Use Of Perioperative Antibiotics Research Articles

Postoperative Infection Rate and Associated Factors Following Endoscopic Sinus Surgery

There is a paucity of data on postoperative infections after endoscopic sinus surgery and associated risk factors. Our objective was to evaluate a cohort of patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis to determine which perioperative factors may be associated with infection in the 30-day postoperative period. A retrospective cohort study of adults who underwent ESS at a tertiary academic medical center from 2015 to 2018 was performed. The primary outcome was incidence of postoperative infection, defined by identification of sinus purulence on nasal endoscopy necessitating antibiotics within 30 days of surgery. Independent variables collated included the result of postoperative cultures and use of perioperative antibiotics, oral corticosteroids, packing, and steroid-eluting stents. Statistical analysis involved bivariate analysis to identify variables that correlated with postoperative infection and subsequent multivariate logistic regression to identify independent risk factors. Three hundred seventy-eight unique ESS cases performed in 356 patients were reviewed. The mean age was 46 years (range, 18-87). The most common indication for surgery was chronic rhinosinusitis without nasal polyposis. The postoperative infection rate was 10.1%. The most commonly cultured pathogen was Staphylococcus aureus. Multivariate logistic regression analysis showed that postoperative systemic corticosteroid use was the only risk factor independently associated with infection (OR 3.47 [95% CI 1.23-9.76], P = .018). The incidence of postoperative infection following ESS was 10.1%. The use of postoperative systemic corticosteroids independently increased the risk of infection by 3.47-fold.

Current practice patterns of society of urologic oncology members in performing inguinal lymph node staging/therapy for penile cancer: A survey study

ObjectivesInguinal lymph node (ILN) staging and therapeutic procedures are important for the diagnosis and management of suspected Inguinal lymph node metastasis in the setting of penile cancer. Morbidity associated with inguinal lymph node dissection (ILND) and the lack of standardization in its perioperative management are both significant. In this study, we aimed to define current management approaches and potential opportunities for improving outcomes. Methods and materialsA questionnaire was developed with 16 questions regarding pre, peri, and postoperative management of patients undergoing ILND. The questionnaire was approved by the Society of Urologic Oncology (SUO) Questionnaire Committee, which facilitated its dissemination through an initial email and a follow-up reminder to 1,003 members. The study was conducted from July to August, 2020. ResultsOf the 1,003 SUO members invited to participate, 93 responded (9.3% response rate); 49% performed 1 to 2 ILNDs annually, and 60% chose open ILND for high-risk primary cancer cN0. For suspicious lymph nodes > 2 cm, 69% preferred ILND, 86% preoperative systemic neoadjuvant chemotherapy, followed by surgery for bulky inguinal metastasis, and 84% used perioperative antibiotics (ABX), 53% of whom discontinued ABX 24 hours after surgery. Prophylactic anticoagulation was used by 78% of respondents, and 60% stopped it after ambulation. Specific ligation of lymphatics (versus none) was used by 82% of respondents, 55% obtained frozen sections, and 94% used inguinal drains. A saphenous sparing technique was used by 75% of respondents. An incisional wound vacuum device was used by 17% of respondents. Compression stockings and/or referral to a lymphedema specialist were used to manage postoperative lymphedema by 61% of respondents. ConclusionsResponses to a penile lymphadenectomy survey were relatively low and were primarily from the academic surgeon subset of the SUO. Significant consensus ( ≥ 70%) was noted for neoadjuvant chemotherapy for bulky nodal metastasis prior to surgery, perioperative antibiotic use, ligation of lymphatics, drain placement, and saphenous sparing dissection techniques. Other evidenced-based strategies that could decrease morbidity were rarely used, including dynamic sentinel node biopsy, incisional wound vacuums, and lymphedema prevention. Prospective trials are needed to validate and resolve existing treatment paradigms and to optimize perioperative pathways to reduce complications in penile cancer management.

Perioperative use and safety of cephalosporin antibiotics in patients with documented penicillin allergy

Approximately 9% of the US population reports a history of a penicillin allergy (PA).1 Cephalosporins, especially cefazolin, are often first-line perioperative antibiotics due to their effectiveness in preventing surgical-site infections caused by common gram-positive and gram-negative bacteria.2 In the perioperative setting, unnecessary avoidance of first-line cephalosporin antibiotics in patients with documented PA is associated with increased surgical-site infections.2

Outcome of tonsillectomy in children without the use of postoperative antibiotics at two tertiary care hospitals of Peshawar

Introduction: Overuse of antibiotics can lead to antimicrobial resistance and unnecessary costs. Although early studies reported improved outcomes following use of perioperative antibiotics for tonsillectomy, more recent studies have not been able to demonstrate a significant benefit on post tonsillectomy morbidity.
 Objective: To determine the need for postoperative antibiotics in children undergoing tonsillectomy under aseptic conditions at two tertiary care hospitals of Peshawar.
 Materials & Methods: Children aged 5-14 years admitted to the departments of Otorhinolaryngology-A unit of Hayatabad Medical Complex and Rehman Medical Institute, Peshawar from March 01, 2018 to September 30, 2018 for recurrent sore throat and recurrent quinsy were included in this quasi-experimental study based on prospective data collection and convenience sampling. Children with blood dyscrasias, upper and lower respiratory tract infections, and cardiopulmonary diseases were excluded. Routine preoperative investigations were done, and all were given postoperative analgesics. The patients were divided into two consecutive groups of 60 each; Group-A was given Co-amoxiclav 20mg/5mg/kg/day for 10 days and Group-B was not given any antibiotic. During their stay in the hospital and on follow up they were asked about pain via Visual Analogue Scale, and presence of fever and/or bleeding were documented.
 Results: Of 120 children, 50 (41.6%) were males and 70 (58.4%) were females, of ages 05-14 years; 01(1.6%) from Group-A and 01(1.6%) from Group-B presented with reactionary hemorrhage. However, 01(1.6%) from Group-A and 25(40%) from Group-B presented with secondary hemorrhage for which they were readmitted and put on injectable antibiotics. Similarly, 05(8.3%) from Group-A and 14(23.3%) from Group-B presented with pain for which pain killers were prescribed.
 Conclusion: Post tonsillectomy antibiotics may have a role in reducing the morbidities associated with the procedure in our setup.
 Keywords: Tonsillectomy; Postoperative Infections; Antibiotic Resistance; Hemorrhage.

Antibiotic Use in Lateral Skull Base Surgery: A Survey of the North American Skull Base Society.

Objectives Antibiotic use in lateral skull base surgery (LSBS) has not been thoroughly investigated in the literature. There is wide variability in antibiotic use and insufficient data to guide management. This study aims to describe the factors and patterns influencing antibiotic use in LSBS among the membership of the North American Skull Base Society (NASBS). Design An online-based survey was designed and distributed to the membership of the NASBS. Data was analyzed using bivariate analysis and logistic regression modeling. Setting Online-based questionnaire. Participants NASBS membership. Main Outcome Measures Use of intraoperative antibiotics and use of postoperative antibiotics. Results The survey response rate was 26% (208 respondents). Of the 208 total respondents, 143 (69%) respondents performed LSBS. Most respondents are neurosurgeons (69%) with the remaining being otolaryngologists (31%). The majority of respondents (79%) are fellowship-trained in skull base surgery. Academic or government physicians make up 69% of respondents and 31% are in private practice with or without academic affiliations. Bivariate analysis showed that practice setting significantly influenced intraoperative antibiotic use ( p = 0.01). Geographic location significantly affected postoperative antibiotic use ( p = 0.01). Postoperative antibiotic duration was significantly affected by presence of chronic otitis media, cerebrospinal fluid leak, and surgeon training ( p = 0.02, p = 0.01, and p = 0.006, respectively). Logistic regression modeling showed that the motivation to reduce infection significantly impacted postoperative antibiotic use ( p = 0.03). Conclusion This study demonstrates significant variations in intraoperative and postoperative antibiotic use in LSBS among the NASBS membership. Appropriate guidelines for optimal perioperative antibiotic use patterns should be determined with randomized studies in the future.

A history of Clostridioides difficile infection portends infection recurrence and worse outcomes after stoma reversal

BackgroundClostridioides difficile infection is reported to occur after 2.2% of colorectal operations and is associated with longer length of hospital stay, greater overall healthcare cost, and significant morbidity and mortality. The incidence of Clostridioides difficile infection is greatest after elective stoma reversal. The purpose of this study was to evaluate the effect of prior Clostridioides difficile infection on patients undergoing stoma reversal. We hypothesized that patients with a history of Clostridioides difficile infection who underwent stoma reversal will be at an increased risk of postoperative Clostridioides difficile infection compared with patients without a history of Clostridioides difficile infection. MethodsThis was an observational cohort study of patients undergoing elective stoma reversal surgery by colorectal surgeons at a single academic institution during a 10-year period. A prospectively maintained institutional database was queried to identify 454 patients who underwent stoma reversal surgery between January 1, 2007 and December 31, 2017. The primary outcomes were Clostridioides difficile infection after stoma reversal and time to Clostridioides difficile infection after bowel refunctionalization. Secondary outcomes included postoperative complications, length of hospital stay, discharge destination, and 30-day readmission rate. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with Clostridioides difficile infection after stoma reversal. ResultsA total of 445 patients were identified who underwent elective stoma reversal, 42 of whom had a history of Clostridioides difficile infection before the stoma reversal. There were no significant differences in patient age, number of days diverted, or use of perioperative antibiotics between patients with and without a history of Clostridioides difficile infection. The incidence of postreversal Clostridioides difficile infection was 23.4% in patients with a history of Clostridioides difficile infection compared with 9.6% in patients with no Clostridioides difficile infection history (P = .004); however, time to Clostridioides difficile infection after reversal did not differ. History of Clostridioides difficile infection was also associated with greater risk of postoperative complications (26.2% vs 9.4%, P < .01), increased length of stay (3 vs 5 days postoperatively, P < .01), increased likelihood of discharge to a skilled-care facility (11.9% vs 6.2%, P < .01), and readmission (13.7 vs 31.0%, P < .01) within 30 days. In a multivariable logistic regression model, history of Clostridioides difficile infection, increased length of hospital stay, and discharge to a skilled facility were associated with increased risk of Clostridioides difficile infection after reversal, while proton pump inhibitors use was associated with decreased risk of Clostridioides difficile infection. ConclusionPatients with a prior history of Clostridioides difficile infection who underwent stoma reversal exhibited higher rates of postoperative Clostridioides difficile infection and were at greater risk of postoperative complications, discharge to a skilled facility, and 30-day readmission. Furthermore, research into interventions aimed at improving outcomes in this unique, high-risk population is needed.

744 Clinical factors associated with gestational latency in women with twins undergoing physical exam-indicated cerclage

A randomized trial demonstrated that, compared to expectant management, physical exam-indicated cerclage (PEIC) reduced preterm birth in twins with advanced cervical dilation < 24 weeks gestational age (GA). However, data are limited to personalize the expected gestational latency after PEIC placement. Thus, we assessed clinical factors associated with gestational latency among pregnant women with twin gestations undergoing PEIC. This single-site retrospective cohort study included all women with a twin gestation who underwent a PEIC and delivered between 2009 and 2018. PEIC was performed in the setting of painless cervical dilation ≥ 1 cm between 16 0/7 and 23 6/7 weeks GA. The primary outcome was gestational latency ≥ 28 days. Generalized linear models using a Poisson error distribution with robust error variances were created. A priori covariates included a history of preterm birth and use of perioperative antibiotics and indomethacin. Other clinical covariates were included based on statistical significance of p < 0.10 on bivariable analyses. Effect modification between clinical variables associated with gestational latency was evaluated using interaction variables. Subgroup analyses were performed for interaction variables significant on multivariable analysis at p < 0.05. 130 women were included. Women who achieved a gestational latency ≥ 28 days had a lower frequency of prolapsing membranes (36.6% v 64.9%, p = 0.003) and cervical dilation ≥ 2 cm (32.3% v. 62.2%, p = 0.002) when compared to those who did not (Table 1). On multivariable analysis, the interaction between prolapsing membranes and cervical dilation was significant (p=0.004). Women with cervical dilation ≥ 2 cm and prolapsing membranes had a lower risk of achieving a gestational latency ≥ 28 days than women with cervical dilation < 2 cm and no prolapsing membranes (aRR 0.51, 95% CI 0.32-0.80, Table 2). Both cervical dilation and prolapsing membranes are associated with gestational latency after PEIC in twin gestations and can be used to counsel women on anticipated clinical outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

792 Intrauterine transfusion practice patterns among members of the society for Maternal-Fetal medicine

To describe practice pattern among providers of intrauterine transfusion (IUT). In this cross-sectional study, maternal-fetal medicine specialists (MFM) were surveyed regarding their IUT practices. The survey was made available to members of the Society for Maternal-Fetal Medicine (SMFM) via posting on the SMFM website and via distribution through the SMFM Special Delivery email list. IUT survey questions included number performed annually, location of procedure, perioperative medications, maternal analgesia, fetal access site, and postoperative care. Data were reported using descriptive statistics. A total of 51 respondents completed the survey. The majority (75%) reported an institutional rate of fewer than 10 IUT per year. The majority (81%) responded that fewer than 5 MFM perform IUT at their institution. While most IUT occur in the operating room (78% viable and 49% previable), previable cases were more likely to occur elsewhere when compared to viable cases (34% vs 14% in Labor/Delivery room; 17% vs 7% in ultrasound suite). There were a variety of responses regarding perioperative use of tocolytics, antibiotics, paralytics, and steroids (Figure 1). Of the 41 who provided information about immediate postoperative care, most reported a minimal fetal monitoring period of a few hours after the procedure, with only 9 (22%) reporting universal admission for extended overnight monitoring. The most commonly reported fetal access site was the placental cord insertion (PCI), followed by a free loop of cord (Figure 2). There appears to be a wide range of IUT-specific practices among IUT-performing members of SMFM. Consideration should be given to convening an expert panel to review the available evidence and provide a list of best practices for IUT. Additional topics to address include frequency of ultrasound monitoring following first IUT, threshold for repeating IUT, and latest gestational age to perform IUT. Querying blood bank personnel regarding IUT-specific preparation of blood products should be another focus of future research.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1361. Variation in Perioperative Antibiotic Use for Children Undergoing Congenital Heart Disease Surgery in U.S. Academically Affiliated Centers

BackgroundPerioperative antibiotics (PA) are routinely given to children undergoing congenital heart disease (CHD) surgery to prevent surgical site infection. National guidelines recommend narrow-spectrum PA (such as Cefazolin) for most CHD procedures. However, indications for broad-spectrum PA are not well established, and limited literature suggests high exposure to broad-spectrum PA in this population. We performed a contemporary, multicenter description of prevalence and variability of broad-spectrum PA exposure within the pediatric CHD surgical population.MethodsWe identified children 0-17 years admitted to U.S. academically-affiliated centers participating in the Vizient Clinical Database/Resource Manager from 2011-2018. Patients who had ICD-9 and ICD-10 codes indicating a CHD surgical procedure with intravenous antibiotics initiated the day of surgery were eligible for inclusion. Antibiotics broader than first- and second-generation cephalosporins were designated broad-spectrum. We excluded centers with 5 or fewer annual procedures. We excluded patients undergoing heart transplant, concurrent non-cardiac procedures, and those with missing medication data.Results19,152 hospital admissions from 24 centers met inclusion criteria. 55% of patients were male, 18% were under 30 days of age at time of surgery, and 5.1% had diagnosis codes for prematurity. Broad spectrum antibiotics were administered in 21.4% of CHD procedures during the study period. Between the 24 centers, the proportion of surgical cases given broad-spectrum PA ranged from 1.5% to 95%, which was unrelated to center annual surgical volume. Children under 30 days of age and those with prematurity were significantly more likely to receive broad-spectrum agents. Vancomycin was the primary antibiotic contributing to broad-spectrum PA exposure.ConclusionSubstantial variation in broad-spectrum PA use was observed among children undergoing congenital heart disease surgery in academically affiliated United States centers from 2011-2018. Neonates and premature infants have the highest rates of exposure to broad-spectrum antibiotics. Standardization of perioperative antibiotics in CHD surgery is a potential intervention to limit antibiotic exposure in young infants.Disclosures All Authors: No reported disclosures

Oral Flora and Perioperative Antimicrobial Interventions in Cleft Palate Surgery: A Review of the Literature.

The role of perioperative antibiotics in cleft palate remains a topic of debate. Advocates stress their importance in preventing local and systemic infections and decreasing the incidence of oronasal fistula formation. However, few studies to date have directly evaluated the role of antibiotics and other antimicrobial measures in cleft palate surgery. The aim of this review is to evaluate the evidence surrounding the use of perioperative antibiotics and other antimicrobial interventions in cleft palate surgery. Additionally, we review the literature on the oral flora unique to the cleft palate patient population. This was accomplished utilizing PubMed, Medline, and the Cochrane Library with MeSH and generic terms. Articles were selected based on predefined inclusion and exclusion criteria. This review highlights the lack of higher level evidence on perioperative antibiotic use and other antimicrobial interventions in cleft palatoplasty and calls for further research on the matter. The literature appears to support the use of preoperative antibiotics for cleft palatoplasty, but the benefits of prolonged postoperative antibiotic use remain questionable.

Comparative analysis of perioperative prophylactic antibiotics in prevention of surgical site infections in stented, distal hypospadias repair

There is limited evidence that prophylactic antibiotics prevent surgical site infection in stented, distal hypospadias repair. Our hypothesis is that the use of prophylactic antibiotics does not affect the rate of surgical site infection in this setting. We conducted a retrospective study of consecutive patients over a 6-year period with distal penile hypospadias treated with urethral stenting. Variables analyzed include age, type of repair, usage of preoperative and/or postoperative antibiotics, and length of follow-up. Patients with a history of proximal or re-operative hypospadias repair were excluded. Surgical site infection was defined by the presence of postoperative penile erythema and/or purulent drainage treated with therapeutic antibiotics. Secondary outcome analysis included the presence of other hypospadias complications. 441 consecutive subjects met our inclusion criteria with a mean age of 13.3 months. Patients were categorized into groups: Group 1 - Preoperative antibiotics (n=64), Group 2 - Both Preoperative & Postoperative antibiotics (n=159), Group 3 - Postoperative antibiotics (n=122), Group 4 - No Preoperative or Postoperative antibiotics (n=96). Two surgical site infections were reported out of the 441 patients: 1 in Group 3 and 1 in Group 4 (p=0.513). There was no significant difference in the total patients with a hypospadias complication between groups. In the table below, Groups 1-3 were combined (345 patients) for comparison to Group 4 (No antibiotics, 96 patients) for further analysis with no difference in SSIs (p=0.388) or respective hypospadias complications. The use of perioperative prophylactic antibiotics, both before and after surgery for distal, stented hypospadias repair, have not been shown to reduce the rate of surgical site infections nor hypospadias complications. Consequently, the benefit of prophylactic antibiotics in this setting is unclear.

Pediatric research priorities in healthcare-associated infections and antimicrobial stewardship.

To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health. The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification). Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship. The multistep, 7-month process included a literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings. A final list of 12 high-priority research topics were generated in the 2 domains. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level "harm index" for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions. We identified 6 healthcare-associated infection topics and 6 antimicrobial stewardship topics as potentially high-impact targets for pediatric research.

Adjunctive techniques to dacryocystorhinostomy: an evidence-based review with recommendations.

Many adjunctive techniques exist for dacryocystorhinostomy (DCR), with varying levels of supportive evidence. Literature from PubMed, EMBASE, and Cochrane Databases was reviewed between January 1990 and January 2020 to examine evidence regarding the utility of adjunctive techniques to DCR, including mucosal flap preservation, concurrent septoplasty, stenting, topical mitomycin C (MMC), and 5-fluorouracil (5-FU), as well as perioperative antibiotics and steroids. Recommendations were made based on the evidence found. Seven adjunctive techniques used in DCR were examined. The literature supported concurrent septoplasty when septal deviation is present. Silicone stents are recommended for external DCR approaches. MMC use is optional in external DCR and revision cases. The literature does not support the routine use of silicone stents or MMC in primary endoscopic DCR. Mucosal flap preservation is optional, with evidence showing comparable results with or without utilization. The level of evidence is limited for topical 5-FU, as well as perioperative antibiotic and steroid use. Recommendations for adjunctive techniques to external and endoscopic DCR surgeries can be made based on the current literature. Higher-level studies are needed to better optimize perioperative approaches to DCR.

Perioperative antibiotics for preventing post-surgical site infections in solid organ transplant recipients.

Solid organ transplant recipients are at high risk for infections due to the complexity of surgical procedures combined with the impact of immunosuppression. No consensus exists on the role of antibiotics for surgical site infections in solid organ transplant recipients. To assess the benefits and harms of prophylactic antimicrobial agents for preventing surgical site infections in solid organ transplant recipients. The Cochrane Kidney and Transplant Register of Studies was searched up to 21 April 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. All randomised controlled trials (RCTs) and quasi-RCTs in any language assessing prophylactic antibiotics in preventing surgical site infections in solid organ transplant recipients at any time point after transplantation. Two authors independently determined study eligibility, assessed quality, and extracted data. Primary outcomes were surgical site infections and antimicrobial resistance. Other outcomes included urinary tract infections, pneumonias and septicaemia, death (any cause), graft loss, graft rejection, graft function, adverse reactions to antimicrobial agents, and outcomes identified by the Standardised Outcomes of Nephrology Group (SONG), specifically graft health, cardiovascular disease, cancer and life participation. Summary effect estimates were obtained using a random-effects model and results were expressed as risk ratios (RR) and 95% confidence intervals (CI). The quality of the evidence was assessed using the risk of bias and the GRADE approach. We identified eight eligible studies (718 randomised participants). Overall, five studies (248 randomised participants) compared antibiotics versus no antibiotics, and three studies (470 randomised participants) compared extended duration versus short duration antibiotics. Risk of bias was assessed as high for performance bias (eight studies), detection bias (eight studies) and attrition bias (two studies). It is uncertain whether antibiotics reduce the incidence of surgical site infections as the certainty of the evidence has been assessed as very low (RR 0.42, 95% CI 0.21 to 0.85; 5 studies, 226 participants; I2 = 25%). The certainty of the evidence was very low for all other reported outcomes (death, graft loss, and other infections). It is uncertain whether extended duration antibiotics reduces the incidence of surgical site infections in either solid organ transplant recipients (RR 1.19, 95% CI 0.58 to 2.48; 2 studies, 302 participants; I2 = 0%) or kidney-only transplant recipients (RR 0.50, 95% CI 0.05 to 5.48; 1 study, 205 participants) as the certainty of the evidence has been assessed as very low. The certainty of the evidence was very low for all other reported outcomes (death, graft loss, and other infections). None of the eight included studies evaluated antimicrobial agent adverse reactions, graft health, cardiovascular disease, cancer, life participation, biochemical and haematological parameters, intervention cost, hospitalisation length, or overall hospitalisation costs. Due to methodological limitations, risk of bias and significant heterogeneity, the current evidence for the use of prophylactic perioperative antibiotics in transplantation is of very low quality. Further high quality, adequately powered RCTs would help better inform clinical practice.

Is Perioperative Antibiotic Necessary in Straightforward Implant Placement Procedures?

The purpose of this nonrandom retrospective cohort study was to evaluate the impact of perioperative antibiotic on early outcomes, including postoperative pain, swelling, bleeding, and cyanosis, in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 men, 30 women) who had completed dental implant placement were included in the study. Patients who used perioperative antibiotics comprised the experimental group, and those who did not comprised the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 hour before surgery and 1 g amoxicillin + clavulanic acid twice a day for 5 days after surgery. The control group received no perioperative antibiotic therapy. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration, and implant failure were analyzed on postoperative days 2, 7, and 14 and at week 12. No statistically significant difference was detected between the 2 groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 (P > .05), while the severity of pain and swelling were greater on day 2 than on days 7 and 14 and week 12 in both groups (P = .001 and P < .05, respectively). Similarly, no significant difference was found between the 2 groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the 2 groups with regard to the percentage of flap dehiscence assessed at other time points. Within the limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized controlled clinical studies with more patients and implants are needed to substantiate our findings.

Antibiotics and Inflatable Penile Prosthesis Insertion: A Literature Review.

Antibiotic stewardship is now a priority for the urologic community. Perioperative antibiotic use at the time of inflatable penile prosthesis (IPP) insertion has become a topic of interest. To review the literature available to inform the practice of antibiotic administration before, during, and after IPP insertion. We performed a literature review based on a search for the terms "Antibiotics" and "Penile Prosthesis" in the PubMed database. Manuscripts were individually reviewed for relevance to the administration of antibiotics in conjunction with IPP insertion. Best practice statements and guidelines from stakeholder organizations were also reviewed. The benefits of preoperative antibiotic prophylaxis have been well studied in the orthopedic and general surgery literature, but a dearth of studies are available in the specific context of IPP insertion. High-quality retrospective studies have demonstrated reduced infection rates with the use of antibiotic-impregnated or antibiotic-coated IPPs. Limited research on the use of postoperative antibiotics after IPP insertion has actually not demonstrated a benefit from this very common practice. Indeed, the broader surgical literature suggests a net harm from continued postoperative antibiosis. A 2017 guideline recommendation from the Center for Disease Control and Prevention states that additional prophylactic antibiotics should not be administered after procedures deemed clean or clean-contaminated. The benefits of single-dose preoperative antibiotics and the use of antibiotic-impregnated or antibiotic-coated IPPs are well established. Postoperatively, the available IPP and broader surgical literature does not reflect a benefit from the administration of additional antibiotics and demonstrates higher rates of antibiotic-associated adverse events and the emergence of drug resistance. In average-risk patients undergoing IPP insertion, contemporary data suggest that it is safe for postoperative antibiotics to be withheld. Dropkin BM, Kaufman MR. Antibiotics and Inflatable Penile Prosthesis Insertion: A Literature Review. Sex Med 2021;9:174-180.

Optimization of Delivery of Pediatric Otolaryngology Surgical Antibiotic Prophylaxis.

There is limited evidence regarding use of routine perioperative antibiotics for pediatric otolaryngologic procedures. The objectives of this quality improvement study were (1) to characterize the otolaryngology case mix for which antibiotics were delivered and (2) determine the percentage of surgical encounters with appropriate timing of antibiotic administration. Pediatric otolaryngology procedures meeting criteria from 2015 to 2019 were evaluated as a component of an institution-wide pediatric surgical antibiotic prophylaxis study using A3 problem solving to identify and roll out interventions for appropriate antibiotic administration. Descriptive statistical analysis of the interrupted time-series data was used to describe the otolaryngology case mix for which antibiotics were delivered. The primary outcome measure was percentage of surgical encounters with appropriate timing of antibiotic administration in minutes relative to incision. In total, 1520 pediatric otolaryngology procedures with perioperative antibiotic delivery were performed from July 2015 to September 2019. While surgical site infection number (n = 2/year) was stable, administration of timely prophylactic antibiotics significantly improved: 27.5% of cases per month at baseline and 86.9% at the conclusion of the rollout of the sequential interventions (P < .001). Given the exceedingly low infection rate of clean otolaryngology surgery, there is limited evidence in favor of perioperative antibiotics for the majority of procedures. Prophylactic antibiotics were most commonly used in otologic surgery involving cochlear implantation or in the setting of draining ears or cholesteatoma and in clean-contaminated head and neck surgery cases. Iterative continuous performance improvement can optimize evidence-based delivery of preoperative prophylactic antibiotics. Additional interventions to ensure antimicrobial stewardship in pediatric otolaryngology are indicated.

Pattern of Perioperative Antibiotic Use in Otorhinolaryngology-Head and Neck Surgery at Third Referral Hospital In Surabaya

Introduction: Surgical site infection (SSI) often occurs in operation. SSI frequently only affects the superficial tissues, but some more serious infections can affect the deeper tissues or other parts of the body. The majority of SSIs become apparent within 30 days of an operative procedure, when a prosthetic implant is used, SSI may occur several months after the operation. To minimize surgical site infection occurrence, prophylaxis antibiotic is often used. The aim of the study is to evaluate the use of perioperative antibiotics for otorhinolaryngology surgery in third referral hospital in Surabaya.Methods: This study was a retrospective cross-sectional method through the medical record of patients cases from December 2017 to January 2018. All data about sex, age, diagnosis, wound classification, surgical intervention including ICD 9 CM codes, and antibiotics regiments are presented descriptively.Results: Of total 68 patients, 42 (61.8%) were male and 46 (61.8%) were aged 18-65 years old. The most common type of operation was clean surgery 52 (76.5%). The most common prophylactic antibiotic was cefazoline 25 (96.6%). Conclusion: Most of the performed surgery was clean surgery. The use of perioperative antibiotics in most performed operations was in accordance with existing literature. The most widely used prophylactic and therapeutic antibiotic was cefazoline and ceftriaxone, respectively. Further research about risk factor of SSI, the use of prophylaxis antibiotic, and bacterial profile with more samples is needed for more accurate results.

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection. Retrospective, single-institution cohort study. This study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 29, 2019. The main outcomes assessed included postoperative surgical site infections, partial or full flap/graft necrosis, hematoma, and dehiscence. A total of 900 defects in 800 patients (mean age [range] = 65.3 [21-96], 54.60% female) were identified over the 7-year period. Patient-specific variables reviewed included comorbidities, age, and smoking status. Surgery-specific variables analyzed included defect characteristics, time interval between Mohs micrographic surgery and reconstruction, reconstructive modalities, and use of postoperative antibiotics. All patients received peri-incisional antibiotics. On regression analysis, use of cartilage grafts (odds ratio [OR]: 6.53; 95% CI: 2.1-20.6; P = .001), current smoking status (OR: 6.67; 95% CI: 2.09-21.30; P = .001), full-thickness defects (OR: 1.2; 95% CI: 1.0-3.4; P = .045), and interpolated flap reconstruction (OR: 3.4; 95% CI: 1.0-11.5; P = .049) were associated with an increased risk of postoperative infections. Smoking and cartilage grafting remained significant on bivariable regression modeling. Use of perioperative antibiotics was not associated with a decreased risk of infection (OR: 1.82; 95% CI: 0.23-14.21; P = .568). We found no association between postoperative infections after Mohs reconstructive surgery and the use of postoperative antibiotics. These data support a more targeted approach to antibiotic prescribing in Mohs reconstructive surgery. 4 Laryngoscope, 131:E434-E439, 2021.

Contamination of suture material and irrigation fluid over time during athroscopic reconstruction of the anterior cruciate ligament (primary and revision) and meniscus surgery

Aims and Objectives:During arthroscopic surgical procedures, some amount of irrigation fluid leaks from the surgical site and accumulates in the sterile reservoir. Whether these fluid collections show bacterial contamination over time in meniscus surgery and reconstruction of the anterior cruciate ligament (ACL) remains unclear.Materials and Methods:In this study, we include 200 patients. 100 patients undergoing ACL reconstruction and 100 patients undergoing meniscus surgery. We collected the samples of irrigation fluid before skin incision and every 15 minutes after the start of surgery. In addition, we evaluated the different types of suture material (Fast Fix and Outside-Inside threads in meniscus surgery and ACL reconstruction threads) for bacterial contamination.Results:At this point we evaluated samples of 152 patients (irrigation fluid of 152 patients, suture material of 100 patients). While no fluid sample showed contamination after 15 minutes, we overall detected bacterial contamination in 18,4%. Suture material was contaminated with bacteria in 28% of cases.Conclusion:At this point, fluid surgical drape reservoirs were abacterial during the first 15 minutes but showed marked bacterial contamination over time. During surgery, irrigation fluid reservoirs should not be withdrawn by suction after skin incision. The tendency of bacterial contamination of the suture material and irrigation fluid reservoir over time has to be further explored. The continues flush and perioperative use of antibiotics might take an important impact on the low number of joint infection compared to the contamination ratio of the suture material. In addition, the effect of saturating suture material with antibiotics needs to be explored.