Practice Of Antibiotic Prophylaxis Research Articles

Randomised controlled trial of preoperative antibiotic prophylaxis in the prevention of surgical site infections in tertiary care hospital of central India

Background Surgical site infections (SSI) remain a significant concern in the realm of surgical interventions, posing a threat to both patient well-being and healthcare systems. This study protocol outlines a rigorous investigation aimed at assessing the effectiveness of pre-operative antibiotic prophylaxis in the prevention of SSIs in clean and clean-contaminated surgical cases within the tertiary care setting of central India. The primary aim is to determine the best suitable antibiotic regimen, optimal timing for administration, and the associated economic burden of SSIs. Method The study utilizes a Randomized Controlled Trial (RCT) design with four intervention groups, each receiving distinct antibiotic prophylaxis protocols. Comprehensive post-operative monitoring, adhering to the Centers for Disease Control and Prevention (CDC) guidelines, will be employed to identify SSI occurrences. Key data collection points include clinical evaluations, temperature monitoring, wound inspection, pain assessments, and culture and sensitivity testing. Expected outcome The study also emphasizes post-operative follow-up assessments, incorporating outpatient visits at 15-, 30-, and 90-days post-surgery. These evaluations will be instrumental in assessing the time duration for effective prophylactic antibiotic administration and determining the economic burden associated with SSI. The findings of this research endeavor hold the potential to enhance patient outcomes, minimize SSI incidences, and reduce the economic impact of SSIs on healthcare systems. By optimizing pre-operative antibiotic prophylaxis practices, this study aims to advance evidence-based guidelines for SSI prevention in clean and clean-contaminated surgical cases. CTRI REF/2023/07/070549

Surgical Antibiotic Prophylaxis Practices and Occurrence of Surgical Site Infections Among Operated Patients at Dodoma Regional Referral Hospital, Tanzania

This study was conducted to determine association between perioperative antibiotic prophylaxis practices and occurrence of surgical site infections at Dodoma Regional Referral Hospital in Tanzania. Surgical site infections (SSIs) are preventable complications following surgery, but still cause significant burden in terms of patient morbidity, mortality and increased cost of treatment. A prospective cohort study was conducted among 162 operated patients. Patients with different trends of antibiotic prophylaxis were followed up for occurrence SSIs. Analysis of data was done by SPSS version 20 program using frequency tables, chi square test, Kaplan-meier and Cox regression methods. Significance level of < 0.05 was taken to establish associations between variables. It was found that, 60.5% of patients received preoperative antibiotic prophylaxis, the overall surgical site infections rate was 14.8%. There was no significant difference in occurrence of surgical site infections between patients who received and those who did not receive preoperative antibiotic prophylaxis (p=0.88). The study concluded that SSIs are significant complications. Perioperative antibiotic prophylaxis is commonly practiced. Establishment of local protocol on antibiotic prophylaxis and adherence to infection prevention can improve the prevailing situation.

Oral Postoperative Antibiotic Prophylaxis for Outpatient Total Hip and Knee Arthroplasty: Describing Current Practices

BackgroundDespite an increase in outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA), large-scale data are lacking on current practice for antibiotic prophylaxis prescribing. We aimed to describe current oral antibiotic prophylaxis practices nationally for outpatient THA and TKA. MethodsThis nationwide retrospective cohort study included primary outpatient THA or TKA procedures in patients aged 18 to 64 years from 2018 to 2021 using a national claims database. Oral antibiotic prescriptions filled perioperatively (defined as 5 days before to 3 days after surgery) were extracted; these were categorized and assumed to represent postoperative prophylaxis. Multivariable logistic regression measured associations between patient and surgery characteristics and perioperative oral antibiotic prophylaxis. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are reported. ResultsOral antibiotic prescriptions were filled in 16.5% of 73,015 outpatient THA and TKA (18.4% of 24,857 THAs, 15.5% of 48,158 TKAs) procedures. Prescriptions were most often for cephalosporins (74.3%), with cephalexin (52.8%), and cefadroxil (19.1%) being the most common. Non-cephalosporin antibiotics prescribed were mainly clindamycin (6.8%), sulfamethoxazole-trimethoprim (6.7%), and doxycycline (6.2%). The odds of receiving oral antibiotic prophylaxis were higher for THA compared to TKA (OR 1.13, 95% CI 1.09 to 1.18, P < .001) and in the presence of obesity, diabetes, and autoimmune conditions (OR 1.08 to 1.13, P < .001 to .01). Ambulatory surgery center procedures also had significantly increased odds of prophylaxis compared to hospital-based outpatient surgeries (OR 2.62, 95% CI 2.51 to 2.73, P < .001). Additionally, regional and time-based variations were noted. ConclusionsPerioperative oral antibiotic prophylaxis prescriptions were filled in only 16.5% of outpatient THA and TKA cases, with variation in the type of antibiotic prescribed. The receipt of any prophylaxis and specific medications was associated with demographic, clinical, and procedure-related characteristics. Follow-up research will evaluate associations with infection risk reduction.

Characterizing antibiotic prophylaxis practices in pediatric deformity spinal surgery and impact on 30-day postoperative infection: an NSQIP pediatric database study.

The aim of this study was to characterize antibiotic prophylaxis practices in pediatric patients who have received posterior arthrodesis for spinal deformity and understand how these practices impact 30-day postoperative infection rates. This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database for year 2021. Patients 18years of age or younger who received posterior arthrodesis for scoliosis or kyphosis correction were included. The outcome of interest was 30-day postoperative infection. Fisher's exact test and multivariable regression analysis were used to analyze the impact of intravenous antibiotic prophylaxis, intraoperative intravenous antibiotic redosing after 4h, postoperative antibiotic prophylaxis, intraoperative topical antibiotics on 30-day postoperative infection, and various antibiotic prophylaxis regimens. A total of 6974 patients were included in this study. The 30-day infection rate was 2.9%. Presurgical intravenous antibiotic (11.5% vs. 2.7%, p = 0.005), postoperative antibiotic (5.7% vs. 2.4%, p < 0.01), and intraoperative topical antibiotic (4.0% vs. 2.7%, p = 0.019) were associated with significantly reduced infection rates. There was no significant difference in infection rates between patients that received cefazolin versus vancomycin versus clindamycin. The addition of Gram-negative coverage did not result in significant differences in infection rates. Multivariable regression analysis found postoperative intravenous antibiotics and intraoperative topical antibiotics to reduce infection rates. We found the use of presurgical intravenous antibiotics, postoperative intravenous antibiotics, and intraoperative topical antibiotics to significantly reduce infection rates. Results from this study can be applied to future research on implementation of standardized infection prevention protocols. Level II.

Perioperative antibiotic prophylaxis in the setting of cochlear implantation: a retrospective analysis of 700 cases.

Postoperative wound infections after cochlear implantation are rare but sometimes serious and can lead to explantation. Therefore, perioperative antibiotic administration is often recommended. However, in clinical practice, the type and duration of antibiotic prophylaxis varies between different centers. The aim of this study was to investigate the role of perioperative antibiotic prophylaxis in preventing postoperative complications. 700 patients who underwent cochlear implantation between 2007 and 2019 were retrospectively evaluated with regard to wound infections within the first 28 postoperative days. These were classified into major and minor complications. Data were analyzed using the IBM statistical program SPSS. In 670 out of 700 patients the type and duration of perioperative antibiotic administration could be reconstructed from the records. Of these 67 patients (10%) received antibiotics as a single shot, 158 patients (23.6%) were treated with antibiotics for a period of 48h, and 445 patients (66.4%) received prolonged antibiotic therapy for more than 72h. In total 64 patients (9.5%) showed abnormalities in wound assessment within the first 28 postoperative days after implantation. Major infections (1.6%) were detected in 11 patients. Overall, there was no statistically significant difference in wound infection rates between the group receiving single-shot antibiosis and the group receiving 48h prophylaxis or antibiotic treatment > 72h (p = 0.46). Patients receiving an antibiotic single shot do not appear to be at significantly increased risk for postoperative wound infections compared with patients with prolonged antibiotic treatment. Continuation of data collection across centers seems reasonable.

Antibiotics Prophylaxis Practice in Arthroplasty Surgeries.

Background Infection in orthopedic surgery is one of the most dreaded complications. It is associated with prolonged morbidity, disability, and increased mortality. One of the cornerstones of the prevention of infections is antibioticprophylaxis. This study assessed the practice of antibiotic prophylaxis in arthroplasty surgeries in our local hospital. Methods One hundred and seventy-one elective joint replacement patients were retrospectively analyzed for documentation of antibiotic plan in postoperative instruction, choice of antibiotic, dose, anddosage. Compliance with the dosage (duration and frequency) of antibiotic prophylaxis was compared among patients who underwent different operations, among patients whose operation notes had antibiotics plans, and among those patients whose operation notes lacked this information. Results Ninety-six females and 75 males with a mean age of 71.4±9.8 years who underwent hip replacement, knee replacement, or shoulder replacement were included in this study. Preoperative and postoperative antibiotics were received by 100% and 94.7% of patients, respectively. In 19.3%, there was no instruction about postoperative antibiotics while 4% missed at least one postoperative dose. The dosage of postoperative prophylactic antibiotics was variable as 26.3% of the patients experienced delayed administration of doses. Not having intravenous access, failure to prescribe antibiotics, and prescribing antibiotics in the "once only" rather than "regular medication" section of the medication chart were the reasons for improper timing of antibiotic doses. Observing surgical safety checklist was effective in ensuring preoperative antibiotic administration, whereasfailing to document antibiotic plan in operation note was associated with poor compliance with postoperative dosage. Interprofessional participation is crucial to compliance with antibioticprophylaxis practice. Conclusion This study identified key areas for improvement in our antibiotics prophylaxis practice. It resulted in implementing strategies to improve staff's awareness about the importance of timely administration of prophylactic antibiotics and proper documentation by all team members.

Exploring Effective Alternatives to Beta-Lactam Antibiotics for Surgical Prophylaxis: A Comprehensive Investigation

Introduction: The significance of administering preventive antibiotics before a surgical procedure is firmly established,moreover the aim of antibiotic prophylaxis is to limit surgical site infections in surgical patients, based essentially on the use of betalactamines, Individuals with a beta-lactam allergy may experience adverse reactions to antibiotics within this class, such as penicillins and cephalosporins, it leeds to life-threatening symptoms that require immediate medical attention, the aim of our study is to evaluate the surgical antibiotic prophylaxis practices by our staff Material and methods: we carried out a survey using a questionnaire aimed at anesthesia-intensive care staff working in different operating rooms of different types of surgeries. to assess antibiotic prophylaxis practices in the case of allergy to betalactam antibiotics (essentially the alternative antibiotic molecules used). The study lasted 3 months and involved 40 anesthesia-intensive care staff. Once the data had been collected from the questionnaires, they were processed using Excel, then presented in the form of tables and figures, reflecting the results obtained in relation to the aim of the study. Results: the results of antibiotic prophylaxis showed that the use of betalactam antibiotics represented 96% of practices and that the antibiotic molecule chosen as an alternative in case of betalactam allergy was compliant in 84.44% of practices in relation to SFAR 2018 recommendations. Conclusion: Antibiotic prophylaxis practices for patients allergic to betalactamines require major caution in order to limit surgical site infections and reduce hospitalization costs.

A review of the practice of surgical antibiotic prophylaxis

Background: Surgical Antibiotic Prophylaxis (SAP) is defined as the use of antibiotics to prevent infections at a surgical site. The appropriate use of SAP is an effective and efficient modality of preventing surgical site infections. Main body: The practice of SAP is however fraught with several challenges e.g., diverse opinions among surgeons regarding the duration of surgical prophylaxis, a dearth of institutional guidelines, and poor compliance with existing guidelines. Unfortunately, the inappropriate use of SAP results in adverse clinical (e.g., increased length of hospitalization, occurrence of surgical site infections, morbidity, etc.) and economic consequences (e.g., increased healthcare costs) in surgical patients. Conclusion: This review article discusses the practice of SAP and the challenges regarding SAP. Finally, some recommendations to overcome the challenges are discussed.

ANTIMICROBIAL PROPHYLAXIS IN SURGERY: A CROSS-SECTIONAL STUDY IN THE SURGICAL WARD OF A TERTIARY CARE CENTRE IN CENTRAL NEPAL

Background: Surgical Antimicrobial Prophylaxis is administration of a short course of antimicrobial agent prior to surgery. It has long been recommended for routine use in preventing occurrence of surgical site infections. The choice of drug, dosage, route, duration and timing of antimicrobial prophylaxis has been specified in the clinical practice guideline issued by American Society of Health-System Pharmacists. In the present study, we aim to seek the practice of antibiotic prophylaxis at a tertiary care centre in central Nepal and report the adherence to American and National Antimicrobial Treatment Guideline where applicable. Methods: This hospital-based cross-sectional study was conducted between January to June 2023 among 232 patients undergoing surgery at Chitwan Medical College Teaching Hospital. Data collection tool prepared with slight modification from previous studies recorded the demographic details, surgical data, surgical antimicrobial prophylaxis usage data and assessment of Prophylaxis data. Data analysis was done using SPSS-20. Results: We observed compliance to selection of drug, route of administration, dosage of antimicrobial prophylaxis with American guideline. All (100%) prophylaxis was administered parenterally for more than 72 hours in over 40% cases. Choice of drug was appropriate in over 84% of cases and dosage adequacy was observed in over 61% cases. Surgical antimicrobial prophylaxis was administered most frequently 30 minutes before surgery (52.59%). Conclusions: All the surgical patients were found to receive surgical antimicrobial prophylaxis. Ceftriaxone was the most commonly administered drug followed by combination of piperacillin and tazobactam. The duration of treatment post-surgery was found to be unnecessarily broader than recommended guideline.

What Is the Ideal Duration for Surgical Antibiotic Prophylaxis?

Background: Surgical antibiotic prophylaxis practice became common in the 1970s and has since become almost universal. The earliest articles used three doses over 12 hours with the first being administered before the start of the operation. Conclusions: The duration of prophylaxis has varied widely in practice over time, but an increasing body of evidence has supported shorter durations, most recently with recommendations in influential guidelines to avoid administration after the incision is closed.

Surgical Site Infections: Prevalence, Economic Burden, and New Preventive Recommendations

Surgical site infections are the most common and significant epidemiological burden worldwide. Despite implementing modern surgical techniques, appropriate antibiotic prophylaxis, sterilization techniques, and aseptic and antiseptic practices, surgical site infections continue to pose a significant challenge. As a result, patients who experience these infections may require increased antibiotic use, extended hospital stays, and higher treatment costs. This is particularly concerning given that such infections are largely preventable. The financial and social burden imposed by the costs of surgical site infections remains a significant problem for many countries. Evidence-based preventive practices should be integrated into the preoperative, intraoperative, and postoperative periods to prevent these infections. It is estimated that approximately half of all surgical site infections can be prevented by applying evidence-based practices.

Evaluation of the practice of surgical antibiotic prophylaxis in a Zonal Referral Hospital in Mbujimayi, Democratic Republic of the Congo (DRC)

BackgroundSurgical Antibiotic Prophylaxis (SAP) is helpful in preventing patients from developing Surgical Site Infections (SSI). In Mbujimayi, the documentation on the practice of SAP is outdated and inadequate. The last study was conducted more than 5 years ago. This study aims at assessing the compliance of the practice of antibiotic prophylaxis in the surgical and obstetrics-gynecology departments of the Bonzola Zonal Referral Hospital (BZRH) compared to the international standards.MethodsA prospective observational study was conducted from March 2020 to March 2021 involving 324 surgical patients who received antibiotic prophylaxis. Interventions were assessed as “compliant” if all the variables individually complied with the criteria for antibiotic prophylaxis use.ResultsThree hundred and twenty-four patients were enrolled in this study. Compliance was found to be 87.35% for the indication for administration; 0.31% for the choice of the molecule; 3.65% for the time of the first administration; none for the duration of antibiotic prophylaxis. Therefore, the overall compliance was nil. This study shows a significant gap when the current practice in Mbujimayi town is compared to the recommendations of international societies.ConclusionSAP is often indicated in accordance with international recommendations in Mbujimayi. However, the choice of the molecule, the dosage, the time of first administration and the duration of SAP deviate from them. Thus, the compliance of SAP is nil.

A European International Multicentre Survey on the Current Practice of Perioperative Antibiotic Prophylaxis for Paediatric Liver Transplantations.

(1) Background: Postoperative infections are major contributors of morbidity and mortality after paediatric liver transplantation (pLTX). Evidence and recommendations regarding the most effective antimicrobial strategy are lacking. (2) Results: Of 39 pLTX centres, 20 responded. Aminopenicillins plus ß-lactamase inhibitors were used by six (30%) and third generation cephalosporins by three (15%), with the remaining centres reporting heterogenous regimens. Broad-spectrum regimens were the standard in 10 (50%) of centres and less frequent in the 16 (80%) centres with an infectious disease specialist. The duration ranged mainly between 24-48 h and 3-5 days in the absence and 3-5 days or 6-10 days in the presence of risk factors. Strategies regarding antifungal, antiviral, adjunctive antimicrobial, and surveillance strategies varied widely. (3) Methods: This international multicentre survey endorsed by the European Liver Transplant Registry queried all European pLTX centres from the registry on their current practice of perioperative antibiotic prophylaxis and antimicrobial strategies via an online questionnaire. (4) Conclusions: This survey found great heterogeneity regarding all aspects of postoperative antimicrobial treatment, surveillance, and prevention of infections in European pLTX centres. Evidence-based recommendations are urgently needed to optimise antimicrobial strategies and reduce the spectrum and duration of antimicrobial exposure.

Antibiotic prophylaxis practices in cesarean section with focus on timing – a Danish national survey

Introduction: The last Danish survey in 1995 on the antibiotic prophylactic practices in cesarean section found that there was no consensus between delivery wards. Since then national guidelines have been established. We therefore wanted to see if clinical practice regarding antibiotic prophylaxis had become more uniform. Methods: In February of 2019 the delivery wards in Denmark (n=21) were contacted to answer an online questionnaire regarding type and dose of antibiotic prophylaxis used, timing of the administration, and differences between elective and emergency cesarean section. Results: All twenty-one wards applied a single dose of 1500 mg Cefuroxime, a 3rd generation cephalosporin. Three wards (14%) administered antibiotic prophylaxis after cord clamping and eighteen (86%) prior to clamping, with nine (43%) wards having changed practice during the last 10 years. Three wards recalled the precise year for the change, six wards gave an approximate range of years, and five wards did not remember. The exact timing of the antibiotic varied from 0-60 minutes prior to incision, with sixteen (76%) wards reporting giving antibiotics usually 0-30 minutes prior to and of those, eleven (52%) immediately prior. All wards had the same prophylactic antibiotics principles for emergency and elective cesarean sections. Conclusion: Most wards adhere to national guideline recommendations, but recollection was imperfect as to when changes in practices were implemented. We suggest that current and previous guidelines from hospitals in Denmark be stored in a national database, or more preferably that a national cesarean birth registry be established, accounting for the frequent local changes and interpersonal differences in clinical practice.

Antibiotic prophylaxis for dental procedures after joint arthroplasty: a cross-sectional survey of orthopaedic surgeons about current practices

Background: Periprosthetic joint infection is a rare, but potentially devastating complication that can occur after prosthetic joint replacement. In 2016, the American Academy of Orthopaedic Surgeons (AAOS) revised its Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. The objective of this study was to survey orthopaedic surgeons regarding their use of prophylactic antibiotics in arthroplasty patients undergoing dental procedures. Additionally, the authors inquired whether surgeons who have undergone arthroplasty procedures themselves practice the antibiotic prophylaxis when faced with decisions regarding their own joints. Methods: The authors surveyed currently practicing orthopaedic surgeons in the United States who perform joint arthroplasty procedures. The questions pertained to demographic data, training background, type of employment, arthroplasty type and volume, antibiotic prophylaxis practices, and awareness of the AAOS/American Dental Association (ADA) recommendations. Results: Two hundred, fourteen surveys were completed, though not all respondents answered every question. Most surgeons (149 of 200, 74.5%) routinely recommend prophylactic antibiotics for all patients with total joint arthroplasties who undergo dental procedures. The majority of the surgeons (163 of 199, 81.9%) reported that they are aware of the current AAOS/ADA guidelines, but that did not have a substantial effect on whether they routinely recommend prophylactic antibiotics (P=0.74). Conclusions: Most orthopaedic surgeons surveyed said they understand the AAOS/ADA guidelines, but that they routinely prescribe prophylactic antibiotics for arthroplasty patients undergoing dental procedures. These prescribing practices have no significant relationship with their knowledge of the AAOS AUC, years of experience, volume, specialty, employment, or personal history of joint replacement. Level of Evidence: Level IV, cross-sectional survey

A revisit to practice of antibiotic prophylaxis in caesarean section

Background: Women undergoing cesarean delivery are 5-20 fold greater risk of infection than women undergoing vaginal delivery. Infectious complications after cesarean delivery are an important cause of maternal morbidity, increase in hospital stay and cost of treatment. The use of antibiotic prophylaxis for cesarean section can reduce the incidence of postoperative infectious morbidity.Material and Methods: This was a prospective case control study involving 140 women undergoing cesarean delivery for various indications, who were divided into two groups, Group A and B with 70 patients in each which was conducted at Maharajah’s Institute Of Medical sciences, vizianagaram, Andhra Pradesh for duration of 1 year. Group A received antibiotic prophylaxis of ceftriaxone 1gm IV 30 minutes before skin incision and another dose at 24 hours, Group B received Ceftriaxone 1gm IV 30 minutes before cesarean section, followed by Ceftriaxone 1gm+ Metronidazole 100ml IV 8th hourly for 48 hours followed by oral cefixime till suture removal. Postoperatively, both groups of patients were followed up for febrile and infectious morbidity and neonatal outcome was followed during hospital stay for infectious morbidity.Results: Total of 140 patients were analysed in both groups of 70 patients in each. Baseline characteristics like age, parity, gestational age, socioeconomic status, were similar in both groups. Postoperative morbidities like Febrile morbidity and surgical site infection (p=0.8) did not differ significantly. The neonatal infectious morbidity in both groups (p=0.66) and recovery was uneventful. Conclusion: Double dose of single antibiotic regimen was equally effective as compared to multiple doses of multiple drugs and extended antibiotic therapy. We can cut down on antibiotic misuse among parturients which has implications in global emergence of antibiotic resistant bacteria and epigenetic and allergic diseases in the offspring.

636. Meningococcal Vaccination and Antibiotic Prophylaxis Practices in Solid Organ Transplant Recipients undergoing Eculizumab Therapy

Abstract Background Eculizumab, an inhibitor of terminal complement activation, has been utilized in pre-transplant desensitization, treatment of antibody-mediated rejection and thrombotic microangiopathy in solid organ transplant recipients (SOTR). Eculizumab is associated with meningococcal disease, leading to guidelines for vaccination against serogroups ACWY (menACWY) and B (menB) at least 2 weeks prior to eculizumab therapy. In persons requiring emergent use of eculizumab, prophylaxis for at least 2 weeks is recommended. SOTRs respond suboptimally to vaccination, raising consideration for pre-transplant vaccination and prolonged prophylaxis in those undergoing eculizumab therapy. We sought to describe meningococcal vaccination and prophylaxis practices among SOTRs receiving eculizumab. Methods We performed a retrospective chart review of meningococcal vaccination, including number and timing pre- or post-transplant, along with prophylaxis prescribing and duration in SOTRs receiving eculizumab across 3 distinct Mayo Clinic Enterprise sites (Rochester, Arizona, and Florida). Results 200 SOTRs receiving at least one dose of eculizumab between 1/1/2008 and 9/16/2021 were reviewed. Eculizumab indications included antibody mediated rejection (38%), desensitization (26%), and thrombotic microangiopathy (19%). 83% (166/200) of SOTRs received eculizumab for an unanticipated post-transplant complication. Vaccination rates were 82% (164/200) and 35.5% (71/200) for menACWY dose 1 and 2, respectively, and 54% (108/200) and 28.5% (57/200) for menB dose 1 and 2, respectively. The majority received their first vaccination post-transplant: menACWY 66.5% (133/200) and menB 2.5% (185/200). Among those without vaccination pre-eculizumab, 22.3% (41/184) were not prescribed prophylaxis. The median duration of prophylaxis was 62 (range 4-2651) days. Conclusion Most SOTRs underwent meningococcal vaccinations near the time of eculizumab administration post-transplant for an unanticipated complication. One-fifth of those meeting criteria were not provided meningococcal prophylaxis. These findings may support pre-transplant administration of meningococcal vaccinations and heightened awareness for meningococcal prophylaxis in SOTRs receiving eculizumab. Disclosures All Authors: No reported disclosures.

Study protocol of REpeat versus SIngle ShoT Antibiotic prophylaxis in major Abdominal Surgery (RESISTAAS I): a prospective observational study of antibiotic prophylaxis practice for patients undergoing major abdominal surgery

IntroductionSurgical site infections (SSIs) are among the most common complications after abdominal surgery and develop in approximately 20% of patients. These patients suffer a 12% increase in mortality, underlying the...

#10 Variation in Antibiotic Use and Incidence of Surgical Site Infections in Pediatric Liver Transplant Recipients

Abstract Background Surgical site infections (SSIs) are an important source of early complication after liver transplantation (LT). Peri-operative antibiotics to prevent SSI is considered standard of care, yet there are limited data on the frequency of SSI and no consensus on a standardized regimen. A major barrier is the lack of a large cohort of pediatric LT recipients. Leveraging merged data from the Pediatric Health Information System (PHIS) and the United Network for Organ Sharing (UNOS) we assembled a large cohort of pediatric LT patients to describe the frequency of SSI, variation in antibiotic prophylaxis practices and associated factors. Method The source cohort included all patients under 18 years in the UNOS database who received a LT at a PHIS-participating institution between January 1st 2006 to August 6th, 2017. We excluded those undergoing multi-visceral transplantation and/or re-transplantation. Patient data were merged using a probabilistic merge algorithm using the following present in both datasets: transplant center, date of birth, gender and date of transplant. Our primary outcome was any SSI present during the first 30 days of the hospitalization in which the LT was performed. SSI was defined using ICD 9 and ICD-10 diagnosis codes for post-operative surgical site infection, in addition to procedure codes for incision and drainage or return to the operating room. Peri-operative prophylaxis regimens were inclusive of antibiotic(s) received on the day of or day after LT. After all unique antibiotic regimens were identified, we further categorized into 6 levels of clinically relevant antibiotic combinations ranging from narrowest (Level 1 was cefazolin) to broadest spectrum (Level 6 was carbapenems). Patients receiving agents from more than one category defaulted to the broadest spectrum group. Vancomycin/linezolid administration was collected as a distinct covariate. Data collected on baseline factors included age at LT, sex, race, specifics of the LT type, and severity of illness (SOI) defined as receiving ICU level care on at least one day in the week prior to LT. Results Data from PHIS was successfully merged to 3055 (94%) of patients in the UNOS cohort. We excluded 264 multi-visceral transplants and/or re-transplants and 205 LT recipients without a categorizable antibiotic regimen with a final cohort of 2586 patients. This cohort was 50.8% female, 11.6% Black and 65% White with median age of 2 years (IQR of 0,9). 11.6% of patients required at least one ICU level of care day in the week prior to LT and the median hospital stay from day of transplant was 20 days (IQR: 13, 35). An SSI was identified during the hospital stay in 284 (11%) patients. As we discovered that patients less than 1-year of age at transplant were almost twice as likely to experience an SSI compared to patients over 1 year (16.2% versus 8.6%), the distribution of other covariates by antibiotic category was assessed after stratifying &amp;lt;1 year versus &amp;gt;=1 year (Table 1A and Table 1B).Category 5 was the most commonly represented antibiotic group.Significant differences in antibiotic regimen included donor type and type of liver transplanted , receipt of dialysis the week prior, and in those meeting SOI criteria. In older patients, differences in antibiotics administered were additionally noted within race category and if there was concern for donor infection. Conclusion SSI was common and varied by age, with children under one more likely to sustain an SSI. Antibiotic regimens administered varied withing each of these age groups. Factors associated broader-spectrum categories included receipt of a living donor LT, dialysis in the week prior to LT, and needing at least one ICU-level of care day in the week prior to LT. Additional multivariate analyses are warranted and will focus on investigating the degree to which center-specific differences are driving variation and will explore the comparative effectiveness of different antibiotic prophylaxis categories on SSI risk.

Practice of antibiotic prophylaxis in patients undergoing mastectomy without immediate reconstruction: A survey of breast surgeons in Pakistan.

e13519 Background: Incidence of surgical site infections after breast surgery range from 0.8-26%. Though preoperative antibiotic prophylaxis (AP) is widely used, international and national guidelines lack focus on post-operative antibiotic prophylaxis (PAP). This survey of surgeons in Pakistan reports surgeon preference for AP in cases of mastectomy without immediate reconstruction but with indwelling drains. Methods: An anonymous, online, validated 16-item survey, exploring peri-operative antibiotic choices and prescribing practices was disseminated to a working-group of 30 leading breast surgeons in Pakistan. Descriptive statistics were performed using Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 25 (response rate: 83.3%) members responded, with the majority being fellowship-trained breast surgeons/surgical oncologists (68%) and having &gt; 10 years’ experience (60%). For mastectomy without reconstruction, though most (76%) reported routine use of pre-operative AP, there was considerable variation in post-operative AP. 36% reported no further AP after a single dose of pre-operative AP, 24% continued AP for 24 hours in high-risk patients only, while 24% continued AP for 24 hours in all patients. 12% continued post-operative AP in all patients for 7 days, while 4% reported continuing post-operative AP for the duration of indwelling drains. Antibiotic choice for peri-operative AP also varied. 56% used cephalosporins, 24% used penicillin, and the remaining 20% reported that their choice varied across patients. Conclusions: There is widespread variation in surgeon comfort with discontinuation of AP after the first pre-operative dose in patients undergoing mastectomy without immediate reconstruction but with indwelling drains. Large randomized controlled trials are necessary to develop guidelines to ensure uniformity and evidence-based post-operative AP.