Prophylactic Antibiotic Usage Research Articles

Strategies to Reduce the Use of Antibiotics in Fresh and Chilled Equine Semen.

The study assessed the impact of four equine semen processing techniques on sperm quality and microbial load immediately post-processing and after 48 h of refrigeration. The aim was to explore the potential reduction of prophylactic antibiotic usage in semen extenders. Semen from ten adult stallions was collected and processed under a strict hygiene protocol and divided into four aliquots: Simple Centrifugation with antibiotics (SC+), Simple Centrifugation (SC-), Single-Layer Colloidal Centrifugation (CC-), and Filtration (with SpermFilter®) (F-), all in extenders without antibiotics. Sperm motility, viability, and microbial load on three culture media were assessed. No significant differences were observed in the main in the sperm quality parameters among the four protocols post-processing and at 48 h (p < 0.05 or p < 0.1). Microbial loads in Columbia 5% Sheep Blood Agar and Schaedler vitamin K1 5% Sheep Blood Agar mediums were significantly higher (p < 0.10) for raw semen than for CS+, CC-, and F- post-processing. For Sabouraud Dextrose Agar medium, the microbial load was significantly higher (p < 0.10) in raw semen compared to CS+ and F-. No significant differences (p < 0.10) were found in 48 h chilled samples. Regardless of antibiotic presence, the evaluated processing methods, when combined with rigorous hygiene measures, maintained semen quality and reduced microbial load to the same extent as a traditional protocol using antibiotics.

Comparative Study of Amoxicillin and Multiple Antibiotics in Caesarean Section

Background: Prophylactic antibiotic usage is important for preventing surgical site wound infections and related complications following caesarean delivery, which can lead to maternal morbidity, prolonged hospital stays, and increased treatment costs. Despite the recommendation for a single dose of preoperative antibiotic prophylaxis, clinicians are hesitant to adopt this approach due to variations in patient characteristics and concerns about aseptic techniques. Objective: To compare the efficacy of a single-antibiotic regimen versus multiple antibiotics in caesarean section procedures. Materials and Methods: It was a randomized clinical trial study. It was carried out in Obs and Gynae, North East Medical College, Sylhet, Bangladesh during the period of January 2022 to June 2022. The study included pregnant women above 34 weeks of gestation admitted to the hospital undergone elective or emergency caesarean delivery for singleton pregnancy. Total 92 sample patients with 46 patients in each group. Study involved two groups. Group A received Amoxicillin single antibiotic. Group B received multiple antibiotics. Statistical data calculations were done using Statistical Package for the Social Science (SPSS Inc., Version 25.0, Chicago, IL, USA) and Chi-square test was done. The p- value &lt;0.05 was considered significant. Results: There were 46 patients in each group. Baseline characteristics, indications for caesarean delivery, duration of operation, duration of hospital stay and difficulties were similar. Post- operative morbidities like wound infection did not differ significantly (P&gt;0.05). None of the women needed prolong hospital stay. Conclusion: The current study found no statistically significant difference in the outcome measures among the two study groups receiving different prophylactic regimens for caesarean delivery. Therefore, it can be concluded that both single and multiple antibiotics provide equally effective protection in reducing maternal .......

25 Measuring Intestinal Permeability When Urine is not an Option

Abstract The need to understand intestinal health is of increasing importance as the livestock industry seeks to maintain performance efficiency while eliminating prophylactic antibiotic usage. Intestinal permeability is a biomarker of intestinal health as it measures the movement of an indigestible marker across the intestinal barrier with excretion in the urine as the primary biological specimen collected for measurement. The adoption of these methods into poultry has been slow due to the lack of urine excretion. Therefore, the objective of this study is to compare differences in intestinal permeability assays in serum of poultry to determine if these assays could be a reliable method to detect changes in intestinal permeability in poultry under a known stressor. To compare the two commonly used methods [fluorescein isothiocyanate-dextran (FITC-D) method and lactulose/mannitol (LMS) dual sugar method], 2 independent trials were conducted with 40 pens split across 2 fed status (fed or fasted for 12 hours) and 4 sugar treatments (no sugar, FITC-D, LMS, FITC-D+LMS). All pens were sampled at 3 timepoints (14, 28, and 42 days of age) with 5 birds sampled per timepoint. Serum FITC-D was determined through fluorescent spectrophotometry, while mannitol and lactulose concentrations were determined using ion chromatography. Data were analyzed using PROC Glimmix. Fed status, sugar treatment, age, and all 2-and 3-way interactions were included as fixed effects. Trial was included in the model as a random effect with pen included as a repeated effect. Serum lactulose and FITC-D increased in fasted compared with fed birds (P &amp;lt; 0.006). Surprisingly, mannitol, which was expected to be similar across fed and fasted, was increased in fed compared with fasted birds (P &amp;lt; 0.001). The increased concentrations of mannitol in fed birds and measurable concentrations of mannitol in birds not given mannitol suggest another molecule eluted at the same rate as mannitol. Therefore, we propose under these conditions that mannitol, and its ratio with lactulose, are not appropriate methods for measuring intestinal permeability in poultry. Lactulose and FITC-D were increased in serum when the birds were provided those sugars and serum concentration of both sugars decreased at 28 days compared with 14 and 42 days (P &amp;lt; 0.003). FITC-D had a significant 2-way interaction for the sugar by fed status (P &amp;lt; 0.05) whereas other 2-and 3-way interactions were similar across treatments (P &amp;gt; 0.202). Serum lactulose concentrations were affected by all 2-and 3-way interactions with elevated serum lactulose concentrations in broilers provided lactulose and fasted (P &amp;lt; 0.001). Birds that did not receive lactulose had very low to undetectable concentrations of lactulose. This reduced background noise for the detection of serum lactulose and the ability statistically to detect small changes in intestinal permeability make lactulose a potential serum biomarker for intestinal permeability in poultry.

Clinical factors associated with extended hospitalization in pediatric patients ≥3 years of age with respiratory syncytial virus or human metapneumovirus infection: A Japanese single-center, retrospective study.

Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) infections are common in children worldwide. However, the clinical factors related to extended hospitalization in Japanese patients aged ≥3 years remain elusive. We aimed to elucidate the clinical risk factors contributing to hospital stays ≥7 days in patients with RSV and hMPV infections. Patients ≥3 years of age who were hospitalized due to RSV or hMPV infection between 2014 to 2020 were included. Twenty-one RSV- and 27 hMPV-infected patients were enrolled. Patients were divided into 2 groups: hospitalization for ≥ and <7 days. Univariate and multivariate analyses determined the clinical risk factors contributing to hospital stay ≥7 days. The RSV- and hMPV-infected patients had similar clinical characteristics. The clinical risk factors contributing to extended hospitalization were analyzed in the 48 infected patients of the 2 groups. The presence of prophylactic antibiotics usage, co-bacterial colonization, and underlying diseases were extracted by univariate analysis (P < .05). In multivariate analysis, underlying diseases were determined as an independent clinical risk factor (odds ratio 8.09, P = .005). Underlying diseases contributed to extended hospitalization in RSV- or hMPV-infected patients ≥3 years of age.

SP8.10 Auditing periprocedural antibiotic prophylaxis (PAP) in emergency surgery using NAPS surgical ™

Abstract Aim The study aimed to investigate the compliance with guidelines and the appropriateness of periprocedural antibiotic prophylaxis (PAP) in emergency surgery at the John Radcliffe Hospital. The study also aimed to determine the usefulness of NAPS surgical™ in monitoring and evaluating PAP usage. Methods The study conducted a retrospective analysis of medical charts for 97 consecutive emergency general surgical operations in August 2022. Data collected included the type of surgery, antibiotics administered, and compliance with local guidelines. The data was analyzed using NAPS surgical™. Results In 97 cases, 40 patients did not receive PAP, 26 of which were deemed appropriate. 57 patients received 76 doses of antibiotics, 51 of which were deemed inappropriate, mainly due to the administration of PAP to low-risk cases or outside of the recommended timing. Cefazolin was the most commonly used drug and no adverse effects were reported. Conclusions The study highlights the value of NAPS surgical™ in monitoring prophylactic antibiotic usage and the need for ongoing monitoring and education. NAPS surgical™ provides a comprehensive evaluation of antibiotic use, is cost-effective, and allows for direct comparison with other hospitals, providing insight into best practices. The hospital found NAPS surgical™ useful in assessing antibiotic stewardship and monitoring stewardship interventions.

Rhinologist Use of Antibiotics With Nasal Packing for Epistaxis.

There is limited evidence supporting the usage of prophylactic antibiotics in the setting of nasal packing for epistaxis. It is unclear what current antiobiotic usage patterns are by otolaryngologists. Characterize the antibiotic prescribing practices employed by otolaryngologists in the management of epistaxis patients treated with packing as well as the underlying rationale. Explore the impact of experience, geography, and academic affiliation on treatment decisions. An anonymous survey of antibiotic prescribing patterns for patients with epistaxis requiring nasal packing was distributed to all physician members of the American Rhinologic Society. Responses to each question were descriptively summarized including 95% confidence intervals and were linked to demographics using Fisher's exact tests. One thousand one hundred and thirteen surveys were distributed with 307 responses (27.6%). Antibiotic prescription rates varied based on packing type, with 20.0% prescribing antibiotics for dissolvable packing compared to 84.2% to 84.6% for nondissolvable packing. The absorbance of nondissolvable packing does not impact the decision to prescribe antibiotics (P > .999). Precisely 69.7% (95% CI: 64.0%-74.8%) stop antibiotics immediately following packing removal. Precisely 85.6% (95% CI: 81.6%-89.9%) cite the risk of toxic shock syndrome (TSS) when prescribing antibiotics. Notable regional differences include greater utilization of amoxicillin-clavulanate in the Midwest (67.6%) and Northeast (61.4%) as compared with the South (42.1%) and West (45.1%) (P = .013). Further, years in practice were positively associated with several patterns including prescribing antibiotics for patients with dissolvable packing (P = .008), citing prevention of sinusitis as a rationale for antibiotic use (P < .001), and a higher likelihood of having treated a patient with TSS (P = .002). Antibiotic use in patients with epistaxis controlled with nondissolvable packing is common. Treatment patterns are influenced by geography, years in practice, and practice type. 4.

Effectiveness of Combination of Pharmacological Treatment and Endoscopic Band Ligation in Active Esophageale Varicos Bleeding

Acute gastrointestinal system bleeding in cirrhotic patients is one of the emergencies of gastroenterology that requires rapid and careful intervention. For this reason, patients who are thought to have esophageal variceal bleeding should be referred to a center that is adequately equipped for follow-up and treatment. There are studies supporting that current approaches to the treatment of esophageal variceal bleeding have a positive effect on life expectancy. Volume replacement is an important condition in the general approach to esophageal variceal bleeding. It is recommended to maintain hemodynamic stability and keep the hemoglobin level at approximately 8 g/dL. Additionally, it is thought that prophylactic antibiotic usage in gastrointestinal system bleeding of cirrhotic patients reduces the risk of bacterial infection and has a positive effect on life expectancy. In addition to these approaches, there are also specific measures for the control of esophageal variceal bleeding and the prevention of early recurrence of these bleedings. Pharmacological treatment for esophageal variceal bleeding can be started as soon as variceal bleeding is considered, even before upper gastrointestinal system endoscopy. Similar efficacy was demonstrated in a meta-analysis of 15 studies comparing emergency sclerotherapy and pharmacological therapy (vasopressin±nitroglycerin, terlipressin, somatostatin, octreotide). In the treatment of esophageal variceal bleeding, the combination of pharmacological and endoscopic treatment seems to be the most appropriate option. A meta-analysis of 8 studies compared the combination of endoscopic treatment [(sclerotherapy or endoscopic band ligation (EBL)] with endoscopic, pharmacological treatment) for acute variceal bleeding. Combination of endoscopic and pharmacological treatment was found superior in terms of bleeding control and risk of recurrence. In this study, we evaluated the efficacy of combination of pharmacological and endoscopic band ligation in patients who admitted to the hospital with esophageal variceal bleeding.

Questioning Prophylactic Antibiotic Use for Pyloromyotomy: Analysis of the Pediatric Health Information System Database

BackgroundPyloromyotomy has a low rate of wound complications, yet antibiotic prophylaxis is still given. The Pediatric Health Information System (PHIS) database was queried to determine whether prophylactic antibiotics decreased wound complications. MethodsRecords for infants with pyloric stenosis between 2016 and 2021 were extracted from the PHIS database and analyzed for demographics, comorbid conditions, and complications within 30 days of pyloromyotomy. Logistic regression was used to evaluate the effect of antibiotic prophylaxis on complications. ResultsAmong 14,247 infants who underwent pyloromyotomy, 29.5% had antibiotic prophylaxis. These patients were more likely to have been admitted to the NICU and have chronic conditions and prematurity (p < 0.01). Antibiotic utilization varied among hospitals from 2.3 to 58.5%. Complication rates among those who received antibiotics was 1.64% versus 1.62% for those who did not. The odds for developing complications in those who received prophylaxis compared to those who did not was 1.10, (0.73, 1.41, 95%, p = 0.93) suggesting there is no effect of antibiotics on complication rates. ConclusionsThere was a wide variation among hospitals in the usage of prophylactic antibiotics for pyloromyotomy. There was no difference in complication rates whether or not patients received antibiotics. These results suggest antibiotic prophylaxis is unnecessary for pyloromyotomy. Level of EvidenceIII.

To Compare Short-term Surgical Outcome among Patients given Continuous Postoperative Antibiotic Prophylaxis and those given no Postoperative Antibiotics after Urethroplasty for Hypospadias: A Pilot Study.

There is no well-accepted guideline or uniform practice for the usage of prophylactic antibiotics along with urethroplasty for hypospadias. As antibiotic resistance is growing, it is imperative to rationalize the usage of antibiotics when a patient is operated for hypospadias. The study is aimed at finding if there is any difference in outcome if prophylactic antibiotics are given after urethroplasty for hypospadias. Prospective randomized controlled study. Forty patients between 6 months and 12 years of age were included in the pilot study. All patients received a single preoperative antibiotic and surgery as per the discretion of the operating surgeon. The participants were randomly assigned to Group A or B, Group A not receiving any prophylactic antibiotic after surgery, and Group B receiving prophylactic antibiotics till indwelling urethral catheter was in situ as per the present antibiotic policy of the institute. The patients were followed up clinically at catheter removal, 1 week after surgery and 1 month after surgery. Urine was analyzed at the start of surgery and after catheter removal. Data were tabulated and analyzed using nonparametric Fischer's exact test with help of Epi Info™ v5.5.8. Twenty-four patients were included in Group A and 16 in Group B. The clinical profile is presented in the detailed manuscript. Although pus cells could be demonstrated on urine examination in 82.5% of the study participants, only 10% grew organisms on culture media. No difference could be demonstrated among the two groups statistically. On following up with the patients for 1 month, the groups were comparable with respect to surgical site infections, and surgical complications such as urethrocutaneous fistula/dehiscence and thin stream. [Table: see text]. There was a wide variability among practicing pediatric urologists in prescribing antibiotic prophylaxis for patients undergoing urethroplasty for hypospadias. In the Urologic Surgery Antimicrobial Prophylaxis Policy by the American Urology Association, no recommendation has been made with respect to urethroplasty. Our results are in concurrence with the available English literature which has not shown any benefit of prophylactic antibiotics after hypospadias repair. Antibiotics may not have a definite role in the prevention of surgical complications and it may be imperative to avoid unnecessary antibiotics to reduce antibiotic resistance.

178. The role of prophylactic antibiotic usage in salivary surgery

The use of prophylactic antibiotics for salivary gland surgery is controversial and unsupported by current evidence. Guidelines point to the lack of evidence supporting use of perioperative antibiotics for clean surgeries. Currently practice is not standardised (Mumtaz et al, 2019). NICE guidelines advised on antibiotic prophylaxis to be given to patients before clean-contaminated surgery but not for clean non-prosthetic uncomplicated surgery. Most routine parotid surgery falls within the latter category.

Antibiotic use in gastrointestinal surgery patients at a Vietnamese national hospital

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

Wandering Spleen with Splenic Torsion: Unusual Cause of Acute Abdomen

Wandering spleen is a rare condition characterised by laxity or lack of splenic ligaments as a result of acquired or congenital causes. There is a possibility of misdiagnosis due to its vague symptoms. In order to make a proper diagnosis, imaging techniques including abdominal ultrasonography and CT scanning are essential. Surgery is the main option of management. If the spleen is viable and there is no thrombosis in the splenic veins, splenopexy is the preferred surgical procedure. Alternatively, splenectomy plus prophylactic antibiotic and vaccination usage may be employed if spleen has infarction. A 12-year-old male child who had previously experienced constipation, mucoid diarrhoea, and abdominal distention arrived with crampy abdominal pain that had lasted for four days. The patient was tachycardic with abdominal tenderness. Whirlpool sign and lack of a spleen in its normal position were visualized on an abdominal ultrasound. The spleen was located intraoperatively in the lower abdomen, adhered to the ileum and appendix. It was 720° twisted and had necrotic areas. The patient underwent an appendectomy with splenectomy with a smooth post-operative course; combination meningococcal and pneumococcal vaccines were administered; and antibiotic prophylaxis was started for the patient. High clinical suspicion and the use of imaging modalities like ultrasound and CT scan are extremely crucial to diagnose wandering spleen and perform splenic salvage surgery because its clinical diagnosis is challenging.

Appropriate Antibiotic Use for Group B Streptococcus Prophylaxis Among Penicillin-Allergic Patients in Academic and Nonacademic Hospitals.

This study estimated prophylactic antibiotic usage rates for the prevention of early-onset invasive neonatal group B Streptococcus infection among patients with penicillin allergy. Undertreatment (no antibiotics, underuse of cefazolin, overuse of clindamycin inconsistent with resistance patterns) and overtreatment (vancomycin use) were common. Academic hospitals were marginally more adherent to guidelines than nonacademic hospitals.

Oral Care in A Post-Antibiotic Age: Problems and Treatment Options

Antibiotic overuse has created a problem with increased antibiotic resistance of disease-causing microorganisms. Prophylactic antibiotic usage in dentistry has contributed to this problem and to adverse events like Clostridioides difficile infection. Antibiotic prescribing practices need review, and so do treatment options for patient care in the post-antibiotic age. Hydrogen peroxide is an example of an antimicrobial that can treat anaerobic organisms and those found in biofilms to reduce periodontal disease and improve general health. The development and use of non-antibiotic, broadspectrum antimicrobial and anti-inflammatory agents and narrowly targeted antibiotic prescription usage will improve dentistry.

Discontinuation of Postoperative Prophylactic Antibiotics for Endoscopic Endonasal Skull Base Surgery.

Background Postoperative prophylactic antibiotic usage for endoscopic skull base surgery varies based on the institution as evidence-based guidelines are lacking. The purpose of this study is to determine whether discontinuing postoperative prophylactic antibiotics in endoscopic endonasal cases led to a difference in central nervous system (CNS) infections, multi-drug resistant organism (MDRO) infections, or other postoperative infections. Methods This quality improvement study compared outcomes between a retrospective cohort (from September 2013 to March 2019) and a prospective cohort (April 2019 to June 2019) after adopting a protocol to discontinue prophylactic postoperative antibiotics in patients who underwent endoscopic endonasal approaches (EEAs). Our primary end points of the study included the presence of postoperative CNS infection, Clostridium difficile ( C. diff ), and MDRO infections. Results A total of 388 patients were analyzed, 313 in the pre-protocol group and 75 in the post-protocol group. There were similar rates of intraoperative cerebrospinal fluid leak (56.9 vs. 61.3%, p = 0.946). There was a statistically significant decrease in the proportion of patients receiving IV antibiotics during their postoperative course ( p = 0.001) and those discharged on antibiotics ( p = 0.001). There was no significant increase in the rate of CNS infections in the post-protocol group despite the discontinuation of postoperative antibiotics (3.5 vs. 2.7%, p = 0.714). There was no statistically significant difference in postoperative C. diff (0 vs. 0%, p = 0.488) or development of MDRO infections (0.3 vs 0%, p = 0.624). Conclusion Discontinuation of postoperative antibiotics after EEA at our institution did not change the frequency of CNS infections. It appears that discontinuation of antibiotics after EEA is safe.

Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical interventions: a nonrandomized, historically controlled equivalence trial.

Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score-matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88-1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27-1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12-3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14-2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13-3.31). No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.

TO STUDY THE OUTCOME OF PATIENT UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY WITH SINGLE DOSE OF ANTIMICROBIAL PROPHYLAXIS.

INTRODUCTION :- Laparoscopic cholecystectomy is very commonly performed surgery for symptomatic cholelithiasis. There is very low risk of infective complications in elective Laparoscopic cholecystectomy and hence standard guideline doesn't recommend prophylactic antibiotic usage for low risk cases. However it is very commonly practicised in dosage and duration inconsistent among various surgeons. This study is being done to assess the efcacy of single dose antibiotic prophylaxis over multiple dose in the prevention of surgical site infection in patients undergoing elective laparoscopic cholecystectomy to avoid antibiotic resistance and overuse of it . METHODS: The study included 60 patients admitted for elective Laparoscopic cholecystectomy. First 30 patients received injectable ceftriaxone 1 gram intravenous peri-operatively, rst dose twelve hour before surgery and second dose half hour before surgical incision and then followed by injection (conventional dose) ceftriaxone 1 gram/day iv twice daily for the rst 5-7 days post-operatively. Next 30 was dened as the single dose (post-operative) antibiotic patients , this group were given only single dosage of injectable ceftriaxone 1 gram intravenous post-operatively.operation-room anesthetic assistant administered prophylactic antibiotics at induction of anaesthesia to all the patients. On the third, fth, tenth and fteenth days post operatively, based on Southampton scoring system the wound was seen and grading of the infection was done RESULT: The post-operative surgical site infection rate in group receiving single dose was 7.76 % and that in multiple dose group was found to be 6.67% . Chi- square test was used to analyse the data and the difference in the rate of SSI in both the groups was found to be statistically insignicant. CONCLUSION: There is no signicant difference in the outcome of elective laparoscopic cholecystectomy in terms of post operative surgical site infection in single dose and multiple dose group. Also single dose of antibiotics are more patient compliant, cost effective, have less adverse effects and reduce the incidence of antibiotic resistance

Prevention of inflammatory complications after surgical extraction of mandibular third molars

Inflammatory complications are the most prevalent problems after surgical extraction of mandibular third molars. The main options for prevention are prophylactic antibiotics usage before surgery or in the postoperative period; a method of postoperative management of a tooth socket, implying healing by primary or secondary closure. Each of the postoperative management types has advantages and disadvantages. The aim of the study was to compare complete suturing versus iodoform gauze packing of tooth socket for prevention of inflammatory complications after mandibular third molar removal. A retrospective cohort study was performed. The medical records of 273 patients who underwent mandibular third molar extraction for orthodontic indications were analyzed. Data of 100 patients were included, in 50 cases the postoperative management was carried out using iodoform packing, in other 50 cases complete suturing was performed. Depending on the type of data and distribution, we used the chi-squared test, Fisher's exact test, Student's t-test, Mann-Whitney U test. A p<0.05 was needed to achieve statistical significance. Alveolitis developed in 8 % cases of iodoform gauze packing and 34% cases of suturing. The differences are statistically significant (p=0.003). The total rehabilitation period (days) in patients with no alveolitis using iodoform gauze packing was 8 (7; 31) (Me (Q1; Q3)), using complete socket suturing was 7 (7; 8) (Me (Q1; Q3)), the differences are statistically significant (p=0.003). The best option for the prophylaxis of alveolitis after surgical extraction of mandibular third molar is secondary closure using iodoform gauze packing. However, in the cases with no alveolitis when complete suturing was performed, healing occurred much faster, which justifies the development of an alternative method for third molar socket healing.

A hospital-based assessment of the efficacy of prophylactic antibiotic usage to that of regular antibiotics usage in patients undergoing elective caesarean section: A comparative study

Aim: This study was planned to assess the efficacy of prophylactic antibiotic usage to that of regular antibiotics usage in patients undergoing elective surgeries. Material and Methods: A comparative Prospective study was conducted in the Department of obstetrics and gynaecology, Mamata Academy of Medical Sciences, Bachupally, Hyderabad, India for the period of 2 years. Total 200 Patients for elective LSCS and BMI < 30 were include in this study. Group A - patients received injection Ceftriaxone 1gm. intravenous stat at the time of induction of anesthesia. Group B - patients received intravenous ampicillin and metronidazole for 1 day followed by oral for next 5 days. Temperature monitoring, vital signs, abdominal, perineal examinations were performed daily till 5-7 days. Results: Patients were randomly divided on alternate number basis, in 2 groups (Group A Ceftriaxone 1gm iv stat and Group B ampicillin and metronidazole for 5 days) each consisted of 100 patients. Mean age was 24.5±4.2 years in group A & 23.4±3.8 years in group B. BMI at the time of admission was 27.9±7.8 kg/m² & 28.8± 6.2 kg/m² in group A & B respectively. Mean duration of surgery was 45.8±6.8 min in group A & 46.1±5.4 in group B. Average blood loss was in groups A 645±70 & 670±75 in group B was comparable. Mean days of hospitalisation was 4.6±4.1 days & 5.4±3.1 days in group A & B respectively. History of previous laparotomy like LSCS, ectopic surgery, etc. was present in 42 & 36 patients from group A & B respectively. Fever was most common morbidity noted (Group A – 7& Group B -5) followed by urinary tract infection (Group A – 5 & Group B -7), wound infection, endometritis & early neonatal sepsis. Statistical difference between group A & B was non-significant for all morbidities. Conclusion: We conclude that the single dose antibiotic prophylaxis is as effective as conventional multi dose antibiotic therapy.

Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection.

Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.