Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis.

BACKGROUND: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. METHODS: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. RESULTS: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). CONCLUSIONS: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

Adecuación de la profilaxis antibiótica en el parto por cesárea / Compliance with an antibiotic prophylaxis protocol in cesarean sections

Objetivo. Evaluar el uso de la profilaxis antibiótica en las cesáreas, estudiando el cumplimiento y la adecuación de la misma y su efecto sobre la incidencia de infección quirúrgica. Pacientes y métodos. Estudio de cohortes prospectivo. Se evaluaron el cumplimiento y la adecuación de la profilaxis antibiótica. Se describen los porcentajes de adecuación. Se estudió la relación entre la adecuación de la profilaxis antibiótica y la incidencia de infección quirúrgica con el riesgo relativo. Resultados. Se incluyó a 680 pacientes. La adecuación global fue del 95,7%. La causa más frecuente de inadecuación fue el tiempo de administración (96,6%). La incidencia de infección fue del 2,5% y no se encontró relación entre la inadecuación de la profilaxis y la infección (RR = 4,5; IC95%: 0,55-38,4; p > 0,05). Conclusiones. La adecuación de la profilaxis fue alta. La incidencia de infección de localización quirúrgica fue baja y no se relacionó con la adecuación de la profilaxis antibiótica (AU)

Objective. To evaluate compliance with a protocol for antibiotic prophylaxis in cesarean sections and its influence on the incidence of surgical wound infection. Patients and methods. A prospective cohort study was carried out to assess compliance with our antibiotic prophylaxis protocol. Percentages of compliance and the cumulative incidence of infection were calculated. The effect of compliance with the protocol for antibiotic prophylaxis on surgical wound infection was estimated with the relative risk. Results. We included 680 patients. Overall compliance with the protocol was 95.7%. The most frequent cause of lack of compliance was the time of administration (96.6%). The cumulative incidence of infection was 2.5% and there was no association between compliance with the protocol and the infection rate (RR = 4.5; 95% CI: 0.55-38.4; P>.05). Conclusions. Compliance with the protocol for antibiotic prophylaxis was high. The cumulative incidence of surgical wound infection was low and was unrelated to antibiotic prophylaxis (AU)

Litiasis vesical / Bladder lithiasis

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Validity of clinical diagnosis in dermatology.

OBJECTIVE: We evaluated the accuracy of the clinical diagnostic process performed by dermatologists. MATERIAL AND METHODS: We conducted a cross-sectional study, based on a retrospective search of data at a dermatology outpatient department. Fifteen skin diseases were selected. A group of patients with those diseases at their first outpatient visit and a further histopathological study were included. The accuracy of any given clinical diagnosis was studied taking the histopathological diagnosis as the gold standard. Validity indices were calculated. RESULTS: We studied 2188 patients. Skin diseases were more prevalent among women (p < 0.05). While the clinical diagnostic process displayed a high level of validity in melanocytic naevi and basal cell carcinoma, a poor level was nevertheless observed for Bowen's disease (sensitivity 22.8%, specificity 96.5%). The most frequent sites of appearance of dermatological problems were face and trunk. CONCLUSIONS: Evaluation of diagnosis in pathologies having an available "gold standard" enables the accuracy of clinical diagnoses to be verified. The validity of clinical diagnosis was high.

Evaluación de la adecuación de la profilaxis antibiótica en cirugía ortopédica y traumatológica / Adequacy Assessment of Antibiotic prophylaxis in orthopedic and traumatologic surgery

La profilaxis antibiótica es una estrategia fundamental en el control de la infección de la herida quirúrgica. Este estudio evalúa la adecuación de la profilaxis antibiótica prequirúrgica en pacientes a los que se les realiza cirugía ortopédica y traumatológica. Métodos Estudio descriptivo transversal. Se incluyeron pacientes a los que se les realizaron implantes de prótesis de cadera, de rodilla y cirugía de columna por inclusión consecutiva. Se hizo una estimación muestral teniendo en cuenta un intervalo de confianza del 95%, una precisión del 5%, una adecuación global del 85% y unas pérdidas del 5%. Así, se estimaron necesarios 206 pacientes. Se evaluó la adecuación de la indicación, del tiempo de administración, de la vía y de la dosis de antibiótico al protocolo del Centro. Se estudió la incidencia acumulada al alta de infección de herida quirúrgica. Resultados Se estudiaron 221 pacientes. El porcentaje de varones fue del 33,5% y 66,5% el de mujeres. La edad media fue de 61,1 años (desviación estándar [DE] de 14,1) y 67,1 años (DE de 12,4), respectivamente (p<0,05). En todos los pacientes estudiados estaba indicada la administración de profilaxis antibiótica. La adecuación global al protocolo fue del 89,1%. La incidencia acumulada de infección de la herida quirúrgica al alta fue del 3,2%. No se encontró relación entre la adecuación de la profilaxis y la infección (p>0,05).Conclusiones La adecuación de la profilaxis antibiótica ha sido alta, pero se puede mejorar (AU)

Antibiotic prophylaxis is an essential strategy for preventing surgical wound infection. This study assesses the adequacy of surgical antibiotic prophylaxis in trauma and orthopedic patients. Methods Cross-sectional study including consecutive patients who underwent hip or knee replacement, or spinal surgery. Sample estimation was based on 95% confidence, 5% precision, an overall adequacy of 85%, and assuming a loss of 5%. Thus, 206 patients were required. The appropriateness of the indication, time of administration, administration route, and dose according to the hospital protocol was assessed. The cumulative incidence of surgical site infection at discharge was determined. Results A total of 221 patients were included, 33.5% men and 66.5% women; mean age was 61.1 (SD=14.1) for men and 67.1 (SD=12.4) for woman (P<0.05). Antibiotic prophylaxis was indicated in all patients. Overall adequacy of prophylaxis according to the hospital protocol was 89.1%. Cumulative incidence of surgical wound infection at discharge was 3.2%. There was no association between the adequacy of antibiotic prophylaxis and surgical site infection (P>0.05).Conclusions The adequacy of postoperative antibiotic prophylaxis was high in this study, but it can be improved (AU)