The Use of Oral Antibiotics to Prevent Surgical Site Infection on Postoperative Modified Radical Mastectomy Patients in Dr. Soetomo General Hospital, Surabaya

Surgical operations on modified radical mastectomy are considered clean procedures by the Centers for Disease Control and Prevention (CDC) wound classification system. Despite this, higher than expected Surgical Site Infection (SSI) rates are reported, varying from 1 % to 26 % across the literature. Some surgeons also prescribe postoperative prophylaxis for postoperative modified radical mastectomy patients to prevent infection despite its lack of proven efficacy. The aim of this study is to analyze the use of oral antibiotics to prevent Surgical Site Infection (SSI) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. This study was double-blinded randomized control trial of 60 postoperative modified radical mastectomy patients (2 groups) during the period of December 2017 to March 2018. Samples were prospectively divided into two groups (random sampling), in group A (n=30) patients received single dose prophylactic antibiotics and continued with oral antibiotics postoperative (Cefadroxil 2 x 500 mg) during 7 days and in group B (n=30) patients received single dose prophylactic antibiotics and continued without postoperative antibiotics (placebo). Both groups were evaluated clinically for surgical site infection up to 30 days. There was no statistically significant difference in both groups {p=1 (p>0.05)}. There was no incidence of surgical site infection in both groups during the 30-day follow-up period (days 3, 7, 14 and 30). There was no difference in the surgical site infection rate among those who received oral postoperative antibiotics prophylactic and without antibiotics (placebo) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required.

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The Use of Oral Antibiotics to Prevent Surgical Site Infection on Postoperative Modified Radical Mastectomy Patients in Dr. Soetomo General Hospital, Surabaya

Folia Medica Indonesiana ◽

10.20473/fmi.v56i1.18449 ◽

2020 ◽

Vol 56 (1) ◽

pp. 36

Author(s):

Norman Hadi ◽

Hantoro Ishardyanto

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

General Hospital ◽

Radical Mastectomy ◽

Antibiotic Use ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Oral Antibiotics ◽

Modified Radical Mastectomy ◽

Significant Difference

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Perioperative Prophylactic Antibiotics in Orthopaedic Surgery

Nepal Orthopaedic Association Journal ◽

10.3126/noaj.v3i1.9318 ◽

2013 ◽

Vol 3 (1) ◽

pp. 5-10

Author(s):

Bikram Prasad Shrestha ◽

Surya Raj Niraula ◽

Parvin Nepal ◽

Guru Prasad Khanal ◽

Navin Karn ◽

...

Keyword(s):

Surgical Site Infection ◽

Orthopaedic Surgery ◽

Controlled Trial ◽

Prophylactic Antibiotics ◽

Drug Resistant ◽

Site Infection ◽

Oral Antibiotics ◽

Randomized Controlled ◽

Orthopaedic Patients ◽

Significant Difference

Introduction: In our country, various institutes have different protocols for postoperative antibiotics. Many western literature have mentioned that administration of prophylactic antibiotics for longer than 24 hours has no advantage and may actually lead to superinfection with drug-resistant organisms. Because of environmental and theater condition most of the surgeon here are very reluctant to use prophylactic antibiotics for only 24 hours. The objective of the study was to find out the effect of duration of prophylactic antibiotics on the rate of surgical site infection in clean elective orthopaedic surgeries. Methods: This was a randomized controlled trial involving 207 clean elective orthopaedic patients undergoing surgery. The patients were divided into three groups which received intravenous prophylactic antibiotics for 24 hours, 48 hours and 48 hours followed by 7 days of oral antibiotics respectively. The patients were followed up for three months postoperatively. Result: There was no significant difference in the rate of surgical site infection among the three groups. Conclusion: We conclude that there is no benefit in prolonging prophylactic antibiotics beyond 24 hours. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9318 Nepal Orthopedic Association Journal 2013 Vol.3(1): 5-10

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Comparative study of single dose preoperative antibiotics versus both preoperative and postoperative antibiotics in laparoscopic appendicectomy for nonperforated appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20173894 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3092

Author(s):

Himabindu Bangaru ◽

Varun V. Gaiki ◽

M. V. Ranga Reddy

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Hospital Stay ◽

Prophylactic Antibiotics ◽

Postoperative Hospital Stay ◽

Laparoscopic Appendicectomy ◽

Site Infection ◽

Significant Difference ◽

Group A ◽

Preoperative Antibiotics

Background: Antibiotics are being administered both preoperatively and postoperatively even in uncomplicated nonperforated appendicitis. Studies regarding role of postoperative antibiotics in laparoscopic appendicectomy for nonperforated appendicitis are sparse. The aim of the study is therefore to study the efficacy of single dose preoperative antibiotics versus both preoperative and postoperative antibiotics in reducing surgical site infection in laparoscopic appendicectomy for uncomplicated nonperforated acute appendicitis.Methods: This is a prospective study done in general surgery department at Malla Reddy institute of medical sciences from September to April 2016.162 patients with nonperforated appendicitis were randomly allocated into two groups. 80 patients in Group A were given single dose of preoperative prophylactic antibiotics. No further antibiotics were given. 82 patients in Group B were given both preoperative and postoperative antibiotics. Postoperative surgical site infection and duration of postoperative hospital stay were compared between both groups. Statistical analysis was done using ANOVA, Fisher’s Exact test and Chi-square test wherever necessary.Results: There was no significant difference in the rate of surgical site infection in both groups. The mean duration of postoperative hospital stay was shorter in preoperative antibiotics only group (Group A). Age and gender had no significant association with surgical site infection. There was no deep incisional or organ space infection in this study.Conclusions: Single dose prophylactic antibiotics would be sufficient in cases of laparoscopic appendicectomy for simple uncomplicated nonperforated acute appendicitis. Postoperative antibiotic administration would not be necessary in these cases.

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Preoperative prophylactic antibiotics in orthopaedic surgery: duration of antibiotic administration

Health Renaissance ◽

10.3126/hren.v11i1.7604 ◽

2013 ◽

Vol 11 (1) ◽

pp. 62-67

Author(s):

BP Shrestha ◽

SR Niraula ◽

P Nepal ◽

GP Khanal ◽

N Karn ◽

...

Keyword(s):

Surgical Site Infection ◽

Orthopaedic Surgery ◽

Controlled Trial ◽

Prophylactic Antibiotics ◽

Antibiotic Administration ◽

Site Infection ◽

Oral Antibiotics ◽

Randomized Controlled ◽

Orthopaedic Patients ◽

Significant Difference

Background: Surgical site infection is one of the most dreaded complications faced by an orthopaedic surgeon. Objective: To find out the effect of duration of prophylactic antibiotics on the rate of surgical site infection in clean elective orthopaedic surgeries. Methods: We conducted a randomized controlled trial involving 207 clean elective orthopaedic patients undergoing surgery. The patients were divided into three groups which received intravenous prophylactic antibiotics for 24 hours, 48 hours and 48 hours followed by 7 days of oral antibiotics respectively. The patients were followed up for three months. Results: There was no significant difference in the rate of surgical site infection among the three groups. Conclusion: We conclude that there is no benefit in prolonging preoperative prophylactic antibiotics beyond 24 hours. Health Renaissance, January-April 2013; Vol. 11 No.1; 62-67 DOI: http://dx.doi.org/10.3126/hren.v11i1.7604

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The Incidence of Surgical Site Infection in Acute Non Perforated Appendicitis

Journal of Chitwan Medical College ◽

10.3126/jcmc.v9i2.24525 ◽

2019 ◽

Vol 9 (2) ◽

pp. 11-14

Author(s):

Suraj Raj Bhattarai ◽

Kishor Kumar Tamrakar

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Perforated Appendicitis ◽

College Teaching ◽

Cross Sectional Study ◽

Age Group ◽

Site Infection ◽

Cross Sectional ◽

Significant Difference ◽

Group Sex

Background: Appendectomy is the most commonly performed emergency surgical procedure and has significant morbidity of surgical site infection (SSIs). Regarding this, there are conflicting reports and dilemma on use of optimal duration of antibiotics. The aim of this study was to evaluate the incidence of SSIs after three doses of perioperative prophylactic antibiotics (single dose before surgery and two doses postoperatively) after appendectomy in acute non- perforated appendicitis (NPA). Methods: This cross sectional study was conducted in the department of General surgery, Chitwan Medical College Teaching Hospital, from May 2018 to April 2019. All the cases received single dose of antibiotics (ceftriaxone and metronidazole) during the induction of anesthesia and two doses of the same antibiotics postoperatively within 24 hours. SSIs was assessed on 2nd and followed up till 7th postoperative day. The data collected was analyzed using SPSS version 16. Results: In the study of 100 patients, who received perioperative three doses of antibiotics, the overall frequency of SSIs on 2nd and 3rd post-operative day were 2% (p=.840) and 6% (p=.539) respectively, which was statistically not significant. In follow up after 3rd postoperative day, there was no evidence of SSIs. Statistically there was no significant difference in the incidence and grade of SSIs between age group, sex and duration of operation. Conclusions: A combined three doses of perioperative antibiotics was adequate for SSIs prevention in patients of any age group and sex with acute NPA after appendectomy in usual operative time.

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Survey of Surgeons Regarding Prophylactic Antibiotic Use in Inguinal Hernia Repair

Scandinavian Journal of Surgery ◽

10.1177/1457496917748229 ◽

2018 ◽

Vol 107 (3) ◽

pp. 208-211 ◽

Cited By ~ 6

Author(s):

A. P. MacCormick ◽

J. A. Akoh

Keyword(s):

Surgical Site Infection ◽

Perceived Risk ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Hernia Surgery ◽

Trust Network ◽

Surgical Trainees ◽

Infected Mesh

Purpose: The use of prophylactic antibiotics in the mesh repair of inguinal hernias remains controversial. The aim of this study was to determine the perception of surgeons about surgical site infection and how this affects their clinical practice. Methods: A SurveyMonkey of general surgeons and senior surgical trainees was conducted via the local trust network and the questionnaire was displayed on the website of the Association of Surgeons of Great Britain and Ireland and Association of Surgeons in Training. Results: Eighty-one responses were received from surgeons who perform an average of 75 hernia repairs per year – the majority by open technique. Thirty-six (44.4%) used routine antibiotic prophylaxis, 40 (49.4%) selectively, and five (6.2%) not at all as the five surgeons who did not use antibiotics perceived their surgical site infection rate to be <1% and have never removed an infected mesh from a hernia wound. There was no clear difference between those who use prophylactic antibiotics routinely or selectively as the experience of mesh explantation is similar (56% versus 55% had 2–10 meshes removed respectively). Seventy-seven (95%) of surgeons felt a new specific set of guidelines was required. Conclusion: This study highlights the fact that in the absence of clear guidelines, most surgeons base their use of prophylactic antibiotics on their perceived risk or experience of surgical site infection. There is a strong need for a new set of guidelines to address the use of prophylactic antibiotics in groin hernia surgery.

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Prophylactic use of antibiotics as per SIGN 104 guidelines versus routine antibiotic prophylaxis for prevention of surgical site infection in clean and clean contaminated ENT surgical procedures: a comparative study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20195698 ◽

2019 ◽

Vol 6 (1) ◽

pp. 106

Author(s):

M. Bharath ◽

J. R. Galagali ◽

Awadhesh Kumar Mishra ◽

Ajay Mallick ◽

E. Nikhilesh

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Surgical Procedures ◽

Antibiotic Use ◽

Site Infection ◽

Significant Difference ◽

Group A ◽

Prophylactic Use ◽

Group B ◽

Clean Contaminated

Background: Many clinicians continue to use antibiotic prophylaxis routinely in all surgical procedures, ignoring the guidelines issued by policy makers. In this prospective study we compared the rate of surgical site infection (SSI) in patients who received prophylactic antibiotics as a routine; with the rate of SSI in patients getting antibiotics strictly as per SIGN 104 Guidelines, for clean and clean contaminated procedures.Methods: The study population comprised 235 patients. Group A consisted of 119 patients having 77 (65%) males and 42 (35%) females while Group B had 116 patients - 71 (61%) males and 45 (39%) females. Group A received routine antibiotic prophylaxis in all cases, while Group B received antibiotic prophylaxis as per SIGN 104 guidelines only. Both the groups were followed up for one month post-operatively for SSI and complications.Results: SSI occurred in 2 patients (1.68%) in Group A and in 3 (2.59%) patients in Group B. There was no significant difference in the rate of SSI between the two groups (p=0.68). Procedure wise maximum SSI occurred in tympanoplasty and laryngectomy. Due to infection one case of tympanoplasty had graft failure and one case of laryngectomy had delayed wound healing. No major complications related to infection or antibiotic use occurred in either group.Conclusions: Selective use of antibiotic prophylaxis as per SIGN 104 Guidelines does not lead to increase in SSI in clean and clean contaminated ENT procedures.

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Experience with modified radical mastectomy in a low-income country: a multi-center prospective observational study

BMC Surgery ◽

10.1186/s12893-021-01374-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giziew Bawoke ◽

Segni Kejela ◽

Abebe Alemayehu ◽

Girmaye Tamirat Bogale

Keyword(s):

Neoadjuvant Chemotherapy ◽

Observational Study ◽

Surgical Site Infection ◽

Low Income ◽

Prospective Observational Study ◽

Radical Mastectomy ◽

Surgical Site Infections ◽

Site Infection ◽

Modified Radical Mastectomy ◽

Retroviral Infections

Abstract Background Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. Methods This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. Results A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30–49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5–8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2–14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1–5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3–3.9)). No in-hospital mortality occurred during the course of the study. Conclusion Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.

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Antibiotic Prophylaxis against Surgical Site Infection after Open Hernia Surgery: A Systematic Review and Meta-Analysis

European Surgical Research ◽

10.1159/000517404 ◽

2021 ◽

pp. 1-13

Author(s):

Lolwah Al Riyees ◽

Wedad Al Madani ◽

Nistren Firwana ◽

Hanan H. Balkhy ◽

Mazen Ferwana ◽

...

Keyword(s):

Systematic Review ◽

Hernia Repair ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Meta Analysis ◽

Prophylactic Antibiotics ◽

Site Infection ◽

Hernia Surgery ◽

Significant Difference

Objective: The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. Methods: We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. Results: Twenty-nine studies (N = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. Conclusion: The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.

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Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection

Pharmaceuticals ◽

10.3390/ph14111088 ◽

2021 ◽

Vol 14 (11) ◽

pp. 1088

Author(s):

Fauna Herawati ◽

Rika Yulia ◽

Heru Wiyono ◽

Firdaus Kabiru Massey ◽

Nurlina Muliani ◽

...

Keyword(s):

Surgical Site Infection ◽

Surgical Procedures ◽

Antibiotic Use ◽

Prophylactic Antibiotics ◽

Surgical Patients ◽

Defined Daily Dose ◽

Site Infection ◽

Therapeutic Guidelines ◽

Bed Days ◽

American Society

Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.

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