Use Of Antibiotics In Surgery Research Articles

The effectiveness of the appropriate prophylactic antibiotic use program for surgery

Background: Evaluation of the adequacy of prophylactic antibiotics in surgery has been implemented as a national policy in Korea since August 2007, and the appropriate use of prophylactic antibiotics has improved. However, antibiotic prescriptions that are not recommended or discontinuation of prophylactic antibiotic administration within 24 hours after surgery are still not well done. This study introduced a program to improve the adequacy of prophylactic antibiotics for surgery and analyzed its effects. Methods: We retrospectively analyzed the effectiveness of the appropriate prophylactic antibiotic use program for surgery conducted at a university hospital in Seoul. The participants were patients aged ≥18 years who underwent any of 18 types of surgery. The program started was implemented in June 2020. First, a computer system was used to confirm the antibiotic prescription recommended for each surgery. It also assessed whether the number of days of administration was exceeded, whether antibiotics were prescribed in combination, and whether antibiotics prescribed for discharge medicine were checked in 4 steps. A pop-up window appeared in each patient record to enter the reason for the prescription. If the reason was appropriate, the prescription was allowed, but if not, the prescription was restricted. In addition, infectious diseases physicians and an insurance review team visited each department to conduct an education session. To analyze the effect 3 months before activity (January–March 2020) and 3 months after activity (October–December 2020), we compared the first antibiotic administration rate within 1 hour prior to skin incision, the recommended prophylactic antibiotic administration rate, and surgery type. The rate of discontinuation of prophylactic antibiotics within 24 hours after administration and the rate of prescription of prophylactic antibiotics at discharge were compared. Results: In total, 1,339 surgeries during the study period were included in the analysis. There were 695 cases before the introduction of the program and 644 cases after the introduction. The rate of first antibiotic use within 1 hour prior to skin incision was 93.1%–99.5% (P < .001), the rate of recommended prophylactic antibiotic administration was 85.0%–99.2% (P < .001), and the rate of discontinuation of antibiotic administration within 24 hours after surgery improved from 51.8% to 98.3% (P < .001), respectively. The prescription rate of antibiotics at discharge improved from 20.7% to 0.8% (P <.001) (Table 1). Conclusions: A computerized program to improve the adequacy of prophylactic antibiotic use in surgery combined with education of medical staff was very effective.Disclosure: None

The Effect of Antibiotic Use in Surgery on the Incidence of Postsurgical Cataract Endophthalmitis

Endophthalmitis is a rare complication that can occur either endogenous or exogenous. Postsurgical endophthalmitis remains the primary exogenous etiology. Its complications remain formidable and involve the functional prognosis see anatomical eye. All interest of the question resides in preoperative prevention by incising on the measures of asepsis and antisepsis and per operatory by administering the antibiotic. Intracameral cefuroxime reduces the incidence of postoperative endophthalmitis of similar or slightly increased efficacy compared to the intravenous tract.

Drug allergy: A 2022 practice parameter update

Drug allergy: A 2022 practice parameter update

176. Topical Antibiotic and Antiseptic Use in the Operating Room: An Opportunity for Antimicrobial Stewardship?

BackgroundData suggest that topical antibiotic and antiseptic use in the operating room is common but not commonly monitored by antimicrobial stewardship programs. Although some data suggest a benefit in certain surgical procedures, the CDC and WHO advise against the routine use of topical antibiotics in surgery due to uncertainty and heterogeneity in the overall data. MethodsWe conducted a retrospective 28-day period prevalence study of topical antibiotic and antiseptic use during surgical procedures performed in the operating room by 6 surgical specialties at a tertiary care medical center. For the subset of patients undergoing orthopedic surgeries, we evaluated the types of topical antibiotics received and the rates of surgical site infections (SSI) and adverse drug events within 28 days of the procedure. ResultsOf 744 surgical procedures reviewed, topical antibiotics were used in 127 (17.1%), topical antiseptics in 71 (9.5%), and both in 18 (2.4%) (Table 1). Antiseptic use was higher in orthopedics relative to all other surgical specialties while topical antibiotic use was higher in neurosurgery. Hand, vascular and plastics had distinguishably lower use. In the orthopedic subgroup, after exclusions, 218 procedures were evaluated. Topical antibiotics were used in 42 (19.2%). Topical antibiotic therapy was more likely to be administered if prosthetic material was implanted, the procedure was emergent, or if a Staphylococcus aureus infection was present. Vancomycin was the most commonly used topical antibiotic and powder was the most commonly used type of application. As shown in table 2, SSI occurred more often when both topical antibiotics and antiseptics were applied; however, SSI events were relatively uncommon, and these were more likely to have infection present at the time of surgery. Adverse events were rare. ConclusionIn our institution we noted significant variability in use of topical antibiotic and antiseptic therapy among surgical specialties as well as within the orthopedic surgical specialty. Although opportunities to standardize use/nonuse of these therapies exist, this may be challenging due to the uncertainty and heterogeneity of currently available data. Disclosures All Authors: No reported disclosures

Use of Feedback Data to Reduce Surgical Site Infections and Optimize Antibiotic Use in Surgery: A Systematic Scoping Review.

Objective:Surgical site infection (SSI) prevention remains significant, particularly in the era of antimicrobial resistance. Feedback on practices and outcomes is known to be key to reduce SSI rates and optimize antibiotic usage. However, the optimal method, format and frequency of feedback for surgical teams remains unclear. The objective of the study is to understand how data from surveillance and audit are fed back in routine surgical practice.Methods:A systematic scoping review was conducted, using well-established implementation science frameworks to code the data. Two electronic health-oriented databases (MEDLINE, EMBASE) were searched to September 2019. We included studies that assessed the use of feedback as a strategy either in the prevention and management of SSI and/or in the use of antibiotics perioperatively.Results:We identified 21 studies: 17 focused on SSI rates and outcomes and 10 studies described antimicrobial stewardship for SSI (with some overlap in focus). Several interventions were reported, mostly multimodal with feedback as a component. Feedback was often provided in written format (62%), either individualized (38%) or in group (48%). Only 25% of the studies reported that feedback cascaded down to the frontline perioperative staff. In 65% of the studies, 1 to 5 implementation strategies were used while only 5% of the studies reported to have utilized more than 15 implementation strategies. Among studies reporting antibiotic usage in surgery, most (71%) discussed compliance with surgical antibiotic prophylaxis.Conclusions:Our findings highlight the need to provide feedback to all levels of perioperative care providers involved in patient care. Future research in this area should report implementation parameters in more detail.

National hospital quality measures for surgical site infections in South Korea: a survey among 20 expert physicians

BackgroundSurgical site infection (SSI) is recognized as an important quality indicator for patient safety. In Korea, the use of prophylactic antibiotics for surgery is conducted as a national quality measures related to SSI prevention. The objective of the present study was to investigate physicians’ perceptions of hospital quality measures for SSI as well as identify obstacles that might hinder its implementation in South Korea.MethodOnline-based questionnaires were administered twice. Twenty physician experts who were members of the Healthcare Review and Assessment Committee that was constituted for the “Assessment of prophylactic use of antibiotics for surgery” participated in the study. The first survey comprised open-ended questions that were designed to elicit the physician who could hinder the implementation of SSI indicators. The second survey, which was developed on the basis of the initial survey’s results, consisted of 10 closed-ended questions about the feasibility of objective perception and the need for subjectivity, with regard to SSI.ResultsFrom among the 20 physicians, we collected data from 16 respondents in the first survey (response rate of 80%) and 15 respondents in the second survey (response rate of 75%).Thirty-one percent of the respondents supported hospital SSI evaluations, and 69% expressed objections. The obstacles that were perceived as being able to hinder hospital SSI evaluations pertained to difficulties in collecting data, unavailability of information, possibility of underreporting, and redundancy of the inquiry undertaken by the Korean National Healthcare-associated Infections Surveillance System-SSI. Physician experts provide significantly higher ratings for the clinical indicator, rate of readmission due to SSI, both in terms of feasibility and need, when evaluating the results of SSI prevention in hospitals.ConclusionThe results of this study show that physicians perceive the need for QI development of hospital SSI measurements to prevent nation-wide SSIs in Korea. However, the feasibility of hospital SSI measurements is low. To develop QIs of hospital SSIs using health insurance claims data, it is necessary to develop a methodology for claims data-based surveillance systems and a data collection system in order to increase the sensitivity and validity of post-operative SSI detection.

Penicillin allergy de-labelling ahead of elective surgery: feasibility and barriers

BackgroundAround 10–15% of the in-patient population carry unsubstantiated ‘penicillin allergy’ labels, the majority incorrect when tested. These labels are associated with harm from use of broad-spectrum non-penicillin antibiotics. Current testing guidelines incorporate both skin and challenge tests; this is prohibitively expensive and time-consuming to deliver on a large scale. We aimed to establish the feasibility of a rapid access de-labelling pathway for surgical patients, using direct oral challenge. Methods‘Penicillin allergic’ patients, recruited from a surgical pre-assessment clinic, were risk-stratified using a screening questionnaire. Patients at low risk of true, immunoglobulin E (IgE)-mediated allergy were offered direct oral challenge using incremental amoxicillin to a total dose of 500 mg. A 3-day course was completed at home. De-labelled patients were followed up to determine antibiotic use in surgery, and attitudes towards de-labelling were explored. ResultsOf 219 patients screened, 74 were eligible for inclusion and offered testing. We subsequently tested 56 patients; 55 were de-labelled. None had a serious reaction to the supervised challenge, or thereafter. On follow-up, 17 of 19 patients received appropriate antimicrobial prophylaxis during surgery. Only three of 33 de-labelled patients would have been happy for the label to be removed without prior specialist testing. ConclusionRapid access de-labelling, using direct oral challenge in appropriately risk-stratified patients, can be incorporated into the existing surgical care pathway. This provides immediate and potential long-term benefit for patients. Interest in testing is high among patients, and clinicians appear to follow clinic recommendations. Patients are unlikely to accept removal of their allergy label on the basis of history alone. Clinical trial registrationClinicalTrials.gov: AN17/92982.

The Prophylactic Use of Antibiotics in Surgery

The Prophylactic Use of Antibiotics in Surgery

Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons.

There is a growing concern for microbial resistance as a result of overuse of antibiotics. Although guidelines have focused on the use of antibiotics for surgery in general, few have addressed plastic surgery specifically. The objective of this expert consensus conference was to evaluate the evidence for efficacy and safety of antibiotic prophylaxis in plastic surgical procedures. THE AUTHORS: searched for existing high-quality systematic reviews for antibiotic prophylaxis in the literature from the MEDLINE, Cochrane Library, and Embase databases. All synonyms for antibiotics were combined with terms for relevant plastic surgery procedures. The searches were not limited by language, and included all study designs. In addition, supplemental hand searches were performed of bibliographies of relevant articles, and extensive "related articles." Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons to reach consensus recommendations. Database searches identified 4300 articles, from which 2042 full-text articles were identified for eligibility. De novo meta-analyses were performed for each plastic surgical category. In total, 67 studies met the inclusion criteria, including nine for breast surgery, 17 for head and neck surgery, 10 for orthognathic surgery, seven for rhinoplasty/septoplasty, 19 for hand surgery, five for skin surgery, and two for abdominoplasty. Systemic antibiotic prophylaxis is recommended for clean breast surgery and for contaminated surgery of the hand or the head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty.

The Role of Prophylactic Antibiotics in Preventing Wound Infection

In this country, antibiotics are probably more misused than used and except for a few “enlightened” souls, most of us continue to prescribe antibiotics today as was done in many developed countries several decades ago. We seem to be stuck in a time warp as far as the rational use of antibiotics in surgery is concerned. The most charitable reason for continuing to prescribe antibiotics haphazardly post-operatively for several days is that the “apprentice” model of learning has been followed faithfully with no thought or idea that such practice may be unnecessary and may indeed cause more harm than good. For most procedures in obstetrics and gynecology, in the absence of purulent abscesses and where wounds are classified as “clean contaminated”—the surgical wound infection (SWI) risk being two to five percent—the need for administration of “prophylactic” antibiotics is advocated unlike “dirty” wounds where “curative” antibiotics are administered for a prolonged period of time post-operatively as well. S. aureus is the most common pathogen causing surgical site infection (SSI), accounting for 30 % of SSIs in the United States. Colonization with S. aureus, primarily in the nares, occurs in roughly one in four persons and increases the risk of SSI by 2- to 14-fold. 1.

Timing, choice and duration of perioperative prophylactic antibiotic use in surgery: A teaching hospital based experience from Eritrea, in 2009

Background: The continuum from surgically clean, through antiseptic techniques to the use of perioperative antibiotic prophylaxis has revolutionized surgical practice and significantly reduced morbidity. Adherence to use of prophylactic antibiotic guidelines varies in different set ups and different diseases. Objective: To document the practice of perioperative prophylactic antibiotic use in a teaching hospital in Eritrea Methods: This is a prospective study conducted in 2009 in Halibet Hospital, Asmara, Eritrea Results: One hundred and one patients were enrolled in the study. Sixty nine percent received prophylactic antibiotics. Of these, 30% were preoperatively and 39% postoperatively. Twenty one percent the majority of whom were in the clean/contaminated group did not receive the required prophylaxis. The surgery site infection rate was 6% mostly from emergency operations recognized during the period of hospitalization. Discussion and conclusion: The use of prophylactic antibiotics in Halibet Hospital needs to be standardized and monitored based on evidence and international benchmarks.

The Appropriate Use of Antibiotics in Surgery: A Review of Surgical Infections

The Appropriate Use of Antibiotics in Surgery: A Review of Surgical Infections

Rational antibiotic use in China: lessons learnt through introducing surgeons to Australian guidelines

BackgroundWorld-wide concern about increasing antibiotic resistance has focused attention on strategies to improve antibiotic use. This research adapted Australian best-practice guidelines on the prophylactic use of antibiotics in surgery to a Beijing teaching hospital and then used them as a quality assessment and improvement tool, supplemented by educational interventions. Qualitative data about factors influencing antibiotic use was also obtained.MethodsAustralian and international guideline materials were amalgamated with the help of Chinese experts. Antibiotics prescribed for surgical prophylaxis in 60 consecutive patients undergoing clean or clean-contaminated surgery (120 total) were then compared with guideline recommendations in three phases; a pre-intervention period from June to August, 2002, an intervention period from June to August 2003 and post-intervention period from September to November 2003. During the intervention phase, feedback about prescriptions not in accord with the guideline was discussed with around 25 prescribers every two weeks. In addition, local factors influencing antibiotic use were explored with 13 junior surgeons and 8 high level informants.ResultsWhile agreement was reached on the principles of antibiotic surgical prophylaxis there was no consensus on detail. Of 180 patients undergoing clean surgery throughout all phases of the study, antibiotic prophylaxis was administered to 78% compared to 98% of the 180 patients undergoing clean-contaminated surgery. Second and third generation cephalosporin antibiotics predominated in both low-risk clean and clean-contaminated operations. The timing of prophylaxis was correct in virtually all patients. The duration of prophylaxis was less than 24 hours in 96% of patients undergoing clean surgery compared to only 62% of patients undergoing clean-contaminated surgery. The intervention produced no improvement in the duration of prophylaxis nor the overuse and inappropriate choice of unnecessary broad-spectrum and expensive drugs. Interviews and focus groups revealed that an important explanation for the latter problem was Chinese government policy which expected hospitals to support themselves largely through the sale of drugs.ConclusionImproving antibiotic use in China will require hospital funding reform, more authoritative best-practice guidelines, and hospital authorities embracing quality improvement.

Electronic Surveillance System for Monitoring Surgical Antimicrobial Prophylaxis

Antimicrobial surgical prophylaxis comprises one third of all antibiotic use in pediatric hospitals and 80% of all antibiotic use in surgery. Previous studies reported that antimicrobial surgical prophylaxis is often inconsistent with recommended guidelines. An electronic surveillance system was developed to measure antimicrobial utilization and to identify opportunities to improve and monitor the administration of antibiotics for surgical prophylaxis. A retrospective cohort study was conducted on patients with selected inpatient surgical procedures performed from May 1999 to April 2000 at 4 US children's hospitals. International Classification of Diseases, Ninth Revision surgical procedure codes were divided into clean or unclean categories, and an electronic surveillance system was designed using antibiotic and microbiologic culture utilization data to measure appropriate antimicrobial use associated with the surgical procedure. A medical chart review was conducted to validate the electronic system. Ninety percent of cases were classified properly by the electronic surveillance system as confirmed by medical chart review. Surgical antibiotic prophylaxis was not in accordance with the American Academy of Pediatrics (AAP) guidelines for almost half of all procedures. Prolonged antimicrobial administration in clean surgical procedures was the most frequent deviation from guidelines. Statistical differences between the index hospital and the comparison hospitals reflect both over- and underutilization of surgical prophylaxis with significant opportunity to improve prophylaxis for all hospitals. Antimicrobial surgical prophylaxis at the children's hospitals studied is not always consistent with published AAP guidelines. This electronic surveillance system provides a rapid, reproducible, and validated tool to measure easily the efforts to improve adherence to AAP surgical prophylaxis guidelines.

O-14. A multi-centre, randomized, double blind, controlled trial of prophylactic antibiotic use in surgery (PAUS) for primary breast cancer

Predicting future customer behavior provides key information for efficiently directing resources at sales and marketing departments. Such information supports planning the inventory at the warehouse and point of sales, as well strategic decisions during manufacturing processes. In this paper, we develop advanced analytics tools that predict future customer behavior in the non-contractual setting. We establish a dynamic and data driven framework for predicting whether a customer is going to make purchase at the company within a certain time frame in the near future. For that purpose, we propose a new set of customer relevant features that derives from times and values of previous purchases. These customer features are updated every month, and state of the art machine learning algorithms are applied for purchase prediction. In our studies, the gradient tree boosting method turns out to be the best performing method. Using a data set containing more than 10 000 customers and a total number of 200 000 purchases we obtain an accuracy score of 89% and an AUC value of 0.95 for predicting next moth purchases on the test data set.

Rational use of antibiotics in surgery

Widespread use of antibiotics has contributed to antibiotic resistance among common bacterial species. Appropriate use of antimicrobial agents is vitally important from a clinical perspective, and is essential if the usefulness of antibiotics is to be preserved and the further spread of resistance limited. A logical approach to managing the infected patient (choosing appropriate antimicrobial agents, giving them by the optimal route and for the correct duration) is essential. This contribution discusses the rationale behind good antimicrobial prescribing in the surgical patient which, in its simplest sense, is based on empirical or targeted therapy. However, the process of regular patient review, reducing the spectrum of cover as results become available, switching from intravenous to oral therapy as soon as is appropriate and clearly defined stop or review dates should be followed in all patients on antimicrobial agents. The use of antimicrobial agents for surgical prophylaxis is not discussed in this review.

Antibiotic use in aesthetic surgery: a national survey and literature review.

Although much has been written regarding the use of antibiotics in surgery, no clear guidelines exist in the literature regarding the use of antibiotics in aesthetic surgery. To determine the pattern of antibiotic use in aesthetic surgery, a comprehensive survey was mailed to 6000 American Society of Plastic and Reconstructive Surgeons members and candidates. A total of 1767 completed responses were returned, which represents a response rate of 30 percent. The type, route, and duration of antibiotic administration are reported for 10 common cosmetic surgical procedures. The results of the survey confirmed that there is widespread use of antibiotics in aesthetic surgery. To provide guidelines for proper antibiotic use, the current literature was extensively reviewed. The authors found little or no correlation between reported clinical practice and the literature. It is hoped that this study will stimulate further investigation into this area of aesthetic surgery.

Antibiotic Use in Aesthetic Surgery: A National Survey and Literature Review

Although much has been written regarding the use of antibiotics in surgery, no clear guidelines exist in the literature regarding the use of antibiotics in aesthetic surgery. To determine the pattern of antibiotic use in aesthetic surgery, a comprehensive survey was mailed to 6000 American Society of Plastic and Reconstructive Surgeons members and candidates. A total of 1767 completed responses were returned, which represents a response rate of 30 percent. The type, route, and duration of antibiotic administration are reported for 10 common cosmetic surgical procedures. The results of the survey confirmed that there is widespread use of antibiotics in aesthetic surgery. To provide guidelines for proper antibiotic use, the current literature was extensively reviewed. The authors found little or no correlation between reported clinical practice and the literature. It is hoped that this study will stimulate further investigation into this area of aesthetic surgery. (Plast. Reconstr. Surg. 109: 1685, 2002.)

Modern surgical antibiotic prophylaxis and therapy--less is more.

Recent findings and recommendations on the use of antibiotics in surgery, both prophylactically and as therapy, suggest that adverse events associated with antibiotics remain a major cause of morbidity and mortality. Wound infection rates generally parallel the presence of one or more of three key risk factors; the overall medical condition of the patient, a prolonged operative time, and a contaminated or dirty operative field. The first choice of prophylactic drug should generally be a first- or second-generation cephalosporin, unless the patient is highly allergic to penicillin. Effective prophylaxis can almost always be achieved with a single dose of antibiotic, but the dose must be administered soon before the incision. New guidelines for the prevention of bacterial endocarditis have reduced both the types of cases that require prophylaxis, and the doses of antibiotic necessary to achieve prophylaxis. Some cases that required endocarditis prophylaxis previously no longer require prophylaxis. Rational antibiotic therapy demands rapid diagnosis and treatment. It is also crucial to distinguish among infection, contamination, and inflammation as soon as possible; contamination requires only a single dose of antibiotic, whereas sterile inflammation requires none at all. The choice of antibiotic for postoperative infection, including intra-abdominal infection, should consider the severity of illness and the risk of resistant bacteria. Failure to stratify for risk may prolong treatment unnecessarily, confound the interpretation of future studies, and increase the prevalence of bacterial resistance.

Concerted action on quality.

The concerted action on quality assurance in hospitals (COMAC) was an EC project which aimed to study strategies for implementation of quality assurance and their effect on improvement of care with respect to four clinical focus areas: • Prophylactic antibiotic use in surgery • Pre-operative assessment • Keeping patient records • Prevention and therapy of bedsores.