Use Of Preoperative Antibiotic Prophylaxis Research Articles

Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery.

The average American today undergoes three inpatient and two outpatient surgical procedures during one's life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient's risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory "pathobiome" following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient's prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis.

Comparing Rates of Postoperative Meningitis After Endoscopic Endonasal Procedures Based on Methicillin-Resistant Staphylococcus aureus/Methicillin-Sensitive Staphylococcus aureus Colonization and Antibiotic Prophylaxis

Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is 0.7%-3%. A variety of methods exist to minimize the risk of meningitis with antibiotic prophylaxis, although their value is not completely understood. This study investigated whether there is a difference in rates of postoperative meningitis based on Staphylococcus aureus colonization and use of preoperative antibiotic prophylaxis. All adult patients who underwent EEA resection at our institution from 2013 to 2021 were retrospectively reviewed. Patients with preoperative cerebrospinal fluid infections were excluded. Data including recent preoperative infections, preoperative colonization status, antibiotic administration, and postoperative outcomes were recorded for each patient. Of 483 patients identified (mean age, 51 years; range, 18-90 years; 274 [56.7%] female), 80 (16.6%) had a positive preoperative methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive Staphylococcus aureus (MSSA) screening swab. Twenty-one (26.3%) colonized patients were treated with preoperative decolonizing antibiotics. Within 30 days of surgery, 13 (2.7%) patients developed culture-positive meningitis. There was no significant difference in meningitis rates based on MRSA/MSSA colonization status. Among colonized patients, there was no significant difference in rates of MRSA/MSSA meningitis based on preoperative antibiotic decolonization. Postoperative rates of meningitis after EEA surgery were not significantly changed based on MRSA/MSSA colonization status of the patient or preoperative decolonization. The utility of preoperative testing of MRSA/MSSA status and antibiotics for decolonization to prevent postoperative meningitis should be further investigated.

A nationwide prospective multicenter study of external ventricular drainage: accuracy, safety, and related complications.

External ventricular drainage (EVD) catheters are associated with complications such as EVD catheter infection (ECI), intracranial hemorrhage (ICH), and suboptimal placement. The aim of this study was to investigate the rates of EVD catheter complications and their associated risk factor profiles in order to optimize the safety and accuracy of catheter insertion. A total of 348 patients with urgently placed EVD catheters were included as a part of a prospective multicenter observational cohort. Strict definitions were applied for each complication category. The rates of misplacement, ECI/ventriculitis, and ICH were 38.6%, 12.2%, and 9.2%, respectively. Catheter misplacement was associated with midline shift (p = 0.002), operator experience (p = 0.031), and intracranial length (p < 0.001). Although mostly asymptomatic, ICH occurred more often in patients receiving prophylactic low-molecular-weight heparin (LMWH) (p = 0.002) and those who required catheter replacement (p = 0.026). Infectious complications (ECI/ventriculitis and suspected ECI) occurred more commonly in patients whose catheters were inserted at the bedside (p = 0.004) and those with smaller incisions (≤ 1 cm) (p < 0.001). ECI/ventriculitis was not associated with preinsertion antibiotic prophylaxis (p = 0.421), catheter replacement (p = 0.118), and catheter tunneling length (p = 0.782). EVD-associated complications are common. These results suggest that the operating room setting can help reduce the risk of infection, but not the use of preoperative antibiotic prophylaxis. Although EVD-related ICH was associated with LMWH prophylaxis for deep vein thrombosis, there were no significant clinical manifestations in the majority of patients. Catheter misplacement was associated with operator level of training and midline shift. Information from this multicenter prospective cohort can be utilized to increase the safety profile of this common neurosurgical procedure.

Practice of antibiotic prophylaxis in patients undergoing mastectomy without immediate reconstruction: A survey of breast surgeons in Pakistan.

e13519 Background: Incidence of surgical site infections after breast surgery range from 0.8-26%. Though preoperative antibiotic prophylaxis (AP) is widely used, international and national guidelines lack focus on post-operative antibiotic prophylaxis (PAP). This survey of surgeons in Pakistan reports surgeon preference for AP in cases of mastectomy without immediate reconstruction but with indwelling drains. Methods: An anonymous, online, validated 16-item survey, exploring peri-operative antibiotic choices and prescribing practices was disseminated to a working-group of 30 leading breast surgeons in Pakistan. Descriptive statistics were performed using Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 25 (response rate: 83.3%) members responded, with the majority being fellowship-trained breast surgeons/surgical oncologists (68%) and having &gt; 10 years’ experience (60%). For mastectomy without reconstruction, though most (76%) reported routine use of pre-operative AP, there was considerable variation in post-operative AP. 36% reported no further AP after a single dose of pre-operative AP, 24% continued AP for 24 hours in high-risk patients only, while 24% continued AP for 24 hours in all patients. 12% continued post-operative AP in all patients for 7 days, while 4% reported continuing post-operative AP for the duration of indwelling drains. Antibiotic choice for peri-operative AP also varied. 56% used cephalosporins, 24% used penicillin, and the remaining 20% reported that their choice varied across patients. Conclusions: There is widespread variation in surgeon comfort with discontinuation of AP after the first pre-operative dose in patients undergoing mastectomy without immediate reconstruction but with indwelling drains. Large randomized controlled trials are necessary to develop guidelines to ensure uniformity and evidence-based post-operative AP.

Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study.

Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations.

The Impact of Clinical Practice Guidelines on Preoperative Antibiotic Administration for Carpal Tunnel Release.

Background: In 2015, the American Association of Plastic Surgeons (AAPS) published a consensus statement against the routine use of preoperative antibiotic prophylaxis to prevent surgical site infection in clean hand surgery. The American Academy of Orthopaedic Surgeons (AAOS) similarly cited "insufficient evidence" in its Appropriate Use Criteria guidelines to support the use of antibiotics in carpal tunnel surgery. Nonetheless, its administration remains a common practice during clean hand surgery. We sought to evaluate the impact of the above guidelines on preoperative antibiotic administration. Methods: An institutional review board-approved retrospective chart review of consecutive patients with carpal tunnel syndrome treated with open carpal tunnel release (CTR) at our institution was performed in the 2 years before and after publication of AAPS/AAOS guidelines. Patient demographics and surgical outcomes were reviewed. Incidence of antibiotic administration, patient demographics, and surgeon factors were collected. Results: A total of 770 primary open CTR procedures were performed in the studied years. In 2013 and 2014, 83.9% of patients received preoperative antibiotics. In 2017 and 2018, 48.2% of patients received preoperative antibiotics. Of the variables analyzed, immunosuppression, history of diabetes, and poorly controlled diabetes (A1c > 7) were found to be statistically significant in its positive correlation to prophylactic preoperative antibiotic use. Diabetes was not associated with surgical site infections. Conclusion: Patients were more likely to receive preoperative antibiotics before the publication of the AAPS/AAOS clinical practice guidelines. Patients with diabetes regardless of their glycemic control are more likely to receive preoperative antibiotics.

Impact of preoperative antibiotic use in preventing complications of cochlear implantation surgery

Objective To examine the impact of preoperative antibiotic prophylaxis on the occurrence of postoperative complications. Materials and Methods Data of 491 patients undergoing cochlear implantation were included in a non–randomized retrospective comparative cohort study. Demographic data, cochlear implant and surgical details, use of preoperative antibiotics and occurrence of postoperative complications were analyzed using a binary logistic regression model. Results There were 317 patients (64.56%) who did not receive preoperative antibiotic prophylaxis and 174 (35.44%) patients who received preoperative antibiotic prophylaxis with ceftriaxone. The overall rate of complications requiring surgical treatment was 2.85%. Younger patient age was identified as a positive predictive factor for administering preoperative antibiotic prophylaxis (p<0.001, OR 1.05 CI 95% 1.0124–1.0826). No difference in complication rate was observed between the two groups. No correlation between sex, age, manufacturer, surgeon and postoperative complications were noted (p=0.45). Conclusion There is insufficient evidence to inform decision making regarding preoperative intravenous ceftriaxone use for prevention of infection after cochlear implantation surgery, with data failing to show that administration of preoperative antibiotics leads to a decrease in complication rate. Considering a very low overall complication rate, with few complications related to infection, routine use of preoperative antibiotic prophylaxis should be analyzed further.

Effectiveness of Cefotaxime in the prevention of surgical site infections in children undergoing elective inguinal surgery at the University Teaching Hospital, Lusaka, Zambia

Introduction and objectives: Inguinal operations are the most performed surgeries in children. There is a divergent view on use of pre-operative antibiotic prophylaxis to prevent Surgical site infections (SSI) after these surgeries. The aim of this study was to detect if the use of cefotaxime had a significant impact on prevention of SSI in children under 8 years undergoing elective inguinal surgery at the University Teaching Hospitals (UTHs), Lusaka.&#x0D; Method: This was a cohort study. A total of 170 patients below 8 years of age undergoing elective inguinal herniotomy, orchidopexy or patent processus vaginalis (PPV) ligation at UTHs were enrolled. Group A with 85 patients received preoperative cefotaxime while group B with 85 patients did not receive any antibiotics. A data collection sheet was used to record pre-operative demographic details. Intraoperative variables and post-operative outcomes. No patient received post-operative antibiotics. Follow up to look for SSI was done at 2 weeks and 30 days.&#x0D; Results: Out of 170 patients, 11(6.47%) had SSI. Six of the 85 that received surgical antibiotic prophylaxis (SAP) had SSI while 5 of the 85 that did not receive SAP had SSI (P=0.551). Deep SSI were seen in 2 patients that did not receive SAP (p=0.155) and grew Staphylococcus aureus in their cultures. Only 1 adverse allergic reaction to preoperative antibiotics was noted.&#x0D; Conclusion: Despite a low risk of adverse reactions, there is no benefit of using pre-operative antibiotics to prevent SSI in children undergoing elective inguinal surgery.

Effectiveness of Cefotaxime in the prevention of surgical site infections in children undergoing elective inguinal surgery at the University Teaching Hospital, Lusaka, Zambia

Introduction and objectives: Inguinal operations are the most performed surgeries in children. There is a divergent view on use of pre-operative antibioticprophylaxis to prevent Surgical site infections (SSI) after these surgeries. The aim of this study was to detect if the use of cefotaxime had a significantimpact on prevention of SSI in children under 8 years undergoing elective inguinal surgery at the University Teaching Hospitals (UTHs), Lusaka.&#x0D; Method: This was a cohort study. A total of 170 patients below 8 years of age undergoing elective inguinal herniotomy, orchidopexy or patent processus vaginalis (PPV) ligation at UTHs were enrolled. Group A with 85 patients received preoperative cefotaxime while group B with 85 patients did not receive any antibiotics. A data collection sheet was used to record pre-operative demographic details. Intraoperative variables and post-operative outcomes. No patient received post-operative antibiotics. Follow up to look for SSI was done at 2 weeks and 30 days.&#x0D; Results: Out of 170 patients, 11(6.47%) had SSI. Six of the 85 that received surgical antibiotic prophylaxis (SAP) had SSI while 5 of the 85 that did not receive SAP had SSI (P=0.551). Deep SSI were seen in 2 patients that did not receive SAP(p=0.155) and grew Staphylococcus aureus in their cultures. Only 1 adverse allergic reaction to preoperative antibiotics was noted.&#x0D; Conclusion: Despite a low risk of adverse reactions, there is no benefit of using pre-operative antibiotics to prevent SSI in children undergoing elective inguinal surgery.

The Use of Preoperative Antibiotics in Elective Soft-Tissue Procedures in the Hand: A Critical Analysis Review.

» The use of preoperative antibiotic prophylaxis is not supported for elective cases of patients undergoing soft-tissue hand procedures that are ≤2 hours in length.» The use of preoperative antibiotic prophylaxis is not supported for patients with diabetes undergoing elective, soft-tissue hand surgical procedures.» There is a paucity of literature evaluating the use of preoperative antibiotic prophylaxis in patients with rheumatoid arthritis, those with cardiac valves, and those taking corticosteroids; because of this, there is no evidence to vary from our general recommendations.

Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants.

Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1–24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4–30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes , but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.

Preoperative antibiotic prophylaxis in prosthetic joint infections: not a concern for intraoperative cultures

BackgroundCulture negative prosthetic joint infections (PJI) still remain an issue even with the advantages of the new diagnostic tools for PJI. This is why some orthopedic surgeons have reservations relative to the use of preoperative antibiotic prophylaxis when a PJI is suspected. The purpose of the present study was to evaluate the influence of preoperative antibiotic prophylaxis on intraoperative cultures. Material and MethodsAn enhanced diagnostic protocol for PJI (Zimmerli criteria) was used for the inclusion criteria in order to collect all PJI that were seen in a university hospital. Patients were prospectively randomized into two groups. The control group received the classical preoperative antibiotic prophylaxis. The study group did not receive prophylaxis prior to surgery. ResultsThere were 14 patients in each group. They correspond to 13 total hip arthroplasty infections, 12 total knee arthroplasty infections and 3 reverse shoulder prosthesis infections. There were 10 patients in the study group and 10 patients in the control group with at least one positive microbiological criterion (P > 0.05). There were 4 patients in each group with a culture negative PJI (P > 0.05). ConclusionsPreoperative antibiotic prophylaxis does not affect intraoperative cultures in suspected or confirmed PJI. Therefore it is essential to deliver antibiotic prophylaxis in any patient in which a prosthesis is to be implanted in order to protect the prosthesis from infection.

Preoperative Antibiotic Prophylaxis Does Not Reduce the Risk of Postoperative Infectious Complications in Patients Undergoing Elective Hepatectomy.

Postoperative infection is not uncommon after hepatectomy. This study assessed the effectiveness of preoperative antibiotic prophylaxis in elective hepatectomy in a randomized clinical trial setting. A total of 120 patients who were scheduled to undergo elective hepatectomy were equally randomized to receive either intravenous cefuroxime 1.5g (group A) or placebo (group B) within 30min prior to skin incision. Overall, postoperative infection occurred in 26 (21.6%) of the 120 patients. There was no statistically significant difference between groups A and B in the incidence of overall infection (23.3 vs. 20.0%, P=0.658), surgical site infection (13.3 vs. 15%, P=0.793), and remote site infection (13.3 vs. 11.7%, P=0.783). The use of preoperative antibiotic prophylaxis as a routine practice in patients undergoing elective hepatectomy is unnecessary because it does not reduce the risk of postoperative infectious complications.

Changing Use of Surgical Antibiotic Prophylaxis in Thika Hospital, Kenya: A Quality Improvement Intervention with an Interrupted Time Series Design

IntroductionIn low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals.MethodsWe conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design.ResultsFrom a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these.ConclusionImplementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.

Can Antibiotic Prophylaxis Prior to Surgical Removal of Teeth reduce the Incidence of Post-operative Infections?

Introduction: Despite the ongoing debate with regards to the use of antibiotic prophylaxis during surgical extractions and whether they should be administered at all, patients attending for surgical removal of teeth may receive antibiotics before and/or after surgery. This review examined the evidence for the use of pre-operative antibiotic prophylaxis for patients undergoing surgical tooth removal. Method: A literature search was performed on PubMed and a thorough literature appraisal was undertaken of all relevant articles obtained. Results: Out of all the eleven articles retrieved in the search only two fit the inclusion criteria. Both articles concluded that there is limited evidence for the use of pre-operative antibiotics prior to the surgical removal of teeth. Conclusion: Although the clinical evidence is limited, preoperative antibiotic prophylaxis may help to reduce the incidence of post-operative infections in susceptible patients who are undergoing surgical removal of teeth. However, further research is necessary in this field.

A Randomized, Double‐blinded Placebo‐controlled Clinical Trial of the Routine Use of Preoperative Antibiotic Prophylaxis in Modified Radical Mastectomy

The effectiveness of antibiotic prophylaxis for prevention of surgical site infection (SSI) following specific types of breast cancer surgery remains uncertain. This study assessed the effectiveness of prophylaxis in modified radical mastectomy (MRM). Women undergoing MRM for breast cancer were recruited. Women were excluded who had diabetes mellitus, severe malnutrition or known allergy to cephalosporins; were receiving corticosteroid therapy or were treated with antibiotics within one week prior to surgery; were scheduled for simultaneous breast reconstruction or bilateral oophorectomy; had existing local infection. Participants were randomized to receive either intravenous cefazolin 1 g or placebo within 30 min prior to skin incision. Standard skin preparation and operative technique for MRM were carried out. Wounds were assessed for SSI and other complications weekly for 30 days. A total of 254 women were recruited. Age, clinical stage, prior chemotherapy, and operative time were similar for antibiotic and placebo groups. The overall incidence of SSI was 14.2 %. There were no significant differences in the infection rate over the 30-day follow-up period between the placebo and antibiotic groups (15 % vs 13.4 %; p = 0.719) or at each week. The majority of SSI were either cellulitis or superficial infection for both groups. There were no significant differences between groups in treatments required for SSI, incidence of hematoma or seroma. The findings of this study, alone and when meta-analyzed with data from studies in similar surgical populations, do not support the use of antibiotic prophylaxis in MRM.

Algorithm for the management of antibiotic prophylaxis in onychocryptosis surgery

Background Antibiotic prophylaxis in nail surgery is not clearly established, and there is scant scientific evidence regarding the need for its use in preventing surgical site infection, hematogenous total joint infection, and infective endocarditis. Objectives To propose an algorithm based on the evidence for the management of antibiotic prophylaxis in onychocryptosis surgery. Methods A literature review was performed in Medline, Pubmed, Cochrane database and Scopus and recent prospective studies were examined. The most-current authoritative guidelines together with new classification system of the pathology have been taken into account. Results In non-risk patients with onychocryptosis stage II or III phenol technique can be used without the need for antibiotics. In stages IV and V, specific antibiotic treatment should be administered before surgery together with partial ablation of nail until the infection is resolved and the process remits to stage II or III. In the case of long-developing onychocryptosis, osteomyelitis should be ruled out, and specific antibiotic treatment besides the preoperative dose should be administered. In high-risk cardiac patients with infective onychocryptosis, the need for prophylaxis for bacterial endocarditis should be considered. Conclusion Current evidence does not support the use of preoperative antibiotic prophylaxis in onychocrytosis surgery except in special patients with infective onychocryptosis.

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We agree with this assessment and the limitations of our study. Certainly, future prospective studies are needed and they should consider all of these valid points. Of interest, our initial goal was to perform a prospective, randomized study that addressed this issue. However, after careful and extensive literature reviews, we were unable to locate a single study that examined postoperative infections and antibiotic use as a primary outcome while using more contemporary management routines (minimizing both postoperative Foley catheter and prolonged antibiotic use). Thus, we elected to conduct a baseline observational study as an initial attempt to address this question and also to provide data upon which to base power and sample size calculations for future prospective studies. We firmly believe that, given the frequency that midurethral slings are placed without concomitant procedures, perioperative guidelines around this surgery should be evidence-based. Our hope is that this study provides one of the steps toward that goal. Editorial CommentUrologyVol. 75Issue 6PreviewWhile the use of preoperative antibiotic prophylaxis has been extensively studied and guidelines have been established by both the AUA and CMS, the use of postoperative antibiotic treatment has not been firmly established. We often use a “gut feeling” that is likely influenced by previous anecdotal outcomes experienced personally or by a colleague. This study raises an excellent question of adverse effects from postoperative antibiotic use of 3-day duration vs limiting antimicrobial agents to a solitary preoperative dose for patients undergoing midurethral sling surgery for the treatment of SUI. Full-Text PDF

Electrocautery used to create incisions does not increase wound infection rates

A prospective, randomized, blinded clinical trial was conducted to determine whether electrocautery as a means of creating abdominal or thoracic wounds would result in increased wound infection rates. Over a 15-month period, 492 consecutively studied patients were randomly placed into 1 of 2 groups: scalpel or electrocautery. There were no differences in age grouping, use of steroids, incidence of diabetes, number of days preoperative, operative time, use of preoperative antibiotic prophylaxis, use of drains, number of obese patients, or gender ratio. Wound infections developed in 38 of the 250 scalpel patients (15%) and in 30 of the 242 cautery patients (12%). The use of electrocautery to create surgical wounds does not increase wound infection rates.