Routine Use Of Antibiotics Research Articles

Reducing Rates of Endophthalmitis from Intravitreal Injections - strategies and areas of controversy.

Post-injection endophthalmitis (PIE) is the most concerning complication that accompanies intravitreal injections. This review discusses the recent literature in endophthalmitis prophylaxis including types of antisepsis, the use of topical antibiotics, methods of anesthesia, masking, and office-based versus operating room-based injections. Povidone iodine (PI) remains the gold standard for PIE prophylaxis. Chlorhexidine gluconate (CHG) is an alternative antiseptic agent utilized in other areas of medicine with similar broad spectrum antibacterial activity. Recent clinical trials have demonstrated that the rate of endophthalmitis is similar with CHG prophylaxis compared to PI prophylaxis while offering improved patient comfort at a similar cost. Routine use of topical antibiotics should be avoided as they do not appear to reduce endophthalmitis risk and may promote bacterial resistance. All methods of anesthesia appear to be acceptable. In-office injections are not associated with an increased rate of endophthalmitis compared to operating room injections. The rate of post-injection endophthalmitis is extremely low due to a myriad of measures employed by retina specialists. Topical antisepsis is the most important tool to combat post-injection endophthalmitis. CHG is emerging as an alternative to PI due to its efficacy and enhanced patient comfort.

Things We Do for No Reason: Routine use of antibiotics for acute uncomplicated diverticulitis.

The treatment of acute uncomplicated diverticulitis (UD) with antibiotics remains common despite substantial evidence supporting the non-inferiority of nonantibiotic outpatient management. In the past 15 years, there have been two landmark randomized-controlled clinical trials, follow-up studies, and numerous retrospective studies that have supported the non-inferiority of nonantibiotic management of UD. Multiple medical societies including the American Gastroenterological Association and the American College of Physicians recommend using antibiotics selectively rather than routinely in UD. We aim to raise physician awareness of the latest guideline recommendations through our article, potentially improving antibiotic stewardship and reducing related healthcare costs.

BN SO48 - Antibiotic prescribing for elective inguinal hernia repairs

Abstract Background Inguinal hernia repairs are a common procedure with over one million operations performed annually in Europe and the US. The European Hernia Society do not recommend the routine use of antibiotics in low-risk patients due to no significant benefit. They advise the consideration of prophylaxis for patients with risk factors including recurrence, age > 70 years or immunosuppression. Many surgeons are using antibiotic prophylaxis in all patients. However, inappropriate antibiotic use contributes to increased antibiotic resistance and increased healthcare cost. Our trust guidelines recommend a single dose of Cefuroxime in all patients undergoing an inguinal hernia repair with mesh. Method The aim of the project was to determine the compliance with current trust guidelines regarding antibiotic use in elective inguinal hernia repair with mesh. We also aimed to report on antibiotic prescribing patterns. Patients undergoing an elective inguinal hernia repair with mesh over a six-month period were identified. Data was collected retrospectively from electronic patient records and included patient’s age, if they were classed as high risk (age over 70, recurrence of hernia, diabetic, steroid therapy), if antibiotics were prescribed, and if so, which antibiotics were utilised. Results Eighty-five patients were included in the final data analysis. The median age of patients included was 67 years of age, and 93% were male. 41 patients were identified as high risk, and most patients were ASA II. Our results reported that 48% of patients were prescribed prophylactic antibiotics at induction. However, only two patients were prescribed the correct antibiotic, as per trust guidelines. Most patients were prescribed Co-Amoxiclav (78%), with a range of other antibiotics being used, including Flucloxacillin, Clarithromycin and Metronidazole. We identified 37% of high-risk patients were not prescribed antibiotics. Conclusion Our trust guidelines were not reflective of best practice and did not consider individual patient or procedure risk factors. We identified varied antibiotic prescribing patterns with low compliance to trust guidelines. Utilising our findings, we have created new guidelines, which recommend that in low-risk patients, routine antibiotic prophylaxis is not required. However, in the presence of patient-related risk factors as mentioned above, then a single dose of Cefuroxime is recommended. The updated guidelines will ensure good antimicrobial stewardship and reduce unnecessary antibiotic prescriptions. In addition, they accurately reflect the current evidence base surrounding antibiotic prophylaxis.

Routine antibiotic prophylaxis and early implant failure: is there a link?

A systematic search was conducted across multiple databases (PubMed via MEDLINE, Cochrane Library, and Web of Science) up to October 1st, 2023. Manual screening of reference lists was performed, alongside searches in clinical trial registries to ensure comprehensive coverage. Only randomized controlled trials (RCTs) that compared antibiotic prophylaxis with no antibiotics or placebo in systemically healthy individuals undergoing dental implant surgery were included. Studies with a high risk of bias, non-randomized studies, and those without a placebo or control group were excluded. Studies focusing on medically compromised patients or other implant techniques (such as mini-implants or immediate placement in sites with apical pathology) were also excluded. Data extraction was carried out independently by two authors, with disagreements resolved through discussion among all review authors. The risk of bias for each included randomized controlled trial (RCT) was evaluated using the Cochrane Risk of Bias tool (RoB-2). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analyses were conducted using a random-effects model, and heterogeneity was checked with both the I² statistic and Q test. A total of 1267 studies were initially identified, with seven randomized controlled trials (RCTs) ultimately meeting the inclusion criteria, comprising data from 1,859 participants and 3014 implants. Four studies were high quality, and three were of moderate quality. Meta-analyses of these studies showed no statistically significant association between the use of antibiotic prophylaxis and a reduction in early dental implant failure (RR: 0.66, 95% CI: 0.30-1.47). The number needed to treat (NNT) to prevent one implant failure was 143, indicating a limited effect of antibiotics in preventing early implant failure. The study concluded that routine antibiotic prophylaxis does not significantly reduce the risk of early implant failure in medically fit patients. Given the very limited benefit and the concern of increasing antibiotic resistance, routine use of antibiotics in dental implant surgery should be avoided.

Recent updates on classification and unsolved issues of diverticular disease: a narrative review.

Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. Diverticular disease is now defined as a variety of clinically significant conditions such as diverticulitis, diverticular bleeding, symptomatic uncomplicated diverticular disease, and segmental colitis associated with diverticulosis. Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. Routine antibiotic use is no longer recommended for all cases of diverticulitis, and simple recurrence is not an indication for surgical treatment. Early colonoscopy with proper preparation is recommended for the treatment of diverticular bleeding, although recent studies have not shown significant efficacy in preventing recurrence. The roles of dietary fiber, nonabsorbable antibiotics, 5-aminosalicylates, and probiotics in the prevention of diverticular disease are controversial and require further investigation.

Therapy of Aspiration: Out-of-Hospital and In-Hospital-Acquired.

Therapeutic considerations for aspiration pneumonia prioritize the risk of multidrug-resistant organisms. This involves integrating microbiological insights with each patient's unique risk profile, including the location at the time of aspiration, and whether it occurred in or out of the hospital. Our understanding of the microbiology of aspiration pneumonia has also evolved, leading to a reassessment of anaerobic bacteria as the primary pathogens. Emerging research shows a predominance of aerobic pathogens, in both community and hospital-acquired cases. This shift challenges the routine use of broad-spectrum antibiotics targeting anaerobes, which can contribute to antibiotic resistance and complications such as Clostridium difficile infections-concerns that are especially relevant given the growing issue of antimicrobial resistance. Adopting a comprehensive, patient-specific approach that incorporates these insights can optimize antibiotic selection, improve treatment outcomes, and reduce the risk of resistance and adverse effects.

Current Trends in the Treatment of Acute Uncomplicated Diverticulitis.

Introduction: Acute diverticulitis represents a significant disease burden in the United States and developed world. This article examines current trends in the treatment of acute diverticulitis and concentrates on the utility of antibiotics in acute uncomplicated cases managed in the outpatient setting. Methods: The literature was reviewed for randomized controlled trials (RCTs) to discern the best practice and recommendations for antibiotics for diverticulitis. The time period included relevant RCTs after 2000. Results: Four recent RCTs examine the use of antibiotics in acute uncomplicated diverticulitis. The AVOD study was an RCT that managed inpatients with either antibiotics or IV fluids alone and demonstrated non-inferiority of non-antibiotic management with respect to recovery, complication rates, or recurrence. The DIABLO trial randomized first episodes of acute uncomplicated diverticulitis admitted to the hospital with antibiotics or supportive care and found no difference in morbidity or mortality between the two groups and longer hospital stay for patients treated with antibiotics. The DINAMO study examined outpatients managed with antibiotics by mouth or without and found no difference in morbidity in 90 day follow-up. The STAND study was the only of these four to use a placebo and found no difference between hospital stay or other adverse events at 30 days. In response to this, the ASCRS, AAFP and other societies now recommend against the routine use of antibiotics in acute uncomplicated diverticulitis. Conclusions: Several quality studies found similar outcomes in cases of acute uncomplicated diverticulitis treated with or without antibiotics. Based on these findings, societal guidelines do not recommend routine antibiotics for acute diverticulitis.

Pseudomonas monteilii bacteremia and sepsis following insertable cardiac monitor implantation: a case report

BackgroundInsertable cardiac monitor implantation is a simple and safe procedure commonly performed in patients with embolic stroke with undetermined source. Routine periprocedural antibiotic use is not recommended, because infection rate is very low, although some local infection or gram-positive bacteremia have been reported. We report a case of Pseudomonas monteilii sepsis immediately after insertable cardiac monitor implantation.Case presentationA 55-year-old Korean male with embolic stroke of undetermined source presented with gram-negative sepsis immediately after implantable cardiac monitor implantation as a first reported complication after the procedure. Pseudomonas monteilii was identified in the blood culture, and no other infection source was seen. He was treated with intravenous antibiotics without removing the device.ConclusionsPrompt diagnosis and adequate management is required in such a patient with sepsis post-insertable cardiac monitor implantation procedure. It can be managed with adequate antibiotic treatment without device removal if there is no sign of inflammation at the insertion site. Further reports or studies should be investigated to reinforce this finding.Learning objectivesThe infection rate after insertable cardiac monitor insertion is extremely low; however, sepsis may occur without pocket infections. Physicians should be aware of signs of systemic infection, particularly when the procedure is performed outside the catheterization room. Sepsis after insertable cardiac monitor implantation can be managed with adequate antibiotic treatment without device removal if there is no sign of inflammation at the insertion site.

Antibiotic administration for open reduction internal fixation of closed ankle fractures: Is one preoperative dose enough?

Although preoperative antibiotics are used routinely in ankle fracture surgery, there is considerable variability in postoperative antibiotic dosing regimens amongst surgeons. The aim of this study is to compare the rate of surgical site infection (SSI) in patients receiving one dose of preoperative antibiotics to patients who received more than one dose of antibiotics. A single-center Level I Trauma Center retrospective review of patients with isolated closed ankle fractures who underwent open reduction internal fixation over a 10-year period was performed. Demographics data and risk factors were obtained from the electronic medical record. SSI was detected using a text-mining algorithm on all postoperative clinic notes. Factors associated with the development of SSI or increased antibiotic dosing were evaluated. Eight-hundred and twenty-six patients were included in the analysis. There was no correlation between infection rate and any of the potential risk factors evaluated. Two-hundred and ninety-two patients received only one dose of antibiotics preoperatively and 534 patients received more than one antibiotic dose. The rate of SSI was not significantly different between the single-dose cohort (5.8 %) and the multi-dose cohort (3.9 %) (p=0.215). Routine use of postoperative antibiotics in open reduction internal fixation of closed ankle fractures did not decrease the rate of SSI, regardless of associated comorbidities. LEVEL OF EVIDENCE: Level III (therapeutic retrospective cohort study).

Infection rates during eras of intrathecal antibiotic use followed by antibiotic-impregnated catheter use in prevention of cerebrospinal fluid shunt infection.

The Hydrocephalus Clinical Research Network (HCRN) implemented a perioperative infection prevention bundle for all CSF shunt surgeries in 2007 that included the relatively unproven technique of intrathecal instillation of the broad-spectrum antibiotics vancomycin and gentamicin into the shunt. In the meantime, the field debated the use of antibiotic-impregnated catheter (AIC) shunt tubing using clindamycin and rifampin, an increasingly widespread, but expensive and controversial, technique. It is unknown whether there were changes in infecting organisms associated with the use of these techniques during CSF shunt surgery at the hospital level. Key comparison periods include during the use of intrathecal antibiotics (period 1 from June 1, 2007, to December 31, 2011, at HCRN hospitals) and AIC (period 2 from January 1, 2012, to December 31, 2015, at HCRN as well as increasing over time at non-HCRN hospitals) and only standard use of routine prophylactic antibiotics (period 1 at non-HCRN hospitals). The aim of this study was to examine rates of CSF shunt surgery-related infections from 2007 to 2012 at the hospital level, including HCRN and non-HCRN hospitals, with a focus on infections with gram-negative organisms. The authors conducted a retrospective observational cohort study at 6 children's hospitals with enrollment from 2007 to 2012 and surveillance through 2015. Bimonthly rates of shunt surgery-related infections were summarized to produce an overall hospital-specific time series, as well as by HCRN/non-HCRN status. An interrupted time series analysis was performed to assess the impact of change in HCRN perioperative infection prevention bundle on overall bimonthly infection rates. Quarterly rates of gram-negative shunt surgery-related infections were summarized to produce an overall hospital-specific time series. The overall bimonthly CSF shunt infection rate over time did not change significantly from 2007 to 2012. There was no difference in the trajectory of infection rates between HCRN and non-HCRN hospitals during the entire study period. No change in distributions of gram-negative organism infections was observed in hospitals from 2007 to 2015. There were no differences observed in hospital-level infection rates for low-risk patients undergoing CSF shunt surgery. This included analyses based on participation in the HCRN network, given their regular use of intrathecal antibiotics in period 1 and a focus on gram-negative infections with increasing adoption of AICs in period 2.

The Impact of Surgical Bowel Preparation on the Microbiome in Colon and Rectal Surgery.

Preoperative bowel preparation, through iterations over time, has evolved with the goal of optimizing surgical outcomes after colon and rectal surgery. Although bowel preparation is commonplace in current practice, its precise mechanism of action, particularly its effect on the human gut microbiome, has yet to be fully elucidated. Absent intervention, the gut microbiota is largely stable, yet reacts to dietary influences, tissue injury, and microbiota-specific byproducts of metabolism. The routine use of oral antibiotics and mechanical bowel preparation prior to intestinal surgical procedures may have detrimental effects previously thought to be negligible. Recent evidence highlights the sensitivity of gut microbiota to antibiotics, bowel preparation, and surgery; however, there is a lack of knowledge regarding specific causal pathways that could lead to therapeutic interventions. As our understanding of the complex interactions between the human host and gut microbiota grows, we can explore the role of bowel preparation in specific microbiome alterations to refine perioperative care and improve outcomes. In this review, we outline the current fund of information regarding the impact of surgical bowel preparation and its components on the adult gut microbiome. We also emphasize key questions pertinent to future microbiome research and their implications for patients undergoing colorectal surgery.

Prophylactic Intracameral Antibiotics and Endophthalmitis After Cataract Surgery

Although the effectiveness of intracameral antibiotics to prevent postoperative endophthalmitis is described, selective use of antibiotics combined with 1% povidone iodine disinfection might be equally effective and could lead to cost reduction and avoidance of unnecessary use of antibiotics. To compare the incidence of postoperative endophthalmitis when 1% povidone iodine disinfection is applied in combination with selective intracameral antibiotics with the incidence after routine use of intracameral antibiotics in combination with 5% povidone iodine. This was a retrospective cohort study using incidence data from the ongoing endophthalmitis register of the Rotterdam Eye Hospital, a specialized hospital providing both secondary and tertiary ophthalmological care, when intracameral antibiotics were used only during cataract procedures with occurrence of a posterior capsular tear in comparison with results from cohorts described in the literature where routine antibiotics were used. All patients who had cataract (phacoemulsification) surgery at the Rotterdam Eye Hospital between 1993 and 2022 were included. No cataract surgical procedures combined with other intraocular procedures were included. Povidone iodine disinfection and intracameral antibiotics during cataract surgery either routinely or only in case of posterior capsular tears. Postoperative endophthalmitis incidence. Postoperative endophthalmitis incidence after 56 598 cataract (phacoemulsification) surgical procedures in the Rotterdam Eye Hospital between 2016 and 2022 was 0.000 (95% CI, 0.000-0.000). A PubMed literature search until September 2023 with respect to the incidence of postoperative endophthalmitis after routine antibiotic prophylaxis yielded 37 publications with an overall postoperative endophthalmitis incidence of 0.000 (95% CI, 0.000-0.000). No difference was observed between the postoperative endophthalmitis incidence during the last 7 years in the Rotterdam Eye Hospital and the overall postoperative endophthalmitis incidence after routine intracameral antibiotics prophylaxis as described in the literature. Disinfection with 1% povidone iodine in combination with selective antibiotic prophylaxis may be equally effective as routine antibiotic use and 5% povidone iodine.

A Transperineal Biopsy of the Prostate Does Not Require Routine Antibiotic Cover.

Introduction A transperineal ultrasound-guided prostate biopsy (TPB) under local anaesthetics (LA) after a prostate MRI scan is the gold standard for performing a prostate biopsy in patients with suspected prostate cancer. It has superseded transrectal ultrasound-guidedprostate biopsy (TRUSB). Historically, TRUSB by definition was performed in a contaminated environment and was routinely covered with antibiotics to reduce the risks of infection. Despite this, the rate of post-biopsy urosepsis has been documented to be as high as 5% in some series. In the transition from TRUSB to the establishment of a TPB under LA service in our unit, we continued to use a single dose of oral antibiotics for all patients attending for biopsy. The aim of this study is to establish whether the use of single-dose antibiotics has any effect on morbidity rates post-TPB. Methods A retrospective analysis of complications was carried out on 326 consecutive patients, who underwent TPB over a six-month period. One cohort of patients were biopsied with no antibiotic cover (n=149, 45.7%) as compared to another cohort who were given a single dose of oral antibiotics (n=177, 54.3%). Those patients in the group receiving antibiotics received either a single dose of co-amoxiclav or a single dose of ciprofloxacin. Patients with indwelling urethral catheters or with a urinary tract infection (UTI) were excluded from the analyses. All patients were followed- up after a multidisciplinary team meeting discussion (MDT) with either a telephone or a face-to-face consultation. Results A total of 324 (99.4%) patients did not report post-procedural complications. Two patients from the antibiotic group presented with infectious complications (1.1%); one patient was admitted with a prostate abscess and required drainage under general anaesthesia, and another was admitted with urosepsis requiring intravenous antibiotics. In the group who did not receive antibiotics, there were no complications reported, which was not significantly different compared to the antibiotic group (p=0.50). Conclusion Our results demonstrate that the routine use of single-dose antibiotics with TPB does not affect morbidity rates. On the basis of this investigation, we have now stopped using routine antibiotic cover for patients undergoing an LA TPB.

Early vs. late lead extraction in CIED infections: evaluating the interplay of infection type, timing, and comorbidities

Abstract Background Cardiovascular Implantable Electronic Devices (CIEDs) may be associated with peri- and post-procedural complications like device-related infection, one of the most serious challenge of CIEDs therapy associated with significant morbidity, mortality, and financial healthcare burden. Despite a routine use of antibiotics, recent studies reported an increase in CIEDs infections, with or without systemic involvement, that often require surgical interventions like transvenous lead extraction. Purpose This study evaluates the outcomes of transvenous lead extraction in patients with infected CIEDs, focusing on the impact of early versus delayed extraction timing on patient outcomes. Methods A retrospective analysis of 165 patients who underwent transvenous lead extraction for CIED infections between 2019 and 2022 was conducted. Patients were categorized into systemic (n=64) or local (n=101) infection groups and further into early (within 7 days from admission, n=102) or delayed (after 7 days, n=63) extraction groups. Post-procedural outcomes, including septic shock, complications, and mortality rates were described. Results The majority of patients were male (75%) with a median age of 73 (IQR 64-80) years. In the early extraction group, the 1-year mortality rate was significantly lower at 6.4%, compared to 25% in the delayed group. Patients with systemic infections had higher 1-month and 1-year mortality rates compared to those with local infections. The success rates of complete device removal were similar across groups. However, the delayed extraction group exhibited higher rates of comorbidities like anemia, chronic kidney disease, and elevated C-reactive protein levels, which were prevalent in 70% of these patients, compared to 45% in the early extraction group. Conclusions Timely management of CIED infections is crucial for improving patient outcomes. Early extraction within 7 days from hospital admission is associated with significantly lower mortality, regardless of local or systemic infection. Patients undergoing delayed extraction often present with greater comorbidity, which may contribute to their higher mortality rates. This underscores the importance of considering patient comorbidities and prompt intervention in managing CIED infections.

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.

Studies on Benefits of Organic Food Products in Human Life during Covid-19

Organic food products have gained considerable attention in recent years due to their perceived health and environmental benefits. This comprehensive review examines the scientific evidence surrounding the advantages of consuming organic foods compared to conventionally produced counterparts. Firstly, organic farming practices emphasize the use of natural fertilizers and biological pest control methods, avoiding synthetic pesticides and genetically modified organisms (GMOs). Numerous studies have demonstrated that organic produce tends to have lower pesticide residues, reducing the potential health risks associated with pesticide exposure. Moreover, organic farming promotes soil health and biodiversity by minimizing the use of synthetic chemicals and fostering sustainable agricultural practices. Healthy soils are essential for nutrient-rich crops and contribute to long-term environmental sustainability. Additionally, organic agriculture typically utilizes crop rotation and intercropping techniques, which enhance soil fertility and resilience. Furthermore, organic livestock production adheres to stringent animal welfare standards, including access to outdoor grazing and the prohibition of routine antibiotic use and growth hormones. As a result, organic meat, dairy, and poultry products often contain higher levels of beneficial nutrients such as omega-3 fatty acids and antioxidants. In terms of nutritional quality, several meta-analyses have suggested that organic fruits and vegetables may have slightly higher levels of certain vitamins, minerals, and antioxidants compared to conventionally grown counterparts. While the differences may be modest, the cumulative effects of consuming organic foods over time could contribute to improved overall health outcomes. Beyond individual health benefits, supporting organic agriculture also has positive implications for environmental conservation and sustainable food systems. By minimizing chemical inputs and promoting biodiversity, organic farming helps mitigate soil erosion, water pollution, and greenhouse gas emissions associated with conventional agriculture.

Is Antibiotic Prophylaxis Needed for the Extraction of Premolars for Orthodontic Purposes?

Introduction Antibiotic prophylaxis for tooth extractions is a common practice in dentistry to prevent postoperative infections. However, the routine use of antibiotics has been questioned due to concerns about bacterial resistance and potential side effects. This study aimed to evaluate the necessity of postoperative antibiotics in patients undergoing orthodontic tooth extraction. Materials and methods This prospective study involved 100 patients requiring orthodontic tooth extraction, divided into two groups. The patients were recruited from Saveetha Dental College and Hospital, Chennai, India, after obtaining approval from the Institutional Human Ethics Committee, Saveetha Dental College (approval number: IHEC/SDC/OMFS-2103/23/293). Group 1 (n = 50) received antibiotics (amoxicillin 500 mg, three times a day for three days) after extraction, while Group 2 (n = 50) did not receive antibiotics. Postoperative infection was assessed on postoperative days (POD) 3and 7.Data analysis was conducted using IBM SPSS Statistics for Windows, version 26.0 (released 2019, IBM Corp., Armonk, NY). Categorical variables were presented as frequencies and percentages, and differences between groups were assessed using chi-square or Fisher's exact tests. A p-value of <0.05 was considered statistically significant. Results The incidence of postoperative infection was recorded in both groups. In group 1 at POD 3 and POD 7, there were two patients and one patientwith infection, respectively. In group 2 at POD 3 and POD 7, there were four patients and two patients with infection, respectively. Conclusion The findings of this study suggest that the routine administration of antibiotics for the non-traumatic extraction of teethin healthy patients might not be necessary. The absence of postoperative infections in patients who did not receive antibiotics indicates that antibiotics may be avoidable in many cases of orthodontic tooth extraction. These results emphasize the importance of reconsidering the widespread use of antibiotics to combat the growing concern of bacterial resistance. Antibiotics should be prescribed judiciously, only for patients with specific medical conditions who are prone to infection. One of the limitations of this study is the limited sample size; hence, studies with larger and heterogeneous groups should be done to validate the same.

Antibiotics for inflammatory bowel disease: Current status.

There is abundant literature reporting about the use of antibiotics in inflammatory bowel disease (IBD), but their role in the management of IBD is not entirely clear. Diverse infectious organisms have been implicated in the pathogenesis of Crohn's disease. Also, infections are believed to be a trigger for flares of ulcerative colitis. The benefit of the routine use of antibiotics in IBD is equivocal. However, there are certain situations, where antibiotics have a clear role and evidence of benefit: perianal fistula, intra-abdominalabscesses in Crohn's disease, acute pouchitis and infection-related flares. However, there is a lack of supportive evidence for the routine use of antibiotics in all disease-related flares. Evidence indicates a lack of benefit of intravenous antibiotics in acute severe ulcerative colitis and only limited benefit in active ulcerative colitis. Limited evidence suggests the role of a combination of oral antibiotics in pediatric ulcerative colitis. Certain targeted antibiotic regimens have been used in IBD. In ulcerative colitis, limited evidence suggests the benefit of the use of an antibiotic cocktail directed against Fusobacterium varium. Therapy directed against Escherichia coli does not seem to have a benefit in inflammatory Crohn's disease. In Crohn's disease, antimycobacterial therapy may result in symptomatic improvement but no durable benefit. Antitubercular therapy (ATT), on the contrary, may result in fibrotic transformation, suggesting a need to avoid misdiagnosis and limit the duration of ATT in Crohn's disease. This review assesses the published literature with respect to antibiotic use and provides guidance to clinicians in appropriate antibiotic use in various situations in the setting of IBD.

Office-based Magnetic Resonance Imaging–guided Transperineal Prostate Biopsy Without Antibiotic Prophylaxis: A Real-world Clinical Utility Study

Advances in for magnetic resonance imaging (MRI)-guided transperineal biopsy (TPBx) techniques have facilitated outpatient prostate biopsies under local anaesthesia to lower postbiopsy infection rates. However, there is debate regarding antibiotic prophylaxis because of concerns regarding antibiotic resistance and interactions. Our objective was to assess the transition from office-based transrectal biopsy to TPBx performed under local anaesthesia without antibiotic prophylaxis despite potential risk factors for infectious complications. We conducted a prospective assessment of 665 men undergoing office-based MRI-guided TPBx. The primary outcome was the rate of urosepsis or febrile urinary tract infections requiring hospitalisation and/or antibiotics within 2 wk after biopsy. Secondary outcomes included patient-reported procedure tolerability and the prostate cancer detection rate. TPBx using a median of nine cores per patient (range 4-15) detected prostate cancer in 534/665 men (80%). Only four men (0.6%) were hospitalised for suspected postbiopsy infection; no patient experienced urosepsis. The TPBx procedure was well tolerated, with low pain scores (median Visual Analogue Scale score of 2, interquartile range [IQR] 1-3) and positive patient ratings (median rating 1 [no problem], IQR 1-2). Limitations include the single-centre analysis and lack of randomisation for antibiotic prophylaxis. An office-based TPBx strategy under local anaesthesia without antibiotic prophylaxis is well tolerated and has a very low risk of side effects. This approach should be considered as the standard of care. Further studies may determine if a subgroup of predisposed men could benefit from antibiotic prophylaxis. For prostate biopsy the sampling needle can be inserted through the rectum or through the perineum, which is the skin between the rectum and the scrotum. Our study confirms that in everyday clinical practice, prostate biopsy via the perineum can be carried out under local anaesthetic and without routine use of antibiotics because of its lower risk of infection. Patients reported low pain scores and positive ratings for the overall experience.

Analysis and suggestions on the complications in 2000 cases of transvaginal natural orifice transluminal endoscopic surgery: Can it be a conventional surgery?

To reflect on the complications of transvaginal natural orifice transluminal endoscopic surgery (vNOTES), identify the corresponding risk factors, and provide caution to surgeons when performing this novel surgery. A retrospective study was carried out among 2000 patients in our hospital who underwent vNOTES between May 2019 and May 2022. Perioperative complications were stratified in chronologicalorder and divided into those developed while establishing the vNOTES approach, during surgery, postoperatively, and 1 month after discharge. The complications were classified based on the Modified Clavien-Dindo classifications. The causes of each type III/IV complication were analyzed. Of the 2000 patients, 88 (4.4%) experienced complications, which is not higher than that reported in laparoendoscopic surgery in previous studies. Grade I, II, III, IV, and V complications developed in 19 (0.95%), 57 (2.85%), 11 (0.55%), 1 (0.05%), and 0 (0%) patients, respectively. Complications were developed while establishing the approach platform, during the surgery, postoperatively, and within 1 month after discharge in 5 (0.25%), 30 (1.50%), 50 (2.50%), and 3 (0.15%) patients, respectively. Eight patients (0.4%) underwent conversion, including five cases of rectal injury repair. The summarized suggestions were divided into three levels. Considering the security and effectiveness of vNOTES, it can be routinely used in various gynecologic operations. However, surgeons should focus on preoperative evaluation, strictly conduct preoperative disinfection, conform to prompt conversion during surgery, call for the presence of experienced doctors, and have routine use of antibiotics to prevent postoperative infections. ChiCTR2100053483.