Modifying pre-operative antibiotic overuse in gynecologic surgery

2018 ◽  
Vol 31 (5) ◽  
pp. 400-405 ◽  
Author(s):  
Robert Shapiro ◽  
Rose Laignel ◽  
Caitlin Kowcheck ◽  
Valerie White ◽  
Mahreen Hashmi
Keyword(s):  
Antibiotic Prophylaxis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
Gynecologic Surgery ◽  
Content Type ◽  
Antibiotic Overuse ◽  
Perioperative Antibiotic Prophylaxis ◽  
System A ◽  
Before And After

Purpose Previous studies indicate adherence to pre-operative antibiotic prophylaxis guidelines has been inadequate. The purpose of this paper is to determine adherence rates to current perioperative antibiotic prophylaxis guidelines in gynecologic surgery at a tertiary care, academic institution. As a secondary outcome, improving guidelines after physician re-education were analyzed. Design/methodology/approach A retrospective chart review (2,463 patients) was completed. The authors determined if patients received perioperative antibiotic prophylaxis in accordance with current guidelines from the America College of Obstetricians and Gynecologists. Data were obtained before and after physician tutorials. Quality control was implemented by making guideline failures transparent. Statistical analysis used Fisher’s exact and agreement tests. Findings In total, 23 percent of patients received antibiotics not indicated across all procedures. This decreased to 9 percent after physician re-education and outcome transparency (p<0.0001). Laparoscopy was the procedure with the lowest guideline compliance prior to education. The compliance improved from 52 to 92 percent (p<0.0001) after re-education. Practical implications Gynecologic surgeons overuse antibiotics for surgical prophylaxis. Physician re-education and transparency were shown to enhance compliance. Originality/value Educational tutorials are an effective strategy for encouraging physicians to improve outcomes, which, in turn, allows the healthcare system a non-punitive way to monitor quality and mitigate cost.

Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections

1987 ◽  
Vol 66 (5) ◽  
pp. 701-705 ◽  
Author(s):  
Ronald F. Young ◽  
Pablo M. Lawner
Keyword(s):  
Antibiotic Prophylaxis ◽  
Foreign Bodies ◽  
The Body ◽  
Wound Infections ◽  
Postoperative Infections ◽  
Dramatic Decrease ◽  
Content Type ◽  
Perioperative Antibiotic Prophylaxis ◽  
The Difference ◽  
Fine Print

✓ The authors report the results of a randomized, prospective study to assess the effectiveness of perioperative antibiotic prophylaxis in preventing postoperative infections following clean neurosurgical operations. The study group comprised 846 patients treated between October, 1979, and June, 1984. Antibiotics, including cefazolin and gentamicin, were administered only in the immediate preoperative and intraoperative periods. Sixteen patients, none of whom developed infections, were excluded from final statistical analysis because they had inadvertently been entered into the study while failing to meet entry criteria. Fifteen wound infections (3.64%) developed in the group of 412 patients who did not receive antibiotics, whereas only four infections (0.96%) were identified among the 418 patients who received antibiotics. The difference is statistically significant (p = 0.008) and represents a 74% reduction in infection rate with antibiotics. An analysis of subgroups of surgical procedures revealed a dramatic decrease in craniotomy infections from 6.77% to 0% (p = 0.003). Of the four infections that occurred among the antibiotic-treated patients, three were in cases where foreign bodies had been implanted. No complications of antibiotic usage were identified. The rates of infection in areas of the body other than the surgical wound were no different in the antibiotic-treated and nontreated groups. All wound infections in both antibiotic-treated and nontreated patients involved similar types of Gram-positive organisms, suggesting that antibiotic prophylaxis did not produce infections with resistant or unusual organisms. This study, combined with other recently published analyses, suggests that routine perioperative antibiotic prophylaxis can significantly reduce the incidence of postoperative neurosurgical infections.

scholarly journals Repeat adrenal vein sampling in aldosteronism: reproducibility and interpretation of persistently discordant results

2020 ◽  
Author(s):  
Gregory A Kline ◽  
Alexander Ah-Chi Leung ◽  
Davis Sam ◽  
Alex Chin ◽  
Benny So
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Final Diagnosis ◽  
Adrenal Vein ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Moderate Correlation ◽  
Initial Attempt ◽  
Adrenal Vein Sampling

Abstract Context The reproducibility of adrenal vein sampling(AVS) is unknown. Objective Determine reproducibility of biochemical results and diagnostic lateralization in patients undergoing repeat AVS. Design Retrospective chart review of single-center, single-operator AVS procedures. Setting Tertiary care center. Patients Patients with confirmed PA undergoing repeat AVS due to concerns about technical success or discordant diagnostic results. Intervention Simultaneous AVS by an experienced operator using a consistent protocol of both pre-and post-cosyntropin infusion. Main Outcome Measures Among successfully catheterized adrenal veins(selectivity index ≥ 2) the correlation of the adrenalaldosterone/cortisol ratio between the first and second AVS. Secondary outcome measure was diagnostic agreement in repeat AVS lateralization(lateralization index ≥ 3). Results There were 46 sets of AVS from 23 patients, median 3 months apart. There was moderate correlation in aldosterone/cortisol ratios in adrenal veins and IVC(Spearman r = 0.49-0.59, p&lt;0.05) pre-cosyntropin. Post-cosyntropin, the correlation was better(Spearman r=0.67-0.76, p&lt;0.05). In technically successful AVS, there was moderate correlation between the repeated lateralization indices(Spearman r=0.53, p&lt;0.05). In 15 patients where repeat AVS was done due to apparent lateralization discordance with CT imaging, the final diagnosis was the same in the second AVS procedure. Initial failed AVS was successful 75% of the time upon repeat attempt. Conclusions Repeat AVS was feasible and usually successful when an initial attempt failed. There was modest correlation between individual repeat adrenal aldosterone/cortisol ratios and lateralization indices when AVS was done twice. Final lateralization diagnosis was identical in all cases. This demonstrates that AVS is a reliable and reproducible localizing test in PA.

Congenital Cytomegalovirus Targeted Screening Implementation and Outcomes: A Retrospective Chart Review

2021 ◽  
pp. 019459982110441
Author(s):  
Evette A. Ronner ◽  
Cheryl K. Glovsky ◽  
Barbara S. Herrmann ◽  
Melissa A. Woythaler ◽  
Mark S. Pasternack ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Chart Review ◽  
Screening Program ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Auditory Brainstem ◽  
Targeted Screening ◽  
Before And After ◽  
Newborn Hearing ◽  
Brainstem Response

Objective To assess the effectiveness and outcomes of a targeted cytomegalovirus (CMV) testing protocol. Study Design Retrospective chart review. Setting Tertiary care institution. Methods Targeted screening for CMV in children who did not pass the newborn hearing screening (NHS) was introduced in July 2015 for the level 2 and 3 nurseries at our hospital. In January 2016, this policy was extended to include all nurseries. Retrospective chart review was performed for all newborns who did not pass their NHS between 2013 and 2020. CMV testing rates and related outcomes were compared before and after rollout. Results A total of 891 charts were reviewed for infants who did not pass their NHS: 530 (60%) had CMV testing, of which 8 (1.5%) tested positive. Three cases were detected prior to and 5 occurred after initiation of targeted screening. Six CMV+ infants demonstrated hearing loss on confirmatory auditory brainstem response, all of whom began treatment with oral valganciclovir. Hearing remained stable in 3 patients, progressed in 2, and improved in 1. The rate of CMV testing in children who did not pass their NHS increased from 14% to 88% after full implementation of targeted screening ( P < .001). The average age at initial infectious disease consultation was significantly younger for infants born after targeted screening ( P < .001). Conclusion Targeted screening is a feasible and effective method to identify CMV+ infants early in life. Implementation of a targeted screening program for CMV in children who do not pass the NHS resulted in significantly higher rates of CMV testing and earlier referral to infectious disease.

Value of postoperative surveillance imaging in the management of children with some common brain tumors

1996 ◽  
Vol 84 (5) ◽  
pp. 726-732 ◽  
Author(s):  
Paul Steinbok ◽  
Stephen Hentschel ◽  
D. Douglas Cochrane ◽  
John R. W. Kestle
Keyword(s):  
Brain Tumors ◽  
Posterior Fossa ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Grade Glioma ◽  
Optic Chiasm ◽  
Current Data ◽  
Content Type ◽  
Surveillance Imaging ◽  
Fine Print

✓ The rationale for obtaining surveillance computerized tomography (CT) scans or magnetic resonance (MR) images in pediatric patients with brain tumors is that early detection of recurrence may result in timely treatment and better outcome. The purpose of this study was to investigate the value of surveillance cranial images in a variety of common pediatric brain tumors managed at a tertiary care pediatric hospital. A retrospective chart review was performed of children with astrocytoma of the cerebral hemisphere, cerebellum, optic chiasm/hypothalamus, or thalamus; cerebellar or supratentorial high-grade glioma; supratentorial ganglioglioma; posterior fossa or supratentorial primitive neuroectodermal tumor (PNET); and posterior fossa ependymoma. Data were analyzed to determine the frequency with which recurrences were identified on a surveillance image and how the type of image at which recurrence was identified related to outcome. In 159 children, 17 of 44 recurrences were diagnosed by surveillance imaging. The percentage of recurrences identified by surveillance imaging was 64% for ependymoma, 50% for supratentorial PNET, 43% for optic/hypothalamic astrocytoma, and less than 30% for other tumors. The rate of diagnosis of recurrence per surveillance image varied from 0% to 11.8% for different tumor types. Only for ependymomas did there appear to be an improved outcome when recurrence was identified prior to symptoms. Our results indicate that, using the protocols outlined in this study, surveillance imaging was not valuable in identifying recurrence of cerebellar astrocytoma or supratentorial ganglioglioma during the study period, but was probably worth-while in identifying recurrence of posterior fossa ependymoma and optic/hypothalamic astrocytoma and, possibly, medulloblastoma. Surveillance protocols could be made more effective by individualizing them for each type of tumor, based on current data on the patterns of recurrence.

scholarly journals Perioperative Antibiotic Prophylaxis Has No Effect on Time to Positivity and Proportion of Positive Samples: a Cohort Study of 64Cutibacterium acnesBone and Joint Infections

2017 ◽  
Vol 56 (2) ◽  
Author(s):  
Alexia Anagnostopoulos ◽  
Daniel A. Bossard ◽  
Bruno Ledergerber ◽  
Patrick O. Zingg ◽  
Annelies S. Zinkernagel ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Joint Infection ◽  
Surgical Site Infections ◽  
Content Type ◽  
Perioperative Antibiotic Prophylaxis ◽  
Perioperative Prophylaxis ◽  
Joint Infections ◽  
Time To Positivity ◽  
Cutibacterium Acnes ◽  
Perioperative Antibiotics

ABSTRACTIf a bone or joint infection is suspected, perioperative antibiotic prophylaxis is frequently withheld until intraoperative microbiological sampling has been performed. This practice builds upon the hypothesis that perioperative antibiotics could render culture results negative and thus impede tailored antibiotic treatment of infections. We aimed to assess the influence of antibiotic prophylaxis within 30 to 60 min before surgery on time to positivity of microbiological samples and on proportion of positive samples inCutibacterium acnesbone and joint infections. Patients with at least one sample positive forC. acnesbetween January 2005 and December 2015 were included and classified as having an “infection” if at least 2 samples were positive; otherwise they were considered to have a sample “contamination.” Kaplan-Meier curves were used to illustrate time to culture positivity. We found 64 cases with aC. acnesinfection and 46 classified as having aC. acnescontamination. Application of perioperative prophylaxis significantly differed between the infection and contamination groups (72.8% versus 55.8%;P< 0.001). Within the infection group, we found no difference in time to positivity between those who had or had not received a perioperative prophylaxis (7.07 days; 95% confidence interval [CI], 6.4 to 7.7, versus 7.11 days; 95% CI, 6.8 to 7.5;P= 0.3). Also, there was no association between the proportion of sample positivity and the application of perioperative prophylaxis (71.6% versus 65.9%;P= 0.39). Since perioperative prophylaxis did not negatively influence the microbiological yield inC. acnesinfections, antibiotic prophylaxis can be routinely given to avoid surgical site infections.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

The healthcare delivery system: an overview

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Delivery System ◽  
Chronic Care ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Healthcare Delivery System ◽  
Care Level ◽  
Primary Care Level ◽  
Internal Markets ◽  
System A ◽  
Policy Challenge

This chapter provides an overview of the healthcare delivery system. A figure illustrates how six different parts of the system relate to each other. The primary care level plays a key role in many countries by representing the gate, in which referrals to secondary care are being made. Tertiary care is principally of two types depending on patients’ prognosis: chronic care or rehabilitation. In addition to the three care levels, there are two parts with quite different roles: pharmacies provide pharmaceuticals, and sickness benefit schemes compensate the sick for their income losses. A recurrent policy challenge is to make each provider level take into account the resource implications of their isolated decisions outside of their own budgets. A brief discussion is included on the scope for ‘internal markets’.

scholarly journals 99. Effectiveness of Antibiotic Prophylaxis Among Patients Undergoing Elective Transurethral Resection of the Prostate in the Era of Antibiotic Resistance

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S179-S180
Author(s):  
Thana Khawcharoenporn ◽  
Pimjira Kanoktipakorn
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Prophylaxis ◽  
Transurethral Resection ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Prophylactic Antibiotics ◽  
Care Hospital ◽  
Extended Spectrum Beta Lactamase ◽  
Observational Cohort

Abstract Background Data existing on effectiveness of antibiotic prophylaxis (AP) for transurethral resection of the prostate (TURP) are limited in the era of antibiotic resistance. Methods A 4-year prospective observational cohort study was conducted among patients undergoing TURP in an academic tertiary-care hospital during 2016–2019. Patients were excluded if pre-operative (pre-op) urine cultures were not sent or grew mixed (&gt;2) organisms, or they had pre-op urinary tract infection (UTI) or lost follow-up after TURP. Appropriateness of AP was defined as 1) correct dosing and duration and narrowest spectrum according to the hospital AP guidelines and local epidemiology and 2) being active against uropathogens isolated from the pre-op culture. Primary outcome was the rate of UTI within 30 days post TURP compared between appropriate antibiotic prophylaxis (AAP) and inappropriate antibiotic prophylaxis (IAP) groups. Results 342 patients were screened and 61 were excluded. Of the 281 patients included, 139 (49%) received AAP and 142 (51%) received IAP. The reasons for IAP were prescribing too broad-spectrum antibiotics (57%), inactive antibiotics (41%) and incorrect dosing (2%). Pre-op urine cultures were no growth in 148 patients (53%). Among the 133 positive urine cultures with 144 isolates, Escherichia coli (52%) was the most commonly isolated. Thirty-one percent of these 144 isolates produced extended-spectrum beta-lactamase (ESBL) and 23 (16%) isolates were multidrug-resistant. The resistant rates of Enterobacteriaceae were 73% for ciprofloxacin, 65% for TMP-SMX and 46% for ceftriaxone. The two most commonly prescribed prophylactic antibiotics were ceftriaxone (51%) and ciprofloxacin (34%). The rate of UTI within 30 days post-TURP was significantly higher in IAP group compared to AAP group (47% vs 27%; P&lt; 0.001). Prescribing inactive prophylactic antibiotics was the independent factor associated with 30-day post-TURP UTI (adjusted odds ratio 2.88; P=0.001). Conclusion Appropriate antibiotic prophylaxis significantly reduced UTI within 30 days of elective TURP. Obtaining pre-op urine culture and prescribing an active prophylactic agent are critical for preventing post-TURP UTI in the era of antibiotic resistance. Disclosures All Authors: No reported disclosures

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