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In December 2022,ESCMID/EUCIC jointly issued the Clinical Practice Guidelines for perioperative antimi-crobial prophylaxis in patients colonized with multidrug-resistant Gram-negative bacteria(MDR-GNB).The guideline was based on systematically evaluating of published studies on perioperative antimicrobial prophylaxis in patients colonized with MDR-GNB.The guideline elaborated on the necessity and timing of screening for MDR-GNB colonization,perioperative antimicrobial prophy-laxis selection,and the timing of dosing,and it provided evidence-based recommendations based on existing studies.This paper in-terpreted the guidelines based on the latest research progress at home and abroad,aiming to reduce the occurrence of surgical site infections in patients colonized with MDR-GNB and benefit patients.
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【Objective】 To explore the impact of intrapartum antibiotic prophylaxis (IAP) on antibiotic resistance genes (ARGs) in the gut microbiota of infants up to 6 months of age and their longitudinal changes, in order to provide theoretical basis for the rational use of antibiotics and antibiotic resistance control. 【Methods】 Fecal samples were collected within 3 days, 2 months, and 6 months from a maternal and birth cohort conducted between January 2018 and June 2019. A panel of 6 common ARGs (aac(6′)-Ib, qnrS, blaTEM, ermB, mecA, tetM) were tested, the absolute abundance and positive detection rate by qPCR were calculated. Nonparametric and linear mixed model (LMM) analysis were used to assess the influence of IAP on the absolute abundance of antibiotic resistance genes and the longitudinal changes in their abundance at the three time points. 【Results】 A total of 157 samples from 65 singleton infants were analyzed, including 15 mothers (23.1%) who received IAP. The detection rate of ARGs was high in infants up to six months of age, and the abundance of ARGs tended to increase over time. IAP significantly increased the abundance of the mecA gene in the gut microbiota of vaginally delivered infants at 6 months of age (6.1±1.1 in the VDIAP group vs. 3.8±4.6 in the VDno-IAP group, P=0.046). Additionally, in cesarean section infants, there was a significant increase in the abundance of aac(6′)-Ib genes at 2 months (β=3.81, ,P<0.05), P<0.05] and 6 months of age (β=4.89, ,P<0.001), P<0.001) compared to 3 days of age. 【Conclusions】 The findings suggest that IAP can increase the abundance of ARGs in 6-month-old infants, and this effect is still significant after stratifying by delivery mode. Therefore, the rational and standardized use of intrapartum antibiotics may help reduce the development of antibiotic resistance.
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Introducción: Las infecciones de sitio quirúrgico (ISQ), se encuentran entre las infecciones asociadas al cuidado de la salud (IACS) más frecuentes, la profilaxis antibiótica administrada en el período preoperatorio contribuye a prevenir las ISQ. Objetivo: determinar si los esquemas antimicrobianos utilizados para profilaxis en cirugía corresponden a recomendados por Guías Internacionales de Tratamiento de Enfermedades Infecciosas; así como conocer los esquemas antimicrobianos utilizados, estimar el costo de la quimioprofilaxis y comparar con los resultados obtenidos en un estudio similar realizado en el mismo servicio en el año 2005. Materiales y métodos: Estudio descriptivo, observacional, retrospectivo donde se seleccionaron todas las historias clínicas de pacientes de ≤15 años de edad sometidos a apendicectomía, con diagnóstico posquirúrgico de apendicitis congestiva o flegmonosa, desde enero a diciembre del 2022. Se elaboró una planilla electrónica donde se cargaron los siguientes datos: antibiótico utilizado, dosis, número de dosis y momento de la administración. Resultados: 53 pacientes ≤ de 15 años fueron sometidos a apendicectomía, de los cuales 21 llenaban los criterios de inclusión. Fue utilizado Amoxicilina/Sulbactam en 19/21. El número total de dosis administradas fue de 68 dosis y la media de 3,3±1,9 dosis; solo en 8 de los pacientes se administró el antimicrobiano profiláctico en el tiempo correcto; solo 1 paciente recibió el esquema correcto, 1 sola dosis, 1 hora antes del inicio de la cirugía. El costo de la profilaxis antimicrobiana por paciente fue de 15,7 USD. Conclusión: Este trabajo nos permitió verificar la falta de aplicación de guías en el uso de antimicrobianos en la profilaxis quirúrgica, lo cual demuestra: i) la necesidad de revisar y estandarizar la conducta de prescripción relacionada en profilaxis quirúrgica, ii) la importancia de elaborar y socializar una guía de manejo de antimicrobianos y iii) el monitoreo de su implementación.
Introduction: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCIs). Antibiotic prophylaxis administered during the preoperative period contributes to preventing SSIs. Objective: to determine if the antimicrobial regimens used for prophylaxis in surgery correspond to those recommended by International Guidelines for the Treatment of Infectious Diseases; as well as knowing the antimicrobial regimens used, estimating the cost of chemoprophylaxis and comparing the current results with those obtained in a similar study carried out in the same service in 2005. Materials and methods: This was a descriptive, observational and retrospective study where we reviewed all medical records of patients ≤15 years of age undergoing appendectomy, with a post-surgical diagnosis of congestive or phlegmonous appendicitis, from January to December 2022. An electronic spreadsheet was prepared where the following data were uploaded: antibiotic used, dose, number of doses and time of administration. Results: 53 patients ≤ 15 years of age underwent appendectomy, of which 21 met the inclusion criteria. Amoxicillin/Sulbactam was used in 19/21. The total number of doses administered was 68 doses and the average was 3.3±1.9 doses; only in 8 of the patients was the prophylactic antimicrobial administered at the correct time; only 1 patient received the correct regimen, 1 single dose, 1 hour before the start of surgery. The cost of antimicrobial prophylaxis per patient was 15.7 USD. Conclusions: This study allowed us to verify the lack of application of existing guidelines in the use of antimicrobials in surgical prophylaxis, which demonstrates: i) the need to review and standardize prescription behavior related to surgical prophylaxis, ii) the importance of developing and disseminating an antimicrobial management guide and iii) the need to monitor its implementation.
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El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.
Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.
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Humanos , Control de Infecciones/métodos , Profilaxis Antibiótica/métodos , Antiinfecciosos/uso terapéutico , Neumonía por Pneumocystis/prevención & control , Tuberculosis/prevención & control , Profilaxis Posexposición , Profilaxis Pre-Exposición , Hepatitis B/prevención & controlRESUMEN
El Comité de Infecciones en Inmunocomprometidos de la Sociedad Chilena de Infectología presenta aquí una actualización en el Manejo de episodios de neutropenia febril en adultos y niños con cáncer, derivado de los grandes cambios ocurridos en los últimos años en el enfrentamiento de estos pacientes. Para estos efectos, un grupo multidisciplinario desarrolló recomendaciones en relación a: su enfrentamiento inicial, exámenes de laboratorio requeridos, el tratamiento antimicrobiano inicial empírico y frente a focos infecciosos conocidos, las infecciones fúngicas invasoras y profilaxis antimicrobiana.
The Committee of Infections in Immunocompromised Patients of the Chilean Society of Infectious Diseases presents an update in the Management of febrile neutropenia in adults and children with cancer. It comes from the significant changes that occurred in recent years in the confrontation of these patients. For which a multidisciplinary task force group developed recommendations in relation to their initial handling, laboratory exams required, the initial empirical antimicrobial treatment and in front of known infectious focus, invasive fungal infections and antimicrobial prophylaxis.
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Humanos , Niño , Adulto , Consenso , Neutropenia Febril/diagnóstico , Neutropenia Febril/tratamiento farmacológico , Neoplasias/complicaciones , Neutropenia Febril/etiología , Antiinfecciosos/uso terapéuticoRESUMEN
Infection is one of the most common causes of death in patients with multiple myeloma, which can lead to early death. The incidence of infection in patients with (multiple myeloma, MM) complicated with diabetes is further increased. Proteasome inhibitors, immunomodulatory drugs and other new drug therapy improve the prognosis of MM, but glucocorticoids used in combination chemotherapy are easy to induce glucocorticoid diabetes, lead to elevated blood glucose, increase the risk of MM infection, and affect the prognosis of patients. This article reviews the relationship between infection and disease progression in patients with MM complicated with diabetes mellitus, infection-related factors, and prevention and treatment measures of different types of pathogen infection.
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Background: The advent of antimicrobial therapy has offered an important adjuvant to the prevention of surgical infection. In spite of vast accumulation of research and review published there are still conflicting views. Some study shows multiple doses require for the eradication of microorganisms in the wound. While numerous authors have reported that single dose of an appropriate antibiotic is effective, but there has been no direct comparison of one dose against three doses regimens. Objective was to study about effect and safety of single dose of antibiotic against routine multiple dose regimens in clean and clean-contaminated abdominal surgeries.Methods: Patients recruited in the study according to specific inclusion and exclusion criteria. The participants were divided in two groups: group I and group II. Group I was given single dose of injection cefotaxime. While another group was given 5 days course of injection cefotaxime and injection amikacin or injection ciprofloxacin and injection metronidazole. Postoperative wound was assessed by Southampton wound grading system.Results: The rate of wound infection on 3rd day was for 16.30% for group I and 13.82% for group II. The infection rate decrease on 7th post-operative day and it was 13.04% for group I and 11.7% for group II.Conclusions: Long course of antibiotic as prophylaxis has no added advantage. Good operative technique plays a major role in preventing infections. Single dose antibiotic regimen has comparable infection rate for clean surgical cases and it saves lot of money in this era of cost containment.
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Background: The practice of giving antibiotic prophylaxis has resulted in the reduction of surgical site infections (SSI), thus reducing cost, morbidity, and mortality. Common nosocomial infections in surgical patients include SSIs, urinary tract infections (UTIs), pneumonias and blood stream infections (BSIs). The present study was, therefore, designed to analyze the efficacy of antimicrobials used for prophylaxis during surgery in a tertiary care hospital in India.Methods: Total 100 patients were enrolled. Name, timing, route, dose of antimicrobials given were recorded. All the relevant data was taken from the patient抯 medication charts and medical records. Chi-square test and t-test were applied.Results: The optimal time of giving antimicrobial prophylaxis in present study was 1 hour before the surgery. A total of 8 different antimicrobials were prescribed to 100 patients, out of which most commonly prescribed were cephalosporin i.e. 82%. Majority of SSI (57.12%) occurred when the duration of surgical antimicrobial prophylaxis (SAP) was for ?2 hours (p value <0.05). Common organisms seen in SSI were E. coli, S. aureus, Pseudomonas and Kleibsella species. The hospital stay of patients with SSI was more as compared to patients without SSI in present study (p value <0.05).Conclusions: It has been observed that inappropriate selection and timing of giving SAP play an important role in developing SSI, which can be adequately controlled by adopting SAP guidelines, good infection control practices and risk factor analysis.
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El uso indiscriminado de antibióticos y el mal manejo de los mismos por parte del personal médico es un problema frecuente a nivel mundial, esto ha incrementado la resistencia bacteriana, los costos del tratamiento y ha creado la necesidad de contar con nuevos antibióticos, frecuentemente más costosos y de mayor toxicidad.Objetivo : evaluar el uso de antibióticos profilácticos en pacientes sometidos a cirugías electivas limpias, en centros privados del estado Aragua, en el periodo comprendido entre febrero y agosto del año 2019.Métodos : estudio prospectivo, observacional, comparativo, longitudinal. La muestra fue no probabilística intencional, se dividió en 2 grupos: grupo A, a quienes se les administró antibioticoterapia profiláctica, y un grupo B, a quienes no se les administró antibiótico.Resultados : Se incluyeron 49 pacientes sometidos a cirugías electivas limpias de tipo colecistectomías (14/28.57%), herniorrafía umbilical (6/12.24%) y hernioplastia inguinal (29/59.18%). La edad promedio fue de 37,7±12,17 años. Predomino el sexo masculino. Al quinto día del postoperatorio no se observaron signos de complicación infecciosa en los grupos A y B. Al décimo día de postoperatorio se observaron signos de complicación infecciosa en un paciente (4.3%) perteneciente al grupo A. No se observó complicación infecciosa en el grupo sin administración de antibiótico, grupo B.Conclusión : La indicación y mantenimiento por 7-10 días de antibiótico profiláctico en cirugía limpia no presenta diferencia en la presentación de complicaciones infecciosas comparado con la no administración de antibióticos para este tipo de cirugía, con el riesgo potencial de producción de efectos adversos y desarrollo de resistencia bacteriana(AU)
The indiscriminate use of antibiotics and their mishandling by medical personnel is a frequent problem worldwide, which has increased bacterial resistance, treatment costs and the need for new antibiotics, often more expensive and of greater toxicity.Objective : to evaluate the use of prophylactic antibiotics in patients undergoing clean elective surgeries, in private centers in the Aragua state, in the period between February and August of 2019.Methods : we conducted a prospective, longitudinal, observational, analytical epidemiological clinical study. The participants consisted of non-probabilistic sample of the intentional type of 49 patients of the total study population, undergoing elective surgery, cholecystectomy (14 / 28.57%), umbilical herniorrhaphy (6 / 12.24%) and inguinal hernioplasty (29 /59.18%). The sample was classified into 2 groups, a group A, who received prophylactic antibiotic therapy and a group B, who did not receive it.Results : the mean age was 37.7 ± 12.17 years, predominantly male. On the fifth day of the postoperative period, no signs of infectious complication were observed neither in group A nor in group B. On the tenth day after the postoperative period, signs of infectious complication were observed in one patient (4.3%) belonging to the antibiotic administration group. No infectious complication was observed in the group without antibiotic administration.Conclusion : it was confirmed that the administration of antibiotics does not reduce the incidence of infection, when comparing an experimental group with a control group(AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Colecistectomía , Farmacorresistencia Bacteriana , Hernia Inguinal , Hernia Umbilical , Antibacterianos/uso terapéutico , Periodo Posoperatorio , Cirugía General , IncidenciaRESUMEN
Objective To evaluate the prophylactic efficacy and safety of posaconazole against invasive fungal disease(IFD)in hematologic patients with neutropenia.Methods Medical records of 18 hematologic patients with neutropenia received posaconazole for preventing IFD in a Beijing hospital between 2014 and 2015,the efficacy and safety was evaluated.Results There was no clinical diagnosis or confirmed diagnosis of IFD among 18 patients during posaconazole prophylaxis period,none of patients stopped posaconazole due to severe adverse reaction.Two patients with acute myeloid leukemia(AML) died of pulmonary infection,1 of whom isolated Stenotrophomonas maltophilia from sputum culture on the 12th day of posaconazole prophylaxis,the other isolated Escherichia coli from sputum culture on the 14th day of posaconazole prophylaxis.Other patients all adherence to posaconazole prophylaxis until granulocyte count recovered,patients were followed up until 100 days medication,no death occurred.The lowest peripheral neutrophil count was(0.00-0.27) x 109/L during posaconazole prophylaxis period,with the median of 0.02 x 109/L;the duration of posaconazole prophylaxis was 8-27days,with the median of 16 days;among patients without IFD breakthrough or received systemic use of other antifungal agents,there were 2 (11.1％) all-cause death within 100 days;there were no adverse reaction,such as liver function abnormalities≥grade 2 and kidney function abnormalities≥grade 2,as well as QTc prolongation.Conclusion Posaconazole is effective for preventing IFD in hematologic patients with neutropenia,adverse reaction is rare.
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Objective To optimize antimicrobial use process,ensure the rational use of preoperative antimicrobial prophylaxis during consecutive operations.Methods Antimicrobial use process in a hospital in December 2015 was optimized,6 072 cases of consecutive operations in May-November 2015 were selected as control group,5 832 cases of consecutive operations in December 2015-May 2016 were as trial group,the qualified rate of rational use of antimicrobial agents was compared between two groups,causes for delayed/prior use was analyzed.Results Before and after the optimization of antimicrobial use process,rates of antimicrobial use were 77.16％ and 78.80％ respectively,there was significant difference between two groups(x2 =8.305,P =0.004).After the optimization of antimicrobial use process,rate of antimicrobial use within 0.5-1 hour was significantly higher than that before the optimization (82.36％ vs 41.11％);rate of antimicrobial use ＜0.5 hour before skin incision decreased from 57.11％ before optimization to 4.32％ after optimization;but rate of antimicrobial use ＞1 hour before skin incision increased from 1.78％ to 13.32％.Causes for delay/prior use of antimicrobial agents was due to the lack of effective communication between doctors and nurses,which resulted in circuit nurses' inaccurate assessment on interval of consecutive operations(62.13％),the duration of intubation or puncture was too long for anesthesiologists (13.57％).Conclusion Optimizing antimicrobial use process in consecutive operations can improve prophylactic antimicrobial use rate within 0.5-1 hour,and is helpful for ensuring the efficacy of antimicrobial prophylaxis.
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Objective To evaluate the effect of multiple intervention measures on perioperative antimicrobial use in pa-tients undergoing typeⅠincision operation in a hospital,and provide basis for rational use of antimicrobial agents. Methods 9 823 patients with type I incision operation in April and October of 2005-2012 were surveyed retrospectively, data of 2005 was as baseline,from 2006 to 2012,multiple measures,including training,examination,supervision,feed-back,and cooperation of relevant departments were conducted,antimicrobial use before and after intervention was com-pared.Results The qualified rate of perioperative antimicrobial use in patients undergoing typeⅠ incision operation in-creased from 14.20% in 2006 to 92.30% in 2012;the rate of combined use of antimicrobial agents was relatively higher (7.00%-9.00%)in 2006-2009,had a downward trend in 2010- 2012,and decreased to 3.20% in 2012.Types of an-timicrobial agents for prophylactic use in typeⅠincision operation in 2006 and 2007 were similar to that of 2005,the main used antimicrobial agents were cephalosporins,penicillin and it’s compounds,and aminoglycosides;the major antimicrobial prophylaxis in 2008-2012 were the first and second generation cephalosporins,penicillin and it’s compounds.Multivariate non-conditional logistic regression analysis showed that age (40 - 59 years old),departments (orthopedics,general surgery,and ophthalmology),and years (2011 and 2012)were the main influencing factors for the qualified use of antimicrobial agents(all P<0.05).Conclusion Implementation of multiple intervention measures can improve the qualified rate of perioperative antimicrobial use in typeⅠ incision operation,reduce types of antimicrobial use and rate of combined antimicrobial use.
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Objective To investigate antimicrobial prophylaxis in clean operation,and provide evidence for formu-lating antimicrobial management measures.Methods 12 types of clean operation cases who discharged from a tertia-ry first-class hospital in May of 2011 -2014 were selected,120 cases were selected each year,patients were divided into group I and group II according to the types of operation,survey forms were designed,assessment criteria for the rationality of antimicrobial use was formulated, antimicrobial use in different years was compared. Results Prophylactic use of antimicrobial agents for clean operation decreased from 93.33% in 2011 to 35.00% in 2013 and 2014;rates of correct medication time increased from 43.75% in 2011 to 97.62% in 2013 and 92.86% in 2014 respectively;rates of medication according to indications,rational choice of antimicrobial agents,and rational treatment course increased from 42.86%,60.71 %,and 21 .43% in 2011 to 100.00% in 2014 (all P < 0.05 ). Conclusion Special rectification activities of antimicrobial use effectively promoted the standard application of anti-microbial agents for clean operation.
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ABSTRACTCONTEXT AND OBJECTIVES: The appropriate use of antibiotic prophylaxis in the perioperative period may reduce the rate of infection in the surgical site. The purpose of this review was to evaluate adherence to guidelines for surgical antibiotic prophylaxis.METHODS:The present systematic review was performed according to the Cochrane Collaboration methodology. The databases selected for this review were: Medline (via PubMed), Scopus and Portal (BVS) with selection of articles published in the 2004-2014 period from the Lilacs and Cochrane databases.RESULTS:The search recovered 859 articles at the databases, with a total of 18 studies selected for synthesis. The outcomes of interest analyzed in the articles were as follows: appropriate indication of antibiotic prophylaxis (ranging from 70.3% to 95%), inappropriate indication (ranging from 2.3% to 100%), administration of antibiotic at the correct time (ranging from 12.73% to 100%), correct antibiotic choice (ranging from 22% to 95%), adequate discontinuation of antibiotic (ranging from 5.8% to 91.4%), and adequate antibiotic prophylaxis (ranging from 0.3% to 84.5%).CONCLUSIONS:Significant variations were observed in all the outcomes assessed, and all the studies indicated a need for greater adherence to guidelines for surgical antibiotic prophylaxis.
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Humanos , Antibacterianos/administración & dosificación , Profilaxis Antibiótica/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Infección de la Herida Quirúrgica/prevención & control , Profilaxis Antibiótica/normas , Adhesión a Directriz/normasRESUMEN
Objective To evaluate the effect of special rectification of clinical antimicrobial use in a hospital. Methods Medical records of patients receiving inguinal hernia repair before (in 2011)and after (in 2012)the per-formance of special rectification were reviewed,and the rationality of perioperative antimicrobial prophylaxis was compared.Results Prophylactic antimicrobial usage rate in patients receiving inguinal hernia repair decreased from 53.90%(76/114)in 2011 to 5.59%(10/179)in 2012,the difference was significant (χ2 =93.68,P <0.05);aver-age expense of antimicrobial use per patient decreased by 86.95% (from ￥ 624.73 in 2011 to ￥ 81 .52 in 2012);Combination use and single use was 93.42% and 80.00% respectively.Surgical site infection did not occur in both groups.Conclusion Through the special rectification activities of the clinical antimicrobial use,perioperative anti-microbial prophylaxis and expense of antimicrobial agents in patients receiving inguinal hernia repair is effectively re-duced.
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Background: Prophylactic antimicrobials have an important adjuvant role in the prevention of Surgical Site Infection (SSI), which is one of the most preventable causes of post-operative complication. In India, due to lack of adequate information and guidelines for antimicrobial prophylaxis in surgery there is a need to generate baseline data on the pattern of use of prophylactic antimicrobials. Aims & Objective: This study is aimed to analyze the pattern of surgical chemoprophylaxis and surgical site infection (SSI) rate in patients who underwent elective orthopedic surgical procedure. Material and Methods: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients’ details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Results: Total 305 patients were enrolled over a period of one year. In 237 (77.70%) patients antimicrobials prescribed by generic name. In preoperatively and intraoperatively, all the patients received parenteral antimicrobial. Postoperatively, 294 (96.40%) patients received only parenteral antimicrobials while in 11 (3.60%) patients received parenteral antimicrobials followed by oral antimicrobials. Preoperatively antimicrobials started 12 hours prior to surgery. Average duration of antimicrobials given postoperatively was 5.05 ± 1.14 days. Third generation Cephalosporins and Aminoglycosides were prescribed most frequently. Average number of antimicrobials used per patient was 4.40 ± 1.05. In follow up 37 (13.03%) patients developed SSI and most common isolated organism was Staphylococcus aureus. Conclusion: Surgical chemoprophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of administration as well as the total duration of prescription, in majority of the cases, leading to higher SSI. Interventions are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial prophylaxis.
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Background & objectives: Perioperative antimicrobial prophylaxis constitutes the bulk of antimicrobial consumption in any hospital. This study was conducted at a level 1 Trauma Centre of a tertiary care hospital of India to assess the efficacy of a short (24 h) course of perioperative antibiotic prophylactic regimen in preventing surgical site infections (SSI) in open reduction and internal fixation (ORIF) of closed fractures of limbs and to assess if the same can be implemented as a general policy. Methods: Patients of either sex, aged 18 yr or more, who were scheduled for ORIF and were willing and able to give informed consent, were included in the study. Patients were randomly allocated into two groups. Group 1 (n=100) received 3 doses of 1 g i.v. cefuroxime perioperatively spaced 12 h apart and group 2 (n=97) received the conventional existing regimen [5 days of i.v. antibiotics (cefuroxime 1 g twice daily along with amikacin 15 mg/kg in 2 divided doses), followed by oral cefuroxime, 500 mg twice daily till suture removal]. Results: Of the 197 patients, four patients developed a surgical site infection (three with methicillin resistant Staphylococcus aureus and one Acinetobacter baumanii). Of these, two patients were in group 1 and the remaining two in group 2. These patients were treated with i.v. antibiotics based on the culture and antimicrobial sensitivity reports. The cost of the short course treatment was ` 150 per patient as compared to ` 1,900 per patient for conventional regimen. Interpretation & conclusions: There was no significant difference in rates of SSI among the two groups in our study. Cost evaluation revealed that shorter course was less expensive than conventional long course regimen. Implementation of a short course perioperative regimen will go a long way in reducing antimicrobial resistance, cost and adverse reactions to antimicrobials.
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No available abstract
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Introduction: Surgical site infections (SSI) are common healthcare associated infections (HAI) that is associated with increased morbidity and cost. Antimicrobial prophylaxis is effective when used appropriately. This study assesses the prophylactic antimicrobial prescribing and practice in the orthopaedic wards based on the Scottish Intercollegiate Guidelines Network (SIGN) guideline on antibiotic prophylaxis in surgery. Materials and Methods: Patients admitted to the Orthopaedics wards over a four-week period were studied (n = 68). Criterions 1 to 4; appropriateness, choice of antimicrobial and route of administration (1- given when indicated, 2- not given when not indicated, 3- appropriate choice and 4- given intravenously), criterions 5 to 7; allergy status and documentation (5: documentation, 6- details and 7- definite or possible history reaction immediately after penicillin therapy should not receive prophylaxis with a beta-lactam antimicrobial), criterions 8 to 10; documentation of antimicrobial given (8- name, dose and route of administration, 9- documentation in the appropriate 'one-off' section of the drug chart and 10- documentation of time of administration and surgical incision) and criterion 11 to 14; time and doses required (11- prophylaxis should be given 30 minutes before surgery, 12- additional intra-operative dose not required, 13- post-operative doses of prophylaxis not given and 14- a 24 hours regimen of prophylactic antimicrobial is given for primary arthroplasty procedures). A simple scoring system was used to allocate level of appropriateness. The rate was considered 'very good' for above 85%, 'good' for 70%-85%, 'moderate' for 50%-69%, 'poor' for 30%-49% and 'very poor' for below 30%. Results: The overall conformation to criteria and standards was 66.4% (95% CI 61.7-70.7). The rates were rated as 'very good' for criterion 1, 3, 4, 5b, 6, 8 and 9, 'good' for criterion 5a and 'poor' for criterions 2 and 5c. The adherence rates were 'very poor' to criterion 10a, 10b, 13 and 14. Intravenous cefuroxime was used as the first choice for antimicrobial prophylaxis. Conclusions: The overall practice was moderate and the choice of drug was considered appropriate. However, certain areas such as documentation need improvement. A local guideline may be useful.
Asunto(s)
Infección de la Herida QuirúrgicaRESUMEN
Toda intervención quirúrgica está expuesta a infectarse. La necesidad de profilaxis antimicrobiana en cirugía ortopédica para casos quirúrgicos agudos o electivas de cirugías limpias ha sido establecida como procedimiento de rutina. En Cirugía Ortopédica y Traumatología cuando se requiere el uso de implantes metálicos con el fin de realizar osteosíntesis o sustitución de las superficies articulares, aumenta el riesgo de infección, por tratarse de materiales extraños que son introducidos en el organismo. En estos casos la antibióticoterapia preventiva es de primordial importancia. Se realizó un estudio de profilaxis antimicrobiana, multicéntrico, aleatorizado, prospectivo, doble ciego, comparativo de grupos paralelos, con el fin de evaluar la eficacia de Cefadroxilo I.V. Vs. Cefazolina I.V. como antibióticos profilácticos mediante la determinación del número de pacientes infectados en cirugía de fracturas cerradas en la cuales se colocó material de síntesis. Se completaron 58 pacientes, 34 en el grupo de cefadroxilo y 24 en el grupo de cefazolina, al inicio los grupos fueron similares en cuanto a edad, sexo, tipo de fractura, tiempo de intervención, tiempo entre la fractura y la intervención.Más pacientes en el grupo de cefadroxilo tenían el tiempo máximo autorizado entre la fractura y la intervención (p: 0,07). Se presentó en el grupo de cefadroxilo una infección de la herida operatoria y un caso de eritema leve que cedió con tratamiento oral con cefadroxilo, sin diferencias entre los grupos.Hubo tres casos de eventos adversos, reacción anafiláctica a las 48 horas en el grupo de cefazolina que ameritó finalización de protocolo y hematoma en miembro inferior derecho y, en el grupo de cefadroxilo, una elevación discreta de enzimas hepáticas. La respuesta terapéutica de profilaxis antimicrobianano mostró diferencia entre los grupos. El cefadroxilo es tan eficaz como la cefazolina para la profilaxis antimicrobiana en pacientes con fracturas...
Any operation is exposed to infection. The need for antimicrobial prophylaxis in orthopedic surgery for acute or elective surgical cases of clean surgery is established as a routine procedure. Orthopedic Surgery when required the use of metallic implants in order to perform internal fixation or replacement of the articular surfaces, increases the risk of infection because they are foreign materials are introduced into the body. In these cases, preventive antibiotic therapy is very important. We performed a study of antimicrobialprophylaxis multicenter, randomized, prospective, double-blind, parallel group comparison in order to evaluate the effectiveness of Cefadroxil IV vs. Cefazolin I.V. as prophylactic antibiotics by determining the number of infected patients after fracture surgery in which synthetic material was placed. Fifty eigth patients were completed, 34 in the cefadroxil group and 24 in the cefazolin group, at the beginning the groups were similar in age, sex, fracture type, operative time, time between fracture and surgery. More patients in the cefadroxil group had the maximum allo-wable time between the fracture and surgery. (P: 0.07). In the cefadroxil group we found a wound infection and one case of mild erythema which resolved with oral treatment with cefadroxil, without differences between groups. There were three cases of adverse events, anaphylactic reaction to cefazolin at 48 h in the group that required finalization of protocol and hematoma in right leg and in the cefadroxil group, a moderate increase in liver enzymes. The therapeutic response of antimicrobial prophylaxis showed no difference between groups. Cefadroxil is as effective as cefazolin for antimicrobial prophylaxis in patients with fractures that warrant placement of synthetic material