Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence

Background: There are no clearly defined guidelines from hand surgical societies regarding preoperative antibiotic prophylaxis. Many hand surgeons continue to routinely use preoperative prophylaxis with limited supporting evidence. This study aimed to determine for which scenarios surgeons give antibiotics, the reasons for administration, and whether these decisions are evidence-based. Methods: An anonymous 25-question survey was e-mailed to the 921-member American Society for Surgery of the Hand listserv. We collected demographic information; participants were asked whether they would administer antibiotics in a number of surgical scenarios and for what reasons. Respondents were broken into 3 groups based on when they said they would administer antibiotics: Group 1 (40 respondents) would give antibiotics in the case of short cases, healthy patients, without hardware; group 2 (9 respondents) would not give antibiotics in any scenario; and group 3 (129 respondents) would give antibiotics situationally. The Fisher exact test compared demographic variables, frequency of use, and indications of antibiotic prophylaxis. Results: Of the 921 recipients, 178 (19%) responded. Demographic variables did not correlate with the antibiotic use group. Operative case time >60 minutes, medical comorbidity, and pinning each increased antibiotic use. Group 1 respondents were more likely to admit that their practice was not evidence-based (74.4%) and that they gave antibiotics for medical-legal concern (75%). Twenty-two percent of respondents reported seeing a complication from routine prophylaxis, including Clostridium difficile infection. Conclusions: Antibiotics are still given unnecessarily before hand surgery, most often for medical-legal concern. Clear guidelines for preoperative antibiotic use may help reduce excessive and potentially inappropriate treatment and provide medical-legal support.

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173TRANSFER OF VITRIFIED BLASTOCYSTS FROM ONE OR TWO SUPEROVULATED LARGE WHITE HYPERPROLIFIC DONORS TO MEISHAN RECIPIENTS: REPRODUCTIVE PARAMETERS AT DAY 30 OF PREGNANCY

Reproduction Fertility and Development ◽

10.1071/rdv16n1ab173 ◽

2004 ◽

Vol 16 (2) ◽

pp. 208

Author(s):

C. Cuello ◽

F. Berthelot ◽

F. Martinat-Botté ◽

P. Guillouet ◽

V. Furstoss ◽

...

Keyword(s):

Pregnancy Rate ◽

Fisher Exact Test ◽

Corpora Lutea ◽

Large White ◽

Embryo Survival ◽

Exact Test ◽

Group 2 ◽

Fresh Semen ◽

Group 1

The present study was designed to determine the effect of pooling embryos from two donors on the reproductive success of transfer of vitrified/warmed porcine blastocysts. Superovulated Large White hyperprolific gilts (n=24) were used as embryo donors. Gilts were artificially inseminated 12 and 24h after initial detection of estrus using fresh semen, and slaughtered on Days 5.5 to 6 of the estrous cycle (Day 0=Onset of estrus). Embryos were recovered by flushing the uterine horns, and unhatched blastocysts were selected. Vitrification and warming were performed as reported previously (Berthelot et al., 2000 Cryobiology 41, 116–124). Embryo transfers were conducted in asynchronous (−24h) Meishan gilts (n=20). Twenty vitrified/warmed blastocysts were surgically transferred into one uterine horn. Ten recipients received embryos from one donor (group 1) and the other ten transfers were performed with mixed embryos from two donors (group 2). Pregnancy was assessed ultrasonographically at Day 25 after estrus and recipients were slaughtered five days later. The pregnancy rate from the different groups was compared using Fisher exact test. The GLM procedure of SAS was used to determine the effect of the origin of embryos (one or two donors) on the number of developed fetuses and viable fetuses at Day 30 of pregnancy. The ovulation rate was 32.5±11.8 (mean±SD). The total number of embryos collected was 634, of which 57 (9.0%), 36 (5.7%), 513 (80.9%) and 28 (4.4%), were unfertilized oocytes and degenerated embryos, morulae, unhatched blastocysts and hatched blastocysts, respectively. The ratio of collected embryos to the number of corpora lutea was 81.3%. The pregnancy rate for group 1 (70%) was not different (P>0.05) than that for group 2 (90%). No significant differences were detected between group 1 and group 2 for in vivo embryo development (number fetuses/transferred embryos in pregnant recipients; 33.3% v. 40%) or in vivo embryo survival (number viable fetuses/transferred embryos in pregnant recipients; 27.9% v. 33.9%). However, the in vivo efficiency (number viable fetuses/total transferred embryos) was higher (P<0.05) when transfers were performed with embryos from two donors (19.5% v. 30.5%). These results indicate that pooling embryos from two donors increases the in vivo efficiency after transfer of vitrified/warmed porcine blastocysts. This study was supported by grant from SENECA (FPI/99, Spain).

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Antibiotics and Facial Fractures: Evidence-Based Recommendations Compared with Experience-Based Practice

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0034-1378187 ◽

2015 ◽

Vol 8 (1) ◽

pp. 64-78 ◽

Cited By ~ 34

Author(s):

Gerhard S. Mundinger ◽

Daniel E. Borsuk ◽

Zachary Okhah ◽

Michael R. Christy ◽

Branko Bojovic ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Evidence Based ◽

Facial Fracture ◽

Prescribing Practices ◽

Orbital Surgery ◽

Level Of Evidence ◽

Fracture Management ◽

Mandible Fractures

Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third. Study level of evidence was assessed according to the American Society of Plastic Surgery criteria, and graded practice recommendations were made based on these assessments. Expert opinions were garnered during the Advanced Orbital Surgery Symposium in the form of surveys evaluating senior surgeon clinical antibiotic prescribing practices by time point and facial third. A total of 44 studies addressing antibiotic prophylaxis and facial fracture management were identified. Overall, studies were of poor quality, precluding formal quantitative analysis. Studies supported the use of perioperative antibiotics in all facial thirds, and preoperative antibiotics in comminuted mandible fractures. Postoperative antibiotics were not supported in any facial third. Survey respondents ( n = 17) cumulatively reported their antibiotic prescribing practices over 286 practice years and 24,012 facial fracture cases. Percentages of prescribers administering pre-, intra-, and postoperative antibiotics, respectively, by facial third were as follows: upper face 47.1, 94.1, 70.6; midface 47.1, 100, 70.6%; and mandible 68.8, 94.1, 64.7%. Preoperative but not postoperative antibiotic use is recommended for comminuted mandible fractures. Frequent use of pre- and postoperative antibiotics in upper and midface fractures is not supported by literature recommendations, but with low-level evidence. Higher level studies may better guide clinical antibiotic prescribing practices.

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Preoperative antibiotic prophylaxis of odontogenic maxillary sinusitis, as a result of the formed oroantral joint

Reviews on Clinical Pharmacology and Drug Therapy ◽

10.17816/rcf184359_363 ◽

2020 ◽

Vol 18 (4) ◽

Author(s):

Nalaliya V. Maksimova ◽

Filipp V. Dulov ◽

Maksim F. Tkachuk

Keyword(s):

Antibiotic Prophylaxis ◽

Tooth Extraction ◽

Antimicrobial Agents ◽

Maxillary Sinusitis ◽

Alveolar Process ◽

Group I ◽

Preoperative Antibiotic Prophylaxis ◽

The Difference ◽

Group 2 ◽

Group 1

The article describes clinical research methods as an assessment of the effectiveness of preoperative antibiotic prophylaxis in operations on the alveolar process of the upper jaw. Methods.70 patients underwent a tooth extraction operation, complicated by perforation of the Schneider membrane in the period 2018-2019. These patients are conditionally divided into two homologous groups (body weight, gender, age, information from the medical history). Group I (34 patients) is scheduled to prescribe antimicrobial agents as preoperative antibiotic prophylaxis. In group II (36 patients), standard seven-day antibiotic therapy was performed. Results.Infectious and inflammatory complications in group 1 occurred in 5.4% of cases, in group 2 in 6.2% of cases, the difference in the occurrence of infectious and inflammatory complications was 1.2%.

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Preoperative antibiotic prophylaxis of odontogenic maxillary sinusitis, as a result of the formed oroantral joint

Reviews on Clinical Pharmacology and Drug Therapy ◽

10.17816/rcf184359-363 ◽

2020 ◽

Vol 18 (4) ◽

pp. 359-363

Author(s):

Nalaliya V. Maksimova ◽

Filipp V. Dulov ◽

Maksim F. Tkachuk

Keyword(s):

Antibiotic Prophylaxis ◽

Tooth Extraction ◽

Antimicrobial Agents ◽

Maxillary Sinusitis ◽

Alveolar Process ◽

Group I ◽

Preoperative Antibiotic Prophylaxis ◽

The Difference ◽

Group 2 ◽

Group 1

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Penggunaan Antibiotik untuk Penanganan Ulkus dan Gangren Diabetikum Pasien Rawat Inap di Rumah Sakit

Jurnal Pharmascience ◽

10.20527/jps.v7i2.8578 ◽

2020 ◽

Vol 7 (2) ◽

pp. 99

Author(s):

Riyan Stiyanto ◽

Iin Suhesti

Keyword(s):

Diabetes Mellitus ◽

Antibiotic Use ◽

Diabetes Mellitus Patient ◽

Therapeutic Outcome ◽

Fisher Exact Test ◽

Chi Square ◽

Exact Test ◽

Chi Square Test ◽

Empirical Antibiotics ◽

Diabetes Melitus

Penyakit Diabetes melitus yang tidak dikelola dengan baik dapat menyebabkan komplikasi dan membahayakan kehidupan pengidapnya. Salah satu komplikasi diabetik yang sering terjadi adalah neuropati (kerusakan syaraf) di kaki yang menyebabkan ulkus kaki, infeksi, dan bahkan keharusan untuk amputasi kaki. Penelitian ini bertujuan untuk mengidentifikasi persentase penggunaan antibiotika empiris yang rasional serta pengaruhnya terhadap outcome terapi pada pasien Diabetes melitus dengan ulkus dan gangren di RSUD Dr Moewardi Surakarta dan RSUD Bagas Waras Klaten. Penelitian ini merupakan penelitian observasional dengan pengambilan data pada penelitian dilakukan secara retrospektif dan prospektif selama periode Januari sampai Agustus 2018. Ketidakrasionalan penggunaan antibiotika empiris dievaluasi dengan metode Gyssens. Sebanyak 36 pasien yang memenuhi kriteria inklusi 75% pasien mendapatkan terapi antibiotika empiris yang rasional dan 25% pasien mendapatkan terapi antibiotika empiris yang tidak rasional. Uji Chi Square dengan taraf kepercayaan 5% (p < 0,05) digunakan untuk membandingkan rasionalitas pengunaan antibiotika terhadap outcome terapi. Hasil Fisher’s Exact Test (Two Tailed) menunjukkan bahwa ada hubungan/pengaruh antara rasionalitas penggunaan antibiotika empiris dengan outcome terapi tetapi pemberian antibiotika empiris tidak berpengaruh pada angka leukosit bagi pasien, baik di RSUD Bagas Waras Klaten maupun RSUD dr. Moewardi Surakarta.Diabetes mellitus that is not managed properly can cause complications to endanger life. One of the diabetic complications that often occurs is foot neuropathy (nerve damage) inducing foot ulcers, infections, and even the necessity for a leg amputation. This study aims to determine the percentage of rational use of empirical antibiotics and their effects on outcomes therapy of diabetes mellitus patient with ulcers and gangrene in RSUD dr. Moewardi Hospital Surakarta and Bagas Waras Hospital Klaten. This study is an observational study with data collection in the study carried out retrospectively and prospectively from January to August 2018. The irrationality of using empirical antibiotics evaluated by the Gyssens method. Thirty six patients were enrolled and 75% of them treated with rational and empirical antibiotic therapy,. Chi-Square Test with a confidence level of 5% (p <0.05) used to compare the rationality of antibiotic use to the therapeutic outcome, the results of the Fisher Exact Test (Two-Tailed) indicated that there were relationship/influence between the rationality of using empirical antibiotics and outcomes therapy, but there was no influence between the rationality of using empirical antibiotics and leucocyte both in RSUD Bagas Waras Klaten and RSUD dr. Moewardi Surakarta.Keywords: Diabetes mellitus, therapeutic outcome, empirical antibiotic rationality

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Resilience, Depression, Anxiety, and Stress among Overseas Filipino Seafarers

Philippine Social Science Journal ◽

10.52006/main.v2i1.68 ◽

2019 ◽

Vol 2 (1) ◽

pp. 116

Author(s):

Jane Marie D. Tamayo

Keyword(s):

Demographic Variables ◽

Management Program ◽

Fisher Exact Test ◽

Snowball Sampling ◽

Depression Anxiety Stress Scale ◽

Length Of Service ◽

Exact Test ◽

Stress Scale ◽

Demographic Profiles ◽

Resilience Scale

This descriptive-correlational study assessed the level of resilience, depression, anxiety, and stress among overseas Filipino seafarers and its relationship to demographic variables such as age, marital status, length of service, position category, and family structure. Also, it sought to find out if resilience is associated with depression, anxiety, and stress, respectively. Sixty-six overseas Filipino seafarers were obtained through convenience and snowball sampling in Iloilo. The data were gathered using the Brief Resilience Scale (BRS) and Depression, Anxiety, Stress Scale (DASS-21) and were analyzed using percentage, mean, Fisher Exact test, and Pearson-r product. The results showed a normal level of resilience and experience normal levels of depression, anxiety, and stress. There is no relationship between resilience, depression, anxiety, stress and demographic profiles. Moreover, resilience is negatively associated with depression, anxiety, and stress. Results of the study served as a basis for resilience enhancement and distress management program for overseas Filipino seafarers.

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Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

Plastic Surgery ◽

10.1177/2292550321997005 ◽

2021 ◽

pp. 229255032199700

Author(s):

Peter Mankowski ◽

Abhiram Cherukupalli ◽

Karen Slater ◽

Nick Carr

Keyword(s):

Antibiotic Prophylaxis ◽

Plastic Surgery ◽

Surgical Procedures ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Evidence Based ◽

Prescribing Practices ◽

Surgical Prophylaxis

Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. Methods: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. Results: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. Conclusion: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

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Role of polymorphisms of genes involved in hemostasis in COVID-19 pathogenesis

Infekcionnye bolezni ◽

10.20953/1729-9225-2021-2-16-26 ◽

2021 ◽

Vol 19 (2) ◽

pp. 16-26

Author(s):

V.N. Gorodin ◽

◽

D.L. Moysova ◽

S.V. Zotov ◽

A.A. Vanyukov ◽

...

Keyword(s):

Severe Disease ◽

Protective Role ◽

Categorical Variables ◽

Fisher Exact Test ◽

Homozygous Mutation ◽

Blood Leukocytes ◽

Gene Encoding ◽

Exact Test ◽

Group 2 ◽

Group 1

Objective. To analyze polymorphisms of genes involved in hemostasis among patients with coronavirus disease 2019 (COVID 19) to improve the diagnosis of coagulopathy and prognosis of COVID-19 severity. Patients and methods. We have examined 52 patients with COVID-19 aged 33 to 84 years. Of them, 30 individuals (Group 1) were hospitalized with extremely severe (1A) and severe (1B) disease, whereas 22 patients with mild and asymptomatic disease were treated in outpatient departments (group 2). We assessed allelic variants of genes associated with hemostasis dysfunction (including FGB, FII, FV, FVII, F13A1, PAI-I, Gp1a, and Gp3a) using genomic DNA isolated from peripheral blood leukocytes. Polymorphisms were detected by polymerase chain reaction. Data analysis was performed using the Statistica, version 12 (StatSoft, USA). To compare independent categorical variables, we constructed contingency tables, performed Pearson chisquare test with Yates correction, Fisher exact test, and calculated relative risk (RR) [CI]. Results. COVID-induced coagulopathy (CAC) was diagnosed in 16.7% of patients; risk of CAC was identified in 30% of patients; sepsis-induced coagulopathy (SIC) was observed in 3.3% of patients; none of study participants had disseminated intravascular coagulation (DIC). Hemostasis impairments were more common in group 1A (RR = 2.28 [1.16–4.48]). Only patients from Group 1 had mutations in the gene encoding prothrombin (FII) –6.9% (RR = 1.78 [1.40–2.28]); protective polymorphisms in the FVII gene were more common in patients from Group 2 (χ2 = 3.28, р = 0.046); the rs 5985 polymorphism in the F13A1 gene was more common in patients from Group 1 (RR = 1.73 [1.06–2.82]). Patients with extremely severe COVID- 19 were more likely to have polymorphisms in the Gp1a gene (ITGA2) (RR =1.64 [1.05–2.56]) and F13A1 gene (χ2 = 2.67, р = 0.05), as well as homozygous mutation in the FII gene; they had no polymorphisms in the FVII gene (10976G→A). Thrombophilia, detected in 3 patients from Group 1, was a risk factor for thrombocytopenia (RR = 13.5 [3.56–51.23]), САС (RR = 9.0 [3.1–26.16]), and death (n = 4). The 4G allele (4G/4G, 4G/5G variants) in the PAI-I gene (rs 1799889), causing impaired fibrinolysis, was more frequently registered in patients with mild COVID-19 (91%) than in those with extremely severe COVID-19 (70%). It is possible that patients with extremely severe disease develop transient hyperfibrinolysis, which results in the transformation of local pulmonary COVID-19 into sepsis. Therefore, the 4G/4G and 4G/5G polymorphisms may have a protective role. Key words: hemostasis, COVID-19, polymorphism, genetics, COVID-induced coagulopathy

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Histologic evaluation of pulpotomy performed with ethyl-cyanoacrylate and calcium hydroxide

Brazilian Oral Research ◽

10.1590/s1806-83242006000300008 ◽

2006 ◽

Vol 20 (3) ◽

pp. 226-230 ◽

Cited By ~ 10

Author(s):

Diana Santana de Albuquerque ◽

Luciana Ferraz Gominho ◽

Roberto Alves dos Santos

Keyword(s):

Calcium Hydroxide ◽

Fisher Exact Test ◽

Hard Tissue ◽

Exact Test ◽

Hydroxide Group ◽

Barrier Formation ◽

Histologic Evaluation ◽

Group 2 ◽

Ethyl Cyanoacrylate ◽

Group 1

The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3% of Group 1, and in 100% of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50% of the ethyl-cyanoacrylate group and 75% of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.

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Mutational profiles and clinical outcomes in metastatic colorectal carcinoma patients with different metastases sites.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16020 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16020-e16020

Author(s):

Xi Zhang ◽

Zhang Jing ◽

Yingmei Li ◽

Shifu Chen

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Fisher Exact Test ◽

Test Results ◽

Mutational Signatures ◽

Exact Test ◽

Kaplan Meier ◽

The Difference ◽

Group 2 ◽

Group 1

e16020 Background: To compare the difference of genomic and survival of first metastases site between first metastases site of metastatic colorectal cancer (mCRC) in liver and other sites (bone, brain, lung, and so on). Methods: Genomic mutations and clinic data of 113,4 CRCs (consisting of 533 metastases) were collected from TCGA database. According to first site(s) of metastases, patients were categorized into group 1 (liver as first metastases site, n = 405) and group 2 (other organs as first metastases site, n = 128). OS curves were estimated with Kaplan-Meier method, p values were calculated by fisher exact test. Results: Mutation frequency in GNAS (2.34%), KRAS (37.78%), BRAF (16.41%) and proportion of MSI-high (8.5%) was significantly higher in group2. Compared with group2, group1 showed significantly higher mutation rate of APC (78.52%) and TP53 (77.28%). We assessed overall survival in the two groups. OS was significantly better for patients in group1 than in group2 (HR 0.57, 95% CI 0.41-0.79, p = 0.00075). Conclusions: According to the results of this study, mCRC patients showed different mutational signatures with respect to the site of first metastases, and presented higher OS rate in liver metastases group. Our findings provided new knowledge to understand the biological progress of different metastases and develop new prognostic markers for metastatic colorectal cancer.

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