Single Dose Of Prophylactic Antibiotics Research Articles

Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy and Risk Factors for Surgical Site Infection: A Randomized Controlled Trial

The aim of this clinical trial was to determine whether prophylactic antibiotics could prevent surgical site infection (SSI) after laparoscopic cholecystectomy and to identify any risk factors for infection. The study included 100 patients undergoing laparoscopic cholecystectomy. They were randomized to receive either a single dose of ceftriaxone (Group A; n = 50) or physiologic saline as placebo (Group B; n = 50) after the induction of anesthesia. Patient demographics and clinical and surgical outcomes were recorded. The incidence of SSI was similar in the two groups: 2 patients in group A and 4 patients in group B (chi(2) = 0.71; p = 0.40). None of the factors studied was associated with surgical site infection statistically, as shown by binary logistic regression analysis. A single dose of prophylactic antibiotic failed to decrease the likelihood of SSI after laparoscopic cholecystectomy.

Randomized, Multicenter Trial of Antibiotic Prophylaxis in Elective Colorectal Surgery

Use of prophylactic antibiotics in elective colorectal surgery is essential. Although single-dose prophylactic antibiotics are recommended, the efficacy of single-dose cephalosporin without metronidazole and oral antibiotics is not fully proven. We conducted a multicenter, randomized trial of a single dose vs 3 doses of the second-generation cephalosporin cefmetazole. A prospective, randomized, multicenter trial in patients undergoing elective colorectal surgery. Seven major hospitals in Japan that offer cancer treatment. Patients with colorectal cancer treated from May 6, 2004, to April 25, 2005. Patients were randomized to 1 of 2 groups: a single-dose group given a single dose of cefmetazole just before skin incision and a 3-dose group given 2 additional doses of cefmetazole every 8 hours after the first dose just before skin incision. Incidences of incisional surgical site infection (SSI), organ or space SSI, and all other infectious complications within 30 days after surgery. A total of 384 patients were enrolled. Seven patients were excluded because of additional surgery or the inability to tolerate mechanical preparation. The incidence of incisional SSI was higher in the single-dose group (27/190 or 14.2%) than in the 3-dose group (8/187 or 4.3%) (P = .009). Incidences of organ or space SSI and other postoperative infectious diseases did not differ significantly between the 2 groups. In multivariate analysis, antibiotic dose was the only significant factor related to the incidence of incisional SSI. Three-dose cefmetazole administration is significantly more effective for prevention of incisional SSI than single-dose antibiotic administration. clinicaltrials.gov Identifier: NCT00292708.

Prevalence of Postoperative Complications After Orthognathic Surgery: A 15-Year Review

This study was conducted to determine the prevalence of postoperative complications after orthognathic surgery and evaluate the use of antibiotic prophylaxis in relation to the infection rate. All patients undergoing orthognathic procedures between 1990 and 2004 were studied retrospectively by retrieving their individual medical records. Demographic data, intraoperative data (specific orthognathic procedures and duration of operation), and postoperative data (type and duration of antibiotic prophylaxis and presence of postoperative complications) were recorded. Patients noted to have suffered any postoperative complications were studied in detail, and various factors, including gender, age, duration of operation, and use of prophylactic antibiotics, were analyzed using statistical tests in relation to postoperative infection. A total of 2,910 orthognathic procedures were performed on 1,294 consecutive patients in the 15-year period, with 1,070 patients undergoing bimaxillary procedures and 224 patients undergoing single-jaw surgery. The orthognathic surgery-related complication rate was 9.7%, of which 7.4% was related to postoperative infection. Of the cases of infection, 58.3% were acute infection and 41.7% were chronic infection. Patients who received a single preoperative dose of antibiotics had a significantly higher infection rate (17.3%) than those who received postoperative antibiotics for various durations. The prevalence of infection after orthognathic surgery was relatively low given the complexity of the procedures. No particular orthognathic procedure was more susceptible to infection. A preoperative dose of prophylactic antibiotics together with at least 2 days of postoperative doses was useful in reducing the infection rate compared with only a single dose of prophylactic antibiotics.

Infection prophylaxis: a prospective study in 106 patients operated on by tibial osteotomy using the hemicallotasis technique

Tibial osteotomy by the hemicallotasis technique is a clean elective operation. With external fixation pins inserted, close to the knee joint, the infection prophylaxis should be considered. The primary aim was to investigate the differences in the postoperative use of antibiotics during the time in external fixation between administrating prophylactic antibiotics for 3 days or as a single dose in patients operated on by the hemicallotasis technique for knee deformities. Secondary aims were to study the differences in pin-site infection rate and grade and complications. A total of 106 consecutive patients of mean age 52 years (range 18-69) operated on by the hemicallotasis technique for knee deformities were included in this prospective study. Sixty patients were prescribed prophylactic antibiotics for 3 days and 46 patients as a single dose. Chlorhexidine (5 mg/ml) in alcohol (70% ethanol) was used as cleansing agent in the pin-site care. The power of the study was calculated to 80% to detect a difference in the postoperative use of antibiotics for 7 days during the treatment in external fixation. There were no differences in postoperative use of antibiotics between 3 days administration or a single dose of prophylactic antibiotics. This was the case with infection rate and grade, positive bacterial cultures, presence of Staphylococcus aureus, nor positive culturing from the tip of the pins at removal. Neither were there any differences in numbers of loose pins and complications. There were no differences between 3 days of administration of prophylactic antibiotics and one single dose. One single dose of prophylactic antibiotics is appropriate together with a pin-site concept preventing pin-site infection in patients operated on by hemicallotasis osteotomy.

Evidence on antibiotic prophylaxis for cesarean section alone is not sufficient to change the practices of doctors in a teaching hospital

To assess the pattern of prophylactic antibiotic use in cesarean sections, identify factors associated with single-dose prescriptions as evidence-based best practice, and evaluate the changes in use of single-dose compared with multiple-dose regimens and the variation of use between doctors after dissemination of evidence. An analytical descriptive study was conducted. The medical records of 432 women undergoing cesarean section from April to September 2001 after dissemination of evidence in a teaching hospital in Southern Thailand were reviewed. Use of single-dose prophylactic antibiotic was the main outcome measure. Patterns of prophylactic antibiotics, and factors associated with pregnant women and doctors, were analyzed and compared with baseline data among 463 women undergoing cesarean section in 1998. Multivariate logistic regression with random effects was used for analysis. After the dissemination of evidence, the rate of single-dose prescriptions increased from 14.2 to 22.4% (P < 0.01), single-dose prescriptions decreased for patients who had experienced longer durations of ruptured membranes, and the timing of the administration of antibiotics improved, but multiple-dose and duration of postoperative prescriptions increased. The variation in prescribing antibiotics between doctors was significant (P < 0.001). Knowledge of evidence alone does not improve practices uniformly. Consequently, other interventions are necessary to improve practices.

Prospective randomized comparison of single‐dose versus 1‐day cefazolin for prophylaxis in gynecologic surgery

The purpose of this prospective, randomized study was to compare the efficacy of single-dose versus 1-day cefazolin prophylaxis for the prevention of postoperative gynecologic infections. From June 2001 to January 2003, 548 patients were randomized to receive either single-dose (1 g of cefazolin intravenously before surgery, 273 patients) or 1-day cefazolin (1 g intravenously before surgery and three more doses every 6 hr after surgery, 275 patients) prophylaxis. A total of 531 (267 patients in the single-dose group and 264 in the 1-day group) completed the study. Only one of 267 (0.37%) patients in the single-dose group developed a trocar wound infection and one of 264 (0.37%) patients in the 1-day group developed a vaginal cuff infection. Had a single dose of prophylactic antibiotics been administered to all patients, the antibiotic cost would have been reduced by 75-80%. The use of single-dose preoperative cefazolin prophylaxis was as effective as four doses of cefazolin for preventing serious infectious morbidity among our patients. Shortening the duration of antibiotics prophylaxis also reduced medical costs and microorganism resistance.

Prospective randomized comparison of single-dose versus 1-day cefazolin for prophylaxis in gynecologic surgery

Background. The purpose of this prospective, randomized study was to compare the efficacy of single-dose versus 1-day cefazolin prophylaxis for the prevention of postoperative gynecologic infections. Methods. From June 2001 to January 2003, 548 patients were randomized to receive either single-dose (1 g of cefazolin intravenously before surgery, 273 patients) or 1-day cefazolin (1 g intravenously before surgery and three more doses every 6 hr after surgery, 275 patients) prophylaxis. Results. A total of 531 (267 patients in the single-dose group and 264 in the 1-day group) completed the study. Only one of 267 (0.37%) patients in the single-dose group developed a trocar wound infection and one of 264 (0.37%) patients in the 1-day group developed a vaginal cuff infection. Had a single dose of prophylactic antibiotics been administered to all patients, the antibiotic cost would have been reduced by 75–80%. Conclusions. The use of single-dose preoperative cefazolin prophylaxis was as effective as four doses of cefazolin for preventing serious infectious morbidity among our patients. Shortening the duration of antibiotics prophylaxis also reduced medical costs and microorganism resistance.

Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: A cost-benefit study in Mozambique

Background. There is a need to assess the cost-benefit of different models of antibiotic administration for the prevention of post cesarean infection, particularly in resource-scarce settings. Design. Randomized, nonblinded comparative study of a single combined preoperative dose of gentamicin and metronidazole vs. a post cesarean scheme for infection prophylaxis. Methods. Pregnant women (n = 288) with indication for emergency cesarean section were randomly allotted to two groups. Group 1 (n = 143) received the single, combined dose of prophylactic antibiotics and group 2 (n = 145) received, over 7 days, the postoperative standard scheme of antibiotics followed in the department. Both groups were followed up during 7 days for detection of signs of wound infection, endometritis, peritonitis and urinary tract infection. Main outcome measures. Prevalence of postoperative infection, mean hospital stay and costs of antibiotics used. Results. Women completing the study (n = 241) were distributed into group 1 (n = 116) and group 2 (n = 125). No significant difference was found neither in the prevalence of postoperative infection nor in the mean hospital stay. No death occurred. The cost of the single dose of prophylactic antibiotics was less than one-tenth of the cost of the standard postoperative scheme. Conclusion. In our setting, the administration of a single dose of 160 mg of gentamicin in combination with 500 mg of metronidazole before emergency cesarean section for prevention of infection is clinically equivalent to existing conventional week-long postoperative therap, but at approximately one-tenth of the cost.

Antibiotic prophylaxis in elective colorectal surgery.

Antibiotics are often administered in elective colorectal surgery to prevent wound infection. The tendency for surgeons to prolong the administration of prophylactic antibiotic therapy in the postoperative period is a well-known fact. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilization in elective colorectal surgery and to determine if evidence-based medicine is employed in relation to this practice. A cross-sectional study encompassing general surgeons performing elective colorectal surgery was performed. Questionnaires were distributed to 144 surgeons (national, academic and private health care). Questions pertaining to the type, timing and duration of antibiotic administration were asked. The prevalence of wound infection audit rate and whether or not there were specific guidelines related to antibiotic administration were also determined. The response rate obtained was 67% (n = 96). Although evidence from the current medical literature and recommended national guidelines support the use of single-dose prophylactic antibiotics, 72% of the respondents used more than a single dose. Forty surgeons (42%) claimed that their prescribing practice was supported by the medical literature, 31 respondents (32%) based their practice on hospital guidelines and personal preference was cited as a reason by 21 surgeons (22%). The remaining four respondents (4%) used a similar scheduling policy to that practiced by their colleagues in relation to antibiotic administration. There was no significant difference in antibiotic dose scheduling between national, private and university academic institutions (P = 0.85). These results suggest that a significant proportion of surgeons administer excessive and unnecessary doses of antibiotics in elective colorectal surgery. Further studies are required to uncover the reasons but lack of appropriate guidelines and failure to exercise evidence-based medicine are major factors that account for this practice.

Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice: is it worth the cost?

There are few published data concerning the economic impact of antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography in the setting of biliary obstruction. To perform decision analysis to determine the costs of prophylaxis in patients undergoing endoscopic retrograde cholangiopancreatography for obstructive jaundice. A decision analysis model was constructed. The probability of biliary sepsis, death and endoscopic retrograde cholangiopancreatography complications was obtained from the medical literature and from a retrospective analysis of our own experience. Costs were obtained from Medicare reimbursement at our institution. The strategies evaluated were endoscopic retrograde cholangiopancreatography with and without single-dose antibiotic prophylaxis. We compared the total costs, number of episodes of cholangitis and deaths associated with each strategy. Based on published data and the results of our retrospective analysis, the strategy of administering single-dose prophylactic antibiotics prior to endoscopic retrograde cholangiopancreatography in patients with obstructive jaundice resulted in lower total costs, fewer episodes of cholangitis and fewer deaths compared to a strategy of not administering antibiotics. The results were sensitive to the rates of cholangitis, cost of antibiotics and the cost of treating an episode of cholangitis. Antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography results in fewer cases of cholangitis and is cost saving when compared to a strategy of no prophylaxis in patients with obstructive jaundice.

ANTIBIOTIC PROPHYLAXIS IN ELECTIVE COLORECTAL SURGERY

Antibiotic administration in elective colorectal surgery is established in preventing wound infection. However, surgeons may have a tendency to prolong the administration of prophylactic antibiotic therapy in the postoperative period. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilisation in elective colorectal surgery and to determine if evidence based medicine was employed in relation to this practice. A cross sectional study encompassing general surgeons performing elective colorectal surgery was performed. Questionnaires were distributed to 144 surgeons (national, academic and private healthcare). Questions pertaining to the type, timing and duration of antibiotic administration were assessed. The prevalence of wound infection audit rate and the presence of specific guidelines related to antibiotic administration were also determined. The response rate obtained was 67% (n = 96). Although evidence from the current medical literature and recommended national guidelines support the use of single dose prophylactic antibiotics, 72% of the respondents employed more than a single dose. Forty surgeons (42%) claimed that their prescribing practice was supported by the medical literature, 31 respondents (32%) based their practice on hospital guidelines and personal preference was cited as a reason by 21 surgeons (22%). The remaining four respondents (4%) used similar scheduling policy as practiced by their colleagues in relation to antibiotic administration. Twenty‐five percent of respondents audited their wound infection rate for elective colorectal surgery. There was no significant difference in antibiotic dose scheduling between national, private and university academic institutions. χ2 = 0.315 (P = 0.854). The above results suggest that a significant proportion of surgeons administer excessive and unnecessary doses of antibiotics in elective colorectal surgery. Further studies are required to uncover the exact reasons but lack of appropriate guidelines and failure to exercise evidence based medicine are major factors that account for this practice.

Early discharge after external anal sphincter repair.

The aim of this study was to describe an accelerated-stay program for repair of the external anal sphincter. Twenty consecutive patients undergoing overlapping repair of the external anal sphincter were included in the study. Effect parameters were length of hospitalization and complications within 30 days after the operation. Surgery was performed during the period of March 1993 to May 1997. The accelerated-stay program included preoperative information, no premedication, a surgical procedure without colostomy, single-dose prophylactic antibiotics, paracetamol for analgesia, free oral fluid and food immediately after the operation supplemented by laxatives, and enforced mobilization. Follow-up by questionnaire was performed at a median of 14 (range, 4-52) months after the operation. Median hospital stay was one day. Fifteen patients were discharged the day after surgery and 5 patients stayed for 48 hours after the operation. There was no 30-day morbidity, and no patient received a colostomy in conjunction with the sphincter repair. Fourteen of 19 patients available for follow-up reported a significantly improved functional result compared with preoperative state. We have described a safe accelerated-stay program (24 to 48 hours) for overlapping repair of external anal sphincter.

A Prospective study of septic complications of endoscopic retrograde cholangiopancreatography

Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). We prospectively performed blood cultures and surveyed patients for complications. The aims were first, to determine the incidence of bacteraemia associated with ERCP, second, to assess the incidence of clinical sepsis following the procedure and third, to evaluate the effectiveness of our antibiotic prophylaxis. One hundred and fifty successive patients underwent 179 ERCP. Bacteraemia related to the procedure or the underlying pathology was found in nine procedures (5.2%). Bacteraemias were more likely to complicate therapeutic procedures (P = 0.015), biliary obstruction (P = 0.045) or underlying pathology (P = 0.022). Although 61% of ERCP received antibiotics, 22 septic events occurred. Five bacteraemic patients were septic despite antibiotics. Septic complications were associated with the same factors as bacteraemia. It was concluded that patients with biliary obstruction and undergoing therapeutic endoscopic procedures are at greatest risk of bacteraemia. Single dose prophylactic antibiotics may not prevent sepsis in these patients and longer-acting drugs or repeated dosing may be necessary.

Preoperative antibiotic prophylaxis in flexural surgery of difficult contamination-prone areas of the skin: The utility of a single dose of antibiotic

The aim of this multicentre controlled study was to analyse the effect of the timing of antibiotic administration on the preoperative prophylaxis of wound infections in contamination-prone areas of the skin and to verify the utility of a single dose of prophylactic antibiotic compared with other multiple dose schemes. A total of 527 patients were surgically treated for skin neoplasms arising in contamination-prone areas. The four prophylactic programmes, to which the patients were randomly allocated, were as follows: (A) no antibacterial prophylaxis; (B) intramuscular cephazolin, 1 g every 12 h beginning 48 h prior to surgery and continuing for 48 h after surgery; (C) intramuscular cephazolin, 1 g every 12 h beginning 2 h before surgery and continuing 24 h after surgery; and (D) intramuscular cephazolin, 1 g single dose 2 h before surgery. The rate of postoperative infections was: group A 12%, group B 4.6%, group C 0.77%, group D 2.96%. Our study confirms the utility of antibiotic prophylaxis in preventio...

Percutaneous feeding gastrostomy

Percutaneous endoscopic gastrotomy tubes have been inserted in 50 patients with no mortality and minimal morbidity. The principal indications for their insertion were an inability to swallow (39 patients), a need for nutritional support (eight patients) and venting (three patients). The most common complication was peristomal wound infection (14 patients), the incidence of which was reduced significantly by the use of single-dose prophylactic antibiotic therapy. Percutaneous gastrostomies provide adequate nutrition with minimal morbidity in an acceptable way to both patients and those who care for them.

Single dose prophylaxis in elective cholecystectomy: A prospective, double-blind randomized study

We tested the effectiveness of a single dose of prophylactic antibiotic (gentamicin) in elective cholecystectomy in a double-blind, controlled randomized study. All patients recognized preoperatively as being at risk were excluded. The treatment group comprised of 102 patients received a single dose of gentamicin and the 74 patients in the control group received a placebo. Of the patients who received gentamicin, wound infection developed in 4.9 percent versus 13.5 percent in the control group. Among 45 patients who had positive bile cultures, the wound infection rate for those in the treatment group was 14 percent versus 44 percent for those in the control group. Of 17 patients who underwent unexpected exploration of the choledochus, none of those in the treatment group had development of wound infection. The rate of wound infection in the control group was 50 percent. As 30 percent of the patients undergoing elective cholecystectomy were found to have risk factors for the development of wound infection which could not be identified pre-operatively, we recommend single dose prophylaxis for all patients undergoing cholecystectomy.

Use of single dose prophylactic antibiotic in routine abdominal hysterectomy - a randomized controlled trial

A randomized controlled trial was conducted in one unit of Gynecology and Obstetrics Dept. of a Govt. hospital by giving a single dose preoperative prophylactic antibiotic and the results were compared with a control group who received a conventional prophylactic regimen of antibiotic combination. A total of 60 samples were taken from the patients currently admitted and undergoing total abdominal hysterectomy in one unit of the Department of Obstetrics &amp; Gynecology of a Govt. hospital for this trial and they were divided into two groups - 30 Cases and 30 Control. Case group were given a single dose cephradine 1 gm IV just before induction of anesthesia. Control group were given Inj. Ciprofloxacin 200 mg IV 12 hrsly plus inj. Metronidazol 500 mg 8 hrsly till oral feeding followed by oral tab. Ciprofloxacin 500 mg 12 hrsly plus tab. Metronidazol 400 mg 8 hrsly in the remaining days which was then practicing in that gynecology unit of the Govt. hospital. Variables measured for the trial were total cost and duration of antimicrobial therapy, rate of postoperative infection and side effects of antimicrobial therapy. While comparing the outcome between the case and control group, it was observed that both the duration and cost (P&lt;0.001) and also the side effects (P&lt;0.05) of antimicrobial therapy were significantly higher in control group than the case group (duration of antimicrobial therapy was 2.9± 0.88 days in case group and 8. 9±0.58 days in control group and cost of antimicrobial therapy was 113.06± 24.53 taka in case group and 957.376±32.05 taka in control group). But the rate of post operative infection which is the main objective of giving preoperative antibiotic prophylaxis, was significantly higher in case group than the control group (P&lt;0.05). But this infection rate could be reduced if the sterilization procedure of the operation theatre and general conditions of the patients were improved. If these risk factors could be minimized, single dose preoperative prophylactic antibiotic could be effectively practiced in our country. DOI: 10.3329/bjpp.v22i1.3560 Bangladesh J Physiol Pharmacol 2006; 22(1/2) : 1-4