Rate of Surgical Site Infections With New Protocol of Prophylactic Antibiotic Use in Dermatologic Surgery

Background Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial health care costs, with increased morbidity and death. The Surgical Care Improvement Project (SCIP) contains standards that are nationally reported with the aim of improving patient outcomes after surgery. Our institution's standards for antimicrobial prophylaxis in the perioperative period are more stringent than these measures and may be considered “beyond SCIP.” The 4 elements of appropriate antimicrobial prophylaxis are timing, antibiotic selection, dosing, and intraoperative redosing. Objective To quantify antimicrobial SSI prophylaxis compliance in accordance with institutional standards and to identify potential opportunities for improvement. Methods Patients aged 18 years or older were included if they had an SSI between January 1, 2009, and June 30, 2010, according to the database maintained prospectively by the Infection Prevention and Control Unit. Adherence to our institution's practice standards was assessed through analysis of antibiotics administered—timing in relation to the incision, closure, and tourniquet inflation times for the procedure and antibiotic selection, dose, and redosing. Results Overall noncompliance with all 4 elements of antimicrobial prophylaxis was 75.4% among the 760 cases. Repeat dosing had the greatest noncompliance (45.1%); antibiotic selection had the lowest incidence of noncompliance (10.8%). Conclusions Noncompliance existed in each element of antimicrobial SSI prophylaxis, with antibiotic redosing leading in noncompliance. With the implementation of tools to assist the surgical team in following institutional standards, noncompliance will likely decline and additional research opportunities will exist.

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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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Surgical Site Infections in Breast Surgery: The Use of Preoperative Antibiotics for Elective, Nonreconstructive Procedures

International Journal of Breast Cancer ◽

10.1155/2016/1645192 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Christopher B. Crawford ◽

James A. Clay ◽

Anna S. Seydel ◽

Jessica A. Wernberg

Keyword(s):

Single Dose ◽

Breast Surgery ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Community Based ◽

Increased Risk ◽

Increase Risk ◽

Multivariable Analyses ◽

Univariate Analyses

Background. Antibiotic prophylaxis for surgical site infections (SSIs) for breast surgery is widespread, but the benefit in clean surgical cases is not well defined.Methods. A retrospective analysis of 855 patients undergoing elective, nonreconstructive breast operations was performed, with 401 patients receiving no antibiotics and 454 patients receiving a single dose of preoperative antibiotic.Results. Administration of a preoperative antibiotic did not decrease the SSI rate. In this community-based study, antibiotic use practices varied considerably by surgeon. In univariate analyses, SSI rates appeared to increase with prophylactic antibiotic use (12% SSI with antibiotics versus 4% without,p<0.0001), likely because the use of underdosed antibiotics was associated with higher rates of SSI (13.2% SSI with cefazolin 1 gram,p<0.0001, and 15.4% SSI with clindamycin 300 mg or less,p=0.0269). Methicillin-resistantStaphylococcus aureuswas the most common isolate from SSI cultures, 31.8% (7 of 22). In multivariable analyses, increased risk of SSI was associated with BMI > 25 kg/m2(OR: 1.08, 95% CI: 1.04–1.11,p<0.0001).Conclusion. The administration of a single dose of preoperative antibiotic did not decrease the rate of SSI in this large series of patients undergoing clean breast operations. BMI >25 kg/m2and the use of an inadequate dose of antibiotics for prophylaxis may increase risk of SSI.

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Prevalence of Nosocomial Infections After Surgery in Greek Hospitals: Results of Two Nationwide Surveys

Infection Control and Hospital Epidemiology ◽

10.1086/502399 ◽

2004 ◽

Vol 25 (4) ◽

pp. 319-324 ◽

Cited By ~ 14

Author(s):

Achilleas Gikas ◽

Maria Roumbelaki ◽

John Pediaditis ◽

Pavlos Nikolaidis ◽

Stamatina Levidiotou ◽

...

Keyword(s):

Risk Factors ◽

Nosocomial Infections ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Developed Countries ◽

Surgical Patients ◽

Prevalence Studies ◽

Day Range ◽

Greek Hospitals

AbstractObjective:To determine the frequency and type of nosocomial infections (NIs) (especially surgical-site infections [SSIs]), risk factors, and the type and duration of antibiotic use among surgical patients in Greek hospitals.Design:Two point-prevalence studies.Setting:Fourteen Greek hospitals.Patients:Those in the hospitals during two prevalence surveys undergoing surgery during their stay.Results:In the 1999 survey, 129 of 1,037 surgical patients had developed 148 NIs (14.3%). A total of 1,093 operations were registered, and 49 SSIs (4.5%) were found. In the 2000 survey, 82 of 868 surgical patients had developed 88 NIs (10.1%). A total of 902 operations were registered, and 38 SSIs were detected (4.2%). The median length of stay (LOS) for surgical patients without SSI was 10.0 days (range, 1-19 days); for patients who developed SSI it was 30 days (range, 1-52 days; P < .001). The median LOS prior to surgery for patients without SSI was 1 day (range, 0-4 days); for patients who developed SSI it was 3 days (range, 0-7.5 days; P < .001). Among 30 possible risk factors studied, wound class, LOS prior to surgery, and central venous catheterization were independent predictors of SSI. Median durations of prophylactic antibiotic therapy were 4 days (range, 1-14 days) and 6 days (range, 1-16 days) in the 1999 and 2000 surveys, respectively.Conclusion:Surgical patients in Greek hospitals suffered higher rates of SSI than did surgical patients in other developed countries while prophylactic antibiotics were used excessively.

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Pengaruh Program Pengendalian Resistensi Antimikroba terhadap Penggunaan Antibiotik Profilaksis pada Bedah Obstetri dan Ginekologi

JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) ◽

10.22146/jmpf.53563 ◽

2020 ◽

Vol 10 (2) ◽

pp. 145

Author(s):

Winarni Winarni ◽

Nanang Munif Yasin ◽

Tri Murti Andayani

Keyword(s):

Incidence Rate ◽

Clinical Outcomes ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Total Sample ◽

Prophylactic Antibiotics ◽

Control Group ◽

Stewardship Program ◽

The Relationship

The incidence of surgical site infections (SSI) in obstetric and gynecological surgery is quite high. Rational prophylactic antibiotics in surgery are important strategies for the prevention of SSI. Antimicrobial Stewardship Program (ASP) for rational prophylactic antibiotic use has been carried out. This study aims to determine the rationality of the use of prophylactic antibiotics and incidence rate of SSI, the effect of ASP on the rationality of prophylactic antibiotics and clinical outcomes in obstetric and gynecology surgery. This study used a quasi-experimental pretest postest design without control group with retrospective data collection. Research time for 2 months from May to June 2019. The subjects of this study were obstetric and gynecology surgery patients at Pandan Arang Hospital Boyolali in 2018 who were divided into 2 groups: patients before the ASP and patients after the ASP with a total sample of 93 patients each group. An evaluation of the type, dose, time of administration, route of administration, and duration of prophylactic antibiotics were performed against the standard. Data analysis used the Pearson Chi-square test to see the relationship between rationality and clinical outcomes with ASP. The rationality of prophylactic antibiotic use increased from 0 (0%) cases before the ASP to 52 cases (55.9%) after the ASP. The SSI incidence rate before ASP was 9.7%, down to 4.3% after ASP. There was a significant relationship between the rationality of prophylactic antibiotics and ASP (p <0.05) but the relationship between clinical outcome (SSI incidence) and ASP was not significant (p> 0.05). The result of this study can be used to promote the implementation of ASP in other wards to increase rational use of antibiotics.

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Single dose prophylactic antibiotic before surgery to prevent surgical site infection: a prospective interventional study

International Surgery Journal ◽

10.18203/2349-2902.isj20190478 ◽

2019 ◽

Vol 6 (3) ◽

pp. 843

Author(s):

K. Saravanan ◽

T. Uma Maheswari

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Elective Surgery ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Site Infection ◽

Nice Guideline ◽

Surgery Patient ◽

Hernia Mesh Repair

Background: Surgical site infections (SSI) are one of the most common postoperative complications leading to increased morbidity which also an important factor of increased hospital stays and increased healthcare cost. The use of prophylactic antibiotics may benefit the patients in preventing the surgical site infection. Aim of the study was to study the single dose prophylactic antibiotic use in preventing surgical site infection in elective surgery.Methods: Patients were included from the list of elective surgery. Patient with comorbid was excluded. The patient was handled as per NICE guideline for prevention of surgical site infection and treatment 2017. Prophylactic antibiotic injection cefuroxime 1500mg administered intravenously 30 minutes before surgery, at the site of the incision.Results: In 110 patients included in the study, 46% of patients were in 35 to 45 years, male were higher in number. 20% of patients underwent hernioplasty followed by cholecystectomy 18.3%. 9% of SSI was recorded in this study. 4 cases in cholecystectomy, 3 cases in hernioplasty, each 1 case in appendicectomy, Hydrocele and ventral hernia mesh repair. The most common bacteria isolated from the samples were Staphylococcus aureus.Conclusions: In uncomplicated surgeries, single dose antibiotics before 30 minutes of surgery may benefit in preventing SSI.

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Attitudes on Prophylactic Antibiotic Use in Dermatologic Surgery

Dermatologic Surgery ◽

10.1097/dss.0000000000002676 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Leora Aizman ◽

John S. Barbieri ◽

Tess M. Lukowiak ◽

Allison M. Perz ◽

Joseph F. Sobanko ◽

...

Keyword(s):

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Dermatologic Surgery

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Perspectives on Prophylactic Antibiotic Use in Dermatologic Surgery

Case Medical Research ◽

10.31525/ct1-nct04150523 ◽

2019 ◽

Author(s):

Keyword(s):

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Dermatologic Surgery

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Comparative study of use of prophylactic antibiotic for elective hernia repair with use of prosthetic material: observational study in a tertiary care institute

International Surgery Journal ◽

10.18203/2349-2902.isj20174896 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3732

Author(s):

Philip Umman ◽

Joyal Jose ◽

Althaf Ahmed ◽

Jeenu Xavier

Keyword(s):

Hernia Repair ◽

Wound Infection ◽

Tertiary Care ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

World Health ◽

Prosthetic Material ◽

Oral Antibiotic ◽

Health Organization

Background: There is widespread misuse of antibiotics leading to increasing reports of drug resistance. This has been highlighted by the World Health Organization (WHO). Wrong antibiotics are chosen, used when not indicated and used in dosages or patterns that are not recommended. We tried to analyse the pattern of antibiotic use for elective hernia repair using polypropylene mesh among the surgical units in our hospital for elective clean cases. The antibiotic use pattern and the incidence of surgical site infections were to be analysed to create uniform policies for antibiotic use across the institution.Methods: We looked at the case records of patients undergoing elective hernia repair in one month in our institution under different surgeons. Inguinal, umbilical and simple incisional hernias were taken into study. Both open and laparoscopic hernia repairs were included in the study. Emergency hernia repairs were excluded. We looked at the type of prophylactic antibiotic given, the dose and approximate time difference between injection and incision time, whether patient received further doses of intravenous or oral antibiotic. If further doses were given, we also looked for reasons if documented. These cases were followed for one month to see if there was any difference in the incidence of surgical site infections.Results: There were thirty-one cases, of which 16 received only a single dose of prophylactic antibiotic while 15 received more than one dose of antibiotic. Only one patient in the prophylactic antibiotic only group developed a culture positive wound infection. There was seroma formation in two patients.Conclusions: There was no evidence of higher incidence of wound infection in patients receiving only prophylactic antibiotic. There is a need for developing institution specific policies on antibiotic use. This will reduce the treatment costs and also avoid the development of antibiotic resistance in the society.

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Is perioperative antibiotic necessary in straightforward implant placement procedures?

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00282 ◽

2020 ◽

Author(s):

Elçin Bedeloğlu ◽

Mustafa Yalçın ◽

Cenker Zeki Koyuncuoğlu

Keyword(s):

Clavulanic Acid ◽

Dental Implant ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Implant Failure ◽

Control Group ◽

Implant Placement ◽

Significant Difference ◽

Amoxicillin Clavulanic Acid ◽

Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p >0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p <0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

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