Evaluation of Antibiotic Prophylaxis Regimens in Gynecological Surgeries in a Referral Teaching Hospital: A Cross Sectional Study

Background: Drug utilization Evaluation is the main tool to assess the clinical and economic effects of drug on health-care system. The aim of the current study is to evaluate the regimens of antibiotic prophylaxis in common gynecological surgeries in a referral teaching hospital Methods: This cross-sectional study was done in Alzahra hospital, Tabriz, Iran, from July 2017 to December 2017. Patients who received antibiotics as surgical site infection prophylaxis were enrolled. Data were collected from patients’ medical records and adherence rate to the American Society of Health-System Pharmacists (ASHP) guideline was studied as the primary endpoint. Results: A total of 210 patients who undergoes common gynecological surgeries were evaluated. Cesarean section (58.6%) and total abdominal hysterectomy (28.1%) were the majority of surgeries. The type of administered antibiotic was adherent to guideline in 71.4%. Doses and duration of prescribed antibiotic (Cefazolin, the most prescribed antibiotic) were not in accordance with the guideline in 100%. Only in 58%, the time of antibiotic administration was corrected. Conclusion: In this study, the misuse of antibiotics in most cases was documented in terms of type, dose and duration of drug administration in Al-Zahra Hospital. It seems necessary to publish evidence-based guidelines and monitor their proper implementation, not only to reduce costs but also to combat antibiotic resistance.

Electrically stimulated eccentric contraction during non-weight bearing knee bending exercise in the supine position increases oxygen uptake: A randomized, controlled, exploratory crossover trial

It is well known that prolonged bed rest induces muscle weakness, muscle atrophy, cardiovascular deconditioning, bone loss, a loss of functional capacity, and the development of insulin resistance. Neuromuscular electrical stimulation is anticipated to be an interventional strategy for disuse due to bed rest. A hybrid training system (HTS), synchronized neuromuscular electrical stimulation for voluntary exercise using an articular motion sensor, may increase the exercise load though bed rest. We assessed oxygen uptake or heart rate during knee bending exercise in the supine position on a bed both simultaneously combined with HTS and without HTS to evaluate exercise intensity on different days in ten healthy subjects (8 men and 2 women) by a randomized controlled crossover trial. The values of relative oxygen uptake during knee bending exercise with HTS were significantly greater than those during knee bending exercise without HTS (7.29 ± 0.91 ml/kg/min vs. 8.29 ± 1.06 ml/kg/min; p = 0.0115). That increment with HTS was a mean of 14.42 ± 13.99%. Metabolic equivalents during knee bending exercise with HTS and without HTS were 2.08 ± 0.26 and 2.39 ± 0.30, respectively. The values of heart rate during knee bending exercise with HTS were significantly greater than those during knee bending exercise without HTS (80.82 ± 9.19 bpm vs. 86.36 ± 5.50 bpm; p = 0.0153). HTS could increase exercise load during knee bending exercise which is easy to implement on a bed. HTS might be a useful technique as a countermeasure against the disuse due to bed rest, for example during acute care or the quarantine for infection prophylaxis.

141. A Blind Spot for Antibiotic Stewardship Programs: Misadministration of Perioperative Antibiotics

Background Hospitalized patients requiring intravenous antibiotics frequently undergo surgical intervention. These surgeries involve multiple transitions of care that may lead to antibiotic delay, additional unnecessary doses, omission, or substitution. While many studies examine the use of antibiotics for surgical site infection prophylaxis, there are no studies investigating antibiotic use in the perioperative period for inpatients already on an IV antibiotic regimen. This study examined the incidence and nature of antibiotic misadministration in the perioperative period among inpatients. Methods We conducted a retrospective cross-sectional study at a Veterans Affairs Medical Center involving all inpatients who underwent surgery in 2019. Patients 18 years or older who were on an IV antibacterial regimen prior to surgery were included. Patients undergoing cardiac surgery and patients only receiving surgical infection prophylaxis were excluded. Through manual chart review, we collected information on the prescribed IV antibiotic regimen and timing of antibiotic doses in the perioperative period. Errors were classified as administration of additional unnecessary IV antibiotics and missed, delayed, and additional doses of prescribed IV antibiotics. Results There were 168 inpatients on an IV antibiotic regimen who underwent surgery in 2019. Complete data was available for 158 patients. Errors in antibiotic administration in the perioperative period were identified in 64 (41%) patients. Missed, delayed, additional unnecessary antibiotics, and additional doses of prescribed IV antibiotics were identified in 21 patients (13%), 14 patients (9%), 13 patients (8%), and 7 patients (4%), respectively (Figure 1). Conclusion We found errors in antibiotic administration for inpatients undergoing surgery to be common, with the most frequent error being a missed dose of a prescribed IV antibiotic. This illustrates an area for quality improvement in inpatient antibiotic stewardship in our hospital and we suspect in other hospitals as well. Future work will incorporate more centers and examine how these errors affect outcomes for inpatients undergoing surgery, particularly in patients with sepsis or those requiring surgery for infection source control. Disclosures All Authors: No reported disclosures

Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT)

Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.

Evaluating the Efficacy of Povidone-Iodine Solution Infection Prophylaxis in Immediate Tissue Expander-Based Breast Reconstruction: A Controlled Retrospective Analysis

Background: There is currently no consensus among plastic surgeons regarding the optimal infection prophylaxis for immediate tissue expander placement following mastectomy. The goal of this study was to determine whether irrigation with 1 L of standard triple antibiotic solution (TAS) can achieve similar infection rates compared to a regimen of 180 mL of TAS with povidone-iodine solution (Betadine) painted on the field immediately prior to the placement of the expander. Methods: The 2 regimens were compared via retrospective propensity matching of all patients of the 2 senior authors who underwent bilateral tissue expander placement immediately following mastectomy with one of 3 mastectomy surgeons from January 2013 to December 2019 (n = 281). Groups were controlled for mastectomy surgeon, mastectomy type, mastectomy weight, age, race, body mass index, diabetes, hypertension, smoking, smoking status, prepectoral/subpectoral placement, use of acellular dermal matrix, operating room time, and duration of postoperative antibiotics. Results: Compared to the Betadine cohort (n = 65), the non-Betadine cohort (n = 65) experienced a similar rate of infections (13.8% vs 12.3%, P = 1.00), including major injections requiring intravenous antibiotic treatment (10.8% vs 9.2%, P = 1.00), after propensity matching. Infections in the non-Betadine cohort did not grow different bacteria on culture, require different antibiotic coverage, or result in prolonged duration of average antibiotic therapy (12.0 days vs 19.3 days, P = .19). Rates of subsequent expander washout and exchange ( P = 1.00) and overall complications that required return to the operating room ( P = .826) were similar between groups. Conclusion: The addition of Betadine solution to TAS added no benefit to infection prophylaxis or reduction of surgical complications in immediate tissue expander placement procedures.