Infection risk in endovascular neurointerventions: a comparative analysis of 549 cases with and without prophylactic antibiotic use

OBJECTIVEA systematic analysis on the utility of prophylactic antibiotics for neuroendovascular procedures has not been performed. At the authors’ institution there is a unique setup to address this question, with some attending physicians using prophylactic antibiotics (cefazolin or vancomycin) for all of their neurointerventions while others generally do not.METHODSThe authors performed a retrospective review of the last 549 neurointerventional procedures in 484 patients at Tisch Hospital, NYU Langone Medical Center. Clinical and radiological data were collected for analysis, including presence of prophylactic antibiotic use, local or systemic infection, infection laboratory values, and treatment. Overall, 306 aneurysms, 117 arteriovenous malformations/arteriovenous fistulas, 86 tumors, and 40 vessel stenosis/dissections were treated with coiling (n = 109), Pipeline embolization device (n = 197), embolization (n = 203), or stenting (n = 40).RESULTSAntibiotic prophylaxis was used in 265 of 549 cases (48%). There was no significant difference between patients with or without antibiotic prophylaxis in sex (p = 0.48), presence of multiple interventions (p = 0.67), diseases treated (p = 0.11), or intervention device placed (p = 0.55). The mean age of patients in the antibiotic prophylaxis group (53.4 years) was significantly lower than that of the patients without prophylaxis (57.1 years; p = 0.014). Two mild local groin infections (0.36%) and no systemic infections (0%) were identified in this cohort, with one case in each group (1/265 [0.38%] vs 1/284 [0.35%]). Both patients recovered completely with local drainage (n = 1) and oral antibiotic treatment (n = 1).CONCLUSIONSThe risk of infection associated with endovascular neurointerventions with or without prophylactic antibiotic use was very low in this cohort. The data suggest that the routine use of antibiotic prophylaxis seems unnecessary and that to prevent antibiotic resistance and reduce costs antibiotic prophylaxis should be reserved for selected patients deemed to be at increased infection risk.

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A Comparative Study of Single Dose and Multiple Dose Antibiotic Prophylaxis In Caesarean Section

VIMS Health Science Journal ◽

10.46858/vimshsj.8301 ◽

2021 ◽

Vol 8 (3) ◽

pp. 89-93

Author(s):

Dr. Poorvi Agarwal ◽

Dr. Harshal Nimbannavar ◽

Dr. Prajakta Khose ◽

Dr. Supraja Subramanian ◽

Dr. Himadri Bal

Keyword(s):

Single Dose ◽

Caesarean Section ◽

Antibiotic Prophylaxis ◽

Multiple Dose ◽

Prophylactic Antibiotic ◽

Dose Schedule ◽

Antibiotic Use ◽

Skin Incision ◽

Significant Difference ◽

Group B

Background: Rampant antibiotic use brought about its own set of problems like the rise in incidence of antibiotic resistant strains, allergies and other complications of antibiotic use. Unfortunately in many of our set ups we are still stuck in prolonged post-operative antibiotic regimes. This study aims to fill that lacunae and thereby aid our gradual shift away from over reliance on prolonged antibiotic usage in prevention of SSI. Hence we decided to investigate the efficacy of the use of a single prophylactic intravenous dose of antibiotic vis a vis multiple doses in reducing post-operative infective morbidity in caesarean sections. Methods: The study included 200 patients at term, satisfying the inclusion and exclusion criteria, reporting to the labour room and undergoing caesarean section. The patients were then divided into two groups of 100 each by simple randomization. Patients in Group A were given a single dose of Inj. Cefotaxime 1gm IV + Inj. Metronidazole 500 mg IV infusion 30 minutes before the skin incision. Group B cases were given the first dose of Inj. cefotaxime 1g IV + Inj. metronidazole 500 mg IV 30 minutes before the skin incision followed by injectables for 2 days: Inj. cefotaxime 1g IV BD and Inj. metronidazole 500mg IV TDS. Subsequently for the next 3 days Tablet Cefixime 200mg BD and Tablet Metronidazole 400mg TDS were administered orally. Results: The present study did not show any significant difference in the post operative infection incidence between the single dose and multiple dose schedule. Conclusion: our study makes an important observation regarding use of antibiotic prophylaxis and its duration for prevention of post operative infections in mothers without compromising any safety aspects of either the mother or the child. As noted in our study, there was no difference in the outcome as regards post operative infectious morbidity in patients of both the groups. Hence, based on the findings of our study we conclude that single dose prophylactic antibiotic should be the norm for caesarean sections.

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Does the Type of Surgical Technique and the Use of Prophylactic Antibiotics Affect the Clinical Results in Symptomatic Ingrown Toenail Patients?

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211043602 ◽

2021 ◽

pp. 153473462110436

Author(s):

Serdar Sargin ◽

Anil Gulcu ◽

Ahmet Aslan

Keyword(s):

Postoperative Morbidity ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Clinical Results ◽

Prophylactic Antibiotics ◽

Recurrence Rates ◽

Ingrown Toenail ◽

Significant Difference ◽

Ingrown Toenails ◽

Positive Effect

Ingrown toenails are a common reason for referral to orthopedics and podiatry clinics. Recurrence and infection are common complications in ingrown toenail surgery. This study investigates the effect of an electrocautery matrixectomy on the recurrence and clinical outcomes in the Winograd technique applied in ingrown toenail surgery and whether prophylactic antibiotic use is necessary for these surgeries. One hundred forty-three patients who underwent surgery for ingrown toenails were analyzed retrospectively. Eighty-two patients underwent the Winograd procedure with electrocautery matrixectomy, whereas 61 patients underwent the Winograd procedure. While 78 patients were given prophylactic antibiotics, 65 patients were not. Patient satisfaction was evaluated with a surgical satisfaction questionnaire (SSQ). A visual analog score was used to evaluate the pain. Recurrence was observed in 3 toenails in the Winograd and electrocautery groups, while recurrence was observed in 9 toenails in the Winograd group ( P = .018). In both groups, there was no statistically significant difference between the infection rates between patients who took antibiotics and those who did not ( P > .05). There was no statistically significant difference between the groups in terms of SSQ scores ( P > .05). It was observed that the surgery performed had a positive effect on pain, and this effect was statistically highly significant in both groups ( P < .05). The outcomes of the present study suggest that the addition of an electrocautery matrixectomy to the Winograd technique in the surgical treatment of symptomatic Ingrown toenails may decrease recurrence rates. Additionally, this study showed that oral antibiotics, when used in addition to Ingrown toenail surgery, do not reduce postoperative morbidity.

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EUS-guided fiducial placement for pancreatobiliary malignancies: safety, infection risk, and use of peri-procedural antibiotics

Endoscopy International Open ◽

10.1055/a-1068-9128 ◽

2020 ◽

Vol 08 (02) ◽

pp. E179-E185

Author(s):

Madhuri Chandnani ◽

Mir Fahad Faisal ◽

Jeremy Glissen-Brown ◽

Mandeep Sawhney ◽

Douglas Pleskow ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Locally Advanced ◽

Prophylactic Antibiotic ◽

Infection Risk ◽

Prophylactic Antibiotics ◽

Patient Demographics ◽

Single Center Study ◽

Significant Difference ◽

Ease Of Access

Abstract Background and study aims Chemoradiation with stereotactic body radiation therapy (SBRT) is increasingly being used for optimal treatment of locally advanced pancreatobiliary cancers. Fiducial markers are used to track these tumors during SBRT. Endoscopic ultrasound (EUS) is the preferred route for fiducial marker placement for ease of access to pancreatobiliary structures and accurate placement. Here we evaluate the safety and infection risk associated with EUS-guided fiducial placement for pancreatobiliary malignancies and use of peri-procedural prophylactic antibiotics. Patients and methods This was a retrospective, single-center study including consecutive patients presenting for EUS-guided fiducial placement in pancreatobiliary region by three expert interventional endoscopists for SBRT from July 2010 to February 2018 at a tertiary care center. Patient demographics, tumor characteristics, EUS technique, fiducials, use of prophylactic antibiotics, adverse events (AEs) and SBRT/Cyberknife administration were reported. Results A total of 355 patients with pancreatobiliary malignancy underwent EUS-guided fiducial placement, of whom 308 patients (86.76 %) successfully underwent SBRT. Of the patients, 304 (85.63 %) received peri-procedural prophylactic antibiotic. Of 355 total patients, 5.9 % (n = 21) were noted to develop AEs (mild to severe) with no significant difference in incidence of infection with or without use of peri-procedural prophylactic antibiotic. Only three patients developed infectious AEs, none of which were definitively related to fiducial placement. Conclusion EUS-guided fiducial placement for pancreatobiliary malignancy is safe and efficacious, and risk of infection is rare, regardless of whether or not peri-procedural antibiotics are used. We favor limiting routine use of peri-procedural antibiotics for patients undergoing EUS-guided fiducial placement in pancreaticobiliary malignancy.

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Is perioperative antibiotic necessary in straightforward implant placement procedures?

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00282 ◽

2020 ◽

Author(s):

Elçin Bedeloğlu ◽

Mustafa Yalçın ◽

Cenker Zeki Koyuncuoğlu

Keyword(s):

Clavulanic Acid ◽

Dental Implant ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Implant Failure ◽

Control Group ◽

Implant Placement ◽

Significant Difference ◽

Amoxicillin Clavulanic Acid ◽

Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p >0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p <0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

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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.v56i1.24585 ◽

2021 ◽

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

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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POST OPERATIVE WOUND INFECTION

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.02.2340 ◽

2010 ◽

Vol 17 (02) ◽

pp. 174-179

Author(s):

AAMIR IJAZ ◽

SUHAIL AMER

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Antibiotic Prophylaxis ◽

Wound Infection ◽

Prophylactic Antibiotics ◽

Postoperative Wound Infection ◽

Wound Infections ◽

Postoperative Wound ◽

Lichtenstein Hernia Repair ◽

Significant Difference

Background: The use of antibiotic prophylaxis during Lichtenstein inguinal hernia surgery is controversial, and no definitive guidelines are available in literature. Objective: To determine effects of prophylactic antibiotics in reducing the frequency of postoperative wound infection in Lichtenstein hernia repair. Study Design: Case control study. Setting: Surgical Unit II, Allied Hospital, Faisalabad. Duration: One year, between January 2007 and December 2007. Methods: Patients undergoing unilateral, primary inguinal hernia repairelectively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.0 g intravenous Cefazolin before the incision or an equal volume of placebo. Wound infection was defined according to the criteria of Centers for Disease Control and recorded. Results were assessed using chi-square test. Results: 100 patients were included in the study. Minimum age of patients in this study was 20 and maximum 75 years with a mean of 44.06 in group A and 44.84 in group B. The total number of wound infections was 7 (7%); 2 (4%) in the antibiotic prophylaxis group and 5 (10%) in the placebo group. Statistical analysis showed no significant difference in the number of wound infections in both groups (p value=0.240). Conclusions: We conclude that in Lichtenstein inguinal hernia repair routine use of prophylactic antibiotics is not needed, as it does not significantly reduce the postoperative wound infection rates.

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Prophylactic Antibiotic Reduces the Risk of Peritonitis after Invasive Gynecologic Procedures

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00218 ◽

2019 ◽

Vol 39 (4) ◽

pp. 356-361

Author(s):

Pei-Yi Fan ◽

Ming-Jen Chan ◽

Sheng-Hsuan Lin ◽

Hsin-Hsu Wu ◽

Ming-Yang Chang ◽

...

Keyword(s):

Antibiotic Treatment ◽

Medical Center ◽

Demographic Data ◽

Group B Streptococcus ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Streptococcus Group ◽

Prophylactic Antibiotic Treatment ◽

Group B ◽

Invasive Techniques

BackgroundPeritonitis is a serious complication after invasive procedures in patients undergoing peritoneal dialysis (PD). Most studies that have investigated peritonitis following invasive gynecologic procedures enrolled small patient populations. This study focuses on the clinical presentation, outcomes, and effects of prophylactic antibiotic use before invasive techniques.MethodsA retrospective study was conducted on patients who underwent invasive gynecologic procedures between 2005 and 2015 in a tertiary medical center. Eligible patients were identified and enrolled and their demographic data were collected. The use of prophylactic antibiotics and the outcomes of peritonitis were recorded.ResultsTwenty-six gynecologic procedures were performed on 18 PD patients. Seven episodes of peritonitis occurred in 6 patients after invasive gynecologic procedures. Eleven procedures were preceded by prophylactic antibiotic treatment (6 oral cefadroxil, 1 oral cefuroxime, 1 oral clindamycin, 1 intravenous [IV] ceftriaxone, 1 IV ceftazidime, and 1 IV cefazolin). The pathogens were diverse (group B Streptococcus, group D Streptococcus, E. coli, and Enterococcus). All episodes of peritonitis were successfully treated using intraperitoneal antibiotics without recurrence, technique failure, or mortality. The odds ratio of peritonitis in the non-prophylaxis group was 20.29 (95% confidence interval 1.01 – 406.35, p = 0.0103).ConclusionThe use of prophylactic antibiotic treatment considerably reduced the risk of peritonitis after invasive gynecologic procedures.

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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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Postdischarge antibiotic use for prophylaxis following spinal fusion

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.117 ◽

2020 ◽

Vol 41 (7) ◽

pp. 789-798

Author(s):

David K. Warren ◽

Katelin B. Nickel ◽

Jennifer H. Han ◽

Pam Tolomeo ◽

Christopher J. Hostler ◽

...

Keyword(s):

Spinal Fusion ◽

Linear Models ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Prophylactic Antibiotics ◽

Factors Associated ◽

American Society ◽

American Society Of Anesthesiologists ◽

Surgical Admission ◽

Significant Factors

AbstractObjective:Despite recommendations to discontinue prophylactic antibiotics after incision closure or <24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion.Design:Multicenter retrospective cohort study.Patients:This study included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites. Patients with an infection during the surgical admission were excluded.Methods:Prophylactic antibiotics were identified at discharge. Factors associated with postdischarge prophylactic antibiotic use were identified using hierarchical generalized linear models.Results:In total, 8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 admissions (3.3%). The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (22.1%), cephalexin (18.8%), and ciprofloxacin (17.1%). Adjusted for study site, significant factors associated with prophylactic discharge antibiotics included American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 1.31; 95% CI, 1.00–1.70), lymphoma (OR, 2.57; 95% CI, 1.11–5.98), solid tumor (OR, 3.63; 95% CI, 1.62–8.14), morbid obesity (OR, 1.64; 95% CI, 1.09–2.47), paralysis (OR, 2.38; 95% CI, 1.30–4.37), hematoma/seroma (OR, 2.93; 95% CI, 1.17–7.33), thoracic surgery (OR, 1.39; 95% CI, 1.01–1.93), longer length of stay, and intraoperative antibiotics.Conclusions:Postdischarge prophylactic antibiotics were uncommon after spinal fusion. Patient and perioperative factors were associated with continuation of prophylactic antibiotics after hospital discharge.

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

The Journal of Knee Surgery ◽

10.1055/s-0039-1695742 ◽

2019 ◽

Vol 33 (02) ◽

pp. 100-105 ◽

Cited By ~ 1

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.

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