Evaluation of surgical antimicrobial prophylaxis in icus of a private tertiary care hospital

Abstract Objectives:The goal of this study was to evaluate the impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery comparing the new in hospital prophylactic agent cefazolin versus the former standard antibiotic cefuroxime, initiated by the antimicrobial stewardship team. Methods: This retrospective observational study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the antimicrobial stewardship team following a new recommendation of the surgical antimicrobial prophylaxis and included 1029 patients who underwent cardiac surgery. Two patient groups including 582 patients receiving Cefuroxime and 447 patients receiving Cefazolin respectively were compared without altering any other preventative perioperative measures. Adherence, overall infection rates, leg wound infections and deep sternal wound infections were compiled and analysed as well as a broad profile of preoperative, intraoperative and postoperative patient data. Results:A complete adherence on the change of the agent was achieved.Overall surgical site infections occurred in 37 (6.6%) of the cases, with 20 (3,4%) SSI in cefuroxime patients and 17 (3,8%) in cefazolin patients (p-value=0,754). No statistically significant differences could be found in any of the primary and secondary endpoints including DSWI (2,1% for cefuroxime, 1,3% for cefazolin), vein harvesting site infections (1,2% for cefuroxime, 2,2% for cefazolin) as well as urinary tract infections, pneumonia, sepsis and overall mortality of all causes. Conclusions:These results demonstrate that compliance to antimicrobial stewardship standards is not associated with more surgical site infections.

Download Full-text

Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01693-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Güzin Surat ◽

Dominik Bernsen ◽

Christoph Schimmer

Keyword(s):

Cardiac Surgery ◽

Antimicrobial Stewardship ◽

Antimicrobial Prophylaxis ◽

Tertiary Care ◽

Surgical Site Infections ◽

Antibiotic Use ◽

P Value ◽

Care Hospital ◽

Surgical Antimicrobial Prophylaxis ◽

Sternal Wound Infections

Abstract Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.

Download Full-text

Pattern of antimicrobial usage for prophylaxis of surgical site infection in a tertiary care hospital of Western Uttar Pradesh

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20190661 ◽

2019 ◽

Vol 8 (3) ◽

pp. 534

Author(s):

Parul Kesar ◽

Surabhi Gupta ◽

H. L. Bhalla ◽

Anita Panday

Keyword(s):

Tertiary Care Hospital ◽

Antimicrobial Prophylaxis ◽

Tertiary Care ◽

Uttar Pradesh ◽

Surgical Site Infections ◽

Blood Stream ◽

Optimal Time ◽

P Value ◽

Care Hospital ◽

Tract Infections

Background: The practice of giving antibiotic prophylaxis has resulted in the reduction of surgical site infections (SSI), thus reducing cost, morbidity, and mortality. Common nosocomial infections in surgical patients include SSIs, urinary tract infections (UTIs), pneumonias and blood stream infections (BSIs). The present study was, therefore, designed to analyze the efficacy of antimicrobials used for prophylaxis during surgery in a tertiary care hospital in India.Methods: Total 100 patients were enrolled. Name, timing, route, dose of antimicrobials given were recorded. All the relevant data was taken from the patient’s medication charts and medical records. Chi-square test and t-test were applied.Results: The optimal time of giving antimicrobial prophylaxis in present study was 1 hour before the surgery. A total of 8 different antimicrobials were prescribed to 100 patients, out of which most commonly prescribed were cephalosporin i.e. 82%. Majority of SSI (57.12%) occurred when the duration of surgical antimicrobial prophylaxis (SAP) was for ≥2 hours (p value <0.05). Common organisms seen in SSI were E. coli, S. aureus, Pseudomonas and Kleibsella species. The hospital stay of patients with SSI was more as compared to patients without SSI in present study (p value <0.05).Conclusions: It has been observed that inappropriate selection and timing of giving SAP play an important role in developing SSI, which can be adequately controlled by adopting SAP guidelines, good infection control practices and risk factor analysis.

Download Full-text

SURGICAL SITE INFECTIONS, AN EXPERIENCE AT TERTIARY CARE HOSPITAL

Journal of University Medical & Dental College ◽

10.37723/jumdc.v12i3.536 ◽

2021 ◽

Vol 12 (3) ◽

Author(s):

Lailama Shah ◽

Shahzada Amir Muhammad Baber ◽

Shabir Ahmed Lehri ◽

Muhammad iqbal Khan ◽

Ibrahim Baloch

Keyword(s):

Surgical Site Infection ◽

Tertiary Care Hospital ◽

Antimicrobial Prophylaxis ◽

Tertiary Care ◽

Medical Institute ◽

P Value ◽

Care Hospital ◽

Site Infection ◽

Cross Sectional ◽

Duration Of Surgery

BACKGROUND & OBJECTIVE: Surgical site (SSI) infections are important cause of morbidity and mortality in admitted patients worldwide. The objective is to determine the incidence of surgical site infection in General Surgical ward of tertiary care hospital. METHODOLOGY: Analytical cross-sectional study conducted at Department of General Surgery, Bolan Medical College/ Post-Graduate Medical Institute Quetta (PGMI) for a period of one year from 1st August 2019 to 31st July 2020. Descriptive statistics were used to present social economics, factors related to surgery and surgical antimicrobial prophylaxis received. Chi square test was used for checking association between infections and different factors keeping p≤ 0.05 as significant. RESULTS: A total of 1500 patients underwent surgery, of which 500 (33.33%) patients were operated as elective cases and 1000 (66.66%) cases as emergency. Out of total 600 (40%) patients developed Surgical Site Infection (SSI). Risk associated with higher incidence of SSI was found to be age (30-45 years) and Diabetes mellitus (uncontrolled diabetes in perioperative period). Postoperatively obesity was noted to be having significant effect with p=0.002, American Society of Anesthesiologists (ASA) score having p-value 0.045, hospital stay with p<0.001 and surgical type and previous surgical history with p<0.001, were as duration of surgery was having <0.001. CONCLUSION: Prevention of SSI’s requires a multipronged approach with emphasis on optimizing preoperative issues, adhering to strict protocols during the intraoperative period and addressing and optimizing metabolic and nutritional status in post-operative period.

Download Full-text