scholarly journals Duration of Prophylactic Antibiotic and Prosthetic Joint Infection in a Developing Country: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Keerati Chareancholvanich ◽  
Chaturong Pornrattanamaneewong ◽  
Pakpoom Ruangsomboon ◽  
Waiwit Sanguanwongwan ◽  
Piyanuch Musikachart ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Developing Country ◽  
Infection Rate ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Prophylactic Antibiotic ◽  
Hospital Length Of Stay ◽  
Perioperative Antibiotic Prophylaxis ◽  
The Difference ◽  
Extended Course

Abstract BackgroundPerioperative antibiotic prophylaxis is one of the standard measures for preventing periprosthetic joint infection (PJI). In developing countries, poor surgical environment and patient hygiene are often cited as reasons for prolonged antibiotic duration without any evidence to support its effectiveness. The aim of this study was to investigate the infection rate after TKA compared between standard course (≤24 hours) and extended course (>24 hours) of perioperative antibiotic prophylaxis in a developing country.MethodsThis retrospective study included patients who underwent unicompartmental knee arthroplasty or total knee arthroplasty during January 2013 to December 2018. A total of 3,316 patients were included. Of those, 1,284 and 2,032 patients received standard and extended course of antibiotic prophylaxis, respectively. The incidence of PJI was compared between groups, and we also analyzed for factors significantly associated with PJI.ResultsPJI developed in 0.5% (6/1,284) of the standard course group, and in 1.2% (24/2,032) of the extended course group. The difference and 95% confidence interval for the difference between groups was -0.714% (-1.338% to -0.043%), which confirms the noninferiority status of the standard course group compared to the extended course group. Longer hospital length of stay significantly associated with higher infection rate (p=0.000). Postoperative wound infection was not found to be associated with age, body mass index, American Society of Anesthesiologists classification, blood transfusion, or surgery type.ConclusionTwenty-four hours of perioperative antibiotic prophylaxis was found to be adequate for PJI prevention in a developing country setting.Trial registrationEthical approval and consent to participate: The study was approved by the Institutional review board of Siriraj Hospital, Mahidol university. [SIRB 847/2559(EC3)]

scholarly journals 2669. Evaluation of Post-Operative Acute Kidney Injury with Piperacillin–Tazobactam Combined with Vancomycin for Lung Transplant Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S936-S936
Author(s):  
Natasha N Pettit ◽  
Cynthia T Nguyen ◽  
Lisa Potter ◽  
Jennifer Pisano
Keyword(s):  
Acute Kidney Injury ◽  
Antibiotic Prophylaxis ◽  
Lung Transplant ◽  
Statistical Significance ◽  
Prophylactic Antibiotic ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Transplant Patients ◽  
The Difference

Abstract Background Several studies have identified that the addition of vancomycin (VAN) to piperacillin–tazobactam (PT) is associated with a higher incidence of nephrotoxicity when compared with other antibiotic regimens. Beginning in June 2017, our lung transplant antibiotic prophylaxis regimen was modified from PT monotherapy to VAN and PT. Methods All adult lung transplant patients between January 1, 2015 and November 10, 2018 were included. Patients were excluded if acute kidney injury (AKI) was present prior to transplant. Rates of AKI within 7 days of transplant were compared between those who received prophylaxis with PT and VAN vs. those receiving alternative regimens (AR). Patients receiving less than 1 dose of vancomycin or less than 3 doses PT (less than 24hours) were deemed to be in the alternative regimen group. AKI was defined as either an increase in serum creatinine (SCr) by ≥0.3 mg/dL within 48 hours or increase in SCr to ≥1.5 times baseline (within 7 days post-transplant). Secondary outcomes included duration of initial prophylactic antibiotic regimens, hospital length of stay (LOS), and all-cause inpatient mortality. Results Eighty-six patients were included, 44 (51%) patients received PT/VAN. Baseline characteristics and results shown in Table 1. Of those receiving PT/VAN for prophylaxis, 24 (54%) developed AKI within 7 days of transplant while 15 (36%) of 42 patients receiving AR developed AKI (P = 0.08). Conclusion A larger proportion of patients that received PT/VAN for transplant antibiotic prophylaxis experienced AKI within 7 days. Although the difference did not reach statistical significance, a 19% higher incidence of AKI warrants need for further investigation. Disclosures All authors: No reported disclosures.

Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

2019 ◽  
Vol 33 (02) ◽  
pp. 100-105 ◽  
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Aldo M. Riesgo ◽  
Preetesh D. Patel ◽  
Michael A. Mont ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Postoperative Infection ◽  
Prophylactic Antibiotic ◽  
The United States ◽  
Prophylactic Antibiotics ◽  
Infection Rates ◽  
Mrsa Infection ◽  
Total Knee

AbstractThe risk of surgical site infection in primary total knee arthroplasty (TKA) has been reduced with the use of prophylactic antibiotics. First or second generation cephalosporins are still recommended as the primary prophylactic choice, but with the rise in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, evidence has emerged in favor of using dual antibiotics including vancomycin. However, it is unclear whether these combinations of antibiotic regimens further reduce postoperative infection rates. As a result, the objective of this review is to summarize the current literature concerning the use of dual prophylactic antibiotics in TKA. The most common dual prophylactic antibiotic combination is cefazolin (C) and vancomycin (V). In general, when comparing the effectiveness of single versus dual antibiotics, conflicting results have been reported. Three studies demonstrated no substantial decrease in overall postoperative infection rates with the use of dual antibiotics when compared with cefazolin alone. One found a significant decrease only in MRSA infection rates when using cefazolin and vancomycin (CV) (0.8% C alone vs. 0.08% CV, p < 0.05). Another investigation evaluated revision TKA patients who had combined cefazolin and vancomycin prophylaxis and showed a significant decline in both overall infection (7.89% [C] vs. 3.13% [CV]) and MRSA infection rates (4.21% [C] vs. 0.89% [CV]; p < 0.05). Concerning the safety profile of dual antibiotics, particular precautions must be adopted with the use of vancomycin because of the risk of acute kidney injury. Instead of vancomycin, an alternate less nephrotoxic antibiotic option might be teicoplanin. Unfortunately, this latter agent is only available outside of the United States. In conclusion, the value of dual antibiotic prophylaxis for the prevention of periprosthetic knee infections remains unclear primarily because all comparative studies performed between dual and single antibiotics have been of low evidence with retrospective designs. Larger multicenter randomized controlled trials are warranted.

Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections

1987 ◽  
Vol 66 (5) ◽  
pp. 701-705 ◽  
Author(s):  
Ronald F. Young ◽  
Pablo M. Lawner
Keyword(s):  
Antibiotic Prophylaxis ◽  
Foreign Bodies ◽  
The Body ◽  
Wound Infections ◽  
Postoperative Infections ◽  
Dramatic Decrease ◽  
Content Type ◽  
Perioperative Antibiotic Prophylaxis ◽  
The Difference ◽  
Fine Print

✓ The authors report the results of a randomized, prospective study to assess the effectiveness of perioperative antibiotic prophylaxis in preventing postoperative infections following clean neurosurgical operations. The study group comprised 846 patients treated between October, 1979, and June, 1984. Antibiotics, including cefazolin and gentamicin, were administered only in the immediate preoperative and intraoperative periods. Sixteen patients, none of whom developed infections, were excluded from final statistical analysis because they had inadvertently been entered into the study while failing to meet entry criteria. Fifteen wound infections (3.64%) developed in the group of 412 patients who did not receive antibiotics, whereas only four infections (0.96%) were identified among the 418 patients who received antibiotics. The difference is statistically significant (p = 0.008) and represents a 74% reduction in infection rate with antibiotics. An analysis of subgroups of surgical procedures revealed a dramatic decrease in craniotomy infections from 6.77% to 0% (p = 0.003). Of the four infections that occurred among the antibiotic-treated patients, three were in cases where foreign bodies had been implanted. No complications of antibiotic usage were identified. The rates of infection in areas of the body other than the surgical wound were no different in the antibiotic-treated and nontreated groups. All wound infections in both antibiotic-treated and nontreated patients involved similar types of Gram-positive organisms, suggesting that antibiotic prophylaxis did not produce infections with resistant or unusual organisms. This study, combined with other recently published analyses, suggests that routine perioperative antibiotic prophylaxis can significantly reduce the incidence of postoperative neurosurgical infections.

scholarly journals Prosthetic joint infection, dental treatment and antibiotic prophylaxis

2009 ◽  
Vol 1 (1) ◽  
pp. 7 ◽  
Author(s):  
Marthinus J. Kotzé
Keyword(s):  
South Africa ◽  
Antibiotic Prophylaxis ◽  
Dental Treatment ◽  
Oral Surgery ◽  
Joint Infection ◽  
Prophylactic Antibiotic ◽  
Working Party ◽  
Heart Association ◽  
British Society ◽  
Joint Prostheses

Current international and national prophylactic antibiotic regimens have been analyzed in respect of the prevention of bacteremia after dental and surgical procedures and, therefore, of joint prosthesis infection. This information was used to formulate guidelines for the Department of Maxillofacial and Oral Surgery. Publications since 2003 were used in this research. In addition, recommendations of accredited institutions and associations were examined. These included the guidelines of the American Dental Association in association with the American Academy of Orthopaedic Surgeons (2003), the American Heart Association (2007), the Working Party of the British Society for Antimicrobial Chemotherapy (2006) and the Australian Dental Guidelines (2005). No guidelines published by any institution in South Africa were found. The general rationale for the use of antibiotic prophylaxis for surgical (including dental) interventions is that those procedures may result in a bacteremia that may cause infection in joint prostheses. Antibiotics, however, should therefore be administered to susceptible patients, e.g. immunocompromised patients, prior to the development of bacteremia. The guidelines recommended for use in South Africa are based solely on those used outside South Africa. South Africa is regarded as a developing country with its own population and demographic characteristics. Eleven percent of our population is infected with HIV, and a specific guideline for prophylactic antibiotic treatment is, therefore, essential.

Dual Antibiotic Prophylaxis in Primary Total Knee Arthroplasty—No Benefit for Extremely Obese Patients

2021 ◽  
Author(s):  
Mark K. Lane ◽  
James A. Keeney
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Primary Total Knee Arthroplasty ◽  
Obese Patients ◽  
Exact Test ◽  
Primary Tkas ◽  
Risk Patients ◽  
Total Knee

AbstractWe performed this study to assess the effectiveness of multimodal total knee arthroplasty prosthetic joint infection (TKA-PJI) prophylaxis including “on-time” dual-antibiotic prophylaxis, and the influence of body mass index (BMI) on prophylaxis effectiveness. After obtaining Institutional Review Board approval, we assessed 1,802 primary TKAs (1,496 patients) who received cefazolin alone or cefazolin combined with vancomycin for TKA-PJI prophylaxis. A detailed chart review was performed to determine patient demographic features (age, gender, BMI, American Society of Anesthesiologists Score), antibiotic selection, vancomycin administration timing, and 1-year PJI rates. Statistical assessment was accomplished using a two-sided Student's t-test or Fisher's exact test. Patients who received dual-antibiotic prophylaxis with “on time” vancomycin infusion (Group CVt) had significantly lower infection rates than other TKA patients (0.8 vs. 2.7%, p < 0.01). “On Time” vancomycin administration was associated with a lower TKA-PJI rate for patients with a BMI < 45 kg/m2 (0.5 vs. 2.6%, p < 0.01) with no infections in 120 TKA patients with a BMI between 40 and 44.9 kg/m2 (p < 0.01). No difference was noted for patients with a BMI ≥ 45 kg/m2 (3.3 vs. 2.6%, p = 0.71). There were no infections in 150 TKA patients with a normal BMI (18–25 kg/m2) in any PJI-prophylaxis treatment group. Adoption of a dual-antibiotic prophylaxis approach can successfully reduce TKA-PJI rates among overweight and moderately obese patients. The approach does not appear to influence outcomes for low risk patients with a normal BMI (18–25 kg/m2) or for higher risk patients with a BMI > 45 kg/m2.

Antibiotic prophylaxis in clean neck dissections

2004 ◽  
Vol 118 (3) ◽  
pp. 213-216 ◽  
Author(s):  
Huseyin Seven ◽  
Ibrahim Sayin ◽  
Suat Turgut
Keyword(s):  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Outcome Variable ◽  
Control Group ◽  
Study Group ◽  
Antibiotic Regimen ◽  
The Difference ◽  
Operative Wound

This study was designed to evaluate the effects of a prophylactic antibiotic regimen on the incidence of wound infection after clean neck dissections. A prospective series of 57 patients undergoing clean neck dissections with the use of perioperative ampicillin-sulbactam for 24 hours was compared with an historical control group of 51 patients undergoing clean neck dissections with no perioperative antibiotic use. The outcome variable was the incidence of post-operative wound infection. The two groups were similar for factors reported to influence the rate of post-operative wound infection. Wound infection occurred in one patient (1.7 per cent) in the study group and in seven patients (13.3 per cent) in the control group, the difference was statistically significant (p = 0.02). These data suggest that the use of a perioperative antibiotic for 24 hours in patients undergoing clean neck dissection results in significant reduction in the incidence of post-operative wound infection.

scholarly journals Compliance and Related Outcomes of Prophylactic Antibiotics in Traumatic Open Fractures

2019 ◽  
Vol 55 (3) ◽  
pp. 193-198
Author(s):  
Hannah C. Johnson ◽  
Abby M. Bailey ◽  
Regan A. Baum ◽  
Stephanie B. Justice ◽  
Kyle A. Weant
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Prophylaxis ◽  
Prophylactic Antibiotic ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Infectious Complications ◽  
Open Fractures ◽  
Hospital Length Of Stay ◽  
Prophylactic Therapy ◽  
Guideline Compliance

Purpose: Prophylactic antibiotic therapy is a standard of care for patients who present with open fractures due to the risk of infectious complications. This study was conducted to characterize the use of initial prophylactic antibiotic use in open fractures, guideline compliance, and its impact on care. Methods: Retrospective chart review of adult patients presenting with an open fracture to a Level 1 Trauma Center Emergency Department over a 12-month period was conducted. Results: Of the 202 patients meeting inclusion criteria, overall compliance with guideline recommendations for antibiotic prophylaxis was found to be 33.2%. The duration of prophylactic therapy was significantly longer in the noncompliant group and among those who received a secondary antibiotic ( P < .05 for both comparisons). The duration of therapy was found to be significantly longer in those patients who developed an infection ( P < .001). Those who developed an infection had a longer hospital length of stay (LOS) ( P < .001) and intensive care unit LOS ( P = .002). In addition, those who developed an infection had significantly more surgeries ( P < .001) and received more red blood cell transfusions ( P < .001). Correlation analysis confirmed a significant association between infection and duration of antibiotic prophylaxis ( P = .02), number of surgeries ( P < .0001), and number of transfusions ( P < .0001). Conclusion: Guideline compliance was exceedingly low due to the extended duration of initial antibiotic therapy and did not appear to yield any clinical benefits. Infection was significantly associated with longer duration of initial prophylactic therapy and morbidity. Opportunities exist to elevate compliance with guidelines and to reevaluate prophylactic antimicrobial therapy in this setting.

scholarly journals Benefits and Adverse Events Associated With Extended Antibiotic Use in Total Knee Arthroplasty Periprosthetic Joint Infection

2019 ◽  
Vol 70 (4) ◽  
pp. 559-565 ◽  
Author(s):  
Neel B Shah ◽  
Beverly L Hersh ◽  
Alex Kreger ◽  
Aatif Sayeed ◽  
Andrew G Bullock ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
Antibiotic Therapy ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Oral Antibiotics ◽  
Significant Difference ◽  
Total Knee ◽  
Extended Course

Abstract Background Total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can be managed with debridement, antibiotic therapy, and implant retention (DAIR). Oral antibiotics can be used after DAIR for an extended time period to improve outcomes. The objective of this study was to compare DAIR failure rates and adverse events between an initial course of intravenous antibiotic therapy and the addition of extended treatment with oral antibiotics. Methods A multicenter observational study of patients diagnosed with a TKA PJI who underwent DAIR was performed. The primary outcome of interest was the failure rate derived from the survival time between the DAIR procedure and future treatment failure. Results One hundred eight patients met inclusion criteria; 47% (n = 51) received an extended course of oral antibiotics. These patients had a statistically significant lower failure rate compared to those who received only intravenous antibiotics (hazard ratio, 2.47; P = .009). Multivariable analysis demonstrated that extended antibiotics independently predicted treatment success, controlling for other variables. There was no significant difference in failure rates between an extended course of oral antibiotics less or more than 12 months (P = .23). No significant difference in the rates of adverse events was observed between patients who received an initial course of antibiotics alone and those who received a combination of initial and extended antibiotic therapy (P = .59). Conclusions Extending therapy with oral antibiotics had superior infection-free survival for TKA PJI managed with DAIR. There was no increase in adverse events, demonstrating safety. After 1 year, there appears to be no significant benefit associated with continued antibiotic therapy.

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