Postoperative Antibiotic Administration Research Articles

Long-term perioperative antibiotic prophylaxis after urethral reconstruction does not improve clinical outcomes and increases incidence of MDR organisms

PurposeTo analyze the impact of long-term postoperative antibiotic prophylaxis following urethral reconstruction on perioperative outcomes, postoperative urine cultures, and the emergence of multidrug-resistant bacteria.MethodsIn this retrospective review of patients undergoing urethral reconstruction with a single surgeon from 2019 to 2023, patients either received long-term prophylactic postoperative antibiotics for 3–4 weeks while indwelling catheters were in place or they did not receive prophylactic antibiotics. Preoperative and postoperative urine cultures were obtained on all patients. The primary outcome measure was the association of prophylactic antibiotics with the presence of multidrug-resistant bacteria in postoperative urine cultures. Secondary outcomes included differences in perioperative outcomes.ResultsOf 166 patients undergoing urethral reconstruction, 147 met all inclusion criteria. Of these, 84 received antibiotic prophylaxis and 63 did not. The number of multidrug-resistant organisms in postoperative urine cultures was significantly different between cohorts indicating a harmful effect of antibiotic prophylaxis (P <.01). There were no significant differences in perioperative outcomes including positive urine cultures, clinical urinary tract infections, wound complications, or recurrence.ConclusionThese data show that the administration of postoperative prophylactic antibiotics does not influence perioperative outcomes but does heighten the risk of encountering multidrug-resistant bacteria. This novel finding should discourage the routine use of antibiotic prophylaxis in patients undergoing urethral reconstruction.

Predictors for prolonged and escalated perioperative antibiotic therapy after microvascular head and neck reconstruction: a comprehensive analysis of 446 cases

Literature suggests that intravenous prophylaxis exceeding 48 h offers no additional benefit in preventing surgical site infections (SSI) in patients with microvascular head and neck reconstruction. However, protocols for antibiotic therapy duration post-reconstruction are not standardized. This study identifies factors predicting prolonged intravenous antibiotic use and antibiotic escalation in patients receiving free flap head neck reconstruction. A retrospective analysis of 446 patients receiving free flap reconstruction was conducted, examining predictors for antibiotic therapy > 10 days and postoperative escalation. 111 patients (24.8%) experienced escalation, while 159 patients (35.6%) received prolonged therapy. Multivariate regression analysis revealed predictors for escalation: microvascular bone reconstruction (p = 0.008, OR = 2.0), clinically suspected SSI (p < 0.001, OR = 5.4), culture-positive SSI (p = 0.03, OR = 2.9), extended ICU stay (p = 0.01, OR = 1.1) and hospital-acquired pneumonia (p = 0.01, OR = 5.9). Prolonged therapy was associated with bone reconstruction (p = 0.06, OR = 2.0), preoperative irradiation (p = 0.001, OR = 1.9) and culture-positive SSI (p < 0.001, OR = 3.5). The study concludes that SSIs are a primary factor driving the escalation of perioperative antibiotic use. Clinical suspicion of infection often necessitates escalation, even in the absence of confirmed microbiological evidence. Microvascular bone reconstruction was a significant predictor for both the escalation and extension of antibiotic therapy beyond 10 days. Furthermore, preoperative radiation therapy, hospital-acquired pneumonia, and prolonged ICU stay were associated with an increased likelihood of escalation, resulting in significantly extended antibiotic administration during hospitalization. Antibiotic stewardship programmes must be implemented to reduce postoperative antibiotic administration time.Trial registration The study was registered approved by the local Ethics Committee (Nr: 18-1131-104).

Placenta Accreta Spectrum: A Comprehensive Review of Guidelines.

Placenta accreta spectrum (PAS) represents a range of disorders characterized by abnormal placental invasion and is associated with severe maternal morbidity and mortality. The aim of this study was to review and compare the most recently published major guidelines on the diagnosis and management of this potentially life-threatening obstetric complication. A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the International Society for Abnormally Invasive Placenta, the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada on PAS disorders was carried out. There is a consensus among the reviewed guidelines regarding the definition and the diagnosis of PAS using specific sonographic signs. In addition, they all agree that the use of magnetic resonance imaging should be limited to the evaluation of the extension to pelvic organs in case of placenta percreta. Moreover, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada agree that screening for PAS disorders should be based on clinical risk factors along with sonographic findings. Regarding management, they all highlight the importance of a multidisciplinary team approach and recommend delivery by elective cesarean section at a tertiary center with experienced staff and appropriate resources. Routine preoperative ureteric stenting and occlusion of pelvic arteries are universally not recommended. Moreover, hysterectomy following the delivery of the fetus, expectant management with placenta left in situ, and conservative management in case of focal disease and desired fertility are all considered as acceptable treatment options. The reviewed guidelines also suggest some measures for intraoperative and postoperative hemorrhage control and recommend prophylactic administration of antibiotics. Methotrexate after expectant management is unanimously discouraged. On the other hand, there is no common pathway with regard to the optimal timing of delivery, the recommended mode of anesthesia, the preferred skin incision, and the effectiveness of the delayed hysterectomy approach. PAS disorders are mainly iatrogenic conditions with a constantly rising incidence and potentially devastating consequences for both the mother and the neonate. Thus, the development of uniform international practice protocols for effective screening, diagnosis, and management seems of paramount importance and will hopefully drive favorable pregnancy outcomes.

Sinonasal inverted papilloma and predictors of health-related quality of life after endonasal endoscopic surgery: A prospective cohort study.

Existing knowledge on health-related quality of life (HRQoL) after surgical removal of sinonasal inverted papilloma (IP) is limited. Moreover, predictors for a better or worse post-operative HRQoL outcome are not known. Our aim was to assess HRQoL in all three health domains (physical, psychological, and social), track its post-operative trajectory, investigate if pre-operative observations could predict distinct post-operative HRQoL outcomes, and evaluate whether physicians' interventions could contribute to improved post-operative HRQoL. Prospective cohort study. Tertiary referral hospital. Seventy-four patients who underwent surgery for an IP were included. They were asked to fill in the Endonasal Endoscopic Sinus and Skull-Base Surgery Questionnaire (EES-Q) pre-operatively, and then 2 weeks, 3 months, and 1 year post-operatively. Linear mixed models analyses were performed to evaluate the overall post-operative HRQoL and the separate health domains, as well as the impact of specific variables (sex, age, American Society of Anaesthesiologists [ASA] classification, smoker, Krouse staging, pre-operative EES-Q score, type of surgery, and post-operative antibiotics) on HRQoL improvement. The total EES-Q score (p < .001) as well as the physical (p < .001), psychological (p = .049), and the social (p = .002) domains significantly improved post-operatively. ASA classification (p = .049), pre-operative EES-Q score (p < .001) and post-operative antibiotics (p = .036) were significant variables. Overall HRQoL, as well as each of the three health domains, improved significantly. A higher ASA score, a higher pre-operative EES-Q score, and the administration of post-operative antibiotics were significant predictors for better HRQoL recovery post-operatively. Further research is necessary to confirm these results.

Comprehensive assessment of dental implant procedures: a comparative study on different antibiotic prophylaxis regimens

Relevance. The administration of antibiotics in implantology is indicated to prevent suppurative inflammation conditions. Two regimens are commonly used: a single preoperative dose or prolonged postoperative antibiotic administration. Due to ethical constraints, certain parameters of antibiotic efficacy cannot be directly evaluated within clinical trials. These include the status of the implant-mandibular segment microbiome and the histological parameters of the tissue's inflammatory response at the implant site.Materials and methods. This study employed a miniature pig model comprising 10 males. The cohort was equally divided into two groups of five animals each. Group 1 received a single preoperative dose of amoxicillin/clavulanic acid 2 ml per 20 kg body weight. Group 2 received the same initial dose prior to implantation, followed by a daily postoperative dose of amoxicillin/clavulanic acid at 1 ml per 20 kg body weight for five days. Each animal received six dental implants. An implant site microbiological test was performed pre-surgery, on Day 1, 3, 7 and 14 post-surgery. Core needle biopsies for histological examination of the tissues were performed on the same postoperative days.Results. Microbiological testing revealed that Group 2 exhibited lower levels of Streptococcus spp. on Day 3 (p = 0.04) and Porphyromonas spp. on Day 7 (p = 0.04). Group 1 demonstrated reduced levels of Fusobacterium spp. on Day 1 (p = 0.02) and Porphyromonas spp. both pre-surgery (p = 0.04) and on Day 1 (p = 0.012). Comparative analysis of histological assays from the implant sites indicated identical tissue inflammatory responses, regardless of the antibiotic prophylaxis regimen.Conclusion. Both the single-dose and the prolonged antibiotic prophylaxis regimens, using amoxicillin/clavulanic acid for dental implantation, demonstrated similar histological patterns of tissue inflammation at the implant site, along with comparable microbiota profiles within the implant site. The oral mucosa exhibited an increased population of Staphylococcus spp. and Streptococcus spp., which might contribute to the development of resistant strains, as well as Candida spp., potentially increasing the risk of candidiasis infection onset.

Optimal antibiotics duration following surgical management of septic olecranon bursitis: a 12-year retrospective analysis.

Introduction: The absence of a standardized postoperative antibiotic treatment approach for patients with surgically treated septic bursitis results in disparate practices. Methods: We retrospectively reviewed charts of adult patients with surgically treated septic olecranon bursitis at Mayo Clinic sites between 1January2000 and 20August2022, focusing on their clinical presentation, diagnostics, management, postoperative antibiotic use, and outcomes. Results: A total of 91 surgically treated patients were identified during the study period. Staphylococcus aureus was the most common pathogen (64 %). Following surgery, 92 % (84 of 91 patients) received systemic antibiotics. Excluding initial presentations of bacteremia or osteomyelitis (), the median duration of postoperative antibiotics was 21 d (interquartile range, IQR: 14-29). Postoperative complications were observed in 23 % (21 of 91) of patients, while cure was achieved in 87 % (79 of 91). Active smokers had 4.53 times greater odds of clinical failure compared with nonsmokers (95 % confidence interval, 95 % CI: 1.04-20.50; ). The highest odds of clinical failure were noted in cases without postoperative antibiotic administration (odds ratio, OR: 7.4). Conversely, each additional day of antibiotic treatment, up to 21 d, was associated with a progressive decrease in the odds of clinical failure (OR: 1 at 21 d). Conclusion: The optimal duration of antibiotics postoperatively in this study was 21 d, which was associated with a 7.4-fold reduction in the odds clinical failure compared with cases without postoperative antibiotics. Further validation through a randomized controlled trial is needed.

Assessment of the effectiveness of weight-adjusted antibiotic administration, for reduced duration, in surgical prophylaxis of primary hip and knee arthroplasty.

Prophylactic antibiotics have significantly led to a reduction in the risk of post-operative surgical site infections (SSI) in orthopaedic surgery. The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed, for the duration of the operation, the minimum inhibitory concentration of the likely organisms that are encountered. Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4% and 8% to between 1% and 3%. Controversy, however, still surrounds the optimal frequency and dosing of antibiotic administration. To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime, combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty. Following ethical approval, patients undergoing primary total hip arthroplasty (THA)/total knee arthroplasty (TKA) with the old regime (OR) of a preoperative dose [cefazolin 2 g intravenously (IV)], and two subsequent doses (2 h and 8 h), were compared to those after a change to a new regime (NR) of a weight-adjusted preoperative dose (cefazolin 2 g IV for patients < 120 kg; cefazolin 3g IV for patients > 120 kg) and a post-operative dose at 2 h. The primary outcome in both groups was SSI rates during the 2 years post-operatively. A total of n = 1273 operations (THA n = 534, TKA n = 739) were performed in n = 1264 patients. There was no statistically significant difference in the rate of deep (OR 0.74% (5/675) vs NR 0.50% (3/598); fishers exact test P = 0.72), nor superficial SSIs (OR 2.07% (14/675) vs NR 1.50% (9/598); chi-squared test P = 0.44) at 2 years post-operatively. With propensity score weighting and an interrupted time series analysis, there was also no difference in SSI rates between both groups [RR 0.88 (95%CI 0.61 to 1.30) P = 0.46]. A weight-adjusted regime, with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.

Comparative efficacy of pre-operative and post-operative administration of amoxicillin in third molar extraction surgery - A systematic review and meta-analysis.

To compare the effectiveness of pre-operative and post-operative administration of amoxicillin in patients undergoing third molar extraction surgery. A systematic search was executed according to PRISMA guidelines for studies published till December 2021. Studies were included based on the pre-eligibility criteria. The risk of bias was assessed using the Cochrane risk of bias tool. The heterogeneity was evaluated, and a random effect model was used for meta-analysis. A total of five studies were included from an initial search of 96 studies. The included studies were randomized controlled trials and comparative studies assessing pre-operative and post-operative administration of antibiotics among patients undergoing third molar extraction surgery. For comparison between pre-operative and post-operative groups, interincisal distance, complications, pain, and swelling were systematically reviewed and meta-analysis was done for interincisal distance and complications. The mean change in interincisal distance ranged from 5.5 to 47.9 and from 4.56 to 46.1 in the pre-operative and post-operative amoxicillin groups, respectively. Complications reported were infections, alveolar osteitis, nausea, diarrhea, gastric pain, rash, and headache with a pooled incidence of 4.3-33% in the pre-operative amoxicillin group and 0-22.7% in the post-operative amoxicillin group. Quantitative synthesis of data carried out from meta-analysis shows a significant difference in the pre-operative and post-operative amoxicillin groups in improving the interincisal distance and incidence of complications post surgery. The qualitative synthesis of data derived from systematic review for pain provides favoring results for post-operative amoxicillin administration. In case of swelling, a non-conclusive result was obtained.

SURGICAL MANAGEMENT OF GRANULOMA IN A 5-YEAR-OLD UDA EWE

Granuloma is a well-known inflammatory condition in veterinary and human medicine. It is a chronic inflammatory reaction triggered by a wide variety of persistent agents, characterized by the recruitment and activation of macrophages, occasionally presenting areas of central necrosis. The aim of the present report is to provide information regarding the manifestation, cytology, histology and management of granuloma in sheep. A five-year-old Uda ewe was presented to the Veterinary Teaching Hospital, University of Jos in September, 2023, with a large mass around the neck, extending towards the jugular furrow. Following cytological examination of the mass, surgical excision was undertaken under mild sedation (2% Xylazine) and local anaesthesia (1% Lidocaine hydrochloride). The mass was subjected to histopathological examination, while routine wound cleansing and care was instituted with post-operative administration of analgesic, anti-inflammatory agent, antibiotics, multivitamins and tetanus toxoid intramuscularly. Histopathological findings comprised of masses having necrotic centre with sulfur granules, area of macrophages, lymphocyte, plasma cell and zones of fibro-connective tissue with evidence of neo-vascularization and perivascular cuffing supporting the diagnosis of granuloma. Follow-up re-examinations of the Ewe were undertaken every other day with stitches removed on day 12 post-operation following complete apposition of the wound edges. After 14 days of management, the ewe was discharged following normal rectal temperature (39.0ºC), pulse rates (80.0 beats/minute) and respiratory rates (28.0 cycles/minute). Therefore, cases of granuloma could be satisfactorily managed by complete surgical excision with thorough post-operative care.

Surgical site infections: a cross-sectional study of bile culture

Background: Surgical site infections (SSIs) are one of the most common reported healthcare-associated infections worldwide. SSIs are also the most common complication of various surgical procedures, including cholecystectomy which is the standard surgical procedure for calculus cholecystitis. The association between SSIs and cholecystectomy is suspected due to infection from pathogens in the bile. This study aims to determine the relationship between bile culture results and the incidence of SSIs in patients with calculus cholecystitis undergoing cholecystectomy procedures. Methods: This study was an analytic observational study with a cross-sectional design which involved 44 subjects. The data obtained were then analyzed using the Chi square method with the IBM statistical package for the social sciences (SPSS) version 26. Results: There were 44 subjects with calculus cholecystitis included in this study. None of the subjects in this study had SSIs, and also 54.5% of the subjects were given postoperative antibiotics. The results of data analysis showed no significant association between bile culture and SSIs (p&gt;0.05). Additional analysis in this study also revealed no association between type of surgery and bile culture (p&gt;0.05) and between postoperative antibiotic administration and SSIs (p&gt;0.05). Conclusions: Positive bile culture was not associated with the incidence of SSIs in calculus cholecystitis patients undergoing cholecystectomy procedures. The findings of this study also revealed no association between type of surgery and SSIs and postoperative antibiotic administration is not a mandatory for every cholecystectomy procedure.

Effects of Postoperative Splinting on Outcomes following Digital Mucous Cyst Excision: A Retrospective Review

BackgroundDigital mucous cysts (DMCs) are masses on the fingers that can be definitively managed with surgical excision. Though uncommon, surgical site infections can develop into septic arthritis. We sought to determine whether postoperative splinting decreases rates of postoperative infection and the need for postoperative antibiotics. We also explored the effect of age, gender, obesity, and preoperative antibiotic administration on infectious complications. MethodsPatients who underwent DMC excision between 2011 and 2021 were retrospectively identified. Chi-squared and Fisher’s exact tests were used to analyze the complication rates including documented infection, postoperative antibiotic administration, mass recurrence, and return to operating room. Associations were analyzed between both preoperative antibiotic administration and postoperative splinting with respect to postsurgical complications. ResultsThe database search identified 373 patients who underwent 394 DMC excisions. Postoperative antibiotics were given in splinted patients at lower rates than their nonsplinted counterparts with a small-to-moderate effect size, but the difference was not statistically significant (2.7 vs. 7.5%). Preoperative antibiotic administration was not found to significantly affect the prescription of postoperative antibiotics. Splinting did not reduce rates of DMC recurrence. Patients who were splinted were more likely to have also received preoperative antibiotics. Males were given postoperative antibiotics more frequently than females (12.6 vs. 4.0%). ConclusionsThough not statistically significant, splinted patients were prescribed postoperative antibiotics less frequently. Postoperative antibiotics were utilized more frequently than the rate of infections typically reported following this procedure, possibly indicating overcautious prescription habits or underreported suspected infections.

Defining a Relationship Between Postoperative Antibiotic Use and Wound Complications in the Setting of an Uncomplicated Laparoscopic Appendectomy.

Appendicitis is a very common diagnosis that surgeons manage daily. Some surgeons are still giving antibiotics to patients suffering from uncomplicated appendicitis in the postoperative setting, despite an abundance of evidence to support a single preoperative dose of antibiotics.In this paper, we will describe the management of post-operative antibiotics at our institutions following uncomplicated appendicitis with regard to the use of antibiotics in the post-operative setting. A retrospective chart review was performed analyzing post-operative antibiotic use and postoperative complications in 179 patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. We retrospectively examined the patients to change our future practices as we perform appendectomies routinely, and there is practice variation at our centers. Current Procedural Terminology (CPT) codes for 'laparoscopic appendectomy' were used to identify the patients within our inclusion criteria. Twenty-four patients were excluded from the analysis as they had complicated appendicitis or met other exclusion criteria. We only studied the patient with uncomplicated appendicitis, as those with complicated appendicitis have a different clinical course that involves post-operative antibiotic administration or prolonged antibiotic administration with or without drain placement. Both arms of the study were homogeneous regarding patient characteristics. An independent test of the development of wound infection for those patients receiving post-operative antibiotics versus those not receiving post-operative antibiotics was conducted using the SPC XL 2010 Microsoft Excel (Redmond, USA) add-in. A p-value of <0.05 was considered statistically significant. This included the odds ratio for the development of complications. Results: There was no difference in the risk of infection rate in patients given post-operative antibiotics; however, given the odds ratio of 6.53, there is an association between an increased wound infection rate and patients who received post-operative antibiotics. Discussion: An appendectomy is a standard surgical procedure for acute appendicitis. The guidelines for using pre-operative antibiotics in uncomplicated appendicitis are well established; however, there is no specific recommendation on whether to continue antibiotics post-operatively. However, there is significant provider variability on this topic. Antibiotic use post-operatively in clean-contaminated cases, such as uncomplicated acute appendicitis, has been associated with higher risks of surgical site infections. Conclusion: The use of antibiotics post-operatively may not be indicated for uncomplicated laparoscopic appendectomy and may increase wound infections. A large-scale study including a larger population and extending it to other hospitals may increase statistical significance and help guide physician management.

Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction.

The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27-83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m2 (20.8-45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12-98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4-42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations.

Implant removal rate after partial carpal arthrodesis in dogs: A retrospective analysis of 22 cases.

The purpose of this study is to determine the rate of implant removal after partial carpal arthrodesis and to investigate factors associated with implant removal. Case records of 22 dogs that underwent partial carpal arthrodesis at two private veterinary referral hospitals were reviewed. Details retrieved were body weight at time of surgery, sex, neuter status, breed, age, cause of carpal hyperextension injury, joint(s) involved in carpal hyperextension injury, laterality, type of implant, administration of post-operative antibiotics, post-operative outcome and indication for implant removal. Association between these factors and implant removal was evaluated. Of 22 partial carpal arthrodesis, 12 (55%) had implant removal due to persistent lameness and 9/12 (75%) returned to full and acceptable function after implant removal. Indications for implant removal were implant interference (8), infection (4), and migration (1). When comparing type of implant, there was a significant difference when observing implant removal rates (p = 0.04). All 5 dogs with pins and wires (100%) required implant removal. Of 17 dogs with a plate, 7 (41.2%) required implant removal. Implant removal was performed on average 114 days post-operative. Implant removal after partial carpal arthrodesis was frequent and was commonly indicated due to pin and wire fixation or plate implant interference. This study may impact how we prepare clients for potential post-operative complications and implant removal when recommending partial carpal arthrodesis.

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications.

Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3-4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.

Impact of the Duration of Postoperative Antibiotics on the Prognosis of Patients with Infective Endocarditis.

Appropriate postoperative antibiotic treatment in patients with infective endocarditis (IE) reduces the risks of recurrence and mortality. However, concerns about adverse drug reactions arise due to prolonged antibiotic usage. Therefore, we compared the recurrence and mortality rates according to the duration of postoperative antibiotic therapy in patients with IE. From 2005 to 2017, we retrospectively reviewed 416 patients with IE treated at a tertiary hospital in South Korea; among these, 216 patients who underwent heart valve surgery and received appropriate antibiotics were enrolled. The patients were divided into two groups based on the duration of usage of postoperative antibiotic therapy; the duration of postoperative antibiotic therapy was more than two weeks in 156 patients (72.2%) and two weeks or less in 60 patients (27.8%). The primary endpoint was IE relapse. The secondary endpoints were 1-year IE recurrence, 1-year mortality, and postoperative complication rates. The median age was 53 (interquartile range: 38-62) years. The relapse rate of IE was 0.9% (2/216). There was no statistical difference in relapse (0.0% vs. 1.3%, p = 0.379), 1-year recurrence (1.7% vs. 1.3%, p = 0.829), or 1-year mortality (10.0% vs. 5.8%, p = 0.274) between patients with postoperative antibiotic administration of two weeks or less versus more than two weeks. The duration of postoperative antibiotic therapy did not affect the 1-year mortality rate (log-rank test, p = 0.393). In conclusion, there was no statistically significant difference in recurrence, mortality, or postoperative complications according to the duration of postoperative antibiotic therapy.

How standardised are antibiotic regimens in otologic surgery?

BackgroundWithin otologic surgery, a paucity of well-controlled studies assessing the use of systemic antibiotic to reduce surgical site infections exists. Moreover, discrepancies in wound classification of procedures challenge consensus in antimicrobial prescribing patterns. We sought to compare surgeons from two different health systems to examine how surgeons’ prescribing habits compared to practice guidelines for numerous otologic procedures.MethodsAn online questionnaire was distributed to 33 Canadian and 32 Austrian surgeons who regularly perform otologic surgery. Current systemic antibiotic prescribing habits for cochlear implantation, cholesteatoma surgery, stapes surgery, and tympanoplasty ± ossiculoplasty were collected.ResultsEighteen of 33 (54.5%) Canadian surgeons provided responses, while 18 of 32 (56.3%) of Austrian surgeons answered. Clear consistency with clinical practice guidelines exists for pre-operative antibiotics use in cochlear implant surgery and infected cholesteatoma surgery. However, for stapes surgery and tympanoplasty ± ossiculoplasty, consensus is lacking for both pre- and post-operative antibiotic prescribing habits. Notable differences between the two countries include post-operative antibiotics for cochlear implant surgery (Austria: 36.4%, Canada: 71.4%) and uninfected cholesteatoma surgery (Austria: 33.3%, Canada: 77.8%). Across all procedures, both induction and post-operative antibiotic administration was not significantly associated with surgeon seniority when stratified by five-year increments.ConclusionThe lack of consensus among each country’s otologic surgeons underscores the uncertainty in wound classification and thus, adherence to clinical practice guidelines.Graphical

Complications and their management in the surgical treatment of Lipohyperplasia dolorosa. English version.

There are both conservative and surgical treatment options for Lipohyperplasia dolorosa (LiDo). Aprocedure that has been established since 1997 is the surgical treatment through Lymphological Liposculpture according to Cornely™. After extensive suctioning of the extremities, an extensive subcutaneous wound cavity with atrabecular connective tissue scaffold remains. Nevertheless, surgery-related complications are rare. Postoperative management and administration of antibiotics and antithrombotics are reviewed. The therapies for complications are presented in detail. Retrospectively, the frequencies of adverse events in 1400 LiDo surgeries in 2020 were evaluated. The mean age of the patients was 47.81years (range 16-78years). Symmetrically, 504 outer legs (outer half of the limb [BO]), 504 inner legs (inner half of the limb [BI]), and 392 arms[A] were surgically treated. Relevant adverse events rarely occurred: infections (1.79%), seromas (0.79%), erysipelas (0.28%), necrosis (0.14%) and deep vein thrombosis (0.07). We were able to reduce the rate of postoperative complications to 3.07% in the Lymphological Liposculpture™ regime for the surgical treatment of LiDo. In their meta-analysis on liposuction, Kanapathy etal. reported an overall incidence of major surgical complications of 3.35%. The overall incidence of minor surgical complications was 11.62%, with seroma (5.51%) being the most common minor complication [26]. Kruppa etal. report that the liposuction procedure including fat removal for esthetic reasons has acomplication rate of 9.5%. Wound infections with 4.5% and the formation of erysipelas with 4% are clearly in the foreground [20].

Complications and their management in the surgical treatment of lipohyperplasia dolorosa

There are both conservative and surgical treatment options for lipohyperplasia dolorosa (LiDo). Aprocedure that has been established since 1997 is the surgical treatment through lymphological liposculpture according to Cornely™. After extensive suctioning of the extremities, an extensive subcutaneous wound cavity with atrabecular connective tissue scaffold remains. Nevertheless, surgery-related complications are rare. Postoperative management and administration of antibiotics and antithrombotics are reviewed. The therapies for complications are presented in detail. Retrospectively, the frequencies of adverse events in 1400 LiDo surgeries in 2020 were evaluated. The mean age of the patients was 47.81years (range 16-78years). Symmetrically, 504 outer legs (outer half of the limb [BA]), 504 inner legs (inner half of the limb [BI]), and 392 arms[A] were surgically treated. Relevant adverse events rarely occurred: infections (1.79%), seromas (0.79%), erysipelas (0.28%), necrosis (0.14%) and deep vein thrombosis (0.07). We were able to reduce the rate of postoperative complications to 3.07% in the Lymphological Liposculpture™ regime for the surgical treatment of LiDo. In their meta-analysis on liposuction, Kanapathy etal. reported an overall incidence of major surgical complications of 3.48%. The overall incidence of minor surgical complications was 11.62%, with seroma (5.51%) being the most common minor complication [26]. Kruppa etal. report that the liposuction procedure including fat removal for esthetic reasons has acomplication rate of 9.5%. Wound infections with 4.5% and the formation of erysipelas with 4% are clearly in the foreground [20].

Appropriateness of choice and duration of surgical antibiotic prophylaxis and the incidence of surgical site infections: A prospective study

ObjectivesSurgical site infections (SSIs) develop within 30–90 days postoperatively. Antibiotic prophylaxis helps reduce SSI incidence, with cefazolin being the most used agent. Current guidelines recommend against postoperative antibiotic administration or a very short course. This study evaluated the appropriateness of prophylactic antibiotics by surgery type, as well as duration and their impact on SSI incidence. MethodsThis was an observational prospective study of adults admitted between June and October 2019 for abdominal or orthopedic surgery who received prophylactic antibiotics. The primary endpoint was compliance of postoperative prophylactic antibiotic duration with the guidelines. Secondary endpoints included appropriateness of antibiotic choice and SSI rates. ResultsOf the 98 patients, 59, 23, and 16 had orthopedic, upper abdominal, and lower abdominal surgery, respectively. Median postoperative antibiotic durations were longer in the abdominal surgery group than in the orthopedic surgery group (7 vs. 5 days; P = 0.03). Hence, overall compliance with the guidelines in terms of postoperative antibiotic duration was 11.2% (13.6%, 13%, and 0% in each surgery group, respectively; P = 0.3). Conversely, antibiotic choice was highly compliant with the guidelines at 71.4% (72.9%, 65.2%, and 75% in each surgery group, respectively; P = 0.74). This was significantly associated with a lower risk of SSIs (odds ratio 0.24, 95% confidence 0.09–0.63). ConclusionWhile there was a lack of guidelines compliance in terms of duration, appropriateness of antibiotic choice was high and was associated with a lower likelihood for SSIs. Clinicians are encouraged to follow the guidelines to improve patients' quality of care by preventing SSIs and reducing the risk of antimicrobial resistance development.