Single-dose Antibiotic Prophylaxis Research Articles

Postoperative continuation of antibiotic prophylaxis beyond 24 h is unnecessary for abdominal surgeries in children and neonates

PurposeDespite recent WHO recommendations, antibiotic prophylaxis is routinely continued for several days after surgery. We conducted a retrospective study to evaluate the safety and efficacy of antibiotic prophylaxis cessation within 24 h after abdominal surgeries MethodsWe retrospectively reviewed the charts of patients who underwent 3 representative gastrointestinal surgeries (1; transumbilical small bowel procedure for intestinal atresia or stenosis, 2; extrahepatic bile duct resection, and hepaticojejunostomy for congenital biliary dilatation, 3; stoma closure for intestinal perforation, anorectal malformation, or inflammatory bowel disease) at our institution between 2011 and 2023. The demographic data collected included age, preoperative hemoglobin level, albumin level, body mass index, and ASA class. Intraoperative and postoperative data were also collected. The patients were divided into 2 groups according to the duration of perioperative antibiotics (‘within 24 h’ and ‘beyond 24 h’), and the incidence of superficial incisional SSI (siSSI) was compared between the 2 groups in each procedure ResultsDuring the study period, 25 cases underwent transumbilical small bowel procedure, 23 cases underwent hepaticojejunostomy, and 45 cases underwent stoma closure. The preoperative care bundle including bowel preparation, cleansing, and operative procedures has not changed during the study period. First- and third-generation cephalosporins were administered to all the patients. All patients received their first single dose of antibiotics within 60 min before the skin incision. In particular, 14 patients who underwent small-bowel procedures received only a single dose. The SSI rates for small bowel procedures, hepaticojejunostomy, and stoma closure were 0%, 4.4%, and 4.4%, respectively. No SSIs were observed in any of the procedures in the 'within 24 h' group ConclusionBased on our study, we conclude that ≤24 h of postoperative continuation of antibiotic prophylaxis is sufficient for siSSI prevention in hepaticojejunostomy and stoma closure. Additionally, single-dose antibiotic prophylaxis is adequate for neonatal small bowel procedures.

Single dose vs prolonged antibiotic prophylaxis of fosfomycin for transrectal prostate biopsy: a single-center prospective, randomized, controlled trial

BackgroundTransrectal prostate biopsy is a commonly performed urological procedure in which antibiotic prophylaxis is recommended. Fluoroquinolone-type antibiotics are no longer acceptable in the EU. Fosfomycin-trometamol may be used, but there is no evidence regarding its ideal dose and administration time. MethodsPatients who underwent prostate biopsy between 2021 and 2023 were evaluated prospectively. 204 patients were randomized into two arms: 102 patients (Arm A) received a single dose of fosfomycin-trometamol one hour before surgery, and 102 patients (Arm B) received one additional dose of fosfomycin-trometamol 48 hours after the first dose. Urine tests and questionnaires were administered during the postoperative period and the subsequent four weeks to identify any symptoms, infectious, or other complications. ResultsThere was no statistical difference in the rate of asymptomatic bacteriuria (4.90% (5) vs 8.82% (9), p = 0.27) symptomatic UTI (0% (0) vs 1.96% (2), p = 0.50), or febrile UTI (0% (0) vs 0.98% (1), p = 1) between the groups. Only haematuria was significantly more common in Arm B (6.86% (7) vs 16.67% (17), p = 0.03), whereas other complications did not differ significantly. There was no statistical difference in hospitalization (0.98% (1) vs 2.94 (3), p = 0.62) or mortality rate (0 % (0) vs 0.98% (1), p = 1). Sub-group analysis of previous antibiotic users showed no difference in terms of complications. ConclusionThere is no significant difference in infectious complications between single dose and prolonged prophylaxis of fosfomycin-trometamol for transrectal prostate biopsy. A single dose of fosfomycin one hour before biopsy is an ideal choice with a better ecological impact compared with prolonged antibiotic prophylaxis for transrectal prostate biopsy.

Preoperative single dose versus conventional antibiotic prophylaxis in thyroid surgery

Preoperative single dose versus conventional antibiotic prophylaxis in thyroid surgery

Prospective cohort study of surgical site infections following single dose antibiotic prophylaxis in caesarean section at a tertiary care teaching hospital in Medchal, India.

Caesarean section (CS) is considered to be a life-saving operative intervention for women and new-borns in certain antepartum and intrapartum conditions. Caesarean delivery may be accompanied by several complications including surgical site infections (SSI). However, there is a significant lack of uniformity in the administration of antibiotics for preventing surgical site infections (SSI) following caesarean deliveries. The present study was conducted to determine the incidence of post CS SSI following the adoption of single-dose antibiotic prophylaxis as recommended by WHO at a tertiary care teaching hospital in Medchal, India. Also, to identify the risk factors of SSI and reported the bacteriological profiles and the antimicrobial susceptibility pattern of the culture positive isolates. To estimate the incidence of surgical site infections (SSI's) according to CDC criteria following WHO-recommended single-dose antibiotic prophylaxis for caesarean section at a tertiary care teaching hospital in Medchal, India. A prospective hospital-based study was conducted between June 2017 and December 2019, in which women who underwent caesarean delivery were followed up for 30 days post-delivery. Clinical details were collected using a structured questionnaire, and participants were followed up weekly after discharge to document any signs and symptoms of SSI. Symptomatic patients were requested to come to the hospital for further investigation and treatment. Standard microbiological tests were conducted to detect microorganisms and their antibiotic sensitivity. The study included 2,015 participants with a mean age of 24.1 years. The majority were multigravida (n = 1,274, 63.2%) and underwent emergency caesarean delivery (n = 1,232, 61.1%). Ninety two participants (4.6%, 95% CI: 3.7% to 5.6%) developed surgical site infections, with 91 (98.9%) having superficial and 1 (1.1%) having a deep infection. Among those who developed an SSI, 84 (91.3%) did so during their hospital stay, while 8 (8.7%) developed an SSI at home. The adjusted relative risk (a RR) for developing an SSI was 2.5 (95% CI: 1.4 to 4.6; power 99.9%) among obese women and 2.3 (95% CI: 1.1 to 4.7; power 100%) among women aged 25 years or younger. Microbial growth in culture was observed from 55 (75.8%) out of total 66 samples. The most common organisms identified were Staphylococcus aureus (n = 7(12.3%)23, 46.0%), Klebsiella sp. (n = 13, 26.0%), and Escherichia coli (n = 12, 24.0%). The rate of SSI following caesarean deliveries subjected to single dose antibiotic prophylaxis was low. Young women and obese women were at high risk of developing SSI.

To study the planned surgical procedure in single-dose antibiotic prophylaxis

Background: Postoperative wound infection may be due to many causes, of which “microbial contamination” is the factor that is influenced by antibiotic administration. Since the concept of antimicrobial prophylaxis has emerged, several workers have searched for optimal antimicrobial drugs, their routes, and the timing of their administration, with the ultimate goal of achieving zero sepsis. The use of preoperative systemic antibiotics has brought down the incidence of wound infection considerably. Aims and Objectives: The aim is to identify which drug is the best option for single-dose antibiotic prophylaxis to prevent postoperative wound infection. Materials and Methods: This is a prospective study. The study was conducted in the surgical ward of J.A. Group of Hospitals, Gwalior, Madhya Pradesh, India, from May 2020 to April 2022. Patients of all sexes and ages were included in the study. Patients were divided into five groups according to a class of antibiotics. The study consisted of a total of 125 patients admitted to the surgical ward. Statistical Package for the Social Sciences–(10 systems) was applied for the study. P<0.05 was considered statistically significant. Results: A total of 125 patients were studied in five groups, depending on the antibiotics. The A, B, C, and D groups were given only a single dose of antibiotics, while group E was given a full course of antibiotics during preoperative, intraoperative, and postoperative periods. Out of 125 cases, only 5 patients had clinical and bacteriological evidence of wound sepsis in different groups of single-dose antibiotics, and one case in group E had multiple doses of antibiotic given. The wound infection rate in clean patients was 20% in ceftazidine, 12.5% with piperacillin tazobactum and cefoperazone sulbactum, and 21.1% in the multiple dose group. No infection was reported with amoxycillin-clavulanic acid. Staphylococcus, Escherichia Coli, and Klebsiella were the offending agents, and anaerobic infections were not found. Conclusion: A single dose of antibiotic prevents the suppression of normal, sensitive microbial flora, which is usually seen with multiple doses of antibiotics. In this way, it helps in keeping the patients infection-free without interfering with their naturally inherited immunological status of the patient.

Antibiotic prophylaxis and surgical site infections in orthognathic surgery – a retrospective analysis

BackgroundThis study was conducted to determine surgical site infection (SSI) rates and potential risk factors as well as to evaluate antibiotic prophylaxis in orthognathic surgery.MethodsThis retrospective observational study included patients who received orthognathic surgery. SSIs and their management were assessed for up to one year post-operatively. The applied antibiotic regime and other possible influencing factors (smoking, age, site of infection, drainage, duration of surgery, displacement distances, craniofacial malformations) were assessed.ResultsIn total 291 patient met the inclusion criteria (56.7% female). The mean age at surgery was 25.5 ± 8.5 years. Fifty-four patients (18.6%) were diagnosed with a craniofacial malformation. Relevant previous surgeries were documented in about one quarter of included patients (n = 75). Ninety-two percent of patients (n = 267) received intraoperative single-dose antibiotic prophylaxis. Surgical site infections occurred in 12.4% (n = 36) of patients. There was a significant association between postoperative infections and type of surgery (P = .037) as well as type of drainage (P = .002). Statistical analyses also revealed a higher prevalence of smokers (P = .036) and previous surgically assisted rapid palatal expansion (SARPE) (P = .018) in the infection group. Furthermore, no significant relationships were observed between postoperative infections and various co-factors (i.e. antibiotic regime, age at surgery, gender, associated craniofacial malformations, surgery duration, displacement distances, mandibular setback vs. advancement).ConclusionLow rates of SSIs occurred following an intraoperative single-dose antibiotic regime. None of the SSIs had a significant effect on the final surgical outcome. Present data do not warrant escalation of the antibiotic regimen. Postoperative smoking and capillary drainage should be avoided.

Surgical site infections in maxillofacial trauma surgery – Single-dose versus prolonged antibiotic prophylaxis

Open reduction with internal fixation (ORIF) for facial fractures has frequently been associated with the occurrence of surgical site infections (SSIs). Perioperative antibiotic prophylaxis is customarily recommended for ORIF. Thus, the comparison of two different antibiotic regimens (i.e., single-dose and prolonged antibiotic prophylaxis) concerning the rate and severity of SSIs in facial fracture patients undergoing ORIF was the main purpose of this study.This retrospective analysis included patients who underwent ORIF for facial fractures. They were distributed into two groups. The single-dose antibiotic prophylaxis group (SDAP) received single-dose perioperative antibiotic prophylaxis, whereas the prolonged antibiotic prophylaxis group (PAP) were administered prophylactic antibiosis over a course of 5 days.122 patients were included in the study. Nine patients in the SDAP group and 15 patients in the PAP group were affected by SSIs; no significant difference in the incidence of SSIs was found (p = 0.218). Moreover, the severity of SSIs did not significantly differ between the two groups (p = 0.982).

A STUDY OF SINGLE DOSE PRE-OPERATIVE ANTIBIOTIC PROPHYLAXIS VERSUS CONVENTIONAL MULTIPLE DOSE POST OPERATIVE ANTIBIOTIC THERAPY IN INGUINAL HERNIA REPAIR SURGERY

Background: Elective inguinal hernioplasty is considered to be a clean procedure which does not require antibiotic prophylaxis but prosthetic material like polypropylene mesh is routinely used during procedure. This makes the topic debatable because the use of prosthetic material like mesh increases the risk of surgical site infection. The incidence of surgical site infection (SSI) after inguinal hernioplasty ranges from 0% to 14 % in international literature. It is also more controversial whether single dose antibiotic or conventional multiple doses of antibiotics for 5 to 7 days is effective. Hence our study aims to compare the efficacy of single dose versus multiple dose antibiotic prophylaxis in open inguinal hernioplasty Patients And Methods: A total of 120 cases of inguinal hernia admitted in Gadag Institute of Medical Sciences in the Department of general surgery underwent Lichtenstein tension free mesh hernioplasty and received either pre-op single dose or post-op multiple dose antibiotic therapy. The two groups were then compared for SSI. Conclusion: Our study shows that a single dose of antibiotics given half an hour prior to open surgery in elective uncomplicated inguinal hernia repair surgery is as effective as multiple doses of antibiotics post-operatively in preventing post-operative surgical site infection.

Single-Dose Antibiotic Prophylaxis with Ertapenem Increases Compliance with Recommendations for Surgical Antibiotic Prophylaxis in Elective Colorectal Surgery: A Retrospective, Single-Center Analysis.

Background: Compliance with guideline recommendations for surgical antibiotic prophylaxis (SAP) in colorectal surgery, particularly redosing, has been suboptimal at many institutions including ours. This study aimed to evaluate if single-dose antibiotic prophylaxis with ertapenem improves compliance with guideline recommendations for SAP versus multiple-dose antibiotic prophylaxis in elective colorectal surgery. Methods: A retrospective, cohort study of the use of ertapenem compared with standard of care antibiotic agents was performed in adult patients undergoing elective colorectal surgery at an academic medical center between January 2020 and February 2022. The primary outcome was compliance with guideline-recommended SAP for colorectal surgery. The secondary outcome was surgical site infections (SSIs) within 30 days after surgery. Results: A total of 135 patients were included in this study. Fifty-eight patients received single-dose antibiotic prophylaxis with ertapenem and 77 patients received multiple-dose antibiotic prophylaxis. Cefazolin plus metronidazole was the most common multiple-dose regimen (65 of 77). Single-dose antibiotic prophylaxis with ertapenem increased overall SAP compliance (96.6% vs. 64.9%; p < 0.001) as well as compliance with antibiotic administration within the recommended time period before incision (96.6% vs. 84.4%; p = 0.022), compliance with intra-operative antibiotic redosing when warranted (100% vs. 83.1%; p < 0.001), and compliance with guideline-recommended dosing (100% vs. 92.2%; p = 0.037). Surgical site infection rates were not statistically different between the groups (12.1% vs. 19.4%; p = 0.248). Conclusions: Single-dose antibiotic prophylaxis with ertapenem increased compliance with guideline-recommended SAP for elective colorectal surgeries. No statistically significant difference was observed in SSI rates regardless of the antibiotic regimen used.

Single-dose versus prolonged antibiotic prophylaxis for alveolar bone grafting in cleft patients

The increase in antimicrobial resistance requires a critical discussion of antibiotic applications. Postoperative antibiotic prophylaxis is still common for intraoral bone transplantation. However, no guidelines exist for alveolar bone grafting (ABG) in cleft patients. This study compared the infection rate between prolonged and single-dose prophylaxis for this procedure, with the null hypothesis of no difference between the two groups. In total, 109 ABG procedures in 94 cleft patients performed by two surgeons were included. Patients received either prolonged or single-dose antibiotic prophylaxis. The complication rate was compared between the groups. Fifty-nine patients (34 male, 25 female) received prolonged prophylaxis (group 1), while 35 (23 male, 12 female) had just a single dose (group 2). Median age at surgery differed between the two groups, but not significantly (P = 0.72). One relevant surgical site infection was observed among patients with postoperative antibiotic application, while no infections occurred in the single-dose prophylaxis group (1.7% vs. 0%); this difference was not statistically significant (P = 0.84). The duration of hospitalization was longer in group 1. The reduction of antibiotic prophylaxis to a single dose did not increase the infection rate. The results strongly encourage reducing antibiotic prophylaxis for ABG procedures in cleft patients.

Effectiveness of Single vs Multiple Doses of Prophylactic Intravenous Antibiotics in Implant-Based Breast Reconstruction

Multiple-dose antibiotic prophylaxis is widely used to prevent infection after implant-based breast reconstruction despite the lack of high-level evidence regarding its clinical benefit. To determine whether multiple-dose antibiotic prophylaxis is superior to single-dose antibiotic prophylaxis in preventing surgical site infection (SSI) after implant-based breast reconstruction. This prospective, multicenter, randomized clinical superiority trial was conducted at 7 hospitals (8 departments) in Sweden from April 25, 2013, to October 31, 2018. Eligible participants were women aged 18 years or older who were planned to undergo immediate or delayed implant-based breast reconstruction. Follow-up time was 12 months. Data analysis was performed from May to October 2021. Multiple-dose intravenous antibiotic prophylaxis extending over 24 hours following surgery, compared with single-dose intravenous antibiotic. The first-choice drug was cloxacillin (2 g per dose). Clindamycin was used (600 mg per dose) for patients with penicillin allergy. The primary outcome was SSI leading to surgical removal of the implant within 6 months after surgery. Secondary outcomes were the rate of SSIs necessitating readmission and administration of intravenous antibiotics, and clinically suspected SSIs not necessitating readmission but oral antibiotics. A total of 711 women were assessed for eligibility, and 698 were randomized (345 to single-dose and 353 to multiple-dose antibiotics). The median (range) age was 47 (19-78) years for those in the multiple-dose group and 46 (25-76) years for those in the single-dose group. The median (range) body mass index was 23 (18-38) for the single-dose group and 23 (17-37) for the multiple-dose group. Within 6 months of follow-up, 30 patients (4.3%) had their implant removed because of SSI. Readmission for intravenous antibiotics because of SSI occurred in 47 patients (7.0%), and 190 women (27.7%) received oral antibiotics because of clinically suspected SSI. There was no significant difference between the randomization groups for the primary outcome implant removal (odds ratio [OR], 1.26; 95% CI, 0.69-2.65; P = .53), or for the secondary outcomes readmission for intravenous antibiotics (OR, 1.18; 95% CI, 0.65-2.15; P = .58) and prescription of oral antibiotics (OR, 0.72; 95% CI, 0.51-1.02; P = .07). Adverse events associated with antibiotic treatment were more common in the multiple-dose group than in the single-dose group (16.4% [58 patients] vs 10.7% [37 patients]; OR, 1.64; 95% CI, 1.05-2.55; P = .03). The findings of this randomized clinical trial suggest that multiple-dose antibiotic prophylaxis is not superior to a single-dose regimen in preventing SSI and implant removal after implant-based breast reconstruction but comes with a higher risk of adverse events associated with antibiotic treatment. EudraCT 2012-004878-26.

Study Comparing Effect of Single Dose Antibiotic Prophylaxis versus Conventional Antibiotic Coverage in Clean, Elective Surgeries – A Randomized Controlled Clinical Trial

BACKGROUND&#x0D; Postoperative wound infection remains the most common complication of surgery. With the fear of developing wound infection after surgery, many surgeons administer antibiotics for 7 -10 days even in clean uncontaminated cases. This practice is not only expensive to the patients but also can lead to hospital-acquired infections. We wanted to assess the effectiveness and efficacy of single-dose antibiotics in clean elective surgical cases in this study.&#x0D; METHODS&#x0D; A prospective interventional study was conducted in the General Surgery department, SRM Medical College Research Centre, Kattankulathur for a period of 18 months between May 2018 and October 2019. In this study, 143 patients were selected according to the inclusion criteria. All the data findings were recorded and analysed.&#x0D; RESULTS&#x0D; Out of 143 patients presented with clean cases, 72 cases were included in the study group and 71 cases in the control group as per the inclusion criteria. In the present study, the incidence of postoperative infection was equal i.e., 6 % in both groups. However, the grade of infection varied. The difference was not statistically significant.&#x0D; CONCLUSIONS&#x0D; Based on my study I would like to conclude that it is recommendable to use single-dose antibiotic prophylaxis for clean surgical cases, as per the study results there is not much difference in the occurrence of SSI when compared to multiple doses.

Study of prophylactic single-dose antibiotic to prevent surgical site infection

Background: Surgical site infections (SSIs) have been linked to longer hospital stays and higher costs. Infection occurs when endogenous flora is translocated to a generally sterile site. It's also feasible to seed the surgical site with illness from afar (especially in patients with prostheses or another implant). SSIs are influenced by bacterial inoculums and pathogenicity, host defenses, preoperative care, and intraoperative management. Antibiotic prophylaxis is therefore essential to address this problem. This study to evaluate the effectiveness of single-dose antibiotic prophylaxis in preventing surgical site infection in elective surgeries.Methods: This prospective study included 50 patients receiving elective surgery at a tertiary hospital's department of general surgery. Relevant information about each patient was obtained using a Performa developed for the project. Cefuroxime was given 30 minutes before the incision, and effect on post-operative wound infection was investigated.Results: We had 50 cases in our study, predominantly males, with maximum individuals in the 41-50 years age group. Cholecystectomy cases presented with the most SSIs (20%). S. aureus was the most common causative organism of SSI in this study.Conclusions: A single preoperative dose of antibiotic cefuroxime effectively prevents surgical site infection in elective cases assuming an uncomplicated procedure.

Surgical site infections in orthognathic surgery: prolonged versus single-dose antibiotic prophylaxis

The oral cavity is densely populated with microorganisms. As a result, intraoral surgical sites are prone to contamination by pathogens, potentially triggering surgical site infections (SSIs). Prophylactic antibiotics have proven beneficial in reducing the rate of SSIs. However, no consensus has been reached regarding the most effective regimen. The purpose of this study was to investigate two different antibiotic regimens – single-dose and prolonged antibiotic prophylaxis – regarding the rate and severity of postoperative SSIs in patients undergoing orthognathic surgery. Data were analysed retrospectively. Patients who underwent bilateral sagittal split ramus osteotomy or bimaxillary surgery in the study department in 2017 were screened for eligibility. Ninety-nine patients were included in the study and were divided into two groups. The prolonged-antibiotic prophylaxis group (PAP; n = 49) received a 5-day antibiotic prophylaxis regimen, while the single-dose antibiotic prophylaxis group (SDAP; n = 50) received single-dose antibiotic prophylaxis. The groups were assessed for the rate and severity of SSIs following orthognathic surgery. Five patients (10.2%) in the PAP group and seven (14%) in the SDAP group developed infections; no statistically significant difference in the occurrence of SSIs was found (P = 0.380). Single-dose antibiotic prophylaxis is as effective as a 5-day antibiotic prophylaxis regimen in preventing SSIs in orthognathic surgery and is a suitable antibiotic prophylaxis option when considering the risk of antibiotic resistance.

MP05-10 MIXING IT UP: ARE PATIENTS WITH MIXED URINE CULTURES AT HIGHER RISK OF POSTOPERATIVE SEPSIS AFTER URETEROSCOPY?

You have accessJournal of UrologyCME1 May 2022MP05-10 MIXING IT UP: ARE PATIENTS WITH MIXED URINE CULTURES AT HIGHER RISK OF POSTOPERATIVE SEPSIS AFTER URETEROSCOPY? Young Son, Julia Scali, Ian Madison, Benjamin Fink, Katelyn Klimowich, Dayna DeVincentz, Paul Chialastri, and Thomas Mueller Young SonYoung Son More articles by this author , Julia ScaliJulia Scali More articles by this author , Ian MadisonIan Madison More articles by this author , Benjamin FinkBenjamin Fink More articles by this author , Katelyn KlimowichKatelyn Klimowich More articles by this author , Dayna DeVincentzDayna DeVincentz More articles by this author , Paul ChialastriPaul Chialastri More articles by this author , and Thomas MuellerThomas Mueller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002522.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy with laser lithotripsy has been used for the treatment of ureteral calculi since the 1980s. Life-threatening urosepsis is one of the most severe complications of this procedure. The American Urological Association (AUA) recommends single-dose antibiotic prophylaxis prior to ureteroscopic stone removal. The significance of colonization in an asymptomatic patient is unknown at this time. Our objective is to determine if preoperative urine cultures with mixed flora on microbiology report, have a higher rate of postoperative sepsis than patients with negative cultures for uncomplicated elective ureteroscopy with laser lithotripsy. METHODS: A retrospective multi-institutional chart review was performed on 306 patients for which procedure code included elective ureteroscopy with lithotripsy from April 2018 until December 2020. Patients were excluded if the mixed urine cultures were treated with antibiotic therapy, inpatient setting, or had percutaneous nephrostomy or nephroureterostomy tubes. Mixed cultures were defined as mixed culture >10,000 CFU (colony forming unit) and positive cultures were defined as bacteria with >100,000 CFU. RESULTS: The overall sepsis rates were 3% with negative culture preoperatively, 10.9% with a mixed culture, and 19.2% with positive culture. There was a significant difference in carbonate apatite composition between mixed culture group and negative culture group (p=0.02) and positive culture group and negative culture group (p=0.01) (Table 1). There was an increased stent duration 38.4 days compared to 16.6 days in septic vs. non-sepsis group (p<0.002). There were discordinate amount of carbonate apatite composition with 37.7% in the sepsis group compared to 14.2% in the non-sepsis group (p=0.003) (Table 2). CONCLUSIONS: We conclude that there is 3.6 times more likely that postoperative sepsis patients had mixed cultures compared to negative cultures. Also, there was 2.7 times more carbonate apatite stone composition in postoperative sepsis group compared to non-sepsis group. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e71 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Young Son More articles by this author Julia Scali More articles by this author Ian Madison More articles by this author Benjamin Fink More articles by this author Katelyn Klimowich More articles by this author Dayna DeVincentz More articles by this author Paul Chialastri More articles by this author Thomas Mueller More articles by this author Expand All Advertisement PDF DownloadLoading ...

Antibiotic prophylaxis for percutaneous nephrolithotomy: An updated systematic review and meta-analysis.

IntroductionA single dose of preventive antibiotics is known to be sufficient to reduce the rate of infection-related complications in percutaneous nephrolithotomy (PCNL). However, some studies reported that the extended dose showed lower complications for high-risk groups. Therefore, we performed a systematic review and meta-analysis comparing single- and extended-dose antibiotic prophylaxis for PCNL.Materials and methodsRelevant studies that compared single- and extended-dose antibiotic prophylactic therapies were identified. Articles were selected from PubMed, EMBASE, KoreaMed, and Google Scholar up to September 2021. Fever and systemic inflammatory response syndrome (SIRS) were compared by meta-analysis. A subgroup analysis was performed according to the degree of risk to the patient.ResultsA total of 10 articles were included in this study. There were no significant differences between single dose and extended dose in the rate of fever [p = 0.93, OR = 0.96, 95% confidence interval (CI) 0.44–2.13, I2 = 64%]. Extended dose showed lower rate of SIRS compared to single dose (p = 0.0005, OR = 1.81, 95% CI 1.30–2.53, I2 = 53%); in the subgroup analysis, extended dose also showed lower rates of SIRS compared to single dose in high-risk patients (p <0.0001, OR = 3.53, 95% CI 1.91–6.54, I2 = 36%).ConclusionsThe results of our meta-analysis showed that single-dose antibiotic prophylaxis can be effective for PCNL, but extended-dose antibiotics can be required in high-risk patients to reduce post-PCNL infection-related complications.

Study of Single Dose of Antibiotic Prophylaxis in Clean Surgeries at a Tertiary Care Centre

Background: Pre-operative single dose antibiotic prophylaxis has shown to reduce the incidence of surgical site infections and thereby patient morbidity. Aims: To evaluate effectiveness of single dose antibiotic prophylaxis in clean surgeries at a tertiary care hospital. Material and Methods: A total of 72 patients undergoing clean surgeries were included after they satisfied the inclusion and exclusion criteria. Results: Single dose of an intravenous prophylaxis of ceftriaxone in clean surgeries excisional biopsy of lipoma, dermoid cyst, sebaceous cyst, enucleation of fibroadenoma, herniotomy, eversion of hydrocele etc. was efficacious in preventing surgical site infection. Surgical site infection was associated with patient’s age, lower haemoglobin levels and longer hospital stay in 3 out of 72 patients. Conclusion: In the present study it was observed that prophylactic single shot of antibiotic is efficacious in averting surgical site infection and is economical for patients undergoing clean surgeries. Factors associated with surgical site infection were patient’s age, haemoglobin and associated co-morbidity like diabetes.

Comparison of three antibiotic protocols for prevention of infection in dental implant surgery: A randomized clinical trial

SummeryThis study aimed to compare the rate of post-surgical infection following single-dose antibiotic prophylaxis with or without post-surgical antibiotics versus post-surgical administration of antibiotics alone. The study consisted of three groups; Group 1 received single-dose antibiotic prophylaxis orally (2 g amoxicillin 1 h before surgery). Group 2 received one dose of prophylactic antibiotic (2 g amoxicillin 1 h before surgery) with additional doses after surgery (500 mg amoxicillin, q8h for 5 days). Group 3 received post-surgical antibiotics alone (500 mg amoxicillin, q8h for 5 days). 450 patients were enrolled. Post-surgical infection was seen in 9 patients of group 1, 11 patients of group 2, and 7 patients of group 3. There was no significant difference in the rate of postoperative infection among the study groups (p value = 0.62). The number of failed implants was 2 in group 2, and 1 in group 3. Subgroup analysis showed no significant difference in infection rates among the three groups regarding concomitant guided bone regeneration. However, there was a significant difference in the rate of post-surgical infection between smokers and non-smokers (p < 0.001). Within the limitations of the study, it seems that a single preoperative dose of antibiotics is sufficient for reducing surgical site infections, adequately and should be preferred after implant placement whenever appropriate.

Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical interventions: a nonrandomized, historically controlled equivalence trial.

Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score-matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88-1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27-1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12-3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14-2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13-3.31). No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.

237 Antibiotic Prophylaxis of Precision Point Prostate Biopsy Under LA: Changed Practice in a District General Hospital

Abstract Aim More than 4 million prostate biopsies are performed worldwide each year (1). Out of three different techniques (Template, transperineal, TRUS), Transperineal precision point biopsy under local anaesthesia is the latest and reported to have fewer infectious complications (2). UTI, Urosepsis, septicaemia are some well-known infectious complications following prostate biopsies. Therefore, the Canadian Urological Association recommended the use of broad-based Gram-negative antibiotic prophylaxis 30 to 60 minutes before the procedure and continued for 2 to 3 days in their guideline (3). Our aim was to compare the outcome of two different antibiotic prophylaxis regimens. Method In our study to assess the outcome of single-dose prophylaxis compared to regular dose, we collected retrospective data of 119 patients who had undergone precision point biopsy in our hospital. Results Among 119 patients, 52 (43.69%) were given 3 days of oral antibiotic followed by preprocedural dose and 67 (56.31%) were given just a single dose before the procedure. None of these patients from both groups were readmitted with any infectious complication post-procedure. 1 patient from the second group (single dose) was admitted with urinary retention but no increased inflammatory markers were found. Conclusions TRUS biopsy breeches the rectal mucosa and carries higher chances of post-biopsy infection so requires antibiotic prophylaxis. Single-dose antibiotic prophylaxis is recommended option for transperineal biopsies as the infection rate is lower. Our study shows the same outcome for single-dose and 3-day regimens for transperineal precision point prostate biopsy. Moreover, the use of single dose will significantly reduce medicine costs and antibiotic resistance to improve patient compliance.