Use Of Postoperative Antibiotics Research Articles

Surgical Management of Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease of the skin, characterized by recurrent draining sinuses and abscesses, predominantly in skin folds carrying terminal hairs and apocrine glands. Treatment for this debilitating disease has been medical management with antibiotics and immune modulators. With the advent of better reconstructive surgical techniques, the role of surgery in the treatment of HS has expanded, from being a last resort to a modality that is deployed earlier. Larger defects can be more easily reconstructed, allowing for a more radical excision of diseased areas. Locoregional flaps, perforator flaps, and propeller flaps that use the fasciocutaneous tissue allow reconstruction of defects with similar tissue, and provide better cosmetic and functional outcomes. They are easy to execute and can be performed even in resource-poor settings with concurrent use of immune modulators and postoperative antibiotics. Hidradenitis can be successfully treated with surgery in early stages as well as severe disease, due to the advances in understanding disease behavior, multidisciplinary care, and advanced reconstructive techniques. Coupled with a multidisciplinary care team, surgery offers a durable, lasting cure for HS, significantly reducing disease morbidity.

An eosinophil peroxidase activity assay predicts acute exacerbations in post-operative chronic rhinosinusitis.

EPX activity has been correlated with eCRS diagnosis and baseline disease severity. Herein, EPX activity is shown to correlate with post-operative antibiotic and steroid use in CRS. EPX activity has potential to act as a prognostic biomarker of CRS disease severity and control.

Post-operative antibiotic prophylaxis in spine surgery patients with thoracolumbar drains: A meta analysis

Closed-suction drains are commonly placed after thoracolumbar surgery to reduce the risk of post-operative hematoma and neurologic deterioration, and may stay in place for a longer period of time if output remains high. Prolonged maintenance of surgical site drains, however, is associated with an increased risk of surgical site infection (SSI). The present study aims to examine the literature regarding extended duration (≥24h) prophylactic antibiotic use in patients undergoing posterior thoracolumbar surgery with closed-suction drainage. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Relevant studies reporting the use of 24-h post-operative antibiotics compared with extended duration post-operative antibiotics in patients undergoing posterior thoracolumbar surgery with closed-suction drainage were identified from a PubMed database query. Six studies were included for statistical analysis, encompassing 1003 patients that received 24h of post-operative antibiotics and 984 patients that received ≥24h of post-operative antibiotics. The SSI rate was 5.16% for the shorter duration group (24h) and 4.44% (p=0.7865) for the longer duration group (≥24h). There is no significant difference in rates of SSI in patients receiving 24h of post-operative antibiotics compared with patients receiving ≥24h of post-operative antibiotics. Shorter durations of post-operative antibiotics in patients with thoracolumbar drains have similar outcomes compared to patients receiving longer courses of antibiotics. Shorter durations of antibiotics could potentially help lead to lower overall cost and length of stay for these patients.

Critically Evaluating the Role for Postoperative Antibiotics in Patients Undergoing Urethroplasty With Buccal Mucosa Graft: A Claims Database Analysis

ObjectivesTo compare outcomes among patients undergoing first-time urethroplasty with buccal mucosa graft (BMG) who receive post-operative antibiotics versus those who do not. MethodsA retrospective cohort study was conducted using the TriNetX claims database between 2008-2022. Using CPT, ICD10, and LOINC codes, patients >18 years old undergoing primary urethroplasty with BMG who received an outpatient prescription for antibiotics between post-operative day 0-30 or did not were queried. Patients with positive pre-operative urine culture or urinary tract infection (UTI) within 30 days pre-operatively were excluded. Surgical outcomes included 5-year revision rates and revision-free survival. Safety outcomes included new UTI within 30 days, surgical site infection (SSI) within 90 days, or Clostridium difficile infection within 30 days of urethroplasty. ResultsWe identified 884 patients (81% antibiotic cohort, 19% non-antibiotic cohort) that met inclusion criteria. Age at time of urethroplasty, suprapubic tube presence, and pre-existing medical comorbidities were comparable between cohorts (Table 1A). There was no difference in 5-year rates and revision-free survival for endoscopic revision (11.5% vs. 9.5%, RR 1.2, 95% CI [0.7, 2.0], RFS log-rank p=0.6), re-do urethroplasty (12.9% vs. 13.7%, RR 0.9, 95% CI [0.6, 1.5], RFS log-rank p=0.7), or all-cause revision (19.8% vs. 17.7%, RR 1.1, 95% CI [0.8, 1.6], p=0.5) between groups. Post-operative rates of UTI, SSI, and Clostridium difficile infection were similar between groups. ConclusionsIn this large retrospective cohort study of patients undergoing urethroplasty with BMG, we observed no significant benefit from use of post-operative antibiotics on long-term revision rates or perioperative infectious complications.

Reconstruction of Orbital Wall Fractures with a Combination of Resorbable Plates and Antibiotic-Impregnated Collagen Sheets.

(1) Background: Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. (2) Methods: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. (3) Results: significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02). (4) Conclusions: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

An Overview of Pre-Operative and Post-Operative Antibiotic Use in Inpatients in Orthopedic Surgery at Dr. H. Moch. Ansari Saleh Banjarmasin

Preoperative and postoperative antibiotics are included in prophylactic antibiotics, which aim to reduce the risk of surgical wound infection. Surgical Site Infection (SSI) is one of the problems of healthcare-associated infections (HAIs). Dr. Hospital H. Moch. Ansari Saleh Banjarmasin is a government hospital that provides many orthopedic surgical procedures and has data related to antibiotic use. This study aims to determine the description of the use of antibiotics as preoperative and postoperative prophylaxis. The research method included a descriptive observational study with a cross-sectional design on medical record data of surgical patients at Dr. RSUD. H. Moch. Ansari Saleh Banjarmasin in August–December 2023, which was taken using a purposive sampling technique with a retrospective approach. Results: 133 samples met the inclusion criteria. The majority of patients were aged 17–25 years (25.6%), the gender was predominantly male (62%), the length of stay was at most 2 days (40.6%), the type of surgery was clean (82%), and they did not have comorbidities (83%). Research shows that cefazolin is most widely used as preoperative prophylaxis by 123 people (92%) and postoperatively by 79 people (59.4%). The study concluded that the most widely used antibiotic for patients undergoing orthopedic surgery at RSUD, Dr. H. Moch. Ansari Saleh Banjarmasin, is cefazolin.

Optimal antibiotics duration following surgical management of septic olecranon bursitis: a 12-year retrospective analysis.

Introduction: The absence of a standardized postoperative antibiotic treatment approach for patients with surgically treated septic bursitis results in disparate practices. Methods: We retrospectively reviewed charts of adult patients with surgically treated septic olecranon bursitis at Mayo Clinic sites between 1January2000 and 20August2022, focusing on their clinical presentation, diagnostics, management, postoperative antibiotic use, and outcomes. Results: A total of 91 surgically treated patients were identified during the study period. Staphylococcus aureus was the most common pathogen (64 %). Following surgery, 92 % (84 of 91 patients) received systemic antibiotics. Excluding initial presentations of bacteremia or osteomyelitis (), the median duration of postoperative antibiotics was 21 d (interquartile range, IQR: 14-29). Postoperative complications were observed in 23 % (21 of 91) of patients, while cure was achieved in 87 % (79 of 91). Active smokers had 4.53 times greater odds of clinical failure compared with nonsmokers (95 % confidence interval, 95 % CI: 1.04-20.50; ). The highest odds of clinical failure were noted in cases without postoperative antibiotic administration (odds ratio, OR: 7.4). Conversely, each additional day of antibiotic treatment, up to 21 d, was associated with a progressive decrease in the odds of clinical failure (OR: 1 at 21 d). Conclusion: The optimal duration of antibiotics postoperatively in this study was 21 d, which was associated with a 7.4-fold reduction in the odds clinical failure compared with cases without postoperative antibiotics. Further validation through a randomized controlled trial is needed.

Postoperative Antibiotics, Outcomes, and Resource Use in Children With Gangrenous Appendicitis

Gangrenous, suppurative, and exudative (GSE) findings have been associated with increased surgical site infection (SSI) risk and resource use in children with nonperforated appendicitis. Establishing the role for postoperative antibiotics may have important implications for infection prevention and antimicrobial stewardship. To compare SSI rates in children with nonperforated appendicitis with GSE findings who did and did not receive postoperative antibiotics. This was a retrospective cohort study using American College of Surgeons' National Surgical Quality Improvement Program (NSQIP)-Pediatric Appendectomy Targeted data from 16 hospitals participating in a regional research consortium. NSQIP data were augmented with operative report and antibiotic use data obtained through supplemental medical record review. Children with nonperforated appendicitis with GSE findings who underwent appendectomy between July 1, 2015, and June 30, 2020, were identified using previously validated intraoperative criteria. Data were analyzed from October 2022 to July 2023. Continuation of antibiotics after appendectomy. Rate of 30-day postoperative SSI including both incisional and organ space infections. Complementary hospital and patient-level analyses were conducted to explore the association between postoperative antibiotic use and severity-adjusted outcomes. The hospital-level analysis explored the correlation between postoperative antibiotic use and observed to expected (O/E) SSI rate ratios after adjusting for differences in disease severity (presence of gangrene and postoperative length of stay) among hospital populations. In the patient-level analysis, propensity score matching was used to balance groups on disease severity, and outcomes were compared using mixed-effects logistic regression to adjust for hospital-level clustering. A total of 958 children (mean [SD] age, 10.7 [3.7] years; 567 male [59.2%]) were included in the hospital-level analysis, of which 573 (59.8%) received postoperative antibiotics. No correlation was found between hospital-level SSI O/E ratios and postoperative antibiotic use when analyzed by either overall rate of use (hospital median, 53.6%; range, 31.6%-100%; Spearman ρ = -0.10; P = .71) or by postoperative antibiotic duration (hospital median, 1 day; range, 0-7 days; Spearman ρ = -0.07; P = .79). In the propensity-matched patient-level analysis including 404 patients, children who received postoperative antibiotics had similar rates of SSI compared with children who did not receive postoperative antibiotics (3 of 202 [1.5%] vs 4 of 202 [2.0%]; odds ratio, 0.75; 95% CI, 0.16-3.39; P = .70). Use of postoperative antibiotics did not improve outcomes in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings.

(144) Contemporary Trends in Testicular Prosthesis Placement: An Analysis Of U.S. Claims Data

Abstract Introduction Testicular prosthesis placement (TPP) is a procedure associated with high patient satisfaction that improves body image and quality of life following orchiectomy. However little information exists regarding contemporary TPP as placement for metastatic prostate cancer has fallen out of favor and gender affirming surgery is on the rise. Objective This study sought to describe current trends in TPP in the United States. Methods Using the IBM® MarketScan® Research Databases (DOI 10.57761/ray7-1g16) we performed a retrospective analysis from 2007 to 2021 and identified 1,059 adult men who had undergone placement of a testicular prosthesis based on ICD-9 codes. Results The median age of TPP was 34 (IQR 23-44; range 18-80). At least 433 (35.5%) men were married. A total of 536 (43.8%) men had orchiectomy concurrently at the time of TPP. Just under half of the cases prescribed antibiotics postoperatively (44.9%). The five most common indications at the time of TPP were malignancy (54.7%), gender dysphoria (10.4%), cryptorchidism (9.6%), atrophy/hypofunction (6.6%), and testicular torsion (3.9%). A total of 46 (3.8%) of men underwent subsequent removal of their prosthesis. A diagnosis of gender dysphoria was associated with prosthesis removal (odds ratio (OR) 4.51, 95% CI 2.10-9.86). No significant associations were seen for other indications, Charlson Comorbidity Index scores, post-operative antibiotic use, tobacco use, psychiatric diagnoses, or prior pain diagnoses. Rates of testicular prosthesis placement for a diagnosis of gender dysphoria are rapidly increasing while placement for prostate cancer is increasingly rare. Conclusions Among the studied population the primary indication for testicular prosthesis placement is for testicular cancer, contradicting the findings of earlier series. We also show that TPP for gender dysphoria is increasingly common. Additionally, we report rates of explanation and complications related to prosthesis that are higher than what is described in the literature. Disclosure No.

Frailty is an independent predictor of postoperative rescue medication use after endoscopic sinus surgery.

The modified five-item frailty index (mFI-5) is a validated risk stratification tool with the ability to predict adverse outcomes following surgery. In this study, we sought to use mFI-5 to assess the potential relationship between unhealthy aging and postoperative endoscopic sinus surgery (ESS) outcomes. Patients who underwent sinus surgery at Vanderbilt between 2014 and 2018 were identified and assessed using the mFI-5, which iscalculated based on the presence of five comorbidities: diabetes mellitus, hypertension requiring medication, chronic obstructive pulmonary disease, congestive heart failure, and non-independent functional status. Multivariate regression analyses were performed to quantify the association of mFI-5 score on need for rescue oral antibiotics, oral steroids,and antibiotic irrigations within 1 year following ESS, adjusting for relevant potential confounders. Four hundred and three patients met inclusion criteria. Within 6 months of surgery, 312 (77%) required rescue antibiotics, 243 (60%) required oral corticosteroids (OCS), and 31 (8%) initiated antibioticirrigations. Increasing mFI-5 scores were significantly associated with higher postoperative use of rescue antibiotics (p<0.0001), OCS(p=0.032), and antibiotic irrigation (p<0.0001). Frailty scores remained as an independent predictor of these outcomes after adjustment for age, polyp status, preoperative sinonasal outcomes test (SNOT-22) score, and revision surgery status. Modified frailty scores may be a useful clinical tool to predict the need for postoperative rescue medication use after ESS.

Use of liposomal bupivacaine in dogs and cats undergoing gastrointestinal surgery is not associated with a higher rate of surgical site infections or multidrug-resistant infections.

To report the rate of surgical site infections (SSIs) after clean-contaminated and dirty gastrointestinal surgery in dogs and cats that did and did not receive incisional infiltration of Nocita and report the bacteria isolated. Client-owned dogs (n = 211) and cats (78). Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and the University of Florida Small Animal Hospital between July 1, 2020, and April 1, 2023, were reviewed for surgical procedures, presence of preoperative septic peritonitis, use of Nocita, perioperative antibiotics administered, postoperative antibiotic use, SSI development postoperatively, and aerobic bacteria isolated. 7 of 124 (5.6%) dogs that received Nocita and 9 of 87 (10.2%) that did not receive Nocita developed an SSI. No dogs presenting with septic peritonitis and given Nocita (n = 5) developed an SSI. Two of 55 (3.6%) cats that received Nocita and 1 of 23 (4%) that did not receive Nocita developed an SSI. Multidrug-resistant (MDR) Escherichia coli was the most common aerobic bacteria isolated from SSIs (n = 3), and MDR bacteria were isolated commonly from both groups (4). Use of Nocita for gastrointestinal surgery in dogs and cats is not associated with higher rates of SSI than published rates of SSI after gastrointestinal surgery. Use of Nocita in dogs with preoperative septic peritonitis is not associated with the development of SSI. MDR bacteria are commonly isolated via culture from both dogs that received Nocita and those that did not.

Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty

Despite the frequency of total knee arthroplasty (TKA) and clinical implications of prosthetic joint infections (PJIs), knowledge gaps remain concerning the incidence, microbiological study results, and factors associated with these infections. To identify the incidence rates, organisms isolated from microbiological studies, and patient and surgical factors of PJI occurring early, delayed, and late after primary TKA. This cohort study obtained data from the US Department of Veterans Affairs (VA) Corporate Data Warehouse on patients who underwent elective primary TKA in the VA system between October 1, 1999, and September 30, 2019, and had at least 1 year of care in the VA prior to TKA. Patients who met these criteria were included in the overall cohort, and patients with linked Veterans Affairs Surgical Quality Improvement Program (VASQIP) data composed the VASQIP cohort. Data were analyzed between December 9, 2021, and September 18, 2023. Primary TKA as well as demographic, clinical, and perioperative factors. Incident hospitalization with early, delayed, or late PJI. Incidence rate (events per 10 000 person-months) was measured in 3 postoperative periods: early (≤3 months), delayed (between >3 and ≤12 months), and late (>12 months). Unadjusted Poisson regression was used to estimate incidence rate ratios (IRRs) with 95% CIs of early and delayed PJI compared with late PJI. The frequency of organisms isolated from synovial or operative tissue culture results of PJIs during each postoperative period was identified. A piecewise exponential parametric survival model was used to estimate IRRs with 95% CIs associated with demographic and clinical factors in each postoperative period. The 79 367 patients (median (IQR) age of 65 (60-71) years) in the overall cohort who underwent primary TKA included 75 274 males (94.8%). A total of 1599 PJIs (2.0%) were identified. The incidence rate of PJI was higher in the early (26.8 [95% CI, 24.8-29.0] events per 10 000 person-months; IRR, 20.7 [95% CI, 18.5-23.1]) and delayed periods (5.4 [95% CI, 4.9-6.0] events per 10 000 person-months; IRR, 4.2 [95% CI, 3.7-4.8]) vs the late postoperative period (1.3 events per 10 000 person-months). Staphylococcus aureus was the most common organism isolated overall (489 [33.2%]); however, gram-negative infections were isolated in 15.4% (86) of early PJIs. In multivariable analyses, hepatitis C virus infection, peripheral artery disease, and autoimmune inflammatory arthritis were associated with PJI across all postoperative periods. Diabetes, chronic kidney disease, and obesity (body mass index of ≥30) were not associated factors. Other period-specific factors were identified. This cohort study found that incidence rates of PJIs were higher in the early and delayed vs late post-TKA period; there were differences in microbiological cultures and factors associated with each postoperative period. These findings have implications for postoperative antibiotic use, stratification of PJI risk according to postoperative time, and PJI risk factor modification.

Development and Validation of a Nomogram Prediction Model for Multidrug-Resistant Organisms Infection in a Neurosurgical Intensive Care Unit.

To develop a predictive model for assessing the risk of multidrug-resistant organisms (MDROs) infection and validate its effectiveness. Logistic regression analysis revealed that sex, hospitalization time, febrile time, invasive operations, postoperative prophylactic use of antibiotics, mechanical ventilator time, central venous catheter indwelling time, urethral catheter indwelling time, ALB, PLT, WBC, and L% were independent predictors of MDROs infection in the NICU. The area under the ROC curve for the training set and validation set were 0.880 (95% CI: 0.857-0.904) and 0.831 (95% CI: 0.786-0.876), respectively. The model's prediction curve closely matched the ideal curve, indicating excellent predictive performance. The prediction model developed in this study demonstrates good accuracy in assessing the risk of MDROs infection. It serves as a valuable tool for neurosurgical intensive care practitioners, providing an objective means to effectively evaluate and target the risk of MDROs infection.

Effect of a New Antibiotic Protocol Adopted by ASU Hospitals on Patients with Intra-Medullary Nailing of Femoral and Tibial Diaphyseal Fractures as Regard Post-Operative Infection

Background This study postulated that systemic antibiotic prophylaxis delivered preoperatively in intramedullary nailing of femur and tibia procedures significantly reduces the incidence of infection. Prophylactic antibiotics should be taken IV before skin incision by 30-60 minutes and no need for antibiotics more than 24 hours after operation. This protocol of antibiotics has multiple benefits such as saving a lot of money, decrease the risk of surgical site infection and decrease antibiotic resistance. Aim of the Work To assess the effect of antibiotic choice, duration on prevalence of surgical site infection among patients with intramedullary nailing of femoral and tibial fractures, and identify risk factors. Patients and Methods This study conducted on 50 cases of femoral and tibial fractures admitted from Al-Demerdash University Hospital in the period from June 2019 to December 2020 with age ranged from 18 to 56 years and with mean ± SD of 28.14 ± 10.14. This study was based on the antibiotic protocol adopted by Ain Shams University Hospitals that we give first generation cephalosporin (zinol) for all patient undergoing intramedullary nailing of femur and tibia, 30 – 60 minutes before skin incision and for 24 hours post-operative. Results The results of this study showed 1 case infected postoperative from 50 cases with a percentage of 2%, by this result we found that by studying the risk factors for infection there was no specific risk factor for infection except for obesity and diabetes. By studying of the results of application of our new antibiotic prophylaxis protocol in our hospital (Ain Shams University Hospitals) from the period from 6-2019 to 12-2020 the new protocol have the benefits of the following: Decrease of the total percentage of infection in all orthopedic surgeries in our department to less than 2%, Presence of fixed, known and effective prophylactic antibiotic protocol in our hospital unlike before every surgeon has his opinion about type and dose of antibiotics causing less controversy and confusion among surgeons in the practice of postoperative antibiotic use. Conclusion This study postulated that systemic antibiotic prophylaxis delivered preoperatively in intramedullary nailing of femur and tibia procedures significantly reduces the incidence of infection.

FTP7.14 A systematic review and meta-analysis evaluating the role of single-dose preoperative versus extended use of antibiotics therapy following acute cholecystectomy

Abstract Laparoscopic cholecystectomy (LC) during index admission for acute cholecystitis is considered a preferred mode of treating gallstone disease. The objective of this study is to evaluate the role of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days in these patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis. Materials and methods RCTs reporting the use of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days following acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results The search of medical databases yielded 4 RCTs on 949 patients undergoing acute cholecystectomy. There were 481 patients in in single dose pre-operative antibiotics group whereas 468 patients received extended doses antibiotics therapy. In the random effects model analysis, the extended use of post-operative antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not confer any extra benefit [risk ratio 1.05, 95%, CI (0.73, 1.51), Z = 0.25, P=0.80] in terms of reducing the infective complications. There was no heterogeneity (Tau2 = 0; Chi2 = 0.40, df = 3; (P = 0.94; I2 = 0 %) among included studies. Conclusion Post-operative extended use of antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not demonstrate extra benefit to reduce infective complications.

WTP7.12 Investigating the duration of empirical antibiotic treatment and subsequent reduction in hospital readmission rates for perforated appendicitis in the paediatric patient population

Abstract Background and Aim Acute appendicitis is the most common surgical emergency in the paediatrics. Complicated appendicitis often involves perforation, requiring a longer course of antibiotics post-appendicectomy [1]. There is considerable variability on post-operative antibiotic regimes and duration within hospital trusts with no national guidelines. Local Trust-based consensus [2] recommends a 5-day course IV co-amoxiclav with American Paediatric Surgical Association guidelines suggesting oral conversion if IV antibiotic duration is less than 5 days [3, 4]. Therefore, we measured compliance with local and international guidelines. Methods Paediatric patients aged 5-17 years were selected for the study using ICD-10 codes for ‘Perforated Appendicitis’ (K35.2 and K35.3). Patients were included if they had operative management for perforated appendicitis between 1 April 2021 and 31 March 2022. Key parameters collated included; re-admission, duration of re-admission, complication, post-operative antibiotic use (selection, intravenous/oral dose and duration of use). Results Twenty-six paediatric appendicectomies for perforated appendicitis occurred within the time frame. Nine had IV antibiotics for &amp;gt;5 days, of this cohort, 7 had oral conversion and completed 2-5 days of oral antibiotics with re-admission rate 33%. Eleven had IV antibiotics for &amp;lt; 5 days with oral conversion for 4-7 days, readmission rate was 18.2% on days 4 &amp; 5 respectively. Six had IV antibiotics for &amp;lt;5 days with no oral conversion and no patients were re-admitted. Conclusions A longer duration of antibiotics with an earlier conversion from IV to oral, reduced readmission rates. However, greater research with more participants and standardised antibiotics can explore other influencing factors.

Single institution retrospective study evaluating the frequency of implant removal and associated risk factors following open fracture fixation in 80 cases (2010–2020)

BackgroundOpen fractures occur commonly in small animals and are characterised by contamination of the fracture site. While never quantified, it is believed that open fractures stabilised with internal implants are at a higher risk for requiring explantation. This retrospective study determines the frequency and risk factors for explantation following use of internal fixation. Medical records of client-owned dogs and cats with an open fracture, between 2010 and 2020 stabilised using internal implants, were included. Data retrieved included signalment, cause and characterisation of the fracture, comorbidities, preexisting infections, and all details related to anesthesia and surgery. Pre-, Peri- and post-operative antibiotic use were detailed. All cases were followed to clinical union. Postoperative complications, including requirement for implant removal were recorded and classified as major or minor. Associations between potential risk factors and need for explantation were assessed.ResultsOf 80 cases, 72 (90%) were dogs and eight (10%) cats. Major complications were encountered in 23 (28.75%) cases and minor complications in 16 (20%) cases. Explantation was performed in 17 cases (21.25%). Out of 72 dogs, 13 required explantation (18%) whereas four of the eight cats needed implants removed (50%). Only diagnosis of postoperative infection was associated with an increased risk of explantation (RR 2.77; 95% CI 1.25; 6.15; p = 0.045).ConclusionApproximately 1 in 5 open fractures stabilised using internal fixation can be anticipated to require explantation, with cats potentially being at a higher risk than dogs. Cases diagnosed with postoperative infection are at a higher risk for requiring implant removal.

Does prophylactic antibiotics post pediatric pyeloplasty reduce the incidence of febrile UTIs?

PurposeThe use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we examined whether low dose antibiotics administered following pediatric pyeloplasty reduce the incidence of febrile urinary tract infections at our institution. As a secondary outcome, in those patients with infection, additional analysis was performed to better quantify which patient population benefits the most from low dose prophylactic antibiotics.MethodsInstitutional review board approval (IRB) was obtained. All methods were carried out in accordance with relevant guidelines and regulations. A retrospective study was performed in patients who underwent pyeloplasty (2011–2017) at our institution. Surgical approach (laparoscopic versus robotic assisted versus open, with or without internal JJ ureteral stent) were based on surgeon preference. Patients of 8 fellowship trained pediatric urologists were included in the study period. Patients with prior history of urologic interventions or other congenital genitourinary tract abnormalities were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven urinary tract infection, surgical details (administration of perioperative antibiotics), and postoperative outcomes including; 1) re-admission 30 days post-surgery, 2) any urine cultures collected due to suspected urinary tract infection.ResultsA total of 209 patients (149 boys, 60 girls) met our inclusion criteria with 55/209 (26%) receiving postoperative prophylactic antibiotics. The average age was 6 years (range: 2 months-18 years). Indwelling ureteral stent was used in 176 (84%) patients. Eleven patients (5%) had a culture-proven urinary tract infection within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of urinary tract infection when comparing surgical approaches, +/- ureteral stent, or the use of antibiotics. Secondary analysis noted statistically significant increase in post-operative urinary tract infection in younger children (2.8 v. 6.2 years, p = 0.02), those patients who had a positive preoperative urine culture (8/11, p = 0.01) and those with public health insurance (p = 0.038).ConclusionThe incidence of postoperative urinary tract infection following pyeloplasty in our cohort was relatively low. There was a higher incidence of urinary tract infection in patients less than 3 years old. The use of antibiotics in patients post pyeloplasty did not appear to affect the incidence of post-operative urinary tract infection, however, they may have a role in children who have not yet potty trained and in patients with positive preoperative urine culture.

A survey of Asian Eye Institutions on perioperative antibiotic prophylaxis in cataract surgery

PurposeTo determine current institutional practice patterns for the use of perioperative antibiotics and other measures to prevent infection after cataract surgery in Asia.MethodsAn online survey-based study of leading eye institutions in China, Hong Kong, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam was conducted. The survey was administered to 26 representative key opinion leaders from prominent tertiary eye institutions that are also national academic teaching institutions in Asia. Survey responses were collated and anonymized during analysis.ResultsAll surveyed institutions used povidone iodine for the preoperative antiseptic preparation of the eye, with notable variations in the concentration of povidone iodine used for conjunctival sac instillation. Preoperative topical antibiotics were prescribed by 61.5% and 69.2% of institutions in low-risk and high-risk cases, respectively. Regarding the use of intra-operative antibiotics, 60.0% and 66.7% of institutions administered intracameral antibiotics in low-risk and high-risk patients, respectively. Postoperative topical antibiotics use patterns were generally very similar in low-risk and high-risk patients. Over half of the institutions (52.2% and 68.0% in low-risk and high-risk patients, respectively) also indicated prolonged postoperative use of topical antibiotics (> 2 weeks). Not all surveyed institutions had established policies/protocols for perioperative antibiotic use in cataract surgery, endophthalmitis surveillance, and/or a monitoring program for emerging antimicrobial resistance.ConclusionThere are variations in antimicrobial prophylaxis approaches to preoperative, intra-operative and postoperative regimens in cataract surgery in Asia. More evidence-based research is needed to support the development of detailed guidelines for perioperative antibiotic prophylaxis to reduce postoperative infections.

Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021.

Surgical site infections (SSIs) are a major public health threat to the success of surgery. This study assessed changes in SSIs and use of antibiotics among caesarean section (CS) and herniorrhaphy patients at a regional hospital in Sierra Leone following operational research. This was a comparative before and after study using routine hospital data. The study included all the CS and herniorrhaphy patients who underwent surgery between two time periods. Of the seven recommendations made in the first study, only one concerning improving the hospital's records and information system was fully implemented. Three were partially implemented and three were not implemented. The study population in both studies showed similar socio-demographic characteristics. The use of postoperative antibiotics for herniorrhaphy in both studies remained the same, although a significant increase was found for both pre- and postoperative antibiotic use in the CS patients, 589/596 (98.8%) in 2023 and 417/599 (69.6%) in 2021 (p < 0.001). However, a significant decrease was observed in the overall incidence of SSIs, 22/777 (2.8%) in 2023 and 46/681 (6.7%) in 2021 (p < 0.001), and the incidence of SSIs among the CS patients, 15/596 (2.5%) in 2023 and 45/599 (7.5%) in 2021 (p < 0.001). The second study highlights the potential value of timely assessment of the implementation of recommendations following operational research.