Meta-analysis of the efficacy of ertapenem in preventing SSIs after elective colorectal surgery

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Vicentini ◽  
A Corradi ◽  
S Corcione ◽  
F G De Rosa ◽  
C M Zotti
Keyword(s):  
Colorectal Surgery ◽  
Antimicrobial Prophylaxis ◽  
Meta Analysis ◽  
Carbapenem Resistance ◽  
Surgical Site Infections ◽  
Resistant Isolate ◽  
Elective Colorectal Surgery ◽  
Surgical Antibiotic Prophylaxis ◽  
Surgical Antimicrobial Prophylaxis ◽  
Reported Data

Abstract Background The efficacy of standard surgical antimicrobial prophylaxis (SAP) regimens in preventing surgical site infections (SSIs) after colorectal surgery is declining, along with rising rates of intestinal colonization with antimicrobial resistant (AMR) Enterobacteriaceae and Bacteroides spp. Ertapenem has been approved by the FDA and EMA for SAP in this context, however it has not been used extensively for this indication out of concern for increasing carbapenem-resistance rates. A limited number of studies have investigated the efficacy of ertapenem in preventing SSIs after colorectal surgery, comparing ertapenem with different agents or combinations of agents. Methods A systematic review was conducted following the PRISMA checklist. PubMed, Embase and Cochrane databases were searched for studies measuring the efficacy of ertapenem in preventing SSIs following elective colorectal procedures. Studies were considered eligible if they reported extractable data on the proportion of SSIs and/or on the proportion of AMR pathogens isolated from SSIs. Data from all ertapenem study arms were extracted. A random effects meta-analysis was performed to estimate the overall proportion of SSI. Results Of 1109 identified studies, 5 met the inclusion criteria and were included in the meta-analysis, totalling 3176 participants. The pooled proportion of SSI was 0.10 (95% CI 0.05-0.18; I2=96%; τ2=0.6323; p ≤ 0.01). Only one study reported data on carbapenem resistance: out of 124 isolates from 30 patients, 1 gram negative carbapenem-resistant isolate was identified. Conclusions The pooled proportion of SSI using ertapenem as SAP found in this study is in line with the proportion of SSI using standard SAP found by a recent meta-analysis (Gandra, 2019). According to this analysis, the benefit of ertapenem does not outweigh the risk of further promoting AMR, although results should be interpreted with caution due to the high heterogeneity among included studies. Key messages According to this study, the efficacy of ertapenem in preventing surgical site infections after elective colorectal surgery is comparable to the efficacy of standard surgical antibiotic prophylaxis. The emergence of carbapenem resistance after surgical prophylaxis with ertapenem should be further investigated through longer term studies before widespread use for this indication.

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

2006 ◽  
Vol 27 (12) ◽  
pp. 1358-1365 ◽  
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.

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

2006 ◽  
Vol 27 (12) ◽  
pp. 1358-1365 ◽  
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&lt; .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55];P&lt; .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84];P&lt; .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79];P&lt; .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&lt;.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.

Adherence to surgical antimicrobial prophylaxis: “checking-the-box” is not enough

2019 ◽  
Vol 32 (2) ◽  
pp. 470-473 ◽  
Author(s):  
Kunal Karamchandani ◽  
Kyle Barden ◽  
Jansie Prozesky
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Administration ◽  
National Guidelines ◽  
Content Type ◽  
Surgical Antibiotic Prophylaxis ◽  
Surgical Antimicrobial Prophylaxis

PurposeThe purpose of this paper is to review surgical antimicrobial prophylaxis administration practices in a small cohort and assess compliance with national guidelines.Design/methodology/approachPatients that developed surgical site infections (SSI) in a tertiary care academic medical center over a two-year period were identified. Their electronic medical records were reviewed for compliance with national guidelines with respect to surgical antibiotic prophylaxis.FindingsOver a two-year period, 283 SSI patients were identified. An appropriate antibiotic was chosen in 80 percent, an appropriate dose was administered in 45 percent and timing complied in 89 percent. The antibiotics were appropriately re-dosed in only 9.2 percent in whom the requirement was met. The prescribing guidelines were adhered to in entirety in only 54 patients (23.8 percent).Practical implicationsTimely and appropriate antibiotic administration prior to surgery is essential to prevent SSI. Proper diligence is required to accomplish this task effectively.Originality/valueBased on the findings, it appears that merely, “checking a box” for antibiotic administration during surgery is not enough, and a multidisciplinary approach should be followed to ensure “appropriate” antibiotic administration.

scholarly journals Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland—a survey

2010 ◽  
Vol 396 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Adrian Businger ◽  
Gabriela Grunder ◽  
Marc-Olivier Guenin ◽  
Christoph Ackermann ◽  
Ralph Peterli ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Bowel Preparation ◽  
Antimicrobial Prophylaxis ◽  
Mechanical Bowel Preparation ◽  
Elective Colorectal Surgery

Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical interventions: a nonrandomized, historically controlled equivalence trial

2021 ◽  
pp. 1-8
Author(s):  
Esmaeil Mohammadi ◽  
Sina Azadnajafabad ◽  
Mehrdad Goudarzi ◽  
Keyvan Tayebi Meybodi ◽  
Farideh Nejat ◽  
...  
Keyword(s):  
Single Dose ◽  
Multiple Dose ◽  
Antimicrobial Prophylaxis ◽  
Meta Analysis ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Pediatric Neurosurgery ◽  
Total Cohort ◽  
Neurosurgical Patients ◽  
Tertiary Center

OBJECTIVE Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. METHODS All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score–matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88–1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. RESULTS The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27–1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12–3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14–2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13–3.31). CONCLUSIONS No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.

scholarly journals Role of oral antibiotics for prophylaxis against surgical site infections after elective colorectal surgery

2017 ◽  
Vol 9 (12) ◽  
pp. 246-255 ◽  
Author(s):  
Shamir O Cawich ◽  
Sachin Teelucksingh ◽  
Samara Hassranah ◽  
Vijay Naraynsingh
Keyword(s):  
Colorectal Surgery ◽  
Surgical Site Infections ◽  
Oral Antibiotics ◽  
Elective Colorectal Surgery
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