Prophylactic Antibiotics In Surgery Research Articles

Protocol for a systematic review and network meta-analysis of the use of prophylactic antibiotics in hand trauma surgery

BackgroundThe use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery.Methods and analysisThe databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. s will be screened by two persons independently to identify eligible studies.This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device).The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies.A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta‐Analysis (CINEMA).DiscussionThis systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing.Systematic review registrationPROSPERO CRD42023429618.

The effectiveness of the appropriate prophylactic antibiotic use program for surgery

Background: Evaluation of the adequacy of prophylactic antibiotics in surgery has been implemented as a national policy in Korea since August 2007, and the appropriate use of prophylactic antibiotics has improved. However, antibiotic prescriptions that are not recommended or discontinuation of prophylactic antibiotic administration within 24 hours after surgery are still not well done. This study introduced a program to improve the adequacy of prophylactic antibiotics for surgery and analyzed its effects. Methods: We retrospectively analyzed the effectiveness of the appropriate prophylactic antibiotic use program for surgery conducted at a university hospital in Seoul. The participants were patients aged ≥18 years who underwent any of 18 types of surgery. The program started was implemented in June 2020. First, a computer system was used to confirm the antibiotic prescription recommended for each surgery. It also assessed whether the number of days of administration was exceeded, whether antibiotics were prescribed in combination, and whether antibiotics prescribed for discharge medicine were checked in 4 steps. A pop-up window appeared in each patient record to enter the reason for the prescription. If the reason was appropriate, the prescription was allowed, but if not, the prescription was restricted. In addition, infectious diseases physicians and an insurance review team visited each department to conduct an education session. To analyze the effect 3 months before activity (January–March 2020) and 3 months after activity (October–December 2020), we compared the first antibiotic administration rate within 1 hour prior to skin incision, the recommended prophylactic antibiotic administration rate, and surgery type. The rate of discontinuation of prophylactic antibiotics within 24 hours after administration and the rate of prescription of prophylactic antibiotics at discharge were compared. Results: In total, 1,339 surgeries during the study period were included in the analysis. There were 695 cases before the introduction of the program and 644 cases after the introduction. The rate of first antibiotic use within 1 hour prior to skin incision was 93.1%–99.5% (P < .001), the rate of recommended prophylactic antibiotic administration was 85.0%–99.2% (P < .001), and the rate of discontinuation of antibiotic administration within 24 hours after surgery improved from 51.8% to 98.3% (P < .001), respectively. The prescription rate of antibiotics at discharge improved from 20.7% to 0.8% (P <.001) (Table 1). Conclusions: A computerized program to improve the adequacy of prophylactic antibiotic use in surgery combined with education of medical staff was very effective.Disclosure: None

Implementation Model of The use of Prophylactic Antibiotics in Surgical Patients Hospital Type B

Infectious diseases are still one of the important public health problems, especially in developing countries. The high incidence of Antibiotic resistance due to the irrational use of antibiotics is a special concern at this time. The government is also trying to control it through the Antimicrobial Resistance Control Program, including the rational administration of prophylactic antibiotics in surgery. Prophylactic antibiotics are antibiotics given before, during, and after surgical procedures to prevent complications of infection or infection of the surgical site (IDO). A retrospective and observational (non-experimental) study to know Patient characteristics, surgical characteristics, characteristics of the use of prophylactic antibiotics, rationality and cost analysis of using prophylactic antibiotics in Sectio Caesarea surgery and Appendectomy of patients at Hospital X Type B Jakarta in the period January 1 2021 – September 30 2021. The results of the study found that the selection of prophylactic antibiotics was not right (55.8%), the timing difference for prophylactic antibiotics was not right (84.5%), the prophylactic Antibiotic dose was not right (85.3%), all were correct the route of administration of prophylactic antibiotics by intravenous drip (100%), all of which are not appropriate for giving prophylactic Antibiotic intervals (100%) and entirely irrational in the use of prophylactic antibiotics in hospitals (100%). Hospitals can save costs, reduce the rate of Antibiotic resistance and reduce the incidence of surgical site infections by increasing physician compliance in using prophylactic antibiotics under hospital guidelines.

Pengaruh Program Pengendalian Resistensi Antimikroba terhadap Penggunaan Antibiotik Profilaksis pada Bedah Obstetri dan Ginekologi

The incidence of surgical site infections (SSI) in obstetric and gynecological surgery is quite high. Rational prophylactic antibiotics in surgery are important strategies for the prevention of SSI. Antimicrobial Stewardship Program (ASP) for rational prophylactic antibiotic use has been carried out. This study aims to determine the rationality of the use of prophylactic antibiotics and incidence rate of SSI, the effect of ASP on the rationality of prophylactic antibiotics and clinical outcomes in obstetric and gynecology surgery. This study used a quasi-experimental pretest postest design without control group with retrospective data collection. Research time for 2 months from May to June 2019. The subjects of this study were obstetric and gynecology surgery patients at Pandan Arang Hospital Boyolali in 2018 who were divided into 2 groups: patients before the ASP and patients after the ASP with a total sample of 93 patients each group. An evaluation of the type, dose, time of administration, route of administration, and duration of prophylactic antibiotics were performed against the standard. Data analysis used the Pearson Chi-square test to see the relationship between rationality and clinical outcomes with ASP. The rationality of prophylactic antibiotic use increased from 0 (0%) cases before the ASP to 52 cases (55.9%) after the ASP. The SSI incidence rate before ASP was 9.7%, down to 4.3% after ASP. There was a significant relationship between the rationality of prophylactic antibiotics and ASP (p <0.05) but the relationship between clinical outcome (SSI incidence) and ASP was not significant (p> 0.05). The result of this study can be used to promote the implementation of ASP in other wards to increase rational use of antibiotics.

The Use of Prophylactic Antibiotics in Surgery for Dupuytren's Disease: A Survey of Hand Surgeons.

BACKGROUNDNational Institute for Health and Care Excellence (NICE) CG74 has set out evidence-based guidance on which types of surgery require antibiotic prophylaxis. Our aim was to establish what the current practice for antibiotic prophylaxis in Dupuytren’s surgery is amongst hand surgeons in the United Kingdom, through the British Society for Surgery of the Hand (BSSH). METHODSPermission was granted for our online survey to be distributed to BSSH hand surgeons via consecutive BSSH e-bulletins. Hand surgeons who did not perform fasciectomy or dermofasciectomy were excluded from the study. RESULTSThere were 64 respondents, represented an estimated 7.4-7.8% of membership. Eleven percent of respondents used antibiotics for fasciectomy, with an increasing trend towards revision surgery and dermofasciectomy. Over 30% prescribed them for revision dermofasciectomy. Dupuytren’s surgery was classified as clean, non-prosthetic and uncomplicated which NICE CG74 suggestions did not require antibiotic prophylaxis. CONCLUSIONThis study highlighted variation in practice amongst hand surgeons in the United Kingdom. Further consultation to create guidelines for hand surgery may help guide members and reduce potentially unnecessary prophylactic antibiotic use.

Antibiotic prophylaxis: current recommendations in plastic surgery

Guidelines for prophylactic antibiotics in surgery have long been established; however, few have focused on recommendations in plastic surgery. Surgical site infection rates remain low, yet the use of prophylactic antibiotics has surged in the past 30 years. This article summarizes current recommendations of prophylactic antibiotic use to produce consensus guidelines in plastic surgery. A literature review was conducted in the PubMed, Cochrane, and Ovid databases and studies were included if randomized controlled trials indicated a statistically significant decrease in surgical site infections. Surveys conducted by the American Society of Plastic Surgeons regarding prophylactic antibiotic use from 1975, 1985, 2000, and 2010 were compiled and analyzed. Of 143 articles found, nine randomized controlled trials showed a reduction in surgical site infections after antibiotic prophylaxis for specific plastic surgery procedures. There are evidence-based recommendations for prophylactic antibiotics in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. The proportion of plastic surgeons using prophylactic antibiotics has steadily increased from 1975 to 2010 with a significant increase from 2000 to 2010. Systemic antibiotic prophylaxis is recommended for use in breast surgery, abdominoplasty, contaminated hand or face surgery, prosthetic surgery, rhinoplasty, microsurgery, and acute and burn reconstruction cases. Recent surveys indicate that the majority of plastic surgeons continue to use prophylactic antibiotics in clean cases of the hand, face, and body despite recommendations. Additional procedure-specific randomized controlled trials are necessary to provide evidence-based recommendations for antibiotic prophylaxis in plastic surgery. Level of Evidence: Level IV, risk / prognostic study

Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behaviour in surgical prophylaxis in 6 hospitals in the metropolitan area of Monterrey, Mexico

BACKGROUND Improper use of antibiotics increases antimicrobial resistance. OBJECTIVE Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. MATERIAL AND METHODS Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. ANALYSIS Frequencies, percentages, medians, ranges and X2 test. RESULTS Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). CONCLUSIONS Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.

Evaluación del uso de antibióticos e impacto de una intervención dirigida a modificar la conducta prescriptiva en profilaxis quirúrgica en 6 hospitales del área metropolitana de Monterrey

BackgroundImproper use of antibiotics increases antimicrobial resistance. ObjectiveEvaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. Material and methodsDesign: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. Analysis: Frequencies, percentages, medians, ranges and X2 test. ResultsPhase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). ConclusionsInappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.

Educational Antimicrobial Stewardship Intervention Ineffective in Changing Surgical Prophylactic Antibiotic Prescribing.

High rates of inappropriate use of prophylactic antibiotics in surgery continue to be reported in the literature, with many institutions designing interventions aimed at improving prescription. This study evaluates the surgical arm of a clinician-focused educational antimicrobial stewardship program implemented in February 2014 at Blacktown Hospital, Australia. A before-after analysis of the surgical antibiotic prophylaxis intervention was conducted at Blacktown Hospital, New South Wales, Australia. Two hundred abdominal general surgical patients were selected via simple random sampling and categorized into pre-intervention (n = 100) and post-intervention (n = 100) groups. Antibiotic prophylaxis regimens were compared with the Australian guideline, Therapeutic Guidelines: Antibiotic (v14) with respect to drug choice, dosage, timing of administration, and duration of administration. Overall adherence rates in the pre- and post-intervention periods were 18% and 15% respectively, demonstrating no substantial change (p = 0.568). No patients in either group were administered antibiotics without an appropriate indication. There were no substantial decreases in error rates across any category, including drug choice, dosage, timing of administration, duration of administration, or re-dosing. The apparent decrease in the rate of inappropriate broad-spectrum cephalosporin usage was not statistically significant (29.3% vs. 18.8%; p = 0.16). The educational intervention studied demonstrated no substantial change to overall adherence. Given the frequent failure of such interventions, stronger and more directly mandated adoption of prescribing guidelines is recommended for surgical services. Future consideration should be given to focused computer-based solutions, integrated with electronic medical records where possible.

Prophylactic antibiotics for surgery

Prophylactic antibiotics for surgery

Cardiac implantable devices: Surveillance of surgical site infections and assessment of professional practices

A programme for quality assurance and prevention of infection risk during implantation of cardiac medical devices (pacemakers and defibrillators) was set up in our hospital. We sought to assess surgical site infection rate and compliance with infection-control practices (principally antibiotic prophylaxis). Surgical site infections associated with implanted medical devices were monitored in patients during a 6-month period and a 1-year follow-up. Professional practices concerning the use of prophylactic antibiotics in surgery were assessed. The surgical site infection rate was 2.3%. Overall compliance was 45% for the use of antibiotic prophylaxis. Optimal compliance with antibiotic prophylaxis was not reached in the present series, which demonstrated a surgical site infection rate of 2.3%. More effort must be made to achieve full compliance with preventive measures in the implantation of medical devices.

Medication Use Evaluation for Prophylactic Antibiotics in Surgery - Effects of Establishing Clinical Decision Support System

Medication Use Evaluation for Prophylactic Antibiotics in Surgery - Effects of Establishing Clinical Decision Support System

A review of evidence for prophylactic antibiotics in surgery for closed fractures

A review of evidence for prophylactic antibiotics in surgery for closed fractures

An Audit of Surgical Site Infection following Surgery for Breast Cancer

Introduction: Breast operations are considered to be “clean” procedures but infection rates range from 3 to 15%. The Cochrane review 2006 found that the use of prophylactic antibiotics in surgery for breast cancer reduced the rate of surgical site infection. We carried out an audit of practice in our Trust following the introduction of a prophylactic antibiotic regime. The results were compared to an audit in 2005.

Infection Prophylaxis Update

The use of prophylactic antibiotics in surgery has been debated for numerous years. Although their indications have been elucidated in the general surgery literature, their role in plastic surgery has yet to be clearly defined. Although the incidence of surgical site infections in clean, elective plastic surgery procedures has been reported to be as low as 1.1%, the use of antibiotics has surged over the past 20 years. Much of the increased use has been attributed to common surgical practice and fear of legal ramifications rather than empirically based data. In contrast, there remain numerous physicians who argue against routine antibiotic use in plastic surgery. This article summarizes the recent literature on infection prophylaxis and advises physicians to consider relative risks and benefits when deciding which patients should receive prophylactic antibiotics.

Prophylactic antibiotics in surgery

Abstract In the UK, it is estimated that 1 in 10 patients admitted to hospital will develop a health care- associated infection; costing the NHS an estimated £1 billion per annum. Included in these figures are approximately 4% of surgical patients who develop a surgical-site infection, adding an average of 6.5 days to their hospital stay. Prophylactic antibiotics can reduce the risk of surgical-site infections. This contribution discusses the theory behind the use of prophylaxis, including adjuncts to standard intravenous regimens and the impact of antibiotic resistance.

Prophylactic antibiotics in surgery

In the UK, it is estimated that 1 in 10 patients admitted to hospital will develop a health care- associated infection; costing the NHS an estimated £1 billion per annum. Included in these figures are approximately 4% of surgical patients who develop a surgical-site infection, adding an average of 6.5 days to their hospital stay. Prophylactic antibiotics can reduce the risk of surgical-site infections. This contribution discusses the theory behind the use of prophylaxis, including adjuncts to standard intravenous regimens and the impact of antibiotic resistance.

Use of selective media for detection of cephalothin-resistant bacteria in surgical patients.

Bacterial colonization in hospitalized patients is an important step in nosocomial infections. Frequent employment of antimicrobials can modify patients' normal microbiota, favoring colonization and infection by antimicrobial-resistant microorganisms. First-generation cephalosporins are frequently used as prophylactic antibiotics in surgery. Intestinal, oropharyngeal and skin colonization by cephalothin-resistant microorganisms were studied in 60 pre-operative patients at the Hospital Universitário Pedro Ernesto. Feces were cultured in Eosin-methylene blue medium containing 32 microg/mL of cephalothin. Swabs obtained from the oropharynx and from skin were inoculated in cistein-lactose electrolytes-deficient medium containing 32 microg/mL of cephalothin. Isolated strains were identified and tested for susceptibility to antimicrobials by disk diffusion. Cephalothin-resistant strains were isolated from the feces of 59 patients (98%), from the oropharynx of 13 patients (22%) and from skin in 10 patients (17%). Enterobacter cloacae was predominant in feces (68% of the patients) and oropharynx (13%). Acinetobacter spp. was the most frequent microorganism isolated from the skin (10%). Antimicrobial multiresistant strains were isolated from at least one of the sites in 38 patients (63%). The employment of selective medium containing antimicrobials is a relatively simple and efficient method, being useful to evaluate microorganisms from hospitalized patients' microbiota that are relevant as potential pathogens in nosocomial infections.

Prophylactic Antibiotics in Surgery and Surgical Wound Infections

Wound infection remains a considerable cause of morbidity and mortality among surgical patients, despite the relative success of prophylactic antibiotics. In modern efforts to control healthcare costs while improving the quality of patient care, we must not overlook the basic principles of wound infections and their appropriate treatment. Predisposing factors for the development of surgical wound infection include the creation of a surgical wound, the presence of bacteria, and a susceptible host. The selection of an appropriate antimicrobial drug depends on the identification of the most likely pathogens associated with a given procedure, as well as the expected antibiotic susceptibility of those pathogens. Ideally, a prophylactic antibiotic should achieve high peak tissue concentration at the site of the wound before the first incision and should be maintained until the time of closure. Currently, the administration of prophylactic antibiotics is indicated for contaminated and clean-contaminated wounds. Despite the proven effectiveness of antibiotic prophylaxis, many researchers would argue that contemporary dosing regimens should be reevaluated. The debates concerning the dosage and timing of ideal prophylactic administration are likely to continue.

Prophylactic antibiotics in surgery.

Prophylactic antibiotics can decrease the incidence of postoperative wound infections in indicated procedures. The accepted indications for administering prophylactic antibiotics have been clean-contaminated procedures and prosthesis insertion, but new indications are evolving that consider wound contamination together with anesthetic risk and relative duration of the operation. A prophylactic antibiotic is chosen on the basis of its activity against endogenous flora likely to be encountered, its toxicity, and its cost, in that order. Potent antibiotics used for serious infections are generally not used for prophylaxis. A maximum dose of a prophylactic antibiotic is given preoperatively so that effective tissue concentration is present at and after the time of incision. In the absence of infection, antibiotics should not be continued beyond the operative day. Regimens for specific procedures are discussed.