"Antibiotic prophylaxis" and "preventive antibiotic therapy": two sides of the same coin.

OBJECT External ventricular drains (EVDs) are commonly used for CSF diversion but pose a risk of ventriculitis, with rates varying in frequency from 2% to 45%. Results of studies examining the utility of prolonged systemic antibiotic therapy for the prevention of EVD-related infection have been contradictory, and no study to date has examined whether this approach confers additional benefit in preventing ventriculitis when used in conjunction with antibiotic-coated EVDs (ac-EVDs). METHODS A prospective performance analysis was conducted over 4 years to examine the impact of discontinuing systemic antibiotic prophylaxis after insertion of an ac-EVD on rates of catheter-related ventriculitis. Ventriculitis and other nosocomial infections were ascertained by a qualified infection disease nurse using definitions based on published standards from the Centers for Disease Control and Prevention, comparing the period when patients received systemic antibiotic therapy for the duration of EVD treatment (Period 1) compared with only for the peri-insertion period (Period 2). Costs were analyzed and compared across the 2 time periods. RESULTS Over the 4-year study period, 866 patients were treated with ac-EVDs for a total of 7016 catheter days. There were 8 cases of ventriculitis, for an overall incidence of 0.92%. Rates of ventriculitis did not differ significantly between Period 1 and Period 2 (1.1% vs 0.4%, p = 0.22). The rate of nosocomial infections, however, was significantly higher in Period 1 (2.0% vs 0.0% in Period 2, p = 0.026). Cost savings of $162,516 were realized in Period 2 due to decreased drug costs and savings associated with the reduction in nosocomial infections. CONCLUSIONS Prolonged systemic antibiotic therapy following placement of ac-EVDs does not seem to reduce the incidence of catheter-related ventriculitis and was associated with a higher rate of nosocomial infections and increased cost.

Download Full-text

SYSTEMS APPROACH FOR ANTIBIOTICS IN COLORECTAL SURGERY IN GROWING ANTIMICROBIAL RESISTANCE BACKGROUND

Koloproktologia ◽

10.33878/2073-7556-2019-18-3-49-54 ◽

2019 ◽

Vol 18 (3(69)) ◽

pp. 49-54

Author(s):

Yu. M. Stojko ◽

V. G. Gusarov ◽

D. A. Kolozyan ◽

A. L. Levchuk ◽

A. V. Maksimenkov

Keyword(s):

Antibiotic Resistance ◽

Colorectal Surgery ◽

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Systems Approach ◽

Antibiotic Use ◽

Defined Daily Dose ◽

Empirical Antibiotic Therapy ◽

Septic Complications ◽

Extended Spectrum Beta Lactamases

AIM: to reduce antibiotic resistance of infectious agents in colorectal surgery using optimal antibiotic therapy. PATIENTS AND METHODS: single-center interventional study with retrospective control has been done. Start point of intervention was January 2017, when it was provided direct administrative control of perioperative antibiotic prophylaxis protocols and empirical antibiotic therapy. The study included 200 patients after colorectal surgery in 2016-2017. Patients divided in two groups: in 2016 y – control (A), in 2017 – interventional one (B). RESULTS: significant decrease was detected in total antibiotic use from 16.1 to 12.2 defined daily dose (DDD) and in duration of antibiotic prophylaxis from 5.5 to 1.9 days (p<0.001). Incidence of infection caused by multi-resistant strains reduced from 84.3% to 50% (p<0.001). Analysis of etiology septic complications in colorectal patients showed a decrease in the number of Enterobacteriales, producing extended-spectrum beta-lactamases (ESBL) from 33.3% to 11.8% (р<0.01). The incidence of carbapenem-resistant Klostridium pneumoniae reduced from 7.8% до 0%, р=0.031. ESKAPE group pathogens decreased from 24 (47.1%) to 12 (17.7%), р<0.001. No difference in postoperative infectious morbidity between groups was detected (32.9% vs 31.0%, р=0.88). Incidence of antibiotic-associated diarrhea decreased from 5% to 0% (р=0.03). CONCLUSION: direct control of antibiotic prophylaxis protocols and empirical antibiotic therapy allowed to decrease the rate of antibiotic use and to decrease rate of infection complications caused by antibiotic resistance strains.

Download Full-text

Mucogingival Abscess Following Implant Surgery

International Journal of Medical and Surgical Sciences ◽

10.32457/ijmss.2015.024 ◽

2018 ◽

Vol 2 (3) ◽

pp. 527-530

Author(s):

Ronald Garrido

Keyword(s):

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Antibiotic Treatment ◽

Bacterial Contamination ◽

Recommended Dose ◽

Postoperative Infections ◽

Implant Surgery

The rehabilitation of lost teeth, by means of implants has grown exponentially and thus the use of antibiotic therapy to prevent postoperative infectious pictures. The use of antibiotics has proved beneficial avoiding the failure of a large number of implants from bacterial contamination , in comparison to non-use of these . Although the use of antibiotic prophylaxis or treatment is controversial , studies suggest that antibiotic prophylaxis is more effective than antibiotic treatment in preventing postoperative infections, being 2g amoxicillin one hour before the recommended dose.

Download Full-text

A Study of Antibiotic Prophylaxis in Unconscious Patients

PEDIATRICS ◽

10.1542/peds.21.2.202 ◽

1958 ◽

Vol 21 (2) ◽

pp. 202-202

Keyword(s):

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Prophylactic Antibiotic ◽

Treated Group ◽

Pulmonary Complications ◽

Prophylactic Antibiotics ◽

Prophylactic Therapy ◽

Gram Negative ◽

Prophylactic Antibiotic Therapy ◽

Unconscious Patients

A group of 72 comatose patients with no evidence of infection were studied in order to establish the influence of prophylactic antibiotics on their subsequent course. Of this group, 32 were treated with penicillin and streptomycin or tetracycline, and 10 received sulfisoxazole or nitrofurantoin; the remaining 30 patients served as controls and received no prophylactic therapy. It was found that there was no difference in mortality between the treated and the untreated groups. However, pulmonary complications developed in 45% of the prophylactically treated group whereas only 15% of the untreated patients developed such complications. In the treated group, bacteremia due to a gram-negative rod occurred in two patients who died. In addition, the usual nasopharyngeal flora of the treated patients was replaced by gram-negative rods. The authors conclude that "prophylactic antibiotic therapy is of no benefit, and is distinctly hazardous in unconscious patients."

Download Full-text

Principles of antibiotic therapy

Perspectives in Surgery ◽

10.33699/pis.2019.98.4.137-144 ◽

2019 ◽

Vol 98 (4) ◽

pp. 137-144

Keyword(s):

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Antibiotic Stewardship ◽

Bacterial Infections ◽

Bacterial Resistance ◽

Antimicrobial Agents ◽

Bacterial Pathogens ◽

Comprehensive Approach ◽

Contemporary Medicine ◽

Selection Of

The paper describes the basic sources and principles of antibiotic therapy in contemporary medicine in which the ability to treat bacterial infections may be lost. The main reason for that is the increasing resistance of bacterial pathogens to antibiotics. A possible solution is to implement a comprehensive program of antibiotic stewardship incorporating adequate consideration of indication and selection of antimicrobial agents including appropriate duration and way of administration. Another important component of the comprehensive approach to bacterial resistance and antibiotic therapy is adequately applied antibiotic prophylaxis in surgery.

Download Full-text

THE POSSIBILITY OF USAGE MOXIFLOXACIN 0.5% SOLUTION IN PERIOPERATIVE PROPHYLAXIS IN CHILDREN

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2018-13-1-14-20 ◽

2018 ◽

Vol 13 (1) ◽

pp. 14-20 ◽

Cited By ~ 1

Author(s):

Maria V. Zaytseva ◽

V. V Brzheskiy ◽

M. O Malysheva ◽

T. V Baranova ◽

T. V Smol’janinova

Keyword(s):

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Staphylococcus Epidermidis ◽

Infectious Complications ◽

Healthy Children ◽

Postoperative Endophthalmitis ◽

Surgical Operation ◽

Second Stage ◽

The Third ◽

Perioperative Prophylaxis

Introduction. Nowadays the problem of postoperative endophthalmitis after intraocular operations remains unresolved. The aim of our research was to study the efficacy of a 0.5% solution of moxifloxacin in the perioperative prophylaxis of children. Material and methods. The study included 97 healthy children (113 eyes) aged from 1 month to 17 years. The swabs from conjunctival sac were taken three times. Results. The growth of microflora was detected in the conjunctival sac at 67.3% of cases. At 45.6% of cases Staphylococcus epidermidis was observed. The highest sensitivity of isolated microorganisms to Antibacterial drugs that are used topically in ophthalmology was shown to the moxifloxacin (95.8 %), ciprofloxacin (94,83%) and levofloxacin (90,5%). Staphylococcus epidermidis was discovered more often in the conjunctival cavity (53,3%, n=16) on the first swab in the second stage of the study. All microorganisms were sensitive to moxifloxacin. After taking a swab, the installation of 0.5% solution of moxifloxacin 1 drop 4 times daily the day before surgery was prescribed. The same drops were used and the second swab was taken in 1 hour and 30 minutes before surgical operation. In 9 cases (30%) Microflora was detected again, at 88.9% of the cases Staphylococcus epidermidis (n=8) was observed. 1 drop 4 times a day for 7 days of 0.5% solution of moxifloxacin was prescribed after surgery and after the course of antibiotic therapy third swab was taken. Microflora was detected in the eyes of two children also in the third study. Instillation of 0.5% solution of moxifloxacin is quite effective in the perioperative antibiotic prophylaxis of infectious complications of intraocular operations and significantly reduces the frequency of detection of microflora in the conjunctival cavity.

Download Full-text

Asplenia congenita

Medico e Bambino pagine elettr ◽

10.53126/mebxxiii196 ◽

2020 ◽

Vol 23 (8) ◽

pp. 196-200

Author(s):

Vanessa Migliarino ◽

Roberta Lapenna ◽

Alberto Comici ◽

Maria Paola Miani ◽

Samuele Naviglio ◽

...

Keyword(s):

Early Diagnosis ◽

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

High Frequency ◽

Autosomal Dominant ◽

Elevated Risk ◽

Autosomal Dominant Transmission ◽

Pneumococcal Sepsis ◽

Invasive Infections

The paper presents a case of congenital asplenia diagnosed occasionally in a child who previously presented with a pneumococcal sepsis. The case offers the opportunity to discuss about the elevated risk of severe invasive infections in patients with congenital asplenia and the importance of early diagnosis so to prevent infections by starting an antibiotic prophylaxis, adequate vaccinations and prompt antibiotic therapy with immediate medical consult in case of fever. First degree relatives should be concerned about the high frequency of autosomal dominant transmission of this condition and should be submitted to early follow-up.

Download Full-text

Compliance and Related Outcomes of Prophylactic Antibiotics in Traumatic Open Fractures

Hospital Pharmacy ◽

10.1177/0018578719836638 ◽

2019 ◽

Vol 55 (3) ◽

pp. 193-198

Author(s):

Hannah C. Johnson ◽

Abby M. Bailey ◽

Regan A. Baum ◽

Stephanie B. Justice ◽

Kyle A. Weant

Keyword(s):

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Prophylactic Antibiotic ◽

Retrospective Chart Review ◽

Antibiotic Use ◽

Infectious Complications ◽

Open Fractures ◽

Hospital Length Of Stay ◽

Prophylactic Therapy ◽

Guideline Compliance

Purpose: Prophylactic antibiotic therapy is a standard of care for patients who present with open fractures due to the risk of infectious complications. This study was conducted to characterize the use of initial prophylactic antibiotic use in open fractures, guideline compliance, and its impact on care. Methods: Retrospective chart review of adult patients presenting with an open fracture to a Level 1 Trauma Center Emergency Department over a 12-month period was conducted. Results: Of the 202 patients meeting inclusion criteria, overall compliance with guideline recommendations for antibiotic prophylaxis was found to be 33.2%. The duration of prophylactic therapy was significantly longer in the noncompliant group and among those who received a secondary antibiotic ( P < .05 for both comparisons). The duration of therapy was found to be significantly longer in those patients who developed an infection ( P < .001). Those who developed an infection had a longer hospital length of stay (LOS) ( P < .001) and intensive care unit LOS ( P = .002). In addition, those who developed an infection had significantly more surgeries ( P < .001) and received more red blood cell transfusions ( P < .001). Correlation analysis confirmed a significant association between infection and duration of antibiotic prophylaxis ( P = .02), number of surgeries ( P < .0001), and number of transfusions ( P < .0001). Conclusion: Guideline compliance was exceedingly low due to the extended duration of initial antibiotic therapy and did not appear to yield any clinical benefits. Infection was significantly associated with longer duration of initial prophylactic therapy and morbidity. Opportunities exist to elevate compliance with guidelines and to reevaluate prophylactic antimicrobial therapy in this setting.

Download Full-text

Cardiac surgery antibiotic prophylaxis and calculated empiric antibiotic therapy

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492314546028 ◽

2014 ◽

Vol 23 (3) ◽

pp. 282-288 ◽

Cited By ~ 6

Author(s):

Armin Gorski ◽

Khaled Hamouda ◽

Mehmet Özkur ◽

Markus Leistner ◽

Sebastian-Patrick Sommer ◽

...

Keyword(s):

Cardiac Surgery ◽

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Empiric Antibiotic Therapy ◽

Empiric Antibiotic

Download Full-text

The antibiotic therapy in pregnancy

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2016.4.7 ◽

2016 ◽

Vol 11 (4) ◽

pp. 331-336

Author(s):

Constantin Dimitrie NANU ◽

◽

Cătălina Diana STĂNICĂ ◽

Adrian NEACȘU ◽

Gabriela ONEAGA ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Therapy ◽

Antibiotic Prophylaxis ◽

Pregnant Women ◽

Development Stages ◽

Prophylactic Administration ◽

Embryotoxic Effect ◽

In Pregnancy

A number of drugs can cross the placenta, having a teratogenic and embryotoxic effect on the fetus. For more than half of the drugs currently used, we do not have appropriate studies in order to reveal their effects on the mother or fetus. However, 45-95% of pregnant women are taking medications during pregnancy, 7% of them are continuing a treatment for a disease diagnosed before pregnancy. 17% of pregnant women receive antibiotics. Antibiotic prophylaxis has created a dangerous “false security”, to circumvent then the aseptic and antiseptic traditional gestures. In obstetrics, antibiotic therapy should take into account the particular field of the host and the existence of the first development stages of the fetus until the end of pregnancy. Antibiotic therapy has an undeniable and important contribution in modern obstetrics, but their prophylactic administration does not cover technical, aseptic and antiseptic errors, producing also an antibiotic resistance. The use of antibiotic therapy is required in cases with higher risk: long labor, ruptured membranes, obstetrical maneuvers, dragged patients or with underlying conditions.

Download Full-text