scholarly journals Antibiotic prophylaxis in pre-hospital trauma care: A review of the literature

2014 ◽  
Vol 11 (5) ◽  
Author(s):  
Lynsey Smit ◽  
Malcolm Boyle
Keyword(s):  
Antibiotic Prophylaxis ◽  
Foreign Bodies ◽  
Hospital Setting ◽  
Prophylactic Antibiotic ◽  
Prophylactic Antibiotics ◽  
Antibiotic Administration ◽  
Search Filter ◽  
Medical Databases ◽  
Penetrating Wound ◽  
Search Terms

AbstractIntroduction Penetrating and open wounds expose an otherwise sealed and protected body to foreign bodies, leaving the patient vulnerable to potentially fatal infection. The objective of this study was to determine if the administration of systemic prophylactic antibiotics by paramedics for penetrating and/or open wounds leads to decreased infection rates and improved patient outcomes.MethodsA literature search of the electronic medical databases CINAHL, Cochrane, EMBASE and MEDLINE was conducted. The databases were reviewed from January 2000 to March 2013. A pre-hospital search filter was applied to each database with additional search terms of ‘open wound’, ‘penetrating wound’, ‘prophylactic antibiotic’. References of retrieved articles were also reviewed. Articles were included if they reported on the administration of prophylactic antibiotics by paramedics for penetrating or significant open wounds. ResultsA total of 1280 articles were identified in the search with four articles meeting the inclusion criteria. All four articles focused on the combat setting and management of soldiers with combat-related open or penetrating wounds. Two studies supported the use of prophylactic antibiotics whereas the third did not, stating that the evidence was low level and the practice of antibiotic administration was more opinion based.ConclusionThis study identified that there is scant evidence to support the use of systematic antibiotic prophylaxis in the civilian pre-hospital setting for open wounds. There is a need for further research to identify if this view may change in the future.

scholarly journals Assessment of antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital.

2016 ◽  
Vol 43 (4) ◽  
pp. 225-234 ◽  
Author(s):  
MARISE GOUVÊA ◽  
CRISTIANE DE OLIVEIRA NOVAES ◽  
ANTONIO CARLOS IGLESIAS
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prophylactic Antibiotic ◽  
University Hospital ◽  
Surgical Patients ◽  
Antibiotic Administration ◽  
Surgical Antibiotic Prophylaxis ◽  
The Right

ABSTRACT Objective : to evaluate the antibiotic prophylaxis in surgical patients at the Gaffrée e Guinle University Hospital - HUGG. Methods : we conducted a rospective study of a cohort of 256 patients undergoing elective operations between January and September 2014. We collected data on demographics, use or not of prophylactic antibiotic and the antibiotic prophylaxis following characteristics: type of antibiotic used, moment of administration and duration of postoperative use. The analyzed outcomes were "justified use or non-use of antibiotic prophylaxis", "correct antibiotic choice," "administration of the antibiotic at the right time" and "discontinuation of the antibiotic at the right time." Results : antibiotic prophylaxis was used in 91.8% of cases. The use or non-use of antibiotic prophylaxis was justified in 78.9% of patients, the choice of the administered antibiotic was considered correct in 97.9%, antibiotic administration was made at the right time in only 27.2% of patients and discontinuation of the antibiotic was performed at the correct time in 95.7% of cases. Conclusion : the surgical antibiotic prophylaxis was not fully adequately performed in the sample.

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

2020 ◽  
Vol 132 (3) ◽  
pp. 797-801 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Omar Tanweer ◽  
Miguel Litao ◽  
Pankaj Sharma ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Medical Center ◽  
Prophylactic Antibiotic ◽  
Systemic Infection ◽  
Antibiotic Use ◽  
Infection Risk ◽  
Prophylactic Antibiotics ◽  
Oral Antibiotic ◽  
Systematic Analysis ◽  
Significant Difference

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.

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

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

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

scholarly journals A Prospective Evaluation of Adverse Reactions to Single-Dose Intravenous Antibiotic Prophylaxis During Outpatient Hand Surgery

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Kristin Sandrowski ◽  
David Edelman ◽  
Michael Rivlin ◽  
Christopher Jones ◽  
Mark Wang ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Single Dose ◽  
Antibiotic Prophylaxis ◽  
Upper Extremity ◽  
Adverse Reactions ◽  
Prophylactic Antibiotic ◽  
Hand Surgery ◽  
Outpatient Setting ◽  
Study Cohort ◽  
Antibiotic Administration

Background: While it is established that routine prophylactic antibiotics are not needed for all hand surgery, some cases do require it. The purpose of this study was to determine the rate of adverse reactions resulting from prophylactic antibiotic administration on patients undergoing outpatient hand and upper extremity surgical procedures. We hypothesize that the rate of complications resulting from the use of antibiotic prophylaxis is smaller than that reported in the currently referenced literature. Methods: We prospectively evaluated 570 consecutive patients undergoing outpatient upper extremity surgery. Patients were excluded if they were on antibiotics prior to surgery, were discharged on antibiotics, or if they wished to be excluded. Nineteen patients were excluded, resulting in a study cohort of 551 patients. Patients were monitored perioperatively, 2 to 3 days postoperatively, during the first postoperative visit and 1 month postoperatively for adverse reactions. The type and timing of the adverse reaction was recorded. Results: Five hundred fifty-one patients were included for evaluation and 8 patients (1.5%) developed an adverse reaction to antibiotics. Five patients (0.9%) reported a rash and 3 patients (0.5%) reported diarrhea within 3 days of surgery. There were no anaphylactic reactions or complications necessitating hospital transfer or admission in the postoperative period. Conclusion: This study represents a prospective investigation designed to determine the rate of adverse reactions to single-dose antibiotics given during outpatient hand surgery. We conclude that the use of intravenous, single-dose prophylactic antibiotic is safe in the outpatient setting for cases that require it.

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

Pharmacia ◽  
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..

scholarly journals Perioperative antimicrobial prophylaxis in patients receiving antibiotic therapy

2021 ◽  
Author(s):  
Yiwei Yin ◽  
Eljim P Tesoro ◽  
Alan E Gross ◽  
Jeffery J Mucksavage
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Antimicrobial Prophylaxis ◽  
Prophylactic Antibiotic ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Surgical Site Infections ◽  
Dose Interval ◽  
Prophylactic Antibiotics ◽  
Antibiotic Administration

Objective: Antimicrobial prophylaxis is administered perioperatively to prevent surgical site infections. However, in patients who have already received antibiotics for the treatment of active infections prior to surgery, the risks and benefits of administering prophylactic antibiotics are unknown. We aimed to assess the necessity of perioperative prophylactic antibiotic administration in patients receiving antibiotic treatment for active infections. Method: This was a retrospective, chart-review cohort study. Between January 2018 to May 2018, adult patients who underwent inpatient surgery at the University of Illinois Hospital and Health Sciences System, and were prescribed prophylactic antibiotics based on institutional protocol, while receiving antibiotic treatment within 48 hours prior to surgery, were included in the study. The primary endpoint was the rate of duplicative antibiotic therapy, which was defined as the administered prophylactic antibiotic (1) exhibiting similar or narrower bacterial coverage as the treatment antibiotic(s), and (2) given within the dose interval of the treatment antibiotic(s). Results: A total of 158 patients were included in the study, of which 70 (44.3%) received duplicative antibiotic therapy, whereas 88 (55.7%) did not. Differences in the incidence of acute kidney injury, C. difficile infection, and surgery site infections were not statistically significant between the two groups. Conclusion We found that it was common for patients receiving therapeutic systematic antibiotics to perioperatively be prescribed additional prophylactic antibiotics at our institution. However, additional prophylactic antibiotics can be unnecessary in decreasing the incidence of surgical site infections.

Optimization of Delivery of Pediatric Otolaryngology Surgical Antibiotic Prophylaxis

2020 ◽  
Vol 163 (2) ◽  
pp. 275-279
Author(s):  
Pratyusha Yalamanchi ◽  
Ashley Parent ◽  
Marc Thorne
Keyword(s):  
Antibiotic Prophylaxis ◽  
Time Series Data ◽  
Prophylactic Antibiotics ◽  
Series Data ◽  
Case Mix ◽  
Antibiotic Administration ◽  
Limited Evidence ◽  
Pediatric Otolaryngology ◽  
Perioperative Antibiotics ◽  
Surgical Antibiotic Prophylaxis

Objectives There is limited evidence regarding use of routine perioperative antibiotics for pediatric otolaryngologic procedures. The objectives of this quality improvement study were (1) to characterize the otolaryngology case mix for which antibiotics were delivered and (2) determine the percentage of surgical encounters with appropriate timing of antibiotic administration. Methods Pediatric otolaryngology procedures meeting criteria from 2015 to 2019 were evaluated as a component of an institution-wide pediatric surgical antibiotic prophylaxis study using A3 problem solving to identify and roll out interventions for appropriate antibiotic administration. Descriptive statistical analysis of the interrupted time-series data was used to describe the otolaryngology case mix for which antibiotics were delivered. The primary outcome measure was percentage of surgical encounters with appropriate timing of antibiotic administration in minutes relative to incision. Results In total, 1520 pediatric otolaryngology procedures with perioperative antibiotic delivery were performed from July 2015 to September 2019. While surgical site infection number (n = 2/year) was stable, administration of timely prophylactic antibiotics significantly improved: 27.5% of cases per month at baseline and 86.9% at the conclusion of the rollout of the sequential interventions ( P < .001). Discussion Given the exceedingly low infection rate of clean otolaryngology surgery, there is limited evidence in favor of perioperative antibiotics for the majority of procedures. Prophylactic antibiotics were most commonly used in otologic surgery involving cochlear implantation or in the setting of draining ears or cholesteatoma and in clean-contaminated head and neck surgery cases. Implications for Practice Iterative continuous performance improvement can optimize evidence-based delivery of preoperative prophylactic antibiotics. Additional interventions to ensure antimicrobial stewardship in pediatric otolaryngology are indicated.

A Study of Antibiotic Prophylaxis in Unconscious Patients

PEDIATRICS ◽  
1958 ◽  
Vol 21 (2) ◽  
pp. 202-202
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Prophylaxis ◽  
Prophylactic Antibiotic ◽  
Treated Group ◽  
Pulmonary Complications ◽  
Prophylactic Antibiotics ◽  
Prophylactic Therapy ◽  
Gram Negative ◽  
Prophylactic Antibiotic Therapy ◽  
Unconscious Patients

A group of 72 comatose patients with no evidence of infection were studied in order to establish the influence of prophylactic antibiotics on their subsequent course. Of this group, 32 were treated with penicillin and streptomycin or tetracycline, and 10 received sulfisoxazole or nitrofurantoin; the remaining 30 patients served as controls and received no prophylactic therapy. It was found that there was no difference in mortality between the treated and the untreated groups. However, pulmonary complications developed in 45% of the prophylactically treated group whereas only 15% of the untreated patients developed such complications. In the treated group, bacteremia due to a gram-negative rod occurred in two patients who died. In addition, the usual nasopharyngeal flora of the treated patients was replaced by gram-negative rods. The authors conclude that "prophylactic antibiotic therapy is of no benefit, and is distinctly hazardous in unconscious patients."

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.

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