Single Dose Of Preoperative Antibiotics Research Articles

Antibiotics for surgical site infections in patients undergoing orthognathic surgery.

PubMed, Embase, Web of Science and Scopus. Randomized Controlled Trials (RCTs) for patients undergoing orthognathic surgery of any type, which evaluated surgical site infections (SSI) in either: long-term (at least 2 days) post-surgical antibiotic dosing versus short term (one day) post-surgical dosing for the same drug; or Orthognathic surgery patients administered a post-surgical single-day antibiotic versus a singular pre-operative dosing of any antibiotic in the post-surgical phase. Singe-arm studies, retrospective studies, unpublished data, studies which were not peer-reviewed, editorials and trials not dealing with patients undergoing orthognathic surgery specifically were not included. Data for the publication year, primary author name, location of the study, antibiotic type, antibiotic protocol with its type, dosing and timing, sample size, protocol of the control group, male gender, age, diagnosis and rates of SSIs were extracted from the included studies. Pooled rates of SSIs were utilized to produce risk ratio (RR). A total of eleven RCTs met the inclusion criteria. As per the meta-analysis, post-orthognathic surgery SSI risk was reduced significantly as a result of long-term prophylactic antibiotic usage when compared to short-term utilization. Further, the meta-analysis demonstrated that there was a significant reduction of SSI risk in patients on a single day prophylactic antibiotic regimen in comparison to those on a single preoperative antibiotic dose. The study observed that long-term (2-7 days) prophylactic antibiotics reduce SSI risk when compared to antibiotic administration over a single day. In turn, it was also found that the latter was of greater benefit over a pre-operative single antibiotic dosage.

Frequency of surgical site infection after single dose of preoperative antibiotics in children with uncomplicated acute appendicitis: a cross-sectional study

Background: Hyperaemic suppurative appendicitis, or uncomplicated appendicitis, often requires an appendectomy. Surgical Site Infection (SSI) is common post-surgery, and prophylactic studies show ceftriaxone and metronidazole effectively protect against most causative organisms. Methods: Ninety patients were included through non-probability convenience sampling. Acute appendicitis was diagnosed using the Alvarado score, with surgery for scores of 7 or higher. A single preoperative dose of ceftriaxone and metronidazole was administered. Follow-up visits included stitch removal on the seventh postoperative day and monitoring up to the tenth postoperative day using the Southampton criteria for wound infection. Results: Of the 90 patients, 64 (71.1%) were male and 26 (28.9%) were female. Fifty (55.6%) scored 7-8 on the Alvarado score, and 40 (44.4%) scored 9-10. Using the Southampton criteria, 5 (5.6%) developed grade I SSI. Infection rates showed no significant difference between male (3.1%) and female (11.5%) patients (p value >0.05) or by Alvarado score and symptom duration. No cases of SSI beyond grade II were observed. Conclusions: Administering a single preoperative antibiotic dose effectively minimizes surgical site infection in children with uncomplicated acute appendicitis, demonstrating clear management advantages.

Efficacy of single-dose versus triple-doses perioperative antimicrobial prophylaxis in patients undergoing laparoscopic cholecystectomy

Introduction: Although debatable, prophylactic antibiotics may be required for patients undergoing cholecystectomy for symptomatic gallstone disease with certain associated risk factors. Our study aimed to perform a non-randomised prospective comparative trial evaluating a single-dose pre-operative antibiotic versus a triple-dose prophylactic post-operative antibiotic in patients with symptomatic uncomplicated cholelithiasis undergoing laparoscopic cholecystectomy. Methodology: This study was a non-randomised prospective comparative study in a single institution. Two hundred patients were enrolled and allocated to two groups. Group A patients were given a single dose of pre-operative prophylactic antibiotic, and Group B patients received a triple dose of prophylactic antibiotic therapy. We also studied the bacteriological profile of bile in all the patients using bile culture and antibiotic sensitivity, and we analysed their association with post-operative surgical site infection (SSI). Results: All the patients were followed up on post-operative days 7 and 30. On post-operative day 7, 2% of patients in Group A and 1% of patients in Group B were found to have SSI, and no statistically significant difference in SSI between the two groups was noted (P = 0.558). On post-operative day 30, no patient was found to have a SSI in either of the two groups. Moreover, post-operative bile culture was obtained in all the cases, and 6% of patients had a positive bile culture. However, none of them developed SSIs on post-operative day 7. Conclusion: A single-dose pre-operative antibiotic is as effective as three perioperative doses in preventing SSI in laparoscopic cholecystectomy for symptomatic, uncomplicated gallstone disease. Our study did not associate port-site SSI with a positive bile culture.

The Impact of Redosing Antibiotics for Pediatric Patients Undergoing Appendectomy for Complicated Appendicitis.

Currently, there is no universally accepted, standardized protocol for pre-operative antibiotic administration in the setting of appendectomy for complicated appendicitis among pediatric patients. Strategies to mitigate surgical site infections (SSIs) must be balanced with optimal antibiotic use and exposure. We conducted a retrospective chart review to compare outcomes between patients treated pre-operatively with a single pre-operative dose of antibiotics with those who received additional antibiotics prior to laparoscopic appendectomy for complicated appendicitis between 2020 and 2022. Of 124 pediatric patients, 18% received an additional dose of pre-operative antibiotics after initial treatment dose. Surgical site infection rates between the two groups were not statistically significant (P-value = .352), thereby suggesting that redosing antibiotics closer to the time of incision may not impact SSI rates. Additional studies are necessary to make clinical recommendations.

Surgical Site Infections in Single-dose versus Multiple-dose Broad-spectrum Intravenous Antibiotic Prophylaxis in Clean Surgeries: A Quasi-experimental Study

Introduction: Surgical Site Infections (SSIs) constitute a prevalent nosocomial concern among surgical patients. The incidence of SSIs typically ranges from 1-2% in the context of clean surgeries, irrespective of the use of antibiotic prophylaxis. Frequently, a single preoperative dose of antibiotics administered up to 60 minutes before surgery suffices. Aim: To compare the rates of postoperative infections following a single preoperative dose of prophylactic antibiotics with those receiving multiple postoperative doses. Materials and Methods: This quasi-experimental study was conducted at the Surgery Department of Kumareshwara Hospital in Bagalkot, Karnataka, India. Participants included individuals aged over 18 years undergoing elective clean surgeries, with their informed consent. Patients with co-morbidities or pre-existing infections at the surgical site were excluded from the study. A total of 161 cases were enrolled, divided into two groups: Group A (single dose of broad-spectrum i.v. antibiotic with 70 patients) and Group B (multiple doses of the same broad-spectrum antibiotic with 91 patients). Independent parameters of outcome variables were analysed using the Chi-square test and Student’s t-test. Results: The mean age of study participants was 41.25±13.47 years. The incidence of SSI in Group A was 1.42%, while in Group B, it was 2.20%. The mean duration of hospital stay was shorter in Group A (6.11±3.87 days) compared to Group B (7.60±4.08 days). Conclusion: In conclusion, the study suggests that the incidence of SSIs in both groups is similar and statistically insignificant for clean surgeries. Importantly, the hospital stay was shorter in the group receiving a single preoperative dose of antibiotics compared to multiple doses of antibiotics.

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

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

FTP7.14 A systematic review and meta-analysis evaluating the role of single-dose preoperative versus extended use of antibiotics therapy following acute cholecystectomy

Abstract Laparoscopic cholecystectomy (LC) during index admission for acute cholecystitis is considered a preferred mode of treating gallstone disease. The objective of this study is to evaluate the role of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days in these patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis. Materials and methods RCTs reporting the use of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days following acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results The search of medical databases yielded 4 RCTs on 949 patients undergoing acute cholecystectomy. There were 481 patients in in single dose pre-operative antibiotics group whereas 468 patients received extended doses antibiotics therapy. In the random effects model analysis, the extended use of post-operative antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not confer any extra benefit [risk ratio 1.05, 95%, CI (0.73, 1.51), Z = 0.25, P=0.80] in terms of reducing the infective complications. There was no heterogeneity (Tau2 = 0; Chi2 = 0.40, df = 3; (P = 0.94; I2 = 0 %) among included studies. Conclusion Post-operative extended use of antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not demonstrate extra benefit to reduce infective complications.

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

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

Effectiveness of Use of Single Dose Preoperative Antibiotic versus both Pre and Post Operative Antibiotics in Patients Undergoing Laparoscopic Uncomplicated Appendectomy in Birat Medical College Teaching Hospital (BMCTH)

Introduction: Acute appendicitis is one of the most common surgical emergency. Rationalized use of antibiotics prevents the risk of post operative complications. There is no conclusive recommendation on the duration of antibiotic usage and role of postoperative use of antibiotics in preventing complications in uncomplicated cases remains controversial till date.
 Objectives: To compare the effectiveness of single dose preoperative antibiotic with preoperative and postoperative antibiotics for patients undergoing laparoscopic uncomplicated appendectomy.
 Methodology: A total number of 113 patients who fulfilled the selection criteria underwent laparoscopic appendectomy for uncomplicated appendicitis and were randomly divided into two groups. Group A patients received only pre operative antibiotics whereas Group B patients received both preoperative and postoperative antibiotics. Patients of both the groups were followed up postoperatively till discharge from the hospital
 Results: In this study, patients who received only pre-operative antibiotic were 57 (50.4%) and patients who received both preoperative and postoperative antibiotics were 56(49.6%). SSI was detected in total of 2 patients (1.8%) one from each group and postoperative lump noted in right iliac fossa (RIF) in 2 patients (1.8%) one in each group intraoperatively in which further antibiotic was continued postoperatively. Hematoma, seroma and peritonitis were absent in both the groups. The difference between the two groups for incidence of SSI and postoperative RIF lump was statistically insignificant with P value of 0.748.
 Conclusion: Single dose preoperative antibiotic is sufficient in preventing postoperative complications in patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. This can be recommended for implementation as standard operating protocol in such cases.

Bladder Microbiota Are Associated with Clinical Conditions That Extend beyond the Urinary Tract.

Background. Since the discovery of the human urinary microbiota (UM), alterations in microbial community composition have been associated with various genitourinary conditions. The aim of this exploratory study was to examine possible associations of UM with clinical conditions beyond the urinary tract and to test some of the conclusions from previous studies on UM. Methods. Catheterised urine samples from 87 men were collected prior to endoscopic urological interventions under anaesthesia. The composition of the bacterial community in urine was characterized using the hypervariable V4 region of the 16S rRNA gene. Samples from 58 patients yielded a sufficient amount of bacterial DNA for analysis. Alpha diversity measures (number of operational taxonomic units, ACE, iChao2, Shannon and Simpson indices) were compared with the Kruskal–Wallis test. Beta diversity (differences in microbial community composition) was assessed using non-metric dimensional scaling in combination with the Prevalence in Microbiome Analysis algorithm. Results. Differences in bacterial richness and diversity were observed for the following variables: age, diabetes mellitus, dyslipidemia, smoking status and single-dose preoperative antibiotics. Differences in microbial community composition were observed in the presence of chronic kidney disease, lower urinary tract symptoms and antibiotic prophylaxis. Conclusions. UM appears to be associated with certain clinical conditions, including those unrelated to the urinary tract. Further investigation is needed before conclusions can be drawn for diagnostics and treatment.

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.

Comparative Evaluation of the Influence of Single Preoperative Antibiotic Dose of Amoxicillin (1gm) and Postoperative Antibiotic Dose of Amoxicillin Drug (500mg) Regimen on Postoperative Outcome and Implant Stability in Single Tooth Dental Implant Surgery: Randomized Controlled Trial

Aims: A single blinded randomized controlled trial was conducted to test the efficiency of two antibiotic regimens on post operative outcome and implant stability in single tooth dental implant to overcome the increasing drug resistance due to over prescription of medicines and side effects of the same.&#x0D; Methodology: 20 participants needing single tooth dental implant were enrolled based on inclusion and exclusion criteria. The participants were randomly assigned into groups. 10 participants in group 1 received only a single preoperative dosage of amoxicillin 1gm which was followed by paracetamol. In group 2, 500mg amoxicillin was given postoperatively followed by a three times a day for 3 days regimen. The postoperative outcome was evaluated based on swelling, post-operative bruising, suppuration and wound dehiscence noticed on 2nd and 7th day postoperatively. ISQ (implant stability quotient) was checked 3 months post implant placement as osseointergration is the main goal of implant placement.&#x0D; Results: Post-operative bruising, suppuration and wound dehiscence were not noticed in the entire study due to sterile environment during implant placement. When swelling was compared between group 1 and 2 it was statistically insignificant on day 2 (Mann Whitney u=40.00, p=0.383) and day 7 (Mann Whitney u=50.00, p=01.00). ISQ (IMPLANT STABILITY QUOTIENT) score in group 1&amp;2 also showed statistically insignificant results (t=0.00, p=1.00) Which states that there was no significant difference in the stability of implants when single preoperative antibiotic dose of amoxicillin(1gm) and postoperative antibiotic dose of amoxicillin drug(500mg) regimen 3 times a day for 3 days was given.&#x0D; Conclusion: this study shows that in healthy individual, when single implant is placed in proper sterile environment with routine dental hygiene such as brushing and chlorhexidine mouthwash use by patient, single preoperative dose of amoxicillin 1gm is sufficient for the success of implant. However, considering the limitations of the study, further work is necessary to validate reliability.&#x0D; No adverse effects were observed in the study&#x0D; Funding: NIL&#x0D; Reg no:DYPDCH/EC/648/12/2021

Do Preoperative Prophylactic Antibiotics Reduce Surgical Site Infection Following Wire-Localized Lumpectomy? A Single-Blind Randomized Clinical Trial.

Data on the benefits of preoperative prophylactic antibiotics for breast surgery are conflicting, and there is no specific guideline for their use in wire-localized lumpectomy. This is a proof-of-concept, single-blind randomized controlled trial carried out from April 2018 to June 2019 at the Centre des Maladies du Sein du CHU de Québec - Université Laval. The objectives were to determine whether a single dose of preoperative antibiotics reduces surgical site infection (SSI) after wire-localized lumpectomy and to identify the risk factors for SSI. The patients were randomized to receive preoperative prophylactic antibiotics or not. SSI was defined by positive breast wound cultures, abscess drainage, and/or antibiotics given for clinical signs of breast infection within 30 days of the operation. This study was registered with ClinicalTrials.gov, NCT04818931. A total of 330 patients were enrolled. Eighteen patients were excluded. The SSI rate was 3.1% (5/160) in the antibiotic group versus 5.9% (9/152) in the control group (p = 0.28). Only obesity was a significant risk factor for SSI. All cases of SSI were treated routinely with antibiotics; one patient required wound re-opening. None of the SSIs delayed the adjuvant treatment. Preoperative antibiotic prophylaxis does not significantly decrease the occurrence of breast SSI. It is safe to omit prophylactic antibiotics for a wire-localized lumpectomy. This could also decrease the treatment costs and avoid unnecessary side effects.

Any Time Laparoscopic Cholecystectomy in Moderate to Severe Acute Cholecystitis without Septic Shock

Introduction: There is an ongoing debate over the timings of laparoscopic cholecystectomy in acute cholecystitis. Most authors recommend surgery within the first 72 hours. We offer laparoscopic cholecystectomies in every patient with acute cholecystitis regardless of the timing of presentation. Material and methods: We prospectively analyzed outcomes of our protocol of any time acute cholecystitis. We perform laparoscopic cholecystectomies within the first 24 hours of presentation to us without considering time since attack if the patient is not in septic shock where we follow survival sepsis guidelines. Results: We performed 110 laparoscopic cholecystectomies between April, 2019-March, 2020. We prefer single-dose preoperative antibiotics (third-generation cephalosporin) in all laparoscopic cholecystectomies. A total of 79 patients were having acute cholecystitis. 67 patients were having grade 2 and 12 patients were having grade 3 cholecystitis according to Tokyo guidelines. 50 patients were presented more than 72 hours after the attack. 21 patients presented more than 48 hours but less than 72 hours. 8 patients presented within 24 hours. The mean duration of the presentation was 120 hours. 5 patients presented after more than 7 days. One patient was having grade 3 cholecystitis and was having septic shock so he was managed with percutaneous cholecystostomy and according to survival sepsis, protocol and lap choly were done after 72 hours. Out of 79 patients included in the study, 2 patients were converted to open; in 3 patients we performed lap subtotal cholecystectomy due to difficult calot triangle. Out of these only 2 patients developed port site infection and 3 patients developed bilioma which was managed by percutaneous drainage. All patients were discharged the same day or the next day. Only two patients with bilioma were readmitted. Rest all of the patients had an uneventful recovery. Conclusion: There is no need to strictly follow the 72-hour time limit for laparoscopic cholecystectomy in acute cholecystitis. Any time laparoscopic cholecystectomy should be the rule inexperienced centre.

Comparative study of single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for pediatric inguinal herniotomy

To compare single dose preoperative antibiotic versus five days antibiotic course in preventing surgical site infection for the pediatric inguinal herniotomy.The present study was conducted on 100 patients of elective inguinal herniotomy from January 2019 to April 2020 and compared on the basis of single dose preoperative antibiotic versus five days antibiotic course. All the patients were evaluated on the 3rd, 7th and 28th post-operative period and instructions were given to the guardians about wound care and to attend for early follow up if any signs &amp; symptoms of wound infection appear.50% of the patients were treated with prophylactic single dose antibiotic, i.e. inj. Ceftriaxone (30 mg/kg/dose) at the time of induction only and rest 50% were treated with inj. Ceftriaxone(30mg/kg/dose) at the time of induction as well as postoperatively at night followed by four days of oral antibiotic with Syr/Tablet. Cephalexin (25mg/kg/day) three times daily for another 4 days.Surgical Site Infection (SSI) in Group-B (4.0%) was higher than that of Group-A (2.0%) on day 3 but it was not significant (p=0.40). There was no significant difference in health status of the patients of the two groups when compared on post-operative day 7 and day 28 (p=0.99, p=0.99 respectively).Implementation of single dose antibiotic prophylaxis regimes tailored to the prevalent organisms in the institution can result in enormous savings, as the study shows significant reduction in hospital stay with no significant increase in incidence of SSI.

Antibiotic prescribing practices in general surgery: a mixed methods quality improvement project

SummaryBackgroundA single pre-operative antibiotic dose provides optimal prophylaxis against surgical site infection (SSI), but significant variability persists in adherence to prophylaxis guidelines. We describe a quality improvement project aiming to improve guideline-driven antibiotic prescribing within surgical teams at a tertiary hospital.MethodsFace-to-face interviews with surgical teams and anonymous surveys of senior surgeons and anaesthetists were used to collect qualitative data on the perceptions and attitudes of prescribers. This informed intervention development, including a daily ward-round checklist using the acronymous ‘ABBDDOMM’, from A (antibiotics) to M (microbiology), combined with education and heightened guideline accessibility. A first audit cycle was performed for patients undergoing intra-abdominal surgery during a two-month period (cycle one). Post-implementation data were collected 12 months later (cycle two).FindingsInterviews provided insight into common themes and barriers surrounding antibiotic prescribing, whilst surveys explored future solutions to these barriers. In cycle one, 100/205 (48.8%) patients received extended antibiotics beyond the single-dose prophylaxis. Following intervention, only 41/138 (29.7%) patients received extended antibiotic courses, demonstrating a 21.5% reduction in prolonged antibiotics (P<0.0005). In cycle one, 107/205 patients (52.2%) received antibiotics compliant with Trust Guidelines, compared to 80/138 (58.0%) in cycle two.ConclusionOur proposed checklist, alongside antimicrobial stewardship education, prompts daily review of important patient parameters and results to significantly reduce inappropriate post-operative antibiotic prescribing. Promoting the sustained use of similar checklists by junior doctors and focusing on measures to improve uptake of pre-operative induction antibiotic guidelines is required to achieve further benefits.

What Is the Proper Antibiotic Prophylaxis Regimen for Dental Implant Placement?

What Is the Proper Antibiotic Prophylaxis Regimen for Dental Implant Placement?

Is a single dose of prophylactic antibiotics sufficient in patients with acute noncomplicated appendicitis

Background Antibiotics prescription before surgery is considered to be effective in reducing the infectious complications of appendectomy. As a result, most surgeons prescribe antibiotics before surgery for patients diagnosed with appendicitis. Objective The aim of study was to evaluate the effect of a single antibiotic dose compared with the concurrent regimen on the outcome of appendectomy, especially infective complications. Patients and methods A total of 60 cases diagnosed with appendicitis were included, and they were divided into two groups: group A (single dose of cefotaxime 1 g and metronidazole 500 mg before surgery) and group B (the same regimen was received, and it was repeated twice daily for 4 days). All cases were subjected to history taking, physical examination, and routine investigations. At follow-up, all cases were clinically assessed. Results There were no significant statistical differences between groups in age, sex, and BMI variables. No significant statistical differences were observed during the surgery and hospitalization period between two groups. Wound infection occurred in 10 and 6.67% of cases in both groups, respectively (P > 0.05). However, the cost was significantly higher in group B. Conclusion A single dose preoperative antibiotics appears to be as efficacious as concurrent regimen in preventing wound infections after appendectomy. Continuing antibiotic prophylaxis in the postoperative period was not necessary, and it added additional unnecessary financial costs.

Antibiotic Resistance in Acute Cholecystitis Graded According to Tokyo Guidelines 2018: The First Prospective Study

Introduction: Single-dose antibiotics are recommended for laparoscopic cholecystectomy, for symptomatic gall stones. However, very few studies are there for subgroup grade-2 and grade-3 cholecystitis according to Tokyo guidelines 2018. Material and methods: We retrospectively analysed outcomes of our protocol of no post-operative antibiotics in grade-2 and grade 3 (moderate to severe) acute cholecystitis according to Tokyo guidelines. We perform laparoscopic cholecystectomies within the first 24 hours of presentation to us without considering time since attack if the patient is not in septic shock where we follow survival sepsis guidelines and also perform percutaneous cholecystostomy. All the data were prospectively analysed. Statistical evaluation was done using SPSS version 21(IBM). Results: We performed 101 laparoscopic cholecystectomies between April 2016 to January 2019. We prefer single dose pre-operative antibiotic (third-generation cephalosporins) in all laparoscopic cholecystectomies and no post-operative antibiotics. A total of 74 patients were having grade 2 or grade 3 cholecystitis. 64 patients were having grade 2 and 9 patients were having grade 3 cholecystitis. One patient was having grade 3 cholecystitis and was having septic shock so he was managed with percutaneous cholecystostomy and according to survival sepsis protocol and lap choly was done after 72 hours and hence excluded from the study. Out of 73 patients included in the study, 2 patients were converted to open; in two patients we performed lap subtotal cholecystectomy due to a difficult calot triangle. Out of this only 1 patient developed port site infection and two patient developed biloma which was managed by percutaneous drainage. All patients were discharged the same day or the next day. Only two patients with biloma were readmitted. Rest all of the patients had an uneventful recovery. Conclusion: Post-operative antibiotics are unnecessary even in grade-2, grade-3 acute cholecystitis without septic shock according to Tokyo guidelines.

Is a single dose of preoperative antibiotic therapy effective for patients treated with megaendoprosthesis after metastatic bone tumour resection?

All patients who underwent primary MPR in MBD were included in this prospective study. All penicillin-sensitive patients received one dose of cefuroxime 1.5gm intravenous at induction. In penicillin-allergic patients, teicoplanin 1.2gm and ciprofloxacin 500mg intravenous was administered. The patients were followed up in the wound clinic and the specialist MBD clinic at 2weeks, 3months, 6months and then annually. Data collected included demographics, primary tumours, surgical procedures, complications and duration of follow-up. All calculations were performed using SPSS® 25(IBM, USA). A p value ≤ 0.05 was considered to be significant. There were 51 patients with a mean age of 65.4years. Procedures included proximal femoral replacement (35), distal femoral replacement (7), proximal humeral replacement (4), distal humeral replacement (3) and total femoral replacement (2). Thirty-seven patients received cefuroxime, and fourteen patients received teicoplanin and ciprofloxacin at induction of anaesthesia. The deep infection rate was 1.9%. Thirty-seven patients died with a median survival of 10months (1 to 51months). Mean follow-up was 18.9months (1 to 70months). Single dose of preoperative antibiotics at anaesthetic induction seems to be safe and effective for preoperative prophylaxis in orthopaedic oncology.