Routine Antibiotics Research Articles

Antibiotic Stewardship for Ambulatory Urological Procedures: Cystoscopy and Vasectomy.

We evaluated physician adherence to antibiotic stewardship for outpatient cystoscopy and vasectomy, which are associated with a low risk of infection and for which prophylactic antibiotics are not routinely recommended. We used Truven Health MarketScan® data to identify individuals who underwent diagnostic cystoscopy or vasectomy between 2009 and 2015. Prophylactic antibiotic use was captured within a 30-day preprocedural window for oral and a 24-hour preprocedural window for parenteral medication, respectively. We assessed demographic and clinical characteristics such as geographic location as possible covariates impacting preprocedural antibiotic use. Trends in antibiotic use and the impact of covariates were determined using logistic regression models with SAS® v9.4 software. Significance was set as 2-tailed p <0.05. During the study period 1,060,199 cystoscopy and 433,013 vasectomy claims were processed. Prophylactic antibiotics were used in 38% of all cystoscopies and 16% of all vasectomies. Antibiotic use increased throughout the study period for cystoscopy (34.9% to 45.2%, p=0.002) and vasectomy (15.8% to 19.5%, p=0.032). On multivariable analysis younger age and geographic residence in the South were the most important predictors of antimicrobial prophylaxis use for cystoscopy while older age, higher Charlson comorbidity index score and geographic residence in the South were associated with an increased likelihood of prophylactic antibiotic use for vasectomy. Despite evidence-based recommendations against routine prophylactic antibiotics for uncomplicated office procedures like cystoscopy and vasectomy, antibiotic use has increased over time. Overuse of antibiotic prophylaxis has implications for antibiotic resistance and changes in normal microbial flora.

Clinical profile of patients with post-caesarean wound infection: experience of Patan Hospital, Nepal

Introduction: Would infection following caesarean delivery adds physical, psychological, and health burden to individual and health care system. This hospital based study aim to determine the rate of infection, the risk factors, pathogens and antibiotic sensitivity.&#x0D; Method: A prospective study was carried out to analyze the wound infection in women following caesarean delivery in the Department of Obstetrics and Gynecology, Patan Hospital, Nepal, between January 2018 to December 2018. The study was approved from the institutional review committee. Clinicodemographic data during perinatal period of caesarean delivery were descriptive analyzed in relation to wound infection.&#x0D; Result: Wound infection occurred in 102 (3.1%)of 3285 caesarean section (of total 7131 deliveries during the study period. The caesarean SSI rate was 3.1%, all were incisional SSI (84 superficial and 18 deep) and there were no organ-space SSI. Majority (81.3%) SSI cases were detected in emergency LSCS. Coagulase Negative Staphylococci was the most common organism isolated from wound swab. Routine postoperative antibiotics did not have a major impact in reducing wound infection rate. Multiple per vaginal examinations, prolonged rupture of membrane and staples for skin closure were more commonly associated with SSI.&#x0D; Conclusion: Reduction in caesarean rate is the major key factor for decreasing the post caesarean wound infection. Protocol should be developed and strictly implemented by all the health care professionals in order to minimize and prevent the infection rate after caesarean section.

Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States.

Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development. We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules. GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3-21.1) outpatient visits and 10.2 (95% CI, 9.0-11.5) antibiotic prescriptions per 1000 US persons aged 0-64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3-105.3) visits and 53.2 (95% CI, 45.2-62.5) antibiotic prescriptions per 1000 children ages 3-9 years, annually, representing 5.9% (95% CI, 5.1-7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9-30.8) outpatient visits and 16.1 (95% CI, 14.0-18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization's 80% efficacy target could prevent 5.4% (95% CI, 4.6-6.4%) of outpatient antibiotic prescriptions among children aged 3-9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0-19.6%) of outpatient antibiotic prescriptions among children aged 3-9 years could be prevented. An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.

Organisms causing urinary tract infections in children and their sensitivity pattern in a level 2pediatric hospital at a district place in South India

Background: Urinary Tract Infection is second the common bacterial infection affecting children. Resistance to routine antibiotics for treating CA-UTI is on the rise. It is necessary to determine the antibiotic sensitivity patterns of uropathogensin a particular region to prevent complications of UTI and to determine empirical antibiotic. Aims: To evaluate the bacteriological profile and antibiotic sensitivity patterns in children with urinary tract infections Setting and Design: Retrospective observational study conducted over a period of 2 years in a level 2 pediatric hospital at a district place in South India Materials and methods: Children between the ages of one day and 13 years who had UTI over a period of 2 years from 01 Jan 2018 to 31 Dec 2019 were included in the study. Urine specimens with the growth of single organism of >105/ml were studied forvariousuropathogens and their sensitivity patterns. Statistical analysis: All the data obtained were presented in percentages and frequencies using Microsoft excel. Results: Out of 446 urine samples, 139 children were positive for pathogenic organisms. Escherichia coli constituted for 118 (84%) organisms followed by Proteus Mb 12 (8.6%) and Klebsiella sp 9 (6.4%).The organisms were found to be most sensitive to Amikacin (98%), Gentamicin (66%), and Ofloxacin (55%.). Conclusion: E.coli is the leading pathogen causing UTI in children. It is highly sensitive to amikacin and is resistant to most of the commonly used antibiotics. This knowledge is necessary to treat UTI empirically in the local population.

Frequency of urinary tract infection in children with antenatal diagnosis of urinary tract dilatation

BackgroundNeonates with congenital urinary tract dilatation (UTD) may have an increased risk of urinary tract infections (UTI). At present, the management of these patients is controversial and the utility of...

3:27 PM Abstract No. 102 Infectious complications and postprocedural antibiotics following initial percutaneous biliary drainage for patients with endoscopically placed stents

To evaluate the risk of cholangitis and role of postprocedural antibiotics for patients with endoscopic biliary stents (EBS) undergoing initial percutaneous biliary cholangiography and drainage (PTC). Retrospective review identified all adult patients undergoing initial PTC without preprocedural evidence of cholangitis over an 18-month period at a large academic center. Cholangitis was defined as fever ≥ 38.5°C within 24 hours of the PTC. Clinical characteristics between patients with and without EBS were compared using chi-squared. 64 patients with a mean age of 62 were included; all patients received preprocedural prophylactic antibiotics. 60 (94%) patients presented with biliary obstruction and 4 (6%) with biliary leak. 45 patients (70%) had a history of endoscopic retrograde cholangiopancreatography (ERCP), 23 (36%) had EBS, and 28 (44%) had a surgical bilioenteric anastomosis. Overall, 9 patients (14%) became cholangitic with one patient developing septic shock. Patients with EBS were more likely to develop cholangitis compared to both the entire cohort (7/23 vs. 2/41, P = 0.005) and patients with history of ERCP alone (7/23 vs. 1/19, P = 0.02). 22 (34.4%) patients were placed on postprocedural empiric antibiotics (i.e., antibiotics without clinical evidence of cholangitis) by their primary team. 6 patients with EBS were placed on empiric post procedure antibiotics and none developed cholangitis, whereas 7 of the 17 (41.2%) not placed on empiric antibiotics developed cholangitis (P = 0.059). These results suggest that patients with EBS may be at high-risk for developing cholangitis after initial PTC beyond the risk conferred to patients with previous ERCP. This may be due to the presence of an indwelling foreign body. The role of routine postprocedural empiric antibiotics for this patient group needs further investigation given the high morbidity associated with cholangitis.

Asymptomatic Bacteriuria in Type II Diabetics and non Diabetics: Risk factors, Bacterial types and their corresponding resistance pattern

Introduction: Silent Bacteruria or asymptomatic bacteriuria (ASB) means the existence of bacteria in urine without clinical signs or symptoms of the host. Both diabetic and non diabetic patients have the possibility of urinary tract infections with or without symptoms. Bacteria cause asymptomatic bacteriuria are colonizing flora which usually arise from the vagina, gut, or periurethral area. The risk of asymptomatic bacteriuria is greater among diabetic and non-diabetic patients particularly women. Asymptomatic bacteriuria is considered clinically significant and worth treating primarily in pregnant women. Objectives: In this study, we examined the silent bacteriuria among diabetics and healthy persons, type of strains, and their corresponding resistance pattern. Materials and Methods: A total of 220 diabetic patients and 70 healthy persons were subjected to study. Diabetic patients without malignancies, asthma or heart diseases, symptoms free regarding urinary tract infection and without prior antibiotic administration were included. Blood sample obtained from all subjects study under aseptic technique for fasting blood sugar and HbA1C. Urine samples were collected, All urine samples were passed to cultivation on suitable culture media. Plates of more than two clinical isolates from the same patient were considered to be contaminated. Plates showing more than 104 CFUs/ mL were considered significant ASB and subjected for confirmation of bacterial type and antibiotic susceptibility test. Results: From diabetics urine samples, 21(9.55%) and from healthy persons 3(4.3%) showed significant bacterial growth. In both diabetics and non-diabetics, women demonstrated a far higher prevalence of ASB than men. The high the HbA1c, the more possibility of positive ASB. In 66,7% of ASB, E. coli was the main uropathogens, followed by K. pneumoniae. These species showed identical antibiotic resistance patterns. Conclusion: These findings emphasize the importance of routine urine culture and antibiotic sensitivity testing for diabetic patients who have risk factors identified. ASB should be treated in order to avoid potential serious renal complications. Amikacin, Gentamicin, Piperacillin/Tazobactam, Fosfomycin, and Ciprofloxacin are recomended for treatment of ASB while Ampicillin is not.

Role of Peri- and Postoperative Antibiotics in Microscopic Laryngeal Surgery

There are no widely accepted guidelines for the use of peri- and postoperative antibiotics for microdirect laryngoscopy (MDL) to prevent postoperative surgical site infection (SSI). This study examines the incidence of not only SSI, but also respiratory and oropharyngeal infections among patients who underwent MDL. Retrospective cohort. Medical records from a quaternary laryngology practice were reviewed retrospectively for patients who underwent MDL between October 2015 and December 2018. Adults who underwent MDL with excision of nonmalignant masses, vocal fold (VF) reconstruction with buccal graft, superficial VF injection, VF injection augmentation, use of carbon dioxide (CO2) or potassium titanyl phosphate (KTP) laser, and laryngeal dilation were included. Subjects were divided into three groups based on the use of antibiotics during the peri- or postoperative period. Group 1 did not receive peri- or postoperative antibiotics. Group 2 received perioperative antibiotics without postoperative antibiotics. Group 3 received both peri- and postoperative antibiotics. Antibiotic use was determined by surgeon policy, which changed over time, not by patient risk factors. Other data collected include demographics, medical comorbidities, surgical procedure, operative time, American Society of Anesthesiology class, incidence of SSI, respiratory or oropharyngeal infection, and postoperative antibiotic and steroid prescriptions for complications. 190 surgeries met inclusion criteria. Groups 1, 2, and 3 consisted of 113, 57, and 20 subjects, respectively. No SSI were reported. Baseline characteristics of median age, American Society of Anesthesiology, wound class, and gender did not differ between groups. Groups were found to have differed in type of procedure performed, with a predominance of vocal fold excision and superficial injection in Group 1, injection laryngoplasty using autologous fat graft and laryngeal reconstruction in Group 3, and a combination of procedure types in Group 2. Laser treatment with CO2 and/or KTP was utilized in 35% of procedures. The mean operative times (total time in which the laryngoscope remained in the oral cavity) for Groups 1, 2, and 3 were 29 (SD = 13), 42 (SD = 23), and 73 minutes (SD = 78), respectively; this was significantly different among the three groups (P < 0.0001). By logistic regression models, operative time was not significantly associated with the overall use of antibiotics (Χ2 = 1.81, P = 0.18) or corticosteroid (Χ2 = .05, P = .82) prescriptions during follow-up. In Groups 1, 2, and 3, 11%, 14%, and 10% of patients, respectively, required a follow-up antibiotic prescription for non-SSI and 11%, 12%, and 0% of patients, respectively, required a follow-up corticosteroid prescription within 30 days postoperatively. There was no significant difference in patients with diabetes or pulmonary comorbidity and patients without comorbidity in use of postoperative antibiotic (P = .45) or corticosteroid (P > .99) prescription. Within 30 days of follow-up, patients in Group 1 experienced VF hemorrhage (defined as any subepithelial blood in the area of excision) at an incidence of 19%. Complications within 30 days of follow-up showed an incidence of substantial pain ranging between 2%-4% and respiratory or oropharyngeal infection between 10%-12%. Two patients in Group 2 reported emergency department visits for dyspnea. One patient in Group 3 was admitted for tongue and floor of mouth swelling secondary to prolonged suspension. There were no incidents of SSI in this cohort. The need for follow-up antibiotic and/or corticosteroid prescription did not differ in relation to use or non-use of perioperative antibiotics, and neither did the incidence of respiratory or oropharyngeal infection. Longer operative time was associated with both peri- and postoperative antibiotic use, but there is no evidence yet that antibiotic use was necessary. These findings suggest that avoidance of routine perioperative and/or postoperative antibiotics may be appropriate; and further research should be encouraged.

Evaluation of antibiotic resistance patterns in Staphylococcus aureus isolates collected from urinary tract infections in women referred to Shahid Beheshti educational and therapeutic center in Maragheh city, year 2016

Background: Staphylococcus aureus is one of the important bacteria causing nosocomial infections. Nowdays, because of overuse of antibiotics, resistance is increasing and this problem has caused anxiety all over the world. The aim of this study was to evaluation of antibiotic resistance pattern in S.aureus isolates from urinary tract infections in Shahid Beheshti educational and therapeutic center in Maragheh city. Methods: In this cross sectional study, 100 S. aureus isolates were collected from patients suffering from urinary tract infections. After doing the biochemical tests for diagnosis of S. aureus, these isolates were identified as S.aureus with proliferation of thermonuclease species-specific gene (nuc) by polymerase chain reaction (PCR) method. Kirby-Bauer method was used for investigation of antibiotic resistance patterns in S. aureus isolates. Results: No significant difference in genotype frequencies was observed between the T2DM patients and normoglycemic controls. The rs7903146 (C/T) polymorphism odds ratios for CC and TC genotypes were 1.75 (95% CI, 0.63 to - 4.88; p=0.28) and 0.94 (95% CI, 0.49 to - 1.79; p = 0.84) compared with the TT genotype, respectively. The rs46522 (C/T) poly-morphism odds ratios for TT and TC genotypes were 1.41 (95% CI, 0.58 to - 3.42; p = 1.41) and 1.22 (95% CI, 0.64 to - 2.35; p = 1.22) compared with the CC genotype, respectively. Conclusion: Results of current study showed high antibiotic resistance in nosocomial S. aureus isolates. Therefore, antibiotics consumption should be avoided without proper prescription and unnecessary usage of routine antibiotics for showed be prevented.

Antibiogram profile of Pseudomonas aeruginosa isolated from wounds of patients attending some selected hospitals in Sokoto metropolis, Nigeria

Pseudomonas aeruginosa is an important opportunistic human pathogen that is found in most communities in Nigeria. One hundred and sixty-five (165) wound swabs specimens were aseptically collected from three hospitals (Specialist Hospital, Maryam Abacha Women and Children Hospital and Noma Children Hospital, Sokoto) and investigated for the possible presence of P. aeruginosa. The swabs were aseptically cultured on MacConkey agar, organisms identified using standard biochemical tests and Muller Hinton agar for sensitivity. A prevalence rate of Pseudomonas aeruginosa isolates amounting to 32(19.4%) was obtained from the wound sites investigated, out of which 14(8.5%) were multi-drug-resistant. Statistically, Chi square analysis showed that there was no significant difference in the number of isolates from SHS, MAWCHS and NCHS and in the occurrence of organism in relation to gender and age (p˃0.05). The incidence of P. aeruginosa was highest (10.9%) at Specialist Hospital, Sokoto, compared with other collection points investigated. Antibiogram studies revealed that P. aeruginosa was most resistant to colistin, aztreonam and ceftazidime to a magnitude of 87.5%, 40.6% and 37.5% respectively, while the organism was most susceptible to imipenem (90.6%) followed by piperacillin-tazobactam (78.1%) and ciprofloxacin (56.3%). Antibiogram becomes very important in clinical cases to forestall possible recrudescence of infection. However, there is need for routine antibiotic sensitivity check.

Réimplantation du pouce après une ischémie prolongée et une exposition à des températures extrêmement chaudes : ces facteurs ont-ils une influence significative sur les résultats finaux ?

Historically, it has been stipulated that the success of replantation of amputations depends, among other factors, on the ischaemia time and temperature. For amputations involving the digits, replantation should take place in lees than 12 hours for warm ischaemia and lees than 24 hours for cold ischaemia Short report letter. We report a unique replantation of a completely amputated thumb following prolonged ischaemia time and hot weather exposure of about 40 °C. This is a case of a 30-year old, otherwise healthy non-smoker male who sustained an electrical saw injury to his left thumb. He was referred to our hospital 23 hours following the initial injury and only after having visited 3 different hospitals. At surgery, the wound was thoroughly irrigated and debrided and adequate shortening of the first metacarpal and proximal phalanx of the amputated thumb was performed. This was followed by first metacarpophalangeal joint arthrodesis using k-wires. The princeps pollicis artery was exposed and repaired and this was followed by repair of both the extensors and flexors. However, it was noted that the flexor pollicis longus was completely retracted proximally necessitating release of the carpal tunnel. The procedure was completed by reconstruction of the venous anastomosis, and exposure and repair of the digital nerves. Finally, a good wash was done and the skin was closed. The patient was placed on routine antibiotics and pentoxifylline. In our case, however, replantation was carried out with excellent final results, although the ischaemia time was 23 hours and the temperature was 40 °C. Mulders et al. described in their study that shorter ischaemia time is associated with successful replantation that replantation of parts of the hand should still be performed even if the ischemia time was prolonged (Lin et al., 2010). We also agree with Yu et al. in their meta-analysis that there was no significant association between ischaemia time and survival rate (Yu et al., 2015). Indeed, one may argue the role of leeching in the salvage of the replanted thumb. In our opinion, however, the decision to resort to such therapy was significant as rapid resolution and re-perfusion started to take place following its initiation. The authors believe that the hand is a crucial part of the body, and if possible, replantation should always be attempted.

Investigating the Effect of Montelukast on the Pyelonephritis Symptoms in Children

BackgroundMontelukast as an anti-inflammatory drug has a protective effect on the kidney’s tissue and also on children with pyelonephritis.ObjectivesTherefore, this study aimed at investigating the effect of montelukast on the pyelonephritis symptoms in children.MethodsIn this study, 100 children with pyelonephritis were divided into two groups, including the intervention (n = 50) and control (n = 50) groups. Patients in both groups received routine antibiotic therapy and in the intervention group, montelukast (5 mg/day, oral) was prescribed (for 14 days). Finally, the clinical manifestations of the patients were evaluated and compared between two groups.ResultsThe mean age (± SD) in intervention and control groups was 7.2 (± 0.43) and 7.18 (± 0.43) years, respectively. Analysis of the results showed that the duration of fever (P < 0.0001), dysuria (P < 0.0001), abdominal pain (P < 0.0001) and urgency (P = 0.003) were significantly lower in the intervention group than the control group.ConclusionsMontelukast lead to rapid improvement of clinical manifestations in children with pyelonephritis and may can be used as an effective auxiliary treatment in these patients.

Acute Myeloid Leukemia (AML) Treated with Azacitidine: Survival Outcomes for Patients Who Complete More Than Six Cycles Are Similar to High-Risk Myelodysplastic Syndrome/Low Blast Count AML

INTRODUCTION: Despite accumulating evidence supporting the efficacy of hypomethylating agents in patients with AML and &gt; 30% bone marrow blasts as well as in relapsed/refractory AML, this therapy is not yet funded by National Health Plans / Healthcare Funding Agencies in a number of countries including Canada. The assistance of an industry-sponsored compassionate program has enabled provision of azacitidine for this group of patients at The Ottawa Hospital. We report here our local "real-world" experience of azacitidine efficacy in this diverse group of AML patients and identify a sub-group whose outcomes are equivalent to that of patients with higher-risk Myelodysplastic Syndrome (MDS) and AML with 20-30% blasts for whom azacitidine therapy has funding approval in Canada. METHODS: All patients who received azacitidine at The Ottawa Hospital between 2009 and 2016 were included in this single-center, retrospective analysis. Azacitidine was administered at a dose of 75mg/m2 subcutaneously daily for 7 consecutive days every 28 days. Response was evaluated with a repeat bone marrow aspirate and trephine biopsy after the 6th cycle. In those patients confirmed to have stable or responsive disease, azacitidine was continued until progression of disease, intolerable side-effects of the drug or the patient chose to discontinue therapy. Overall survival curves were generated using the Kaplan-Meier method and log-rank tests were used to compare subgroups of patients. Actuarial median survival months were calculated with 95% confidence intervals (CI). P-values less than 0.05 were considered statistically significant. RESULTS: During the study period, 109 patients received azacitidine: 54 had MDS /AML with 20-30% blasts (the 'funded' group) and 55 had either AML with &gt; 30 % blasts (n=23), AML relapsed post-intensive chemotherapy (n=14), AML relapsed post-allogeneic stem cell transplant (n=10) or primary refractory AML (n=8) (the 'unfunded' group). Median survival of the 'funded' group was 12.2 months while median survival of the 'unfunded' group was 5.6 months (95% CI 3.3-7.7; p=0.0058). Of the AML patients in the 'unfunded' group, 24% completed more than 6 cycles of azacitidine compared to 52% of patients in the 'funded' group. In both the 'funded' and 'unfunded' groups, patients who completed more than 6 cycles of azacitidine had similar survival outcomes (p=0.7277): the 'funded' group had a median survival of 19 months (95% CI 14.4-25.3) while the median survival of this sub-population of the 'unfunded' AML group was 22 months (95% CI 11.7-24.9). Patients in both groups who failed to complete more than 6 cycles of azacitidine also had a similar outcome (p=0.39), with a median survival of 5.7 months (95% CI 4.0-6.3) for patients with MDS/AML 20-30% blasts and 3.6 months (95% CI 2.2-5.1) for AML patients with &gt; 30% blasts or relapsed/refractory disease. Reasons for patients not completing at least 6 cycles of azacitidine included progression of disease (25%), bacterial infections most commonly pneumonia (53%) and patient preference (7%). CONCLUSION: A significant sub-population of AML patients with &gt; 30% blasts or refractory/relapsed AML can achieve a meaningful survival benefit with the hypomethylating agent, azacitidine. A higher proportion of this AML patient population discontinued azacitidine as a result of infective complications. The provision of routine prophylactic antibiotics may enable more patients with AML to receive an adequate amount of azacitidine to achieve therapeutic benefit and warrants further investigation. Our results add to the growing body of 'real-world' evidence that supports healthcare funding agencies to provide coverage of azacitidine for patients with AML who in some countries at present do not fulfill government funding criteria. Disclosures Bredeson: Otsuka: Research Funding. Maze:Pfizer Inc: Consultancy; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Sabloff:Novartis Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; ASTX: Membership on an entity's Board of Directors or advisory committees, Research Funding; Actinium Pharmaceuticals, Inc: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas Pharma Canada: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi Canada: Research Funding.

Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk

BackgroundThe studies that established historical rates of surgical infection after cholecystectomy predate the modern era of laparoscopy and routine prophylactic antibiotics. Newer studies have reported a much lower incidence of infections in “low-risk” elective, outpatient, laparoscopic cholecystectomies. We investigated the current rate of postoperative infections in these cases within a large, U.S. database. MethodsWe retrospectively reviewed elective laparoscopic cholecystectomies from the 2016-2017 American College of Surgeons National Surgical Quality Improvement Program database. Our primary outcome was postoperative surgical site infection; secondary was Clostridium difficile infection. Logistic models evaluated the associations of patient and operation characteristics with these outcomes. ResultsSurgical infection occurred in 1.0% of cases (293/30,579). Cdifficile infection occurred in 0.1% (31 cases). In our adjusted multivariable models, other/unknown race/ethnicity, diabetes, hypertension, smoking, American Society of Anesthesiologists >2, operative minutes, and wound class 4 were associated with a significantly higher odds of surgical infection; no covariates were significantly associated with Cdifficile infection. ConclusionsIn the setting of modern U.S. surgical practice, the incidence of infection after elective laparoscopic cholecystectomy is very low, on par with clean cases. Our study identified several patient characteristics that were strongly associated with surgical infection. Many of these are not included as risk factors in current guidelines for antibiotic prophylaxis and may help to identify those at higher risk for this rare complication.

Postoperative Oral Antibiotics in Outpatient Foot and Ankle Surgery: Are We Affecting Postoperative Infections or Wound Healing Complications?

Category:InfectionIntroduction/Purpose:Postoperative infections after foot and ankle surgery can cause devastating outcomes for patients. Studies of postoperative infection rates in outpatient foot and ankle surgery range from 0.5-6.5%, with increasing numbers found in diabetic patient populations. The use of perioperative antibiotics in the prevention of postoperative infection in outpatient surgery is a topic that has often been discussed yet there remains considerable controversy. The authors hypothesize that there is no difference in postoperative infection rate or wound healing complications in patients who received postoperative oral antibiotics versus those that did not. Additionally, the authors sought to identify patient characteristics associated with postoperative infections or wound complications.Methods:Retrospective chart review of 649 elective outpatient foot and/or ankle surgery cases over a 2-year period performed by two fellowship trained foot and ankle surgeons at an academic medical center ambulatory surgical unit. All cases were included with at least one follow-up visit and no evidence of chronic wounds or infection. Those cases that did not have adequate follow up or if postoperative antibiotic treatment could not be determined were subsequently excluded. Analysis evaluated patients that received postoperative oral antibiotics (PAB) and those that did not receive postoperative oral antibiotics (NAB) to identify whether a difference in infection rate or wound healing complication were present. Patient demographics, medical comorbidities, BMI, smoking status, and tourniquet time were analyzed to identify contributing factors or comorbidities that may be more prevalent in those that developed postoperative infections in the PAB and NAB groups.Results:633 operative cases were included in the study. The average age of patients in the PAB group and NAB group was equal (age 45 ± 17). The number of infections in PAB was 6, while the number of infections in NAB was 10 (3% vs. 2%, p = 0.60). The number of deep versus superficial infections and wound complications between the two groups was not statistically significant. Patients that developed infections versus those that did not were older (average age 55 vs. 45, p = 0.02), demonstrated a higher prevalence of hypertension (44% vs. 17%, p = 0.01), and a history of neoplasm (19% vs. 2%, p < 0.01). No significant difference was found between groups based on BMI, diabetes, tourniquet time, or smoking status.Conclusion:There are limited studies published on the efficacy of routine postoperative antibiotics in outpatient foot and ankle surgery, despite a majority of surgeons (75%) reporting using postoperative antibiotics.2 The present study suggests there is no benefit to prescribing postoperative oral antibiotics in an outpatient surgery setting. Additionally, older patients, patients with hypertension, and patients with a history of neoplasm made up a larger percentage of patients in the postoperative infection group. BMI, diabetes, tourniquet time and smoking status did not have a significant difference in postoperative infections between the PAB group and NAB group.

Pseudomonas aeruginosa: distribution and antibiotic profile of one of the ESKAPE pathogen

Background: Pseudomonas aeruginosa is an opportunistic gram-negative pathogen known for its ingenious mode of infection. The management of infections with Pseudomonas has been quite a challenge. The bacteria have intrinsic resistance against most of the routine antibiotics. Such a scenario places the health care delivery system at a challenging end point with very minimal options of care and increased rates of morbidity and mortality. This study was done to assess the pattern of presentation of Pseudomonas aeruginosa in hospital settings. Methods: This cross-sectional study was carried out among 280 specimens which were isolated for a period of 17 months in our tertiary care hospital. The blood culture bottles were placed in Bac T/ Alert 3 D and the positive culture bottle was processed by Grams stain and in routine bacteriological media for inoculation and incubated. Pseudomonas aeruginosa organisms isolated from all the clinical samples were subjected for determining the identification and antibiotic susceptibility profile by VITEK 2 and manual methods. Results: A total of 280 samples were analyzed in this study. The background characteristics of the specimens analyzed is given in table 1. In this study, majority of the samples were from inpatients (71.4%). Among the total samples, most specimens were urine samples (37.5%), followed by pus (23.1%). The organisms showed high sensitivity to Amikacin, Ceftazidime and Gentamycin (98%). Conclusion: From the present findings, we understand that Amikacin and Gentamycin can be the proposed drug of choice for severe infections with Pseudomonas aeruginosa.

Current Evidence on Oral Antibiotics for Infective Endocarditis: A Narrative Review.

Infective endocarditis (IE) continues to be associated with high morbidity and mortality, even when treated with optimal antibiotic regimens. The selection of treatment depends on the causative pathogen, its antibiotic susceptibility profile, local and systemic complications and the presence of prosthetic materials or devices. Standard therapy typically involves 4–6 weeks of intravenous (IV) bactericidal therapy. However, there are instances in which IV antibiotic administration may be challenging due to cost, complications of IV access, adverse side-effects of the medication or concerns for misuse of the IV line. Current clinical guidance from the American Heart Association and the European Society of Cardiology cite scenarios where oral antibiotics can be considered for treatment of IE, though these situations are relatively infrequent and data to show their non-inferiority limited. Recently, a well-designed randomized clinical study reported favorable outcomes for partial oral antimicrobial therapy regimens given to patients with staphylococcal, streptococcal and enterococcal IE deemed clinically stable and without complications such as perivalvular abscess. Oral antibiotics, usually given in combination, were selected by infectious disease providers for their favorable pharmacologic properties and predicted bactericidal activity. There was a careful selection of patients who were transitioned to oral regimens. Before recommending routine use of oral antibiotics in the care of patients with IE, additional studies that better define eligible patients and that use regimens available in the countries that adopt this practice should be performed. If further studies confirm non-inferior outcomes with partial oral antibiotics for the treatment of IE, medical treatment could be delivered in a simpler, more costeffective manner, and likely with lower rates of adverse side-effects.

Incidence of urinary tract infections and antimicrobial susceptibility pattern among pregnant women in Akure, Nigeria

Abstract Background Urinary tract infection (UTI) is the most common medical complications of pregnancy together with anemia and hypertension and it occurs approximately in 5–10% of all pregnancies. Objectives This study was carried out to evaluate the incidence and antimicrobial susceptibility pattern of isolated microbes among pregnant women attending ante natal clinics in Akure, Nigeria. Methods A total of 300 clean midstream urine samples were collected in a clean universal bottle. The urine samples were cultured, Microbact identification system was used to identify the presence of bacteria. Results Out of the 300 urine samples cultured, 183(61.0%) showed significant growth of urinary pathogens while 117(39.0%) showed lack of growth and insignificant growth of urinary pathogens. Escherichia coli 58(31.7%) was the dominant pathogen isolated, followed by Klebsiella pneumoniae 32(17.5%), Staphylococcus aureus 27(14.8%), and the least isolated were Citrobacter freudii and Providencia retgerri 2(1.1%) and 2(1.1%), respectively. Gram negative bacteria showed 77.6%, 67.9% and 61.2% susceptibility to Ciprofloxacin, Augmentin and Chloramphenicol, respectively. Resistance against Septrin, Chloramphenicol, Sparfloxacin, Amoxicillin, Augmentin, Gentamycin, Pefloxacin, Trivid and Streptomycin were observed in the range 23.1% to 70.1%. Gram positive uropathogens showed high resistance to Amoxicillin (68.4%) and high susceptibility to the other antibiotics in the range 65.8% to 89.5%. Conclusion There is need to treat pregnant women with UTIs with proven antibiotics that microbes are susceptible to in order to combat the evolution of resistant pathogens. Routine microbiological analysis and antibiotic sensitivity test of urine samples of pregnant women should be carried out so as to enhance the treatment and management of UTIs.

What is the Short-Term Effect of a Dose of Antibiotics on Gut Microbiota in Thyroid Cancer Patients After Surgery? An Observational Clinical Study

International guidelines do not recommend routine systemic antibiotic prophylaxis in thyroidectomy patients as post-operative wound infections are rare, though many surgeons prefer to give preoperative antibiotics. However, the molecular-based short-term consequences of one dose of antibiotics on the human intestinal microbiota are rarely explored.

Role of Postoperative Antibiotics in Patients Undergoing Type I Thyroplasty with Gore-Tex Implant

The purpose of this study was to determine the need for postoperative antibiotic administration in patients undergoing type I thyroplasty performed with Gore-Tex implant. Retrospective analysis. Medical records of patients from a quaternary care laryngology practice who underwent type I thyroplasty for glottic insufficiency using Gore-Tex (W.L. Gore, Newark, Delaware) implant between the years 2013 and 2019 were reviewed retrospectively. Subjects were divided into two groups determined by those who did or did not receive routine postoperative antibiotics. All patients received two grams of cefazolin IV (for the standard 70-kilogram patient), and 10 mg of dexamethasone as a one-time dose given 10 minutes prior to incision. Patients allergic to cefazoline who received a single preoperative dose of 600 mg of clindamycin IV. All subjects were seen in the office at least three times after the procedure: one day, one week, and approximately six weeks following surgery. Statistical analysis was performed on the collected data using χ2 analysis for categorical data and a student t test for means. A P value of less than 0.01 was considered significant. There was no significant difference in infection rate or other complications between groups. Routine use of antibiotics following type I thyroplasty with Gore-Tex (W.L. Gore, Newark, Delaware) appears unnecessary.