Postoperative Antibiotics Research Articles

Effect modifiers influencing the periodontal healing of the adjacent second molar following mandibular third molar removal

Studies were selected, using appropriate key words, from the following databases: Cochrane Central Register of Controlled Trials; Medline (via Pubmed); Scopus/Elsevier; and Embase. A manual search was also conducted of five periodontology and oral and maxillofacial surgery journals. It was not clarified what proportion of studies included were derived from which source. Inclusion criteria included prospective studies and randomised controlled trials published in English, with a minimum 6-month follow-up reporting on parameters of periodontal healing distal to the mandibular second molar following removal of M3M in human subjects. These parameters included pocket probing depth (PPD) reduction and final depth (FD), clinical attachment loss (CAL) reduction and FD, alveolar bone defect (ABD) change and FD. Given prognostic indictors and interventions were investigated, the studies were screened using PICO and PECO (Population, Intervention, Exposure, Comparison, Outcome). Cohen's kappa statistic measured the level of agreement between 2 selecting authors (0.96 stage 1 screening, 1.00 stage 2 screening). Disagreements were resolved with a tie-breaker 3rd author. Ultimately, from 918 studies, 17 met the inclusion criteria and 14 were included in the meta-analysis. Studies were excluded on the basis of same patient pools, non-representative outcomes of interest, insufficient follow-up period, and unclear results. The 17 studies meeting the inclusion criteria underwent validity assessment and data extraction, including risk of bias analysis. Meta-analysis was performed to calculate mean difference and standard error for each outcome measure. If these were unavailable, a correlation coefficient was calculated. Meta-regression was used on different subgroups to determine factors affecting periodontal healing. For all analyses, statistical significance was determined as p < 0.05. Statistical variability in outcomes beyond the expected was estimated using I2 analyses, with a value >50% indicating significant heterogeneity. The periodontal parameters investigated yielded the following results after meta-analysis: overall PPD reduction of 1.06 mm at 6 months and 1.67 mm at 12 months; final PPD of 3.81 mm at 6 months; CAL change of 0.69 mm at 6 months; final CAL of 4.28 mm at 6 months and 4.37 mm at 12 months; ABD reduction of 2.62 mm at 6 months; ABD of 3.2 mm at 6 months. The authors found no statistically significant effect on periodontal healing from the following confounding factors: age; M3M angulation (specifically, mesioangular impaction); optimisation of periodontal health prior to surgery; scaling and root planing of the distal second molar at the time of surgery; post-operative antibiotics or chlorhexidine prophylaxis. There were statisticallysignificant correlations between baseline PPD and final PPD. There was improved PPD reduction at 6 months with a three-sided flap compared to others, and regenerative materials and bone grafts improved all periodontal parameters. Although M3M removal results in modest improvement in periodontal health distally of the second mandibular molar, periodontal defects remain onwards of 6 months. There is limited evidence suggesting a three-sided flap is more beneficial than an envelope flap in PPD reduction at 6 months. Regenerative materials and bone grafts result in significant improvements across all periodontal health parameters. The most important predictive factor in final PPD of the distal second mandibular molar is baseline PPD.

A Comparative Study of the Effectiveness of Prophylactic Antibiotics With or Without Additional Post-op Antibiotics Administration in Cesarean Section Patients for Prevention of Post-op Infection in a Private Hospital

OBJECTIVES: To assess the effectiveness of prophylactic antibiotics with or without additional post-op antibiotics on infectious complications in women undergoing cesarean section. MATERIALS AND METHODS: Retrospective chart review of cesarean section patients at Bangkok Hospital Chiang Mai between 1 January 2016 to 31 December 2018 was carried out. Women at 37-42 weeks’ gestational age who underwent cesarean section and received prophylactic antibiotics with or without additional post-op antibiotic administration were reviewed. They were divided into 2 groups: those who received post-delivery antibiotic vs those who did not. To compare post cesarean delivery infection rate from the delivery day until 6 weeks after. The primary end point is post cesarean section infection from delivery to 6 weeks’ post-operative RESULTS: 481 women received prophylactic antibiotic prior to delivery by cesarean section. 46 were excluded 32 due to being less than 37 weeks’ gestational age, 3 received antibiotics a week prior to delivery, 11 with history of allergic reaction to penicillin or cephalosporin. So, only 435 women met these research study criteria. Within these, 170 cases (39.1%) received additional antibiotics after cesarean delivery, 265 cases (60.9%) didn’t receive antibiotics after cesarean delivery. 20% of prophylactic antibiotic patients only spent more than 60 minutes in the operation room, while 55.29% of those with additional antibiotic post-op did so. 4 (2.4%) cases of additional antibiotic post-op group had post-delivery infection. While 2 (0.8%) cases of patient without additional post-op antibiotic developed infection. CONCLUSION: Additional post-op antibiotics didn’t decrease the incidence of post-delivery infections.

Postoperative Antibiotics Confer No Protective Association After Fat Grafting for Breast Reconstruction.

Autologous fat grafting after breast reconstruction is a commonly used technique to address asymmetry and irregularities in breast contour. While many studies have attempted to optimize patient outcomes after fat grafting, a key postoperative protocol that lacks consensus is the optimal use of perioperative and postoperative antibiotics. Reports suggest that complication rates for fat grafting are low relative to rates after reconstruction and have been shown to not be correlated to antibiotic protocol. Studies have additionally demonstrated that the use of prolonged prophylactic antibiotics do not lower the complication rates, stressing the need for a more conservative, standardized antibiotic protocol. This study aims to identify the optimal use of perioperative and postoperative antibiotics that optimizes patient outcomes. Patients in the Optum Clinformatics Data Mart who underwent all billable forms of breast reconstruction followed by fat grafting were identified via Current Procedural Terminology codes. Patients meeting inclusion criteria had an index reconstructive procedure at least 90 days before fat grafting. Data concerning these patient's demographics, comorbidities, breast reconstructions, perioperative and postoperative antibiotics, and outcomes were collected via querying relevant reports of Current Procedural Terminology; International Classification of Diseases, Ninth Revision; International Classification of Diseases, Tenth Revision; National Drug Code Directory, and Healthcare Common Procedure Coding System codes. Antibiotics were classified by type and temporal delivery: perioperatively or postoperatively. If a patient received postoperative antibiotics, the duration of antibiotic exposure was recorded. Outcomes analysis was limited to the 90-day postoperative period. Multivariable logistic regression was performed to ascertain the effects of age, coexisting conditions, reconstruction type (autologous or implant-based), perioperative antibiotic class, postoperative antibiotic class, and postoperative antibiotic duration on the likelihood of any common postoperative complication occurring. All statistical assumptions made by logistic regression were met successfully. Odds ratios and corresponding 95% confidence intervals were calculated. From more than 86 million longitudinal patient records between March 2004 and June 2019, our study population included 7456 unique records of reconstruction-fat grafting pairs, with 4661 of those pairs receiving some form of prophylactic antibiotics. Age, prior radiation, and perioperative antibiotic administration were consistent independent predictors of increased all-cause complication likelihood. However, administration of perioperative antibiotics approached a statistically significant protective association against infection likelihood. No postoperative antibiotics of any duration or class conferred a protective association against infections or all-cause complications. This study provides national, claims-level support for antibiotic stewardship during and after fat grafting procedures. Postoperative antibiotics did not confer a protective benefit association against infection or all-cause complication likelihood, while administering perioperative antibiotics conferred a statistically significant increase in the likelihood that a patient experienced postoperative complication. However, perioperative antibiotics approach a significant protective association against postoperative infection likelihood, in line with current guidelines for infection prevention. These findings may encourage the adoption of more conservative postoperative prescription practices for clinicians who perform breast reconstruction, followed by fat grafting, reducing the nonindicated use of antibiotics.

Preoperative Prophylactic Antibiotics in Mandibular Fractures and Surgical Site Infection.

Compared with other facial fractures, mandibular fractures have the highest rate of postsurgical site infection. There is strong evidence to suggest that postoperative antibiotics do not reduce rates of surgical site infections (SSIs) regardless of duration. However, there are conflicting data in the literature regarding the role of prophylactic preoperative antibiotics in reducing rates of SSIs. This study reviews the rate of infections in patients who underwent mandibular fracture repair who received a course of preoperative prophylactic antibiotics compared with those who received no or 1 dose of perioperative antibiotics. Adult patients who underwent mandibular fracture repair at Prisma Health Richland between 2014 and 2019 were included in the study. A retrospective cohort review was conducted to determine the rate of SSI, comparing 2 groups of patients who underwent mandibular fracture repair. Patients who received more than 1 dose of scheduled antibiotics before surgery were compared with those who did not receive any antibiotic treatment before surgery or received only a single dose of antibiotics within 1 hour of incision time (perioperative antibiotics). The primary outcome was the rate of SSI between the 2 groups of patients. There were 183 patients who received more than 1 dose of scheduled antibiotics before surgery and 35 patients who received a single dose of perioperative antibiotics or did not receive any antibiotics. The rate of SSI was not significantly different in the preoperative prophylactic antibiotics group (29.3%) compared with the patients who received a single perioperative dose or no antibiotics (25.0%). Extended regimens of preoperative prophylactic antibiotics beyond a single dose at time of surgery do not reduce SSIs after surgical repair in mandibular fractures.

Postoperative Antibiotics for Complicated Appendicitis in Children: Piperacillin/Tazobactam Versus Ceftriaxone with Metronidazole

Recent studies are discordant regarding postoperative use of piperacillin/tazobactam (PT) versus ceftriaxone/metronidazole (CM) for pediatric complicated appendicitis. Some argue that the broader spectrum PT decreases intraabdominal abscess formation; however, antibiotic stewardship, and once-a-day dosing favor CM. We aim to compare outcomes of postoperative antibiotic utilization using a large administrative database. We queried the Pediatric Health Information System for patients 2-18 years old who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Patients were grouped into PT, CM, or other using the first postoperative day antibiotics. Adverse events and antibiotic use trends were evaluated. We included 29,015 children from 45 hospitals. CM was used in 51.9% and 31.3% received PT. Wide variation was seen among hospitals with PT use decreasing over the years. Overall rate of abscess was 9.2%. On multivariable regression, PT was associated with higher risk for abscess formation (RR 1.35, 99% CI 1.04-1.75) and readmission (RR 1.38, 99% CI 1.13-1.68) compared to the CM group. However, following adjustment for hospitals with high CM prevalence, these associations were no longer significant. Postoperative use of PT for complicated appendicitis is associated with higher rates of readmissions and intraabdominal abscess when compared to CM. However, this effect is mitigated when adjusting for common practice patterns. Level III. Retrospective Comparative Study.

Postoperative Antibiotics Following Reduction Mammaplasty Does Not Reduce Rates of Surgical Site Infection.

The efficacy of antibiotic utilization following reduction mammaplasty has not been well studied. Furthermore, there is a lack of data describing subgroups who are historically at high risk for surgical site infection (SSI), specifically the obese population. This study compares SSI rates in reduction mammaplasty patients who received postoperative courses of antibiotics with those who did not. Additional analysis was performed for the subgroup of patients with a body mass index (BMI) ≥30 kg/m2. The 2010 to 2021 PearlDiver Mariner data set was reviewed to identify reduction mammaplasty patients. Patients were confirmed to have received perioperative antibiotics. Postoperative antibiotic use was determined based on the presence of postoperative prescriptions, and 1:1 matching was performed for those with and without postoperative antibiotics based on age and the Elixhauser Comorbidity Index. Rates of SSI, emergency department (ED) visits, and readmissions for the 90 days following surgery were recorded and compared. A subgroup analysis was performed on patients with a BMI of ≥30 kg/m2. Among patients who were confirmed to have received perioperative antibiotics, 2230 patients who also received postoperative antibiotics were identified and matched to 2230 patients who did not. Rates of SSI, ED visits, and readmission were not statistically different. A total of 218 obese patients were identified from this group and matched. Rates of SSI, ED visits, and readmission were not statistically different. In the current study, no difference in SSI rates between patients who received postoperative antibiotics and those who did not was found. These observations were corroborated in the obese population. These data may assist surgeons when considering postoperative antibiotics following reduction mammaplasty.

Application of metagenomic next-generation sequencing in the detection of pathogens in spinal infections

The precise diagnosis and treatment of spinal infections (SI) remains challenging for spine surgeons. Identifying the pathogens of SI through metagenomic next-generation sequencing (mNGS) may be a key approach to addressing this challenge. To evaluate the accuracy and applicability of mNGS in determining the etiology of SI. Diagnostic test study. Twenty-five patients who had a clinical suspicion of SI and underwent mNGS testing. The specificity, sensitivity, and time cost of mNGS and bacterial culture were compared. Clinical outcomes were assessed using the numeric rating scale (NRS) score, Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. Demographic data and laboratory results (blood cell count (WBC), erythrocyte sedimentation rate (ESR), neutrophil percentage (NEUT%), and C-reactive protein level (CRP) were also evaluated. In this retrospective study, samples were obtained from 25 eligible patients via surgery or CT-guided puncture and subjected to histopathological examination, bacterial culture, and mNGS. The sensitivity and specificity of the bacterial cultures and mNGS were calculated with respect to the histopathological results as a reference. Postoperative antibiotics or antituberculosis drugs were administered on the basis of mNGS results, combined with clinical manifestations, imaging examination, and histopathology. The changes of clinical outcomes and laboratory results after treatment were observed. Of the 25 patients, 21 had a positive pathology, of which 10 showed a tuberculous pathology, and the remaining 11 showed a nontuberculous inflammatory pathology. The sensitivity of mNGS was higher than that of the bacterial culture. However, the difference in specificity between bacterial culture and mNGS was not significant. Moreover, the time needed to perform mNGS was significantly lower than that of bacterial culture and pathology. All patients were followed up for more than three months, and CRP and NEUT% significantly decreased by three months after treatment. There was no significant difference in WBC and ESR. The ODI, NRS and JOA scores were significantly improved after treatment. Metagenomic next-generation sequencing technology can play an important role in the detection of pathogens in SI and should be further investigated and applied in future studies.

Is Topical Vancomycin an Option? A Randomized Controlled Trial to Determine the Safety of the Topical Use of Vancomycin Powder in Preventing Postoperative Infections in Total Knee Arthroplasty, as Compared With Standard Postoperative Antibiotics

BackgroundThe demand for total knee arthroplasties (TKAs) is expected to rise in the coming decades, increasing the burden of periprosthetic joint infections (PJIs). The use of intrawound vancomycin powder (VP) has proven to be effective in reducing the incidence of PJIs after spinal surgery. That said, its effectiveness in TKA remains unclear. This trial aims to examine the efficacy of intrawound vancomycin powder first versus standard postoperative antibiotics in preventing PJIs after TKA. MethodsThis study was a double-blinded, noninferiority, randomized controlled trial. All participants received standard preoperative intravenous (IV) antibiotics (Cefazolin/Vancomycin) within 60 minutes of skin incision. Patients in the treatment group received 1 gram of VP applied intraoperatively by the orthopedic surgeon (500 mg directly on the prosthesis, 500 mg above the closed joint capsule). These patients did not receive postoperative antibiotics. Patients in the control group received standard postoperative IV antibiotics. The primary outcome was the incidence of acute surgical site infection within 42 days of procedure. ResultsThere were 80 patients randomized to the treatment group and 85 patients randomized to the control. Groups were matched with respect to baseline characteristics, including average age (66 versus 64), BMI (35.7 versus 33.4), and diabetics (16 versus 13). The trial was halted at 1 year as a significantly greater proportion (P = .03) of patients in the treatment group (n = 3, 3.75%) were diagnosed with PJIs compared to the control (n = 0). ConclusionOur trial demonstrated the intrawound application of VP to be inferior to standard postoperative IV antibiotics in reducing the incidence of PJIs after TKA.

To ADM or not to ADM? Outcomes of Pre-pectoral Prosthetic Reconstruction after Nipple-Sparing Mastectomy with and without Acellular Dermal Matrix

Objective: Pre-pectoral reconstruction after nipple-sparing mastectomy (NSM) avoids animation deformity and is associated with less morbidity. Traditionally, NSM poses an increased risk of nipple ischemia and potential implant contamination through the remaining nipple ducts. Therefore, it appears of importance that a “barrier” between the prosthesis and the outside world be preserved. In subglandular prosthetic reconstruction, acellular dermal matrix (ADM) has been used with success but also linked with increased complications. This study compared surgical outcomes of implant-based pre-pectoral reconstruction after NSM with and without ADM. Methods: All patients who underwent immediate breast reconstruction with pre-pectoral tissue expander (TE) or direct-to-implant (DTI) after NSM by the senior author between April 2013 to January 2021, were included in this study. Cohorts were stratified into breasts with ADM or without ADM. DTI and TE groups were also analyzed irrespective of ADM use. Complications within 30 days were analyzed. Minor complications included erythema, seroma, flap necrosis, nipple necrosis, and prescription of extra antibiotics. Major complications included hematoma, dehiscence, infection, hospitalization, necrosis requiring surgery, any surgical intervention, capsular contracture, and implant loss. Ecchymosis was individually measured. Results: A total of 115 pre-pectoral reconstructions were performed in 66 patients, including 80 TE and 35 DTI placements. The mean patient age was 48 ± 11 years and BMI 27 ± 5.3. Groups appeared uniform with regards to patient demographics. Major complications occurred in 65 (56.5%) of reconstructed breasts, with necrosis requiring excision being the most common complication (24/65, 37%). Smokers experienced 3.1 times more major complications (p<0.012) and required 4.5 times more post-operative antibiotics (p<0.01) irrespective of ADM use or implant type. There were 75 breasts with ADM and 40 breasts with no ADM. ADM breasts had higher rates of ecchymoses (70.7% vs 30%, p<0.001) and nipple necrosis (28% vs 10%, p=0.026). ADM use was also associated with less capsular contracture (16% vs 37.5%, p<0.01) at latest follow-up 577 ± 453 days. Interestingly, although DTI volumes were greater than initial TE fill volumes (473±88 ml vs 229±130 ml, p<0.0001), DTI was associated with lower rates if major complications (37.14% vs 65%, p<0.005), including loss of implant (5.7% vs 38.75%, p<0.001) or any complication necessitating surgery (14.3% vs 27.5%, p=0.024). Conclusion: ADM use in pre-pectoral implant-based breast reconstruction after NSM increases the likelihood of ecchymoses, mastectomy flap necrosis and nipple necrosis, but appears protective against capsular contracture, which could be due to its properties as a subareolar barrier. As compared to DTI, TE placement led to more complications possibly due to suspected intra-operative flap ischemia that likely influenced device choice. Intra-operative perfusion mapping should be employed to identify ischemia and increase success of prosthetic reconstruction. In smokers, prosthetic reconstruction after NSM leads to exceptionally high complication rates and should be offered with caution. Corresponding Author: Elizabeth Bushong, 15 Michigan St NE, Grand Rapids, MI 49503, [email protected], (760) 285-4085

Role of Metronidazole after Appendicectomy in Simple Cases of Acute Appendicitis

Background: Simple cases of acute appendicitis are usually dealt with appendicectomy and post-operative antibiotics. Causative organisms include both aerobes as well as anaerobes. The antibiotic spectrum to cover aerobes varies from hospital to hospital but the drug Metronidazole is used to cover anaerobes which is fairly common Aim: To determine the role of metronidazole after appendicectomy in simple cases of acute appendicitis Study design: Randomized, controlled, multicenter trial. Place and duration of study: Department of Surgery, Central Park Teaching Hospital Lahore, Noor Hospital, Kot Radha Kishan and Bilquees Hospital, Kasur from 1st January 2020 to 31st December 2021 Methodology: One hundred and thirty patients were included in the study divided into 2 groups (65 in each group). Inclusion criteria included all patients of simple acute appendicitis from age 13 to 70 years. Exclusion criteria were patients with complications of acute appendicitis. Patients receiving Metronidazole were allocated group A, while those not receiving this drug were allocated group B. Open appendicectomy was done in all cases. Variables of interest were post-operative wound infection, hospital stay and nausea/vomiting. Results: Mean age of patients of group A was 29.39±16.32 years while mean age of patients in group B was 34.18±18.05 years. 44.6% patients of group A were male and 55.4% were females. On the other hand 50.8% patients of group B were male and 49.2% were females. In group A, 6 patients got wound infection (9.2%) while 59 patients had uneventful recovery (90.8%). In group B, 4 patients got wound infection making it 6.2% while rest of the 61 patients had uneventful recovery (93.8%). The difference between the 2 groups was not statistically significant (p-value 0.11). Mean hospital stay in group A patients was 2.28±0.89 days while in group B it was 2.12±0.73 days. Conclusion: Metronidazole is an effective drug against anaerobes but in simple cases of non-perforated appendicitis this drug does not decreases the wound infection rate after appendicectomy. Keywords: Metronidazole, Appendicitis, Appendicectomy

Gram-Negative Rod Breast Wound Infections After Postcancer Reconstructive Surgery

Background After mastectomy, breast reconstructive surgeries using breast tissue expander (BTE) placement have a particularly high risk of infection. Whereas previous studies showed these infections to consist of primarily gram-positive organisms, gram-negative rods consist of up to 26% of the microorganisms isolated in some studies. Here we highlight the prevalence of gram-negative rods, particularly Pseudomonas aeruginosa, in BTE infections. Methods We used a retrospective chart review at a comprehensive cancer center to identify BTE infections caused by gram-negative rods over a 2-yearperiod. We collected data on the organism from wound cultures and antimicrobial susceptibilities. Results During this period, we isolated 38 gram-negative rod infections from BTE surgeries from a sample size of 215 organisms. The most common gram-negative rod was P. aeruginosa (44.7%), followed by Serratia marcescens (15.7%) and Klebsiella pneumoniae (7.9%). All Pseudomonas and Klebsiella isolates were susceptible to all antibiotics tested; Serratia isolates were resistant to cefazolin and cefoxitin. Significant resistance to ampicillin, cefazolin, cefoxitin, and ceftazidime was found in the organisms tested. Antipseudomonal antimicrobials, notably cefepime, piperacillin/tazobactam, ciprofloxacin, tobramycin, and gentamicin, had activity against all organisms tested. Conclusions Perioperative antimicrobial prophylaxis consisting of cefazolin often does not have activity against gram-negative rods. In addition, postoperative antibiotics often do not have activity against Pseudomonas. In our study sample, all antibiotics tested had activity against Pseudomonas. Empiric antibiotics used to treat postsurgical BTE infections should include activity against Pseudomonas.

Facial masculinization surgery

Facial masculinization surgery

Postoperative antibiotics can be de-escalated after laparoscopic surgery for complex appendicitis

Appendicitis is the most common surgical emergency globally, and surgery remains the mainstay of treatment in more than 98% of cases.1,2 However, variations in management are extremely common and are under-researched. For example, there is little agreement over the best preoperative diagnostic strategy, the role of antibiotics as a primary treatment, and how to best implement laparoscopic appendicectomy in low-income and middle-income countries. Evidence regarding the duration of antibiotics after surgery is scarce, and cautious behaviours tend to result in longer courses being prescribed.

2 days versus 5 days of postoperative antibiotics for complex appendicitis: a pragmatic, open-label, multicentre, non-inferiority randomised trial

The appropriate duration of postoperative antibiotics for complex appendicitis is unclear. The increasing global threat of antimicrobial resistance warrants restrictive antibiotic use, which could also reduce side-effects, length of hospital stay, and costs. In this pragmatic, open-label, non-inferiority trial in 15 hospitals in the Netherlands, patients with complex appendicitis (aged ≥8 years) were randomly assigned (1:1) to receive 2 days or 5 days of intravenous antibiotics after appendicectomy. Randomisation was stratified by centre, and treating physicians and patients were not masked to treatment allocation. The primary endpoint was a composite endpoint of infectious complications and mortality within 90 days. The main outcome was the absolute risk difference (95% CI) in the primary endpoint, adjusted for age and severity of appendicitis, with a non-inferiority margin of 7·5%. Outcome assessment was based on electronic patient records and a telephone consultation 90 days after appendicectomy. Efficacy was analysed in the intention-to-treat and per-protocol populations. Safety outcomes were analysed in the intention-to-treat population. This trial was registered with the Netherlands Trial Register, NL5946. Between April 12, 2017, and June 3, 2021, 13 267 patients were screened and 1066 were randomly assigned, 533 to each group. 31 were excluded from intention-to-treat analysis of the 2-day group and 30 from the 5-day group owing to errors in recruitment or consent. Appendicectomy was done laparoscopically in 955 (95%) of 1005 patients. The telephone follow-up was completed in 664 (66%) of 1005 patients. The primary endpoint occurred in 51 (10%) of 502 patients analysed in the 2-day group and 41 (8%) of 503 patients analysed in the 5-day group (adjusted absolute risk difference 2·0%, 95% CI -1·6 to 5·6). Rates of complications and re-interventions were similar between trial groups. Fewer patients had adverse effects of antibiotics in the 2-day group (45 [9%] of 502 patients) than in the 5-day group (112 [22%] of 503 patients; odds ratio [OR] 0·344, 95% CI 0·237 to 0·498). Re-admission to hospital was more frequent in the 2-day group (58 [12%] of 502 patients) than in the 5-day group (29 [6%] of 503 patients; OR 2·135, 1·342 to 3·396). There were no treatment-related deaths. 2 days of postoperative intravenous antibiotics for complex appendicitis is non-inferior to 5 days in terms of infectious complications and mortality within 90 days, based on a non-inferiority margin of 7·5%. These findings apply to laparoscopic appendicectomy conducted in a well resourced health-care setting. Adopting this strategy will reduce adverse effects of antibiotics and length of hospital stay. The Netherlands Organization for Health Research and Development.

Impact of Extended Antibiotic Use After Pancreaticoduodenectomy for Patients with Preoperative Metallic Biliary Stenting Treated with Neoadjuvant Chemotherapy

IntroductionPancreaticoduodenectomy (PD) remains a complex surgical procedure with infectious complications affecting nearly 50% of patients. Patients who undergo biliary drainage with stent placement prior to neoadjuvant treatment (NAT) reportedly have higher infection rates following PD. The aim of the current study is to evaluate the differences in postoperative infectious complication rates based on the duration of post operative prophylactic antibiotics in patients with indwelling metal biliary stent who had NAT. MethodsA retrospective institutional pancreatic cancer database was queried for patients who had a metal biliary stent placed prior to NAT initiation, followed by subsequent PD between 2014 and 2021. Duration of postoperative prophylactic antibiotics was defined as short (SC: ≤ 24 h) or extended (EC: > 24 h–7 days). The primary outcome of interest was surgical site infection (SSI). ResultsTwo hundred and ninety-five (n = 295) patients were identified of which the majority (n = 205, 69.5%) received a short course of antibiotics postoperatively. Baseline characteristics were similar between the two cohorts including age, sex, BMI, and comorbidity index. EC patients received more NAT cycles (4 vs. 3, p < 0.001) and underwent an open PD more frequently (61.8% vs. 41.0%, p < 0.001). SSI occurred in 64 (21.7%) patients; SC cohort: 54, 26.3% vs. EC cohort:10, 11.1%, (p = 0.003). Additionally, the SC cohort demonstrated a higher incidence of major complications (Clavien-Dindo ≥ 3: 51 [24.9%] vs. 13 [14.4%], p = 0.045). On the logistic regression model examining factors associated with SSI, higher BMI (continuous variable) was associated with increased odds of SSI (OR: 1.05 [95%CI: 1.00, 1.10, p = 0.040), while EC was protective (OR: 0.36 [95%CI: 0.17, 0.75], p = 0.007). ConclusionsThese data suggest that an extended course of perioperative antibiotic correlates with reductions in SSI and major morbidity following PD in patients with a metallic biliary stent placed prior to NAT course. These results require validation in a future randomized clinical trial examining a larger cohort of patients with further emphasis on the types of perioperative antibiotics administered.

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.

A RANDOMISED CONTROL TRIAL TO ASCERTAIN IF POSTOPERATIVE ANTIBIOTICS ARE NECESSARY FOLLOWING LAPAROSCOPIC APPENDICECTOMY IN NONPERFORATED APPENDICITIS

Background: The most frequent cause of severe abdominal discomfort is acute appendicitis. Prophylactic antibiotics should be used as directed to reduce the risk of postoperative surgical site infections (SSIs). There is no denitive recommendation, though, for how long to use antibiotics. There has only been one preoperative prophylactic dose several randomised control trials strongly suggest. Therefore, the goal of the study was to ascertain if postoperative antibiotics were necessary following laparoscopic appendix surgery for nonperforated appendicitis. Methods: A total of 52 nonperforated appendicitis patients were separated into two groups and underwent laparoscopic appendectomy. Patients in group B (n=26) received three postoperative doses of antibiotics in addition to the one preoperative dose given to group A's (n=26) patients. Regular investigations, such as Complete blood count, blood urea, serum creatinine, and other tests like an abdominal ultrasound were also carried out. After a laparoscopic appendicectomy, the surgical incision was examined to check for any evidence of postoperative SSI after 48, 72, and 7 days. Results: Group A had a mean age of 30.6± 10.5 years compared to group B's mean age of 30.7 ±9.5 years (p=0.75). Right iliac fossa pain was the initial complaint of every subject in the research. Grade III SSIs occurred in 0ne patient in group A (4%) and one patient in group B (4%) and were treated conservatively. The difference in the incidence of SSIs between the two groups was statistically negligible (p=1.000). Conclusions: After a laparoscopic appendicectomy, prophylactic postoperative doses of antibiotics offer no additional advantage over a single preoperative dosage in terms of preventing postoperative SSIs

Incidence and risk factors for surgical site infection following enucleation in dogs.

Surgical site infections (SSI) increase morbidity, increase treatment costs, and can delay onset of necessary adjunctive therapy. The goal of this retrospective study was to determine the incidence of and risk factors of SSI after enucleation in dogs. Medical records were searched at one veterinary teaching hospital and identified 280 dogs that underwent enucleation and had an adequate follow-up to assess SSI. Multiple preoperative (e.g., reason for enucleation), peri-operative (e.g., surgical approach and surgeon experience level), and post-operative (e.g., use of post-operative antibiotics or anti-inflammatory medications) variables were assessed as risk factors for development of SSI. The incidence of SSI after enucleation was 5%, and no risk factors for SSI were identified. Dogs that received cephalexin as a prophylactic post-operative antibiotic were statistically more likely to develop SSI versus those that received a different post-operative antibiotic (p = 0.045). However, the clinical significance of this finding is unclear as administration of prophylactic post-operative antibiotics overall did not reduce the risk of SSI in the population evaluated here. No risk factors were identified to guide clinical decision-making for prevention of SSI. Additionally, the results do not support the use of prophylactic antibiotics after enucleation in dogs.

Antiseptic Techniques in Breast Implant Surgery: Insights From Plastic Surgeons in Saudi Arabia.

Breast implant surgery is a popular procedure worldwide, and the same holds true for Saudi Arabia. Ensuring a sterile surgical environment is crucial to avert postoperative infections. This study explores the various antiseptic techniques adopted by Saudi plastic surgeons during breast implant procedures. This study aims to assess Saudi plastic surgeons' adherence to antiseptic measures in breast implant surgery, and determine what types of antiseptic measures are most commonly used among Saudi plastic surgeons. The authors conducted a cross-sectional survey among board-certified plastic surgeons in Saudi Arabia, collecting data through a self-administered online questionnaire. This questionnaire, which covered their demographic information and their antiseptic practices during breast implant surgery, was disseminated via a WhatsApp (Menlo Park, CA) broadcast message from May 15 to June 27, 2023. Of the 52 Saudi plastic surgeons who completed the questionnaire, all reported employing preoperative antibiotics and skin disinfection. Other measures included pocket irrigation (86.5%), implant irrigation (92.3%), sleeve/funnel usage (65.4%), nipple shield usage (51.9%), and glove change during the procedure (96.2%). Nearly, all respondents used only a surgical cap for head cover (96.2%) and postoperative antibiotics as prophylaxis (98.1%). However, more than half of them did not minimize door movement during the procedure (51.9%). This study offers a valuable insight into the antiseptic practices during breast implant surgery in Saudi Arabia. The findings underline the need for further research to establish evidence-based guidelines for antiseptic practices in this field.

Clinical Presentation and Management of Primary Mycotic Aortic Aneurysms: A Single Center Experience and Review of the Literature

Background: Primary mycotic aortic aneurysm (PMAA) is a localized dilation of the aortic wall caused by direct spread of bacteria via the bloodstream to the aortic wall and subsequent development of an aneurysm. The term mycotic aortic aneurysm was first used to describe a patient with four aortic aneurysms which have a mushroom-like appearance, and the term has since been used. Aim: To conduct a literature review and to report a series of cases of infra-renal mycotic aortic aneurysms, their presentation and subsequent outcome and management. Methods: Information was gathered retrospectively from medical records for patients who were over the age of 18 and who had presented with PMAAs at Cumberland infirmary o from April 2016 to July 2022. Results: A total of six patients were assessed in our study, mean age was 57-88 years. Presenting complains were: Back pain (n=2), abdominal pain (n=1), fever (n=4), collapsed (n=2), confusion (n=1) and other clinical presentations were leg pain, feeling unwell and malaise each reported in one patient each. Potential risk factors for PMAA identified were malignancy (n=2), diabetes mellitus (n=2), chronic kidney disease (n=2), immunosuppressive medication (n=2) and alcohol misuse (n=1). Potential sources of infection were retroperitoneal inflammation (n=1), pyelonephritis (n=1), retroperitoneal /psoas infection (n=2), duodenitis (n=1), systemic sepsis (n=1). Management can be surgical intervention such as Endovascular aortic repair (EVAR) (n=2), or axillo-bifemoral bypass (n=2) all of them had post-operative antibiotics or only antibiotics (n=3), however two patients of them died. Conclusion: PMAAs are rare but they have high risk of morbidity and mortality. The diagnosis is challenging but CT A-abdomen and pelvis remains valuable for diagnosis. Surgery, either bypass or EVAR with antibiotics, is a cornerstone for management, however other alternatives can be considered.