A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis

Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.

Is there a need for antibiotic cover in clean surgery like laparoscopic cholecystectomy: a prospective study

Background: Even with a low post-operative infection complication rate in elective laparoscopic cholecystectomy (LC), most surgeons use prophylactic antibiotics out of habit. This prospective study was done to analyze the need for such prophylaxis in cases of elective LC.Methods: 135 successive patients undergoing elective LC were included in the study. Patients were randomized into 3 groups. Group A (n=45) cases received 3 doses of injection ceftriaxone in the post op period, group B (n=48) cases received a single dose of injection ceftriaxone at the time of induction of anesthesia, and group C (n=42) cases did not receive any antibiotic pre or post operatively. Post-operative infectious complications between three groups were compared.Results: There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, duration of surgery and hospital stay. Intraoperative spillage of bile [6.7% (A): 4.6% (B): 5.2% (C)] did not increase infectious complications.Conclusions: Routine use of prophylactic antibiotic in a clean, uncomplicated cases of laparoscopic cholecystectomy is not required. One dose of ceftriaxone at the time of induction or 3 doses of injection ceftriaxone post operatively following elective LC even in the urban Indian setting should be abandoned as it neither reduces the rate of surgical site infection but also contributes to adverse reactions, drug resistance, and unnecessary financial burden.

A comparative study on antibiotics and no antibiotics in clean surgical cases

Background: Surgical wound infection is one of the most commonly occurring complications and its incidence has been lowest in clean surgical cases. Prophylactic antibiotics are routinely used in all surgical cases. But this is not indicated in clean surgical cases. Due to undue fear of infections, many practicing surgeons use antibiotics in clean surgical cases. Misuse of antimicrobials leads to drug toxicity, super infections, high health care cost and colonization of wards by highly resistant microbes. Objective of the study is to compare the frequencies of wound site infections in patients undergoing clean elective general surgery operations with no antibiotics and single dose prophylactic antibiotics.Methods: A comparative study of 100 patients undergoing elective clean surgeries at Victoria Hospital from November 2012 to October 2014 was undertaken. Data was collected by history taking, clinical examination, hematological and microbiological investigations and follow up.Results: Two cases in each group had post-operative infections noticed on the day 2 wound examination. All the four cases had culture positive with isolates being S. aureus in three and E. coli in single case.Conclusions: Post-operative wound infections noted in two cases in both the groups do not have any clinical and statistical significance; hence single dose of prophylactic antibiotics is not required in all the clean surgical cases. A simple size of large number is required in this area of research to conclude with statistical significance.

Single Dose vs Multiple Dose Prophylactic Antibiotic to Prevent Early Port-Site Infection in Elective Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment of symptomatic cholelithiasis. The need of the hour is to understand the fact that PSI is a totally different subset of infection and antibiotics are not a solution to this problem. The core issue of “prevention” is the principal solution. The study was undertaken to revalidate these well known facts with an effort to bring about a radical reform to this “social” rather than clinical problem. Material and Methods: The study comprised of 60 patients admitted for elective LC. The first thirty patients undergoing elective LC were given single dose (SD) ciprofloxacin (500 mg) within an hour between the induction and making of the first port. While the control group received ciprofloxacin (500mg) post-operatively in the ward from ward nurses (MD). Operation-room anesthetic assistant administered prophylactic antibiotics at induction of anaesthesia to all the patients. Results: Of the 30 cases that received single dose prophylactic antibiotic pre-operatively, 16.67% were males and 83.3% were females. And, of the 30 cases that received multiple dose prophylactic antibiotic pre as well as post-operatively, 10% were males and 90% were females. Analysis showed that there was no statistically significant difference across the groups in regard to the duration of preoperative hospital stay. Of the 30 cases that received single dose prophylactic antibiotic preoperatively, only one patient suffered gross contamination during the surgery. Conclusion: The rate of early PSI after administration of single dose ciprofloxacin (500 mg) intravenously at induction of anesthesia and multiple dose ciprofloxacin (500 mg given thrice or four times) intravenously post-operatively for two or three days in addition to peri-operative dose is comparable in elective laparoscopic cholecystectomy. Furthermore, hospital cost can be reduced with single dose antibiotic regimen. So single dose of ciprofloxacin 500 mg can be used safely in elective cases of laparoscopic cholecystectomy to avoid infection at port site.

Comparison of prophylactic versus regular use of antibiotics in elective major obstetrical and gynecological surgeries

Background: Surgical site infections better prevented by parenteral antibiotic in sufficient doses generally should be given before the operation which helps to achieve the therapeutic drug level both in the blood and related tissue during the operation. Ceftriaxone, when administered together as a prophylaxis can fulfil the above criteria of a good antibiotic. Thus, this study was planned to assess the efficacy of prophylactic antibiotic usage to that of regular antibiotics usage in patients undergoing elective surgeries.Methods: This randomized controlled study was conducted in a tertiary care teaching hospital during the study period of June 2017 to April 2018 with 140 cases. Group A received a single dose of Injection Ceftriaxone 1g. Group B, received Injection Ceftriaxone 1 gm and Injection Metronidazole 500 mg for five days. The data was entered in excel sheet and analyzed using SPSS (Version 16).Results: The mean age group in Group A and Group B was found to be 34.24±10.5 and 35.97±11.89, respectively. There was no statistical significance between group A and B for incidence of infection in the post-operative period and duration of hospital stay. The mean value in group A for duration of surgery was found to be 67.5±13.5 and in group B mean value was 72.1±14.9. (p value <0.05).Conclusions: This study demonstrated that administration of prophylactic antibiotic rather than conventional antibiotic at caesarean and gynecological surgeries are not associated with significant difference in post-operative morbidities.

Efficacy of a single- dose fosfomycin as antibiotic prophylaxis prior to transrectal ultrasound-guided prostate biopsy

Objectives@#The goal to prevent increasing antibiotic resistance in urologic procedures has a significant impact on the choice of preoperative antibiotic prophylaxis. The efficacy of an old-new antibioticfosfomycin in TRUS-guided prostate biopsy was also evaluated. @*Methods@#Included were patients who underwent TRUS-guided prostate biopsy from August 1, 2015- July 31, 2016. Patients who satisfied the inclusion criteria were included. Patients were asked to take a single dose of 3g oral fosfomycin 1-3 hours prior to the procedure. Urinalysis was taken pre biopsy and post biopsy (at least 7-10 days). Occurrence of afebrile and febrile UTI were noted. Patients were informed of the signs and symptoms that need to be reported to the investigators. @*Results@#There were 74 patients enrolled in the study. The mean average age of patients was 66.5(±7). Majority of patients were having moderate lower urinary tract symptoms (40.5%) followed by patients with indwelling foley catheter (31.1%). Seventeen percent of patients had concomitant diseases like diabetes mellitus, cystolithiasis, nephrolithiasis, hypertension, etc. Pre biopsy, 51.4% of patients had asymptomatic urinary tract infection and 35% of these patients showed resolution of UTI post biopsy. The incidence of febrile UTI was 4%, 3.8% of patients with UTI pre biopsy and 50% of patients without UTI pre biopsy. Finally, the presence of afebrile and febrile UTI pre and post biopsy was statistically significant at 5% level of significance. @*Conclusion@#Single dose oral fosfomycin as prophylactic antibiotic in TRUS- guided prostate biopsy can be an alternative to reduce the rate of fluoroquinolone- resistant infections.

¿Se deben o no utilizar antibióticos profilácticos en el paciente recién nacido a término con factores de riesgo de infección neonatal? / Is it due or not to use prophylactic antibiotics in term newborn with risk factors for neonatal infection patient?

Objetivos: Evaluación en la Clínica General San Diego de Barranquilla de febrero de 2014 a diciembre de 2015 de los recién nacidos con factores de riesgo para infección y el beneficio de usar o no antibióticos profilácticos como preventivos de sepsis neonatal y el análisis de la morbilidad asociada. Material y métodos: Estudio prospectivo donde se analizan 155 casos en los cuales se utilizó o no antibiótico profiláctico en paciente con factores de ries-go de sepsis. Resultados: De un total de 4159 nacimientos, 155 recién nacidos (3,72 %) presentaron factores de riesgo; de estos pacientes en 74 se usaron antibióticos (grupo 1) y en 81 no se usaron antibióticos (grupo 2). En ninguno de los grupos se presentaron casos positivos de sepsis.

Objectives: Evaluation of newborns with risk factors for developing neonatal sepsis at San Diego General Clinic in Barranquilla between February 2014 to December 2015, and the benefit of using prophylactic antibiotics as a prevention for neonatal sepsis. Methods: A prospective study was performed in which 155 cases were followed and analyzed, both with and without antibiotic prophylaxis, in patients with risk factors for sepsis to determine whether it affects morbidity or not. Analyzes were performed. Results: From a total of 4159 births, 155 new born(3.72 %) presented risk factors; antibiotics were used in 74 patients and in 81 patients there were no use of anti-biotics.

The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh

Aim: This study aimed to evaluate the role of cefazolin in prevention of various infections after abdominal wall repair by mesh. Materials and methods: This is a prospective study consisted of 300 patients with various kinds of hernia (inguinal, femoral, bilateral, incisional, umbilical and lumbar hernias who were treated for elective mesh repair in from September 2010 to October 2014. Results: In the present study, 300 patients with different kinds of hernia were selected for elective surgery. Of them 200 patients (66.6%) were males and 100 patients (33.4%) were females with mean age of 50-55 years. Patients were assigned into study group and control group. 180 patients (60%) received prophylactic cefazolin, this group was named as study group and 120 patients (40%) were named as control group and did not receive any prophylactic antibiotics. The mean age of patients in control group was 51.5±13.45 years and that in study group was 53.0±15.75 years which was not significantly different. (p =0.05). 22 patients (18.3%) of 120 control group patients had epigastric hernia, 18 patients (15%) had incisional hernia, 46 patients (38.3) had inguinal hernia, 34 patients (28.3%) had umbilical hernia and all these patients were not given any prophylactic antibiotics. 44 patients (24.4%) of 180 study patients had epigastric hernia, 31 patients (17.2%) had incisional hernia, 85 patients (47.2%) had inguinal hernia and 20 patients (11.1) had umbilical and all these patients were given prophylactic antibiotic. One patient who received rives repair in the study group developed deep surgical site infection which necessitated readmission and partial debridement of the mesh without complete excision. T. Uma Maheswara Rao. The role of prophylactic cefazolin in the prevention of infection after various types of abdominal wall hernia repair with mesh. IAIM, 2016; 3(6): 124-129. Page 125 Conclusion: This study results did not support the use of cephazolin as a prophylactic for various kinds of abdominal wall hernia repair with mesh

Estudio comparativo de tres regímenes de tratamiento Profiláctico antes de la cirugía bucal

La remoción quirúrgica de los terceros molares ocasiona considerable dolor, edema y disfunción. Los factores que contribuyen a estas secuelas son complejos. Las estrategias farmacológicas para minimizar las manifestaciones clínicas del trauma quirúrgico son dirigidas hacia el bloqueo de la inflamación aguda, infección y dolor. Existe mucha controversia acerca de la necesidad de tratamiento antibiótico profiláctico antes de la cirugía bucal. Objetivo: El objetivo del presente estudio fue evaluar el efecto sobre el edema, trismus y dolor, de tres regímenes de tratamiento profiláctico antes de la cirugía bucal. Pacientes y Métodos: Cuarenta y cinco pacientes fueron seleccionados al azar para recibir el protocolo antibiótico. Se establecieron tres grupos. El primer grupo recibió 500mg de Amoxicilina oral, 3 veces al día por 7 días luego de realizada la intervención quirúrgica. El segundo grupo recibió una única dosis de 2g de Amoxicilina oral, una hora antes de la cirugía. En el tercer grupo los pacientes recibieron placebo. Los parámetros evaluados fueron presencia de edema, trismus y dolor. Todos los datos fueron tabulados y estadísticamente analizados. Resultados: Los resultados obtenidos demostraron la superioridad de la terapia con Amoxicilina en el control del edema postoperatorio y del trismus. No se encontraron diferencias estadísticamente significativas en cuanto al dolor. Conclusiones: Nuestros resultados mostraron que una sola dosis de antibiótico antes de la cirugía es tan buena como el tratamiento de 7 días después de la cirugía para prevenir el trismus, y resultó mejor en el control del edema, por consiguiente debería ser recomendada.

The surgical removal of impacted third molar teeth can result in considerable pain, swelling and dysfunction. The factors contributed to postoperative pain, swelling and trismus are complex. Pharmacologic strategies for minimizing the clinical manifestation of surgical trauma are often directed toward blocking the acute inflammation, bacterial infections disease and pain. Therefore, much controversy has arisen about the necessity of prophylactic antibiotic treatment. Purpose: The aim the present study was to evaluate three regimes of prophylactic oral treatment before oral surgery. Patients and Methods: Forty five patients were assigned at randon for antibiotic protocol. Three groups were established In the first group, antibiotic treatment with oral Amoxicillin 500mg, 3 times daily was carried out for 7 days postoperatively. The second group received 2g oral Amoxicillin one hour before surgery. In the third group the patients received placebo. The parameters that we evaluated were swelling, trismus and pain. All data were tabulated and statistical analyzed by test. Results: This investigation revealed a higher efficacy of the therapy with amoxicillin to swelling and trismus postoperative control. Our results demonstrated no statically significant differences with regard to pain. Conclusions: Our results showed that a single dose before surgery is as well as the 7 day- treatment after surgery to prevent postoperative trismus, and better to swelling postoperative control and therefore should be recommended.

¿Es realmente necesaria la antibióticoterapia profiláctica en la cirugía del tercer molar?

La remoción quirúrgica de los terceros molares puede resultar en algunos casos en infecciones bacterianas en el período postoperatorio. Por consiguiente existe mucha controversia acerca de la necesidad de tratamiento antibiótico profiláctico. Objetivo: El objetivo del presente estudio fue evaluar la necesidad de tratamiento antibiótico sistémico profiláctico en la remoción de los terceros molares asintomáticos. Pacientes y Métodos: Cuarenta y cinco pacientes fueron seleccionados al azar para recibir el protocolo antibiótico. Se establecieron tres grupos. El primer grupo recibió 500mg de Amoxicilina oral, 3 veces al día por 7 días luego de realizada la intervención quirúrgica. El segundo grupo recibió una única dosis de 2g de Amoxicilina oral, una hora antes de la cirugía. En el tercer grupo los pacientes recibieron placebo. Los parámetros evaluados fueron infección, y los posibles efectos adversos a la medicación implementada. Todos los datos fueron tabulados y estadísticamente analizados. Resultados: Los pacientes incluidos en el grupo A y B no mostraron infección, en cambio en tres pacientes del grupo C se observó el desarrollo de un proceso infeccioso, esto fue estadísticamente significativo. No encontramos diferencia significativa entre el primer y segundo grupo. Conclusiones: Nuestros resultados mostraron que una sola dosis de antibiótico antes de la cirugía parece ser tan buena como el tratamiento de 7 días, después de la cirugía para prevenir la infección postoperatoria, y por consiguiente debería ser recomendada.

The surgical removal of third molar teeth can result in bacterial infections disease. Therefore, controversy has arisen about the necessity of prophylactic antibiotic treatment. Purpose: The aim the present study was to evaluate the need for prophylactic oral antibiotic treatment in the removal of asymtomatic third molars. Patients and Methods: Forty five patients were assigned at randon for antibiotic protocol.Three groups were established In the first group, antibiotic treatment with oral Amoxicillin 500mg, 3 times daily was carried out for 7 days postoperatively. The second group received 2g oral Amoxicillin one hour before surgery. In the third group the patients received placebo. We evaluated infection and adverse postperative side effects. All data were tabulated and statistical analyzed by test. Results: In three patients, an infection was developed. All patients belonged to the placebo group, showed significant differences. We could not find any significant difference between the first group and second group. Conclusions: Our results showed that a single dose before surgery could be so effective than the 7 day- treatment after surgery to prevent postoperative infection, and therefore should be recommended.

Association between the Pattern of Prophylactic Antibiotic Use and Surgical Site Infection Rate for Major Surgeries in Korea / 예방의학회지

OBJECTIVES: The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use (PAU) and the surgical site infection (SSI) rate for major surgeries in Korea. METHODS: We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. RESULTS: The proportion of patients who received their first prophylactic antibiotics (PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk (RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision (RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance (RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. CONCLUSIONS: These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.

Evaluation of postoperative prophylactic antibiotic medication in third molar surgery

We evaluated the need for prophylactic postoperative oral antibiotic medication in extraction of asymptomatic impacted mandibular third molars. All patient didn't show sign of pain, inflammation, swelling and trismus at the time of extraction. In the experimental group, oral antibiotic medication(Amoxicillin) was carried out for 5 days postoperatively. In the control group, the patients received no antibiotic medication. All groups didn't use antibiotic irrigation solution. Rule of group composition randomized. The surgical technique was the same in all cases. Parameters that were evaluated were infection, pain, facial swelling, trismus. We could not find any significant difference between the experimental and control groups.(P<0.05) The results of our study show that post operative oral prophylactic antibiotic medication after the extraction of impacted mandibular third molars does not contribute to less infection, pain, facial swelling and increased mouth opening after surgery. Therefore we suggest that prophylactic postoperative oral antibiotic medication is not needed in extraction of asymptomatic impacted mandibular third molars.

The clinical study on prophylactic antibiotic therapy in patients with severe viral hepatitis / 中国实用内科杂志

Objective To evaluate the effectiveness of prophylactic antibiotic therapy on nosocomial infection in patients with severe viral hepatitis,and inquire into its applied mechanism.Methods 159 cases of severe viral hepatitis were divided into groups according to clinical stage and the applied circumstance of antibiotic medicine;Group A:receiving no prophylactic antibiotics therapy,Group B intravenous injection of the third generation cephalosporins and Group C intravenous injection of the semisymthetic penicillins.All cases had no infection on admission and received no antibiotics for 7 days before entering hospital and had stayed in hospital over 72 hours.Results Nosocomial infection occurred in 76 patients among the 159 selected cases.The incidence of nosocomial infection of Group A,Group B and Group C was 56.16%(41/73),34.0%(17/50) and 50.0% (18/36),respectively.The occurring time of nosocomial infection of Group B in early,middle and late stage patients with severe viral hepatitis was significantly later than Group A.The incidence of nosocomial infection in middle and later stage patients was significantly lower,and the mortality was significantly decreased in middle stage patients.There was significantly difference between group A and B(P0.05).Conclusion Prophylactic usage of antibiotics of third generation cephalosporins can not only delay nosocomial infection but also decrease the incidence of nosocomial infection in middle and late stage patients and mortality in middle stage patients with severe viral hepatitis.

Prophylactic antibiotic in minor traumatic wound: Is it worth.

Antibiotics in minor traumatic wounds may not be useful if the wounds are not severely contaminated and received appropriate management since the chance of infection is usually low. Our objective is to determine the value of antibiotics in minor traumatic wounds. A randomized control trial was done in 166 patients (123 males, 43 females), aged between 6 and 60 years, with minor traumatic wounds. Most wounds were located on head and extremity regions. Cultures were done before suturing in all wounds. The wounds were cleaned and sutured as usual, then divided into two groups, group B treated with antibiotics for at least 3 days, group A no antibiotics was used. Antibiotics were given in 83 wounds. One hundred wounds were completely followed up, 50 with oral antibiotic treatment (penicillin v, cloxacillin or erythromycin). Infection rates of those with and without antibiotic treatment were compared using Chi-square test. Initial cultures showed 91 positive wound cultures (54.6%). Staphylococcus coagulase negative was the major organism (69.2%) found. Four wounds were infected though oral antibiotics were given (group B), where as in the non-antibiotic group(group A) 2 wounds were infected. Comparison with Chi-square test showed no statistical significant difference (p>0.05). We conclude that usage of antibiotics in minor traumatic wound does not reduce wound infection rate. Prophylactic antibiotic in minor traumatic wound should be limited because the incidence of infection is too low to justify the expense and risk of antibiotic administration. Wound debridement and cleansing are more advantageous than antibiotic alone.