Prophylactic Antibiotics In Patients Research Articles

Incidence des infections urinaires post-cystomanométrie chez les patients présentant une vessie neurogène – évaluation des pratiques

ObjectiveThe indication for prophylactic antibiotic therapy during cystomanometry to prevent urinary tract infection (UTI) has long been recommended. However, limited data support this approach. Our study aims to evaluate the incidence of UTIs following cystomanometry without prophylactic antibiotics in patients with neurogenic bladder. Materials and methodsThis prospective, monocentric study was conducted from February 2023 to March 2023 at a specialized neuro-urology center, including all consecutive patients with lower urinary tract disorders of neurogenic origin referred for cystomanometry. The occurrence of UTIs following cystomanometry was assessed via telephone follow-up on day 14. ResultsA total of 100 patients were included, with a median age of 51years, with neurogenic bladder predominantly attributed to spinal cord injury (69/100). Ultimately, 11 patients reported UTIs within 14days post-cystomanometry, with only one being febrile, and none requiring hospitalization. No specific risk factors could be identified. ConclusionAccording to our study, the incidence of UTIs following cystomanometry without prophylactic antibiotic therapy is 11%, which is equivalent to the incidence with antibiotic prophylaxis. These preliminary results support the lack of benefit of peri-cystomanometry antibiotic therapy.

Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials.

Laparoscopic cholecystectomy (LC) in patients admitted with acute cholecystitis is considered the preferred, feasible and safe mode of managing gallstone disease. The objective of this study is to evaluate the role of single-dose pre-operative prophylactic antibiotics in patients undergoing emergency LC for mild to moderate acute cholecystitis. All randomized control trials (RCTs) reporting the use of single-dose pre-operative prophylactic antibiotics in patients undergoing acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Standard medical databases search produced only 3 RCTs on 781 patients undergoing acute cholecystectomy. There were 384 patients in single dose pre-operative antibiotics group whereas 397 patients were recruited in the no-antibiotics group. In the random effects model analysis, the use of single-dose preoperative prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate cholecystitis failed to demonstrate any extra advantage of reducing the risk of [risk ratio (RR) =0.69; 95% confidence interval (CI): 0.46-1.03; Z=1.80; P=0.07] infective complications. There was no heterogeneity [Tau2 =0; Chi2 =1.74, df =2 (P=0.42; I2=0%)] among included studies. A preoperative single dose of prophylactic antibiotics in patients undergoing acute LC for mild to moderate acute cholecystitis does not offer extra benefits to reduce infective complications.

962 Are We Right to Continue to Omit Antibiotic Prophylaxis in Trans-Perineal Prostate Biopsies? A Clinical Audit in a Single NHS Trust

Abstract Introduction Transperineal Prostate Biopsies (TPPB) offer lower rates of infection-related complications than Transrectal Prostate Biopsies (TRPB), with post-procedural sepsis rates reported between 0.5% and 3%. The intuitive evolution from TRPB to TPPB has, however, involved the use of routine antibiotic prophylaxis, but studies have shown that there may be no difference in infection rates post procedure in patients with and without antibiotics. Aim This audit aimed to assess infection-related complications in patients undergoing TPPB without antibiotic prophylaxis in a single NHS Trust, following the Trust decision to discontinue antibiotic use. Method Retrospective analysis of 200 patients that had been biopsied between April 2022 and October 2022 was performed. 28-day post procedure hospitalisation and sepsis rates were assessed, in addition to 28-day GP presentations, antibiotic prescriptions and relevant co-morbidities. Results The cohort had a mean age of 70.1 years. The most common co-morbidities included Hypertension and Type 2 Diabetes Mellitus. 1 patient presented to hospital with sepsis within 28 days, representing a post-procedure infection rate of 0.5%. This patient received IV antibiotics in hospital and was discharged after 3 days. No patients presented to their GP within 28 days post procedure or were prescribed antibiotics in the community. Conclusions Given the low post procedure infection rates, we believe the evidence provided in this audit further supports and justifies the discontinuation of routine prophylactic antibiotics in patients undergoing TPPB. We believe this to be relevant in a world where antibiotic stewardship is becoming an ever more important issue.

SP6.10 Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials

Abstract Objective Laparoscopic cholecystectomy in patients admitted with acute cholecystitis is considered preferred, feasible and safe mode of managing gallstone disease. The objective of this study is to evaluate the role of single dose pre-operative prophylactic antibiotics in these patients undergoing acute cholecystectomy. Materials and methods All RCTs reporting the use of single dose pre-operative prophylactic antibiotics in patients undergoing acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results Standard medical databases search produced only 3 RCTs on 781 patients undergoing acute cholecystectomy. There were 384 patients in single dose pre-operative antibiotics group whereas 397 patients were recruited in the no-antibiotics group. In the random effects model analysis, use of single does preoperative prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate cholecystitis failed to demonstrate any extra advantage of reducing the risk of [risk ratio 0.69, 95%, CI (0.46, 1.03), Z = 1.80, P=0.70] infective complications. There was no heterogeneity (Tau2 = 0; Chi2 = 1.74, df = 2 (P = 0.42; I2 = 0 %) among included studies. Conclusion Preoperative single dose of prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not offer extra benefit to reduce infective complications.

Acute pancreatitis: Early Management

Abdominal pain caused by acute pancreatitis (AP) is not uncommon in day to day medical practice worldwide. AP is the sudden inflammation of the pancreas, and it may be confined to the pancreas, or may be more life-threatening, affecting all organs and systems. It progresses mildly in 80% of patients and resolves with treatment, but in cases of severe AP, with mortality of around 30% has been recorded. AP is most often established by clinical symptoms and at least threefold raised enzymes and by imaging (any two of these three).In the management AP, treatment is mainly related to the severity of the disease and approaches are constantly being updated. With early diagnosis and treatment, most of the patients can be discharged, and the development of complications and mortality can be reduced. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Early targeted fluid therapy within the first 48 h is critical to improve the outcome of severe AP. Patients with organ failure and or SIRS should be admitted to an ICU /HDU whenever possible. Emergency management decision are early fluid management strategy, utility and timing of antibiotics, the timing and type of nutritional support and in relevant cases endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy approachescan change the course of the disease and the length of stay in the hospital. Therefore, emergency management is important.Enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided.Routine use of prophylactic antibiotics in patients with severe AP and or sterile necrosis is not recommended.In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. Successful clinical management requires close interdisciplinary cooperation and coordination from experienced gastroenterologists, intensive care physicians, surgeons, and radiologists. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188-189

The Use of Prophylactic Antibiotics for Cesarean Section Delivery and The Incident of Surgical Site Infection

According to the 2018 Riskesdas data, the ratio of deliveries by cesarean section in 2018 was recorded at 17.6% of a total of 78,736 deliveries. One of the serious problems in postoperative treatment that has an impact on increasing morbidity, mortality, and increasing medical costs is surgical site infection (SSI). To reduce the risk of infection, efforts are made by giving prophylactic antibiotics followed by surgical procedures. The aim of this study was to determine the use of prophylactic antibiotics in cesarean section surgery and to determine the incidence of surgical site infection (SSI) in patients after Sectio Caesarea surgery in one of a private hospital in Kediri City. This study was an observational descriptive study with retrospective data collection through tracing of medical record data of patients who underwent Caesarean section surgery in 2021. The samples that entered the inclusion criteria were patients who received surgical prophylaxis with antibiotics and returned to the hospital for control after 1 week postoperatively. Samples that met the inclusion criteria were 89 patients. The sampling technique used purposive sampling. This study collected data on prophylactic antibiotics used and the incidence of SSI on days 1, 3 and (7-10) postoperatively. The results showed that the types of prophylactic antibiotics in patients undergoing sectio caesarea were ceftriaxone 2 g (99%) and cefotaxime 2 g (1%). Whereas there were 3 patients (3%) who had SSI on days 7-10 postoperatively.

Impact of Extended Antibiotic Use After Pancreaticoduodenectomy for Patients with Preoperative Metallic Biliary Stenting Treated with Neoadjuvant Chemotherapy

IntroductionPancreaticoduodenectomy (PD) remains a complex surgical procedure with infectious complications affecting nearly 50% of patients. Patients who undergo biliary drainage with stent placement prior to neoadjuvant treatment (NAT) reportedly have higher infection rates following PD. The aim of the current study is to evaluate the differences in postoperative infectious complication rates based on the duration of post operative prophylactic antibiotics in patients with indwelling metal biliary stent who had NAT. MethodsA retrospective institutional pancreatic cancer database was queried for patients who had a metal biliary stent placed prior to NAT initiation, followed by subsequent PD between 2014 and 2021. Duration of postoperative prophylactic antibiotics was defined as short (SC: ≤ 24 h) or extended (EC: > 24 h–7 days). The primary outcome of interest was surgical site infection (SSI). ResultsTwo hundred and ninety-five (n = 295) patients were identified of which the majority (n = 205, 69.5%) received a short course of antibiotics postoperatively. Baseline characteristics were similar between the two cohorts including age, sex, BMI, and comorbidity index. EC patients received more NAT cycles (4 vs. 3, p < 0.001) and underwent an open PD more frequently (61.8% vs. 41.0%, p < 0.001). SSI occurred in 64 (21.7%) patients; SC cohort: 54, 26.3% vs. EC cohort:10, 11.1%, (p = 0.003). Additionally, the SC cohort demonstrated a higher incidence of major complications (Clavien-Dindo ≥ 3: 51 [24.9%] vs. 13 [14.4%], p = 0.045). On the logistic regression model examining factors associated with SSI, higher BMI (continuous variable) was associated with increased odds of SSI (OR: 1.05 [95%CI: 1.00, 1.10, p = 0.040), while EC was protective (OR: 0.36 [95%CI: 0.17, 0.75], p = 0.007). ConclusionsThese data suggest that an extended course of perioperative antibiotic correlates with reductions in SSI and major morbidity following PD in patients with a metallic biliary stent placed prior to NAT course. These results require validation in a future randomized clinical trial examining a larger cohort of patients with further emphasis on the types of perioperative antibiotics administered.

Antimicrobial prophylaxis in patients undergoing endoscopic mucosal resection for 10- to 20-mm colorectal polyps: A randomized prospective study

Endoscopic mucosal resection (EMR) is frequently used for the removal of colorectal neoplasms. However, the use of prophylactic antibiotics in patients undergoing EMR is debatable. The aim of this randomized controlled trial was to assess whether antimicrobial prophylaxis is crucial in the perioperative period of EMR, especially for 10- to 20-mm lesions in this setting. Two hundred and sixty-four patients were randomized equally into 2 groups, the antibiotic (cefixime) group and the control group. The occurrence of adverse events was examined at 1 to 3 days after EMR. Plasma levels of inflammatory markers were analyzed at pre-operation, 1 day post-operation and 3 days post-operation. Blood samples collected at 1 day post-operation were used for culture. A total of 264 and 268 polyps were removed by EMR in the antibiotic group and the control group, respectively. There were 5 cases of fever, with 2 in the antibiotic group and 3 in the control group. In the antibiotic group, 12 patients had abdominal pain and 10 suffered bleeding, whereas in the control group, abdominal pain and bleeding were observed in 10 and 11 patients, respectively. There were no significant differences in the proportion of patients with fever or the incidences of postoperative complications between the groups. No significant differences between the groups were reported in plasma levels of white blood cell count, erythrocyte sedimentation rate, C-reactive protein or procalcitonin at pre-operation or post-operation. No patients provided positive blood cultures. The use the prophylactic antibiotics for EMR procedures in the perioperative period is no longer required when the lesions are 10 to 20 mm in size.

Overview of Evaluation of Prophylactic Antibiotics in Patients with Hernia Cases at a Private Hospital in South Tangerang, Indonesia, during the Period January 2019 – December 2020

Surgical Site Infection (SSI) is one of the complications of surgery in a hospital. The SSI can increase the morbidity and mortality of patients. The primary prevention in the SSI case is to give the right prophylactic antibiotics following the applicable guidelines, which include the proper indication, the right type, the correct dose, the right time, and the right route for giving prophylactic antibiotics. One of the recommended surgical operations using prophylactic antibiotics is a hernia. The purpose of this study was to evaluate the accuracy of giving preventative antibiotics to patients with hernia cases at a private hospital in South Tangerang from January 2019 - December 2020. This study retrospectively used medical records, and the type of research used was non-experimental with a descriptive design. Based on the data obtained, the administration of prophylactic antibiotics to patients with hernia cases at a private hospital in South Tangerang showed 100% correct indication, 45% correct type, 100% correct dose, 68% timely, 100% correct route of administration of prophylactic antibioti cs.

TH2.1 Antibiotics during Pancreatitis… Is it “NICE”??

Abstract Aim National Institute for Health and Care Excellence (NICE), British Society of Gastroenterology, the American College of Gastroenterology and the trust guidelines do not recommend prophylactic antibiotics in patients with uncomplicated acute pancreatitis. Our three-cycle study was focused on finding out adherence to these guidelines. Method Three cycles of the study were conducted over a span of 2 years with 87, 78 and 121 patients with the peak age range of 20–40 in the first, 41–60 in the others respectively. Unspecified acute pancreatitis and gallstone pancreatitis were the most common diagnosis in the second and third cycles respectively. Majority of patients were prescribed antibiotics on 1–2 days after admission in the first and second cycle and on the day of admission in the third cycle. Results 44.8%, 39.7%, 35.5% of the patients admitted with pancreatitis were prescribed antibiotics in the three cycles respectively. Interestingly, in the first cycle 74.3% patients were prescribed antibiotics without any clear indication. However, we saw an improvement in the trend of prescribing antibiotics without indication from 45% in the second cycle to 37.2% in the last cycle. The maximum number of patients had a hospital stay of 2–4 days in all the cycles. Co-amoxiclav was the most prescribed antibiotic in the first and the third cycle. In the second cycle, the order was Metronidazole followed by Amoxicillin. Conclusion The prescription of empirical antibiotics in acute pancreatitis doesn't improve the duration or outcome of the disease. Therefore, antibiotics must be used judiciously in this era of ever-increasing antibiotic- resistant microbes.

EP-245 A snapshot review of the use of prophylactic antibiotics for emergency gastrointestinal surgeries: a tertiary care centre experience

Abstract Aim The administration of recommended prophylactic antibiotics on time for emergency gastrointestinal surgery (GIS) is effective in reducing surgical site infections (SSI) and expediting post-operative recovery. This audit aims to assess the optimum use of prophylactic antibiotics in patients undergoing emergency GIS. Methods The data of all patients undergoing emergency GIS over a 1-month period was reviewed according to UH Sussex NHS trust (microguide) guidelines. The data was extracted, transferred and analysed using Microsoft Excel. Results Forty-one patients underwent emergency GIS during the study period. Emergency GIS procedures included laparoscopic appendicectomy (n=20), open colorectal resections (n=5), laparoscopic colorectal resections (n=3), perforated duodenal ulcer repair (n=2), inguinal hernia repair (n=2), diagnostic laparoscopy (n=2), defunctioning ileostomy (n=2) and other (n=5). Recommended antibiotics were administered in 17 (41.5%) patients and 29 (70.8%) patients were administered antibiotics at the correct time. Surgical site infections (SSI) were seen in 6 (14.5%) patients, of which 2 (11%) patients were in the recommended-antibiotics group and 4 (16.5%) in the non-recommended antibiotics group (p= 0.05). Two patients (2/29; 6.8%) contracted SSI in the group which received antibiotics on time. The major factor behind using non-recommended antibiotics and not administering antibiotics at the recommended time was the continuation of antibiotics commenced at the time of admission. Conclusion A significantly higher proportion of patients undergoing emergency GIS were not administered the recommended antibiotics. Moreover, almost one third of patients were not administered antibiotics on time. Use of non-recommended antibiotics results in higher incidence of SSI in patients undergoing emergency GIS.

Pediatric Non-Testicular Torsion Acute Scrotum–Is the Use of Prophylactic Antibiotics in Patients With Normal Urine Analysis Justified?

ObjectiveTo determine if empirical antibiotic treatment for non-testicular torsion (NNT) acute scrotum is necessary in the setting of a normal urine analysis (UA). MethodsRetrospective chart review revealed 314 pediatric patients with clinically diagnosed NTT acute scrotum with negative UA between 2004-2019. Exclusion criteria included previous urological history and immunocompromised state. Patients were divided into those with antibiotics treatment vs those without. The independent t test was used to compare numerical variables while the chi-squared test was used to compare categorical variables. ResultsOf the 314 patients identified, 141 (44.9%) received empiric antibiotics despite negative UA. Clinical findings and demographic characteristics between groups were not found to be significant. Patients clinically diagnosed with epididymo-orchitis were more likely to be prescribed antibiotics (48.2 vs 30.6%, P =.02). Trimethoprim-sulfamethoxazole accounted for 83% of the antibiotics that were prescribed in our study. There was no significant difference in symptom resolution between patients prescribed antibiotics and those not prescribed antibiotics (5.1 days vs 4.6 days, P =.71). Additionally, no patient in either group returned with complications such as worsening symptoms or urinary tract infection between presentation and their scheduled follow up visit. ConclusionBased on our analysis, antibiotics in NTT acute scrotum appear to have no benefit in symptom resolution or complication reduction in patients without any predisposing urological risk factors and negative UA at presentation. Given the risk and rise of antibiotic resistance providers need to be careful to select treatments based on available evidence.

The Risk of Opportunistic Infections and the Role of Antibiotic Prophylaxis in Patients on Checkpoint Inhibitors Requiring Steroids.

Immune-related adverse events (irAEs) often require treatment with high-dose systemic steroids (SS) and other immunosuppressive agents (ISAs). NCCN Guidelines recommend prophylactic antibiotics for Pneumocystis jirovecii pneumonia (PJP) for patients receiving prolonged SS/ISAs. However, there is a paucity of evidence regarding the incidence of opportunistic infections (OIs) and non-OIs and the role of prophylactic antibiotics in patients on SS/ISAs for irAEs. A retrospective analysis was conducted of patients treated using immune checkpoint inhibitor (ICI) therapy at 5 MedStar Health hospitals from January 2011 to April 2018. OIs were defined per the Infectious Diseases Society of America guidelines for the prevention and treatment of OIs in patients with HIV. The study cohort included patients who received ≥20 mg daily of a prednisone equivalent for ≥4 weeks to manage irAEs. The study cohort identified 112 (15%) of 758 total patients treated using ICIs. Baseline characteristics included the following: median age was 64 years, 74% (n=82) of patients were White, 89% (n=100) had an ECOG performance status ≤1, 61% (n=68) had melanoma, 19% (n=21) had non-small cell lung cancer, 45% (n=50) were treated using an anti-PD-(L)1 ICI, and 33% (n=37) were treated using an anti-PD-1/anti-CTLA-4 combination. The median starting SS dose was 100 mg of a prednisone equivalent, and 25% of patients required additional ISAs, with infliximab (n=15) and mycophenolate mofetil (n=9) being the most common. We found that 20% (n=22) of patients developed any infection, including 7% (n=8) with OIs (oral candidiasis [n=4], nondisseminated varicella zoster infection [n=2], PJP [n=1], and Listeria monocytogenes endophthalmitis [n=1]) and 13% (n=14) with non-OIs (most common: Clostridium difficile and pneumonia [n=5 each]). PJP prophylaxis with sulfamethoxazole/trimethoprim was given to 13% (n=14) patients, of whom 43% (n=6) developed OIs/non-OIs. Our study highlights the fundamental issues for patients on ICI therapy who require SS/ISAs for irAEs: the degree of immunosuppression and the relative risk of OI. We noted a low incidence of OIs overall and breakthrough infections despite PJP prophylaxis. We question whether PJP prophylaxis is efficacious or necessary. Prospective trials are required to answer these questions.

Prophylactic Use of Antibiotics for Fever After Drainage Removal Following a Dural Tear During Lumbar Spinal Surgery: A Retrospective Study.

BackgroundDural tear and subsequent cerebrospinal fluid leakage are frequent complications during lumbar spine surgery. This retrospective study aimed to investigate the risk factors and the use of prophylactic antibiotics in patients with fever after drainage removal (FDR) following lumbar dural tear during lumbar spinal surgery.Material/MethodsThe authors retrospectively analyzed 2812 patients who underwent different spinal surgical procedures from January 2015 to December 2017. The basic information of patients was obtained to analyze the risk factors of dural tear and FDR. The patients were divided into 5 groups according to their antibiotic strategies for FDR (no antibiotics, ceftriaxone, vancomycin, ceftriaxone+vancomycin, other antibiotics). Body temperature, laboratory test results, and pathogen profiles were collected for analysis.ResultsThere were 326 cases diagnosed as dural tear, including 198 cases of FDR. Sex, age, type of disease, and previous lumbar surgery played significant roles in the dural tear rate (P<0.05). Patients older than 60 years old had a higher incidence of FDR after dural tear (P<0.05). There was no significant difference in the incidence of surgical site infection among the various treatment groups (P>0.05).ConclusionsAge has obvious effect on dural tear and FDR, whereas sex, revision surgery, primary diagnosis, and procedure type only affect the rate of dural tear. The prophylactic use of antibiotics has no effect on the incidence of surgical site infection when fever after drainage removal occurred in patients with dural tear.

Comparison of synbiotics combined with enteral nutrition and prophylactic antibiotics as supportive care in patients with esophageal cancer undergoing neoadjuvant chemotherapy: A multicenter randomized study

Established supportive care to reduce the toxicity of neoadjuvant chemotherapy (NAC) is lacking. This multicenter randomized study compared the administration of synbiotics combined with enteral nutrition (EN) versus that of prophylactic antibiotics as supportive care treatment for patients with esophageal cancer undergoing NAC. Patients with advanced esophageal cancer scheduled to receive NAC were randomly administered either prophylactic antibiotics (antibiotic group) or synbiotics combined with EN (Syn+EN group). The primary endpoint was the febrile neutropenia (FN) incidence during the first course, and the secondary endpoints were other adverse events, changes in intestinal environment, including fecal microbiota, organic acid concentrations, pH, and chemotherapy tolerability. Eighty-one patients were enrolled. The FN incidence was nonsignificantly lower (P=0.088) in the Syn+EN group. The incidences of grade 4 neutropenia and grades 2-4 diarrhea were significantly lower in the Syn+EN group (P=0.014 and 0.033, respectively). Relative dose intensity was significantly higher in the Syn+EN group (92.0±10.9%) than in the antibiotic group (83.2±18.2%) (P=0.01). Alpfa diversity was significantly higher in the Syn+EN group than in the antibiotic after chemotherapy (P=0.002). The numbers of Bifidobacterium (P<0.05), Lacticaseibacillus (P<0.001), and Enterobacteriaceae (P<0.001) and the concentration of acetic acid (P<0.001) were significantly higher in the Syn+EN group than in the antibiotic group after chemotherapy. The severity of diarrhea and occurrence of FN were significantly correlated with Clostridioides difficile abundance and were significantly inversely correlated with acetic acid concentration after chemotherapy. Synbiotics combined with EN may be an alternative supportive care treatment to prophylactic antibiotics in patients with cancer undergoing toxic chemotherapy (https://jrct.niph.go.jp; jRCTs051180153).

Comparison of erythrocyte sedimentation rate and C-reactive protein in patients with distal radius fractures according to the prophylactic antibiotic period: 1 day versus 1 week

Purpose: Surgical site infection is a serious postoperative complication. Most surgical site infections after distal radius fracture (DRF) surgery are superficial and early-onset, and they can be prevented by prophylactic antibiotics. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are representative inflammatory markers. The aim of this study was to compare serial serum ESR and CRP levels in DRF patients according to the period of prophylactic antibiotic use.Methods: A retrospective study was conducted on 46 patients with DRF treated with internal fixation. Twenty-two patients treated between September 2019 and March 2020 were in group A and 24 patients who underwent treatment from September 2020 to March 2021 comprised group B. The patients in group A were administered the first-generation cephalosporin for 1 week, as was customary. Group B received 1-day antibiotic prophylaxis. Surgery was performed by a single surgeon using volar locking plates. The surgical wounds and serum ESR and CRP levels were examined before surgery, 2 days after surgery, and 1 week after surgery and compared between the two groups.Results: The CRP level, but not the ESR, changed significantly over time within each group. However, no statistically significant difference was observed between the two groups, and there were no surgical site infections.Conclusion: The use of prophylactic antibiotics for 1 week had no significant effect on reducing ESR and CRP compared to 1-day prophylactic antibiotics in patients with DRFs.

Evaluasi Penggunaan Antibiotika Profilaksis Operasi Digestif Laparatomi di Rumah Sakit Kota Surabaya

Laparotomy is a major operation and causes a lot of injuries, so the risk of infection of the laparotomy surgery wound is quite high. Surgical Site Infection (ILO) or Surgical Site Infection (ITP). Prevention of postoperative infection in patients with clean-contaminated surgery, and some clean operations with the use of prophylactic antibiotics. The purpose of this study was to evaluate the use of prophylactic antibiotics in patients with laparotomy surgery in a hospital in Surabaya. The research method is descriptive operational with retrospective data. The results of this study obtained as many as 160 patients aged 46-55 years at 20.6%, the sex of the respondents were dominated by male sex 66.3%, and the diagnosis of generalized peritonitis was 46.9%. The use of prophylactic antibiotics is class I cephalosporin antibiotics (cefazolin) with a dose of 1000-2000 mg, which is by the 2011 Ministry of Health guidelines.

The effect of first- and third-generation prophylactic antibiotics on hospitalization and medical expenditures for cardiac surgery

BackgroundThis study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitalizations, and medical costs.MethodsAll adult patients (≥ 20 years) undergoing cardiac surgery at one hospital from January 01, 2009, to December 31, 2016, were included in this study. A single prophylactic antibiotic was administered at a dose of 1 g within one hour of the surgical incision and for three days after surgery at eight-hour intervals. After propensity score matching, 194 patients in each antibiotic prophylaxis group (first-generation vs third-generation) were analyzed. Among the 388 patients, the incidence of surgical site infections was compared according to the type of prophylactic antibiotic, and risk factors were evaluated by chi-squared tests followed by multivariate logistic regression analysis.ResultsThe incidence of deep surgical site infections was significantly lower in the first-generation group (5.7%) than in the third-generation group (16.5%). The pathogens isolated from the surgical infection sites were similarly distributed in both groups. However, the prevalence of highly infectious gram-positive bacteria was more than that of gram-negative bacteria (67% vs 23%). The preoperative hospitalization duration, mean operation time, and ventilator use time were similar in both groups, but the postoperative hospitalization duration was significantly shorter in the first-generation group (25.5 days) than in the third-generation group (29.8 days). In addition, the medical costs were lower in the first-generation group (20,594 USD) than in the third-generation group (26,488 USD).ConclusionIn conclusion, the first-generation prophylactic antibiotic was better than the third-generation in reducing surgical site infection rates, hospitalization length, and medical expenditures.

696. Optimal Duration of Prophylactic Antibiotics in Patients with Cirrhosis and Upper Gastrointestinal Bleeding

Abstract Background Spontaneous bacterial peritonitis (SBP) is a serious complication of variceal hemorrhage. Guidelines recommend a maximum of seven days of antibiotics after variceal hemorrhage to prevent SBP and reduce rates of rebleeding and mortality. However, studies supporting these guidelines used varied durations of therapy including those with less than seven days. The objective of this study was to determine if less than seven days of antibiotic prophylaxis was noninferior to seven or more days in patients with cirrhosis and variceal hemorrhage. Methods This was a single-center, retrospective cohort conducted from August 2019 to August 2020 including adult patients who received treatment for variceal hemorrhage and antibiotics for prevention of SBP during hospitalization. Patients were excluded if they were diagnosed with non-variceal hemorrhage, received treatment with antibiotics within 72 hours prior to the variceal hemorrhage, or expired or transitioned to end of life care within 48 hours of hospital admission. The primary outcome was in-hospital mortality. Secondary outcomes included SBP within the first 30 days after variceal hemorrhage, 30-day mortality, 30-day readmission rate, incidence of rebleeding at seven and 30 days, incidence of Clostridioides difficile infection, and intensive care unit and hospital length of stay. Results 64 patients were included with 45 patients in the less than seven days group and 19 patients in the seven or more days of antibiotic prophylaxis group. In each group, patients were primarily male with a median age of approximately 60 years. There was no difference in the primary outcome of in-hospital mortality between the less than seven days group as compared to the seven or more days group (22.2% vs 0%, p=1). No difference was identified between the less than seven days group as compared to the seven or more days group for any of the secondary outcomes. Conclusion This study identified no difference in patient-centered outcomes when comparing less than seven days of prophylactic antibiotics to seven or more days in patients with variceal hemorrhage. Less than seven days of prophylactic antibiotics may be a reasonable duration for prevention of SBP. Disclosures All Authors: No reported disclosures

Prophylactic antibiotics in patients with artificial rupture of membranes during labor: (Randomized controlled clinical trial)

Abstract Background Amniotomy, also known as artificial rupture of membranes (AROMs) and by the lay description "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider. This procedure is common during labor management and has been performed by obstetrical providers for at least a few hundred years. Amniotomy during labor induction is associated with a faster time to delivery, most notably in nulliparous women, without an increase in cesarean delivery or maternal and neonatal morbidity. Shortening time to delivery is associated with decreased hospital costs and increased patient satisfaction, and therefore, early amniotomy, given the safety profile, should be considered when a faster delivery is of importance to patients and providers. Objective To determine the efficacy of prophylactic antibiotics in patient during labor on reducing maternal and neonatal morbidities. Methods This prospective randomized study was performed from January 2020 to July 2020, at maternity hospital of Ain Shams University. Informed consent was obtained from all participants. Candidates for this study included all patients with singleton gestations between 37 weeks and 41 weeks of gestation underwent artificial rupture of the membranes during active phase of labor. Gestational age was confirmed by a reliable last menstrual period, early sonogram. Amniotomy was confirmed by visualization of pooling fluid in the posterior vaginal fornix through the cervix after artificial rupture of membrane by sterile hook. Results There were no statistical significance differences between two groups regarding demographic characteristics, endometritis, cord-prolapse and abruptio placenta. Maternal septicemia was absent in both groups. Chorio-amnionitis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage were significantly less frequent in prophylaxis group. Conclusion Using of prophylactic antibiotics with amniotomy in pregnant women during labor reduced maternal and neonatal morbidities as chorio-amnionitis, endometritis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage. On the other side it had no proved protective effect against maternal septicemia, cord-prolapse and abruptio placenta.