Single Dose Of Prophylactic Antibiotics Research Articles

#2189 Percutaneous peritoneal dialysis catheter implantation

Abstract Background and Aims There are three main techniques to implant a peritoneal dialysis catheter (PDC): percutaneously, laparoscopically or through open surgery; and current guidelines recommend individualising according to previous abdominal surgeries and anaesthetic risk. Recent metanalysis show the percutaneous technique to be safe, non-inferior in catheter survival, and with an equal incidence in mechanic complications (within <3 months after implantation) and infectious complications (within <1 month after implantation) to laparoscopic technique. On the other side, as the percutaneous PDC implantation is a minimal intervention that requires neither surgery room nor over 24h hospitalisation, it allows for a lower waiting time to PDC implantation, a shorter period until usage, and it's economically efficient. Considering these benefits and its non-inferiority described in the literature, our centre started using this technique since 2018. In this study we analyse our results. Method This is an observational retrospective unicentric study, which included the first PDC implantation in adult patients between January 2019 and August 2023, were we analysed the mechanical and infectious complications associated with the implantation technique. All PDC were double-cuff straight Tenckhoff, placed using Seldinger technique with radioscopy. A single dose of prophylactic antibiotic was used. We considered as mechanic complication all those non-infectious incidences that required repositioning or replacement of the PDC within 3 months of implantation (excluding those patients whose catheter was removed because of kidney transplantation, death by other reasons non related to the procedure, or trespass to haemodialysis); and we considered as infectious complications all those peritonitis diagnosed the first month after implantation. Results We analysed a total of 147 patients, 71.4% were male, mean age was 61 years old, and mean kidney function at implantation time was 11.5 ml/min/1.73 m2. We found a total of 8.1% of mechanical complications (33% required repositioning and 66% required replacement) and 5.4% infectious complications. There were no deaths related to percutaneous PDC technique. Conclusion In this study we observe that mechanic or infectious complications associated with percutaneous PDC technique are similar to those published in the literature: ISPD guidelines recommend the incidence of peritonitis associated to catheter implantation to be less than 5%. And though there is no clear percentage of mechanical complications that are considered acceptable or unavoidable, many studies report a survival of 76-86% PDC at 90 days of implantation in percutaneous and laparoscopic procedures, without significant differences between them.

THE ROLE OF PROPHYLACTIC ANTIBIOTICS IN ZONE II AND ZONE V ACUTE FLEXOR TENDON INJURIES

Our study sought to establish the necessity of prolonged pre-operative antibiotic prophylaxis in patients presenting with zone II and zone V acute flexor tendon injuries (FTI). We hypothesized that a single dose of prophylactic antibiotic was adequate in prevention of post-operative wound infection in acute zone II and V FTI.This was a prospective study of 116 patients who presented with zone II and zone V acute FTI. The study included patients who were 18 years and older. Those with macroscopic contamination, immunocompromised, open fractures, bite injuries, and crush injuries were excluded. Patients were randomised into a group receiving a single dose of prophylactic antibiotic and another group receiving a continuous 8 hourly antibiotic doses until the day of surgery. Each group was subdivided into occupational and non-occupational injuries. Their post-operative wound outcomes were documented 10 – 14 days after surgery. The wound outcome was reported as no infection, superficial infection (treated with wound dressings), and deep infection (requiring surgical debridement).There was 0.9% rate of deep post-operative wound infections, which was a single zone V acute FTI case in a single dose prophylactic antibiotic group. There was a 7.8% superficial post-operative wound infection rate, which was mainly zone II acute FTI in both antibiotic groups. There was a strong association between zone II acute FTI and post-operative wound infection (p < 0.05). There was no association between (antibiotic dosage or place of injury) with post-operative wound infection (p > 0.05).There is no benefit in prescribing prolonged pre-operative antibiotic in patients with acute, simple lacerations to zone II and zone V FTI if there is no macroscopic wound contamination.

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.

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.

Efficacy of 1 Versus 3 Days of Intravenous Amikacin as a Prophylaxis for Patients Undergoing Transurethral Resect Prostate: A Prospective Randomized Trail

Background: The goal of the current study was to investigate the safety of a single dose of IV Amikacin given a period of three days as compared to a single dose of one and two days, when used as a surgical prophylactic antibiotic prior to transurethral prostate resection. Study Design: This was a randomized and prospective study conducted at Urology Department of Niazi Medical & Dental College Sargodha for the duration of six-months from May 2022 to October 2022. Methods: There were 300 men who participated in total and had their prostates transurethral resected (TURP). Three groups, A, B, and C, each with 100 participants, were created randomly from among the participants. The participants will either be assigned at random to receive a single dose of Amikacin that complies with recommendations for groups A, B, and C on days 1, 2, and 3. Follow Up until day 30 following surgery, routinely gathered data from TURP will be the end of the study. Within 60 minutes of the incision, all patients received a single dose of prophylactic antibiotics. Results: The Groups A and B had higher rates of significant bacteriuria than Group C, the intention-to-treat analysis determined that this difference was not statistically significant. The results of a per-protocol analysis were similar. (p=0.88; 0.13). This suggests that postoperative bacteriuria poses a significant risk for the emergence of UTI symptoms (p=o.oo2**). Antibacterial drug resistance has a significant relationship with the progression of infectious complications and was associated with a history of diabetes (95% [CI]]: 0.08-3.11, OR=0.33; p=0.01*) and surgical history and ESBL positivity were indicate infection-related issues (95% [CI]: 1.51-1.86, OR=5.1; p=0.023 and 95% [CI]: 2.55-13.1, OR=4.90; p<0.0001***). Conclusions The Amikacin was safe for surgical prophyaxis in single dose until 3 days as compared to 1 and 2 days because of the incidence of postoperative complication such as UTI reduced. It was greater role to decrease antibiotic resistance. Keyword: Bacterial infection, Urinary tract, Antibiotics.

PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION

You have accessJournal of UrologyCME1 Apr 2023PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION Justina Tam, Heng Ruan, Matthew Mikula, Hannah Koenig, Alvaro Lucioni, Wai Lee, Jason Kim, Una Lee, and Kathleen Kobashi Justina TamJustina Tam More articles by this author , Heng RuanHeng Ruan More articles by this author , Matthew MikulaMatthew Mikula More articles by this author , Hannah KoenigHannah Koenig More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Wai LeeWai Lee More articles by this author , Jason KimJason Kim More articles by this author , Una LeeUna Lee More articles by this author , and Kathleen KobashiKathleen Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intradetrusor injection of onabotulinumtoxinA (BTX) is safe and efficacious in the treatment of neurogenic and non-neurogenic overactive bladder (OAB). Urinary tract infection (UTI) is a known potential adverse event. Published guidelines for cystoscopic procedures with manipulation recommend the use of prophylactic antibiotics, and prophylactic antibiotics are commonly administered pre-BTX. However, there is a paucity of data demonstrating that pre-procedural antibiotic administration decreases the rate of post-procedural UTI after BTX. In the era of antibiotic stewardship and avoidance of antibiotic overuse, we aimed to study the difference in UTI rates between patients asymptomatic for UTI who receive and do not receive antibiotics at the time of BTX in a prospective, randomized multi-institutional study. Here, we report our preliminary study results. METHODS: Patients with OAB undergoing BTX who were not symptomatic for UTI and had urinalysis demonstrating fewer than 2+ leukocyte esterase at the time of injection were randomized to receive either a single dose of pre-procedural prophylactic antibiotics or no antibiotics. Patients who had taken antibiotics within 48 hours of the procedure were excluded from study participation. Symptomatic UTIs within 2 weeks of injection was identified and recorded. Demographics and past medical history were recorded. RESULTS: Of 86 patients who have been enrolled, 40 were randomized to receive antibiotics, and 46 were randomized to not receive antibiotics. Table 1 summarizes the patient demographics, clinical history, and UTI rate. At 2-week follow up, a total of 4 patients developed UTI. One patient in the antibiotic group developed UTI, and 3 patients who did not receive antibiotics developed UTI. CONCLUSIONS: Our preliminary results suggest that the use of a single dose of prophylactic antibiotic may not affect the rate of post-procedural UTI. Patient enrollment is ongoing to determine if these findings hold true in a larger patient cohort. Source of Funding: 2020 Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction Foundation Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e413 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justina Tam More articles by this author Heng Ruan More articles by this author Matthew Mikula More articles by this author Hannah Koenig More articles by this author Alvaro Lucioni More articles by this author Wai Lee More articles by this author Jason Kim More articles by this author Una Lee More articles by this author Kathleen Kobashi More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of single dose prophylactic antibiotics versus phytotherapy in altering the microbial colonization related to indwelling double-J stent A prospective randomized controlled multicenter study

Effect of single dose prophylactic antibiotics versus phytotherapy in altering the microbial colonization related to indwelling double-J stent A prospective randomized controlled multicenter study

A comparative study of single dose prophylactic antibiotic versus empirical post-operative antibiotics in prevention of SSI

A comparative study of single dose prophylactic antibiotic versus empirical post-operative antibiotics in prevention of SSI

Incidence of Infectious Morbidity Following Single Dose of Prophylactic Antibiotics In Women Undergoing Elective Cesarean Section

Introduction: Cesarean delivery is a major obstetrical surgicalprocedure aiming to save the lives of mothers and fetuses.The incidence of cesarean section varies between 10.0% and25.0% in most developed countries.1Material and Methods: 80 cases for elective cesarean sectionadmitted in ward/labour room of Department of Obstt andGynae, SRMSIMS were studied to determine the incidenceof infectious morbidity, i.e., UTI, SSI, puerperal sepsis andendometritis on different occasions that are immediatepostoperatively, 48 hours post-operative, on discharge (4–5thday) and upto 6 weeks post-partum.Preoperative routine blood and urine examination were doneto recruit low-risk patients.Preoperative part preparation with betadine was done the nightbefore surgery, followed by intraurethral catheterization with 3swabs under all aseptic precautions.Results: There is a relationship between the timing ofadministration of prophylactic antibiotics and infectiousmorbidity. On comparing demographic factors concerninginfectious morbidity, a statistically significant p-value wasobserved with the women's age, parity and BMI.Conclusion: Single dose of prophylactic antibiotics shouldbe effective if given within 30 minutes of skin incision in anelective cesarean section, especially in women with mean age26.2 ± 4.2 years, low parity and with mean BMI of 24.9±2.4(kg/m2). The neonatal outcome is not much affected on givingprophylactic antibiotics before cord clamping. Despite ofprophylactic antibiotics aseptic technique during intraurethralcatheterization and check dressing at 48 hours postoperativelyof the surgical site is the most important factor in preventinginfectious morbidity.

Post-Operative Infection Rate Between Single Dose Versus Multiple Dose Antibiotic Therapyin Patients Undergoing Laparoscopic Cholecystectomy

Objective: To compare the frequency of post-operative infection rate between single dose versus multiple dose antibiotic therapy in patients undergoing laparoscopic cholecystectomy.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Surgical Department, Combined Military Hospital, Lahore Pakistan from Oct 2017 to Feb 2020.
 Methodology: Patients of both genders undergoing laparoscopic cholecystectomy for simple cholelithiasis were included. Group-A patients underwent laparoscopic cholecystectomy using single-dose prophylactic antibiotic therapy with 2-gram 3rd generation cephalosporin at the time of induction of anaesthesia. In contrast, Group-B patients underwent laparoscopic cholecystectomy using 2-grams of 3rd generation Cephalosporin intravenously at the time of induction of anaesthesia followed by intravenous 1-gram Ceftriaxone two doses 12 hours apart. All patients were followed up on the first postoperative day, and then 1-week and 2-week follow up were done for any surgical site infection.
 Results: Patients in Group-A had a mean age of 37.12±6.53 years, while patients in Group-B had a mean age of 37.74±6.40 years. The post-operative infection rate in Group-A (single dose antibiotic therapy) was seen in 08 (4.28%), while in Group-B (multiple dose antibiotic therapies) was seen in 18 (9.63%) patients (p-value = 0.042).
 Conclusion: This study concluded that the single-dose prophylactic antibiotic is as good as multiple-dose antibiotic therapy used as prophylaxis for the prevention of post-operative infection rate among patients with cholecystectomy done via the laparoscopic method.

Expanded Risk-Based Strategy for Postpartum Antibiotic Prophylaxis in Deliveries Complicated by Intraamniotic Infection: Results of a Pre- and Post-Intervention Study

Intraamniotic infection (IAI) during labor is a risk factor for postpartum endometritis. Current practice guidelines for IAI support a single dose of prophylactic antibiotics in the postpartum period following cesarean but not vaginal deliveries. This study aimed to determine whether a standardized risk-based strategy of extended antibiotic prophylaxis was associated with a reduced rate of endometritis.

Comparison between outcome of single dose of prophylactic antibiotic versus postoperative antibiotic in inguinal hernia surgery.

Objectives:To compare the outcome prophylactic antibiotics and routine pre-surgical and post-surgical in terms of incidence of surgical site infection (SSI) and to explore the effect of various factors such as duration of surgery and patient characteristics (if any).Methods:A double-blinded prospective analysis of a total of 60 patients with the primary inguinal hernia was conducted from 24th August 2020 to 24th August 2021 at the Surgical Department of Nishtar Medical University & Hospital, Multan. The participants of the study were categorized into two groups such that 30 consecutive patients were placed in the study group who were administered with a single dose of prophylactic antibiotic 30 minutes before to mesh repair surgery and the remaining 30 patients were placed in the control group who were administered routine antibiotics pre and post-operatively. The effects in patients were observed till 30 days following surgery for any sign of infection. All the collected data were analyzed through SPSS (version 19).Results:The rate of infection in both groups was noted. The incidence of infection in the study group (13.3%) was higher as compared to the control group (10%). No patient underwent mesh removal and no significant difference in terms of post-operative complications was observed in the results of both groups.Conclusion:Both the treatments, prophylactic antibiotics and routine pre-surgical and post-surgical were equally effective. However, we recommend the administration of prophylactic since they are cost-effective and prevent bacterial drug resistance.

Sepsis rates after template prostate biopsy with single-dose prophylactic antibiotic.

IntroductionUrosepsis is a significant risk associated with prostate biopsy. Resistance of microorganisms to antibiotics is a challenging issue for clinicians in everyday practice. In the current study, we investigated the rates of sepsis and hospital admissions following transperineal (TP) prostate biopsies using a single dose of gentamicin.Material and methodsData for consecutive patients who underwent TP prostate biopsies (March 2019–March 2020) were included. Patients received a single-dose of prophylactic gentamicin 120 mg IV and had skin preparation with antiseptic povidone-iodine or chlorhexidine solution prior to the procedure. Patient’s electronic records were reviewed for rates of sepsis and readmission to hospital within 7 days following TP prostate biopsy.ResultsA total of 365 consecutive patients were included in the study. After exclusion of non-eligible patients, 280 patients were included in final analysis. The median age was 67 years (32–83), the median prostate-specific antigen (PSA) level was 8.5 ng/ml (0.2–58), and the median prostate size was 44 cc (10–188). Approximately 58% of patients had one or more comorbidities in the form of diabetes mellitus (DM), hypertension, asthma, chronic kidney disease, or ischemic heart disease. Adenocarcinoma was found in 71.7% of patients. None of the 280 patients developed sepsis. Urinary tract infection (UTI) occurred in 2.8% of patients with E.coli, none of them required hospital readmission.ConclusionsOur single centre experience showed a 0% sepsis rate after TP prostate biopsy with single prophylactic dose of gentamicin. Future randomized controlled trials (RCTs) should explore the possibility of performing these procedures without antibiotic prophylaxis in order to reduce the unnecessary use of antibiotics.

Single Dose Versus Multiple Dose Prophylactic Antibiotics in Cesarean Section in a Tertiary Care Hospital

Introduction: Choice of antibiotics as prophylaxis has become crucial factor for morbidity of women after delivery and neonatal complication associated thereafter. The purpose of this study was to compare the efficacy of single dose versus multiple dose of ceftriaxone in cesarean section (CS). Methods: A prospective experimental study was carried out in Universal College of Medical Sciences and Teaching Hospital, Tribhuvan University, Bhairahawa, from May 2015 to October 2016. One hundred patients who had undergone cesarean section were divided in two groups with fifty in each. Patients in group I were treated with single dose of ceftriaxone, whereas patients in group II were treated with multiple dose of ceftriaxone. The data were analyzed using independent "t" test, chi-square test as appropriate. A p-value of <0.05 was considered significant. Results: The distribution of Emergency CS and Elective CS were 72% and 28% in prophylactic single dose group and 88% and 12% in postoperative multiple dose regime and was statistically non-significant difference between single and multiple dose ceftriaxone. One wound infection was observed in multiple dose ceftriaxone treated women as compared to single dose ceftriaxone treated women. Febrile morbidity (8%) and urinary tract infections (2%) were observed in postoperative multiple dose regimen as compared to prophylactic single dose regimen. Conclusion: Prophylactic single dose of ceftriaxone was effective in reducing infective morbidity in patients with cost benefit, and also reduces chances of drug resistant in future.

A Comparative Study of Single Dose and Multiple Dose Antibiotic Prophylaxis In Caesarean Section

Background: Rampant antibiotic use brought about its own set of problems like the rise in incidence of antibiotic resistant strains, allergies and other complications of antibiotic use. Unfortunately in many of our set ups we are still stuck in prolonged post-operative antibiotic regimes. This study aims to fill that lacunae and thereby aid our gradual shift away from over reliance on prolonged antibiotic usage in prevention of SSI. Hence we decided to investigate the efficacy of the use of a single prophylactic intravenous dose of antibiotic vis a vis multiple doses in reducing post-operative infective morbidity in caesarean sections. Methods: The study included 200 patients at term, satisfying the inclusion and exclusion criteria, reporting to the labour room and undergoing caesarean section. The patients were then divided into two groups of 100 each by simple randomization. Patients in Group A were given a single dose of Inj. Cefotaxime 1gm IV + Inj. Metronidazole 500 mg IV infusion 30 minutes before the skin incision. Group B cases were given the first dose of Inj. cefotaxime 1g IV + Inj. metronidazole 500 mg IV 30 minutes before the skin incision followed by injectables for 2 days: Inj. cefotaxime 1g IV BD and Inj. metronidazole 500mg IV TDS. Subsequently for the next 3 days Tablet Cefixime 200mg BD and Tablet Metronidazole 400mg TDS were administered orally. Results: The present study did not show any significant difference in the post operative infection incidence between the single dose and multiple dose schedule. Conclusion: our study makes an important observation regarding use of antibiotic prophylaxis and its duration for prevention of post operative infections in mothers without compromising any safety aspects of either the mother or the child. As noted in our study, there was no difference in the outcome as regards post operative infectious morbidity in patients of both the groups. Hence, based on the findings of our study we conclude that single dose prophylactic antibiotic should be the norm for caesarean sections.

Antibiotic administration for negative midstream urine culture patients before percutaneous nephrolithotomy.

To investigate how to administrate antibiotics for negative midstream urine culture (UC-) patients prior to percutaneous nephrolithotomy (PCNL), we retrospectively analyzed UC-patients receiving 0 or 3days of cefuroxime prior to PCNL between July 2017 and May 2020. Patients were further divided into four groups (Group1A = urine with positive both nitrite and white blood cell (N + WBC +) and 0-day pre-operative cefuroxime; Group1B = N + WBC + and 3-day cefuroxime; Group2A = N - WBC + and 0-day cefuroxime; Group2B = N - WBC + and 3-day cefuroxime). All patients routinely received a dose of cefuroxime 30min prior to the surgery. In addition, Group1B were matched to the Group1A; Group2B were matched to the Group2A at a 1:1 ratio regarding stone burden, the degree of hydronephrosis, stone hardness, age and sex in a sequentialorder. A total of 560 patients were included (Group1A = 72; Group1B = 72; Group2A = 208; Group2B = 208). The baseline characteristics were equally distributed between the matched-pair groups. Compared to Group1B, Group1A had a significantly higher incidence of SIRS, fever, urosepsis requiring only additional antibiotics, and an increased postoperative hospitalization stay. Compared to Group2B, Group2A had similar rate of infectious complications. In addition, Group1B was associated with a significantly lower rate of positive pelvic urine culture (PUC +) than that of Group1A; whereas, there was similar rate of PUC + between Group2A and Group2B. UC-patients with N + WBC + should be treated with extended period of antibiotic administration, and a single dose of prophylactic antibiotic was sufficient for UC-patients with N - WBC + prior to PCNL. Despite UC, it is suggested to stratify pre-operative antibiotics tailored to individual patients to optimize its application.

The Use of Oral Antibiotics to Prevent Surgical Site Infection on Postoperative Modified Radical Mastectomy Patients in Dr. Soetomo General Hospital, Surabaya

Surgical operations on modified radical mastectomy are considered clean procedures by the Centers for Disease Control and Prevention (CDC) wound classification system. Despite this, higher than expected Surgical Site Infection (SSI) rates are reported, varying from 1 % to 26 % across the literature. Some surgeons also prescribe postoperative prophylaxis for postoperative modified radical mastectomy patients to prevent infection despite its lack of proven efficacy. The aim of this study is to analyze the use of oral antibiotics to prevent Surgical Site Infection (SSI) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. This study was double-blinded randomized control trial of 60 postoperative modified radical mastectomy patients (2 groups) during the period of December 2017 to March 2018. Samples were prospectively divided into two groups (random sampling), in group A (n=30) patients received single dose prophylactic antibiotics and continued with oral antibiotics postoperative (Cefadroxil 2 x 500 mg) during 7 days and in group B (n=30) patients received single dose prophylactic antibiotics and continued without postoperative antibiotics (placebo). Both groups were evaluated clinically for surgical site infection up to 30 days. There was no statistically significant difference in both groups {p=1 (p>0.05)}. There was no incidence of surgical site infection in both groups during the 30-day follow-up period (days 3, 7, 14 and 30). There was no difference in the surgical site infection rate among those who received oral postoperative antibiotics prophylactic and without antibiotics (placebo) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required.

A clinicopathological study of thyroid swellings in a tertiary centre

Background: The role of prophylactic antibiotics in preventing surgical site infection (SSI) after surgeries like gastrointestinal, Orthopedics, and plastic surgical procedures are quite well known, although their efficacy in clean, elective major surgeries are still debatable. An effective antimicrobial prophylaxis that providing coverage throughout the entire procedure, not only reduces the risk of surgical site infections, but also of complications associated with it. Various studies have shown that appropriately-timed “single shot” antibiotic prophylaxis is as effective as multiple-dose prophylaxis. Aim: To assess the efficacy of single dose prophylactic antibiotics in preventing SSI after clean, elective surgery. Materials and methods: Patients planned for clean, elective surgeries were included in a prospective study which was conducted for a year in a tertiary centre. Post operatively, the patients were then assesses. Results: Of the total 100 cases, 55 patients belonged to the female gender and 45 cases belonged to male gender. In this study, maximum number of patients belonged to the age group of 26 to 50 years, 48 cases belonged to 51 to 75 years, and single case belonged to the age group less than 25 years. Regarding the complication developed post surgically 7 cases were observed to develop purulent discharge from the surgical site and about 7 other cases developed seroma and discharge. Of the 100 cases, 4 cases were discharged on the first postoperative day, 86 patients were discharged on second or third post operative day. The rest were discharged on subsequent days. Conclusion: Recent developments in the antibiotic prophylaxis, including the initial time of antibiotic administration, proper choice of antibiotic agent that cover all possible infective agents, the short duration of antibiotic treatment have proved to improve the efficacy of these drugs in surgical settings. A systemic regimen of a single dose of an appropriately selected cephalosporin given during the immediate preoperative period is safe and effective in clean elective surgeries.

Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients

Background and purpose — The optimal type and duration of antibiotic prophylaxis for primary arthroplasty of the hip and knee are subject to debate. We compared the risk of complete revision (obtained by a 1- or 2-stage procedure) for periprosthetic joint infection (PJI) after primary total hip or knee arthroplasty between patients receiving a single dose of prophylactic antibiotics and patients receiving multiple doses of antibiotics for prevention of PJI. Patients and methods — A cohort of 130,712 primary total hip and 111,467 knee arthroplasties performed between 2011 and 2015 in the Netherlands was analyzed. We linked data from the Dutch arthroplasty register to a survey collected across all Dutch institutions on hospital-level antibiotic prophylaxis policy. We used restricted cubic spline Poisson models adjusted for hospital clustering to compare the risk of revision for infection according to type and duration of antibiotic prophylaxis received. Results — For total hip arthroplasties, the rates of revision for infection were 31/10,000 person-years (95% CI 28–35), 39 (25–59), and 23 (15–34) in the groups that received multiple doses of cefazolin, multiple doses of cefuroxime, and a single dose of cefazolin, respectively. The rates for knee arthroplasties were 27/10,000 person-years (95% CI 24–31), 40 (24–62), and 24 (16–36). Similar risk of complete revision for infection among antibiotic prophylaxis regimens was found when adjusting for confounders. Interpretation — In a large observational cohort we found no apparent association between the type or duration of antibiotic prophylaxis and the risk of complete revision for infection. This does question whether there is any advantage to the use of prolonged antibiotic prophylaxis beyond a single dose.

STEP TOWARDS PREVENTION OF ANTIBIOTIC RESISTANCE – A PROSPECTIVE STUDY IN LAPAROSCOPIC CHOLECYSTECTOMY.

Introduction: Traditionally antibiotics have been advised pre and post operatively in surgery for gall bladder. The knowledge about usage of a single dose prophylactic preoperative antibiotic in comparison to conventional usage of perioperative antibiotics in laparoscopic Cholecystectomy is limited. Hence, this study focuses on comparing the efficacy of a single dose prophylactic antibiotic versus the usage of pre and postoperative antibiotics in laparoscopic Cholecystectomy.
 Method: This is a prospective study conducted in the General Surgery department of Apollo Institute of Medical Sciences and Research. Over 192 consecutive patients subjected for laparoscopic Cholecystectomy were included in study. They were divided in two groups (A&B) after applying exclusion. 74 patients in group A were given single dose of preoperative prophylactic antibiotic. No further post-operative antibiotics were given. 78 patients in group B were given both pre and postoperative antibiotics. Infective complications and cost constraints were compared between both the groups. Statistical analysis was done using chi-square test wherever necessary.
 Results: there is no significant difference in the rate of incidence of wound infection in both the groups. Age and gender had no significant association for SSI. The overall cost of Group B was found to be significantly higher than Group A.
 Conclusion: Usage of single dose prophylactic preoperative antibiotics with no further post operative antibiotics would be sufficient to prevent surgical site infection in uncomplicated laparoscopic Cholecystectomy.
 Keywords: Prevention, Antibiotic Resistance, Laparoscopic Cholecystectomy.