scholarly journals Antimicrobial stewardship measures in cardiac surgery and its impact on surgical site infections

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Güzin Surat ◽  
Dominik Bernsen ◽  
Christoph Schimmer
Keyword(s):  
Cardiac Surgery ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Prophylaxis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
P Value ◽  
Care Hospital ◽  
Surgical Antimicrobial Prophylaxis ◽  
Sternal Wound Infections

Abstract Objective The goal of this study was to monitor the compliance and impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery favouring cefazolin instead cefuroxime, initiated by the hospital’s antimicrobial stewardship team. Methods This quality improvement study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the hospitals antimicrobial stewardship team following a revision of the standard for surgical antimicrobial prophylaxis including 1029 patients who underwent cardiac surgery. 582 patients receiving cefuroxime and 447 patients receiving cefazolin respectively were compared without altering any other preventative perioperative measures including its postoperative duration of less than 24 h. Adherence and surgical site infections were compiled and analysed. Results A complete adherence was achieved. Overall surgical site infections occurred in 37 (3.6%) of the cases, 20 (3.4%) in cefuroxime patients and 17 (3.8%) in cefazolin patients (p value = 0.754). No statistically significant differences could be found in any of the primary endpoints, but there was a trend towards less deep sternal wound infections in the cefazolin group. Conclusions The study supports the role of antimicrobial stewardship in cardiac surgery and mirrors the success of a multidisciplinary team aiming to minimize adverse events by optimizing antibiotic use.

scholarly journals Implementation of Antimicrobial Stewardship Measures in Cardiac Surgery: Change of Protocol for Surgical Antibiotic Prophylaxis and Its Impact on Surgical Site Infections

2020 ◽  
Author(s):  
Güzin Surat ◽  
Dominik Bernsen ◽  
Christoph Schimmer
Keyword(s):  
Cardiac Surgery ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Prophylaxis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Care Hospital ◽  
Wound Infections ◽  
Surgical Antimicrobial Prophylaxis ◽  
Tract Infections ◽  
The Impact

Abstract Objectives:The goal of this study was to evaluate the impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery comparing the new in hospital prophylactic agent cefazolin versus the former standard antibiotic cefuroxime, initiated by the antimicrobial stewardship team. Methods: This retrospective observational study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the antimicrobial stewardship team following a new recommendation of the surgical antimicrobial prophylaxis and included 1029 patients who underwent cardiac surgery. Two patient groups including 582 patients receiving Cefuroxime and 447 patients receiving Cefazolin respectively were compared without altering any other preventative perioperative measures. Adherence, overall infection rates, leg wound infections and deep sternal wound infections were compiled and analysed as well as a broad profile of preoperative, intraoperative and postoperative patient data. Results:A complete adherence on the change of the agent was achieved.Overall surgical site infections occurred in 37 (6.6%) of the cases, with 20 (3,4%) SSI in cefuroxime patients and 17 (3,8%) in cefazolin patients (p-value=0,754). No statistically significant differences could be found in any of the primary and secondary endpoints including DSWI (2,1% for cefuroxime, 1,3% for cefazolin), vein harvesting site infections (1,2% for cefuroxime, 2,2% for cefazolin) as well as urinary tract infections, pneumonia, sepsis and overall mortality of all causes. Conclusions:These results demonstrate that compliance to antimicrobial stewardship standards is not associated with more surgical site infections.

scholarly journals Pattern of antimicrobial usage for prophylaxis of surgical site infection in a tertiary care hospital of Western Uttar Pradesh

2019 ◽  
Vol 8 (3) ◽  
pp. 534
Author(s):  
Parul Kesar ◽  
Surabhi Gupta ◽  
H. L. Bhalla ◽  
Anita Panday
Keyword(s):  
Tertiary Care Hospital ◽  
Antimicrobial Prophylaxis ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
Surgical Site Infections ◽  
Blood Stream ◽  
Optimal Time ◽  
P Value ◽  
Care Hospital ◽  
Tract Infections

Background: The practice of giving antibiotic prophylaxis has resulted in the reduction of surgical site infections (SSI), thus reducing cost, morbidity, and mortality. Common nosocomial infections in surgical patients include SSIs, urinary tract infections (UTIs), pneumonias and blood stream infections (BSIs). The present study was, therefore, designed to analyze the efficacy of antimicrobials used for prophylaxis during surgery in a tertiary care hospital in India.Methods: Total 100 patients were enrolled. Name, timing, route, dose of antimicrobials given were recorded. All the relevant data was taken from the patient’s medication charts and medical records. Chi-square test and t-test were applied.Results: The optimal time of giving antimicrobial prophylaxis in present study was 1 hour before the surgery. A total of 8 different antimicrobials were prescribed to 100 patients, out of which most commonly prescribed were cephalosporin i.e. 82%. Majority of SSI (57.12%) occurred when the duration of surgical antimicrobial prophylaxis (SAP) was for ≥2 hours (p value <0.05). Common organisms seen in SSI were E. coli, S. aureus, Pseudomonas and Kleibsella species. The hospital stay of patients with SSI was more as compared to patients without SSI in present study (p value <0.05).Conclusions: It has been observed that inappropriate selection and timing of giving SAP play an important role in developing SSI, which can be adequately controlled by adopting SAP guidelines, good infection control practices and risk factor analysis.

scholarly journals Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital

2019 ◽  
Vol 12 ◽  
pp. 117863371989226 ◽  
Author(s):  
Kerebih Alamrew ◽  
Tamrat Assefa Tadesse ◽  
Alfoalem Araba Abiye ◽  
Workineh Shibeshi
Keyword(s):  
Antibiotic Prophylaxis ◽  
Protective Factor ◽  
Antimicrobial Prophylaxis ◽  
Addis Ababa ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Outcome Variable ◽  
Bivariate Analysis ◽  
P Value ◽  
Surgical Antimicrobial Prophylaxis

Background: Surgical site infections (SSIs) are infections that develop within 30 days after an operation or surveillance of surgical wound infection implementation within 90 days after surgery when an implant is placed. The objective of this study was to assess preoperative and postoperative antimicrobial use in St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. Methods: A hospital-based cross-sectional study was undertaken in surgery wards of SPHMMC for 4 months by reviewing 413 patients’ charts. All patients 13 years and older who were admitted and underwent different types of surgical procedures were included in the study. Epi info 7 was used for data entry, and then data were exported to Statistical Package for Social Sciences (SPSS) version 20.0 software for analysis. Descriptive analyses were computed and rate of SSI was calculated in this study. Moreover, bivariate analysis was done to examine the relationship between the outcome variable and predictor variables with a value of P < .2 retained for subsequent multivariate analyses using multiple logistic regressions. P value of <.05 was considered as statistically significant. Results: Out of 413 patients, 152 (36.8%) were operated for general surgery, and the remaining were for other types of surgeries. Most of the patients, 196 (79.7%), were managed by a single surgical antibiotic agent, followed by 2 agents (20.3%) for surgical prophylaxis indication. Surgical site infections occurred in 46 (11.1%) patients before discharge from the hospital. In those patients who need treatment for SSIs, almost half of them (49.5%) received combination therapy of ceftriaxone and metronidazole. Emergency surgical cases were 2.647 times more likely to develop SSIs than the elective surgical cases (adjusted odds ratio [AOR] = 2.647; 95% confidence interval [CI] = 1.406-4.983; P = .003). Patients who did not receive antibiotic prophylaxis were 2.572 times more likely to develop SSIs compared to those who received antibiotic prophylaxis (AOR = 2.572; 95% CI = 1.02-6.485; P = .045). Clean-contaminated and contaminated types of wound were a protective factor against SSI in our study. Conclusions: This study indicated that most of the patients (72.1%) received surgical antimicrobial prophylaxis. The overall incidence rate of SSIs was 11.1% in the studied hospital. Ceftriaxone was the most commonly used drug. Being not receiving prophylaxis, wound class, and surgery types were significantly associated with the development of SSI.

scholarly journals Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery

2021 ◽  
Author(s):  
Shishir Murugharaj Suranigi ◽  
SR Ramya ◽  
C Sheela Devi ◽  
Reba Kanungo ◽  
Syed Najimudeen
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Antimicrobial Prophylaxis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Care Hospital ◽  
Chi Square ◽  
Exact Test ◽  
Bacteriological Profile ◽  
Superficial Skin

Background and Objectives: Surgical site infection (SSI) is a challenge for the surgeon. Incidence of SSI reported in literature varies from 0.5% to 15%. Severity of SSI ranges from superficial skin infection to life-threatening condition like septicaemia. It is responsible for increased morbidity, mortality, and economic burden to the hospital in general, and the patient in particular. The aim of this study was to assess the risk factors, bacteriological profile, length of hospitalization, and cost due to orthopaedic SSI in patients admitted to a tertiary care hospital. Materials and Methods: This was a prospective case control study. Cases were diagnosed based on CDC definition of nosocomial SSI. All cases were assessed preoperatively, intraoperatively and postoperatively, according to type of surgery, wound class, duration of operation, antimicrobial prophylaxis, use of drain, preoperative hospital stay, causative micro organism, total hospital stay, re-admission rates and cost incurred. Age, sex and surgical procedure matched controls without SSI, were also assessed. Chi- square test and Fisher's exact test were used for analysis. P= <0.05 was considered significant. Results: Out of 1023 patients, 47 cases had SSI, with a rate of 4.6%. Cigarette smoking was a risk factor for SSI (P = 0.0035). The most common etiologic agents were Acinetobacter baumannii and Staphylococcus aureus. Incidence of re- admission among SSI cases was more compared to controls (P= 0.0001). Costs attributable to SSI (Indian Rupees) was Rs 32,542 (17,054 to 87,514) which was significantly more than those without SSI (P= <0.001). Conclusion: Despite latest surgical amenities, meticulous sterilization protocols and pre-operative antibiotic prophylaxis, SSI continues to be present in healthcare settings. The increase in duration of hospital stay due to SSI adds to additional burden to an already resource-constrained healthcare system.

scholarly journals Prescription analysis of drug prescribed in post-operative period in a teaching hospital in Bhilai, Chhattisgarh, India

2018 ◽  
Vol 6 (8) ◽  
pp. 2763
Author(s):  
Nishikant Ingole ◽  
Yogendra Keche ◽  
Archana Wankhade ◽  
Sunita Chandraker
Keyword(s):  
Antimicrobial Prophylaxis ◽  
National Research Council ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Postoperative Prophylaxis ◽  
Prophylactic Use ◽  
Surgical Antimicrobial Prophylaxis ◽  
Clean Contaminated ◽  
Prolonged Hospital

Background: Surgical site infections are associated with prolonged hospital stays and increased cost of therapy. Prophylactic use of antimicrobials is to prevent the incidence of postoperative wound infection. To generate data on postoperative use of antimicrobials this study was planned.Methods: The information was collected in semi-structured questionnaire format from the patient’s case paper. Information regarding the antimicrobials prescribed by surgeon, including drug combinations, duration of therapy, frequency of drug administration, and diagnosis for the surgery was collected. Surgical wounds were classified based on National Research Council (NRC) criteria.Results: Mean duration of antibiotic use was 3.71 days for clean surgeries (70%) and ranging from 2.67 days to 6 days for clean contaminated, contaminated and dirty types of surgeries. average number of antimicrobials prescribed for surgical antimicrobial prophylaxis was 3 per patients. Ceftriaxone, cefixime, ofloxacin, levofloxacin, amikacin, amoxycillin + clavulanic acid, ampicillin, metronidazole were used for postoperative prophylaxis.Conclusions: As per guidelines, the usage of antibiotics was found to be inappropriate in some conditions. Third generation cephalosporin was the preferred or most prescribed choice of drug for postoperative prophylaxis. The average number of antimicrobials prescribed for postoperative prophylaxis was 3 per patients.

scholarly journals The study of incidence of post operative delirium in geriatric patients who needed prolonged ICU stay after undergoing a major cardiac surgery in a tertiary care hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 3504-3506
Author(s):  
Dr Aswin Rajeev ◽  
Dr George Paul ◽  
Dr Sunil K S ◽  
Dr Priya Vijayakumar
Keyword(s):  
Cardiac Surgery ◽  
Elderly Patients ◽  
Artery Bypass ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Icu Stay ◽  
Care Givers ◽  
Hospitalized Elderly ◽  
Prolonged Icu Stay

INTRODUCTION: Delirium, defined as an acute disorder of attention and global cognitive function  is a common, serious and potentially preventable source of morbidity and mortality in  hospitalized elderly patients.  Different studies have shown that prolonged post operative ICU stay contributes to occurrence of delirium OBJECTIVE: To assess the incidence of post operative delirium in elderly patients who needed prolonged ICU stay after  undergoing a major cardiac surgery (coronary artery bypass grafting). MATERIALS AND METHODS: Prospective cohort study, Study Period: 1 ½ years. Using a prepared questionnaire after obtaining fully informed written consent. 3 visits for each patient: 1) before surgery, 2) in the ICU: 48 hours after surgery and 3) In ward after shifting out from ICU. Prolonged ICU stay was defined as admission more than 3 days in ICU. The details from nursing staff and care givers were taken. RESULTS: Out of total 250 patients included in the study, 43 (17.2%) patients developed post operative delirium. 32 (26%) out of 19 patients who needed prolonged ICU stay developed post operative delirium compared to 11 (8.7%) out of 116 patients who spent less than 3 days in ICU in post operative period. (p Value: <0.001). Prolonged ICU stay contributes to post operative delirium and measures have to be instituted to shift out the patient from ICU at the earliest after stabilization.

scholarly journals Compliance of surgical antimicrobial prophylaxis practices in the departments of general surgery and orthopaedics at a tertiary care centre in India

2020 ◽  
Vol 7 (10) ◽  
pp. 1492
Author(s):  
Gandham Ravi ◽  
Gaurav Chikara ◽  
Arkapal Bandyopadhyay ◽  
Shailendra Handu
Keyword(s):  
General Surgery ◽  
Prospective Observational Study ◽  
Antimicrobial Prophylaxis ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Tertiary Care Centre ◽  
Standard Clinical Practice ◽  
Antibiotic Duration ◽  
Surgical Antimicrobial Prophylaxis ◽  
One Year

Background: Antimicrobial (AM) prophylaxis is one of the major interventions to prevent surgical site infections. The guideline recommendations are meant for helping the surgeons to select the rationale and effective approach while. This study aimed to assess the compliance of surgical AM prophylaxis in terms of choice of antibiotic, duration and timing of administration using standard international and national guidelines.Methods: A prospective observational study was done in General Surgery and Orthopaedics over a period of one year. All the relevant data was collected and analysed. Results were then compared with standard Clinical Practice Guidelines (CPGAS-2013 and ICMR-2017).Results: In terms of choice of AM, 31.32% of the cases from general surgery and 97.59% of the cases from orthopaedics according to ICMR 2017 guidelines; 28.91% of the cases from general surgery and none of the cases from orthopaedics according to CPGAS 2013 guidelines were found to be compliant. In terms of duration of prophylaxis, 28.91% and 22.89% of the cases from general surgery were found to be compliant to ICMR 2017 and CPGAS 2013 guidelines respectively; but none of the cases from orthopaedics were compliant to either of the guidelines. Timing of administration was found to be compliant with the guidelines in both the departments. Conclusions: Surgical prophylaxis practices were found to be partially compliant with the guidelines in the selected departments.

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