Antibiotics to Prevent Surgical Site Infection (SSI) in Oral Surgery: Survey among Italian Dentists

The benefit of an antibiotic prophylaxis for most oral surgical procedures is controversial. The aim of this study was to collect information on the prescribing habits of a sample of Italian dentists with respect to the role of antibiotic prophylaxis in preventing surgical site infections (SSI). An anonymous questionnaire was prepared and made accessible online by sharing a Google Forms link. General anagraphic data and educational background information were collected to obtain a profile of the participants. Different clinical scenarios were then proposed, with the participants asked to choose whether they would prescribe an antibiotic prophylaxis and with which dosage regimens. In total, 169 dentists participated in the questionnaire and the obtained data were assessed through a percentage report. The results showed a substantial agreement in antibiotics prescription, but only in a limited number of clinical scenarios, such as deciduous teeth extraction or simple extractions in healthy adult patients. Discordant responses were found for several clinical cases, particularly for cases of comorbidities, surgical or multiple extractions, implant placement and abscess drainage. The answers obtained from the survey sample were notably heterogeneous, indicating that the choice to prescribe an antibiotic prophylaxis to prevent SSIs is often discretionary. Moreover, the dosage regimen of prophylaxis is also controversial. The results of this study demonstrate the need for specific guidelines on antibiotics in dentistry and, specifically, on antibiotic prophylaxis in oral surgery. Such guidelines would help to avoid unnecessary prescriptions.

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A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection

Antibiotics ◽

10.3390/antibiotics10070768 ◽

2021 ◽

Vol 10 (7) ◽

pp. 768

Author(s):

Yoann Varenne ◽

Stéphane Corvec ◽

Anne-Gaëlle Leroy ◽

David Boutoille ◽

Mỹ-Vân Nguyễn ◽

...

Keyword(s):

Antibiotic Prophylaxis ◽

Bone Tumor ◽

Tumor Resection ◽

Surgical Site Infections ◽

Implant Removal ◽

Pelvic Bone ◽

Resistance Pattern ◽

Cure Rate ◽

Implant Retention ◽

The Impact

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

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The role of Ayurveda management in preventing surgical site infections instead of surgical antibiotic prophylaxis

Journal of Ayurveda and Integrative Medicine ◽

10.1016/j.jaim.2017.03.003 ◽

2017 ◽

Vol 8 (4) ◽

pp. 263-265 ◽

Cited By ~ 2

Author(s):

Subhash Yadav ◽

Sanjay Jain ◽

Jatinder Chaudhary ◽

Rahul Bansal ◽

Manoj Sharma

Keyword(s):

Antibiotic Prophylaxis ◽

Surgical Site Infections ◽

Surgical Antibiotic Prophylaxis

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Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor

Clinical Infectious Diseases ◽

10.1086/512192 ◽

2007 ◽

Vol 44 (7) ◽

pp. 921-927 ◽

Cited By ~ 167

Author(s):

M. E. E. van Kasteren ◽

J. Mannien ◽

A. Ott ◽

B.-J. Kullberg ◽

A. S. de Boer ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Antibiotic Prophylaxis ◽

Hip Arthroplasty ◽

Surgical Site Infections ◽

Total Hip ◽

Timely Administration

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

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700075305 ◽

2006 ◽

Vol 27 (12) ◽

pp. 1358-1365 ◽

Cited By ~ 2

Author(s):

Marisa I. Gómez ◽

Silvia I. Acosta-Gnass ◽

Luisa Mosqueda-Barboza ◽

Juan A Basualdo

Keyword(s):

Surgical Site Infection ◽

Antibiotic Prophylaxis ◽

Final Stage ◽

Antimicrobial Prophylaxis ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Prospective Survey ◽

Surgical Antibiotic Prophylaxis ◽

Surgical Antimicrobial Prophylaxis

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

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Antibiotic Prophylaxis of Surgical Site Infections—A Double-edged Sword for Oncology Patients?

JAMA Oncology ◽

10.1001/jamaoncol.2021.6619 ◽

2022 ◽

Author(s):

Valerae O. Lewis ◽

Christina L. Roland

Keyword(s):

Antibiotic Prophylaxis ◽

Surgical Site Infections ◽

Oncology Patients

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A retrospective case series evaluating the efficacy of preoperative, intra-incisional antibiotic prophylaxis in Mohs micrographic surgery: An effective method to reduce surgical-site infections and minimize systemic antibiotic use

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2020.05.146 ◽

2020 ◽

Vol 83 (5) ◽

pp. 1501-1503

Author(s):

Teo Soleymani ◽

David G. Brodland ◽

John A. Zitelli

Keyword(s):

Antibiotic Prophylaxis ◽

Case Series ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Mohs Micrographic Surgery ◽

Micrographic Surgery ◽

Retrospective Case ◽

Systemic Antibiotic ◽

Retrospective Case Series

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Consent in Oral Surgery: a Guide for Clinicians

Dental Update ◽

10.12968/denu.2020.47.2.92 ◽

2020 ◽

Vol 47 (2) ◽

pp. 92-102

Author(s):

Mohammed M Dungarwalla ◽

Edmund Bailey

Keyword(s):

Surgical Procedures ◽

Secondary Care ◽

Clinical Relevance ◽

Oral Surgery ◽

Clinical Care ◽

Consent Process ◽

Oral Surgical Procedures ◽

Informed Decisions ◽

The Law

The consent process remains a pillar of excellent clinical care. The changes in the law after the Montgomery ruling in 2015 has changed the shape of consent, and now, taking adequate consent can be extensive and sometimes confusing for clinicians and patients. Dentists are sometimes faced with the unenvious task of weighing up what patients should know versus what they want to know. This paper aims to describe the consent process for more common oral surgical procedures, helping clinicians to allow their patients to make informed decisions. CPD/Clinical Relevance: To assist primary and secondary care clinicians in taking adequate consent for oral surgical procedures.

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