Use of Prolonged Prophylactic Antibiotics with Closed Suction Drains in Ventral Abdominal Hernia Repair

2019 ◽  
Vol 85 (4) ◽  
pp. 403-408
Author(s):  
Eric Weiss ◽  
Paul Mcclelland ◽  
James Krupp ◽  
Murad Karadsheh ◽  
Mary Sue Brady
Keyword(s):  
Hernia Repair ◽  
Primary Outcome ◽  
Univariate Analysis ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Abdominal Hernia ◽  
Limited Evidence ◽  
Closed Suction ◽  
Increased Risk ◽  
Ventral Abdominal Hernia

Closed suction drains (CSD) are commonly used in ventral hernia repair (VHR), with or without prolonged postoperative prophylactic antibiotics (PPA) for the duration of their use. We examine the evidence that PPA with CSD reduce surgical site infection (SSI) in patients undergoing VHR. We also examine the evidence assessing the association between SSI and CSD in VHR. A systematic review of PubMed, CIHNL, and Cochrane databases was performed to identify studies analyzing rates of SSI with CSD in patients undergoing abdominal VHR and related procedures with or without the concomitant use of PPA. The primary outcome was the rate of SSI. Five studies totaling 772 patients were identified, 525 patients were confirmed to have CSD, and 434 patients received prolonged antibiotics while drains were in place. PPA had no significant effect on SSI in two studies and were associated with decreased SSI in one study (Odds ratio 0.235, 95% confidence interval 0.090–0.617, P = 0.003). Two studies documented a higher rate of SSI in patients with CSD (79% vs 49% and 19% vs 10%) on univariate analysis. One study demonstrated a very low risk of SSI despite CSD (4.2%) and another demonstrated no increased risk with or without CSD. The use of drains is not clearly associated with an increased risk of SSI in VHR, and there is limited evidence to support antibiotic use while the drains are in place to decrease the potential risk. Prospective randomized studies are needed to more clearly assess these associations.

Protein-losing enteropathy resolved after ventral abdominal hernia repair

2018 ◽  
Vol 41 (5) ◽  
pp. 313-315
Author(s):  
Lara Aguilera Castro ◽  
Luis Téllez Villajos ◽  
Antonio López San Román ◽  
José Ignacio Botella Carretero ◽  
Ana García García de Paredes ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Abdominal Hernia ◽  
Protein Losing Enteropathy ◽  
Abdominal Hernia Repair ◽  
Ventral Abdominal Hernia

scholarly journals Risk Factors for Postpartum Maternal Infection Following Spontaneous Vaginal Delivery Complicated by Chorioamnionitis

2020 ◽  
Vol 10 (02) ◽  
pp. e159-e164
Author(s):  
Helen A. Daifotis ◽  
Megan M. Smith ◽  
Anna E. Denoble ◽  
Sarah K. Dotters-Katz
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Primary Outcome ◽  
Perineal Wound ◽  
Antibiotic Use ◽  
Bivariate Statistics ◽  
Spontaneous Vaginal Delivery ◽  
High Risk Women ◽  
Increased Risk ◽  
Perineal Wound Infection

Abstract Objective Guidelines for the management of chorioamnionitis include intrapartum antibiotics, while postpartum antibiotics after spontaneous vaginal delivery (SVD) are reserved high-risk women. Our objective is to describe the incidence of and risk factors for postpartum infection after SVD complicated by chorioamnionitis. Study Design This is a retrospective study of SVDs with clinically diagnosed chorioamnionitis at a single center. The primary outcome was a composite of postpartum infection. Women who developed the primary outcome were compared with those who did not using bivariate statistics. Regression models were developed to estimate adjusted odds of outcomes. Results In this cohort, 346 women underwent SVD complicated by chorioamnionitis. Of these, 23 (6.6%) developed postpartum infections (endometritis n = 7, urinary tract infection/pyelonephritis n = 6, sepsis n = 4, and perineal wound infection n = 6). Receipt of antibiotics intra- or postpartum did not differ between groups, but women with postpartum infections were more likely to deliver prior to 32 weeks (17.4 vs. 4.9%, p = 0.04). When controlling for antibiotic use, delivery at < 32 weeks was associated with 3.8-fold increased (95% confidence interval: 1.07–13.7) odds of postpartum infection. Conclusion Postpartum infections occur in ∼1/15 women delivering vaginally with chorioamnionitis, with those who deliver at < 32 weeks' gestation being at increased risk.

Risk Factors Associated With Readmission After Pancreatectomy: A Single-Institution Retrospective Cohort Study

2021 ◽  
pp. 000313482098882
Author(s):  
Morgan Bonds ◽  
Tabitha Garwe ◽  
Noah Rozich ◽  
Babawale Oluborode ◽  
Zoona Sarwar ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Univariate Analysis ◽  
Surgical Site Infections ◽  
Inclusion Criteria ◽  
Dose Response Relationship ◽  
Increased Risk ◽  
Multivariable Analyses ◽  
Limited Precision ◽  
The Many ◽  
Multivariable Adjustment

Background Pancreatectomy has a significant rate of procedure-specific morbidity which can result in readmission. Readmission has been proposed as a measure of quality. The goal of this study is to determine what factors are associated with readmission after pancreatectomy and whether readmission can be prevented. Methods A retrospective review of a single institution’s pancreatectomies between January 2011 and April 2015 was performed. Demographic, perioperative, and outpatient data were collected from the medical record. Primary outcome was 90-day readmission. Univariate and multivariable analyses were performed to determine which factors were associated with increased risk for readmission. Results A total of 257 patients met inclusion criteria; the 90-day readmission rate was 32.7%. The median time to readmission was 13 days. Readmitted patients were more likely to have a postoperative pancreatic fistula (POPF) on univariate analysis. Surgical site infections were more common in readmitted patients (18% vs 6.4%, P = .0138). Upon multivariable adjustment, only POPF ( P = .0005) remained significant. A positive dose-response relationship was noted between POPF grade and the odds of readmission with odds ratios (ORs) ranging from 1.6 (95% Confidence Interval (CI): .6-4.1) for grade A to 16.7 (95% CI: 1.8-156.8) for grade C, albeit with limited precision. Conclusions Readmission after pancreatectomy is a common occurrence despite the many advancements in perioperative care. Our data suggest that POPF is a risk factor for readmission after pancreatectomy. Presently, this factor is not clearly preventable. This suggests that readmission may not be the best measure of quality to utilize in the evaluation of pancreatic surgery.

scholarly journals Association of oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin with the risk of serious ventricular arrhythmia: a nationwide cohort study in Korea

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e020974 ◽  
Author(s):  
Yongil Cho ◽  
Hyun Soo Park
Keyword(s):  
Cohort Study ◽  
Ventricular Arrhythmia ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Population Based ◽  
Administrative Claims ◽  
Increased Risk ◽  
Oral Ciprofloxacin ◽  
Reduced Risk

ObjectiveTo evaluate whether oral ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin increase the risk of ventricular arrhythmia in Korea’s general population.DesignPopulation-based cohort study using administrative claims data on a national scale in Korea.SettingAll primary, secondary and tertiary care settings from 1 January 2015 to 31 December 2015.ParticipantsPatients who were prescribed the relevant study medications at outpatient visits.Primary outcome measuresEach patient group that was prescribed ciprofloxacin, levofloxacin, ofloxacin or moxifloxacin was compared with the group that was prescribed cefixime to assess the risk of serious ventricular arrhythmia (ventricular tachycardia, fibrillation, flutter and cardiac arrest). Using logistic regression analysis with inverse probability of treatment weighting using the propensity score, OR and 95% CI for serious ventricular arrhythmia were calculated for days 1–7 and 8–14 after the patients commenced antibiotic use.ResultsDuring the study period, 4 888 890 patients were prescribed the study medications. They included 1 466 133 ciprofloxacin users, 1 141 961 levofloxacin users, 1 830 786 ofloxacin users, 47 080 moxifloxacin users and 402 930 cefixime users. Between 1 and 7 days after index date, there was no evidence of increased serious ventricular arrhythmia related to the prescription of ciprofloxacin (OR 0.72; 95% CI 0.49 to 1.06) and levofloxacin (OR 0.92; 95% CI 0.66 to 1.29). Ofloxacin had a 59% reduced risk of serious ventricular arrhythmia compared with cefixime during 1–7 days after prescription. Whereas the OR of serious ventricular arrhythmia after the prescription of moxifloxacin was 1.87 (95% CI 1.15 to 3.11) compared with cefixime during 1–7 days after prescription.ConclusionsDuring 1–7 days after prescription, ciprofloxacin and levofloxacin were not associated with increased risk and ofloxacin showed reduced risk of serious ventricular arrhythmia. Moxifloxacin increased the risk of serious ventricular arrhythmia.

scholarly journals 2445. Risk for Readmission and Mortality Amongst LTACH Residents with New-Onset Healthcare-Associated Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S845-S845
Author(s):  
Kyle D Massey ◽  
Melissa Murphy ◽  
Todd Miano ◽  
Shawn Binkley ◽  
Steven C Morgan ◽  
...  
Keyword(s):  
Acute Care ◽  
Primary Outcome ◽  
Univariate Analysis ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Model ◽  
Unplanned Readmission ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Increased Risk ◽  
Healthcare Associated

Abstract Background Long-term acute care hospitals (LTACH) provide cost-effective alternatives for stable patients requiring ICU-level care. LTACH patients are at increased risk for adverse outcomes including healthcare-associated infections (HAI). There is a paucity of data describing outcomes associated with HAIs in LTACH patients. Methods This was a single-center, retrospective study of LTACH patients over a 3 year period. Patients with an HAI (bloodstream [BSI], pneumonia [PNA], urinary tract [UTI], and Clostridioides difficile [CDI] infections) as defined by NHSN criteria were matched by length of stay (LOS) at the time of inclusion to unexposed patients. Follow-up was 30 days from the date of inclusion. The primary outcome was a composite of unplanned readmission to an acute care hospital or death at the LTACH. Secondary outcomes included all-cause mortality. Patients with HAIs were further evaluated to determine risk factors associated with readmission Antibiotics and cultured organisms were collected. Outcomes were analyzed using Cox proportional hazards model. Variables found to have a P < 0.1 on univariate analysis and those of clinical interest were included in the models. Results 250 patients were included, 125 in each group. The distribution of HAIs was 40 BSI, 39 UTI, 26 PNA, and 20 CDI. The incidence of the primary outcome and mortality were 26.0% and 11.6% respectively. HAI was associated with increased risk of the primary outcome, but the effect varied over time: Risk increased seven-fold during the first 5 days (HR, 7.47 [95% CI, 2.86–19.42]) but was smaller and non-significant after day five (HR, 1.94 [95% CI, 0.85–4.43]). Mortality was not significantly different between groups (HR, 1.58 [95% CI, 0.74–3.38]). After adjustment, only hypotension (HR, 2.27 [95% CI 1.21–4.27]) and referral hospital LOS > 28 days (HR, 1.97 [95% CI 1.10–3.53]) were associated with readmission. 37% of cultured organisms were multi-drug-resistant. 17% of Enterobacteriaceae were carbapenem resistant. Empiric antibiotics failed to cover in 35% of infections. Conclusion HAI was associated with a significant increase in risk of readmission. Exploration of modifiable variables of infection, including hypotension and antibiotic selection, may help to reduce rates of readmission. Disclosures All authors: No reported disclosures.

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