postprocedural antibiotics do not significantly affect rates of endometritis after uterine fibroid embolizationa

Impact of Eliminating Postprocedural Antibiotic Prophylaxis in Patients without Biliary Instrumentation or Bypass Undergoing Hepatic Artery Embolization for Hepatic Malignancies.

To assess the infection rate after eliminating postprocedural antibiotics in patients undergoing hepatic artery embolization (HAE) for primary and secondary hepatic malignancies. In this historical cohort study, adults ≥18 years of age without prior biliary instrumentation or bypass who underwent HAE and received pre- and postprocedure antibiotic prophylaxis between September 1, 2014, and August 31, 2015, comprised group A, whereas similar patients receiving only preprocedure antibiotic prophylaxis between October 1, 2015, and September 30, 2016, comprised group B. Procedures conducted between September 1, 2015, and September 30, 2015, were excluded. The primary outcome was any infection occurring within 30 days of HAE. A total of 150 patients underwent 204 HAE procedures in group A, and 171 patients underwent 221 procedures in group B. Cefazolin given as a 1-g dose (or 2 grams if obese) was administered in 391 of 425 evaluable procedures (92%). Clindamycin plus gentamicin was prescribed in 34 patients (8%) who had severe penicillin allergy. There was significant improvement in adherence to the postprocedure antibiotic regimen, from 68% (138 of 204 procedures) to 98% (216 of 221 procedures) (P < .001) with elimination of postprocedure prophylaxis. There were no significant differences in 30-day infection rates (5 [3%] vs. 5 [2%]; P= .57), hospital readmissions (13 [6%] vs. 12 [5%]; P= .68), or all-cause mortality (3 [1%] vs. 3 [1%]; P= .62) between the 2 groups. Elimination of postprocedural antibiotics after HAE did not lead to an increase in infectious complications. This finding supports the 2018 Society of Interventional Radiology recommendation for preprocedural prophylaxis only for HAE in the setting of an intact sphincter of Oddi.

Postoperative Antibiotic Prophylaxis Following Cardiac Implantable Electronic Device Placement.

Infections related to cardiac implantable electronic device (CIED) placement are associated with poor clinical outcomes. As such, preprocedural prophylactic antibiotic therapy is indicated for all patients prior to device insertion. However, the available data are less clear on the impact of postprocedural antibiotic therapy on rates of CIED infection when used in addition to preprocedural therapy. This is single-center, retrospective cohort study of 913 patients who underwent CIED-related procedures between October 2010 and August 2014 sought to compare the rate of CIED infections in patients receiving only preprocedural antibiotics with those receiving both preprocedural and postprocedural antibiotics. Univariate analysis was used to detect independent risk factors for CIED infection. After excluding patients receiving concomitant antibiotics for other conditions, those undergoing CIED extraction alone, and those with a lack of follow-up data and/or adequate documentation of clinical encounters, 569 patients were identified for inclusion in the final analysis. The majority of patients who received postprocedural antibiotics received three to five days of therapy, with the most common antibiotic used being cephalexin. There was no statistically significant difference in the incidence of infection between patients who did and did not receive postoperative antibiotics (4.5% versus 6.1%; p = 0.398). In a multivariate analysis, the use of postprocedural antibiotic therapy was not a significant risk factor for infection (adjusted odds ratio: 0.692; 95% confidence interval: 0.314–1.525; p = 0.361). It is therefore reasonable to withhold prescribing postoperative antibiotics in patients following CIED implantation. Individualized risk factor evaluation of patient comorbidities and procedural characteristics may be needed to aid in determining whether postoperative antibiotics are reasonable in different patients. The validity of these findings is contingent on further confirmation via a prospective, randomized clinical trial.

Antibiotics for urethral catheterization in children undergoing cystography: retrospective evaluation of a single-center cohort of pediatric non-toilet-trained patients.

Antibiotics are often used to prevent post-catheterization urinary tract infections (UTIs) in patients undergoing cystography. However, there is no universally accepted protocol and the literature data are conflicting. We aimed to determine prevalence and risk factors of post-cystography UTIs in non-toilet-trained children. We retrospectively evaluated 216 non-toilet-trained children not assuming antibiotics when undergoing cystography. Only the patients with dilated vesico-ureteral reflux (VUR) assumed antibiotics just after the exam (within 15min). One hundred eleven patients without vesico-ureteral reflux (VUR) and 29 patients with non-dilated VUR did not receive post-procedure antibiotics and did not develop UTIs. Out of the 76 patients who showed a dilated VUR and received post-procedure antibiotics, only 5 (6.6%) developed a UTI. The most significant factor associated with post-cystography UTIs was the presence of dilated VUR (p = 0.005) with the presence of bilateral VUR also being significant (p = 0.02).Conclusion: Patients without dilated VUR or bilateral VUR could not benefit from antibiotic prophylaxis for cystography. What is Known: • There is no universally accepted protocol about antibiotic administration in children undergoing cystography. • Literature data are conflicting. What is New: • Among 216 non-toilet-trained children undergoing cystography, 111 patients without vesico-ureteral reflux (VUR) and 29 patients with non-dilated VUR did not receive post-procedure antibiotics and did not develop UTIs.Out of the 76 patients who showed a dilated VUR and received post-procedure antibiotics, only 5 (6.6%) developed a UTI. • The most significant factor associated to post-cystography UTIs was the presence of dilated VUR (p = 0.005) with presence of bilateral VUR also being significant (p = 0.02).

Efficacy of Endoscopic Ultrasound-Guided Transmural Stent Drainage for Peripancreatic Fluid Collections: A Retrospective Analysis

Introduction: Hospital admissions due to acute pancreatitis have risen by 20% worldwide and by 50% in the United States since 2000. Common complications of acute and chronic pancreatitis include peripancreatic fluid collections (PFCs) such as pancreatic pseudocysts and walled-off necrosis. Most PFCs disappear within 6 months, but up to 15% can persist. While treatment for symptomatic PFCs has historically been surgical, the advent of endoscopic transmural drainage-cystogastrostomy-has provided a less invasive treatment option. The aim of this study is to assess the efficacy of cystogastrostomy for symptomatic PFCs and identification of variables associated with clinical outcomes. Methods: We conducted a retrospective review of all cystogastrostomy cases done at our institution for symptomatic PFCs. Our primary outcome was change in PFC size. We also analyzed both baseline characteristics and clinical factors such as PFC location and transmural approach. An analysis of variance was done to test differences in mean reduction of PFC size among our clinical variables. We performed a simple regression analysis to assess correlation between outcomes and baseline characteristics. Results: A total of 15 patients underwent cystogastrostomies from January 2013 to April 2018. The median and mean observation period were 35 and 238 days, respectively. Cystogastrostomy resulted in improvement of PFC size in 93% (14/15) of the cohort and complete resolution thereof in 60% (9/15) at most recent follow up. A trans-gastric drainage approach was associated with greater reduction of PFC size when compared to trans-duodenal drainage (P-value 0.02). In addition, PFCs located within the head of the pancreas were associated with a smaller reduction in PFC size when compared to those located within the body and tail of pancreas. We did not see a significant difference in change of PFC size based on age, sex, use of plastic versus metal stents, or use of pre- versus post-procedure antibiotics. Conclusion: Cystogastrostomy is an effective treatment option for symptomatic PFC. Our single center study suggests that a trans-gastric approach is associated with improved clinical outcomes. The endoscopic approach is determined by the PFC location, the patient's anatomy, and the endoscopist's preference. Larger prospective studies that can account for the aforementioned variables are needed to validate these findings.2836_A Figure 1. Baseline Characteristics of PFC Cohort2836_B Figure 2. Analysis of Variance Between Variables and Mean Size Reduction of PFC (in cm)2836_C Figure 3. Simple Regression Analysis with Change in PFC Size (in cm)