Prophylactic Antibiotic Usage Research Articles

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.

The Prevalence and Factors Associated with Prophylactic Antibiotic Use during Delivery: A Hospital-Based Retrospective Study in Palembang, Indonesia.

Prophylactic antibiotic usage during delivery is a common practice worldwide, especially in low- to middle-income countries. Guidelines have been published to reduce antibiotic overuse; however, data describing the use of prophylactic antibiotics and clinician adherence to guidelines in low- to middle-income countries remain limited. This study aimed to describe the prevalence of prophylactic antibiotic use, factors associated with its use, and clinician adherence to guidelines. A retrospective review was conducted for all deliveries from 1 January 2016 to 31 December 2018 at a tertiary level hospital in Indonesia. The prevalence of prophylactic antibiotic use during delivery was 47.1%. Maternal education level, Ob/Gyn specialist-led delivery, a history of multiple abortions, C-section, premature membrane rupture, and antepartum hemorrhage were independently associated with prophylactic antibiotic use. Clinician adherence to the guidelines was 68.9%. Adherence to guidelines was the lowest in conditions where the patient had only one indication for prophylactic antibiotics (aOR 0.36, 95% CI 0.24–0.54). The findings showed that the prevalence of prophylactic antibiotic use during delivery was moderate to high. Adherence to local guidelines was moderate. Updating the local prescribing guidelines may improve clinician adherence.

Knowledge about antibiotic resistance among dental students in Chengalpattu district, Tamil Nadu – A cross-sectional study

Objectives: Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanism is emerging and spreading globally, threatening our ability to treat common infectious diseases. Dentists prescribe about 9–11% of all common antibiotics. The aim of this study was to assess the knowledge and attitude of antibiotic resistance among graduating dental students. Materials and Methods: A cross-sectional study was conducted among 294 participants between November 2019 and December 2019. A structured questionnaire consisting of 14 questions was administered to the dental students. Descriptive analysis of demographic variables was done and knowledge score and attitude score were performed using Kruskal–Wallis H test. Results: About 85% of the participants suggested amoxicillin as the choice of antibiotic. Among the four domains suggesting the solution for antibiotic resistance, 48% of the final year students suggested avoiding self-medication as a solution, 34% of interns suggested avoiding over dosage, and 48% of the 3rd year students suggested completing the course of antibiotics. A majority of (87%) of the final year students suggested the usage of prophylactic antibiotics in patients with infective endocarditis. The difference in mean change in attitude scores among the groups was statistically significant (P = 0.028). Conclusion: The research showed variable levels of knowledge and attitude about antibiotic resistance among the students of different year of study. The study result insists the need to educate the dental students more regarding antibiotics and their proper use.

P02.18 Indwelling Pleural Catheter Placement in a Large UK District General Hospital

Indwelling pleural catheters (IPC) have become the main stay for patient centred treatment of malignant pleural effusions. They can be inserted as day case procedures, have very low complication rates and improve quality of life. They also reduce inpatient length of stay in respect to the malignant effusion. We have an established pleural service and analysed our practice over 4 years. All the notes of patients requiring IPC insertion between 2015 and 2019 were reviewed. 159 patients had an IPC inserted. 130 had died; mean survival 162 days. Mean age was 72.3 years and 39% of patients were female (n=62). 78 IPCs were done for mesothelioma, 61 done for other malignancies (29 lung, 24 breast, rest varied : melanoma, prostate cancer, ovarian cancer, colorectal cancers amongst others). 20 were done for non-malignant indications such as fibrinous pleuritis, cardiac amyloidosis, effusions of unknown cause, liver cirrhosis, heart failure. 146 IPCs were inserted as a day case, the rest were already inpatients. IPCs are done in theatre with a one off dose of prophylactic antibiotics. Complications included 4 infections (3 of pleural space by staph epidermidis and gram negative bacilli, 1 of site: site infection by staph. aureus {MSSA} – 2.5% (lower than national average in the UK), 6 blockages- 3.8 %, requiring removal (less than national average) and 2 small pneumothoraces post insertion. 1 patient had fast AF and hypotension post insertion.13 patients had loculations requiring intervention (8%- lower than national average) with intra-fibrinolytics, All of these patients had died by the time of data collection and we have stopped this practice in light of recent evidence that palliative care is more apporpriate. 57 IPCs were removed (36%- at a national average) for spontaneous pleurodesis. We provide an safe and effective indwelling pleural catheter service. Our lower rates of infection might be due to prophylactic antibiotic usage and insertion in theatre.

Prophylactic antibiotic use in acellular dermal matrix-assisted implant-based breast reconstruction.

Prophylactic antibiotics are used in acellular dermal matrix-assisted implant-based breast reconstructions. However, there are no universally accepted guidelines regarding the best regimen. This retrospective, multicentre study was designed to compare the different prophylactic antibiotic regimens in these patients in three hospitals across two NHS trusts over a five-year period. Case notes and electronic records were reviewed for all patients undergoing acellular dermal matrix-assisted implant-based breast reconstructions between January 2010 and December 2014. Prophylactic antibiotic regimens, duration of use, wound infection, implant loss, seroma and therapeutic antibiotic use was recorded. Patients were divided into groups based on prophylactic antibiotic regimen and actual duration of use. Intergroup analysis was performed using Stata 13.0. Implant loss due to infection was the primary outcome measure. A total of 105 patients had 122 breast reconstructions performed over the study period. Four prophylactic antibiotic regimens were identified: single dose (n = 20), three doses (n = 17), antibiotics for five-seven days (n = 51) and antibiotics until drains removed (n = 32). There was no statistically significant difference (p > 0.05) between the various regimens in implant loss, wound infection, therapeutic antibiotic prescription or seroma rates. Based on the actual duration of prophylactic antibiotics usage, three groups were identified: prophylactic antibiotics given for one day (n = 26), antibiotics for up to one week (n = 76) and for more than one week (n = 13). Again, no statistically significant difference was observed in the groups for any outcome measure. The study demonstrated no difference in outcomes between different prophylactic antibiotic regimens in acellular dermal matrix-assisted implant-based breast reconstructions.

Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey.

One of the most important aspects of inappropriate antibiotic use among general surgeons in Turkey is the use of surgical antibiotic prophylaxis (SP). In order to shed light on the current situation, we conducted a survey of general surgeons in our country. Our aim was to evaluate the approach taken by our general surgeons in prescribing SP, while providing data pertinent to the effectiveness of the 'Rational Drug Use' (AIK) national action plan. A questionnaire on the subject of personal SP usage and compliance with guidelines was distributed amongst general surgeons between 2018-2019. The questions related to individual approaches taken by surgeons when treating patients with either clean or clean-contaminated wounds. Results of the questionnaires were collated and compliance with ASHP guidelines was evaluated. A total of 317 completed questionnaires were evaluated. According to the questionnaire results, the rate of total compliance with ASHP guidelines was 26.8%. The compliance rate for preoperative SP was 69.7% in the clean wound group and 54.6% in the clean-contaminated wound group. Although 96.5% of the participants reported correct timing for the first dose of SP, this number dropped to 79.5% apropos the adminstration of further doses of prophylaxis. The percentage of surgeons prescribing continued antibiotics at discharge for clean and clean-contaminated cases was 22.7% and 38.5%, respectively. The results of this study indicate that inappropriate use of SP is widespread in our country, and that antibiotics continue to be prescribed at discharge.

STEP TOWARDS PREVENTION OF ANTIBIOTIC RESISTANCE – A PROSPECTIVE STUDY IN LAPAROSCOPIC CHOLECYSTECTOMY.

Introduction: Traditionally antibiotics have been advised pre and post operatively in surgery for gall bladder. The knowledge about usage of a single dose prophylactic preoperative antibiotic in comparison to conventional usage of perioperative antibiotics in laparoscopic Cholecystectomy is limited. Hence, this study focuses on comparing the efficacy of a single dose prophylactic antibiotic versus the usage of pre and postoperative antibiotics in laparoscopic Cholecystectomy.&#x0D; Method: This is a prospective study conducted in the General Surgery department of Apollo Institute of Medical Sciences and Research. Over 192 consecutive patients subjected for laparoscopic Cholecystectomy were included in study. They were divided in two groups (A&amp;B) after applying exclusion. 74 patients in group A were given single dose of preoperative prophylactic antibiotic. No further post-operative antibiotics were given. 78 patients in group B were given both pre and postoperative antibiotics. Infective complications and cost constraints were compared between both the groups. Statistical analysis was done using chi-square test wherever necessary.&#x0D; Results: there is no significant difference in the rate of incidence of wound infection in both the groups. Age and gender had no significant association for SSI. The overall cost of Group B was found to be significantly higher than Group A.&#x0D; Conclusion: Usage of single dose prophylactic preoperative antibiotics with no further post operative antibiotics would be sufficient to prevent surgical site infection in uncomplicated laparoscopic Cholecystectomy.&#x0D; Keywords: Prevention, Antibiotic Resistance, Laparoscopic Cholecystectomy.

Sustained Postoperative Fever Without Evident Cause After Spine Instrumentation as an Indicator of Surgical Site Infection.

Surgical site infection after spinal instrumentation increases morbidity and mortality as well as medical costs and is a burden to both patients and surgeons. Late-onset or sustained fever increases the suspicion for comorbid conditions. This retrospective, exploratory cohort study was conducted to identify the rate of and risk factors for sustained or late-onset postoperative fever after spinal instrumentation operations and to determine its relationship with surgical site infection. Five hundred and ninety-eight patients who underwent lumbar or thoracic spinal instrumentation were retrospectively reviewed. The patients were divided according to (1) whether or not they had had a sustained fever (SF[+] or SF[-]) and (2) whether or not they had had a surgical site infection (SSI[+] or SSI[-]). Clinical characteristics, surgical factors, prophylactic antibiotic usage, fever pattern, and laboratory/imaging findings were recorded for all patients by electronic medical chart review. In total, 68 patients (11.4%) had a sustained fever. The rate of surgical site infection was significantly higher when the patient had sustained fever (13.2% [9 of 68] compared with 0.9% [5 of 530]; p < 0.001). Comparison of the patients who had a sustained fever but no surgical site infection (SF[+], SSI[-]) and those with both a sustained fever and surgical site infection (SF[+], SSI[+]) showed that continuous fever, an increasing or stationary pattern of inflammatory markers, and a C-reactive protein (CRP) level of >4 mg/dL on postoperative days 7 to 10 were diagnostic clues for surgical site infection. The sensitivity and specificity of postoperative magnetic resonance imaging (MRI) for the detection of surgical site infection were 40.0% and 90.9%, respectively, when MRI was performed within 1 month after surgery. Although most patients with sustained fever did not have surgical site infection, fever was significantly related to surgical site infection. Continuous fever, increasing patterns of inflammatory markers, and high CRP on postoperative days 7 to 10 were diagnostic clues for surgical site infection. This study demonstrated provisional results for factors that can discriminate febrile patients with surgical site infection from febrile patients without infection. Further investigation with a larger sample size is warranted for clarification. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Factors Influencing Postoperative Morbidity in Women Undergoing Excisional Procedures of the Cervix [09H

INTRODUCTION: Pain, discharge, and bleeding are common after excisional procedures of the cervix. While generally benign, they can herald complications. Our hypothesis was that age, prophylactic antibiotics, smoking and/or diabetes might be associated with these postoperative concerns. METHODS: Medical records for women undergoing excisional or ablative procedures of the cervix at Cooper University Hospital from January 2013 to December 2018 were reviewed. There were 621 total subjects. Seventy-eight were excluded due to inadequate follow-up, yielding 543 analyzable procedures. Records were reviewed for pain, discharge, and bleeding. Subsequent interventions were then recorded. Age, smoking status, procedure type, prophylactic vaginal metronidazole usage (off-label) as well as smoking and diabetic history were collected. Descriptive data are reported as such, and proportions were analyzed via chi-squared tests. RESULTS: The average age of our subjects was 40.28 years (median 36.9, standard deviation 12.4). In total, 208 women re-presented with at least one postoperative concern following their procedure. Of these, 103 required intervention. Procedure type, postoperative prophylactic antibiotic usage (n=38), age greater than the median, and active smoking status (n=115) failed to predict postoperative complications. Former smokers (n=129, P=.047) did report more concerns, although they did not require more interventions (P=.14). CONCLUSION: Excisional and ablative procedures of the cervix are essential for the prevention of cervical cancer in patients with moderate to severe cervical dysplasia. Postoperative complaints of pain, bleeding and discharge are common and bothersome for patients. Based on our retrospective review, age, prophylactic vaginal metronidazole, smoking and diabetes were not associated with worse postoperative outcomes.

Evaluation of prophylactic antibiotics in penetrating brain injuries at an academic level 1 trauma center

ObjectiveInfections from penetrating brain injuries (PBI) lead to higher morbidity and mortality rates. The results of this research will be evaluated to develop institutional guideline for antibiotic prophylaxis in this patient population. The objective was to characterize the prophylactic antibiotic usage for patients presenting with PBI. Patients and methodsThis retrospective chart review included patients with a PBI identified through the institution’s trauma center registry between December 2015 and July 2018. The primary outcome was the proportion of patients that received prophylactic antibiotics. Secondary outcomes included antibiotic administration timing, selection and duration of antibiotic regimens, infection rates and patient outcomes. ResultsThe study population included 33 patients, with 82 % males and an average age of 32 years. The most common mechanism of injury was a gunshot wound (94 %). Of the 33 patients, 24 (73 %) received at least one dose of prophylactic antibiotics. The median time to antibiotic administration was 52.8 min (IQR, 18-120), while the median duration of prophylaxis was 24 h (IQR, 7-84). The most common antibiotic regimen was a single cefazolin dose, with the next most common regimen included scheduled ceftriaxone and metronidazole. Overall, there were no documented central nervous system or skin and soft tissue infections during the initial admission, while 4 patients (12 %) were treated for pneumonia. Survivors (67 %) had a median hospital length of stay of 5.8 days. ConclusionThe median duration of prophylaxis was shorter than the current data suggesting antibiotics for 5 days; however, there were no documented central nervous system infections, which is less than previously reported in the literature.

Patterns of antibiotics and pathogens for anastomotic leakage after colorectal cancer surgery

Purpose Anastomotic leakage (AL) is a type of intra-abdominal infection (IAI) which requires appropriate antibiotics with proper intervention. This study aimed to improve the appropriateness of antibiotic treatment by assessing the patterns of antibiotic treatment and resistance of pathogen profiles in patients who had AL after colorectal cancer surgery. Methods From June 2006 through December 2017, the medical records of the patients who had AL after elective abdominal surgery for colorectal cancer in Kyung Hee University Hospital at Gangdong, Seoul, Korea were reviewed retrospectively. Baseline characteristics and consistence of antibiotics with culture study results were analyzed to evaluate the appropriateness of treatment. Results Among 982 patients who underwent primary surgery for colorectal cancer, 41 (4.2%) had AL. Mean time of diagnosis of AL from surgery was 6.3 days. The most commonly used prophylactic antibiotics for the primary surgery was 2nd generation cephalosporin (66.6%). Mean duration of prophylactic antibiotics usage was 2.8 days. The most commonly used empirical antibiotics after AL occurred was piperacillin and tazobactam (32.6%). Mean duration of empirical antibiotics usage was 8.2 days. The most commonly identified pathogens were Escherichia coli and Enterococci spp. (26.8% each), and 12.2% of the “ESKAPE” pathogens were identified. Resistance to empirical antibiotics was 45.5% (10/22). Conclusion Penetration of culture study for AL after colorectal cancer surgery appeared relatively low, although the profile of pathogens isolated from the AL patients can give important clues and evidence for appropriate antibiotics use. Surgeons should pay attention in performing culture studies for IAI including AL for proper patient treatment. Keywords: Intraabdominal infection, Antibiotics, Resistance, Colonic neoplasms, Anastomotic leakage

A study to evaluate and assess the antibiotic prescription pattern for the surgical prophylaxis to prevent post-operative wound infection (SSI) in a tertiary care hospital

Surgical site infection is a major complication following surgery affecting up to 50 % of operated patients which can be prevented by appropriate antibiotic prophylaxis. Hence this study aims to investigate the pattern of the prophylactic antibiotic usage in patients undergoing elective surgery and to assess the percentage of drugs included in the National List of Essential Medicines (NLEM). This is a Prospective study conducted at Saveetha Medical College and Hospital from April 2018 to April 2019 included medical records of 1093 Patients above 18yrs of age including both sex (male and female) who has undergone elective surgery in Department of General Surgery. Patient's demographic data and comorbidities was also collected and verified for antibiotic prophylaxis, i.e. choice and duration of antibiotics, time of administration, intra-operative dosing, choice and duration of the postoperative use. Pediatrics, Neonatal Surgeries, Pregnant and lactating women were excluded from this study. The obtained data was analyzed, and conclusions were drawn with the help of SPSS analysis software. The results shows Third-generation cephalosporin's injection Taxim (Cefotaxime) was mainly used preoperatively in 486(44.46%) patients by intravenous route followed by cefixime-191(17.47%),ciprofloxacin-161(14.73%). In addition,458(41.90%) patients received either Inj.TT or Metronidazole along with the 1st pre-operative drug. The antibiotics were administered in 2 doses (i.e.) overnight dose and other dose is given just half an hour prior to surgery. No intraoperative redosing was given. The duration of the postoperative prophylaxis was extended to 3 days to 5 days in all 1093 cases. SSI was identified in 25 cases, and overall incidence in our study is 2% which is quite compatible with other studies and incidence is common among patients with age-related risk factors and comorbidities. This study revealed that third-generation cephalosporin Cefotaxime was considered as the main pre and post-operative drug, which is based on surgeon's experience, type of surgery and local antibiotic resistance pattern. Various measures like the development of local hospital Policy, surveillance on SSIs, hospital antibiotic policy, promoting good surgical techniques and strict asepsis in the operating theatre, usage of single antibiotics, and completion of course of antibiotics can prevent the emergence of multi-resistant organisms.

Microbial metabolite deoxycholic acid controls Clostridium perfringens-induced chicken necrotic enteritis through attenuating inflammatory cyclooxygenase signaling

Necrotic enteritis (NE) caused by Clostridium perfringens infection has reemerged as a prevalent poultry disease worldwide due to reduced usage of prophylactic antibiotics under consumer preferences and regulatory pressures. The lack of alternative antimicrobial strategies to control this disease is mainly due to limited insight into the relationship between NE pathogenesis, microbiome, and host responses. Here we showed that the microbial metabolic byproduct of secondary bile acid deoxycholic acid (DCA), at as low as 50 µM, inhibited 82.8% of C. perfringens growth in Tryptic Soy Broth (P < 0.05). Sequential Eimeria maxima and C. perfringens challenges significantly induced NE, severe intestinal inflammation, and body weight (BW) loss in broiler chickens. These negative effects were diminished (P < 0.05) by 1.5 g/kg DCA diet. At the cellular level, DCA alleviated NE-associated ileal epithelial death and significantly reduced lamina propria cell apoptosis. Interestingly, DCA reduced C. perfringens invasion into ileum (P < 0.05) without altering the bacterial ileal luminal colonization. Molecular analysis showed that DCA significantly reduced inflammatory mediators of Infγ, Litaf, Il1β, and Mmp9 mRNA accumulation in ileal tissue. Mechanism studies revealed that C. perfringens induced (P < 0.05) elevated expression of inflammatory mediators of Infγ, Litaf, and Ptgs2 (Cyclooxygenases-2 (COX-2) gene) in chicken splenocytes. Inhibiting the COX signaling by aspirin significantly attenuated INFγ-induced inflammatory response in the splenocytes. Consistent with the in vitro assay, chickens fed 0.12 g/kg aspirin diet protected the birds against NE-induced BW loss, ileal inflammation, and intestinal cell apoptosis. In conclusion, microbial metabolic product DCA prevents NE-induced BW loss and ileal inflammation through attenuating inflammatory response. These novel findings of microbiome protecting birds against NE provide new options on developing next generation antimicrobial alternatives against NE.

Prophylactic antibiotic usage by Belgian veterinarians during elective caesarean section in Belgian blue cattle

The use of prophylactic antibiotics in veterinary surgery reduces the occurrence of postoperative complications. In order to limit the development of antimicrobial resistance in bacteria and to maximize therapy efficacy, antibiotics should be used prudently and efficiently. A survey was sent to Wallonian rural veterinarians in order to assess the use of antibiotics before, during and after bovine elective caesarean section, the most common surgical procedure in Belgian rural practice. Results were analysed in the light of the current guidelines formulated by the Belgian Centre of Expertise on Antimicrobial Consumption and Resistance in Animals.Among 380 contacted veterinarians, 113 answered the survey. All veterinarians use antibiotics during caesarean section. Veterinarians predominantly use penicillin as the first drug of choice, whereas a minority use drugs considered as second or third choice, such as amoxicillin, oxytetracyclin or lincomycin-spectinomycin. Also, 31/113 veterinarians simultaneously use molecules from different antibiotic classes. The majority (100/113) of veterinarians inject antibiotics during or after surgery, while a minority (13/113) administer antibiotics preoperatively. Most veterinarians (67/113) limit the duration of their antibiotic treatment to 1 day. Considering the administration route, most veterinarians (88/113) systematically use the intraperitoneal injection route, which is not registered. Intramuscular injection and injection between muscle layers during surgery are carried out by 82/113 and 43/113 respondents, respectively. Twenty-two respondents apply intra-uterine antibiotics. Most veterinarians (87/113) combine several administration routes. The dosage of antibiotics varies enormously and excessive injection volumes are common, especially when multiple injection routes are combined.Our results show a striking lack of consistency in the antibiotic therapy during elective CS by rural veterinarians. Whereas the drug of choice and the treatment duration were largely in line with the current guidelines, this is certainly not the case for the dosage and the administration route. The intraperitoneal injection of antibiotics cannot be justified. Incorrect dosage of antibiotics should be avoided at all cost. The use of second and third line molecules and the simultaneous use of different antibiotic classes should be discouraged. A major challenge lies in the education of veterinary students and the sensitization of practitioners to avoid or unlearn unnecessary habits concerning antibiotic use. Finally, more clinical trials are needed in order to refine the current guidelines for antibiotic use and to determine the optimal drug of choice, treatment moment and application route in elective caesarean section in cattle.

2819 The Role of Prophylactic Antibiotics in Peritoneal Dialysis Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

INTRODUCTION: End stage renal disease patients on peritoneal dialysis (PD) are at risk of peritonitis due to possible bacterial translocation from the colon during preparation for colonoscopy or during performing colonoscopy. ASGE guidelines and ISPD (International Society for Peritoneal Dialysis) guidelines suggest antibiotic prophylaxis while European Society of Gastroenterology does not give a clear guideline in this regard. ASGE guidelines in this regard is based on weak evidence. We attempted to conduct a systematic literature review and a meta-analysis to provide more evidence in this area. METHODS: A systematic search of PubMed, Medline, Web of Science, and Google Scholar through April 2019 using PRISMA and MOOSE guidelines identified 3 studies that reported on the occurrence of peritonitis during colonoscopy in patients on peritoneal dialysis. Case reports were excluded. Only prospective and retrospective large series studies were included. Random-effects pooled odds ratio and 95% confidence intervals were estimated. Heterogeneity was measured by Cochrane Q and I2 statistics. RESULTS: A total of 3 studies reporting on 216 colonoscopy procedures performed on patients undergoing peritoneal dialysis were included in the final analysis. The mean age ranged from 44 to 64 years. The pooled Odd's ratio of developing peritonitis while on antibiotics during colonoscopy was 0.68 (95% 0.19-2.4, I2 = 0, P = 0.56). This was not statistically significant. No heterogeneity was noted in the analysis. CONCLUSION: Based on our study, the administration of antibiotics does not seem to affect the incidence of peritonitis in PD patients undergoing colonoscopy. However, this is based on very limited number of studies and unequal sample-size in comparison groups. We, therefore, cannot recommend or refute the usage of prophylactic antibiotics in PD patients undergoing colonoscopy. This analysis shows the paucity of data available at this time in this regard. More robust studies with similar comparison groups are warranted to guide decision making.

Risk factors and prognostic effects of cholangitis after Kasai procedure in biliary atresia patients: A retrospective clinical study

PurposeCholangitis after Kasai procedure has been previously shown to be related to poor prognosis in Biliary Atresia (BA). To investigate the risk factors and clinical outcomes of cholangitis, we did a retrospective study in post-Kasai BA patients. MethodsTwo-year follow-up data of 180 type-III BA patients after Kasai procedure in 2016 in our hospital were analyzed, including 119 cholangitis patients (66.11%). Among the cholangitis group, patients were further divided into early vs late cholangitis and single vs recurrent cholangitis groups. Liver pathology, liver function, cholangitis occurrence and frequency, jaundice clearance, and survival rates were examined. ResultsHigher gamma-glutamyl transferase level before Kasai is a risk factor for cholangitis (p = 0.0393). Older age and higher liver fibrosis score at Kasai are risk factors for recurrent cholangitis (p < 0.05). Shorter prophylactic intravenous antibiotics usage may contribute to early cholangitis, which may lead to higher cholangitis frequency (p < 0.0001). Recurrent cholangitis is associated with earlier cholangitis onsets (p < 0.0001). Cholangitis patients have a relatively delayed jaundice clearance, while early and recurrent cholangitis may contribute to lower overall survival. ConclusionsPersonalized treatment considering risk factors in individual BA patients is needed to prevent cholangitis, especially early onsets, and to improve postoperative outcomes. Level of evidenceIII

Infection prevalence and patterns in self-inflicted gunshot wounds to the face

Self-inflicted gunshot wounds (SIGSWs) to the craniomaxillofacial region are uncommon injuries but are associated with a high mortality rate. Therefore, treating these patients is a rare occurrence even in the largest trauma centers. As with many rare conditions, data specifically addressing this injury pattern are scarce. Because of the proximity of the blast, even low-velocity injuries can be associated with significant avulsion of tissue, comminution of structures, and tissue die back. Previous case reports have recommended the use of prophylactic antibiotics, but no study has specifically investigated the postinjury infection rate or microbial patterns in this patient population. The purpose of this study was to answer the following clinical question: "Among patients with SIGW to the maxillofacial region, what is the prevalence of postinjury infection, and are there any microbial patterns that can guide empiric antibiotic selection?" We designed retrospective cohort study at a level I trauma center in Portland, Oregon. Data on 17 patients who had sustained a SIGSW involving the maxilla or the mandible and survived their initial injury were collected from 2010 to 2017. Patients who had a culture-positive infection within 30 days of their injury were defined to have a postinjury infection. Six of the 17 patients (35%) developed a postinjury infection, with an average time to infection of 11 days from initial injury (range 3-19 days). Of the 17 subjects, 15 (88%) received a course of prophylactic antibiotics, on average, for 14 days (range 3-24 days). Of the 6 cases of postinjury infection, culture grew gram-negative bacteria in 4 cases-anaerobic bacteria in 2 and polymicrobial organisms in 2. There was no clear pattern or prevalence of any specific bacterium, but cultures notably included Staphylococcus aureus, Enterobacter species, Bacteroides species, and Escherichia coli. SIGSWs are associated with a high rate of postinjury infection (35%) despite prophylactic antibiotic usage in 88% of these cases. Given the antimicrobial patterns observed in this study, prophylactic antibiotics in this patient population should include empiric coverage for gram-negative and anaerobic bacteria.

Restriction of Central Line Insertion and Prophylactic Antibiotics Usage in Moderate and Late Preterm Infants from a Quality Improvement Perspective

Objective: The care provided to moderate and late preterm (MLPT) infants is an area of significant practice variation and most of the quality improvement initiations are for very low birth weight infants. The objective of this study was to analyze hospital outcome changes in MLPT infants with central line insertion and prophylactic antibiotics usage restriction as a quality improvement method. Methods: This was a retrospective cohort study for MLPT infants who were admitted at Kangwon National University Hospital neonatal intensive care unit during 2013-2016. The groups were divided into period I (from 2013 to 2014) and period II (from 2015 to 2016) based on the changes in clinical practices. Since period II, feeding protocol was changed to rapid full-feeding and central line insertion practice was restricted to cases with feeding intolerance over 3 days of life. Prophylactic antibiotics were restricted to ampicillin with gentamycin except for special cases and indications were restricted depending on maternal factors plus clinical symptoms after birth. Results: Gestational age was lower and respiratory distress syndrome was frequent at period II. Central line insertion was reduced from period I to II (83% [147/177] vs. 36% [75/207]). Antibiotics exposures were less at period II (584 vs. 206 days per 1,000 patient-days). Clinical sepsis and central line associated bloodstream infection was significantly decreased at period II. Conclusion: Quality improvement for reducing central line insertion and prophylactic antibiotics usage in MLPT infants may be effective to reduce the incidence of infection related complications, especially sepsis.

Prophylactic antibiotic for open mesh repair of inguinal hernia; from principe to nécessité

PURPOSE: The use of prophylactic antibiotics (PAs) in open mesh repair (MR) of inguinal hernia (IH) is controversial. Clean surgeries do not require PA. However, prosthetic implants may require PA. As a part of quality improvement project, “guideline-based treatment for IH” where the European Hernia Society guidelines were adapted and PA was administered only if necessary, not as a routine for open MR of IH since May 1, 2015. The aim of this study was to assess the practice in the use of PA in open MR of IH and the outcome at a single surgical unit. METHODS: This is a retrospective analysis of health records of all the male patients who underwent open MR of IH at a single surgical center, during the period from May 1, 2015 to May 1, 2016, where it was considered not to administer PA routinely, but to only when required (de necessite). Data of patients who underwent open MR of IH during the period May 1, 2014–April 30, 2015, where PA was administered routinely (de principe) for open MR of IH, were collected for comparison. Demographic, immune-compromised status, operation techniques, PA, and surgical site infections data were analyzed. RESULTS: There were 62 and 78 male patients who underwent open MR of IH during PA de principe and PA de necessite periods, respectively. The mean ages were 38.32 (range 21–74) and 35.51 (range 21–70) years, respectively, during PA de principe and PA de necessite. There were no patients with immunocompromised status. PA usage has reduced from 96.8% (n = 60) during the PA de principe to 11.5% (n = 9) during PA de necessite period. Surgical site infection rate was 1.6% and 1.3%, respectively, during PA de principe and PA de necessite periods. CONCLUSION: In a low-risk environment, open MR of IH can be carried out without PA in a majority of patients.