Extended antibiotic prophylaxis for prevention of surgical-site infections in morbidly obese women who undergo combined hysterectomy and medically indicated panniculectomy: a cohort study

Background: The aim of the present study is to investigate the role of the colonization of suture thread to identify patients at risk of developing a surgical site infection (SSI) after clean surgical procedures. Methods: Patients who underwent elective clean surgery procedures at the Surgery Unit of the AOU-University of Campania Luigi Vanvitelli in a 21-month period were prospectively enrolled. For each patient, a synthetic absorbable thread in Lactomer 9-1 was inserted into the surgical site at the end of surgery and microbiologically evaluated after 48 h. Antibiotic prophylaxis was chosen according to international guidelines. Results: A total of 238 patients were enrolled; 208 (87.4%) of them were subjected to clean procedures without the placement of prosthesis, and 30 (12.6%) with prosthesis. Of the 238 patients, 117 (49.2%) underwent an antimicrobial prophylaxis. Overall, 79 (33.2%) patients showed a bacterial colonization of the thread: among the 208 without the implantation of prosthesis, 19 (21.8%) of the 87 with antibiotic prophylaxis and in 58 (47.9%) of the 121 without it; among the 30 patients with the implantation of prosthesis, only two patients showed a colonized thread. The patients with antibiotic prophylaxis developed a colonization of the thread less frequently than those without it (17.9% vs. 47.9%, p < 0.001). SSI was observed in six (2.5%) patients, all of them showing a colonized thread (7.6% vs. 0%, p < 0.001). The bacteria identified in colonized threads were the same as those found in SSIs. Conclusions: Our study presents a new method that is able to precociously assess patients who have undergone clean procedures who may develop SSI, and identify the microorganism involved.

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341: Negative pressure wound therapy reduces cesarean delivery surgical site infections in morbidly obese women

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.11.599 ◽

2017 ◽

Vol 216 (1) ◽

pp. S207 ◽

Cited By ~ 2

Author(s):

Margaret S. Villers ◽

Maeve K. Hopkins ◽

Benjamin S. Harris ◽

Leo R. Brancazio ◽

Chad A. Grotegut ◽

...

Keyword(s):

Cesarean Delivery ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Surgical Site Infections ◽

Morbidly Obese ◽

Obese Women ◽

Wound Therapy

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Hysteroscopic Sterilization in Morbidly Obese Women: A Cohort Study

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2009.08.271 ◽

2009 ◽

Vol 16 (6) ◽

pp. S73

Author(s):

S.A. El-Nashar ◽

M.R. Hopkins ◽

D.J. Creedon ◽

E.T. Carey ◽

A.O. Famuyide

Keyword(s):

Cohort Study ◽

Morbidly Obese ◽

Obese Women

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Prevention and Management of Surgical Site Infections in Morbidly Obese Women

Obstetrics and Gynecology ◽

10.1097/aog.0b013e3181945625 ◽

2009 ◽

Vol 113 (2, Part 1) ◽

pp. 411-415 ◽

Cited By ~ 22

Author(s):

Christine Walsh ◽

Courtney Scaife ◽

Harriet Hopf

Keyword(s):

Surgical Site Infections ◽

Morbidly Obese ◽

Obese Women

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Effect of compliance with an antibiotic prophylaxis protocol in surgical site infections in appendectomies. Prospective cohort study

Cirugía y Cirujanos (English Edition) ◽

10.1016/j.circen.2017.05.013 ◽

2017 ◽

Vol 85 (3) ◽

pp. 208-213

Author(s):

Tomás Sánchez-Santana ◽

Juan Antonio del-Moral-Luque ◽

Pablo Gil-Yonte ◽

Luis Bañuelos-Andrío ◽

Manuel Durán-Poveda ◽

...

Keyword(s):

Cohort Study ◽

Antibiotic Prophylaxis ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Surgical Site Infections

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Antibiotic Prophylaxis for Cesarean Delivery: A Survey of Anesthesiologists

Anesthesiology Research and Practice ◽

10.1155/2020/3741608 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Emily S. Reiff ◽

Ashraf S. Habib ◽

Brendan Carvalho ◽

Karthik Raghunathan

Keyword(s):

Antibiotic Prophylaxis ◽

Cesarean Delivery ◽

Online Survey ◽

Current Practice ◽

Obstetric Anesthesia ◽

Substantial Improvement ◽

Morbidly Obese ◽

Obese Women ◽

Infectious Morbidity ◽

Cesarean Deliveries

Background. The most common complication after cesarean delivery is surgical site infection. Antibiotic prophylaxis reduces infectious morbidity and current anesthetic quality metrics include preincision antibiotic prophylaxis. Recently, studies suggest reductions in infectious morbidity with the addition of azithromycin for unscheduled cesarean delivery. Larger doses of cefazolin are recommended for morbidly obese women, but evidence is conflicting. The aim of this study was to survey anesthesiologists to assess current practice for antibiotic prophylaxis for cesarean delivery. Methods. We invited a random sample of 10,000 current members of the American Society of Anesthesiologists to complete an online survey about their current practice of antibiotic prophylaxis for cesarean delivery in November 2017. The survey included questions similar to a previous survey on this topic in 2012. Results. The response rate was 12.2% (n = 1223). Most respondents had at least 15 years of experience (684, 55.9%), work at a nonteaching or community hospital (729, 59.6%), with >500 cesarean deliveries annually (619, 50.6%), and administer obstetric anesthesia several times a week (690, 56.4%). Routine preincision antibiotic prophylaxis was reported by 1162 (95.0%) of the 1223 respondents, a substantial improvement versus the 63.5% reported in the previous study in 2012. For intrapartum cesarean deliveries, 141 (11.5%) administer azithromycin for unscheduled cesarean deliveries. Those who use cefazolin, 509 (42.5%) administer 3 g for morbidly obese women. Conclusion. Adherence to preincision antibiotic prophylaxis for cesarean delivery is very high, a significant improvement within 5 years. A minority of anesthesiologists utilize azithromycin for intrapartum cesarean deliveries. The dose of cefazolin for morbidly obese women varies widely.

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Faculty Opinions recommendation of Minimally Invasive Surgery in Morbidly Obese Women.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.737043468.793570312 ◽

2020 ◽

Author(s):

Eva Chalas

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Morbidly Obese ◽

Obese Women

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A new customised placental weight standard redefines the relationship between maternal obesity and extremes of placental size and is more closely associated with pregnancy complications than an existing population standard

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174419000576 ◽

2019 ◽

Vol 11 (4) ◽

pp. 350-359

Author(s):

Jacqueline M. Wallace ◽

Joeleita P. Agard ◽

Graham W. Horgan

Keyword(s):

Pregnancy Complications ◽

Maternal Obesity ◽

Population Based ◽

Multiple Regression Model ◽

Placental Weight ◽

Morbidly Obese ◽

Obese Women ◽

Entire Cohort ◽

Multiparous Women ◽

The Difference

AbstractPlacental weight is a valuable indicator of its function, predicting both pregnancy outcome and lifelong health. Population-based centile charts of weight-for-gestational-age and parity are useful for identifying extremes of placental weight but fail to consider maternal size. To address this deficit, a multiple regression model was fitted to derive coefficients for predicting normal placental weight using records from healthy pregnancies of nulliparous/multiparous women of differing height and weight (n = 107,170 deliveries, 37–43 weeks gestation). The difference between actual and predicted placental weight generated a z-score/individual centile for the entire cohort including women with pregnancy complications (n = 121,591). The association between maternal BMI and placental weight extremes defined by the new customised versus population-based standard was investigated by logistic regression, as was the association between low placental weight and pregnancy complications. Underweight women had a greater risk of low placental weight [<10thcentile, OR 1.84 (95% CI 1.66, 2.05)] and obese women had a greater risk of high placental weight [>90th centile, OR 1.98 (95% CI 1.88, 2.10)] using a population standard. After customisation, the risk of high placental weight in obese/morbidly obese women was attenuated [OR 1.17 (95% CI 1.09, 1.25)]/no longer significant, while their risk of low placental weight was 59%–129% higher (P < 0.001). The customised placental weight standard was more closely associated with stillbirth, hypertensive disease, placental abruption and neonatal death than the population standard. Our customised placental weight standard reveals higher risk of relative placental growth restriction leading to lower than expected birthweights in obese women, and a stronger association between low placental weight and pregnancy complications generally. Further, it provides an alternative tool for defining placental weight extremes with implications for the placental programming of chronic disease.

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A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection

Antibiotics ◽

10.3390/antibiotics10070768 ◽

2021 ◽

Vol 10 (7) ◽

pp. 768

Author(s):

Yoann Varenne ◽

Stéphane Corvec ◽

Anne-Gaëlle Leroy ◽

David Boutoille ◽

Mỹ-Vân Nguyễn ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Bone Tumor ◽

Tumor Resection ◽

Surgical Site Infections ◽

Implant Removal ◽

Pelvic Bone ◽

Resistance Pattern ◽

Cure Rate ◽

Implant Retention ◽

The Impact

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

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