scholarly journals 808. Appropriate Use of Cephalotin Before and After Implementation of a Cardiac Surgery Antibiotic Prophylaxis Protocol in Guatemala

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S498-S498
Author(s):  
Herberth G Maldonado ◽  
Brooke M Ramay ◽  
Lourdes A Sandoval
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Patient Characteristics ◽  
Appropriate Use ◽  
Surgical Incision ◽  
Protocol Implementation ◽  
Delayed Sternal Closure ◽  
Hospitalization Costs ◽  
Duration Of Surgery ◽  
Before And After

Abstract Background The appropriate use of Surgical Antibiotic Prophylaxis (SAP) contributes to reducing the prevalence of Surgical Site Infections (SSI). Inappropriate use increases the risk of SSIs, hospitalization costs and potentially contributes to the emergence of antimicrobial resistance. We aimed to compare the appropriate use before and after implementing a SAP protocol in our institution Methods We conducted a retrospective chart review in patients older than 18 undergoing elective cardiac surgery with cardiopulmonary bypass using cephalotin as SSI prophylaxis. We excluded patients who received other antimicrobials for prophylaxis, those undergoing non-elective surgery, and patients with delayed sternal closure. We identified SSIs according to the Centers for Disease Prevention and Control criteria. We evaluated if appropriate dosing (2g-3g) and timing ( >60 min.) occurred before the surgical incision, if redosing was administered, and if prophylaxis was administered > 48 hours. We evaluated before and after implementation of the protocol (August 2016-July 2017; October 2017-2018) Results The study included 262 and 285 patients before and after protocol implementation, respectively. Patient characteristics were similar between comparator groups (Table 1). We found that 1.1% of patients vs. 63% of patients had appropriate dosing before the surgical incision, before and after protocol implementation, respectively (p < 0.05). There was no difference in appropriate redosing when the duration of surgery was greater than 4 hours and no difference in inappropriate prophylaxis administration > 48 hours after protocol implementation. A total of 8 SSIs were identified in each group, with no statistical difference in the incidence, length of stay, or clinical outcome between comparator groups Table 1. Patient Characteristics and Appropriate use of Cephalotin Before and After Implementation of a Cardiac Surgery Antibiotic Prophylaxis Protocol in Guatemala Conclusion Based on our findings, implementing a local guideline-protocol for SAP resulted in significant improvement of pre-surgical antimicrobial dosing. We observed continual unnecessary administration of antibiotic prophylaxis in the postoperative period that needs more proactive interventional pharmacy-guided strategies such as automatic stops or audits width feedback. Disclosures Lourdes A. Sandoval, Master of Science in Pharmacovigilance and Pharmacoepidemiology, Abbott (Employee)

Appropriateness of Antibiotic Prophylaxis for Major Surgery in Korea

2007 ◽  
Vol 28 (8) ◽  
pp. 997-1002 ◽  
Author(s):  
Won Suk Choi ◽  
Joon Young Song ◽  
Jung Hae Hwang ◽  
Nam Soon Kim ◽  
Hee Jin Cheong
Keyword(s):  
Antibiotic Prophylaxis ◽  
Initial Dose ◽  
Medical Records ◽  
Colon Surgery ◽  
Major Surgery ◽  
Antibiotic Administration ◽  
Surgical Incision ◽  
Duration Of Surgery ◽  
Tertiary Hospitals ◽  
Gyeonggi Province

Objective.To determine the appropriateness of antibiotic prophylaxis regimens for major surgery in Korea.Design.Retrospective study using a written survey for each patient who underwent arthroplasty, colon surgery, or hysterectomy.Setting.Six tertiary hospitals in Seoul and Gyeonggi Province.Patients.From each hospital, a maximum of 150 patients who underwent each type of surgery were randomly chosen for the study.Results.Of 2,644 eligible patients, 1,914 patients were included in the analysis; 677 of these patients underwent arthroplasty, 578 underwent colon surgery, and 659 underwent hysterectomy. Nineteen patients were excluded from the analyses of the class and number of antibiotics used for prophylaxis because they underwent multiple surgeries at different sites. For each of the 1,895 remaining patients, antibiotic prophylaxis involved a mean ( ± SD) of 2.8 ± 0.9 classes of antibiotics. The most commonly prescribed agents were cephalosporins (prescribed for 1,875 [98.9%] of the patients) and aminoglycosides (1,404 [74.1%]). A total of 1,574 (83.1%) of patients received at least 2 classes of antibiotics simultaneously. Only 15 (0.8%) of 1,895 patients received antibiotic prophylaxis in accordance with published guidelines. Of 506 patients for whom the initial dose of antibiotics was evaluated, 374 (73.9%) received an appropriate initial dose. Of the 1,676 patients whose medical records included information about antibiotic administration relative to the time of surgery, only 188 (11.2%) received antibiotic prophylaxis an hour or less before the surgical incision was made. Of the 1,748 patients whose medical records included information about duration of surgery, antibiotic prophylaxis was discontinued 24 hours or less after surgery for only 3 (0.2%) of the patients.Conclusion.Most patients who had major surgery in Korea received inappropriate antibiotic prophylaxis. Measures to improve the appropriateness of antibiotic prophylaxis are urgently required.

scholarly journals A single center retrospective analysis of a protocol for high-dose methotrexate and leucovorin rescue administration

2017 ◽  
Vol 25 (1) ◽  
pp. 76-84 ◽  
Author(s):  
Zak Cerminara ◽  
Alison Duffy ◽  
Jennifer Nishioka ◽  
James Trovato ◽  
Steven Gilmore
Keyword(s):  
Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Protocol Implementation ◽  
Dose Methotrexate ◽  
Before And After ◽  
The Cost

Background Methotrexate has a wide dosing range. High-dose methotrexate is a dose of 1000 mg/m2 or greater. In the 1970s, the incidence of mortality associated with High-dose methotrexate ranged from 4.6 to 6%. In 2012, the University of Maryland Medical Center implemented a standardized high-dose methotrexate protocol. The purpose of this study was to evaluate whether the institution followed recommendations based on the Bleyer nomogram for the administration of high-dose methotrexate more closely after the implementation of the protocol. Methods In this retrospective chart review, 37 patients received 119 cycles of high-dose methotrexate before the protocol implementation (1 January 2009 through 31 December 2010) and 45 patients received 106 cycles of high-dose methotrexate after protocol implementation (1 January 2013 through 31 December 2014). Patient characteristics, protocol data, and complications were analyzed. Results Protocol implementation significantly reduced the deviation of methotrexate level timing at 24, 48, and 72 h: median 7.47 vs. 1.46 h, 7.23 vs. 1.35 h, and 7.00 vs. 1.52 h before and after implementation, respectively (p < 0.0001 for each). The protocol significantly reduced deviation of the first dose of leucovorin administration: median 5.2 vs. 0.675 h before and after implementation, respectively (p<0.0001). After protocol implementation, there was an increase in the use of leucovorin prescriptions written appropriately for patients discharged before methotrexate levels reached a value of ≤0.05 µmol/L. Conclusions Implementation of a protocol for the administration of high-dose methotrexate improved the adherence to consensus recommendations. Further analysis is needed to assess clinical pharmacist involvement and the cost savings implications within this protocol.

Effect of Optimized Antibiotic Prophylaxis on the Incidence of Surgical Site Infection

2006 ◽  
Vol 27 (12) ◽  
pp. 1340-1346 ◽  
Author(s):  
Judith Manniën ◽  
Marjo E. E. van Kasteren ◽  
Nico J. Nagelkerke ◽  
Inge C. Gyssens ◽  
Bart Jan Kullberg ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Detrimental Effect ◽  
Antimicrobial Prophylaxis ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Surveillance Network ◽  
Duration Of Surgery ◽  
Before And After ◽  
Clean Contaminated

Objective.To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.Design.Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.Methods.During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contamination class, duration of surgery, length of hospital stay before surgery, and urgency of surgery (elective or acute).Results.A total of 3,621 procedures were included in the study, of which 1,668 were performed before the intervention and 1,953 after. The overall SSI rate decreased from 5.4% to 4.5% (P = .22). Among the procedures included in the study, the largest proportion (55%) were total hip arthroplasty, and the smallest proportion (2%) were replacement of the head of the femur. SSI rates varied from 0% for vaginal hysterectomy to 21.1% for femoropopliteal or femorotibial bypass surgery. Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention (P>.1).Conclusions.An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery, as measured by SSI rate.

Effect of Optimized Antibiotic Prophylaxis on the Incidence of Surgical Site Infection

2006 ◽  
Vol 27 (12) ◽  
pp. 1340-1346 ◽  
Author(s):  
Judith Manniën ◽  
Marjo E. E. van Kasteren ◽  
Nico J. Nagelkerke ◽  
Inge C. Gyssens ◽  
Bart Jan Kullberg ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Detrimental Effect ◽  
Antimicrobial Prophylaxis ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Surveillance Network ◽  
Duration Of Surgery ◽  
Before And After ◽  
Clean Contaminated

Objective.To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.Design.Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.Methods.During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contamination class, duration of surgery, length of hospital stay before surgery, and urgency of surgery (elective or acute).Results.A total of 3,621 procedures were included in the study, of which 1,668 were performed before the intervention and 1,953 after. The overall SSI rate decreased from 5.4% to 4.5% (P= .22). Among the procedures included in the study, the largest proportion (55%) were total hip arthroplasty, and the smallest proportion (2%) were replacement of the head of the femur. SSI rates varied from 0% for vaginal hysterectomy to 21.1% for femoropopliteal or femorotibial bypass surgery. Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention (P&gt;.1).Conclusions.An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery, as measured by SSI rate.

A Systematic Review of Antibiotic Prophylaxis for Delayed Sternal Closure in Children

2020 ◽  
pp. 215013512094768
Author(s):  
John T. Kennedy ◽  
Olivia DiLeonardo ◽  
Christopher G. Hurtado ◽  
Jennifer S. Nelson
Keyword(s):  
Antibiotic Prophylaxis ◽  
Antimicrobial Prophylaxis ◽  
Relevant Literature ◽  
Bloodstream Infections ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Sternal Closure ◽  
Single Drug ◽  
Delayed Sternal Closure ◽  
Drug Regimens

Antibiotic prophylaxis following delayed sternal closure in pediatric cardiac surgery is not standardized. We systematically reviewed relevant literature published between 1990 and 2019 to aid future trial design. Patient characteristics, antimicrobial prophylaxis regimens, and postoperative incidence of infection were collected. Twenty-eight studies described 36 different regimens in over 3,000 patients. There were 11 single-drug regimens and 25 multidrug regimens. Cefazolin-only was the most common regimen (9/36, 25%). The overall incidence of surgical site infection was 7.5% (217/2,910 patients) and bloodstream infection was 7.4% (123/1,667 patients). In the 2010s, multidrug regimens were associated with a significantly lower incidence of both surgical site infections (4.6% vs. 20%, P < .001) and bloodstream infections (6.0% vs. 50%, P < .001) compared to single-drug regimens.

scholarly journals Evaluation of Surgical Site Infections After Change in Surgical Prophylaxis in VAD Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s230-s231
Author(s):  
Emily Min ◽  
Timileyin Adediran ◽  
Kerri Thom ◽  
Emily Heil
Keyword(s):  
Antibiotic Prophylaxis ◽  
Medical Center ◽  
Surgical Site Infections ◽  
Surgical Prophylaxis ◽  
Ventricular Assist ◽  
Exact Test ◽  
Pertinent Data ◽  
Delayed Sternal Closure ◽  
Before And After ◽  
The Difference

Background: In October 2013, the University of Maryland Medical Center established a formal antibiotic prophylaxis protocol for patients undergoing ventricular assist device (VAD) placement, replacing a previous system of various broad-spectrum antibiotic combinations typically for prolonged durations based on surgeon preference. This new protocol consisted of a standardized regimen of 72 hours of vancomycin and ceftriaxone after the procedure. The objective of this project was to evaluate the rate of surgical site infection (SSI) related to VAD placement to ensure that implementing the new protocol did not cause an increase in SSI rates. Methods: The study was a retrospective cohort study of patients who had undergone VAD placement before the protocol change (January 1, 2011, to October 1, 2013) and after the change (October 1, 2013, to November 15, 2015). The primary outcomes was the difference in SSI rate before and after the protocol change using CDC NHSN definitions. Pertinent data points of interest included reason for VAD placement, duration/type of antibiotics used, delayed sternal closure, SSI, characterization of infection (bloodstream, driveline, or pocket), organism identified on culture and mortality at 30 days and 1 year. SSI rates were assessed using the Fischer exact test, and descriptive statistics were used for other outcome variables. Results: In total, 75 patients were included before the protocol and 46 after the protocol change. Overall, 27% and 17% of patients were on therapeutic antibiotics prior to the VAD placement, respectively (P = 0.23). Also, 8 (6.6%) patients in the preintervention group had an SSI compared to 1 patient (0.8%) in the postintervention group (P = .15). Adherence to the protocol was suboptimal, with 27% of patients in the postintervention group receiving non–protocol-adherent antibiotics and 65% of patients receiving antibiotics >96 hours postoperatively. When evaluating the patients collectively, SSI rates were the same when antibiotics were discontinued <72 hours postoperatively versus when antibiotics were continued beyond 72 hours postoperatively or were not given at all postoperatively (3.1% vs 10.7% vs 0%; P = .24). SSI rates were also no different among patients who received cefazolin monotherapy (0%), vancomycin and ceftriaxone (2.7%), vancomycin and piperacillin tazobactam (2%), and other antibiotic combinations (7.7%) for surgical prophylaxis (P = 0.1). Conclusions: No change in SSI rates was noted after a protocol change narrowing the spectrum and duration of antibiotic prophylaxis was implemented. Evaluation of optimal surgical prophylaxis in this patient population is difficult due to low event rates and frequent therapeutic indications for antibiotics outside the standard prophylaxis. Despite these challenges, this study supports the safety of studying SSI prophylaxis reduction in the VAD population. Further studies are reasonable and warranted.Funding: NoneDisclosures: None

Lung and chest wall mechanical properties before and after cardiac surgery with cardiopulmonary bypass

1994 ◽  
Vol 76 (1) ◽  
pp. 166-175 ◽  
Author(s):  
G. M. Barnas ◽  
R. J. Watson ◽  
M. D. Green ◽  
A. J. Sequeira ◽  
T. B. Gilbert ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Tidal Volume ◽  
Chest Wall ◽  
Respiratory System ◽  
Supine Posture ◽  
Duration Of Surgery ◽  
Before And After ◽  
System Properties

From measurements of airway and esophageal pressures and flow, we calculated the elastance and resistance of the total respiratory system (Ers and Rrs), chest wall (Ecw and Rcw), and lungs (EL and RL) in 11 anesthetized-paralyzed patients immediately before cardiac surgery with cardiopulmonary bypass and immediately after chest closure at the end of surgery. Measurements were made during mechanical ventilation in the frequency and tidal volume ranges of normal breathing. Before surgery, frequency and tidal volume dependences of the elastances and resistances were similar to those previously measured in awake seated subjects (Am. Rev. Respir. Dis. 145: 110–113, 1992). After surgery, Ers and Rrs increased as a result of increases in EL and RL (P < 0.05), whereas Ecw and Rcw did not change (P > 0.05). EL and RL exhibited nonlinearities (i.e., decreases with increasing tidal volume) that were not seen before surgery, and RL showed a greater dependence on frequency than before surgery. The changes in RL or EL after surgery were not correlated with the duration of surgery or cardiopulmonary bypass time (P > 0.05). We conclude that 1) frequency and tidal volume dependences of respiratory system properties are not affected by anesthesia, paralysis, and the supine posture, 2) open-chest surgery with cardiopulmonary bypass does not affect the mechanical properties of the chest, and 3) cardiac surgery involving cardiopulmonary bypass causes changes in the mechanical behavior of the lung that are generally consistent with those caused by pulmonary edema induced by oleic acid (J. Appl. Physiol. 73: 1040–1046, 1992) and decreases in lung volume.

scholarly journals Progression of cerebral infarction before and after thrombectomy is modified by prehospital pathways

2021 ◽  
pp. neurintsurg-2020-017155
Author(s):  
Alexander M Kollikowski ◽  
Franziska Cattus ◽  
Julia Haag ◽  
Jörn Feick ◽  
Alexander G März ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Vessel Occlusion ◽  
Time Intervals ◽  
Vessel Occlusion ◽  
Before And After ◽  
Transferred Patients ◽  
Stroke Center

BackgroundEvidence of the consequences of different prehospital pathways before mechanical thrombectomy (MT) in large vessel occlusion stroke is inconclusive. The aim of this study was to investigate the infarct extent and progression before and after MT in directly admitted (mothership) versus transferred (drip and ship) patients using the Alberta Stroke Program Early CT Score (ASPECTS).MethodsASPECTS of 535 consecutive large vessel occlusion stroke patients eligible for MT between 2015 to 2019 were retrospectively analyzed for differences in the extent of baseline, post-referral, and post-recanalization infarction between the mothership and drip and ship pathways. Time intervals and transport distances of both pathways were analyzed. Multiple linear regression was used to examine the association between infarct progression (baseline to post-recanalization ASPECTS decline), patient characteristics, and logistic key figures.ResultsASPECTS declined during transfer (9 (8–10) vs 7 (6-9), p<0.0001), resulting in lower ASPECTS at stroke center presentation (mothership 9 (7–10) vs drip and ship 7 (6–9), p<0.0001) and on follow-up imaging (mothership 7 (4–8) vs drip and ship 6 (3–7), p=0.001) compared with mothership patients. Infarct progression was significantly higher in transferred patients (points lost, mothership 2 (0–3) vs drip and ship 3 (2–6), p<0.0001). After multivariable adjustment, only interfacility transfer, preinterventional clinical stroke severity, the degree of angiographic recanalization, and the duration of the thrombectomy procedure remained predictors of infarct progression (R2=0.209, p<0.0001).ConclusionsInfarct progression and postinterventional infarct extent, as assessed by ASPECTS, varied between the drip and ship and mothership pathway, leading to more pronounced infarction in transferred patients. ASPECTS may serve as a radiological measure to monitor the benefit or harm of different prehospital pathways for MT.

Intraoperative transesophageal assessment of coronary artery flow can predict 5 type myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Zagatina ◽  
M Novikov ◽  
N Zhuravskaya ◽  
V Balakhonov ◽  
S Efremov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Index Number ◽  
Left Main ◽  
Coronary Flow Velocity ◽  
Before And After ◽  
Flow Velocities

Abstract Background Stenosis of a coronary artery results in an increase in flow velocity in the pathologic segment. Effective grafting should decrease the stenotic native coronary velocity according to hemodynamic law. The range of decreased velocity before and after cardiac surgery can hypothetically reflect the effectiveness of a graft. The aim of the study is to determine if measuring coronary flow velocity changes during coronary artery bypass grafting (CABG) can predict intraoperative myocardial infarction. Methods One hundred sixty-six (166) consecutive patients (121 men, 64±9 years old) referred for cardiac surgery, were prospectively included in the study. A standard basic perioperative transesophageal echocardiography (TEE) examination was performed with additional scans of the left main, left anterior descending (LAD), and circumflex (LCx) arteries' proximal segments. Measurements of coronary flow velocities were performed before and after grafting in the same sites of the arteries. The maximal value of cardiac troponin I (cTnI) after CABG and the additive criteria were accounted for in the analysis as it is described in the expert consensus document for Type 5 myocardial infarction (MI) definition. Results One hundred sixty-three patients (98%) had arterial hypertension, 28 patients (17%) had diabetes mellitus, 35 patients (21%) were currently smokers. The feasibility of coronary flow assessment during cardiac operations was 95%. Before grafting, the mean velocity in the left main artery was 91±49 cm/s, in LAD 101±35 cm/s, and in LCx 117±49 cm/s. There was a significant correlation between changes in coronary flow velocities during operation and the value of cTnI (R=0.34, p&lt;0.0001). Ten patients met the criteria for Type 5 MI. There were no differences in age, body mass index, number of coronary arteries with stenoses, frequency of prior MI, ejection fraction or coronary flow velocity before surgery in patients with and without Type 5 MI. The group of patients with Type 5 MI had an increase in native artery velocities during surgery in comparison with patients without MI, who had a significant decrease in coronary flow velocity after grafting (30±48 vs. −10±30 cm/s; p&lt;0.0006). Increases in native coronary velocities greater than 3 cm/s predicted Type 5 MI with 81% accuracy (sensitivity 88%, specificity 70%). Conclusion Coronary flow velocity assessment during cardiac surgery could predict an elevation of cardiac troponins and Type 5 MI. Funding Acknowledgement Type of funding source: None

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