Routine Antibiotic Prophylaxis Research Articles

BN SO48 - Antibiotic prescribing for elective inguinal hernia repairs

Abstract Background Inguinal hernia repairs are a common procedure with over one million operations performed annually in Europe and the US. The European Hernia Society do not recommend the routine use of antibiotics in low-risk patients due to no significant benefit. They advise the consideration of prophylaxis for patients with risk factors including recurrence, age > 70 years or immunosuppression. Many surgeons are using antibiotic prophylaxis in all patients. However, inappropriate antibiotic use contributes to increased antibiotic resistance and increased healthcare cost. Our trust guidelines recommend a single dose of Cefuroxime in all patients undergoing an inguinal hernia repair with mesh. Method The aim of the project was to determine the compliance with current trust guidelines regarding antibiotic use in elective inguinal hernia repair with mesh. We also aimed to report on antibiotic prescribing patterns. Patients undergoing an elective inguinal hernia repair with mesh over a six-month period were identified. Data was collected retrospectively from electronic patient records and included patient’s age, if they were classed as high risk (age over 70, recurrence of hernia, diabetic, steroid therapy), if antibiotics were prescribed, and if so, which antibiotics were utilised. Results Eighty-five patients were included in the final data analysis. The median age of patients included was 67 years of age, and 93% were male. 41 patients were identified as high risk, and most patients were ASA II. Our results reported that 48% of patients were prescribed prophylactic antibiotics at induction. However, only two patients were prescribed the correct antibiotic, as per trust guidelines. Most patients were prescribed Co-Amoxiclav (78%), with a range of other antibiotics being used, including Flucloxacillin, Clarithromycin and Metronidazole. We identified 37% of high-risk patients were not prescribed antibiotics. Conclusion Our trust guidelines were not reflective of best practice and did not consider individual patient or procedure risk factors. We identified varied antibiotic prescribing patterns with low compliance to trust guidelines. Utilising our findings, we have created new guidelines, which recommend that in low-risk patients, routine antibiotic prophylaxis is not required. However, in the presence of patient-related risk factors as mentioned above, then a single dose of Cefuroxime is recommended. The updated guidelines will ensure good antimicrobial stewardship and reduce unnecessary antibiotic prescriptions. In addition, they accurately reflect the current evidence base surrounding antibiotic prophylaxis.

Routine antibiotic prophylaxis and early implant failure: is there a link?

A systematic search was conducted across multiple databases (PubMed via MEDLINE, Cochrane Library, and Web of Science) up to October 1st, 2023. Manual screening of reference lists was performed, alongside searches in clinical trial registries to ensure comprehensive coverage. Only randomized controlled trials (RCTs) that compared antibiotic prophylaxis with no antibiotics or placebo in systemically healthy individuals undergoing dental implant surgery were included. Studies with a high risk of bias, non-randomized studies, and those without a placebo or control group were excluded. Studies focusing on medically compromised patients or other implant techniques (such as mini-implants or immediate placement in sites with apical pathology) were also excluded. Data extraction was carried out independently by two authors, with disagreements resolved through discussion among all review authors. The risk of bias for each included randomized controlled trial (RCT) was evaluated using the Cochrane Risk of Bias tool (RoB-2). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analyses were conducted using a random-effects model, and heterogeneity was checked with both the I² statistic and Q test. A total of 1267 studies were initially identified, with seven randomized controlled trials (RCTs) ultimately meeting the inclusion criteria, comprising data from 1,859 participants and 3014 implants. Four studies were high quality, and three were of moderate quality. Meta-analyses of these studies showed no statistically significant association between the use of antibiotic prophylaxis and a reduction in early dental implant failure (RR: 0.66, 95% CI: 0.30-1.47). The number needed to treat (NNT) to prevent one implant failure was 143, indicating a limited effect of antibiotics in preventing early implant failure. The study concluded that routine antibiotic prophylaxis does not significantly reduce the risk of early implant failure in medically fit patients. Given the very limited benefit and the concern of increasing antibiotic resistance, routine use of antibiotics in dental implant surgery should be avoided.

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

IntroductionDog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given? MethodsA structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed. ResultsA total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days. ConclusionHigh-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed. Level of EvidenceLevel II – systematic review.

Safety Study of Percutaneous Gastroscopic Gastrostomy in Patients After Ventriculoperitoneal Shunt.

To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt. We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge. In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications. Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure.

Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery

Although the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics. To compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine. This was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included. Povidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears. Postoperative endophthalmitis incidence. Postoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000). No difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.

Ureterorenoscopic Stone Removal without Antibiotic Prophylaxis

Introduction: The aim of this study was to assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection undergoing ureterorenoscopy (URS) for stone removal. Methods: A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship. Patients with preoperative unremarkable urine culture received no antibiotic prophylaxis for URS stone removal (NoPAP). The NoPAP group was compared to a historic URS cohort, when antibiotic prophylaxis (PAP) was standard of care. Analysis focused on postoperative complications. Results: Postoperative fever occurred in 1% of the NoPAP and 2% of the PAP patients (p = 0.589). Clavien 1–3 complications did not differ between groups with 9% in the NoPAP and 6.2% in the PAP (p = 0.159). No Clavien 4–5 complications were seen. We identified a residual stone (p = 0.033) and an ASA score 3–4 (p = 0.004) as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis, the overall antibiotic usage was reduced from 100% (PAP) to 8.3% (NoPAP). Conclusion: Sparing a routine antibiotic prophylaxis during URS for stone removal seems feasible in patients with unremarkable preoperative urine culture for most of the patients. A prospective validation is warranted.

Antibiotic Prophylaxis Prior to Dental Procedures After Total Hip and Knee Arthroplasty Does Not Decrease the Risk of Periprosthetic Joint Infection

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication after total hip and total knee arthroplasty (THA/TKA). While some guidelines no longer recommend routine use of prophylactic antibiotics for dental procedures, many surgeons continue to prescribe antibiotics for their THA/TKA patients. In a setting of increasing antibiotic resistance, it is important to reduce unnecessary antibiotic use. This study aims to evaluate antibiotics prior to dental procedures and the association between dental procedures and PJI. MethodsWe conducted a retrospective cohort study of patients who underwent THA/TKA between January 1, 2019 and December 31, 2020. The primary outcome was late-presenting PJI, occurring > 90 days after surgery. Patients were designated in the antibiotic group (2,000 mg of amoxicillin) or non-antibiotic group based on their surgeon’s prophylaxis protocol. Dental-associated PJIs were considered if the patient had evidence of poor dentition or a recent dental procedure prior to the onset of PJI symptoms. ResultsThere were 2,871 (26.4%) patients in the no antibiotics group and 8,023 (73.6%) patients in the antibiotics group. We found 27 (0.3%) late-presenting PJIs and 4 dental-associated PJIs. In the univariate and multivariable analyses, body mass index ≥-30 and revision surgery were the only variables that increased the odds of late-presenting PJI. All 4 dental-associated PJIs occurred in patients prescribed antibiotics. ConclusionsWe found a low rate of late-presenting PJI. Routine antibiotics prior to dental procedures were not shown to affect the risk of late-presenting PJI. These findings suggest that routine antibiotic prophylaxis before dental procedures is not necessary after THA/TKA.

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.

Treatment with gentamicin-impregnated collagen sponges in reducing infection of implantable cardiac devices: 10-year analysis with propensity score matching

Introduction and ObjectivesThe incidence of device infection has increased over time and is associated with increased mortality in patients with cardiac implantable electronic devices (CIEDs). Gentamicin-impregnated collagen sponges (GICSs) are useful in preventing surgical site infection (SSI) in cardiac surgery. Nevertheless, to date, there is no evidence concerning their use in CIED procedures. Our study aims to determine the effectiveness of treatment with GICSs in preventing CIED infection. MethodsA total of 2986 adult patients who received CIEDs between 2010 and 2020 were included. Before device implantation, all patients received routine periprocedural systemic antibiotic prophylaxis. The study endpoints were the CIED infection rate at one year and the effectiveness of the use of GICSs in reducing CIED infection. ResultsAmong 1524 pacemaker, 942 ICD and 520 CRT implantations, CIED infection occurred in 36 patients (1.2%). Early reintervention (OR 9 [95% CI 3.180–25.837], p<0.001), pocket hematoma (OR 11 [95% CI 4.195–28.961], p<0.001), diabetes (OR 2.9 [95% CI 1.465–5.799], p=0.002) and prolonged procedural time (OR 1.02 [95% CI 1.008–1.034], p=0.001) were independent risk factors for CIED infection. Treatment with GICSs reduced CIED infections significantly ([95% CI −0.031 to −0.001], p<0.001). ConclusionsThe use of GICSs may help in reducing infections associated with CIED implantation.

PD38-05 IS ROUTINE ANTIBIOTIC PROPHYLAXIS REQUIRED FOR TRANSPERINEAL PROSTATE BIOPSY?

You have accessJournal of UrologyCME1 Apr 2023PD38-05 IS ROUTINE ANTIBIOTIC PROPHYLAXIS REQUIRED FOR TRANSPERINEAL PROSTATE BIOPSY? Apoorv Dhir, Alexander Zhu, Ji Qi, Stephanie Ferrante, Kevin Ginsburg, Alice Semerjian, Craig Rogers, Amit Patel, Brian Stork, Arvin George, and For the Michigan Urological Surgery Improvement Collaborative Apoorv DhirApoorv Dhir More articles by this author , Alexander ZhuAlexander Zhu More articles by this author , Ji QiJi Qi More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Craig RogersCraig Rogers More articles by this author , Amit PatelAmit Patel More articles by this author , Brian StorkBrian Stork More articles by this author , Arvin GeorgeArvin George More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal prostate biopsy (TPBx) has successfully reduced the risk of infectious complications compared to the transrectal approach. Contemporary guidelines continue to recommend antibiotic prophylaxis due to potential rectal/skin flora contamination or entry into the urinary tract; however, this inherently risks escalating antimicrobial resistance. We sought to evaluate the current practice patterns of antibiotic prophylaxis (ATB) for TPBx and the associated rates of infectious complications. METHODS: Men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) prostate cancer registry who underwent non-fusion (systematic) TPBx between 2017 and 2022 were analyzed. Patient demographics, disease characteristics, and peri-procedural outcomes were assessed. The primary outcome was infectious complications after TPBx. Infections were defined as fever, sepsis, and/or UTI. RESULTS: We identified 2212 men who underwent non-fusion (systematic) TPBx in the study period, 669 (30%) of whom did not receive ATB for TPBx (Table 1). The yearly percentage of patients with no ATB rose from 0.81% in 2017 to 65.6% in 2022 (Figure 1). Between patients with ATB and no ATB, there were no statistically significant difference in rates of infection (0.65% vs 0.45%, p=0.77) or infectious hospitalizations (0.32% vs 0.45%, p=0.70). CONCLUSIONS: Use of antibiotic prophylaxis for TPBx has decreased over time in the state of Michigan. Antibiotic prophylaxis was not associated with rates of infection and infectious hospitalizations after transperineal fusion biopsy. Source of Funding: funding from Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e994 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Apoorv Dhir More articles by this author Alexander Zhu More articles by this author Ji Qi More articles by this author Stephanie Ferrante More articles by this author Kevin Ginsburg More articles by this author Alice Semerjian More articles by this author Craig Rogers More articles by this author Amit Patel More articles by this author Brian Stork More articles by this author Arvin George More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials.

Ultrahigh molecular weight polyethylene (UHMWPE) is widely used in total joint arthroplasties as a load-bearing surface. Periprosthetic joint infections, the majority of which occur shortly after joint replacement, constitute almost 25% of total knee revision surgeries, and the complete eradication of bacterial infection poses a major challenge. A promising way to tackle this problem is to ensure the local sustained delivery of antibiotic concentrations sufficient to inhibit the bacteria to support routine systemic antibiotic prophylaxis. There is increased research into the development of efficient local drug delivery devices. Although established antibacterial testing methods for drugs can be used to test the antibacterial efficacy of drug-eluting materials, they are lacking in terms of providing real-time and longitudinal antibacterial efficacy data that can be correlated to the elution profiles of antibiotics from these devices. Here, we report a direct and versatile methodology to determine the antibacterial efficacy of antibiotic-eluting UHMWPE implants. This methodology can be used as a platform to avoid bacterial culture at each time point of a lengthy experiment and can also be adapted to other local drug delivery devices.

Інфекційний ендокардит у дітей із вродженими вадами серця: важливість стану ротової порожнини

The health of the oral cavity and cardiovascular system are closely related. Bacteria from the oral cavity can enter the bloodstream and cause infectious endocarditis (IE). Children with artificial valves or artificial material used during surgical procedures and cyanotic congenital heart defects (CHD) are particularly vulnerable. Purpose - to summarize literature data on the need of prevention of IE in healthy children and in children with CHD before dental interventions; to determine whether prophylactic antibiotic therapy should be routinely prescribed to children without CHD and children with corrected and uncorrected CHD. It is important to understand why IE affects particularly the valves. Bacteria spread with the blood stream and settle down on valves with a rough surface (prosthetic or anatomically altered). The peculiarity of the blood supply to the valves and the individual state of the patient's immune system determine the difficulty of fighting against the infection. According to the literature data, children with CHD are at greater risk of developing caries due to insufficient mineralization of primary tooth enamel, reduced saturation, and cardiac medications they take reduce salivation, thus increasing the risk of caries. Children with CHD and poor oral health have a high risk of developing oral bacteraemia and a greater risk of developing IE compared to children CHD and satisfactory oral health. Scientists concluded that, in fact, low-grade accumulative bacteremia is associated with daily brushing, flossing and chewing and is much more likely to cause IE compared to a one-time dental intervention. Therefore, it is concluded that maintaining optimal oral health plays a much more important role in reducing the frequency of IE than routine antibiotic prophylaxis for all dental interventions. Conclusions. Individual and professional hygiene and dental treatment should be carried out routinely for all children, regardless of age and concomitant pathology. Dental caries and its complications, as well as periodontitis serve as a potential source of bacteremia that threatens by the development of IE, which is simply - sepsis with a focus in the heart. Children who are not at risk of developing IE should not be routinely prescribed prophylactic antibiotic therapy. Instead, children with corrected and uncorrected CHD are at increased risk of developing IE and therefore require prophylactic antibiotic therapy during and after dental procedures. No conflict of interests was declared by the authors.

Preoperative antibiotic prophylaxis in mastectomy: A retrospective comparative analysis of 1413 patients with breast cancer.

The reported rate of surgical site infections (SSIs) in breast cancer surgery varies widely in previous literature. The use of antibiotic prophylaxis is controversial but recommended by several guidelines. The aim of this study was to evaluate the efficacy of routine antibiotic prophylaxis in patients with breast cancer undergoing mastectomy. In this retrospective single-institution study, we reviewed 1413 consecutive female breast cancer patients who underwent mastectomy and/or axillary lymph node surgery between years 2012 and 2019. Prophylactic antibiotics for all patients undergoing mastectomy was introduced in our hospital in 2016 and before that the prophylaxis was prescribed individually on surgeons' preference. All patient records for 30 postoperative days were evaluated in detail and all SSIs were recorded. The rate of SSIs was compared between patients who received antibiotic prophylaxis and those who did not. A multivariate logistic regression model was used to define the odds ratio (OR) for the efficacy of antibiotic prophylaxis. A total of 335 patients underwent mastectomy without antibiotic prophylaxis and 1078 with prophylaxis. The rate of SSIs was 6.9% in patients who received prophylaxis and 6.3% in patients without prophylaxis (p = 0.70). The rate of SSIs was similar before and after the introduction of regular antibiotic prophylaxis and there was no difference in any of the patient subgroups investigated. In multivariable logistic regression analysis, the OR for antibiotic prophylaxis was 1.04 (95% CI: 0.62-1.73, p = 0.88). Routine use of antibiotic prophylaxis did not reduce the rate of SSIs in mastectomy. Unselective antibiotic prophylaxis for all patients does not seem mandatory in mastectomy.

A COMPARATIVE STUDY OF MANAGEMENT OF SEPTOPLASTY WITH AND WITHOUT ANTIBIOTIC COVER POSTOPERATIVELY

Objective: The septum is the cartilage that divides the nostrils of the nose. It usually lies in the middle and equally separates the nostrils. However, this is not the case with all. Many individuals have a septum that is uneven, causing one nostril to be bigger than the other. A deviated septum is a severe unevenness. It may lead to health problems including a plugged nose or trouble breathing. The aim of the study was to study role of the antibiotics in post-operative period after septoplasty and to compare complications with and without pre- and post-operative antibiotics. Methods: It was a prospective longitudinal and comparative type study. The present study was carried out on 60 patients with microscopically evident deviated nasal septum and was listed for septoplasty. Patients were divided into three groups: Group A, Group B, and Group C. Alternate patients were randomized in Group A, Group B, and Group C, respectively, with each group is 20 patients. The study was conducted in the Department of Otorhinolaryngology in Nalanda Medical College and Hospital, during the period of January 2019 to December 2020. Results: The present study included 60 patients among them 39 were male (65%) and 21 female (35%) with a male to female ratio of 1.85:1. In the present study, while analyzing pre-operative NOSE score, it showed that maximum 37 (61.7%) patients showed significant problem (3). Mild (1) and Moderate (2) problem was observed in 8 (13.3%) and 6 (10%) patients, respectively. Severe (4) problem was observed in 9 (15%) patients. Post-operative NOSE score showed a significant improvement after septoplasty in almost every case irrespective of groups. Conclusion: We conclude that infections after elective nasal surgery in healthy patients rarely occur, making routine antibiotic prophylaxis redundant. Patients who are immunocompromised, those with valvular heart disease, or patients otherwise susceptible to infections should receive antimicrobial prophylaxis even for simple procedures, as bacteremia may occur during nasal procedures.

Routine Postoperative Antibiotic Prophylaxis Offers No Benefit after Hepatectomy-A Systematic Review and Meta-Analysis.

Background: Prophylactic antibiotics are frequently administered after major abdominal surgery including hepatectomies aiming to prevent infective complications. Yet, excessive use of antibiotics increases resistance in bacteria. The aim of this systematic review and meta-analysis is to assess the efficacy of prophylactic antibiotics after hepatectomy (postoperative antibiotic prophylaxis, POA). Method: This systematic review and meta-analysis were completed according to the current PRISMA guidelines. The protocol has been registered prior to data extraction (PROSPERO registration Nr: CRD42021288510). MEDLINE, Web of Science and CENTRAL were searched for clinical reports on POA in hepatectomy restrictions. A random-effects model was used for synthesis. Methodological quality was assessed with RoB2 and ROBINS-I. GRADE was used for the quality of evidence assessment. Results: Nine comparative studies comprising 2987 patients were identified: six randomized controlled trials (RCTs) and three retrospectives. POA did not lead to a reduction in postoperative infective complications or have an effect on liver-specific complications—post-hepatectomy liver failure and biliary leaks. POA over four or more days was associated with increased rates of deep surgical site infections compared to short-term administration for up to two days (OR 1.54; 95% CI [1.17;2.03]; p = 0.03). Routine POA led to significantly higher MRSA incidence as a pathogen (p = 0.0073). Overall, the risk of bias in the studies was low and the quality of evidence moderate. Conclusion: Routine POA cannot be recommended after hepatectomy since it does not reduce postoperative infection or liver-specific complications but contributes to resistance in bacteria. Studies into individualized risk-adapted antibiotic prophylaxis strategies are needed to further optimize perioperative treatment in liver surgery.

Infectious complications of induction treatment for acute myeloid leukaemia using the "7 + 3" protocol without antibiotic prophylaxis - 15 years of experience of one clinical site.

Infectious complications during induction chemotherapy of acute myeloid leukaemia are very common. Prophylactic use of antibiotics however is an ongoing challenge in this situation due to bacterial multi-drug resistance. The aim of this study was to provide a comprehensive overview of the incidence of infectious complications in patients with AML undergoing induction therapy using the "7+3" protocol without routine antibiotic prophylaxis at one clinical site providing specialised haematological care in the Czech Republic, over a period of 15 years. The study also evaluates the aetiological spectrum of causative agents and the development of antibiotic resistance in the context of the use of the various classes of antibiotics. The analysis includes evaluation of the importance of risk factors for infectious complications and their impact on treatment of the underlying disease. The data are compared with published figures for similar cohorts of patients. This study presents a retrospective analysis of infectious complications in 242 patients with acute myeloid leukaemia undergoing the first cycle of induction therapy without routine antibiotic prophylaxis in one clinical site in Czech Republic during years 2006-2020. A total of 363 febrile episodes (FE) were recorded. At least 1 FE during the induction was detected in 229 (94.6%) patients. Clinically defined infection was the cause in 96 (26.4%) FEs and blood stream infection in 69 (19.0%) FEs. Both complications occurred simultaneously in 29 (8.0%) FEs. 169 (46.6%) FEs were evaluated as fever of unknown origin (FUO). The achievement of complete remission had a significant effect on the duration of the FE (6 vs. 9 days, P=0.0005) and on the overall survival duration (79.3 vs. 6.5 months, P<0.0001). Patients diagnosed with infection or FUO at diagnosis were significantly more likely to suffer from colonisation by multi-drug resistant bacterial strains at discharge (29.2% vs. 16.3%, P=0.022). This group of patients used antibiotic therapy for a significantly longer time (35 vs. 23 days, P<0.0001). Infection was a contributing cause of death in 18 (7.4%) patients. Mortality was significantly related to the failure to achieve complete remission (P<0.0001). Infectious mortality during induction treatment without routine antibiotic prophylaxis was comparable to the published cohorts with prophylaxis. Regular microbiology surveillance with adequate initial antibiotic treatment can compensate routine antibiotic prophylaxis with slower development of antibiotic resistance.

Effect of Antibiotic Prophylaxis on Surgical Site Infection in Thyroid and Parathyroid Surgery: A Systematic Review and Meta-Analysis.

Thyroid and parathyroid surgery are considered clean procedures, with an incidence of surgical site infection (SSI) after thyroidectomy ranging from 0.09% to 2.9%. International guidelines do not recommend routine antibiotic prophylaxis (AP), while AP seems to be employed commonly in clinical practice. The purpose of this systematic review is analyzing whether the postoperative SSI rate in thyroid and parathyroid surgery is altered by the practice of AP. We searched Pubmed, Scopus, the Cochrane Library, and Web of Science (WOS) for studies comparing AP to no preoperative antibiotics up to October 2021. Data on the SSI rate was evaluated and summarized as relative risks (RR) with 95% confidence intervals (95% CI). Risk of bias of studies were assessed with standard methods. Nine studies (4 RCTs and 5 nRCTs), including 8710 participants, were eligible for quantitative analysis. A meta-analysis showed that the SSI rate was not significantly different between AP and no preoperative antibiotics (SSI rate: 0.6% in AP vs. 2.4% in control group; RR 0.69, 0.43–1.10 95% CI, p = 0.13, I2 = 0%). A sensitivity analysis and subgroup analysis on RCTs were consistent with the main findings. Evidence of low quality supports that AP in thyroid and parathyroid surgery produce similar SSI rates as to the absence of perioperative antibiotics.

Antibiotic Prophylaxis in Torso, Maxillofacial, and Skin Traumatic Lesions: A Systematic Review of Recent Evidence.

Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.

A National Survey of Endophthalmitis Prophylaxis during Cataract Surgery in Pakistan: A 2020 Perspective

Purpose: To assess national endophthalmitis prophylaxis practice patterns during phacoemulsification surgery in Pakistan. Study Design: Cross sectional survey. Place and Duration of Study: Eye units registered with the British Pakistani Ophthalmic Society (BPOS) between September and November 2020. Methods: A survey-based cross sectional study was conducted in Pakistan between September and November 2020. A proforma was designed using a survey client (Survey Monkey) and distributed to the eye units registered with the British Pakistani Ophthalmic Society (BPOS). The survey explored demographic factors, current antibiotic prophylaxis practice during cataract surgery and audit practice in Pakistan. Results: A total of 339 respondents completed the survey. The survey was representative of ophthalmic surgeons working in the major provinces of Pakistan. A small majority of ophthalmic surgeons provided some form of routine antibiotic prophylaxis (n = 140, 53.8%). Povidone iodine 5% (PVP-I) solution on skin and in the conjunctival sac proved the most popular protocol (n = 163, 66.3%). This was followed by immediate postoperative topical antibiotics (n = 101, 41.1%). Intracameral antibiotic prophylaxis accounted for less than half of current antibiotic practice during cataract surgery in Pakistan (n=99, 40.3%). Most of the respondents did not conduct any audit regarding endophthalmitis (n = 119, 55.6%). Conclusion: Our survey provides an up-to-date view on the state of antibiotic prophylaxis during cataract surgery in Pakistan and highlights several areas for improvement. This includes policy changes to increase adherence to gold standard antibiotic prophylaxis guidelines, improvement in transparency of surgical outcomes and to audit current postoperative outcomes. Key Words: Acute postoperative endophthalmitis, Surgical wound infection, Antibiotic, Cataract, Pakistan.

Antibiotic Prophylaxis for the Medically Compromised Dental Implant Patient.

In the 47(4), August 2021 issue of Journal of Oral Implantology, the editorial asked, “What is the proper antibiotic prophylaxis regimen for dental implant placement?” Considerations were the following:This editorial will examine relevant literature regarding the need for possible additional postoperative antibiotic doses in medically compromised patients. The benefits of administering antibiotic prophylaxis both pre- and postoperatively are often misunderstood and can lead to irrational expectations and unnecessary use. The principles of antibiotic prophylaxis are well-known; however, they are not frequently followed. Pre- and postoperative antibiotic prophylaxis are beneficial only in select clinical scenarios. Proper antibiotic prophylaxis use is beneficial in patients with a compromised immune system, but unnecessary use may cause adverse effects. Implant clinicians must be aware of the indications and contraindications for postoperative antibiotic prophylaxis. Prophylactic antibiotics are indicated to diminish or eliminate surgical site and metastatic bacteremia in high risk patients.2Clinicians take precautionary steps to assure successful implant treatments. However, arbitrary antibiotic use is unacceptable and may not lead to better implant success rates, but rather increase the risk of failure due to the overgrowth of nonsusceptible microorganisms. Binanhmed et al3 found there was no greater efficacy observed with a 7-d postoperative antibiotic therapeutic course vs. a single preoperative dose.Lockhart et al4 performed a systematic literature search addressing antibiotic prophylaxis for invasive dental procedures in patients with 8 controversial medical conditions (or devices) who are traditionally given pre- and postoperative antibiotic prophylactic doses. The conditions and devices were (i) cardiac-native heart valve disease, prosthetic heart valves, and pacemakers; (ii) hip, knee, and shoulder prosthetic joints; (iii) renal dialysis shunts; (iv) cerebral fluid shunts; (v) vascular grafts; (vi) immunosuppression secondary to cancer and chemotherapy; (vii) insulin dependent (type 1) diabetes mellitus; and (viii) systemic lupus erythematosus. The practice of prescribing postoperative antibiotics is driven by long-standing dogma and habit, medicolegal concerns, and the potentially devastating consequences of infection in some patients. The weight of evidence suggests that the practice of routine antibiotic prophylaxis for many of the patients in these groups should be re-evaluated. The focus should be directed towards daily, thorough oral hygiene to purposefully reduce chronic oral bacteremia.4 There is a lack of evidence regarding the benefits of prolonged antibiotic prescribing; however, there is a problem of identifying patients at high risk, and there is no well-defined list of dental procedures that increase the patient's inherent danger. Therefore, prospective, randomized placebo-controlled clinical trials are needed to guide clinicians in making confident antibiotic prescribing recommendations regarding which patients and implant procedures represent a significantly increased risk of distant site infections.4Based on information currently available in the peer-reviewed literature, it would be incorrect to say that all medically compromised patients require postoperative antibiotic coverage for 7–10 d. Understanding the severity of a patient's compromised immune response will guide the need for postoperative antibiotic coverage and thus prevent some distant site infections. It is unreasonable to expect a dental implant clinician to have the ability, skills, or knowledge to evaluate which patients may or may not benefit from postoperative antibiotic coverage. The patient's physician would be the professional most likely able to determine the value in providing additional antibiotics in these cases. Physicians have the responsibility of understanding how to effectively evaluate a patient's immune risk.It would be clinically wrong to provide all medically compromised patients postoperative antibiotic therapy. Overprescribing antibiotics can lead to (i) an increased risk of superinfections, (ii) promotion of antibiotic-resistant microorganisms that could induce damage to hosts and the microbial ecological niche, and (iii) encouragement of careless or inept surgical techniques. When antibiotics are not used prudently, there may be an increased probability of antibiotic-induced allergies and toxic reactions. Remember, if no antibiotic prophylaxis is provided, there are no drug-related adverse effects to be harmful. However, ignoring the use of antibiotics 100% of the time would be negligent and may lead to poor clinical outcomes in some patients due to unnecessary infections.5For the medically compromised patient, a consultation with the patient's physician is necessary to determine whether postoperative antibiotic prophylaxis is required to prevent a systemic infection from the proposed invasive dental implant procedure. The consultation with the physician should begin with the implant clinician explaining what is to be done, how aggressive the intended procedure is, and what the expected procedural or surgical time is. Providing this information is the responsibility of the implantologist. The physician's responsibility is to provide guidance regarding the nature and risks of the patient's medical condition(s), and if the current treatment is optimized. Once the consultation has been completed, a well-informed decision regarding the need for a single preoperative dose or longer postoperative prophylactic antibiotic prescribing can be made.