scholarly journals Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

2012 ◽  
Vol 2 (3) ◽  
pp. 207-211
Author(s):  
J N Shah ◽  
S B Maharjan ◽  
K Manandhar
Keyword(s):  
Antibiotic Prophylaxis ◽  
Current Practice ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Local Institutions ◽  
Medical Sciences ◽  
Observation Study ◽  
Cross Sectional ◽  
Hospital Protocol

Objective: Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis (AP) before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections (SSIs). However, proper timing of AP remains problematic as reported by various studies, though none so far from  local institutions in Nepal. Aim of this cross sectional observation study was to assess and address the issues of timing of AP and need for improvements. Material & Methods: Convenient sample target of 100 cases of preoperative AP were studied from Oct 1 to Oct 30, 2010. Data were prospectively entered in predesigned ‘AP form’ for all major elective surgeries, except obstetric cases, who received AP of intravenous Cefazoline 1 g as per existing hospital protocol. Time of AP administration in respect to incision time was analyzed. Results: There were 125 cases during study period. Majority, 81% received AP before incision, while 19% had AP after the incision. Only 1% of patients received AP within recommended period within 60 to 30 minutes before incision. Conclusion: Current practice of antibiotic prophylaxis (AP) at our institutions needs improvement as per standard guidelines of AP within 60 to 30 minutes before incision. DOI: http://dx.doi.org/10.3126/ajms.v2i3.5610 Asian Journal of Medical Sciences 2 (2011) 207-211 

scholarly journals Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

2010 ◽  
Vol 49 (179) ◽  
Author(s):  
Jay N Shah ◽  
SB Maharjan ◽  
R Piya ◽  
A Shrestha ◽  
K Shrestha ◽  
...  
Keyword(s):  
Observational Study ◽  
Antibiotic Prophylaxis ◽  
Prospective Observational Study ◽  
Current Practice ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Optimum Concentration ◽  
Infection Prophylaxis ◽  
Time Period

INTRODUCTION: Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections . However, proper timing of AP remains problematic as reported by various studies, though none so far from Nepal. Aim of this prospective observational study was to assess and address the issues for improvements in timing of AP. METHODS: The pattern of antibiotic prophylaxis were prospectively collected in respect to time of induction, and incision time were recorded on predesigned 'AP form'. The study included all the elective major cases who received AP of intravenous Cefazoline 1 g as per our existing protocol. The emergency surgeries and obstetric cases were excluded from the study. RESULTS: There were 125 cases of which 89% received AP before incision (63% within 5 minutes before incision), while 11% had AP after the incision and 1% within the recommended time period of 2 hour to 30 minutes before incision. CONCLUSIONS: Current practice of antibiotic prophylaxis (AP) needs improvement as per standard guidelines of AP within 2 hour to 30 before incision. Keywords: antibiotic, infection, prophylaxis, surgery.

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

2015 ◽  
Vol 52 (2) ◽  
pp. 83-87 ◽  
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.

Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin/Cefotaxime Increases Inguinal Surgical Site Infection Rate After Lower Extremity Revascularization

2019 ◽  
Vol 18 (2) ◽  
pp. 135-142 ◽  
Author(s):  
Francis Rezk ◽  
Håkan Åstrand ◽  
Stefan Acosta
Keyword(s):  
Lower Extremity ◽  
Vascular Surgery ◽  
Antibiotic Prophylaxis ◽  
Infection Rate ◽  
Odds Ratio ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Arterial Disease ◽  
Lower Extremity Revascularization

Due to the consistently high proportion of surgical site infections (SSI) after vascular surgery, a change of prophylactic antibiotic therapy from cloxacillin/cefotaxime to trimethoprim/sulfamethoxazole (TMP-SMX) was conducted in 2016. The study included consecutive patients undergoing lower extremity revascularization due to acute or chronic lower extremity arterial disease. The antibiotic regime was changed in between the two sampling periods (2014 -2016 versus 2016 -2017). The diagnosis of SSI was based on clinical examination and microbiological results, and severity was classified according to the Szilagyi classification. One hundred and twenty-two patients in the cloxacillin/cefotaxime and 67 patients in the TMP-SMX group were included. The SSI rates were 32.0% and 40.3%, respectively (p=0.25). The proportion of women were higher in the TMP-SMX group (32.8% versus 47.8%, respectively, p=0.043). No other differences between the two groups were found regarding patient, vascular surgery procedure characteristics or severity of SSI. Groin infection rate was higher in the TMP-SMX group (15.4% versus 30.5%, respectively, p=0.022). When adjusting for gender, groin infection was more common in the TMP-SMX group (Odds Ratio 2.5, 95% CI 1.1 -5.4). The groin SSI rate was higher after elective surgery in the TMP-SMX group (13.0% versus 27.8%, respectively, p=0.027), and also after adjusting for gender (Odds Ratio 2.6, 95% CI 1.1 -6.2). The change in antibiotic prophylaxis from Cloxacillin/Cefotaxime to TMP-SMX was associated with an increased rate of inguinal SSI in patients undergoing lower extremity revascularization, despite a possible Hawthorne effect.

scholarly journals Single dose antibiotic prophylaxis for prevention of surgical site infection in elective surgery

2017 ◽  
Vol 5 (1) ◽  
pp. 27 ◽  
Author(s):  
Swaroop V. Borade ◽  
Obaid Syed
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Relevant Information ◽  
Site Infection ◽  
Intraoperative Management ◽  
Clean Contaminated ◽  
A Prospective Study

Background: Surgical site infections are associated with prolonged hospital stays and increased costs. Infection develops when endogenous flora is translocated to a normally sterile site. Seeding of the operative site from a distant site of infection can also occur (especially in patients with prosthesis or another implant). Factors influencing the development of surgical site infections include bacterial inoculums and virulence, host defences, preoperative care and intraoperative management. Hence there is the need for antibiotic prophylaxis to overcome this problem. This study was planned to evaluate the effect of prophylactic antibiotic in clean and clean contaminated cases and to assess the outcome.Methods: A prospective study was conducted which include 100 patients undergoing elective surgery admitted to the department of general surgery IIMSR’s Medical College and Hospital, Warudi, Jalna, relevant information of each patient was collected according to the Performa designed for the study. Cefuroxime was used preoperatively 30 min prior to incision and its impact on postoperative wound infection was studied.Results: We had 100 cases in our study predominantly males with maximum individuals in 31-40 years age group, we had 67% clean and 33% clean contaminated surgeries done and had 3% case of superficial surgical site infection.Conclusions: A single preoperative dose of antibiotic Cefuroxime is effective to prevent surgical site infection in elective case assuming an uncomplicated procedure.

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

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

scholarly journals Intervention to Improve Timing of Preoperative Antibiotic Prophylaxis in Major Elective Surgery

2013 ◽  
Vol 7 (1) ◽  
pp. 15-18
Author(s):  
Jay N Shah ◽  
SB Maharjan ◽  
K Manandhar ◽  
A Shrestha ◽  
R Piya ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Elective Surgery ◽  
Cross Sectional Study ◽  
Study Data ◽  
Microsoft Excel ◽  
Cross Sectional ◽  
Improve Compliance ◽  
Feasible Option ◽  
Preoperative Antibiotic Prophylaxis ◽  
Taking Charge

Aims: Timely administration of antibiotic before incision ensures effective concentration in blood and tissues. Compliance with established guidelines is problematic due to logistics. Aim of this study was to improve timing of antibiotic prophylaxis (AP) with appropriate intervention in existing practices. Methods: Cross sectional study was conducted from May-June 2011 with target of enrolling at least 100 elective major cases (excluding obstetrics) who received AP before surgery. Anesthetists took responsibility of AP administration (Cefazoline 1 g as per our protocol unless indicated otherwise) instead of floor nurse as our earlier practice. Institutional ethical committee approved the study. Data collected in a pre-designed proforma was analyzed using Microsoft Excel. Results: Out of 120 patients, 64% were female. Average age was 43 years (4 to 87). General surgery cases were 51%, urosurgery 20%, gynecology and orthopaedic each 13% and others 6%. One hundred nineteen (99%) received AP before incision, 58(48%) within 60 to 30 minutes before incision and 1 (1%) after the incision. Conclusions: Anesthetist taking charge of the team for AP administration is a feasible option to improve compliance. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 15-18 DOI: http://dx.doi.org/10.3126/njog.v7i1.8827

scholarly journals CROSS–SECTIONAL STUDY OF SURGICAL PROPHYLACTIC ANTIBIOTIC ADMINISTRATION IN MARZOEKI MAHDI HOSPITAL, BOGOR, INDONESIA

2017 ◽  
Vol 10 (11) ◽  
pp. 87
Author(s):  
Nisa Najwa Rokhmah ◽  
Retnosari Andrajati ◽  
Maksum Radji
Keyword(s):  
Antibiotic Prophylaxis ◽  
Medical Records ◽  
Prophylactic Antibiotic ◽  
Cross Sectional Study ◽  
Antibiotic Administration ◽  
National Guidelines ◽  
Cross Sectional ◽  
Surgical Antibiotic Prophylaxis ◽  
Rational Use Of Antibiotics ◽  
Surgical Clinic

  Objective: This study was conducted to evaluate the prophylactic antibiotic administration in the surgical clinic of Dr. H. Marzoeki Mahdi Hospital, Bogor, Indonesia.Methods: The data were assessed from the medical records of all patients who underwent surgery from January to December 2013 retrospectively. Antibiotic prophylaxis was assessed based on the Scottish Intercollegiate Guidelines and the National Guidelines of Antibiotic Usage, which includes the type, time, and duration of prophylactic administration of antibiotics.Results: A total of 577 patients were included in this study, consisting of 202 men and 375 women. The most frequently performed surgery is a common surgery 347 (60.1%), followed by obstetric operations 176 (30.5%), and orthopedic surgery 54 (9.4%). In this study, all patients received prophylactic antibiotics before surgery. Cefotaxime (87.8%) was the most commonly used antibiotics for surgical prophylaxis. Of the 577 patients, only 1.1% of patients reported with surgical site infection (SSI).Conclusion: This study shows that adherence to the guidelines of surgical antibiotic prophylaxis is still very low. Therefore, efforts should be made to increase the compliance of using antibiotic prophylaxis in accordance with standard guidelines to improve the rational use of antibiotics.

Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction

2018 ◽  
Vol 159 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Michael P. Veve ◽  
Joshua B. Greene ◽  
Amy M. Williams ◽  
Susan L. Davis ◽  
Nina Lu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head And Neck Cancer ◽  
Antibiotic Prophylaxis ◽  
Head And Neck ◽  
Neck Cancer ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Cross Sectional Study ◽  
Microvascular Reconstruction ◽  
Cross Sectional

Objective To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design Cross-sectional study with nested case-control design. Setting Nine American tertiary care centers. Subjects and Methods Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

scholarly journals Saudi orthopedic surgeons’ knowledge, attitude, and practice regarding surgical antibiotic prophylaxis

2021 ◽  
Vol 0 ◽  
pp. 1-11
Author(s):  
Khalid A. Binown ◽  
Faisal A. Alhabradi ◽  
Abdulrahman M. Aljahani ◽  
Abdulaziz M. Shadid
Keyword(s):  
Saudi Arabia ◽  
Antibiotic Prophylaxis ◽  
Positive Attitude ◽  
Surgical Site Infections ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Adequate Knowledge ◽  
Orthopedic Surgeons ◽  
Surgical Antibiotic Prophylaxis

Objectives: The objectives of the study were to evaluate the knowledge, attitudes, and practice of orthopedic surgeons practicing in Saudi Arabia regarding surgical antibiotic prophylaxis (SAP). Methods: A cross-sectional study was conducted on certified and under-training orthopedic surgeons registered in the Saudi Council for Health Specialties. An email, including an online validated self-administered survey using a voluntary response sampling technique, was sent between November 2020 and January 2021. The questionnaire comprised 12 questions that tested knowledge regarding SAP, five questions that analyzed surgeon attitudes toward SAP, and three questions on SAP-related practice. Results: This study included 271 orthopedic surgeons from different areas of Saudi Arabia. The majority of respondents were registrars (or equivalent) (n = 92; 33.9%), and most of them were male (n = 257; 94.8%). Almost 95% of respondents reported that SAP was indicated for internal fixation, spinal surgeries, and prosthetic joint replacement. Moreover, 82.7% of the respondents stated that cefazolin was considered the first-line SAP. Almost 85% of the respondents demonstrated a positive attitude toward SAP, with a mean score of 2.48. However, 87.5% of them believed that adhering to SAP general guidelines would reduce the rate of infection in orthopedic surgeries. Almost 53% of respondents reported using only one guideline as a reference in their surgical practice. Moreover, 41.3% of surgeons switched between guidelines depending on the surgery. Conclusion: This study revealed adequate knowledge and a positive attitude toward SAP among orthopedic surgeons. However, a discrepancy in the practice habits of orthopedic surgeons was observed, which is explained by non-adherence to SAP protocols. Common guidelines that can be used by all orthopedic surgeons need to be developed and implemented to reduce surgical site infections and non-adherence to SAP protocols. This task can be done by a general trusted body like the Saudi Orthopedic Association.

scholarly journals A study on comparison of short term three dose antibiotic prophylaxis with conventional prolonged postoperative antibiotic coverage in development of surgical site infections

2018 ◽  
Vol 5 (6) ◽  
pp. 2114
Author(s):  
M. V. Saila Suman Konidala ◽  
Padmaja Rani Gopalam ◽  
Jithendra Kandati
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Short Term ◽  
Group A ◽  
Group B ◽  
Associated Risk Factors ◽  
Antibiotic Coverage

Background: Surgical site infections are still an increasing threat to the surgeons despite advances in techniques of surgery, patient care and sterilization practices. Most of the studies state that pre-operative antibiotic prophylaxis is effective in reducing the risk of wound infection in surgical procedures and has been a standard practice followed in many surgeries. Prolonged administration of prophylactic antibiotic has been associated with development of resistant bacterial strains and predisposes the patient in development of wound infection. The aim of the present study is to study the effectiveness of short term antibiotic coverage during decisive period in prevention of post-operative infection in surgical procedures.Methods: A prospective randomized and comparative study was done for one year with 100 cases divided into two groups A and B. Group A received prophylactic Ceftriaxone three doses intravenously, 12 h before surgery 1st dose, 1h before surgery 2nd dose and third 10h after surgery. Group B received Ceftriaxone twice daily for 5 days after surgery. The two groups were compared for development of SSI and associated risk factors.Results: The mean age of the total study group was 37.11± 12.12 years with 60% of males and 40% females. Overall incidence of SSI in study was 24% with Group A 10% and 14% in group B. Anemia, associated drain, increased BMI and undernourishment was associated risk factors and a statistically significant association was found with these risk factors in present study. Pseudomonas and Methicillin resistant staphylococcus aureus were the isolates in the study.Conclusions: Present study strongly recommends the use of antibiotics during surgery than administration after surgery. More care and proper management of the cases are required with associated risk factors like increased BMI, presence of drain and low Hb%. Large multicentric studies are further required to establish further associated risk factors and to identify the local pathogens and their resistance pattern. Appropriate use of antibiotics can substantially reduce the emergence of resistant pathogens and limit the cost of treatment.

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