Preoperative Antibiotics Research Articles

Using a Data-Driven Improvement Methodology to Decrease Surgical Site Infections in a Community Neurosurgery Practice: Optimizing Preoperative Screening and Perioperative Antibiotics

We used a data-driven methodology to decrease the departmental surgical site infection rate to a goal of 1%. A prospective interventional study with historical controls comparing preimplementation/intervention (unknown methicillin-sensitive Staphylococcus aureus [MSSA]/methicillin-resistant Staphylococcus aureus [MRSA] status and standard weight and drug allergy-based preoperative antibiotics) with postimplementation/intervention (optimized preoperative chlorhexidine showers, MSSA/MRSA screening, MSSA/MRSA decolonization, and optimized preoperative antibiotic order set implementation). The American College of Surgeons National Surgical Quality Improvement Program was used for case surveillance. The primary outcome was the presence of a surgical site infection with a secondary outcome of cost(s) of implementation. A total of 317 National Surgical Quality Improvement Program abstracted neurosurgical cases were analyzed, 163 cases before implementation and 154 cases after implementation. There were no significant differences between the preimplementation and postimplementation cohorts regarding patient demographics and baseline comorbidities, with the exceptions of inpatient and functional status (P < 0.001). The most common procedures were lumbar decompression (31%), lumbar discectomy (27%), and anterior cervical discectomy and fusion (10.4%). After implementation, 30 patients were MSSA positive (20%) and 4 MRSA positive (2.6%). Thirty patients received preoperative intranasal mupirocin decolonization (88%), and 4 patients received adjusted preoperative antibiotics (12%). After protocol implementation, the surgical site infection rate decreased from 6.7% (odds ratio, 2.82) to 0.96% (odds ratio, 0.91). The cost of implementation was $27,179, or $58 per patient. The findings highlight the importance of systematically investigating areas of gap in existing clinical practice and quality improvement projects to increase patient safety and enhance the value of care delivered to neurosurgical patients.

Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study.

Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.

A study to assess the outcomes following tonsillectomy in patients who were administered only prophylactic pre-operative antibiotics vis-à-vis patients who were administered both pre and post-operative antibiotics

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tonsillectomy is one of the common operative surgery performed by an ENT surgeon. With aim to reduce the hospital stay and post-operative complications, the use of antibiotics has become every common.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 40 patients undergoing tonsillectomy were recruited into the study subsequent to obtaining informed consent. The patients were divided in to two groups, group A and group B. Both the groups were given tablet amoxicillin with clavulanic acid orally for 3 days prior to surgery and subsequently were administered injection amoxicillin and clavulanic acid intravenously 1 hour prior to surgery pre operatively. Only group A patients were given injection amoxicillin and clavulanic acid intravenously 12 hourly for 5 days in the post-operative period. The patients from both the groups were assessed on the following criteria: pain, slough in the tonsillar fossa, fever, clot formation and return to normal daily activities. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Both the groups were comparable with regard to demographics, post-operative infections, post-operative pain and time to return to normal daily activities. There was no cognisant difference for all the parameters assessed.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Administration of antibiotics in patients undergoing tonsillectomy can be restricted to pre-operative antibiotics only as giving antibiotics post-operatively does not affect the clinical outcome and also prevents indiscriminate use of antibiotics which can lead to mutant antibiotic resistant strains of bacteria which can also have an economic impact.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Pharmacological evaluation of prophylactic anti-microbial use in laparoscopic cholecystectomy; an open labelled study evaluating theconcentrations of single dose intravenous ceftriaxone at serum and tissue level.

The goal of administering preoperative systemic prophylactic antibiotics is to have the concentration in the tissues at its optimum level at the start and throughout the surgery. The rationale for the use of antibiotics is not well accepted; possible side effects and development of microbial resistance patterns are potential risks along with the financial burden. Therefore, the present study was conducted with the aim to clinically evaluate the serum and tissue concentration of single-dose prophylactic ceftriaxone during an ongoing laparoscopic cholecystectomy (LC) and to find out risk factors for post operative surgical site infections (SSI). It was an open labelled prospective study in 50 consecutive patients who underwent elective laparoscopic cholecystectomy under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by HighPerformanceLiquidChromatography during the ongoing surgery. Subjects were observed for any post-operative complications including SSI. Serum and tissue concentrations of ceftriaxone were significant at test value of 4milligrams/Litre. Body mass index was significantly correlated with the tissue concentration of ceftriaxone at the time of incision. The rate of SSI was 2%. It significantly correlated with age more than 60years, diabetes and infected bile. A single prophylactic intra-venous dose of 1g ceftriaxone immediately prior to skin incision in LC is good enough for prevention of SSI in Indian patients.

Comparison of post‐operative inflammatory response in horses undergoing elective castration treated preoperatively with ceftiofur crystalline free acid or procaine penicillin G

SummaryCastration is among the most common surgical procedures performed in the horse (Equus Caballus) and a variety of post‐operative complications can occur. This study aims to determine if a single dose of long‐acting ceftiofur crystalline free acid (CCFA) used as a preoperative antimicrobial in equine field castrations offers any reduction in post‐operative inflammatory markers when compared to procaine penicillin G (PPG). Sixty‐five horses aged 8 months to 2 years were randomly assigned to the CCFA (n = 33) or PPG (n = 32) treatment groups. Horses were castrated under general anaesthesia using a closed castration technique with removal of the median raphe. Quantitative and qualitative inflammatory markers were measured and short‐term complications were recorded post‐operatively on Days 3, 8 and 14. No clinically significant difference in any post‐operative inflammatory markers between the CCFA and PPG group was detected. In the CCFA group, 48% of horses experienced short‐term post‐operative complications compared to 31% in the PPG group. Regardless of the preoperative treatment, castration induced significant elevation in serum amyloid A (P&lt;0.0001), preputial oedema (P&lt;0.0001) and scrotal oedema (P&lt;0.0001) at Day 3. These values returned to baseline levels by Day 8. Horses with grade 3 or above preputial oedema had elevated serum amyloid A values (P&lt;0.001). The data from this study indicate CCFA used as a preoperative antibiotic for routine castration offers no advantages over PPG. The difference in complication rate between groups is likely of minimal clinical importance, as all complications were mild and self‐limiting.

Is a single dose of preoperative antibiotic therapy effective for patients treated with megaendoprosthesis after metastatic bone tumour resection?

All patients who underwent primary MPR in MBD were included in this prospective study. All penicillin-sensitive patients received one dose of cefuroxime 1.5gm intravenous at induction. In penicillin-allergic patients, teicoplanin 1.2gm and ciprofloxacin 500mg intravenous was administered. The patients were followed up in the wound clinic and the specialist MBD clinic at 2weeks, 3months, 6months and then annually. Data collected included demographics, primary tumours, surgical procedures, complications and duration of follow-up. All calculations were performed using SPSS® 25(IBM, USA). A p value ≤ 0.05 was considered to be significant. There were 51 patients with a mean age of 65.4years. Procedures included proximal femoral replacement (35), distal femoral replacement (7), proximal humeral replacement (4), distal humeral replacement (3) and total femoral replacement (2). Thirty-seven patients received cefuroxime, and fourteen patients received teicoplanin and ciprofloxacin at induction of anaesthesia. The deep infection rate was 1.9%. Thirty-seven patients died with a median survival of 10months (1 to 51months). Mean follow-up was 18.9months (1 to 70months). Single dose of preoperative antibiotics at anaesthetic induction seems to be safe and effective for preoperative prophylaxis in orthopaedic oncology.

Oral pain and infection control strategies for treating children and adolescents in India.

Introduction:Oral and dental health form an integral part of complete well being of an individual and society at large. Promoting oral health and societal progression go hand in hand.Aim:To investigate dentists' attitudes about pain and infection control while treating children and adolescents by assessing their recommendations of pre- and postoperative analgesics and antibiotics, and use of local anesthesia (LA) for definitive treatment in different clinical scenarios.Materials and Method:A total of 400 dentists, both general dental practitioners (GDPS) as well as specialist dentists, were surveyed over a period of 2 months by using a pre-tested close-ended questionnaire. The data was statistically analyzed using Pearson's Chi-square test and backward logistic regression analysis for analysis of categorical variables and independent variables, respectively. Level of significance was set at 5%.Results:It was found that there was a gross overuse of antibiotics and analgesics and under use of LA by GDPs compared to specialist dentists. Postoperative antibiotics and analgesics were used more commonly than preoperative antibiotics and analgesics. These strategies were used more often in permanent teeth than primary teeth except the use of LA, which was used with equal frequency in both primary as well as permanent dentition.Conclusion:Dependence on antibiotics and analgesics for achieving pain and infection control in children has to be minimized and focus has to be shifted on judicious definitive treatment involving use of LA, aseptic techniques, and behavior management techniques.

Prophylactic antibiotic in general surgery

Objectives: To evaluate the role of antibiotic prophylaxis in general surgery with the incidence of wound infection and in comparison with extended regimen antibiotics.Methods: A prospective study of 150 patients were enrolled and operated upon electively which are divided into 2 groups. 100 patients were taking prophylactic antibiotics and 50 patients were on extended antibiotic regimen. Questionnaires concerning age, sex, type of surgery, complications and parameters of antibiotic prophylaxis (antibiotic choice, route, dose, timing of first dose and duration of prophylaxis) were completed.Results: Patients with prophylactic antibiotic, 79% of patients underwent a clean surgical operation and 21% underwent a clean contaminated operation. Inguinal hernia and open cholecystectomy were the commonest operation in each category, 4% of this group developing wound infection, also we take comparison with 50 cases in which we use extended antibiotic regimen Laparoscopic cholecystectomy and Para umbilical hernia were the commonest operations in this category, 6% of this group developing wound infection Ampicillin and cefotaxime were the most frequently prescribed antibiotics (50%, 50% respectively). All the 100 patients were received the antibiotic on time.Conclusions: This study found that the use of pre-operative prophylactic antibiotics does have a statistically significant effect on postoperative infection rates in surgical management.

Incidence of Microflora from Cultures of Gall Bladder Bile of Laparoscopic Cholecystectomy

Background: Gallstone disease is one of the most common problem affecting the digestive tract. Through experience it has been accepted that bile in normal conditions remains sterile. Bactibilia is a common finding in individuals at high risk or with complicated cholecystolithiasis, however few data prevails about the prevalence of bactibilia in patients operated on for uncomplicated laparoscopic cholecystectomy. There is a common usage of preoperative and postoperative antibiotics in the different patients without the existence of any actual bacteriologic and epidemiologic evidence. Material and methods: 222 patients with diagnosis of cholecystolithiasis postoperated of laparoscopic cholecystectomy had a bile sent to bacteriology. Bile was aspirated from the gall bladder during laparoscopic cholecystectomy. Results: Bactibilia was identified in 50 (23%) of the cultures of mild chronic cholecystitis. A total of 172 negative cultures were obtained (77) and 50 positive (23%). In the present study out of 50 patients, 32 (64%) were females and 18 (36%) were males. We found total of 25 (50%) black pigmented stones, 15 (30%) were brown and 10 (20%) were cholesterol stones. In this study bile culture was showing growth of the following organisms. The commonest organism was Enterococcus (32%) followed by E. coli (26%), Klebsiella (14%). Conclusions: Bactibilia has long been known to be associated with biliary tract diseases and culturable bacteria in bile can represent a state of asymptomatic bactibilia which can disseminate after any intervention causing infective complication. Exploring the microflora of gall bladder bile important role in choosing the appropriate antibiotic to prevent complication.

Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa

ABSTRACT BACKGROUND: Periprosthetic joint infections (PJIs) are a leading cause of revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA), worldwide. Asymptomatic bacteriuria (ASB) is an independent risk factor for PJIs; however, a paucity of data relevant to developing countries exists. The aim of this study was to describe the prevalence of preoperative ASB and the subsequent incidence of PJIs in patients undergoing total joint arthroplasty (TJA) in South Africa. METHODS: We retrospectively reviewed primary THA and TKA patients. All patients were screened for ASB preoperatively. Patients with positive urinalysis for ASB were identified and treated prior to surgery (treated-ASB). The primary outcome was ASB prevalence and the incidence of PJIs and other perioperative complications. Secondary outcomes included risk factors for ASB and subsequent PJIs in treated-ASB patients, respectively, compared to those with no evidence of ASB (non-ASB). Lastly, we aimed to compare the infective microorganisms cultured from preoperative urinalysis and perioperative sampling of PJIs. RESULTS: We included 179 patients (67 THA; 80% female) with mean follow-up of 2.45 years. ASB prevalence was 22% (n = 39). Patients older than 70 years were 3.5 times more likely to have ASB compared to younger patients (p = 0.005). The prevalence of ASB was 22% (n = 10) for human immunodeficiency virus (HIV) positive and 22% (n = 29) for HIV-negative patients (p = 0.084). PJI incidence was 8% (n = 3) in the treated-ASB and 1% (n = 1) in non-ASB. Treated-ASB patients had an 11.6-fold increased likelihood of PJIs than non-ASB patients (p = 0.046). pJi microorganisms cultured did not correlate to isolates from urine cultures. CONCLUSION: The prevalence of ASB in a TJA population in South Africa is 22% which is higher than reported findings worldwide. Although the value of preoperative antibiotic therapy for ASB remains controversial, there is a role for routine urinalysis preoperatively to identify patients predisposed to PJI. This is of specific significance in the management of HIV-positive patients and in developing countries to guide healthcare providers in resource-constrained environments. Level of evidence: Level 2. Keywords: total hip arthroplasty, total knee arthroplasty, asymptomatic bacteriuria, periprosthetic joint infection, developing country

Comparative study of single dose preoperative antibiotics versus preoperative and postoperative antibiotics in laparoscopic appendicectomy for uncomplicated appendicitis in rural hospital

Comparative study of single dose preoperative antibiotics versus preoperative and postoperative antibiotics in laparoscopic appendicectomy for uncomplicated appendicitis in rural hospital

899. Reduction of Surgical Site Infections Post Cesarean Section through Implementation of Novel Evidenced Based Bundle

BackgroundA frequent complication post cesarean section (C-section) is surgical site infections (SSI) which are associated with heightened maternal morbidity and mortality, decreased patient satisfaction, prolonged hospitalization, and increased costs. In Calendar Year 2019, our Infection Control Committee identified an increase in the incidence of post-operative C-section SSI rates over an 8 month period from January through August of 2019.. The purpose of this study was to develop, implement and measure the compliance and efficacy of a novel pre-operative bundle (POB) for patients undergoing C-section.Calendar Year 2019 Jan. through Aug. C-Section Infections Raw Numbers MethodsIn October 2019, our multidisciplinary team consisting of Infection Control, Pharmacy, Nursing, and Physicians developed and implemented POB for patients undergoing C-section. The POB included the following:1. Mandatory interventions of vaginal cleansing using povidone iodine2. Chlorhexidine (CHG) 2% wipes to abdomen3. Addition of Azithromycin 500mg x 1 dose as pre-operative antibiotic.Primary endpoint of the study was to measure the overall C-section SSI incidence for 8 months period pre and 8 months post implementation of the POB. This Secondary endpoint of the study included POB compliance and efficacy of real-time prospective audit and feedback for non-compliance.Novel Preoperative Bundle Auditing Compliance ResultsThere were total of 212 patients who received C-section in Pre-POB group and 182 in Post-POB group. Baseline characteristics between the groups were similar. Overall C-section rates Pre-POB was 3.8 % vs 0% in Post-POB group. We noted a bundle compliance of 97.9% since implementation of POB. Real time prospective audit and feedback was provided to total of 122 cases after implementation of POB.Comparison of C-Section Raw Numbers Calendar Year 2019 Pre and Post Novel Bundle Implementation ConclusionWith implementation of POB, we noticed a significant drop in our C-section SSI. We observed a very high bundle compliance with implementation of prospective audit and feedback approach. This is the first study evaluating implementing a novel pre-operative bundle for patients undergoing C-section. Continued auditing and real time feed back of novel bundle will ensure continued success.Disclosures All Authors: No reported disclosures

96. Surgical Site Infection Prophylaxis Selection and Postoperative Clinical Outcomes in Patients with Reported Penicillin Allergy

BackgroundAdministration of preoperative antibiotics are known decrease risk of postoperative surgical site infections (SSI) and deviation from first line prophylaxis increases this risk. Patients who report penicillin (PCN) allergy are less likely to receive cefazolin preoperatively despite being the preferred antibiotic for SSI prevention in the majority of surgical procedures.MethodsA single center retrospective descriptive study was performed during the 2018–2019 academic year. Perioperative antimicrobial administration practice was evaluated for all types of surgical procedures. Patient demographics, PCN allergy history, development of Clostridioides difficile infection (CDI) within 90 days of procedure, and total hip and knee arthroplasty SSIs were assessed.ResultsDuring the study period, 16,376 procedures were performed with perioperative antibiotic administration. Cefazolin (12,756; 77.9%) was most frequently administered followed by clindamycin (1,396; 8.5%), and vancomycin (735, 4.5%). PCN allergy was reported in 2,051 (12.5%) patients, of which 1,180 (57.5%) had record of previously receiving a cephalosporin. Interestingly, 694 (33.8%) and 11,799 (82%) patients with and without a reported PCN allergy respectively received cefazolin perioperatively (P< 0.001). The incidence of joint replacement SSI was higher in patients with a reported PCN allergy (6 of 97; 6.2%) compared to those without (12 of 671; 1.8%) (P=0.018). CDI occurred in 44 (1.1%) of 3,883 and 70 (0.5%) of 12,493 patients who received a non-cefazolin or cefazolin respectively for prophylaxis (OR 2.1; 95% CI 1.5–2.9). In multivariate analysis controlling for surgery type, age, weight, and renal function, receipt of a non-cefazolin antibiotic was independently associated with developing CDI (OR 1.6; 95% CI 1.1–2.4).ConclusionPatients with a reported PCN allergy were more likely to receive a non-cefazolin antibiotic perioperatively and were more likely to develop a SSI following hip or knee replacement. Administration of a non-cefazolin antibiotic was independently associated with increased risk of CDI. Efforts should be made to minimize inappropriate avoidance of first line perioperative prophylaxis due to reported PCN allergies.DisclosuresRyan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium.

Postoperative infectious related complications are not uncommon after percutaneous nephrolithotomy. Previously, we noted that 7 days of antibiotics did not decrease sepsis rates compared to just perioperative antibiotics in a low risk percutaneous nephrolithotomy population. This study aimed to compare the same regimens in individuals at moderate to high risk for sepsis undergoing percutaneous nephrolithotomy. Patients were prospectively randomized in this multi-institutional study to either 2 days or 7 days of preoperative antibiotics. Enrolled patients had stones requiring percutaneous nephrolithotomy and had either a positive preoperative urine culture or existing indwelling urinary drainage tube. Primary outcome was difference in sepsis rates between the groups. Secondary outcomes included rate of nonseptic bacteriuria, stone-free rate and length of stay. A total of 123 patients at 7 institutions were analyzed. There was no difference in sepsis rates between groups on univariate analysis. Similarly, there were no differences in nonseptic bacteriuria, stone-free rate and length of stay. On multivariate analysis, 2 days of antibiotics increased the risk of sepsis compared to 7 days of antibiotics (OR 3.1, 95% CI 1.1-8.9, p=0.031). Patients receiving antibiotics for 2 days had higher rates of staghorn calculus than the 7-day group (58% vs 32%, p=0.006) but post hoc subanalysis did not demonstrate increased sepsis in the staghorn only group. Giving 7 days of preoperative antibiotics vs 2 days decreases the risk of sepsis in moderate to high risk percutaneous nephrolithotomy patients. Future guidelines should consider infectious risk stratification for percutaneous nephrolithotomy antibiotic recommendations.

A prospective study of single dose preoperative antibiotic cover in clean elective surgical cases- a single center study

Background: Surgical site infection (SSI) is the third most common nosocomial infections occurring worldwide, thus leading to increasing cost, mortality and morbidity. The main objective was to know the incidence of SSI in clean surgical procedures carried out in the institute of MGMCRI and to determine various pathogens causing SSI.Methods: This was a prospective observational study done on 100 patients in Department of General Surgery in MGMCRI, Puducherry from June 2015 to August 2017 who underwent clean surgical procedure. Preoperatively single done of injection cefazolin 1gm intravenous preparation was given 30 minus before the skin incision and patient were observed and followed up meticulously for the incidence of SSI and to determine the bacterial flora in the event of SSI.Results: In our study a total of 100 patients were included. In our study a total of three out of 100 patients developed SSI which was around 3%.Out of the 3 patients who had SSI all were a male which is around 4.6% in our study. In relation to the distribution based on the age group more than 50 year of the age are most frequently associated with SSI in our study. The bacterial flora includes staphylococcus aureus which was isolated from one patient and Klebsiella pneumonia isolated from two patients who had surgical site infections.Conclusions: This study concludes that single dose pre-operative antibiotic has advantage in prevention of SSI and it is cost effective for patient.

Oral Flora and Perioperative Antimicrobial Interventions in Cleft Palate Surgery: A Review of the Literature.

The role of perioperative antibiotics in cleft palate remains a topic of debate. Advocates stress their importance in preventing local and systemic infections and decreasing the incidence of oronasal fistula formation. However, few studies to date have directly evaluated the role of antibiotics and other antimicrobial measures in cleft palate surgery. The aim of this review is to evaluate the evidence surrounding the use of perioperative antibiotics and other antimicrobial interventions in cleft palate surgery. Additionally, we review the literature on the oral flora unique to the cleft palate patient population. This was accomplished utilizing PubMed, Medline, and the Cochrane Library with MeSH and generic terms. Articles were selected based on predefined inclusion and exclusion criteria. This review highlights the lack of higher level evidence on perioperative antibiotic use and other antimicrobial interventions in cleft palatoplasty and calls for further research on the matter. The literature appears to support the use of preoperative antibiotics for cleft palatoplasty, but the benefits of prolonged postoperative antibiotic use remain questionable.

Supracondylar Fractures: A Retrospective Chart Review Comparing Infection Rate, Antibiotic Use, Surgical Time and Cost of Full Surgical Preparation and Draping vs "Semi-Sterile" Technique.

BackgroundSemi-sterile and full preparation and draping techniques are commonly used in closed reduction percutaneous pinning (CRPP) of supracondylar fractures. Debate exists whether full preparation and draping is safer than semi-sterile technique in regards to infection risk and the utility of pre-operative antibiotics. This study is a comparison of infection rates, pre-operative antibiotic administration, cost and surgical time between techniques.MethodsA retrospective chart review of 336 pediatric patients with supracondylar fractures repaired with CRPP at our institution was completed between January 2014 and April 2018, 168 per technique. Infection rates, pre-operative antibiotic administration, preparation-to-incision time and cost in semi-sterile draping versus full preparation and draping techniques were compared.ResultsOf the 336 patients, 1/168 (0.1%) in the full preparation and draping group developed an infection compared to 0/168 (0%) patients in the semi-sterile group. Pre-operative antibiotics (Cefazolin) were administered to 76/168 (23%) patients in the full preparation and draping group and 0/168 (0%) in the semi-sterile group. The infection found received pre-operative antibiotics. Mean preparation-to-incision time for the semi-sterile group was 2.4±2.0 minutes and the full preparation and draping group was 9.9 ±4.2 minutes (p <0.001). Surgical supply cost was $80.72 [CDN] and 108.24$ [CDN], respectively, for the semi-sterile and full preparation and draping groups.ConclusionRisk of infection using a semi-sterile draping technique was safe and comparable to a full preparation and draping technique when used in CRPP of supracondylar fractures. The administration of pre-operative antibiotics does not appear to make a difference in infection rates. Semi-sterile operative technique is cost effective and has decreased preparation-to-incision time.

Comparative analysis of perioperative prophylactic antibiotics in prevention of surgical site infections in stented, distal hypospadias repair

There is limited evidence that prophylactic antibiotics prevent surgical site infection in stented, distal hypospadias repair. Our hypothesis is that the use of prophylactic antibiotics does not affect the rate of surgical site infection in this setting. We conducted a retrospective study of consecutive patients over a 6-year period with distal penile hypospadias treated with urethral stenting. Variables analyzed include age, type of repair, usage of preoperative and/or postoperative antibiotics, and length of follow-up. Patients with a history of proximal or re-operative hypospadias repair were excluded. Surgical site infection was defined by the presence of postoperative penile erythema and/or purulent drainage treated with therapeutic antibiotics. Secondary outcome analysis included the presence of other hypospadias complications. 441 consecutive subjects met our inclusion criteria with a mean age of 13.3 months. Patients were categorized into groups: Group 1 - Preoperative antibiotics (n=64), Group 2 - Both Preoperative & Postoperative antibiotics (n=159), Group 3 - Postoperative antibiotics (n=122), Group 4 - No Preoperative or Postoperative antibiotics (n=96). Two surgical site infections were reported out of the 441 patients: 1 in Group 3 and 1 in Group 4 (p=0.513). There was no significant difference in the total patients with a hypospadias complication between groups. In the table below, Groups 1-3 were combined (345 patients) for comparison to Group 4 (No antibiotics, 96 patients) for further analysis with no difference in SSIs (p=0.388) or respective hypospadias complications. The use of perioperative prophylactic antibiotics, both before and after surgery for distal, stented hypospadias repair, have not been shown to reduce the rate of surgical site infections nor hypospadias complications. Consequently, the benefit of prophylactic antibiotics in this setting is unclear.

Urinary Tract Infection After Robot-assisted Laparoscopic Pyeloplasty: Are Urine Cultures and Antibiotics Helpful?

To evaluate how variations in peri-operative urine culture (UCx) and antibiotic prophylaxis utilization following robot assisted laparoscopic pyeloplasty (RALP) affect post-RALP urinary tract infection (UTI) rates in children, then use data to generate a standardized care pathway. Patients undergoing RALP at a single institution from January 2014 to October 2018 were retrospectively reviewed. Patients with vesicoureteral reflux, neurogenic bladder, intermittent catheterization, <=2 months follow-up after stent removal, or age >=18 years were excluded. UCx use, UCx results, and pre- and post-RALP antibiotic use were recorded. The primary outcome was symptomatic UTI, tracked until 60 days after stent removal. UTI was defined as presence of fever or urinary symptoms, a positive UCx with >=10,000 colony forming units of one uropathogen, and a positive urinalysis. A total of 152 patients were included (72% male [73% circumcised], 61% white, and 23% Hispanic). One underwent a re-operative pyeloplasty, yielding 153 encounters. Eight patients (5.2%; 95% CI 1.7-8.7%) developed post-RALP UTI. Uncircumcised status and use of pre-operative prophylactic antibiotics were associated with post-RALP UTI (P = .03 and P < .01, respectively). Use of post-RALP antibiotics, whether prophylactic or therapeutic, was not associated with lower UTI rates (P = .92). Positive pre-RALP UCx and positive intra-operative stent removal UCx were associated with higher UTI rates (P = .03 and P < .01, respectively). UTI occurred in 5.2% of our cohort of >150 patients. As post-RALP antibiotic use was not associated with lower UTI rates, prophylactic antibiotics may be reserved for patients with risk factors. A standardized care pathway could safely reduce unnecessary utilization of UA/UCx and antibiotics.

Antibiotic prophylaxis as a quality of care indicator: does it help in the fight against surgical site infections following fragility hip fractures?

Fragility hip fractures are associated with increased morbidity, mortality, and costs. To improve patient care, quality indicator programs were introduced. Yet, the efficacy of these programs and specific quality indicators are questioned. We aimed to determine whether defining prophylactic pre-surgical antibiotic treatment as a quality indicator affected hip fracture outcomes. A retrospective study comparing consecutive patients, 65years and older, who were operated for fragility hip fractures between 01/01/2011 and 30/06/2016, before and after the prophylactic pre-surgical antibiotic treatment quality indicator, which was introduced in 01/2014. Primary outcomes were 1-year surgical site infections (SSI). Secondary outcomes were meeting the quality index and mortality rates, either within a hospital or during the first post-operative year. 904 patients, ages 82.5 ± 7.2years were operated for fragility hip fractures. 403 patients presented before the antibiotic prophylaxis quality indicator, and 501 following its administration. Patients demographics were comparable. In the pre-quality indicator period, documentation of prophylactic antibiotic treatment was lacking. Only 19.6% had a record for antibiotic administration in their surgical records and for merely 10.4% the type of antibiotic was stated. However, in the post-quality indicator period, 97.0% of patients had a registered prophylactic antibiotic regimen in the hour preceding the surgical incision (p < 0.001). Post-operative SSI rates were equivalent, and as were in-hospital infections, mortality and recurrent hospitalizations CONCLUSIONS: The introduction of the pre-operative antibiotic treatment quality indicator increased the documentation of antibiotic administration yet failed to influence the incidence of post-operative orthopaedic and medical infections in fragility hip fracture patients.