Postoperative Antibiotics Research Articles

Are Antibiotics Needed in Septorhinoplasty? An Evidence-Based Approach.

The use of prophylactic antibiotics in the context of septorhinoplasty (SRP) is a frequently debated topic among plastic surgeons. Most surgeons routinely use antibiotics to prevent the dreaded physical and psychological morbidity of postoperative infections, although this practice is controversial. With antimicrobial resistance becoming a global threat, however, optimizing antibiotic prescribing is essential. The current evidence would suggest that the rate of postoperative infection is low and routine antibiotic use is unnecessary in SRP surgery. Rates range from 0.5 to 2% in simple SRP surgery, majority of which are minor nasal infections which respond to oral antibiotics and do not require hospital admission. In cases of complex SRP, defined as revision cases or where grafts or implants have been utilized, infection rates can be much higher with an incidence of 7 to 11%, and as such utilization of antibiotics is reasonable. When considering the regime to be utilized, a single preoperative dose of intravenous antibiotics has the same efficacy in reducing the incident of postoperative infection as a postoperative 7-day course of oral antibiotics. In the authors' practice, all patients receive a single intravenous dose of antibiotics on induction, and in the case of utilization of a graft from a nonnasal site, this is complimented with an oral course of postoperative antibiotics. With this approach, infections rates are at the lowest range of available published literature.

Endophthalmitis prophylaxis in cataract surgery and intravitreal injection in the US

AbstractEndophthalmitis is not a “never event” following cataract surgery or intravitreal injection, therefore the occurrence of endophthalmitis does not necessarily imply a break in technique or that the surgeon somehow “did something wrong”. Endophthalmitis cannot be prevented, but its rate can be reduced using evidence‐based measures. Endophthalmitis prophylaxis techniques include more than the use of antibiotics; specifically, prep/drape, speculum use, wound construction, etc.In the US, intracameral antibiotics are not universally used. The decision to use routine intracameral antibiotics appears to depend on many “non‐medical” factors, including internal health system policies, local standards of care, and other concerns. In the US, there is no packaged antibiotic that is specifically approved for intracameral use so all such agents are used “off‐label”; this factor appears to be suppressing the use of intracameral antibiotics at least in some locations.In the US, intravitreal injections are almost always performed in the clinic rather than in an operating room or similar setting. (In fact, it can be difficult to get reimbursed for anti‐VEGF drugs injected in an operating room.) Many practices use a standard examination room rather than a minor procedure room or a room dedicated to performing injections. Eyelid speculums are very widely used, although there is a growing acceptance of the use of bimanual retraction from a skilled assistant, rather than an eyelid speculum. In many practices, topical antibiotics are not used.It is the author's opinion (although there is little or no evidence from randomized clinical trials to support this opinion) that post‐surgical endophthalmitis differs from post‐injection endophthalmitis in how the microorganisms gain access to the intraocular space. Following cataract surgery, it seems most likely that microorganisms enter the eye through the incision in the postoperative period; this would explain the relatively later onset of infection, as well as the apparent benefits of postoperative topical antibiotics, proper wound construction, and suturing the incision when necessary. Following intravitreal injection, it seems most likely that microorganisms enter the eye at the moment of the injection; this would explain the relatively sooner onset of infection, as well as the apparent lack of benefit of postoperative topical antibiotics.

Mechanical and oral antibiotics bowel preparation for elective rectal cancer surgery: A propensity score matching analysis using a nationwide inpatient database in Japan.

The best bowel preparation method for rectal surgery remains controversial. In this study we compared the efficacy and safety of mechanical bowel preparation (MBP) alone and MOABP (MBP combined with oral antibiotic bowel preparation [OABP]) for rectal cancer surgery. In this retrospective study we analyzed data from the Japanese Diagnosis Procedure Combination (DPC) database on 37 291 patients who had undergone low anterior resection for rectal cancer from 2014 to 2017. Propensity score matching analysis was used to compare postoperative outcomes between MBP alone and MOABP. A total of 37 291 patients were divided into four groups: MBP alone: 77.7%, no bowel preparation (NBP): 16.9%, MOABP: 4.7%, and OABP alone: 0.7%. In propensity score matching analysis with 1756 pairs, anastomotic leakage (4.84% vs 7.86%, P < 0.001), small bowel obstruction (1.54% vs 3.08%, P=0.002) and reoperation (3.76% vs 5.98%, P=0.002) were less in the MOABP group than in the MBP group. The mean duration of postoperative antibiotics medication was shorter in the MOABP group (5.2d vs 7.5d, P < 0.001) than in the MBP group. There was no significant difference between the two groups in the incidence of Clostridium difficile (CD) colitis (0.40% vs 0.68%, P=0.250) and methicillin-resistant Staphylococcus aureus (MRSA) colitis (0.11% vs 0.17%, P=0.654). There was no significant difference in in-hospital mortality between the two groups (0.00% vs 0.11% respectively, P=0.157). MOABP for rectal surgery is associated with a decreased incidence of postoperative complications without increasing the incidence of CD colitis and MRSA colitis.

Risk factors for revision surgery in operative treatment of traumatic injuries of the olecranon and prepatellar bursa

IntroductionTraumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary.Material and methodsIn this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed.Results150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma.ConclusionsGiven the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions.Level of evidenceLevel of evidence IV.

Antibiotic use in gastrointestinal surgery patients at a Vietnamese national hospital

BackgroundInvasive gastrointestinal surgery may be performed as an open or endoscopic procedure, such as laparoscopic semi-colon surgery, laparoscopic appendectomy, laparoscopic gastrectomy, and anal surgery, among other such operations. Regardless of the approach, the operative procedure interferes with the patient’s gastrointestinal tract, necessitating the rational use of prophylactic antibiotics to improve treatment outcomes and minimize postoperative infections.ObjectiveTo investigate the prophylactic and postoperative antibiotic usage in patients who underwent invasive gastrointestinal surgery, and to identify factors associated with postoperative infection.DesignThis descriptive, cross-sectional study included 112 patients who underwent invasive gastrointestinal surgery at the Department of Gastroenterology, Thong Nhat Hospital. We conducted a cross-sectional study in all inpatients aged 18 years and older, who underwent invasive gastrointestinal surgery between January 2020 and December 2020. We recorded patient characteristics, the administration and appropriateness of antibiotics, as well as treatment outcomes. The appropriateness of prophylactic and postoperative antibiotic usage was assessed based on 2015 Vietnamese national guideline for antibiotic use. Multivariable logistic regression analysis was used to determine the factors associated with postoperative infection.ResultsPatients’ mean age was 59.7 ± 17.2 years. Most surgeries (89.3%) were clean-contaminated procedures. The rates of appropriate types of antibiotics selected, doses, and overall rates of appropriateness of antibiotic prophylaxis were 68.0%, 76.4% and 54.7%, respectively. Of the patients investigated, 34.8% had at least one sign of postoperative infection; the overall appropriate rate of postoperative antibiotic was 38.5%. Old age was associated with postoperative infection and longer length of hospitalization.ConclusionImplementation of the guidelines recommended for the prophylactic and therapeutic use of antibiotics is essential to improve treatment outcomes.

Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery.

Chylous ascites (CA) presents a challenge as a relatively common postoperative complication in gastric cancer (GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a low-fat diet. Drainage tube (DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA. To propose novel conservative treatment strategies for CA following GC surgery. The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively. 53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association (R 2 = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost (postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001; total hospitalization: 33.2 d vs 24.7 d, P < 0.01; antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01; hospitalization cost: ¥9.2 × 104 vs ¥6.5 × 104, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal. Furthermore, DT removal times were shorter in seven patients who underwent DT clamping (clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047; clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA. Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.

Customized Postoperative Therapy Improves Bile Drainage in Biliary Atresia: A Single Center Preliminary Report

BackgroundControversies in management of biliary atresia (BA) after hepatoportoenterostomy (HPE) lead to variable treatment protocols. We implemented standardized medical management after HPE, customizing the use of antibiotics and corticosteroids based on patient-specific factors. MethodsIn this retrospective analysis, 20 consecutive infants underwent HPE for BA and were compared to a historical cohort. Analysis of successful biliary drainage 3 months after HPE (defined as serum total bilirubin <2 mg/dL) was the primary endpoint; survival with native liver at 2 years was the secondary endpoint. ResultsSixteen of 20 (80%) infants had successful bile drainage, compared to 8 of 20 (40%) infants in the historical cohort (P = 0.0225). Sixteen of 20 patients in the new protocol have reached 2 years of age or required liver transplantation. Among the sixteen, 11 (68.8%) are alive with native livers versus 10 of 20 (50%) in the historical cohort (P = 0.0970). ConclusionThis preliminary report suggests the potential benefit of tailored use of postoperative antibiotics and corticosteroids in improving biliary drainage after HPE. Level of evidenceIII.

Antibiotic Use and Surgical Site Infections in Immunocompromised Patients After Mohs Micrographic Surgery: A Single-Center Retrospective Study.

As Mohs micrographic surgery becomes more widely used in immunosuppressed patients, it is important to understand the risks in this unique population. To determine whether immunosuppressed patients are at an increased risk for surgical site infection and evaluate the utility of postoperative antibiotics for the prevention of surgical site infection. A single-center retrospective review of patients who underwent Mohs micrographic surgery between October 9, 2014, and August 20, 2021, was performed. Five thousand eight hundred eighty-six independent cases were identified. Factors associated with an increased incidence of antibiotic use included preoperative lesion size >40 mm (86.7%, n = 13; p < .01) and high-risk lesion location (46.4%, n = 1,268; p < .01). Patients were not more likely to be prescribed antibiotics if immunosuppressed (37.0%, n = 269 vs 34.2%, n = 1765; p = .14), and immunosuppression was not independently associated with antibiotic use on multivariate analysis (odds ratio 1.2, 95% confidence interval 1.0-1.5). Infection rates were similar between immunocompromised patients and immunocompetent patients (2.1%, n = 15 vs 1.6%, n = 80, respectively; p = .30). In immunosuppressed patients, antibiotic use did not decrease the likelihood of infection (3.0%, n = 8 vs 1.5%, n = 7; p = .19). There was no association between immunosuppression and surgical infection rate. Furthermore, postoperative antibiotics should not be indicated in these patients unless other high-risk criteria exist.

The Role of Surgical Drainage on Complications after Sentinel Lymph Node Biopsy for Melanoma.

This is a retrospective study of patients who underwent SLNB for melanoma from 2016 to 2021. Patients were dichotomized into two groups according to the use of drain. The between-group comparison (drainage group versus no drainage group) was performed by using Mann-Whitney U test and chi-square test. A regression analysis was conducted to identify predictors of complications. Of 218 individuals analyzed, 18 (8.4%) had postoperative complications. The most common complications were seroma (5.1%) and wound dehiscence (1.4%). The between-group analysis showed no significant differences in complication rate, whereas the operative time was significantly higher in the drainage group (P = 0.007), as well as the hospital stay (P ≤ 0.0001) and the duration of postoperative antibiotic therapy (P = 0.02). The regression analysis found body mass index and multiple basins of SLNB (axilla with groin) to be significant predictors of having a complication (P = 0.03 and P = 0.05, respectively). The operative time was found to be a predictor of seroma (P = 0.04). Drainage use in SLNB prolonged hospital stays and duration of postoperative antibiotic therapy, thus resulting in higher costs. The preemptive use of drainage is suggested in selected settings of patients.

Oral Contraceptive Use and Alveolar Osteitis Following Third Molar Extraction: A Systematic Review and Meta-Analysis.

Alveolar osteitis (AO) is a common postoperative complication of third molar extractions that is thought to be associated with the intake of oral contraceptives (OCPs). This meta-analysis sought to evaluate the risk of AO associated with OCP use and sex independently and whether this risk was affected by the use of postoperative analgesics or antibiotics. PubMed/Medline, EMBASE, and Cochrane databases were searched for articles pertaining to OCP use and the incidence of AO using MESH terms. The measured outcome was the development of AO following a third molar extraction. Additional variables such as sex, analgesic, and antibiotic use were documented and included in the analysis. The data were analyzed in R using the Mantel-Haenszel method. Fifteen studies with a total of 1366 female participants who were OCP users and 2919 nonuser female participants were included in this meta-analysis. OCP users were approximately twice (pooled-RR: 1.98, 95% CI: 1.42-2.76) as likely to develop AO following a third molar extraction when compared to nonuser females. The increased incidence of AO in the OCP group was statistically significant (p < 0.01). The pooled-RR of AO in females not taking OCPs was not significantly different from males (p=0.45). OCP use significantly elevated the risk of AO in females. Females who did not take OCPs had a similar risk of developing AO compared to males, suggesting that OCP use is a potential effect modifier. Neither postoperative antibiotics use nor the type of postoperative analgesic significantly affected AO incidence in those taking OCPs.

Perioperative Antibiotics in Appendicitis-Do We Need to Adjust Therapy for the Elderly? A Matched Pair Analysis.

(1) Background: Perioperative Antibiotics for acute complicated appendicitis are a standard of care. While there are plenty of trials for pediatric patients, data for elderly patients are scarce. The goal of our study was to evaluate whether elderly patients carry more resistant bacteria and thus have less favorable outcomes after an appendectomy that may warrant intensified perioperative antibiotic treatment (2) We present a retrospective single-center matched pair (139 patients each) analysis of perioperative and microbiological outcomes of an elderly appendicitis cohort (i.e., older than 60 years) compared with a younger adult cohort (i.e., ≤60 years). Both groups were matched one for one according to gender, duration of symptoms, c-reactive protein at presentation and whether they presented with uncomplicated or complicated appendicitis. (3) Results: After matching, complicated appendicitis was present in 76.3% of both groups. Elderly patients more frequently received preoperative diagnostic CT (p &lt; 0.001) than the young. Both operative strategy (laparoscopic appendectomy in 92.1% each) and duration of surgery (57 vs. 56 min) were equal in both groups. Postoperative antibiotics were prescribed in ~57% for a median of 3 days in both groups and antibiotic selection was similar. The incidence of surgical site infections was higher in the young (12.2% vs. 7.9%) yet not significant. There was no difference in culture positivity or bacterial spectrum and the elderly cohort did not present with increased resistant bacterial isolates. (4) Conclusions: While overall resistant bacterial strains were rare, perioperative outcomes between the young and the elderly did not differ and did neither warrant longer nor intensified antibiotic treatment.

Diagnosis and surgical management of gastric and duodenal foreign bodies in a 15 month old male Alaskan husky: A case report

A 15 months old male Alaskan husky weighing 28 kg was presented to the hospital with a history of acute onset of frequent emesis and not passing stools which had persisted for 5 days, on physical examination animal was in dull mentation having lethargy and generalised malaise. Clinical examination revealed that prolonged capillary refill time and skin tenting time. Haemato-biochemical profile revealed mild granulocytosis and increased packed cell volume. Plain abdominal radiography revealed two large radiopaque foreign bodies in the stomach and proximal portion of intestinal loops. Immediately we performed exploratory laparotomy followed by gastrotomy, enterotomy and retrieved two large sized thick rubber objects which obstructed the stomach and a portion of duodenal lumen completely. The animal have shown an uneventful recovery after 1 week of proper postoperative care, fluid and antibiotic therapy.

Stapled Hemorrhoidectomy: A Safe Procedure for Third and Fourth Grade Hemorrhoids

Objective: To evaluate the safety outcome of staple hemorrhoidectomy in grade III and IV hemorrhoids. Study Design: Descriptive study Place and Duration of Study: Department of Surgery, Shahida Islam Medical Complex, Lodhran from 1st July 2020 to 30th June 2021. Methodology: Seventy patients were selected who were suffering from third or fourth grade hemorrhoids. The age of the patients was between 21-56 years with both gender been presented. Longos method was opted with spinal analgesic been delivered in lithotomy positioning. The complete surgical protocol was maintained with preoperative antibiotic deliverance. The procedure took 30-50 minutes. Patient was then kept in recovery room for three hours post operation and all postoperative antibiotics were timely administered. Results: Mean age of study participants was 41.2±3.2. Men appeared to be higher in number as compared to women. Grade III patients were more in number as compared to grade IV. Most common complication which was observed in present study is postoperative pain. Majority of the patients (70%) showed no associated complications. Conclusion: Staple hemorrhidectomy is appeared to be a safe and reliable surgical procedure for the treatment of grade III and grade IV hemorrhoids. Keywords: Hemorrhoids, Surgical procedure, Stenosis, Efficacy, Conventional

Post-operative antibiotics for cutaneous abscess after incision and drainage: Variations in clinical practice

Acute cutaneous abscess is a common surgical condition that mostly requires incision and drainage. Despite this, there is no standardized national or international guidance on post-operative antibiotics prescription. Traditionally, antibiotics are not indicated unless complications and/or risk factors such as immunocompromisation, diabetes or cellulitis exist. We aimed to study the local practice for post-operative antibiotics prescription for cutaneous abscesses in a UK university teaching hospital. Retrospective data collection for emergency general surgical admissions for a period of 6 months was carried out. All patients with cutaneous abscesses were included in this analysis. Scrotal, breast and limb abscesses were excluded. Patients' demographics, co-morbidities and complications, including local (cellulitis, necrosis) and systemic (e.g sepsis), were studied. Approval for access to patient data was granted by the local clinical governance department prior to the commencement of this study. Computations were performed using IBM SPSS version 26. Chi square (X 2), Pearson correlation (r), one or two samples t-test (one or two tailed) were applied. A total of 148 patients were included. The mean age was 40 years (55 % males). The most common site of abscess was perianal (27.7 %), followed by pilonidal (20.3 %) and axilla (16.9 %). A total of 107 (73 %) were managed surgically with incision and drainage, and of these 92 (86 %) were managed within 24 h. Altogether, 83 (76 %) were prescribed post-operative antibiotics, while only 25 (23 %) had indications. The most used post-operative empirical antibiotics was co-amoxiclav (59 %). There was a significant relationship between 'abscess site' × 'antibiotics' [X 2 (36)=54.8, P=0.023]. A total of 103 patients' average duration of post-operative antibiotics was 7.2 (sd 2.9) days. Ten patients subject to readmission spent an average of 8.4 (sd 3.8) days on antibiotics. There were variations in clinical practice regarding post-operative antibiotic prescription for cutaneous abscesses. Research is required in the future in cooperation with microbiologists to develop a standardized evidence-based treatment protocol for the management of such a common surgical condition.

Evaluation of Adjunctive Low Level Laser Therapy in Postoperative Management of Pain, Swelling, Trismus Following Surgical Removal of Impacted Mandibular Third Molars

Our aim is to evaluate the effectiveness of Low Level Laser Therapy (LLLT) in the control of postoperative pain, swelling, and trismus associated with the surgical removal of impacted mandibular third molars. This study was carried out as a single centre, prospective study with a sample size of 30 patients to evaluate the effectiveness of LLLT following surgical removal of impacted third molars. Patients were randomly divided into two groups of 15 each. Group 1(Study /LLLT group) consisted of patients undergoing LLLT and with the use of postoperative analgesics and antibiotics. Group 2 (Control) included patients who were administered postoperative analgesics and antibiotics without the concurrent use of LLLT. The predictor variable was the LLLT application following mandibular third molar impaction surgery. The outcome variables namely pain, swelling, and trismus were evaluated on the day of surgery and 1st, 3rd, and 7th postoperative days (POD).Results:The pain was highest on POD 1 and gradually reduced by POD 7 in the study group when compared to the control group. Swelling showed a steep increase on POD 1 and thereafter a gradual reduction was observed on POD 7, when compared to the control group, the study group showed a significant decrease in swelling. Mouth opening was the lowest on POD1 and gradually increased by POD 7 in the study group than in the control group. Conclusion: The results of the study suggest that the application of LLLT to impacted mandibular third molar sockets helps eliminate/or reduce postoperative pain, swelling, and trismus.

Biliary Tract Microflora in Patients Undergoing Cholecystectomy for Acute Biliary Tract Disease: An Analysis of the Effect of Bile Spillage and Microbiology on Outcomes

INTRODUCTION: Bile spillage (BS) is common during laparoscopic cholecystectomy and has been shown to be associated with an increased risk of surgical site infection (SSI). We hypothesized that positive bile cultures (PBCs) increase the risk of postoperative complication including SSI. METHODS: A retrospective chart review was conducted of all patients older than 18 years undergoing urgent laparoscopic cholecystectomy at an academic hospital from January to September 2019. Charts were reviewed for the index admission and postoperative visits. We compared those who had PBCs with those who did not. Our primary endpoint was the rate of SSI. A univariate analysis, as well as a multivariate logistic regression, were used to identify predictors of SSI. RESULTS: A total of 272 patients underwent laparoscopic cholecystectomy. Indications for operation included acute cholecystitis (62.5%), symptomatic cholelithiasis (12.5%), and other indications (25%). Bile was spilled in 191 patients (70.2%). PBCs were obtained in 78 of 249 (31.3%) patients and were associated with preoperative endoscopic retrograde cholangiopancreatography (ERCP; 44% vs 26%, p = 0.014) and drain placement (50% vs 28.9%, p = 0.031). Eleven postoperative complications were noted, including 6 SSI (2.2%). Positive bile culture (3.8% vs 1.8%, p = 0.38), BS (3.1% vs 0%, p = 0.18), ERCP (1.4% vs 2.5%, p = 1.0), and drain placement (6.7% vs 1.7%, p = 0.13) were not associated with SSI. Multivariate analysis demonstrated that positive cultures were not predictive of complication or SSI (p = 0.13, p = 0.91, respectively). CONCLUSION: Positive bile cultures are not inherently associated with an increased risk of SSI and therefore should not lead to ongoing postoperative antibiotic therapy.

Comparison of Inflammatory Markers Changes in Patients Who Used Postoperative Prophylactic Antibiotics within 24 Hours after Spine Surgery and 5 Days after Spine Surgery.

C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count are inflammatory markers used to evaluate postoperative infections. Although these markers are non-specific, understanding their normal kinetics after surgery may be helpful in the early detection of postoperative infections. To compliment the recent trend of reducing the duration of antibiotic use, this retrospective study investigated the inflammatory markers of patients who had received antibiotics within 24 hours after surgery according to the Health Insurance Review & Assessment Service guidelines and compared them with those of patients who had received antibiotics for 5 days, which was proven to be non-infectious. We enrolled 74 patients, divided into two groups. Patients underwent posterior lumbar interbody fusion (PLIF) at a single institution between 2019 and 2020. Group A included 37 patients who received antibiotics within 24 hours after the PLIF procedure, and group B comprised 37 patients who had used antibiotics for 5 days. A 1 : 1 nearest-neighbor propensity-matched analysis was used. The clinical variables included age, sex, medical history, body mass index, estimated blood loss, and operation time. Laboratory data included CRP, ESR, and WBC, which were measured preoperatively and on postoperative days (POD) 1, 3, 5, and 7. CRP dynamics tended to decrease after peaking on POD 3, with a similar trend in both groups. The average CRP level in group B was slightly higher than that in group A; however, the difference was not statistically significant. Multiple linear regression analysis revealed operation time, number of fused levels, and estimated blood loss as significant predictors of a greater CRP peak value (r²=0.473, p<0.001) in patients. No trend (a tendency to decrease from the peak value) could be determined for ESR and WBC count on POD 7. Although slight differences were observed in numerical values and kinetics, sequential changes in inflammatory markers according to the duration of antibiotic administration showed similar patterns. Knowledge of CRP kinetics allows the assessment of the degree of difference between the clinical and expected values.

Variation in the use of infection control measures and infection-related revision incidence after breast implant surgery in the Netherlands

The use and effect of most infection control measures (ICMs) in breast implant surgery are still debated, likely resulting in undesired variation in current practices. This study investigated the relationship between the number and combinations of ICMs used and the infection-related revision incidence after breast implant surgery. Additionally, national variation between Dutch healthcare institutions in ICM use was evaluated. For this multicentre, population-based study, all patients who received a primary breast implant or tissue expander for breast augmentation or reconstruction between 2015 and 2019 were identified from the Dutch Breast Implant Registry. Seven prospectively collected ICMs were investigated: preoperative antibiotics, implant and/or pocket irrigation, glove change, nipple guards, insertion sleeve, postoperative drains, and postoperative antibiotics. This study included 52,415 implants (85% augmentation, 15% reconstruction).The median (IQR) number of ICMs used was 3 (3-4) for augmentation and 4 (4-5) for reconstruction. Median follow-up was 30 months for augmentation and 34 months for reconstruction. Infection-related revision incidence was 0.1% for augmentation and 2.1% for reconstruction. Most infection-related revisions occurred within 2 months for augmentation and 2.5 months for reconstruction. The impact of ICM use on infection-related revision incidence remained unclear, given its low incidence. A significant variation was observed between institutions in the use of postoperative antibiotics and drains. Although the use of different ICMs varied considerably between institutions, the infection-related revision incidence after breast implant surgery was generally low. Most surgeons used four ICMs for breast reconstruction and three ICMs for breast augmentation. Further studies on the causes and effects of the observed variation are needed.

Reduced incidence of CIED infections with peri- and post-operative antibiotic use in CRT-P/D and ICD procedures.

Higher cardiac implantable electronic device (CIED) infection incidence has been observed with cardiac resynchronization therapy pacemaker/defibrillator (CRT-P/D) and implantable cardioverter defibrillator (ICD) devices compared to traditional pacemakers with a 1.2% rate reported at 1 year. CIED infection management has high morbidity/mortality. A previous study from this institution demonstrated significantly reduced CIED infection rate when peri/post-operative antibiotics were given for traditional pacemaker procedures. The present study examines CIED infection incidence following peri/post-operative antibiotics during CRT-P/D and ICD procedures. All patients who underwent CRT-P/D and ICD procedures from 1996 to 2015 received IV cephalexin/clindamycin pre- and 8-hours post-procedure followed by 5 days of oral therapy. There were 427 procedures (CRT-P = 146 (34.2%); CRT-D = 142 (33.3%); ICD = 139 (32.6%)). Mean age at time of procedure was 61.6 years. Mean follow-up duration was 4.26 years. CIED infection occurred in 6 patients (ICD = 4, CRT-P = 1, CRT-D = 1), amounting to a rate of 4.96/1000 device-years in total. Times to CIED infection from procedure were: 1.7, 3.5, 6.7, 7.3, 7.9 and 9.2 years. Five out of 6 infections occurred in patients with repeat procedures. This study demonstrates that administration of peri- followed by post-operative antibiotics during CRT-P/D and ICD procedures is associated with a very low rate of CIED infection. This rate of 4.96 infections per 1000 device-years compares favorably to contemporary rates of 8.9 infections per 1000 device-years. Most CIED infections occur late and well-beyond the 1-year follow-up of the Prevention of Arrhythmia Device Infection Trial, the largest trial on this question. This approach should be considered pending a definitive trial

Prophylaxis for the Prevention of PJI after TAA: Is It Economically Justifiable?

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Prosthetic joint infection (PJI) is a costly and potentially fatal complication in total ankle arthroplasty (TAA). Some surgeons will use intraoperative vancomycin powder or copiously irrigate the surgical site with Povidone-iodine to prevent this outcome. Additionally, many surgeons will prescribe a short course of postoperative antibiotics. However, the efficacy of such prophylaxis continues to be debated, and little is known about the cost-effectiveness of these agents. Therefore, the purpose of this study was to perform a 'break-even' analysis to determine the number of cases that could be performed while only preventing a single PJI and still breaking even on cost. Methods: The literature was searched to determine the rate of PJI and the mean cost of total ankle replacement. The prices of topical vancomycin powder and Povidone-iodine were obtained from our institution's purchasing records. An online drug database was then used to determine the cost of a 14 day twice daily course of Sulfamethoxazole/Trimethoprim (800/160 mg), Cephalexin (500 mg), and Amoxicillin/Potassium Clavulanate (875/125 mg). A break-even analysis was then performed to determine the absolute risk reduction (ARR) necessary to make a drug cost-effective. Using the ARR, we calculated the number of patients that would need to be treated with these agents to prevent a single PJI (NNT). Results: The price of intraoperative vancomycin powder was found to be $3.06 while povidone-iodine was found to cost $3.64. Sulfamethoxazole/Trimethoprim (800/160 mg), Cephalexin (500 mg), and Amoxicillin/Potassium Clavulanate (875/125 mg) were determined to cost $3.00, $3.64, and $14.51, respectively. At the prices obtained Vancomycin Powder, Povidone-iodine, Sulfamethoxazole/Trimethoprim, and Cephalexin were all cost-effective if the initial rate decreased by ARRs of 0.01%. Likewise, Amoxicillin/Potassium Clavulanate was cost-effective if the initial rate decreased by an ARR of 0.03%. Additional analyses run found that all drugs-maintained cost-effectiveness even if the initial rate of PJI was as low as 0.1%. Conclusion: PJI following TAA is devastating and costly. Despite the ongoing debate regarding the efficacy of prophylactic measures to reduce the risk of PJI in TAA, limited is known about their cost-effectiveness. Our study demonstrates that intraoperative vancomycin powder, povidone-iodine lavage, and multiple commonly prescribed antibiotics are all highly cost- effective to prevent PJI following TAA. We feel that a tailored approach to taking measures to reduce PJI with cost-effectiveness in mind is crucial to providing value-based care.