Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

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.

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Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

Asian Journal of Medical Sciences ◽

10.3126/ajms.v2i3.5610 ◽

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

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Antibiotic overuse in obstetric and gynecologic procedures at Zagazig university hospitals: A prospective observational study

Pharmacia ◽

10.3897/pharmacia.68.e71923 ◽

2021 ◽

Vol 68 (4) ◽

pp. 883-889

Author(s):

Ahmed M. Magdy ◽

Mahmoud A. Seksaka ◽

Gehan F. Balata

Keyword(s):

Observational Study ◽

Antibiotic Prophylaxis ◽

Prospective Observational Study ◽

Prophylactic Antibiotic ◽

Prophylactic Antibiotics ◽

Poor Adherence ◽

University Hospital ◽

World Health ◽

Utilization Rate ◽

Antibiotic Selection

Surgical site infection (SSI) constitutes a major problem in healthcare in terms of healthcare cost, morbidity and mortality. Surgical antibiotic prophylaxis (SAP) is one of the effective strategies for SSI prevention. Poor adherence to SAP guidelines across different countries has been observed. Misuse of prophylactic antibiotics threatens patient safety and leads to an increase in the acquisition of antibiotic resistance. The aim of this study was to assess the utilization of SAP in obstetric and gynecologic procedures in terms of indication for prophylaxis, antibiotic selection, timing of administration and prophylaxis duration. A prospective observational study was conducted at the obstetrics and gynecology department of Zagazig University Hospital during the period from January 2020 to June 2020. Medical records of 264 women were recorded and evaluated. The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines, World Health Organization (WHO) recommendations and The American College of Obstetricians and Gynecologists (ACOG) practice bulletin were used for data evaluation and hence women were stratified into two groups. For women who underwent procedures in which guidelines recommended the use of SAP (200 patients; 75.75%), 198 women (99%) received preoperative prophylaxis. None of women (0%) received the recommended first line antibiotic by guidelines while the most commonly used prophylactic antibiotics were Cefotaxime (86 patients; 43.43%) and Ampicillin-sulbactam (62 patients; 31.31%). Preoperative antibiotic prophylaxis timing was 0-60 minutes before skin incision. All women received postoperative prophylaxis that extended to an average of 7 days. Regarding the other group who underwent procedures in which prophylactic antibiotics weren’t recommended by guidelines (64 patients; 24.24%), 37 women (57.81%) followed the guidelines and didn’t receive SAP while 27 women (42.18%) received SAP. Poor adherence to guidelines recommendations regarding prophylactic antibiotic selection and prophylaxis duration was observed. High utilization rate of prophylactic antibiotics in procedures that didn’t require their use was reported..

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The Association Between Incorrect Use of Antibiotic Prophylaxis and in-Hospital Surgical Site Infections – A Prospective Observational Study

Infection and Drug Resistance ◽

10.2147/idr.s260238 ◽

2020 ◽

Vol Volume 13 ◽

pp. 3063-3072

Author(s):

Gosaye Mekonen Tefera ◽

Beshadu Bedada Feyisa ◽

Getu Melesie Taye ◽

Gurmu Tesfaye Umeta ◽

Fekadu Negash Bereded ◽

...

Keyword(s):

Observational Study ◽

Antibiotic Prophylaxis ◽

Prospective Observational Study ◽

Surgical Site Infections

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

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619838749 ◽

2019 ◽

Vol 18 (2) ◽

pp. 135-142 ◽

Cited By ~ 2

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.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20175494 ◽

2017 ◽

Vol 5 (1) ◽

pp. 27 ◽

Cited By ~ 1

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.

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Current Practice and Barriers to an Early Antimicrobial Conversion from Intravenous to Oral among Hospitalized Patients at Jimma University Specialized Hospital: Prospective Observational Study

Interdisciplinary Perspectives on Infectious Diseases ◽

10.1155/2019/7847354 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Alemseged Beyene Berha ◽

Gizat Molla Kassie

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Current Practice ◽

Significant Proportion ◽

Severe Infection ◽

Hospitalized Patients ◽

P Values ◽

Specialized Hospital ◽

Jimma University ◽

Clinical Stability

Objective. The aim of the present study was to explore the current practice and its barriers to an early antimicrobial conversion from intravenous (IV) to oral (PO) therapy among hospitalized patients.Method. Hospital based prospective observational study was conducted to assess the practice of an early antimicrobial IV to PO conversion and its barriers using medical chart and case-specific physicians’ interviews, respectively, from February to September, 2014. Patient charts and medication records were reviewed for appropriateness of IV to PO conversion program every 24hrs using a pretested data collection abstraction format. Independent samplest-test was used to compare the duration of therapy and time to clinical stability between converted and nonconverted patients. Two-tailed P values of < 0.05 were regarded as statistically significant.Results. One hundred forty-two patients were included in the study, of whom two-thirds (67.6%) of the patients were eligible for IV to PO antimicrobial conversion. However, only 20.9% of patients’ timely conversion was made. A shorter duration of IV therapy was recorded for converted (2.80±1.87) versus nonconverted patients (8.50±6.32), (P=0.009). The most important barriers of not converting IV to PO in clinically stable patients were presence of comorbidity; clinicians perceived that the patient should always complete IV course of antimicrobials as a standard practice.Conclusion. Conversion from IV to PO antimicrobials was found to be unnecessarily delayed in a significant proportion of patients hospitalized with moderate to severe infection due to a range of different barriers. Addressing these issues has the potential to reduce inappropriate antimicrobial use and resistance.

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Duration of antibiotic prophylaxis for cardiac surgery: Prospective observational study

Journal of Infection ◽

10.1016/j.jinf.2009.02.008 ◽

2009 ◽

Vol 58 (4) ◽

pp. 291-298 ◽

Cited By ~ 7

Author(s):

Mical Paul ◽

Eyal Porat ◽

Aeyal Raz ◽

Hefziba Madar ◽

Shai Fein ◽

...

Keyword(s):

Cardiac Surgery ◽

Observational Study ◽

Antibiotic Prophylaxis ◽

Prospective Observational Study

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

BMC Surgery ◽

10.1186/s12893-021-01374-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giziew Bawoke ◽

Segni Kejela ◽

Abebe Alemayehu ◽

Girmaye Tamirat Bogale

Keyword(s):

Neoadjuvant Chemotherapy ◽

Observational Study ◽

Surgical Site Infection ◽

Low Income ◽

Prospective Observational Study ◽

Radical Mastectomy ◽

Surgical Site Infections ◽

Site Infection ◽

Modified Radical Mastectomy ◽

Retroviral Infections

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

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The clinical application of preoperative self-anticipated pain score and the correlation with surgical pain after elective surgery - a prospective observational study

10.21203/rs.3.rs-18199/v2 ◽

2020 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

Pain Score ◽

Prospective Observational Study ◽

Rating Scale ◽

Elective Surgery ◽

Perioperative Period ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Younger patients (<40 years) (P=0.042) and those took regular benzodiazepine at bedtime (P=0.043) anticipated significantly higher pain levels. Male patients anticipated significantly lower pain intensities than females (odd ratio 1.710; 95% CI 1.254-2.331, P=0.001). Patients who scheduled for laparotomies (P=0.037), orthopedic surgeries (P=0.040) or long procedures (P<0.001) reported higher anticipated pain. Although higher anticipated pain scores were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that patients who are female, younger age (<40 years), use regular benzodiazepines at bedtime and scheduled for long procedures (>2 h), laparotomies or orthopedic surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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Perioperative Risk Factors for Intraoperative Hypothermia in Adult Patients Undergoing Elective Surgery at a National Referral Hospital in Bhutan: A Prospective Observational Study

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201966 ◽

2019 ◽

Author(s):

Kinley Zangmo ◽

Sunisa Chatmongkolchart ◽

Pasuree Sangsupawanich

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Observational Study ◽

Prospective Observational Study ◽

Elective Surgery ◽

Perioperative Risk ◽

Referral Hospital ◽

Adult Patients ◽

Intraoperative Hypothermia ◽

National Referral Hospital

Objective: Intraoperative hypothermia is commonly encountered in anesthetic practice. It is related to several risk factors and can lead to various adverse events. It is important to detect it early and prevent the complications related to it. This study was done to identify incidence and perioperative risk factors of intraoperative hypothermia at a national referral hospital in Bhutan.Material and Methods: A prospective observational study was conducted in adult patients who underwent elective surgery lasting more than 30 minutes. Patient characteristics, incidence of hypothermia, and any interventions for treatment of hypothermia during the operation were recorded. Intraoperative hypothermia was defined as a core body temperature less than 36 °C measured with an esophageal probe.Results: Data were obtained from 91 patients with a mean (±standard deviation; S.D.) age of 42.3 (17.2) and American Society of Anesthesiologists (ASA) scores of 1 and 2 in 62.6% and 37.4% of the patients, respectively The patients underwent elective surgery with a mean (S.D.) duration of 73.24 (48.1) minutes and a mean (S.D.) duration of anaesthesia of 80.9 (49.2) minutes. The incidence of intraoperative hypothermia was 61.5% (56/91). Preoperative heart rate more than 80 beats per minute [hazard ratio (HR) 0.45, 95% confidence interval (CI), 0.26-0.77] was a protective factor and duration of anesthesia more than 60 minutes (HR 1.82, 95% CI, 0.98–3.38) was a risk factor for intraoperative hypothermia.Conclusion: Patients with a preoperative heart rate less than 80 beats per minute and undergoing duration of anesthesia more than 60 minutes should be assessed from the preoperative period and continuously monitored throughout the intraoperative period.

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