Use Of Preoperative Antibiotics Research Articles

Preoperative antibiotics are not indicated prior to closure of oroantral communication

AbstractObjectiveThe aim of this paper was to determine whether the use of preoperative antibiotics improves surgical outcomes following oroantral communication (OAC) closure.Materials and MethodsA single‐centre, retrospective study was conducted on all OAC repair procedures over a 24‐month period assessing a number of datapoints including the site of OAC occurrence, time to repair, local anaesthetic or general anaesthetic, and any complications noted. Patient follow‐up was up to 3 months post‐operative OAC closure. Data outputs primarily included descriptive statistics for demographic datasets included in the study. Fisher's exact test was used to determine non‐random associations between categorical variables (preoperative antibiotics vs. no preoperative antibiotics; successful closure vs. failed closure).ResultsThirty‐one patients met the inclusion criteria and timeframe of this study. All OACs were a result of dental extraction. For patients who had an OAC visualised immediately after extraction, 18 had an OAC repair completed on the same day. Fifteen patients had a delayed closure, defined as a closure over 48 h following the development of OAC. Thirteen patients had their procedure completed under local anaesthetic; none had preoperative antibiotics prior to surgery. Only one patient with delayed closure of an OAC who had a procedure completed under local anaesthetic had a prophylactic dose 1 h prior to surgery. Patients who underwent OAC closure under general anaesthetic received an intra‐operative dose of antibiotics. Using Fisher's exact test, there was no significant difference between the two groups (preoperative antibiotics given vs. no preoperative antibiotics given) with regard to the likelihood of success following OAC closure (p = 0.1419).ConclusionThis study demonstrates that the routine use of preoperative antibiotics may not improve surgical outcomes following the closure of oroantral communication.

To study the planned surgical procedure in single-dose antibiotic prophylaxis

Background: Postoperative wound infection may be due to many causes, of which “microbial contamination” is the factor that is influenced by antibiotic administration. Since the concept of antimicrobial prophylaxis has emerged, several workers have searched for optimal antimicrobial drugs, their routes, and the timing of their administration, with the ultimate goal of achieving zero sepsis. The use of preoperative systemic antibiotics has brought down the incidence of wound infection considerably. Aims and Objectives: The aim is to identify which drug is the best option for single-dose antibiotic prophylaxis to prevent postoperative wound infection. Materials and Methods: This is a prospective study. The study was conducted in the surgical ward of J.A. Group of Hospitals, Gwalior, Madhya Pradesh, India, from May 2020 to April 2022. Patients of all sexes and ages were included in the study. Patients were divided into five groups according to a class of antibiotics. The study consisted of a total of 125 patients admitted to the surgical ward. Statistical Package for the Social Sciences–(10 systems) was applied for the study. P<0.05 was considered statistically significant. Results: A total of 125 patients were studied in five groups, depending on the antibiotics. The A, B, C, and D groups were given only a single dose of antibiotics, while group E was given a full course of antibiotics during preoperative, intraoperative, and postoperative periods. Out of 125 cases, only 5 patients had clinical and bacteriological evidence of wound sepsis in different groups of single-dose antibiotics, and one case in group E had multiple doses of antibiotic given. The wound infection rate in clean patients was 20% in ceftazidine, 12.5% with piperacillin tazobactum and cefoperazone sulbactum, and 21.1% in the multiple dose group. No infection was reported with amoxycillin-clavulanic acid. Staphylococcus, Escherichia Coli, and Klebsiella were the offending agents, and anaerobic infections were not found. Conclusion: A single dose of antibiotic prevents the suppression of normal, sensitive microbial flora, which is usually seen with multiple doses of antibiotics. In this way, it helps in keeping the patients infection-free without interfering with their naturally inherited immunological status of the patient.

Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials.

Laparoscopic cholecystectomy (LC) in patients admitted with acute cholecystitis is considered the preferred, feasible and safe mode of managing gallstone disease. The objective of this study is to evaluate the role of single-dose pre-operative prophylactic antibiotics in patients undergoing emergency LC for mild to moderate acute cholecystitis. All randomized control trials (RCTs) reporting the use of single-dose pre-operative prophylactic antibiotics in patients undergoing 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. Standard medical databases search produced only 3 RCTs on 781 patients undergoing acute cholecystectomy. There were 384 patients in single dose pre-operative antibiotics group whereas 397 patients were recruited in the no-antibiotics group. In the random effects model analysis, the use of single-dose preoperative prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate cholecystitis failed to demonstrate any extra advantage of reducing the risk of [risk ratio (RR) =0.69; 95% confidence interval (CI): 0.46-1.03; Z=1.80; P=0.07] infective complications. There was no heterogeneity [Tau2 =0; Chi2 =1.74, df =2 (P=0.42; I2=0%)] among included studies. A preoperative single dose of prophylactic antibiotics in patients undergoing acute LC for mild to moderate acute cholecystitis does not offer extra benefits to reduce infective complications.

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.

SP6.10 Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials

Abstract Objective Laparoscopic cholecystectomy in patients admitted with acute cholecystitis is considered preferred, feasible and safe mode of managing gallstone disease. The objective of this study is to evaluate the role of single dose pre-operative prophylactic antibiotics in these patients undergoing acute cholecystectomy. Materials and methods All RCTs reporting the use of single dose pre-operative prophylactic antibiotics in patients undergoing 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 Standard medical databases search produced only 3 RCTs on 781 patients undergoing acute cholecystectomy. There were 384 patients in single dose pre-operative antibiotics group whereas 397 patients were recruited in the no-antibiotics group. In the random effects model analysis, use of single does preoperative prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate cholecystitis failed to demonstrate any extra advantage of reducing the risk of [risk ratio 0.69, 95%, CI (0.46, 1.03), Z = 1.80, P=0.70] infective complications. There was no heterogeneity (Tau2 = 0; Chi2 = 1.74, df = 2 (P = 0.42; I2 = 0 %) among included studies. Conclusion Preoperative single dose of prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not offer extra benefit to reduce infective complications.

Machine Learning and Artificial Intelligence: A Web-Based Implant Failure and Peri-implantitis Prediction Model for Clinicians.

To develop a machine learning model that can predict dental implant failure and peri-implantitis as a tool for maximizing implant success. This study used a supervised learning model to retrospectively analyze 398 unique patients receiving a total of 942 dental implants presenting at the Philadelphia Veterans Affairs Medical Center from 2006 to 2013. Logistic regression, random forest classifiers, support vector machines, and ensemble techniques were employed to analyze this dataset. The random forest model possessed the highest predictive performance on test sets, with receiver operating characteristic area under curves (ROC AUC) of 0.872 and 0.840 for dental implant failures and peri-implantitis, respectively. The five most important features correlating with implant failure were amount of local anesthetic, implant length, implant diameter, use of preoperative antibiotics, and frequency of hygiene visits. The five most important features correlating with peri-implantitis were implant length, implant diameter, use of preoperative antibiotics, frequency of hygiene visits, and presence of diabetes mellitus. This study demonstrated the ability of machine learning models to assess demographics, medical history, and surgical plans, as well as the influence of these factors on dental implant failure and peri-implantitis. This model may serve as a resource for clinicians in the treatment of dental implants. Int J Oral Maxillofac Implants 2023;38:576-582. doi: 10.11607/jomi.9852.

The Use of Preoperative Antibiotics in Hardware-Based Hand Procedures Is Not Necessary: A Single-Surgeon Experience.

A survey to American Society for Surgery of the Hand members by Dunn et al showed that the use of preoperative antibiotics was random and not standardized for all hand procedures (Hand (N Y). 2020;15(4):534-541). Previous publications support that preoperative antibiotics for clean, soft-tissue procedures are not necessary, but there is minimal evidence regarding the need for preoperative antibiotics for hardware-based hand procedures. The purpose of our study is to compare infectious outcomes for patients undergoing hardware-based hand surgery between those who did and those who did not receive preoperative antibiotics. A retrospective cohort analysis was performed on hardware-based surgical patients from the senior author's hand practice between January 2015 and October 2021. All patients either received imbedded permanent hardware or temporary percutaneous k-wire fixation. Exclusion criteria included polytrauma patients, patients with open hand wounds, and patients with less than 2 outpatient follow-up visits. Primary outcomes measured were 30- and 90-day postoperative antibiotic prescriptions and need to return to the operating room. Basic demographic information such as age, sex, body mass index, diabetes, and smoking status were recorded and compared. Four hundred seventy-two patients were reviewed, with 365 patients meeting inclusion and exclusion criteria. Two hundred twenty patients did not receive preoperative antibiotics and 145 patients did receive preoperative antibiotics. χ2 tests to analyze for associations between the variables were used. Thirteen patients in the no preoperative antibiotic group (5.9%), compared with 5 patients in the preoperative antibiotic group (3.4%), received a postoperative antibiotic prescription within 30 days (P = 0.288). Sixteen patients in the no preoperative antibiotic group (7.3%), compared with 8 patients in the preoperative antibiotic group (5.5%) received a postoperative antibiotic prescription within 90 days (P = 0.508). One patient in the nonantibiotic group required return to the operating room for irrigation and debridement. There are no significant differences in the need for 30- and 90-day postoperative antibiotic prescriptions between those who did or did not receive preoperative antibiotics based on this single-surgeon experience.

Pharmacist adjustment of preoperative antibiotic orders to the preferred preoperative antibiotic cefazolin for patients with penicillin allergy labeling.

Emerging literature has detailed the safe use of cefazolin in patients with immunoglobulin E-mediated penicillin allergy labeling (PAL) such as hives and anaphylaxis. The purpose of this article is to detail efforts led by an antimicrobial stewardship pharmacist working with an interdisciplinary team to optimize preoperative antimicrobials in patients with PAL. A pharmacist-led, interdisciplinary collaborative practice agreement (CPA) was activated in January 2020 to permit pharmacists to independently optimize preoperative antibiotics to the preferred cefazolin in patients with PAL if nonsevere or severe reactions had been reported. A patient registry was established covering the timeframe between January 8, 2020, and January 6, 2022. Reaction during surgery was assessed via 2-provider documentation, which included surgeon and anesthesiology staff documentation of any complications during the procedure related to a suspected allergic safety event. Utilization of cefazolin, clindamycin, and vancomycin for preoperative prophylaxis was monitored before and after implementation of the CPA. During the stated timeframe, 10,182 procedures and/or surgeries were completed on 1,572 (15.4%) patients with PAL and 659 (41.9%) patients previously reporting at least one reaction categorized as a severe reaction, which was hives for 71.2% of these patients. Of the 659 patients with PAL reporting a severe reaction, 356 received a preoperative cephalosporin (cefazolin, 98.8%; ceftriaxone, 1.2%) and tolerated it without a reported safety event, including 52 patients with PAL previously reporting anaphylaxis. An increase in preferred preoperative antimicrobial prophylaxis utilization was noted (cefazolin: 86% to 96.3%, P < 0.001; 2019 to 2021) with reductions noted in the use of nonpreferred preoperative antibiotics (clindamycin: 2.1% to 0.2%, P < 0.001; vancomycin: 3.2% to 0.4%, P < 0.001; 2019 to 2021). A pharmacist-led, interdisciplinary CPA increased preferred preoperative antimicrobial use in patients with PAL reporting severe allergic reactions, including hives and anaphylaxis, without reported safety events.

Impact of a perioperative pharmacist on completion rates for preoperative antibiotics

BackgroundEnsuring appropriate use of preoperative antibiotics and monitoring antibiotic administration timing are responsibilities a perioperative pharmacist may perform. Antibiotics requiring prolonged infusions such as vancomycin and fluoroquinolones should be administered within 120 min of the first surgical incision. These antibiotics require longer infusion times, so they may not be completed before the first surgical incision. Incomplete infusions may cause procedural delays and increase the risk of surgical infections. By implementing a perioperative pharmacist, we aim to increase the percentage of completed infusions of presurgical antibiotics that require prolonged administration times, which may decrease the incidence of postsurgical skin and soft tissue infections and urinary tract infections. MethodsThis retrospective cohort analysis compared the completion rates of prolonged infusion preoperative antibiotics between pre- and post-implementation of a perioperative pharmacist. Antibiotics of interest were those with infusion times of 60 min or greater which included vancomycin, ciprofloxacin, and levofloxacin. A survey was constructed to evaluate perioperative staff satisfaction with the Department of Pharmacy pre- and post-implementation of a perioperative pharmacist. ResultsAssessing presurgical antibiotic doses, 59.6% of vancomycin, ciprofloxacin, and levofloxacin were completely infused prior to the first surgical incision during the perioperative pharmacist pilot compared with 26.5% pre-implementation (p<0.001). A difference in the incidence of postsurgical skin and soft tissue infections and urinary tract infections within 30-days postoperatively was not detected. In the perioperative staff satisfaction survey, the statement: “a pharmacist in the perioperative setting improves patient care” was answered strongly agree or agree in 95% of respondents in the post-survey as compared to 71% in the pre-survey. Furthermore, 95% of the perioperative staff that completed the post-survey supported the continuation of a perioperative pharmacist role indefinitely. ConclusionImplementation of a perioperative pharmacist increased presurgical antibiotic prophylaxis infusion completion rates of vancomycin, ciprofloxacin, and levofloxacin and increased perioperative staff satisfaction with the Department of Pharmacy.

Do Post-injury Prophylactic Antibiotics Reduce Infection for Isolated Midface Fractures: A Cohort Study

Fractures of the midface are a core component to the practice of contemporary oral and maxillofacialtrainees and surgeons. As such, in an era where antibiotic resistance is increasing it is important to investigate if antibiotics are required after midface fractures to prevent infections before follow-up in an outpatient setting. The purpose of this study is to determine whether postinjury prophylactic preoperative antibiotics reduce rates of infection after midface fracture. A retrospective multicenter cohort study was conducted in Queensland, Australia. Patients who presented to Royal Brisbane Hospital and Townsville Hospital with isolated midface fractures betweenJanuary 2017 and January 2019 were included. Clinical and demographic data of patients who received postinjury prophylactic antibiotics were compared to those who did not using the χ2 test. Logistic regression was used to determine factors associated with increased odds of postinjury prophylactic antibiotic prescription. In total, 1,353 patients with midfacial fractures over the 2-year period were included. In addition, 724 (53.5%) patients received postinjury antibiotics and 629 (46.5%) patients did not. The overall rate of infection was very low: 1 patient who received postinjury prophylactic antibiotics (0.1%) developed infection compared to 2 patients (0.3%) who did not receive postinjury prophylactic antibiotics, and this difference was not significant (χ2=0.49; P=.48). Male sex (odds ratio 1.4; 95% confidence interval, 1.1 to 1.7; P=.02) and tobacco use (odds ratio 1.4; 95% confidence interval, 1.1 to 1.7; P=.008) were associated with an increased odds of postinjury prophylactic antibiotic prescription in the univariate analyses,but were no longer significant once site, age, and fracture type were adjusted for in the multivariate model. The rate of infection after midface fracture was low and there was no significant difference in infection rates for patients who received postinjury prophylactic antibiotics compared to those who did not. Use of postinjury prophylactic preoperative antibiotics for midfacial fractures should be reconsidered.

The Use of Antibiotics for the Prevention of Surgical Site Infections in Two Government Hospitals in Taif, Saudi Arabia: A Retrospective Study.

BackgroundSurgical site infections (SSIs) are among the most common postoperative complications. To reduce the occurrence of surgical wound infections, suitable antimicrobials should be administered.Aim of the workThis study investigated the prophylactic use of antibiotics to prevent SSIs, in terms of agents and/or combination preferences, and the adherence of surgeons to both national and international guidelines of surgical antibiotic prophylaxis in Taif city government hospitals.MethodsThis is a retrospective study using a chart review of patients' medical records in two government hospitals in Taif city, Saudi Arabia, from July 2016 to July 2018. While maintaining the confidentiality of the patient’s data, it was collected and analyzed using the chi-squared and Fisher’s exact tests, and the difference between means was tested using the student’s t-test.ResultsProphylactic antibiotics were used in 157 patients who had surgery (Group 1) while 52 patients did not receive preoperative antibiotics (Group 2). The most commonly used prophylactic antibiotics were metronidazole, cefuroxime, cefazolin, and ceftriaxone. Other antimicrobials used included cefotaxime, amoxicillin/clavulanic acid, cephalexin, and amoxicillin. Surgical site infections developed in one patient of those who received antibiotics preoperatively and in three Group 2 patients. The mean hospital length of stay in Group 1 was 38.5±9.2 hours, and 57.3±12.1 hours in Group 2 patients. The types of antibiotics used were generally within the scope of national and international recommended guidelines.ConclusionThe use of preoperative prophylactic antibiotics significantly reduces the development of surgical site infections and the mean length of hospital stay. Various antimicrobial drugs that were used prophylactically in surgical practice are within the recommendations of both national and international guidelines.

Oral antibiotics and a low-residue diet reduce the incidence of anastomotic leakage after left-sided colorectal surgery: a retrospective cohort study.

Anastomotic leakage is a potential complication after colorectal surgery. We investigated the effects of oral antibiotics and a low-residue diet on the incidence of anastomotic leakage after left-sided colorectal surgery. Outcomes were retrospectively compared between 64 patients who underwent mechanical bowel preparation alone (group A) and 183 patients who underwent mechanical bowel preparation with addition of oral kanamycin and metronidazole (group B) on the day before left-sided colorectal surgery. After surgery, patients in group A received a normal diet containing dietary fiber and those in group B received a low-residue diet. The primary outcome was the incidence of anastomotic leakage. Secondary outcomes were rates of other postoperative complications, length of postoperative hospital stay, and laboratory data. Anastomotic leakage, surgical site infection, and diarrhea were less common in group B than in group A (4.9% vs 18.8%, 6.6% vs 23.4%, and 25.7% vs 43.8%, respectively). Postoperative C-reactive protein levels were significantly lower in group B. The median postoperative hospital stay was significantly shorter in group B than in group A (8days vs 9days, P = 0.010). Adaptive double least absolute shrinkage and selection operator regression revealed that use of preoperative oral antibiotics and a postoperative low-residue diet were associated with lower incidence of anastomotic leakage (odds ratio 0.163, 95% confidence interval 0.062-0.430; P < 0.001). Oral antibiotics and a low-residue diet reduced the incidence of anastomotic leakage and shortened the postoperative hospital stay by 1day.

The Effect of Pre-Operating Antibiotic Prophylaxis on Post C-Section Infection In RSUD DR. Soetomo Period January 2021 – June 2021

Cesarean section has some risk of around 90% post operative morbidity caused by Surgical Site Infection. The use of prophylactic antibiotics is one of the prevention of surgical wound infections with a decrease of about 30-65%. This study will use a prospective and cross-sectional study design, to determine the relationship between the use of preoperative prophylactic antibiotics on the prevention of infection after cesarean section. The results is From 72 cesarean section patients, it can be concluded that the age group of most cesarean section patients in this study was the age group of 20-35 years. The highest BMI group in cesarean section patients was with BMI &gt; 30 by 43.1%. The most indications for cesarean section patients are patients with a history of previous cesarean section with a total of 30 people. The most prophylactic antibiotic use was cefazolin as much as 95.8% The incidence of infection in patients using cefazolin prophylactic antibiotics was 3 patients out of 69 patients, while the incidence of infection who did not use cefazolin was 1 patient out of 3 patients. There is a relationship between the use of preoperative prophylactic antibiotics on the prevention of infection after cesarean section

Postoperative Rather Than Preoperative Neutropenia Is Associated With Early Catheter-related Bloodstream Infections in Newly Diagnosed Pediatric Cancer Patients.

The relationship of early catheter-related bloodstream infections (CRBSIs) with perioperative neutropenia and antibiotic prophylaxis is not well established. We sought to evaluate perioperative factors associated with early CRBSIs in newly diagnosed pediatric cancer patients, particularly hematologic indices and antibiotic use. We retrospectively reviewed national registry records of newly diagnosed pediatric cancer patients with port-a-caths inserted using standardized perioperative protocols where only antibiotic use was not regulated. Thirty-day postoperative CRBSI incidence was correlated with preoperative factors using logistic regression and with postoperative blood counts using linear trend analysis. Among 243 patients, 17 CRBSIs (7.0%) occurred at median 14 (range, 8-28) postoperative days. Early CRBSIs were significantly associated with cancer type [acute myeloid leukemia and other leukemias (AML/OLs) vs. solid tumors and lymphomas (STLs): odds ratio (OR), 5.09; P = 0.0036; acute lymphoblastic leukemia vs. STL: OR 0.83; P = 0.0446] but not preoperative antibiotics, absolute neutrophil counts and white blood cell counts. Thirty-day postoperative absolute neutrophil counts and white blood cell trends differed significantly between patients with acute lymphoblastic leukemia and STLs (OR 0.83, P < 0.05) and between AML/OLs and STLs (OR 5.09, P < 0.005), with AML/OL patients having the most protracted neutropenia during this period. Contrary to common belief, low preoperative absolute neutrophil counts and lack of preoperative antibiotics were not associated with higher early CRBSI rates. Instead, AML/OL patients, particularly those with prolonged neutropenia during the first 30 postoperative days, were at increased risk. Our findings do not support the use of empirical preoperative antibiotics and instead identify prolonged postoperative neutropenia as a major contributing factor for early CRBSI.

Review of Perioperative Prophylactic Antibiotic Use during Laparoscopic Cholecystectomy and Subsequent Surgical Site Infection Development at a Single Children's Hospital.

With the rise of antibiotic resistance, the use of prophylactic preoperative antibiotics (PPA) has been questioned in cases with low rates of surgical site infection (SSI). We report PPA usage and SSI rates after elective laparoscopic cholecystectomy at our institution. A retrospective review of children younger than 18 years who underwent elective outpatient laparoscopic cholecystectomy between July 2010 and August 2020 was performed. Demographic, preoperative work-up, antibiotic use, intraoperative characteristics, and SSI data were collected via chart review. SSI was defined as clinical signs of infection that required antibiotics within 30 days of surgery. A total of 502 patients met the inclusion criteria; 50% were preoperatively diagnosed with symptomatic cholelithiasis, 47% with biliary dyskinesia, 2% with hyperkinetic gallbladder, and 1% with gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). In total, 60% (n = 301) of patients received PPA, while 40% (n = 201) did not; 1.3% (n = 4) of those who received PPA developed SSI, compared with 5.5% (n = 11) of those who did not receive PPA (p = 0.01). Though PPA use was associated with a 77% reduction in the risk of SSI in multivariate analysis (p = 0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics, while the remainder were treated with outpatient antibiotics. Gender, age, body mass index, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA. Given the relatively low morbidity of the superficial SSI, conservative use of PPA is advised to avoid contributing to antibiotic resistance.

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.

Septoplasty with and without additional sinonasal surgery: postoperative sequelae and the use of prophylactic antibiotics

PurposeOne of the most common complications after septoplasty is a postoperative infection. We investigated the number of postoperative infections and unplanned postoperative visits (UPV) in septoplasties with and without additional nasal surgery at our institution and evaluated the role of antibiotic prophylaxis.MethodsWe collected data of all consecutive 302 septoplasty or septocolumelloplasty patients operated during the year 2018 at the Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital (Helsinki, Finland). Hospital charts were reviewed to record sociodemographic patient characteristics and clinical parameters regarding surgery and follow-up.ResultsAltogether 239 patients (79.1%) received pre- and/or postoperative prophylactic antibiotics and within this group 3.3% developed a postoperative infection. The infection rate in the non-prophylaxis group of 63 patients was 12.7% (p = 0.007). When all patients who received postoperative antibiotics were excluded, we found that the infection rate in the preoperative prophylaxis group was 3.8%, as opposed to an infection rate of 12.7% in the non-prophylaxis group (p = 0.013). When evaluating septoplasty with additional sinonasal surgery (n = 115) the rate of postoperative infection was 3.3% in the prophylaxis group and 16.7% in the non-prophylaxis group (p = 0.034). These results show a statistically significant stand-alone effect of preoperative prophylactic antibiotics in preventing postoperative infection in septoplasty, especially regarding additional sinonasal surgery.ConclusionThe use of preoperative antibiotics as a prophylactic measure diminished statistically significantly the rate of infections and UPVs in septoplasty when all postoperative infections, superficial and mild ones included, were taken into account.

Surgical site infections in gynecology: the latest evidence for prevention and management.

Surgical site infection (SSI) remains one of the most common postoperative surgical complications. Prevention and appropriate treatment remain paramount. Evidence-based recommendations include recognition and reduction of preoperative risks including hyperglycemia and smoking, treatment of preexisting infections, skin preparation with chlorhexidine gluconate, proper use of preoperative antibiotics, and implementation of prevention bundles. Consideration should be given to the use of dual antibiotic preoperative treatment with cephazolin and metronidazole for all hysterectomies. Despite advancements, SSI in gynecologic surgery remains a major cause of perioperative morbidity and healthcare cost. Modifiable risk factors should be evaluated and patients optimized to the best extent possible prior to surgery. Preoperative risks include obesity, hyperglycemia, smoking, and untreated preexisting infections. Intraoperative risk-reducing strategies include appropriate perioperative antibiotics, correct topical preparation, maintaining normothermia, and minimizing blood loss. Additionally, early recognition and prompt treatment of SSI remain crucial.

465 No Role for Postoperative Antibiotics in Uncomplicated Appendicitis

Abstract Introduction Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences. Method This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection. Results 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1). Conclusions Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.

555 Preterm birth rates with vaginal progesterone and cerclage for incidentally found shortened cervical length

Administration of vaginal progesterone to asymptomatic women with short cervical length (CL) decreases the risk of spontaneous preterm birth (PTB). Insufficient evidence exists to assess the additive effect of progesterone and cerclage. While most physicians use vaginal progesterone for incidentally found short CL, the benefit of continuing this after cerclage placement is unclear. Our objective was to determine if continuing vaginal progesterone with cerclage reduces rate of PTB and prolongs pregnancy latency when compared to cerclage alone in patients with incidentally found short CL and without history of PTB. IRB approved retrospective cohort study of singleton pregnancies who received cerclage for incidentally found short CL from October 2013 to June 2019. Institutional practice was to offer vaginal progesterone at CL<25mm and cerclage at CL<15mm. Primary outcome was gestational age (GA) at delivery. Secondary outcomes were CL and GA at diagnosis, delivery at <34 and <28 weeks, use of preoperative antibiotics, postoperative tocolysis, and genitourinary infection. Of 43 patients, 22(51.2%) continued vaginal progesterone after cerclage. Baseline demographics, preoperative antibiotics, postoperative tocolysis, suture type, genitourinary infection, delivery and neonatal outcomes were similar between groups. There was also no significant difference in GA, CL, and cervical dilation at cerclage placement. Delivery at <34 weeks and <28 weeks occurred in 27.3% and 13.6% in the combined group and 42.9% and 28.6% with cerclage alone, respectively. Median GA at delivery was 37.5 weeks (IQR 30.7-38.9) for the combined group and 35.9 weeks (IQR 27-39.1) for cerclage alone. These differences were not statistically significant (Table 1). In patients with cerclage for incidentally found short CL, there was no significant difference in GA at delivery between those who continued vaginal progesterone versus those who did not. However, our results indicate a potential pregnancy latency of one to two weeks with continued use of vaginal progesterone. This warrants future study.View Large Image Figure ViewerDownload Hi-res image Download (PPT)