Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin/Cefotaxime Increases Inguinal Surgical Site Infection Rate After Lower Extremity Revascularization

2019 ◽  
Vol 18 (2) ◽  
pp. 135-142 ◽  
Author(s):  
Francis Rezk ◽  
Håkan Åstrand ◽  
Stefan Acosta
Keyword(s):  
Lower Extremity ◽  
Vascular Surgery ◽  
Antibiotic Prophylaxis ◽  
Infection Rate ◽  
Odds Ratio ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Arterial Disease ◽  
Lower Extremity Revascularization

Due to the consistently high proportion of surgical site infections (SSI) after vascular surgery, a change of prophylactic antibiotic therapy from cloxacillin/cefotaxime to trimethoprim/sulfamethoxazole (TMP-SMX) was conducted in 2016. The study included consecutive patients undergoing lower extremity revascularization due to acute or chronic lower extremity arterial disease. The antibiotic regime was changed in between the two sampling periods (2014 -2016 versus 2016 -2017). The diagnosis of SSI was based on clinical examination and microbiological results, and severity was classified according to the Szilagyi classification. One hundred and twenty-two patients in the cloxacillin/cefotaxime and 67 patients in the TMP-SMX group were included. The SSI rates were 32.0% and 40.3%, respectively (p=0.25). The proportion of women were higher in the TMP-SMX group (32.8% versus 47.8%, respectively, p=0.043). No other differences between the two groups were found regarding patient, vascular surgery procedure characteristics or severity of SSI. Groin infection rate was higher in the TMP-SMX group (15.4% versus 30.5%, respectively, p=0.022). When adjusting for gender, groin infection was more common in the TMP-SMX group (Odds Ratio 2.5, 95% CI 1.1 -5.4). The groin SSI rate was higher after elective surgery in the TMP-SMX group (13.0% versus 27.8%, respectively, p=0.027), and also after adjusting for gender (Odds Ratio 2.6, 95% CI 1.1 -6.2). The change in antibiotic prophylaxis from Cloxacillin/Cefotaxime to TMP-SMX was associated with an increased rate of inguinal SSI in patients undergoing lower extremity revascularization, despite a possible Hawthorne effect.

scholarly journals Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

2012 ◽  
Vol 2 (3) ◽  
pp. 207-211
Author(s):  
J N Shah ◽  
S B Maharjan ◽  
K Manandhar
Keyword(s):  
Antibiotic Prophylaxis ◽  
Current Practice ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Local Institutions ◽  
Medical Sciences ◽  
Observation Study ◽  
Cross Sectional ◽  
Hospital Protocol

Objective: Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis (AP) before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections (SSIs). However, proper timing of AP remains problematic as reported by various studies, though none so far from  local institutions in Nepal. Aim of this cross sectional observation study was to assess and address the issues of timing of AP and need for improvements. Material & Methods: Convenient sample target of 100 cases of preoperative AP were studied from Oct 1 to Oct 30, 2010. Data were prospectively entered in predesigned ‘AP form’ for all major elective surgeries, except obstetric cases, who received AP of intravenous Cefazoline 1 g as per existing hospital protocol. Time of AP administration in respect to incision time was analyzed. Results: There were 125 cases during study period. Majority, 81% received AP before incision, while 19% had AP after the incision. Only 1% of patients received AP within recommended period within 60 to 30 minutes before incision. Conclusion: Current practice of antibiotic prophylaxis (AP) at our institutions needs improvement as per standard guidelines of AP within 60 to 30 minutes before incision. DOI: http://dx.doi.org/10.3126/ajms.v2i3.5610 Asian Journal of Medical Sciences 2 (2011) 207-211 

scholarly journals Single dose antibiotic prophylaxis for prevention of surgical site infection in elective surgery

2017 ◽  
Vol 5 (1) ◽  
pp. 27 ◽  
Author(s):  
Swaroop V. Borade ◽  
Obaid Syed
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Relevant Information ◽  
Site Infection ◽  
Intraoperative Management ◽  
Clean Contaminated ◽  
A Prospective Study

Background: Surgical site infections are associated with prolonged hospital stays and increased costs. Infection develops when endogenous flora is translocated to a normally sterile site. Seeding of the operative site from a distant site of infection can also occur (especially in patients with prosthesis or another implant). Factors influencing the development of surgical site infections include bacterial inoculums and virulence, host defences, preoperative care and intraoperative management. Hence there is the need for antibiotic prophylaxis to overcome this problem. This study was planned to evaluate the effect of prophylactic antibiotic in clean and clean contaminated cases and to assess the outcome.Methods: A prospective study was conducted which include 100 patients undergoing elective surgery admitted to the department of general surgery IIMSR’s Medical College and Hospital, Warudi, Jalna, relevant information of each patient was collected according to the Performa designed for the study. Cefuroxime was used preoperatively 30 min prior to incision and its impact on postoperative wound infection was studied.Results: We had 100 cases in our study predominantly males with maximum individuals in 31-40 years age group, we had 67% clean and 33% clean contaminated surgeries done and had 3% case of superficial surgical site infection.Conclusions: A single preoperative dose of antibiotic Cefuroxime is effective to prevent surgical site infection in elective case assuming an uncomplicated procedure.

scholarly journals Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

2010 ◽  
Vol 49 (179) ◽  
Author(s):  
Jay N Shah ◽  
SB Maharjan ◽  
R Piya ◽  
A Shrestha ◽  
K Shrestha ◽  
...  
Keyword(s):  
Observational Study ◽  
Antibiotic Prophylaxis ◽  
Prospective Observational Study ◽  
Current Practice ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Optimum Concentration ◽  
Infection Prophylaxis ◽  
Time Period

INTRODUCTION: Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections . However, proper timing of AP remains problematic as reported by various studies, though none so far from Nepal. Aim of this prospective observational study was to assess and address the issues for improvements in timing of AP. METHODS: The pattern of antibiotic prophylaxis were prospectively collected in respect to time of induction, and incision time were recorded on predesigned 'AP form'. The study included all the elective major cases who received AP of intravenous Cefazoline 1 g as per our existing protocol. The emergency surgeries and obstetric cases were excluded from the study. RESULTS: There were 125 cases of which 89% received AP before incision (63% within 5 minutes before incision), while 11% had AP after the incision and 1% within the recommended time period of 2 hour to 30 minutes before incision. CONCLUSIONS: Current practice of antibiotic prophylaxis (AP) needs improvement as per standard guidelines of AP within 2 hour to 30 before incision. Keywords: antibiotic, infection, prophylaxis, surgery.

How Admission to a Vascular Surgery Department Improves Medical Treatment in Patients with Lower Extremity Peripheral Arterial Disease

2017 ◽  
Vol 40 ◽  
pp. 85-93 ◽  
Author(s):  
Martina Thiney ◽  
Nellie Della Schiava ◽  
Patrick Feugier ◽  
Patrick Lermusiaux ◽  
Jacques Ninet ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Vascular Surgery ◽  
Medical Treatment ◽  
Arterial Disease ◽  
Peripheral Arterial ◽  
Surgery Department

Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease?

2020 ◽  
Vol 54 (7) ◽  
pp. 618-624
Author(s):  
Jasper C. M. Langenberg ◽  
Joost Roijers ◽  
Jan A. J. W. Kluytmans ◽  
Hans G. W. de Groot ◽  
Gwan H. Ho ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Chronic Renal Disease ◽  
Graft Infection ◽  
Surgical Site Infections ◽  
Arterial Disease ◽  
Occlusive Disease ◽  
Aortoiliac Occlusive Disease ◽  
Occlusive Arterial Disease ◽  
Acute Surgery ◽  
Aortoiliac Surgery

Background: Surgical site infections (SSI) are frequently seen after aortoiliac vascular surgery (2%-14%). Deep SSIs are associated with graft infection, sepsis, and mortality. This study evaluates the difference in incidence and nature of SSI following open aortoiliac surgery for aneurysmal disease compared to occlusive arterial disease. Methods: A retrospective cohort study was conducted, including all consecutive patients who underwent open aortoiliac vascular surgery between January 2005 and December 2016 in the Amphia Hospital, Breda, the Netherlands. Patients were grouped by disease type, either aneurysmal or occlusive arterial disease. Data were gathered, including patient characteristics, potential risk factors, and development of SSI. Surgical site infections were defined in accordance with the criteria of the Centers for Disease Control. Results: Between January 2005 and December 2016, a total of 756 patients underwent open aortoiliac surgery of which 517 had aortoiliac aneurysms and 225 had aortoiliac occlusive disease. The group with occlusive disease was younger, predominantly male, and had more smokers. After exclusion of 228 patients undergoing acute surgery, the SSI rate after elective surgery was 6.2%, with 10 of 301 SSIs in the aneurysmal group (3.0%) and 22 of 213 SSIs in the group with occlusive disease (10.3%, P < .001). Also, infection-related readmission and reintervention were higher after occlusive surgery, 6.6% versus 0.9% ( P < .001) and 4.2% versus 0.9% ( P = .003), respectively. Staphylococcus aureus was found as the most common pathogen, causing 64% of SSI in occlusive disease versus 10% in aneurysmal disease ( P = .005). Logistic regression showed occlusive arterial disease and chronic renal disease were associated with SSI. Conclusion: Our study presents evidence for a higher rate of SSI in patients with aortoiliac occlusive disease compared to aortoiliac aneurysmal disease, in part due to inherent use of inguinal incision in patients with occlusive disease. All precautions to prevent SSI should be taken in patients undergoing vascular surgery for arterial occlusive disease.

scholarly journals ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

2015 ◽  
Vol 52 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Álvaro Antônio Bandeira FERRAZ ◽  
Luciana Teixeira de SIQUEIRA ◽  
Josemberg Marins CAMPOS ◽  
Guido Correa de ARAÚJO JUNIOR ◽  
Euclides Dias MARTINS FILHO ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Continuous Infusion ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Anesthesia Induction ◽  
Site Infection ◽  
Cross Sectional ◽  
Group I ◽  
Bariatric Patients

Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 47-53 ◽  
Author(s):  
David Parizh ◽  
Enrico Ascher ◽  
Syed Ali Raza Rizvi ◽  
Anil Hingorani ◽  
Michael Amaturo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Vascular Surgery ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Surgical Site Infections ◽  
Quality Improvement Initiative ◽  
Site Infection ◽  
Surgical Site Infection Rate ◽  
Patient Demographics ◽  
Revascularization Procedures

Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. Summary background data: In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p < 0.005). Conclusions Preventative measures, in the form of a standardized protocol, to decrease surgical site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

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