Incidence of postoperative anastomotic leak and surgical site infection amongst colorectal ERAS patients receiving only oral antimicrobial prophylaxis preoperatively

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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ANTIMICROBIAL PROPHYLAXIS TO PREVENT SURGICAL SITE INFECTION

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200605000-00028 ◽

2006 ◽

Vol 88 (5) ◽

pp. 1149-1150

Author(s):

JOSEPH BERNSTEIN ◽

MENACHEM M. MELLER

Keyword(s):

Surgical Site Infection ◽

Antimicrobial Prophylaxis ◽

Site Infection

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Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1086/509845 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 23

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30];P< .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55];P< .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84];P< .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79];P< .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89];P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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Relationship between timing of surgical antimicrobial prophylaxis and surgical site infection in a tertiary-care hospital

Drugs & Therapy Perspectives ◽

10.1007/s40267-016-0347-9 ◽

2016 ◽

Vol 32 (12) ◽

pp. 539-544

Author(s):

Tejas Khakhkhar ◽

Rima Shah ◽

K. G. Hemavathi

Keyword(s):

Surgical Site Infection ◽

Tertiary Care Hospital ◽

Antimicrobial Prophylaxis ◽

Tertiary Care ◽

Care Hospital ◽

Site Infection ◽

Surgical Antimicrobial Prophylaxis

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Infection and Antimicrobial Use in Laparoscopic Cholecystectomy

Infection Control and Hospital Epidemiology ◽

10.1086/501685 ◽

1999 ◽

Vol 20 (9) ◽

pp. 624-626 ◽

Cited By ~ 30

Author(s):

Maryanne McGuckin ◽

Judy A. Shea ◽

J. Sanford Schwartz

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Site Infection ◽

Infection Rate ◽

Chart Review ◽

Antimicrobial Prophylaxis ◽

Retrospective Chart Review ◽

Low Risk ◽

Antimicrobial Use ◽

Site Infection ◽

Surgical Site Infection Rate

AbstractRetrospective chart review of 1,702 patients undergoing laparoscopic cholecystectomy (LC) revealed an overall infection rate of 2.3% and a surgical-site infection rate of 0.4%. Preoperative antimicrobial prophylaxis was received by 79% of patients, but only 33% of these received the agent within 1 hour or less prior to surgery. These facts suggest that antimicrobial prophylaxis may not be necessary for low-risk LC patients.

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Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline–based antimicrobial prophylaxis in lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.4.7 ◽

2007 ◽

Vol 6 (4) ◽

pp. 327-329 ◽

Cited By ~ 51

Author(s):

Masahiro Kanayama ◽

Tomoyuki Hashimoto ◽

Keiichi Shigenobu ◽

Fumihiro Oha ◽

Daisuke Togawa

Keyword(s):

Single Dose ◽

Lumbar Spine ◽

Surgical Site Infection ◽

Spine Surgery ◽

Multiple Dose ◽

Dose Group ◽

Antimicrobial Prophylaxis ◽

Lumbar Spine Surgery ◽

Site Infection ◽

Control And Prevention

Object Antimicrobial prophylaxis (AMP) reduces the rate of surgical site infection (SSI) in lumbar spine surgery, but a great deal of variation exists regarding the timing and duration of AMP. The authors had previously used prophylactic antibiotics for 5 to 7 postoperative days. Based on the Centers for Disease Control and Prevention (CDC) guideline, the AMP period was changed to the day of surgery only. In the current study, the authors compared the rate of SSI in lumbar spine surgeries between two different protocols of AMP. Methods Data from 1597 consecutive uninfected patients who had undergone lumbar spine surgery between January 1999 and September 2004 were reviewed. The pathophysiologies among these patients included disc herniation in 686, degenerative spondylolisthesis in 340, spinal stenosis in 259, failed lumbar surgeries in 73, degenerative scoliosis in 52, isthmic spondylolisthesis in 48, spinal trauma in 34, foraminal stenosis in 27, spinal tumor in 27, and miscellaneous in 51 patients. The rate of SSI was compared between the two AMP groups. There were 1133 patients in the multiple-dose group, and 464 patients in the single-dose group. The rate of instrumentation surgery was not statistically different between the multiple-dose group (43%) and the single-dose group (39%). The overall rate of SSI was 0.7%. The SSI rate was 0.8% in the multiple-dose group and 0.4% in the single-dose group; the difference between the two was not significant. Regarding the organisms of SSI, resistant strains of bacteria were cultured in five (83.3%) of six patients in the multiple-dose group, whereas none was cultured in the single-dose group. Conclusions Data in the current study did not demonstrate a difference in the rate of SSI between the two different AMP protocols. Based on the CDC guideline, a single dose of AMP was proven to be efficacious for the prevention of SSI in lumbar spine surgeries. A shorter duration of first-generation cephalosporin use may effectively prevent the emergence of antibiotic-resistant bacterial infection.

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