Dose Of Preoperative Antibiotics Research Articles

Prophylaxis of Wound Infections-antibiotics in Renal Donation (POWAR): A UK Multicentre Double Blind Placebo Controlled Randomised Trial.

Postoperative infection after hand-assisted laparoscopic donor nephrectomy (HALDN) confers significant morbidity to a healthy patient group. Current UK guidelines cite a lack of evidence for routine antibiotic prophylaxis. This trial assessed if a single preoperative antibiotic dose could reduce post HALDN infections. Eligible donors were randomly and blindly allocated to preoperative single-dose intravenous co-amoxiclav or saline. The primary composite endpoint was clinical evidence of any postoperative infection at 30 days, including surgical site infection (SSI), urinary tract infection (UTI), and lower respiratory tract infection (LRTI). In all, 293 participants underwent HALDN (148 antibiotic arm and 145 placebo arm). Among them, 99% (291/293) completed follow-up. The total infection rate was 40.7% (59/145) in the placebo group and 23% (34 of 148) in the antibiotic group (P = 0.001). Superficial SSIs were 20.7% (30/145 patients) in the placebo group versus 10.1% (15/148 patients) in the antibiotic group (P = 0.012). LRTIs were 9% (13/145) in the placebo group and 3.4% (5/148) in the antibiotic group (P = 0.046). UTIs were 4.1% (6/145) in the placebo group and 3.4% (5/148) in the antibiotic group (P = 0.72).Antibiotic prophylaxis conferred a 17.7% (95% confidence interval 7.2%-28.1%), absolute risk reduction in developing postoperative infection, with 6 donors requiring treatment to prevent 1 infection. Single-dose preoperative antibiotic prophylaxis dramatically reduces post-HALDN infection rates, mainly impacting SSIs and LRTIs.

A Study to Evaluate the Efficacy of Single Dose versus Multiple Dose of Pre Operative Antibiotic

A Study to Evaluate the Efficacy of Single Dose versus Multiple Dose of Pre Operative Antibiotic

Influence of a single preoperative dose of antibiotics on the early implant failure rate. A randomized clinical trial.

The use of a preoperative single dose of antibiotics as routine in conjunction with implant surgery is controversial, in light of the unclear effect on early implant failure rate and risk for development of resistant bacterial strains. This randomized clinical trial compared the early implant failure rates in two different patient cohorts: One group receiving a single dose of preoperative antibiotics (AB group) and one group receiving no antibiotics, prior to implant surgery (noAB group). Patients were referred for treatment at four specialist clinics in the county council of West Sweden, Vastra Gotaland and randomly assigned into one of the two groups. A total of 447 patients received 963 implants were included in the study. Of these, 223 patients (535 implants) belonged to the AB-group and 224 patients (428 implants) to the noAB-group. Four commercial implant brands were utilized, albeit one system was only represented with four implants. The outcome was evaluated after 4 months using either a one-stage or two-stage procedure. The surgical procedures were performed by experienced implant surgeons and the surgical protocol for implant placement follows standard. Failure was defined as removal of an implant for any reason. The study outcomes were statistically analyzed to evaluate the differences between the two groups. Twelve implants failed in 11 patients for the AB group, and 32 implants failed in 29 patients for the noAB group. Preoperative antibiotics, AB group, had significantly (P < 0.0011) lower implant failure 2.2% compared to 7.5% in the noAB group analyzed on implant level adjusted for dependence within patients, OR = 0.30, 95% confidence interval (0.14-0.62). Administration of a single dose of antibiotics in conjunction with implant placement surgery resulted in a statistically significant lower early implant failure rate compared to when no antibiotics were used.

Applying Surgical Antimicrobial Standards in Cesarean Deliveries

(Am J Obstet Gynecol. 2018;218(4):416.e1–416.e4) Surgical site infections are costly and common in the United States. Most surgical guidelines for antimicrobial prophylaxis endorse repeat antibiotic administration after an estimated blood loss (EBL) of 1500 mL or following 1 to 2 half-lives of the agent. The American College of Obstetricians and Gynecologists have not made recommendations for redosing antibiotics in obstetric surgeries, and currently a single dose of preoperative antibiotics is considered standard of care. Parturients have increased renal clearance and may benefit from antimicrobial redosing.

Prophylaxis of Wound Infections- Antibiotics in Renal Donation (POWAR): A Multicentre UK Double Blinded Placebo Controlled Randomised Trial

Background: Postoperative infection following hand assisted laparoscopic donor nephrectomy (HALDN) confers significant morbidity to a healthy patient group. Current UK guidelines cite a lack of evidence for routine antibiotic prophylaxis. This trial assessed if a single preoperative antibiotic dose could reduce post HALDN infections. Methods: Eligible donors were randomly and blindly allocated to preoperative single dose intravenous co-amoxiclav or saline. The primary composite endpoint was clinical evidence of any postoperative infection at 30 days including surgical site infection (SSI), urinary tract infection (UTI) and lower respiratory tract infection (LRTI). The study aimed to detect a 10% or greater reduction in the primary endpoint with 90% power (α 0·05). All analyses were by intention to treat (ITT). Findings: 293 participants underwent HALDN (148 antibiotic arm and 145 placebo arm). 99% (291 of 293) completed follow up. The total infection rate was 40.7% (59 of 145) in the placebo group and 23% (34 of 148) in the antibiotic group (p=0·001). Superficial SSIs were 20·7% (30 of 145 patients) in the placebo group vs 10.1% (15 of 148 patients) in the antibiotic group (p=0·012). LRTIs were 9% (13 of 145) in the placebo group and 3.4% (5 of 148) in the antibiotic group (p=0.046). UTIs were 4.1% (6 of 145) in the placebo group and 3.4% (5 of 148) in the antibiotic group (p=0.72). Reportable adverse events occurred in 22 patients per group (14·7% (antibiotic) vs 15·2% (placebo), p=0·54). Antibiotic prophylaxis conferred a 17.7% (95% CI 7.2–28.1%), absolute risk reduction (ARR) in developing postoperative infection, with 6 donors requiring treatment (NNT) to prevent one infection. Interpretation: Single dose preoperative antibiotic prophylaxis dramatically reduces post HALDN infection rates, mainly impacting SSIs and LRTIs. Trial Registration Number: Trial registration was with the European Union clinical trials register, no 2012-000942-36. Funding Statement: National Institute for Health Research (Project Number PB-PG-1010-23108). Declaration of Interests: We declare the authors have no competing interests. Ethics Approval Statement: Ethical approval for the study was granted by the London Harrow Research Ethics Committee and regulatory approval by the Medicines and Healthcare Products Regulatory Agency (MHRA). All subjects provided written consent.

Is There a Difference in Infection Risk Between Single and Multiple Doses of Prophylactic Antibiotics? A Meta-analysis.

The prevention of surgical site infection guidelines issued by the Centers for Disease Control and Prevention (CDC) recently recommended that only a single dose of preoperative antibiotics be administered to patients undergoing clean-contaminated procedures based on data from a variety of surgical disciplines. For orthopaedic procedures, where postoperative infections can have significant consequences, the existing evidence for this recommendation is widely debated. Is there a difference in postoperative infection risk when utilizing a single dose of preoperative antibiotics compared with multiple doses of perioperative antibiotics for orthopaedic procedures where implants are placed? MEDLINE, EMBASE, Google Scholar, and Cochrane were systematically reviewed for randomized controlled trials (RCTs) of a single dose of preoperative antibiotics compared with pre- and postoperative prophylaxis from 1980 to 2017 for all orthopaedic procedures where implants were being placed. Infection (both superficial and deep) as a primary outcome through all available followup was required for inclusion. Fourteen RCTs detailing 9691 orthopaedic procedures were included for analysis, including seven arthroplasty, one spine, and six general orthopaedic trials (two specific to hip fracture fixation). Pooled infection outcomes were analyzed with random-effects modeling in light of study heterogeneity. Bias was evaluated using the Cochrane risk of bias tool as well as a funnel plot for publication bias, and quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Bias was largely uncertain; however, a high risk of bias was noted in four studies. No significant overall publication bias was noted. The quality of evidence was determined to be very low based on the GRADE tool, downgraded based on risk of bias, inconsistency, and imprecision. Despite the quality of evidence, the data were pooled in light of the current recommendations from the CDC to critically evaluate the recommendation that a single dose of antibiotics be utilized. There were no differences in infection risk between single- versus multiple-dose groups (single: 83 of 4263 [2%], multiple: 101 of 5428 [2%]; odds ratio, 0.92 [95% confidence interval, 0.56-1.51]; p = 0.740, I = 36% for statistical heterogeneity). There is no difference in infection risk between a single dose and multiple doses of perioperative antibiotics for orthopaedic procedures where implants are utilized, consistent with recent recommendations. However, the quality of evidence for orthopaedic procedures is low, and a randomized study with a sufficient sample size is needed to examine the issue before universal adoption of a single antibiotic dose. Level I, therapeutic study.

A randomized control trial to determine the need for postoperative antibiotics after laparoscopic appendicectomy in nonperforated appendicitis

Background: Acute Appendicitis is the most common cause of acute pain in the abdomen. Appropriate use of prophylactic antibiotics prevents the risk of postoperative surgical site infections (SSIs). However, there is no conclusive guideline concerning the duration of antibiotic usage. A single preoperative prophylactic dose has been recommended by many randomized control trials. Hence, the study aimed to determine the need for postoperative antibiotics after laparoscopic appendicectomy for nonperforated appendicitis.Methods: A total of 100 patients with nonperforated appendicitis undergoing laparoscopic appendicectomy divided into two groups. Group A (n=50) patients received single dose of preoperative antibiotic and group B (n=50) patients received preoperative dose, as well as three postoperative doses of antibiotics. Routine investigations including complete blood count, blood urea, serum creatinine; other investigations such as ultrasound of abdomen were also performed. Following laparoscopic appendicectomy, surgical wound was inspected after 48 h, 72 h, and on day 7 to look for any signs of postoperative SSI.Results: The mean age in group A was 30.74±10.69 years compared to 30.72±9.56 years (p=0.757) in group B. All the patients in study presented with right iliac fossa pain. Three patients in group A (6%) and two patients in group B (4%) had grade III SSIs, which were managed conservatively. The difference between both the groups for incidence of SSIs was statistically insignificant (p=1.000).Conclusions: Prophylactic postoperative doses of antibiotics confer no additional benefit over a single preoperative dose in preventing the postoperative SSIs after laparoscopic appendicectomy.

Antibiotic prophylaxis in ureteroscopic lithotripsy: a systematic review and meta-analysis of comparative studies.

To explore the efficacy of antibiotic prophylaxis and the different strategies used to prevent infection in ureteroscopic lithotripsy (URL) by conducting a systematic review and meta-analysis. A systematic literature search using Pubmed, Embase, Medline, the Cochrane Library, and the Chinese CBM, CNKI and VIP databases was performed to find comparative studies on the efficacy of different antibiotic prophylaxis strategies in URL for preventing postoperative infections. The last search was conducted on 25 June 2017. Summarized unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the efficacy of different antibiotic prophylaxis strategies. A total of 11 studies in 4 591 patients were included in this systematic review and meta-analysis. No significant difference was found in the risk of postoperative febrile urinary tract infections (fUTIs) between groups with and without antibiotic prophylaxis (OR: 0.82, 95% CI 0.40-1.67; P = 0.59). Patients receiving a single dose of preoperative antibiotics had a significantly lower risk of pyuria (OR: 0.42, 95% CI 0.25-0.69; P = 0.0007) and bacteriuria (OR: 0.25, 95% CI 0.11-0.58; P = 0.001) than those who did not. Intravenous antibiotic prophylaxis was not superior to single-dose oral antibiotic prophylaxis in reducing fUTI (OR: 1.00, 95% CI 0.26-3.88; P = 1.00). We concluded that preoperative antibiotic prophylaxis did not lower the risk of postoperative fUTI, but a single dose could reduce the incidence of pyuria or bacteriuria. A single oral dose of preventive antibiotics is preferred because of its cost-effectiveness. The efficacy of different types of antibiotics and other strategies could not be assessed in our meta-analysis. Randomized controlled trials with a larger sample size and more rigorous study design are needed to validate these conclusions.

A comparative study between a single dose pre-induction antibiotic versus continuous antibiotics to prevent urinary tract infection during ureteroscopy

Background and objective: This study aimed to evaluate the effect of adding postoperative antibiotics in reducing the incidence of symptomatic urinary tract infections following ureteroscopic stone treatment beyond the recommended preoperative dose. Methods: This prospective comparative study was conducted between March and November 2017. A total of 80 patients with preoperative negative urine cultures who underwent ureteroscopy were randomly allocated. All the patients received a single dose antibiotic before the induction of anesthesia, and a group of them also received postoperative antibiotics. The rate of symptomatic urinary tract infection was compared between the patients who received only preoperative antibiotics (group 1) and those who received pre- and postoperative antibiotics (group 2). Results: Eighty patients underwent ureteroscopy for stone treatment. The time to follow up was 4±2 weeks from ureteroscopy. Eleven (13.8%) patients in total developed urinary tract infections postoperatively, including five (12.5%) from group 1 and six (15%) from group 2, P = 0.74. In group 1, four patients presented with cystitis and one with sepsis; those patients with infections in group 2 presented with pyelonephritis (n=2) and cystitis (n=4). Risk factors such as preoperative stenting, nephrostomy tubes, and Foleys catheters did not differ between groups. Conclusion: The postoperative symptomatic urinary tract infection rate in this study (13.8%) is in agreement with previous reports. This study suggests that a single preoperative dose of antibiotics is sufficient, and additional postoperative antibiotics do not decrease infection rates after ureteroscopic stone treatment.

Assessing Quality and Safety in Pediatric Supracondylar Humerus Fracture Care.

Recently, there has been an emphasis on improving quality, safety, and value in the delivery of health care in the United States. The American Board of Orthopedic Surgery (ABOS) has developed a performance improvement questionnaire (PIQ) for orthopaedic surgeons managing pediatric supracondylar humerus fracture (PSCHF). Using the supracondylar PIQ as a guide, this study evaluates the process of measuring the outcomes and variations in care to PSCHF patients among pediatric orthopaedic surgeons. An 88-question survey incorporating the ABOS PIQ was administered to 35 pediatric orthopaedic surgeons at 3 institutions. A retrospective chart review of patients who received operative management of a PSCHF during 2013 was performed. Each of the 17 eligible surgeons supplied 5 patients for a total of 85 patients. Medical records and radiographic imaging were reviewed using the ABOS PIQ data collection sheet. This data collection sheet encompasses the preoperative assessment, intraoperative treatment and assessment, and clinical and radiographic outcomes of patients with PSCHF. A total of 35 surgeons from 6 hospitals completed the online PSCHF survey. Uniform consensus among all 35 surgeons was identified in 21/79 of the questions (27%). Consensus among surgeons within a hospital group but not with surgeons from the other groups was identified in 39/79 (49%) of the questions. No consensus among the surveyed surgeons could be identified in 19/79 (24%) of the questions. For the 85 PSCHF patients the average age was 6 years, and 37% of fractures were type II, 57% of fractures were type III, and there was 1 flexion type. Ninety percent of the patients received a preoperative dose of antibiotics and the postoperative immobilization placed in the operating room was changed in the clinic before pin removal in 58% of the cases. Pins were removed at 3 weeks in 60%, 4 weeks in 30%, 5 weeks in 7%, and after 5 weeks in 3% of the patients and no malunions occurred. Pin tract infection occurred in 2 patients (2.4%). The procedure time ranged from 13 to 171 minutes, with a median time of 37 minutes. Total anesthesia time ranged from 32 to 233 minutes, with a median of 72 minutes. The number of outpatient follow-up visits ranged from 2 to 7 visits, with a median of 3 visits. The number of postoperative radiographs obtained ranged from 1 to 14, with a median of 3 studies. Four patients (5%) returned to the operating room for a repeat surgery. The survey responses from the surgeons at 6 different hospitals demonstrate that there is still considerable variation in care among surgeons, even for such a routine injury. Our chart review also revealed substantial variation in care with subsequent quality and cost-implications. The variations in operating room time, anesthesiology time, number of postoperative visits, number of radiographs ordered, and the initial intraoperative immobilization, all point to opportunities for standardization and lowering of costs. Level IV.

Postoperative antibiotic therapy after appendectomy in patients with non-perforated appendicitis.

Background:Appendectomy intra-abdominal is the most frequently performed emergency surgery. This study was conducted to determine the role of postoperative antibiotics in reducing surgical site infections (SSIs) and abscess formation after open appendectomy.Methods:In the Department of Surgery, Shahid Beheshti Hospital, Babol, Iran, from October 2013 to October 2014 one hundred and fifty two patients, who underwent appendectomy for nonperforated appendicitis (NPA) and fulfilled the selection criteria, were randomized into two groups. Group A patients received a single dose of preoperative antibiotics (ceftriaxone and metronidazole) and group B patients received the same regimen, in addition, antibiotics were administered 24 hours postoperatively. Patients of both groups were followed-up for 30 days to assess the postoperative infectious complications.Results:Both groups comprised 76 patients, as well both groups were compared in baseline characteristics. Statistically, there was no significant difference in rates of SSIs between both groups. None of the patients developed intra-abdominal collection.Conclusion:Single dose of preoperative antibiotics (ceftriaxone and metronidazole) was sufficient in reducing SSIs after appendectomy for NPA. Postoperative antibiotics did not add an appreciable clinical benefit in these patients.

Lichtenstien repair of inguinal hernia under local anesthesia - day case surgery

This prospective study was carried on 250 patients to study the complication and recurrence rate associated with Lichtenstien repair of inguinal hernia in our clinical and socioeconomic settings. The cost effectiveness and return to work after surgery were the other outcome measures. Two hundred and fifty patients underwent mesh repair of inguinal hernia at two different centers over a period of two years. All the patients were operated under local anesthesia. A bolus dose of preoperative antibiotic was given intravenously. The patients were followed up for two years and their post operative course was assessed according to a prescribed proforma. The rate of minor complications was in the range of 11.8%. The recurrence rate was 1.2%.There was minimal pain and the procedure was cost effective in terms of operative cost and less economic loss due to early return to work. It is concluded that Lichtenstien repair as a day case is safe and effective procedure to be performed by a trained general surgeon under local anesthesia. The infection rate and the recurrence rate are low. The compliance and acceptability of the patient and ease of carrying out the procedure under local anesthesia by surgeon is acceptable. In our view this type of hernial repair is an appropriate method in district hospital and tehsial headquarter hospitals where provision of anaesthesia facilities are yet to be fully developed and hospitals cater a major hernial load due to elderly patients with background of farming professions being admitted. The patient can be sent home on same day after surgery.

Surgical Site Infections in Breast Surgery: The Use of Preoperative Antibiotics for Elective, Nonreconstructive Procedures.

Background. Antibiotic prophylaxis for surgical site infections (SSIs) for breast surgery is widespread, but the benefit in clean surgical cases is not well defined. Methods. A retrospective analysis of 855 patients undergoing elective, nonreconstructive breast operations was performed, with 401 patients receiving no antibiotics and 454 patients receiving a single dose of preoperative antibiotic. Results. Administration of a preoperative antibiotic did not decrease the SSI rate. In this community-based study, antibiotic use practices varied considerably by surgeon. In univariate analyses, SSI rates appeared to increase with prophylactic antibiotic use (12% SSI with antibiotics versus 4% without, p < 0.0001), likely because the use of underdosed antibiotics was associated with higher rates of SSI (13.2% SSI with cefazolin 1 gram, p < 0.0001, and 15.4% SSI with clindamycin 300 mg or less, p = 0.0269). Methicillin-resistant Staphylococcus aureus was the most common isolate from SSI cultures, 31.8% (7 of 22). In multivariable analyses, increased risk of SSI was associated with BMI > 25 kg/m2 (OR: 1.08, 95% CI: 1.04–1.11, p < 0.0001). Conclusion. The administration of a single dose of preoperative antibiotic did not decrease the rate of SSI in this large series of patients undergoing clean breast operations. BMI >25 kg/m2 and the use of an inadequate dose of antibiotics for prophylaxis may increase risk of SSI.

Efficacy of Management for Rational Use of Antibiotics in Surgical Departments at a Multi-Disciplinary Hospital: Results of a 7-year Pharmacoepidemiological Research

Irrational medicine use including excessive use and abuse of antibiotics remains a crucial problem for the healthcare systems. In this regard, studies examining approaches to improving the clinical use of medicines are highly important. to assess the efficacy rate of management for the rational use of antibiotics in surgical departments of a multi-disciplinary hospital. The intervention complex combined the research, educational, and methodological activities: local protocols for perioperative antibiotic prophylaxis (PABP) for various surgical departments were developed; local PABP protocols were discussed with the physicians of specialized surgical departments; official order on implementation of PABP was issued; the list of drug prescriptions for registration of the first pre-operative antibiotic dose was changed; audit and feedback processes were introduced as well as consultations of a clinical pharmacologist were implemented. We assessed the efficacy rate of the interventions basing on the changes in consumption of antibiotics (both quantitatively and qualitatively) at surgical departments of a hospital using ATC/DDD methodology. Comparison of the studied outcomes was performed before and after the intervention implementation and between the departments (vascular and abdominal surgery). The consumption of antibacterial agents (ATCJ01) was measured as a number of defined daily doses (DDD) per 100 bed-days (DDD/100 bed-days, indicator recommended by the World Health Organization, WHO) and DDD per 100 treated patients (DDD/100 treated patients). From 2006 to 2012, a decrease in antibacterial consumption in surgical departments by 188 DDD/100 treated patients was observed. We obtained the opposite results when using an indicator of DDD/100 bed-days (increase by 2.5 DDD/100 bed-days) which could be explained by the dependence on indices of overall hospital work and its changes during the examined period. Observed changes in antibacterial consumption varied in different surgical departments. The most pronounced positive changes were noted in the department of vascular surgery: decrease in total antibacterial consumption by 298 DDD/100 treated patients, decrease in the use of cephalosporins of the III generation from 141 to 38 DDD/100 treated patients. These positive changes were accompanied by the same (low) level of consumption/use of reserve antibiotics. In the department of abdominal surgery, there was no decrease in total antibiotic consumption, as well as in consumption of broad-spectrum cephalosporins of the III generation and fluoroquinolones, and we observed an increase in the use of reserve antibiotics (carbapenems) during the study period. Positive changes in antibiotic consumption were associated with the positive attitude of the manager/head of the department towards interventions: we observed the most pronounced decrease in antibiotic consumption straight after the publication of the administrative order on perioperative antibacterial prophylaxis. The combination of scientific, educational, and methodological interventions is effective for improving antibiotic application. The study results provide the rationale for analyzing the drug consumption using the DDD/100 treated patients measure in addition to the WHO-recommended indicator of DDD/100 bed-days which depends on overall hospital performance.

Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results

Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. Case-control study of adult patients hospitalized with orthopedic infections. Among 2740 episodes of orthopedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1-3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even a single pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; χ²-test, p = 0.01) and skin commensals (17/74 vs. 274/2350; p = 0.01) compared to episodes without preceding prophylaxis. Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals.

Reduction or discontinuation of antibiotic prophylaxis in vascular access surgery, tendon sheath incision and PD catheter placement.

Immune response in dialysis patients is suppressed and these patients are susceptible to bacterial infections. Therefore, minimal use of antibiotics in dialysis patients is recommended to avoid generating drug-resistant bacteria. However, minor surgeries including vascular access surgery, tendon sheath incision and peritoneal dialysis (PD) catheter placement are inevitable in dialysis patients and evidence-based recommendations on the judicious use of antibiotics are not currently available for these procedures. In this study, the optimal antibiotic prophylaxis for minor surgeries was evaluated. This is a retrospective study. In dialysis patients at Kawashima Hospital, a three-step reduction of antibiotic use was performed in 651 cases of arteriovenous fistula (AVF) and tendon sheath incision surgeries from July 2009 through October 2012. Moreover, general surgical guidelines-recommended dose of preoperative antibiotics only were used in 532 cases of arteriovenous graft (AVG) and PD catheter placement from January 2010 through October 2012. The surgical site was observed for 2 weeks after the surgery. In only one case of AVF surgery, redness of the skin around the stitches was noticed 5 days after the surgery, which was healed with antibiotics taken orally for 3 days. Neither AVG nor PD catheter placement demonstrated any infection at the surgical site during the 2-week observation period. Even in dialysis patients, neither pre- nor postoperative antibiotics are necessary for AVF and tendon sheath incision surgeries. AVG and PD catheter placement surgeries require only a small amount of antibiotics preoperatively.

A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: A matched cohort study

Infections following implant-based breast reconstruction can lead to devastating consequences. There is currently no consensus on the need for post-operative antibiotics in preventing immediate infection. This study compared two different methods of infection prevention in this group of patients. A retrospective matched cohort study was performed on consecutive women undergoing implant-based breast reconstruction at University Health Network, Toronto (November 2008-December 2012). All patients received a single pre-operative intravenous antibiotic dose. Group A received minimal interventions and Group B underwent maximal prophylactic measures. Patient (age, smoking, diabetes, co-morbidities), oncologic and procedural variables (timing and laterality) were collected. Univariate and multivariate logistic regression were performed to compare outcomes between the two groups. Two hundred and eight patients underwent 647 implant procedures. After matching the two treatment groups by BMI, 94 patients in each treatment group yielding a total of 605 implant procedures were selected for analysis. The two groups were comparable in terms of patient and disease variables. Post-operative wound infection was similar in Group A (n=11, 12%) compared with Group B (n=9, 10%; p=0.8). Univariate analysis revealed only pre-operative radiotherapy to be associated with the development of infection (0.004). Controlling for the effect of radiotherapy, multivariate analysis demonstrated that there was no statistically significant difference between the two methods for infection prevention. Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant-based breast reconstructions.

160: Dose of preoperative antibiotics and obstetric surgical site infection in morbidly obese women

160: Dose of preoperative antibiotics and obstetric surgical site infection in morbidly obese women

Perioperative Antibiotics

Consensus: The preoperative dose of antibiotics should be administered within one hour of surgical incision; this can be extended to two hours for vancomycin and fluoroquinolones. Furthermore, surveillance measures are critical in ensuring clinician compliance with this objective.

Are Systemic Antibiotics Indicated in Aesthetic Breast Surgery? A Systematic Review of the Literature

Sir: We read with great interest the recent article by Hardwicke et al. entitled: “Are Systemic Antibiotics Indicated in Aesthetic Breast Surgery? A Systematic Review of the Literature.”1 In their work, a systematic review of the literature concerning the use of systemic antibiotics in aesthetic breast surgery is performed. We congratulate the authors for the proficient analysis of the literature and the interesting findings they reported, and we would like to further discuss some aspects of this common issue. Frequently, surgeons deal with compelled choices, resulting from common sense more than from scientific evidence. For example, many surgeons dip the prosthesis in povidine-iodine, other disinfectants, or antibiotic solutions before breast implantation for the purpose of reducing the incidence of capsular contracture and/or infections. Until now, only a few studies succeeded in assessing the true benefit of such procedures, with contrasting results in the literature.2,3 The same applies to the choice of whether to prescribe postoperative antibiotic therapy or not after dismissal from the hospital.4 In the past decade, the fear of medicolegal lawsuits and claims has become a major reason leading to infection-reducing strategies or so-claimed ones in clinical practice. The surgeons had to protect themselves from further risk5 in a context where a surgical complication, such as a postoperative infection, is very likely to become an accusation by a lawyer, on the chance of procedural errors such as type and timing of antibiotic prophylaxis. As a consequence, the choice of using antibiotic therapy up to the removal of the drain or to limit it to a single dose of preoperative antibiotic is certainly an interesting and meaningful topic in the postsurgery treatment geared to prevent infections. We strongly believe that the procedures performed to reduce the risk of infection should be codified by international protocols. In our opinion, the article by Hardwicke and colleagues1 is an important piece of evidence on this topic. Nevertheless, as long as surgeons will have to answer to a judge regarding any postoperative issue, they will always be conditioned to implement any procedure protecting them from possible legal issues. Official international guidelines are of paramount importance to overcome the need for “defensive medicine.” DISCLOSURE The authors have no conflict of interest to declare; they received no funding for this research. Pierluigi Gigliofiorito, M.D. Luca Piombino, M.D. Stefano Campa, M.D. Francesco Segreto, M.D. Alfonso Luca Pendolino, M.S. Paolo Persichetti, M.D., Ph.D. Plastic and Reconstructive Surgery Unit Università Campus Bio-Medico di Roma Rome, Italy