Surgical Site Infections: Does Inadequate Antibiotic Therapy Affect Patient Outcomes?

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures

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Perioperative antimicrobial prophylaxis in patients receiving antibiotic therapy

10.1101/2021.06.14.21255125 ◽

2021 ◽

Author(s):

Yiwei Yin ◽

Eljim P Tesoro ◽

Alan E Gross ◽

Jeffery J Mucksavage

Keyword(s):

Antibiotic Therapy ◽

Antibiotic Treatment ◽

Antimicrobial Prophylaxis ◽

Prophylactic Antibiotic ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Surgical Site Infections ◽

Dose Interval ◽

Prophylactic Antibiotics ◽

Antibiotic Administration

Objective: Antimicrobial prophylaxis is administered perioperatively to prevent surgical site infections. However, in patients who have already received antibiotics for the treatment of active infections prior to surgery, the risks and benefits of administering prophylactic antibiotics are unknown. We aimed to assess the necessity of perioperative prophylactic antibiotic administration in patients receiving antibiotic treatment for active infections. Method: This was a retrospective, chart-review cohort study. Between January 2018 to May 2018, adult patients who underwent inpatient surgery at the University of Illinois Hospital and Health Sciences System, and were prescribed prophylactic antibiotics based on institutional protocol, while receiving antibiotic treatment within 48 hours prior to surgery, were included in the study. The primary endpoint was the rate of duplicative antibiotic therapy, which was defined as the administered prophylactic antibiotic (1) exhibiting similar or narrower bacterial coverage as the treatment antibiotic(s), and (2) given within the dose interval of the treatment antibiotic(s). Results: A total of 158 patients were included in the study, of which 70 (44.3%) received duplicative antibiotic therapy, whereas 88 (55.7%) did not. Differences in the incidence of acute kidney injury, C. difficile infection, and surgery site infections were not statistically significant between the two groups. Conclusion We found that it was common for patients receiving therapeutic systematic antibiotics to perioperatively be prescribed additional prophylactic antibiotics at our institution. However, additional prophylactic antibiotics can be unnecessary in decreasing the incidence of surgical site infections.

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Incidence of post operative surgical site infection in thyroid surgery following single dose of prophylactic antibiotic

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v22i1.45073 ◽

2020 ◽

Vol 22 (1) ◽

pp. 15-20

Author(s):

Md Abul Hossan ◽

Md Ariful Islam ◽

Tapas Chakraborty ◽

Firoz Ahmed Khan ◽

Md Mozharul Islam

Keyword(s):

Antibiotic Therapy ◽

Surgical Site Infection ◽

Thyroid Surgery ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Empirical Antibiotic Therapy ◽

Site Infection ◽

Cross Sectional

Surgical site infection after thyroid surgery is a less common incidence. Prophylactic antibiotic before surgery and empirical antibiotic therapy after surgery is a common practice in our country. But international guidelines do not suggest antibiotic in clean surgical procedure. Aim: To compare the incidence of surgical site infection after thyroid surgery with and without empirical antibiotic therapy. Method: It was a cross sectional study, done from July 2010 to December 2010 in 3 medical college hospitals in Dhaka city. Total 100 cases were included in this study, 50 cases for study in which only single prophylactic antibiotic used half an hour before operation, 50 cases for control in which 7 days antibiotic used per orally in addition to prophylaxis. Result: Among 100 cases male were 24 & female 76 (M: F= 1:3.2). Oldest patient was 56 yrs & youngest 21yrs. 47% patient operated for solitary thyroid nodule, 35% multinodular goiter & only 6% diffuse goiter. 47% patient was done hemithyroidectomy & only 7% total thyroidectomy. All the operations were completed within 2 hours where 40% within one hour. No surgical site infections were found in both study and control cases. Conclusion: There is no statistical difference between routine antibiotic use and no use of antibiotic after thyroid surgery. Bangladesh J Otorhinolaryngol; April 2016; 22(1): 15-20

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Transcriptome Sequence of Antibiotic-Treated Pseudomonas aeruginosa

Microbiology Resource Announcements ◽

10.1128/mra.01367-18 ◽

2019 ◽

Vol 8 (12) ◽

Cited By ~ 1

Author(s):

Saika Esani ◽

Tsute Chen ◽

Kai P. Leung ◽

Tricia A. Van Laar

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibiotic Therapy ◽

Patient Outcomes ◽

Content Type

Pseudomonas aeruginosa is known to tolerate antibiotic therapy during infection. This prevents clearance of infection and negatively impacts patient outcomes.

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