Use Of Antimicrobial Prophylaxis Research Articles

The role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma

BackgroundTo investigate the role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma.MethodsWe retrospectively enrolled 1000 patients who underwent laparoscopic nephrectomy from August 2019 to November 2021 in the Peking Union Medical College Hospital. Patients were divided into group without antimicrobial prophylaxis (n = 444) and group with antimicrobial prophylaxis (n = 556). Outcomes including 30-day postoperative infection rate, the increase rate of pre- and post-operative white blood cell counts and hospital stay were analyzed.ResultsThe overall infection rate was 5.0% (28/556) in the group with antimicrobial prophylaxis, which was similar to 4.1% (18/444) in the group without antimicrobial prophylaxis (P = 0.461). The increase rate of pre- and post-operative white blood cell counts was significantly lower (85.5% versus 97.0%) in the group with antimicrobial prophylaxis (P = 0.004). The postoperative hospital stay was 5 (4, 6) days in both groups (P = 0.483). Logistic regression analyses identified the use of antimicrobial prophylaxis had no influence on the occurrence of infection events (odds ratio = 0.797; 95% confidence interval, 0.435–1.460; P = 0.462). Hemoglobin (odds ratio = 0.430; 95% confidence interval, 0.257–0.719; P = 0.001) and partial nephrectomy (odds ratio = 2.292; 95% confidence interval, 1.724–3.046; P < 0.001) influenced the use of antimicrobial prophylaxis independently.ConclusionsThe use of antimicrobial prophylaxis had no impact on postoperative infection in patients receiving laparoscopic nephrectomy for renal cell carcinoma.

Safety of bendamustine for the treatment of indolent non-Hodgkin lymphoma: a UK real-world experience

AbstractBendamustine is among the most effective chemotherapeutics for indolent B-cell non-Hodgkin lymphomas (iNHL), but trial reports of significant toxicity, including opportunistic infections and excess deaths, led to prescriber warnings. We conducted a multicenter observational study evaluating bendamustine toxicity in real-world practice. Patients receiving at least 1 dose of bendamustine with/without rituximab (R) for iNHL were included. Demographics, lymphoma and treatment details, and grade 3 to 5 adverse events (AEs) were analyzed and correlated. In total, 323 patients were enrolled from 9 National Health Service hospitals. Most patients (96%) received bendamustine-R, and 46%, R maintenance. Overall, 21.7% experienced serious AEs (SAE) related to treatment, including infections in 12%, with absolute risk highest during induction (63%), maintenance (20%), and follow-up (17%) and the relative risk highest during maintenance (54%), induction (34%), and follow-up (28%). Toxicity led to permanent treatment discontinuation for 13% of patients, and 2.8% died of bendamustine-related infections (n = 5), myelodysplastic syndrome (n = 3), and cardiac disease (n = 1). More SAEs per patient were reported in patients with mantle cell lymphoma, poor preinduction performance status (PS), poor premaintenance PS, and abnormal preinduction total globulins and in those receiving growth factors. Use of antimicrobial prophylaxis was variable, and 3 of 10 opportunistic infections occurred despite prophylaxis. In this real-world analysis, bendamustine-related deaths and treatment discontinuation were similar to those of trial populations of younger, fitter patients. Poor PS, mantle cell histology, and maintenance R were potential risk factors. Infections, including late onset events, were the most common treatment-related SAE and cause of death, warranting extended antimicrobial prophylaxis and infectious surveillance, especially for maintenance-treated patients.

Surgical site infection and antimicrobial prophylaxis prescribing profile, and its determinants among hospitalized patients in Northeast Ethiopia: a hospital based cross-sectional study

The inappropriate use of surgical antimicrobial prophylaxis is a common cause for increased risk of morbidity and mortality from surgical site infection in patients who underwent surgical procedures. The study aimed to evaluate surgical antimicrobial prophylaxis prescribing patterns, Surgical Site Infection (SSI), and its determinants in the surgical ward of Debre Berhan Comprehensive Specialized Hospital, northeast Ethiopia. A prospective cross-sectional study was conducted from October 1st 2022 to January 31st, 2023. Data collected from patient medical record cards and patient interviews were entered and analyzed using SPSS V26.0. The determinants of surgical site infection were determined from the multivariable logistic regression. P-value ≤ 0.05 was considered statistically significant. Ceftriaxone (70.5%) followed by a combination of ceftriaxone with metronidazole (21.90%) was the most frequently used prophylactic antibiotic. One hundred fifty-nine (78%) of patients were exposed to inappropriately used prophylactic antimicrobials and 62.2% of these were exposed to inappropriately selected antibiotics. One hundred twenty-six (61.9%) patients developed Surgical Site Infection (SSI). Duration of procedure longer than an hour and inappropriate use of antimicrobial prophylaxiswere the independent predictors for the occurrence of surgical site infections. Patients whose operation was lasted in longer than an hour were 3.39 times more likely to develop SSI compared to those whose operation was completed in less than an hour, AOR = 3.39 (95% CI: 1.24–9.30). Similarly, controlling the effect of other covariate variables, individuals who were given inappropriate antimicrobial prophylaxis were 6.67 times more likely to develop SSI compared to those given appropriate prophylaxis, AOR = 6.67 (95% CI: 1.05–42.49). The high rate of SSI requires due attention from clinicians as well as health policymakers. Duration of surgical procedure greater than an hour and inappropriate antimicrobial prophylaxis use was the independent predictor of surgical site infections.

A Spanish Survey on the Perioperative Use of Antimicrobials in Small Animals.

Appropriate use of perioperative antimicrobials can significantly reduce the risk of post-operative infections. However, inappropriate antimicrobial use can result in the creation of multidrug-resistant bacteria, increased costs, host flora disruption, side effects and increased risk of hospital-acquired infections. This survey evaluated the current perioperative use of antimicrobials in small animals by Spanish veterinarians using a web-based questionnaire. Responses were represented using descriptive statistics and a statistical analysis of the association between demographic data and perioperative antimicrobial use was performed. Pre-operative antimicrobials were administered in clean surgery by up to 68.3% of participants, 81.0% in clean-contaminated surgery and 71.3% in dirty surgery, while in the post-operative period, antimicrobials were administered by up to 86.3% of participants in clean surgery, 93.2% in clean-contaminated surgery and 87.5% in dirty surgery. Factors considered "very important" for antimicrobial selection were the degree of wound contamination, patient immunosuppression and use of prosthesis. The most frequently used antimicrobial was beta-lactamase-resistant (or potentiated) penicillin. Post-operative antimicrobial use was associated with participants without specific surgical postgraduate training. This study highlights an overuse of antimicrobials in perioperative procedures in small animal surgery in Spain. Therefore, evidence-based guidelines and further education regarding the correct use of antimicrobial prophylaxis are recommended.

High burden of clinically significant adverse events associated with contemporary therapy for pediatric T-cell acute lymphoblastic leukemia/lymphoma.

Despite improvements in survival for children with T-cell acute lymphoblastic leukemia and lymphoma (T-ALL/LLy), morbidity remains high. However, data are lacking regarding comprehensive descriptions of clinically relevant adverse events (AEs) experienced during early intensive chemotherapy. This single-institution retrospective study evaluated children aged 1-21 years with T-ALL/T-LLy diagnosed from 2010 to 2020. Physician chart abstraction identified and graded 20 clinically relevant AEs. AE rates were analyzed by T-ALL or LLy, minimal residual disease status, induction steroid, and use of antimicrobial prophylaxis. Statistical comparisons used the Kruskal-Wallis test (continuous variables) and Chi-square or Fisher's exact test (categorical variables). The cohort included 120 patients (T-ALL: 88; T-LLy: 32). Most patients experienced AEs during induction (85 out of 120; 70.8%) and consolidation (89 out of 111; 80.2%). Nonsepsis infection was common in induction (26 out of 120; 21.7%) and consolidation (35 out of 111; 31.5%). Patients treated with dexamethasone during induction had significantly higher rates of nonsepsis infection and/or sepsis during consolidation than those who received prednisone (p<.01). Clinically significant AEs are extremely common during induction and consolidation therapy for patients with T-ALL/LLy. Infectious AEs are particularly prevalent. These results can inform conversations with patients and families and aid in the development of toxicity-related aims in the next generation of, prospective clinical trials in T-ALL/LLy.

Executive summary of consensus clinical practice guidelines for the prevention of infection in patients with multiple myeloma.

Infection remains a significant contributor to morbidity and mortality in patients with myeloma. This guideline was developed by a multidisciplinary group of clinicians who specialise in the management of patients with myeloma and infection from the medical and scientific advisory group from Myeloma Australia and the National Centre for Infections in Cancer. In addition to summarising the current epidemiology and risk factors for infection in patients with myeloma, this guideline provides recommendations that address three key areas in the prevention of infection: screening for latent infection, use of antimicrobial prophylaxis and immunoglobulin replacement and vaccination against leading respiratory infections (severe acute respiratory syndrome coronavirus 2, influenza and Streptococcus pneumoniae) and other preventable infections. This guideline provides a practical approach to the prevention of infection in patients with myeloma and harmonises the clinical approach to screening for infection, use of prophylaxis and vaccination to prevent infectious complications.

ANTIBIOTIC PROPHYLAXIS USE IN PATIENTS ADMITTED IN GENERAL SURGERY DEPARTMENT AT A TERTIARY CARE TEACHING HOSPITAL IN HARYANA

Objective: In India, due to a lack of adequate information and guidelines for antimicrobial prophylaxis in surgery, there is a need to generate baseline data on the pattern of the use of prophylactic antibiotics. Hence, we planned this study with an objective to study the antimicrobial prophylaxis use in the patients admitted to the general surgery department. Methods: The present study was a prospective observational study conducted in the department of pharmacology in collaboration with the department of surgery with the prior approval of the Institutional Ethical committee. All data were retrieved from the patients’ case records. Using a convenient sampling method, 100 adult patients who underwent surgical procedures in MMIMSR during the study period were taken. Results: A total of 100 patients admitted to the general surgery department of MMIMSR fulfilling the inclusion and exclusion criteria were enrolled. Out of 100 patients, 52 (52%) were male and 48 (48%) were female patients who underwent surgery and the majority of the patients enrolled are between 48 and 58 years (40%) of age. Cholecystectomy (28%) was the most frequent performed surgery type followed by hernial repair (24%) and hemorrhoidectomy (14%) Among all cases, surgical antibiotic prophylaxis was recommended in 93 (93%) patients. The most preferred route of administration of surgical antibiotic prophylaxis was parenteral route 100 (100%) and ceftriaxone was most commonly prophylactically prescribed antibiotic. Conclusion: Surgical site infection is the most common nosocomial infections in surgical patients accounting for prolonged hospital stay, mortality, and increased cost of care. According to the analyzed results of our study and from view of literature, the present study provides us patterns of antibiotic usage in patients admitted in surgery wards.

Antimicrobial Prophylaxis in Dentistry: Survey among Dental Surgeons in Porto Alegre, Brazil, and the Metropolitan Region.

The irrational use of antimicrobial drugs has become a serious epidemiological problem due to the development of bacterial resistance, causing consequences for global health. In dentistry, antibiotics are the second most common pharmacological class prescribed. Thus, we evaluated the use of antimicrobial prophylaxis by dentists in Porto Alegre, Brazil, and the metropolitan region using an online questionnaire. Dentists were asked to complete an anonymous questionnaire concerning antimicrobial prescription. The questionnaire was prepared on the Microsoft Forms platform and shared with dentists through social media and was available for a period of 40 days. The questionnaire was answered by 82 dentists, and 85.3% of them reported prescribing antibiotic prophylaxis (AP). Many different protocols were observed, but the majority of dentists prescribe amoxicillin (2 g) 1 hour before a procedure. The greatest diversity was found in the prescriptions for post-procedure prophylaxis, but most professionals prescribe 500 mg of antibiotics every 8 hours for 7 days. An overwhelming 91.5% of participants think that guidelines for prescribing antibiotics in dentistry are necessary, and 62.2% believe that the use of AP can have some impact on bacterial resistance. There is a wide range of different prescriptions for antimicrobials, suggesting a need for better aligned guidelines and education of professionals on the proper use of antimicrobials and its consequences on bacterial resistance to antibiotics.

P004 Infective complications in patients with secondary haemophagocytic lymphohistiocytosis: a case series from a large central London teaching hospital

Abstract Background/Aims Haemophagocytic lymphohistiocytosis (HLH) is a rare systemic inflammatory condition that is characterised by excessive macrophage activation in response to a wide range of triggers, including infections, rheumatological and haematological conditions. HLH is associated with high morbidity and mortality, and treatment requires significant immunosuppression. University College London Hospitals (UCLH) operates an HLH service; we were keen to understand the burden of infective complications in our cohort of patients and establish specific guidelines. Methods A retrospective descriptive analysis was performed of all adults with secondary HLH over a two-year time-frame (1stApril 2019 to 1st April 2021) at UCLH. UCLH has a designated HLH multi-disciplinary team (MDT) supported by rheumatology, infectious diseases, tropical medicine, virology, haematology and critical care. This work was registered as a service evaluation project by the Medical Specialities Division. Data was collated from electronic health records into REDCap, and processed in R version 1.4.1103 and Microsoft Excel by two independent authors. Results 40 patients were identified, with a median age of 37. 14 patients had an identified haematological trigger (35%), 12 an infectious one (30%) and 5 a rheumatological (12.5%). 24 patients (60%) were admitted to intensive care and 13 died during admission (32.5%). 35 patients (87.5%) received steroids at some time during their admission, with 24 (60%) receiving a long course. Four patients (10%) had prolonged neutropaenia during admission. Twenty-four patients (60%) developed an infection during their admission; with 33 bacterial, 7 viral and 12 fungal infections (5 proven, 2 probable and 5 possible) identified. Sixteen patients had &amp;gt;1 infection. Those who did not have a diagnosed infection during their admission were more likely to survive than those who did (93% vs 44%, p = 0.047). The mortality rate of those with fungal infections was 89%, compared to 43% for bacterial and viral infections. Of the 24 patients who received a long course of steroids, 14 (58%) did not receive anti-fungal prophylaxis during their admission and three of these patients were diagnosed with fungal infections during their admission. Of the 4 patients with prolonged neutropenia, 1 (25%) did not receive antifungal prophylaxis and did suffer from a confirmed fungal infection. One patient with confirmed PCP had not previously been taking PCP prophylaxis. Of the seven patients with viral infections, 2 had HSV-1 infections and neither had received anti-viral prophylaxis before their infection start date. Conclusion We demonstrate that a high proportion of patients with HLH develop infective complications, which is associated with increased mortality. Prior to this analysis, the use of antimicrobial prophylaxis was variable. We have since written a specific guideline for the routine use of antimicrobial prophylaxis for patients with HLH, with a view to auditing future care against this guideline. Disclosure P. Saha: None. N. McCann: None. M. Brown: None. N. Stone: None. E. Sanchez: None. B. Carpenter: None. A. Laurence: None. M. Hutchinson: None. A. Jones: None. S.H. Gohil: None. J. Manson: None.

Risk factors for healthcare-associated infections in newborns after surgery in a neonatal intensive care unit.

Health care-associated infections (HAIs) are a common cause of morbidity and mortality. There is little information on the risk factors associated with HAI in surgical newborns. To identify the risk factors associated with healthcare-associated infections in surgical newborns. Nested case-control study carried out during 2016-2017. Cases were newborns with healthcare-associated infections and controls were newborns without infection. Perinatal characteristics, use of antimicrobial prophylaxis, use of central venous catheter (CVC), mechanical ventilation, parenteral nutrition, age, and weight at the time of surgery, type of surgery, surgical wound classification, duration of surgery, number of surgical procedures, postsurgical HAIs and type of infection were registered. Univariate and multivariate analyses were performed. Seventy-one cases and 142 controls were included. The most frequent HAI was bloodstream infection (36.6%); the main microorganisms isolated in blood cultures were gram-positive cocci. Independent risk factors associated with HAIs in the multivariate analysis were CVC duration > 8 days (aOR = 17.2, 95% CI = 3.8-49.1), ≥ 2 surgeries (aOR = 16.5, 95% CI 5.8 -42.1) and abdominal surgery (aOR = 2.6, 95% CI = 1.2-6.6). Newborns undergoing surgery, mainly those with risk factors, require close monitoring during the postoperative period. CVC should be withdrawn as soon as possible.

2112. Incidence and outcomes of infections in liver transplant recipients during the first year post-transplant.

Abstract Background Despite the use of antimicrobial prophylaxis in liver transplant recipients (LTR), infection remains the most likely cause of death (18.94%) in the first year. There is limited data describing the characteristics, &amp; infections of LTR while hospitalized in the first year post-transplantation. We aimed to review the incidence and outcomes of infections in LTR in the first year post-transplant during hospitalization or re-hospitalization. Graph 1.Y-axis; Number of cultures collected, X-axis; type of organism dived over time. Site of bacterial infection Table 1.Number of bacterial infections divided by site/system, involved compared to timing of infection. Methods We performed a single-center retrospective cohort study at The University of Rochester. Electronic medical records of 298 first time adult LTR between 03/5/2011 and 04/01/2020 were reviewed. Demographic and comorbidity data was obtained at time of transplant. Microbiologic data and outcomes were obtained during the first year post-transplant. We compared mortality between those with infection and those without using log-rank survival analysis. Graph 2. Y-Axis; Number of patients with diagnosed viral infection. X-axis virus divided over time. Results 160 (53.7%) patients suffered at least 1 infection while hospitalized in the first year post-transplant. There were 178 bacterial infections in 130 patients of which 115 were intra-abdominal (table 1). The most common organism was Enterococcus sp. (n=102), 65 were vancomycin resistant (VRE). The most common site of fungal infection was abdominal (n=13) and the most common organism was C. glabrata (n=9). The most common viral infection was CMV at 7-12 months although other viral infections occurred between 1-6 months (graph 2). In a univariate chi-square model, bacterial infection at any time was associated with all-cause mortality in the first year (CI 1.7-8.9 p-adj= 0.002). Fungal infection between 2-6 months was also associated with increased mortality (CI 2.7-12.2 p-adj= 0.0005). Conclusion Bacterial infections are the most common type of infection in LTR and occur more frequently during the first 6 months. Bacterial infection at any point was independently associated with increased mortality in the first year post-transplant. The most common organism was Enterococcus with a high rate of VRE which should be taken into consideration for empiric coverage at our institution. Fungal infection between 2 to 6 months was associated with increased mortality. We observed that early bacterial and fungal infections are markers of poor prognosis. Disclosures All Authors: No reported disclosures.

Evaluation of Infection in Patients with Myelodysplastic Syndromes Treated with Hypomethylating Agents: A Systematic Review

BACKGROUND: Myelodysplastic syndromes (MDS) are a heterogeneous group of disorders associated with cytopenias and risk of febrile neutropenia and infection. Hypomethylating therapy, such as azacitidine and decitabine, form the backbone of outpatient chemotherapy for many patients with MDS. Current literature reports heterogeneous and variable frequency, location, and severity of infections among patients receiving this treatment. Further, the relationship between infection and neutropenia is not well established. OBJECTIVE: To facilitate evidence-informed supportive care therapy, we evaluated the incidence and severity of infection and neutropenia among patients with MDS treated with hypomethylating therapy. We also aimed to evaluate the relationship between neutropenia and infection (CRD42022339150). POPULATION: Adult patients (age ≥ 18 years) with MDS (≥80% of the study population) treated with hypomethylating agents. OUTCOMES: Our primary outcome was febrile neutropenia, as per the National Cancer Institute's Common Toxicity Criteria for Adverse Events (NCI-CTCAE). Secondary outcomes included infection of any grade, grade 3 or 4 infections, death due to infection, microbial and clinical infection subtype, frequency of grade 3 or 4 neutropenia, duration of neutropenia, and use of antimicrobial prophylaxis. METHODS: We identified randomized controlled trials (RCT) from Medline, Embase, CENTRAL, and CINAHL from inception to April 2021. RCTs were included if they evaluated hypomethylating therapy in patients with MDS and reported at least one outcome of interest. We used Freeman-Tukey transformation to calculate the weighted summary proportion using a random effects model. RESULTS: We included 21 unique trials enrolling 1380 patients. 14 trials evaluated azacitidine (n=946 patients) and 8 trials studied decitabine (n=434 patients). The median patient age was 70, and 56% were male. 10 trials (n=729 patients) reported risk by International Prognostic Scoring System, of which 5% were low risk, 30% were intermediate-1 risk, 41% were intermediate-2 risk, and 24% were high risk. 49% of patients had grade 3 or 4 neutropenia (95% confidence interval (CI) 34%-63%, n=10 trials, n=697 patients). Febrile neutropenia was reported in 22% of patients (95% confidence interval (CI) 16% to 29%; n=16 trials, n=1124 patients). Grade 3 or 4 infection was reported in 33% of patients (95% CI 0% to 67%; n=3 trials, n=294 patients). Death due to infection occurred in 7% of patients (95% CI 4%-10%; n=9 trials, n=528 patients). Reporting of infection location was inconsistent, and uninterpretable on a per-patient basis. Microbial subtype of infection, duration of neutropenia, and antimicrobial prophylaxis use were not reported. CONCLUSION: In patients with MDS treated with hypomethylating therapy, grade 3 or 4 neutropenia, febrile neutropenia, and grade 3 or 4 infection were common, yet reported rates were heterogeneous between trials. Limited information was available to define the relationship between neutropenia and infection, as well as the use of antimicrobial prophylaxis. Trials commonly reported infection events in the absence of patient-specific risk estimates. Comprehensive reporting of febrile neutropenia, infection and use of antimicrobial prophylaxis is needed to direct evidence-informed care.

Evaluation of Infection in Patients with Acute Myeloid Leukemia Treated with Hypomethylating Agents: A Systematic Review

BACKGROUND: Acute myeloid leukemia (AML) is characterized by bone marrow failure, cytopenias, and complications related to bleeding and infection. In many adults with AML, hypomethylating agents (e.g., azacitidine, decitabine) comprise the backbone of outpatient chemotherapy. Due to underlying disease and/or treatments, patients with AML frequently have severe and prolonged neutropenia, which increases risk of infectious complications. The frequency and severity of infectious complications have not been well defined for patients receiving treatment with hypomethylating agents, either alone or in combination with venetoclax. OBJECTIVE: To inform optimal supportive care therapy to minimize infection risk, we evaluated the incidence and severity of neutropenia, febrile neutropenia, and infections among patients with AML treated with hypomethylating therapy. We also aimed to study the incremental risk with combination hypomethylating therapy, and the reported use of antimicrobial prophylaxis (CRD42022339158). POPULATION: Adult patients (age ≥ 18 years) with AML (≥80% of the study population) treated with hypomethylating agents. OUTCOMES: Our primary outcome was febrile neutropenia, as per the National Cancer Institute's Common Toxicity Criteria for Adverse Events (NCI-CTCAE). Secondary outcomes included infection of any grade, grade 3 or 4 infections, death due to infection, microbial and clinical infection subtype, frequency of grade 3 or 4 neutropenia, duration of neutropenia, and use of antimicrobial prophylaxis. METHODS: We searched Medline, Embase, CENTRAL and CINAHL from inception to April 2021. We included randomized controlled trials if they evaluated hypomethylating therapy in patients with AML and reported at least one outcome of interest. We used Freeman-Tukey transformation to calculate the weighted summary proportion using a random effects model. RESULTS: From 13,225 citations, we included 18 unique trials (published between 2010 and 2021), enrolling 2,788 patients. Azacitidine was evaluated in 8/18 trials (n = 984 patients) while 6/18 trials (n = 877 patients) evaluated decitabine, and 4/18 trials (n = 927 patients) evaluated combination therapy with hypomethylating agents and venetoclax. The median patient age was 74 years (interquartile range 72 to 76 years); males represented 53% of the population. 31% of patients had grade 3 or 4 neutropenia (95% confidence interval (CI) 21% to 41%; n = 9 trials; 1,407 patients). Febrile neutropenia affected 31% patients receiving single agent hypomethylating therapy (95% CI 26% to 37%; n = 11 trials; 1,382 patients), with increased risk among patients treated with the combination of hypomethylating therapy and venetoclax (46%; 95% CI 35% to 57%; n = 2 trials; 398 patients). 45% of AML patients reported infection (95% CI 33% to 57%; n = 11 trials; 1,232 patients). The most frequent infections were respiratory infections (31%), bacteremias (24%), skin and soft tissue infections (18%), and urinary tract infections (11%). Infection-related death occurred in 8% of patients with AML (95% CI 6% to 11%; n = 9 studies; 898 patients). Microbial subtype of infection and duration of neutropenia were not reported. Antimicrobial prophylaxis was reported in only one trial. CONCLUSION: Neutropenia and infection occur commonly in patients with AML treated with hypomethylating agents, with increased risk with venetoclax combination therapy. Reported risks were heterogenous among trials, and limited data was available to evaluate the relationship between neutropenia and infection. Antimicrobial prophylaxis was rarely reported. Clinical trials are needed to inform optimal supportive care interventions to decrease infection risk in this high-risk patient population.

Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery

Use of postoperative antimicrobial prophylaxis is common in pediatric surgery despite consensus guidelines recommending discontinuation following incision closure. The association between postoperative prophylaxis use and surgical site infection (SSI) in children undergoing surgical procedures remains poorly characterized. To evaluate whether use of postoperative surgical prophylaxis is correlated with SSI rates in children undergoing nonemergent surgery. This is a multicenter cohort study using 30-day postoperative SSI data from the American College of Surgeons' Pediatric National Surgical Quality Improvement Program (ACS NSQIP-Pediatric) augmented with antibiotic-use data obtained through supplemental medical record review from June 2019 to June 2021. This study took place at 93 hospitals participating in the ACS NSQIP-Pediatric Surgical Antibiotic Prophylaxis Stewardship Collaborative. Participants were children (<18 years of age) undergoing nonemergent surgical procedures. Exclusion criteria included antibiotic allergies, conditions associated with impaired immune function, and preexisting infections requiring intravenous antibiotics at time of surgery. Continuation of antimicrobial prophylaxis beyond time of incision closure. Thirty-day postoperative rate of incisional or organ space SSI. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for SSI rates and postoperative prophylaxis use. SSI measures were adjusted for differences in procedure mix, patient characteristics, and comorbidity profiles, while use measures were adjusted for clinically related procedure groups. Pearson correlations were used to examine the associations between hospital-level postoperative prophylaxis use and SSI measures. Forty thousand six hundred eleven patients (47.3% female; median age, 7 years) were included, of which 41.6% received postoperative prophylaxis (hospital range, 0%-71.2%). Odds ratios (ORs) for postoperative prophylaxis use ranged 190-fold across hospitals (OR, 0.10-19.30) and ORs for SSI rates ranged 4-fold (OR, 0.55-1.90). No correlation was found between use of postoperative prophylaxis and SSI rates overall (r = 0.13; P = .20), and when stratified by SSI type (incisional SSI, r = 0.08; P = .43 and organ space SSI, r = 0.13; P = .23), and surgical specialty (general surgery, r = 0.02; P = .83; urology, r = 0.05; P = .64; plastic surgery, r = 0.11; P = .35; otolaryngology, r = -0.13; P = .25; orthopedic surgery, r = 0.05; P = .61; and neurosurgery, r = 0.02; P = .85). Use of postoperative surgical antimicrobial prophylaxis was not correlated with SSI rates at the hospital level after adjusting for differences in procedure mix and patient characteristics.

The Association of Adherence to Antimicrobial Prophylactic Recommendations for Clean Neurosurgeries with Post-operative Surgical Site Infection

Objective: The use of antimicrobial prophylaxis to prevent surgical site infections (SSI) is well established. This study examined the association of adherence to antimicrobial prophylaxis for clean neurosurgeries with post-operative surgical site infection (SSI) rates. Methods: A retrospective descriptive study was conducted at the Philippine General Hospital (PGH) among pediatric patients who underwent clean neurosurgical procedures between January 1, 2018 – December 31, 2019. The outcome measured was the development of SSI. Univariate and multivariate analysis was performed to show the association of risk factors with SSI. Compliance to existing antibiotic prophylaxis recommendation was assessed. Results: One hundred eighty-nine (189) medical charts were reviewed. Overall prevalence of SSI was 9.5% and fever was the most common initial symptom of SSI. Staphylococcus species was identified from cultures of surgical sites, consistent with existing literature, however gram-negative organisms including multidrug-resistant organisms (MDRO) were noted. All cases received prophylactic antibiotics, but adherence to all parameters (antimicrobial choice, dose, timing, route, re-dosing and duration of prophylaxis) was low at 7.9%. Appropriate antibiotics were prescribed in only 15.9% and antibiotics were discontinued beyond 24 hours post-surgery in 45.5% of cases. Patients who received a regimen fully compliant with antimicrobial prophylaxis recommendations did not develop SSI. Conclusion: Adherence to existing antimicrobial prophylaxis protocol for neurosurgeries is low at 7.9%. Patients who received a regimen fully compliant with the recommendations did not develop SSI. Interventions to improve compliance to antimicrobial prophylaxis guidelines are needed.

Incidence and Significance of Microbiological Results and Antimicrobial Prophylaxis in Patients Undergoing Total Pancreatectomy with Autologous Islet Cell Transplant

Introduction: The impact of microbiological findings in the preservation, cannulation solutions, and final islet cell product is debatable amongst providers taking care of patient undergoing total pancreatectomy with autologous islet cell-transplantation (TPAIT). It is further challenged by the lack of guidelines on the type and duration of antimicrobial prophylaxis needed. We aimed to correlate post-op infections to theses cultures and the efficacy of antimicrobial prophylaxis. Methods: Twenty-two patient’s (February 1, 2018 to August 31, 2021) microbiological data from the preservation, cannulation, and final islet cell cultures and their 60 days post-transplant infections were retrospectively analyzed. Results: Microbial cultures were positive in 5 (22.7%) patient’s preservation solution, 4 (18.2%) cannulation solution, and 6 (27.3%) final products (Table 1). Most common antimicrobial prophylaxis regimens were piperacillin/tazobactam (pip/tazo), vancomycin, and micafungin (n=9). The average duration was seven days (range: 2-10). Six patients were discharged on amoxicillin/clavulanic acid. Three patients (14%) had infections: 2 (9%) had Clostridium difficile (22 and 37 days after surgery), 1 (5%) had Candida albicans growing from the abdominal collection (59 days) with no growth in any of the isolation cultures, and 1 (5%) had Burkholderia cepacia in urine (44 days). Conclusion: Isolation procedure and final product cultures were not associated with any infections. Broad spectrum antimicrobial use intra- and post-operatively and extended oral antimicrobial therapy may have minimized the number of infectious outcomes. Consideration is warranted regarding the use of antimicrobial prophylaxis and duration as some of these agents pose a risk for C. difficile.Tabled 1EP02F-020Final Islet Cell CulturePreservation SolutionCannulation Solution1Yeast like organisms in anaerobic cultureNegativeYeast like organisms in anaerobic culture2Initially resulted as gram positive cocci with final identification as Granulicatella adiacensNegativeInitially resulted with gram negative rods in both aerobic and anaerobic cultures. Final report of Klebsiella pneumonia in the aerobic culture and Enterobacter species in anaerobic culture.3Streptococcus massiliensis from aerobic cultureNegativeNegative4Yeast like organisms in anaerobic cultureGram negative rods in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic cultures5NegativeGram positive rods in anaerobic cultureNegative6Gram positive cocci in anaerobic cultureGram negative rods in aerobic cultureNegative7Gram positive cocci in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic culturesGram negative rods in aerobic and anaerobic cultures8NegativeGram positive cocci in anaerobic cultureNegative Open table in a new tab

“Prospective study evaluating incidence of surgical site infection in thyroidectomy: Is antibiotic prophylaxis required?

Objective: Occurrence of surgical site infection (SSI) is considered a rare occurrence in patients undergoing thyroidectomy. International guidelines do not recommend usage of antimicrobial prophylaxis (AP) for thyroid surgery and this study is aimed at finding whether such guidelines hold ground in a developing country like India. Study design: This prospective comparative study included 293 patients who underwent thyroidectomy at a single institution. Setting: The study was conducted in a tertiary referral hospital (Amrita institute of medical sciences, Kochi, Kerala, India) between 2017 - 2019. Methods: One group undergoing thyroidectomy received AP and other did not. Incidence of SSI was assessed in all patients during in-patient stay, 10th day and 30th day. Details of the data collected includes patient’s age, gender, co-morbidity, nutritional status, operative and drain duration, length of stay in the hospital. Results: Out of 293 patients, five cases of SSI were diagnosed in the group without AP (Four – superficial SSI and one - deep incisional SSI) and zero cases in the group with AP. Our study revealed an infection rate of 1.7 % in thyroid surgery. Comparing incidence of SSI in patients with and without AP, there was no statistically significant difference (p=0.152). In multivariate analysis, type 2 Diabetes Mellitus (p=0.016) and overweight/obesity (p=0.045) were identified as independent risk factors for SSI. Conclusion: Our results were found to be in synchronization with international guidelines and concluded that AP is not a necessary pre-operative preparation for all patients undergoing thyroidectomy but in a developing country like India multiple factors could predispose patients to SSI resulting in significant strain on the hospital and the patients’ financial resources. Patients with Type 2 Diabetes Mellitus and overweight/obese patients may be considered as high-risk patients in whom selective use of antimicrobial prophylaxis may be beneficial.

Cellulitis in patients with chronic lower-limb lymphedema due to HIV-related Kaposi sarcoma.

Chronic Lower Limb Lymphedema (CL-LL) secondary to Kaposi sarcoma (KS) has not been recognized as a risk factor for cellulitis. The aim was to describe the clinical spectrum and use of antimicrobial prophylaxis in patients with cellulitis and CL-LL due to KS. HIV patients with KS, CL-LL, and at least one episode of cellulitis seen at the AIDS Cancer Clinic at INCan in Mexico from 2004 to 2019 were included. Demographic and clinical data were obtained from medical records. Thirty-nine men all with CL-LL were included. Clinical factors associated with cellulitis were groin and/or lymph-node KS infiltration (69.2%), onychomycosis and/or tinea pedis (44.7%), ulcerated lesions (38.4%), and obesity (2.5%). Eighteen (46.1%) were hospitalized in the first episode and eight (20.5%) in recurrence. Six (25.3%) died, two of toxic shock syndrome (TSS), and one of septic shock. Fourteen (35.8%) had at least one recurrent episode of cellulitis. Twenty-five (64.1%) received prophylaxis. Patients without prophylaxis had significantly more unfavorable outcomes (hospitalization and recurrences) than those with prophylaxis. CL-LL due to KS is a risk factor for cellulitis and severe complications in patients with a long life expectancy. Antimicrobial prophylaxis needs to be explored as it could prevent complications.

Incidence and Outcomes of Toxoplasma Reactivation in Patients with Hematologic Diseases after Allogeneic Hematopoietic Stem Cell Transplantation

Incidence and Outcomes of Toxoplasma Reactivation in Patients with Hematologic Diseases after Allogeneic Hematopoietic Stem Cell Transplantation

Contemporary use of antimicrobial prophylaxis for surgical patients: An observational cohort study.

Antimicrobial prophylaxis is commonly used to prevent surgical site infection (SSI), despite concerns of overuse leading to antimicrobial resistance. However, it is unclear how often antimicrobials are used and whether guidelines are followed. To describe contemporary clinical practice for antimicrobial prophylaxis including guideline compliance, the rate of postoperative infection and associated side effects. A prospective, multicentre, observational cohort study. Twelve United Kingdom National Health Service hospitals. One thousand one hundred and sixteen patients, aged at least 18 years undergoing specific colo-rectal, obstetric, gynaecological, urological or orthopaedic surgical procedures. Compliance with guidelines for antimicrobial prophylaxis. The primary outcome was SSI within 30 days after surgery. Secondary outcomes were number of doses of antimicrobials for prophylaxis and to treat infection, incidence of antimicrobial-related side effects and mortality within 30 days after surgery. Data are presented as number with percentage (%) or median with interquartile range [IQR].Results of logistic regression analyses are presented as odds ratio/rate ratio (OR/RR) with 95% confidence intervals (95% CIs). 1102 out of 1106 (99.6%) patients received antimicrobial prophylaxis, which was compliant with local guidelines in 929 out of 1102 (84.3%) cases. 2169 out of 51 28 (42.3%) doses of antimicrobials were administered as prophylaxis (median 1 [1 to 2] dose) and 2959 out of 5128 (57.7%) were administered to treat an infection (median 21 [11 to 28] doses). 56 patients (5.2%) developed SSI. Antimicrobial prophylaxis administered according to local guidelines was not associated with a lower incidence of SSI compared with administration outside guidelines [OR 0.90 (0.35 to 2.29); P = 0.823]. 23 out of 1072 (2.2%) patients experienced a side effect of antimicrobial therapy. 7 out of 1082 (0.6%) patients died. The median hospital stay was 3 [1 to 5] days. Antimicrobial prophylaxis was administered for almost all the surgical procedures under investigation. However, this was not always compliant with guidelines. Further research is required to determine whether the amount of prophylactic antimicrobials could be safely and effectively reduced without increasing the incidence of SSI.