Topical Rifamycin Prophylaxis in Gynecological and Obstetric Surgery

OBJECTIVE: Antibiotic prophylaxis is one of the most important steps to reduce surgical site infections. First-generation cephalosporin (cefazolin) is used prophylactically in the majority of operations. Rifamycin is a broad-spectrum semisynthetic antibiotic that is bactericidal against gram (+) and gram (˗) microorganisms. To the best of our knowledge, there are no studies on the use of rifamycin in antibiotic prophylaxis. In this study, we aimed to analyze whether there is a difference between the use of only cefazolin and only rifamycin in terms of surgical site infections. STUDY DESIGN: One hundred patients were included in this case-control study during the last quarter period of 2017. These patients (n=100) were divided into two groups according to their antibiotic use; 50 patients who received only 1 g cefazolin constituted Group 1, 50 patients who received only 250 mg topical rifamycin over the incision line based on surgeon’s preference constituted Group 2. RESULTS: The use of prophylactic topical rifamycin reduced the incidence of wound infection. compared with cefazolin. Surgical site infection was detected in 5 (10%) of the patients who received cefazolin, whereas surgical site infection was not observed in patients who received rifamycin (p=0.022). CONCLUSIONS: The use of topical rifamycin is effective but does not imply that systemic antibiotics should replace prophylaxis. The use of rifamycin would aid in systemic antibiotic prophylaxis.

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Antibiotic prophylaxis for subdural and subgaleal drains

Journal of Neurosurgery ◽

10.3171/2016.4.jns16275 ◽

2017 ◽

Vol 126 (3) ◽

pp. 908-912 ◽

Cited By ~ 10

Author(s):

Ariane Lewis ◽

Rajeev Sen ◽

Travis C. Hill ◽

Herbert James ◽

Jessica Lin ◽

...

Keyword(s):

Clostridium Difficile ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Site Infection ◽

Cranial Surgery ◽

Systemic Antibiotics ◽

Retrospective Database

OBJECTIVE The authors sought to determine the effects of eliminating the use of prolonged prophylactic systemic antibiotics (PPSAs) in patients with subdural and subgaleal drains. METHODS Using a retrospective database, the authors collected data for patients over the age of 17 years who had undergone cranial surgery at their institution between December 2013 and July 2014 (PPSAs period) or between December 2014 and July 2015 (non-PPSAs period) and had subdural or subgaleal drains left in place postoperatively. RESULTS One hundred five patients in the PPSAs period and 80 in the non-PPSAs period were identified. The discontinuation of PPSAs did not result in an increase in the frequency of surgical site infection (SSI). The frequency of Clostridium difficile (CDI) and the growth of resistant bacteria were reduced in the non-PPSAs period in comparison with the PPSAs period. In the 8 months after the drain prophylaxis protocol was changed, $93,194.63 were saved in the costs of antibiotics and complications related to antibiotics. CONCLUSIONS After discontinuing PPSAs for patients with subdural or subgaleal drains at their institution, the authors did not observe an increase in the frequency of SSI. They did, however, note a decrease in the frequency of CDI and the growth of resistant organisms. It appears that not only can patients in this population do without PPSAs, but also that complications are avoided when antibiotic use is limited to 24 hours after surgery.

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Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700075305 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 2

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Infection Control and Hospital Epidemiology ◽

10.1086/509845 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 23

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30];P< .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55];P< .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84];P< .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79];P< .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89];P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

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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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Incidence of post operative surgical site infection in thyroid surgery following single dose of prophylactic antibiotic

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v22i1.45073 ◽

2020 ◽

Vol 22 (1) ◽

pp. 15-20

Author(s):

Md Abul Hossan ◽

Md Ariful Islam ◽

Tapas Chakraborty ◽

Firoz Ahmed Khan ◽

Md Mozharul Islam

Keyword(s):

Antibiotic Therapy ◽

Surgical Site Infection ◽

Thyroid Surgery ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Empirical Antibiotic Therapy ◽

Site Infection ◽

Cross Sectional

Surgical site infection after thyroid surgery is a less common incidence. Prophylactic antibiotic before surgery and empirical antibiotic therapy after surgery is a common practice in our country. But international guidelines do not suggest antibiotic in clean surgical procedure. Aim: To compare the incidence of surgical site infection after thyroid surgery with and without empirical antibiotic therapy. Method: It was a cross sectional study, done from July 2010 to December 2010 in 3 medical college hospitals in Dhaka city. Total 100 cases were included in this study, 50 cases for study in which only single prophylactic antibiotic used half an hour before operation, 50 cases for control in which 7 days antibiotic used per orally in addition to prophylaxis. Result: Among 100 cases male were 24 & female 76 (M: F= 1:3.2). Oldest patient was 56 yrs & youngest 21yrs. 47% patient operated for solitary thyroid nodule, 35% multinodular goiter & only 6% diffuse goiter. 47% patient was done hemithyroidectomy & only 7% total thyroidectomy. All the operations were completed within 2 hours where 40% within one hour. No surgical site infections were found in both study and control cases. Conclusion: There is no statistical difference between routine antibiotic use and no use of antibiotic after thyroid surgery. Bangladesh J Otorhinolaryngol; April 2016; 22(1): 15-20

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

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032015000200002 ◽

2015 ◽

Vol 52 (2) ◽

pp. 83-87 ◽

Cited By ~ 4

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.

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Effect of Prophylactic Antibiotics in Orthopaedic Surgery

10.53350/pjmhs2115112969 ◽

2021 ◽

Vol 15 (11) ◽

pp. 2969-2970

Author(s):

Muhammad Siraj ◽

Abbas Ali ◽

Mudir Khan

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Orthopaedic Surgery ◽

Prophylactic Antibiotics ◽

Implant Removal ◽

Diabetic Patients ◽

Site Infection ◽

Post Surgery ◽

Group 2 ◽

Group 1

Background: Orthopaedic surgeries require sensitive protocol for prevention of infection pre and post-surgery. Antibiotic-prophylaxis has been reported for reducing risk of infection in orthopaedic surgeries such as removal of implants. Aim: To assess the effect of prophylactic antibiotics in orthopaedic surgery. Study design: Retrospective study Place and duration of study: Dept. of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-1-2020 to 31-12- 2020. Methodology: One hundred and ten patients within 18-75 years were divided into two groups. Each group had 55 patients. Group 1 were given prophylactic antibiotics pre-operative as a single dose while group 2 were given only saline. All patients were admitted for removal of orthopaedic implants in foot, ankle or leg. Patients 30 days record was observed for any surgical-site infection. Results: The mean age of patient was 42.95±10.8 years. Group 1 and Group 2 had more males than females. There were 10.9% and 9.09% diabetic patients within group 1 and group 2. The 30 days assessment of post implant removal orthopaedic surgery showed a decrease of surgical-site infection in group 1. Surgical-site infection decreased by a rate of 5.4% among patients who were given cefazolin antibiotic. Conclusion: The effect of prophylactic antibiotic reduces chance of surgical-site infection in orthopaedic surgery. Keywords: Antibiotic-prophylaxis, Orthopaedic surgery, Implant-removal, Surgical-site infection

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Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery

Scientific Reports ◽

10.1038/s41598-021-95831-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

M. Alonso-García ◽

A. Toledano-Muñoz ◽

J. M. Aparicio-Fernández ◽

F. M. De-la-Rosa-Astacio ◽

D. Rodríguez-Villar ◽

...

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Cumulative Incidence ◽

Surgical Site Infections ◽

Neck Surgery ◽

Adjusted Relative Risk ◽

Site Infection ◽

Administration Route ◽

The Relationship ◽

Time Of Administration

AbstractHealth care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0–92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4–11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6–10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.

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A single-dose antibiotic prophylaxis to prevent surgical site infection in clean-contaminated surgery among diabetic patients

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v1i2.16637 ◽

2015 ◽

Vol 1 (2) ◽

pp. 8-10

Author(s):

Kamal Koirala ◽

Rupesh Mukhia ◽

Suman Sharma ◽

Sujan Manandhar ◽

Niroj Banepali ◽

...

Keyword(s):

Single Dose ◽

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Diabetic Patients ◽

Outpatient Basis ◽

Site Infection ◽

Significant Difference ◽

Group 2 ◽

Clean Contaminated ◽

Group 1

Introductions: Guidelines on antibiotics use in surgical patients recommends a single dose prophylaxis for clean-contaminated cases and therapeutic course for contaminated and dirty cases. Compliance to this guideline is poor among diabetic patients. The aim of this study was to test the efficacy of single dose antibiotic prophylaxis on the occurrence of postoperative surgical site infection (SSI) in clean-contaminated surgery in diabetic patients.Methods: Retrospective cross-sectional study was carried out at KIST Medical College and Teaching Hospital from September 2008 to August 2012 involving 144 diabetic patients who underwent major clean-contaminated surgery. Forty eight patients received one gram of ceftriaxone intravenously as prophylactic antibiotic within 30 minutes prior to incision (group 1) and 96 patients received three doses of ceftriaxone (group 2). One dose was given within 30 minutes prior to incision and other two doses were given postoperatively. All patients were followed up for 30 postoperative days on outpatient basis. The SSI rates were compared in two groups. Pus from the infected wound was tested for culture and sensitivity.Results: The SSI rates in group 1 and group 2 were of 5/48 (10.42%) and of 9/96 (9.37%) respectively. There was no significant difference in SSI rates between group 1 and group 2 (p=0.322).Conclusions: Single dose of Ceftriaxone shows the similar effect as three doses in clean-contaminated surgery in diabetic patients.

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Nonconcordance with Surgical Site Infection Prevention Guidelines and Rates of Surgical Site Infections for General Surgical, Neurological, and Orthopedic Procedures

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00562-11 ◽

2011 ◽

Vol 55 (10) ◽

pp. 4659-4663 ◽

Cited By ~ 36

Author(s):

Barnaby Young ◽

Tat Ming Ng ◽

Christine Teng ◽

Brenda Ang ◽

Hwei Yee Tai ◽

...

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Univariate Analysis ◽

Surgical Site Infections ◽

Orthopedic Procedures ◽

Site Infection ◽

Chi Square ◽

Chi Square Test ◽

Prevention Guidelines ◽

Complication Of Surgery

ABSTRACTSurgical site infection (SSI) is a common and preventable complication of surgery, but the relative importance of individual measures recommended by guidelines has not been determined. Elective general surgical, neurological, and orthopedic procedures requiring antibiotic prophylaxis from a 3-month period were retrospectively studied to determine concordance with SSI prevention guidelines and to identify factors which predicted the development of SSIs. A total of 216 surgeries were reviewed, with 18 SSIs (8.3%). A mean of 1.4 antibiotic prophylaxis errors per surgery were identified, with correct antibiotic type identified for 64%, antibiotic timing for 83%, supplemental antibiotic dosing for 34%, and antibiotic duration of less than 24 h for 44%. Normothermia was present in 79% of surgeries, and normoglycemia was present in 17%. Univariate analysis of the SSI rate identified four significant factors. Antibiotic prophylaxis for less than 24 h postoperatively (odds ratio [OR], 0.213; 95% confidence interval [95% CI]0.060 to 0.757) and neurosurgery (OR, 0.118; 95% CI, 0.15 to 0.903) correlated with a reduced risk of SSI. The mean number of prophylaxis errors (OR, 1.6; 95% CI, 1.02 to 2.4) and a duration of surgical drainage for more than 3 days (OR, 2.679; 95% CI, 1.009 to 7.113) predicted SSI. By multivariate analysis, errors in individual antibiotic prophylaxis measures were not significantly associated with SSI; however, the presence of more than two errors was significant (OR, 4.030; 95% CI, 1.018 to 15.96). A strong correlation was identified between the degree of concordance to SSI prevention guidelines and the SSI rate (P= 0.001, Mantel-Haenszel linear-by-linear association chi-square test).

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