scholarly journals Systematic review of the cost-effectiveness of preoperative antibiotic prophylaxis in reducing surgical-site infection

BJS Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 81-98 ◽  
Author(s):  
J. Allen ◽  
M. David ◽  
J. L. Veerman
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Site Infection ◽  
Preoperative Antibiotic Prophylaxis ◽  
The Cost

scholarly journals Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

2020 ◽  
Author(s):  
Katherine Romero Viamonte ◽  
Adrian Salvent Tames ◽  
Rosa Sepùlveda Correa ◽  
María Victoria Rojo Manteca ◽  
Ana Martín Suárez
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Drug Utilization ◽  
Educational Interventions ◽  
Site Infection ◽  
Drug Utilization Study ◽  
Chi Square ◽  
Antibiotic Selection ◽  
Preoperative Antibiotic Prophylaxis ◽  
The Cost

Abstract Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR=2.79, P=0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR=1.33, P=0.649). Also, a significant relationship was found between SSI and patient age (Chisq=8.08, P=0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

scholarly journals Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

2020 ◽  
Author(s):  
Katherine Romero Viamonte ◽  
Adrian Salvent Tames ◽  
Rosa Sepùlveda Correa ◽  
María Victoria Rojo Manteca ◽  
Ana Martín Suárez
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Drug Utilization ◽  
Educational Interventions ◽  
Site Infection ◽  
Drug Utilization Study ◽  
Chi Square ◽  
Antibiotic Selection ◽  
Preoperative Antibiotic Prophylaxis ◽  
The Cost

Abstract Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR=2.79, P=0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR=1.33, P=0.649). Also, a significant relationship was found between SSI and patient age (Chisq=8.08, P=0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

scholarly journals Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Katherine Romero Viamonte ◽  
Adrian Salvent Tames ◽  
Rosa Sepúlveda Correa ◽  
María Victoria Rojo Manteca ◽  
Ana Martín-Suárez
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Drug Utilization ◽  
Educational Interventions ◽  
Site Infection ◽  
Drug Utilization Study ◽  
Chi Square ◽  
Antibiotic Selection ◽  
Preoperative Antibiotic Prophylaxis ◽  
The Cost

Abstract Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

Cost-Effectiveness of Preoperative Nasal Mupirocin Treatment in Preventing Surgical Site Infection in Patients Undergoing Total Hip and Knee Arthroplasty: A Cost-Effectiveness Analysis

2012 ◽  
Vol 33 (2) ◽  
pp. 152-159 ◽  
Author(s):  
Xan F. Courville ◽  
Ivan M. Tomek ◽  
Kathryn B. Kirkland ◽  
Marian Birhle ◽  
Stephen R. Kantor ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Decision Tree ◽  
Surgical Site Infection ◽  
Hypothetical Cohort ◽  
Preoperative Treatment ◽  
Site Infection ◽  
Tree Model ◽  
Effectiveness Analysis ◽  
Nasal Mupirocin ◽  
The Cost

Objective.To perform a cost-effectiveness analysis to evaluate preoperative use of mupirocin in patients with total joint arthroplasty (TJA).Design.Simple decision tree model.Setting.Outpatient TJA clinical setting.Participants.Hypothetical cohort of patients with TJA.Interventions.A simple decision tree model compared 3 strategies in a hypothetical cohort of patients with TJA: (1) obtaining preoperative screening cultures for all patients, followed by administration of mupirocin to patients with cultures positive for Staphylococcus aureus; (2) providing empirical preoperative treatment with mupirocin for all patients without screening; and (3) providing no preoperative treatment or screening. We assessed the costs and benefits over a 1-year period. Data inputs were obtained from a literature review and from our institution's internal data. Utilities were measured in quality-adjusted life-years, and costs were measured in 2005 US dollars.Main Outcome Measure.Incremental cost-effectiveness ratio.Results.The treat-all and screen-and-treat strategies both had lower costs and greater benefits, compared with the no-treatment strategy. Sensitivity analysis revealed that this result is stable even if the cost of mupirocin was over $100 and the cost of SSI ranged between $26,000 and $250,000. Treating all patients remains the best strategy when the prevalence of S. aureus carriers and surgical site infection is varied across plausible values as well as when the prevalence of mupirocin-resistant strains is high.Conclusions.Empirical treatment with mupirocin ointment or use of a screen-and-treat strategy before TJA is performed is a simple, safe, and cost-effective intervention that can reduce the risk of SSI. S. aureus decolonization with nasal mupirocin for patients undergoing TJA should be considered.Level of Evidence.Level II, economic and decision analysis.Infect Control Hosp Epidemiol 2012;33(2):152-159

scholarly journals Antibiotic Prophylaxis against Surgical Site Infection after Open Hernia Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Lolwah Al Riyees ◽  
Wedad Al Madani ◽  
Nistren Firwana ◽  
Hanan H. Balkhy ◽  
Mazen Ferwana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Meta Analysis ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Hernia Surgery ◽  
Significant Difference

<b><i>Objective:</i></b> The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. <b><i>Methods:</i></b> We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. <b><i>Results:</i></b> Twenty-nine studies (<i>N</i> = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. <b><i>Conclusion:</i></b> The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.

Timing of Preoperative Antibiotic Prophylaxis and Surgical Site Infection

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Stijn W. de Jonge ◽  
Quirine J. J. Boldingh ◽  
Anna H. Koch ◽  
Lidewine Daniels ◽  
Eefje N. de Vries ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Site Infection ◽  
Preoperative Antibiotic Prophylaxis

scholarly journals Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection

Medicine ◽  
2017 ◽  
Vol 96 (29) ◽  
pp. e6903 ◽  
Author(s):  
Stijn Willem de Jonge ◽  
Sarah L. Gans ◽  
Jasper J. Atema ◽  
Joseph S. Solomkin ◽  
Patchen E. Dellinger ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Site Infection ◽  
Preoperative Antibiotic Prophylaxis

scholarly journals Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e057468
Author(s):  
Evans Otieku ◽  
Ama Pokuaa Fenny ◽  
Felix Ankomah Asante ◽  
Antoinette Bediako-Bowan ◽  
Ulrika Enemark
Keyword(s):  
Cost Effectiveness ◽  
Surgical Site Infection ◽  
Outcome Measures ◽  
Teaching Hospital ◽  
Phone Call ◽  
Site Infection ◽  
Surgical Wound ◽  
Healthcare Associated Infection ◽  
Provider Perspectives ◽  
The Cost

ObjectiveTo assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study.DesignBefore and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire.SettingKorle-Bu Teaching Hospital (KBTH), Ghana.ParticipantsAll prospective patients who underwent surgical procedures at the general surgical unit of the KBTH.Main outcome measuresThe primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel.ResultsBefore-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually.ConclusionThe intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.

scholarly journals Infections in breast implants: a review with a focus on developing countries

2014 ◽  
Vol 8 (09) ◽  
pp. 1089-1095 ◽  
Author(s):  
Corrado Rubino ◽  
Sergio Brongo ◽  
Domenico Pagliara ◽  
Roberto Cuomo ◽  
Giulia Abbinante ◽  
...  
Keyword(s):  
Developing Countries ◽  
Breast Reconstruction ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Breast Implants ◽  
Aesthetic Surgery ◽  
Empiric Therapy ◽  
Site Infection ◽  
Antibiotic Solution ◽  
Preoperative Antibiotic Prophylaxis

The risk of surgical site infection is always present in surgery; the use of prosthetic materials is linked to an increased possibility of infection. Breast augmentation and breast reconstruction with implants are gaining popularity in developing countries. Implant infection is the main complication related to breast aesthetic and reconstructive surgery. In the present paper, we reviewed the current microbiological knowledge about implant infections, with particular attention to risk factors, diagnosis, clinical management, and antibiotic prophylaxis, focusing on reports from developing countries. After breast aesthetic surgery, up to 2.9% of patients develop a surgical site infection, with an incidence of 1.7% for acute infections and 0.8% for late infections. The rate of surgical site infection after post-mastectomy breast reconstruction is usually higher, ranging from 1% to 53%. The clinical features are not constant, and bacterial culture with antibiogram is the gold standard for diagnosis and for identification of antibiotic resistance. While waiting for culture results, empiric therapy with vancomycin and extended-spectrum penicillins or cephalosporins is recommended. Some patients require removal of the infected prosthesis. The main methods to bring down the risk of infection are strict asepsis protocol, preoperative antibiotic prophylaxis, and irrigation of the surgical pocket and implant with an antibiotic solution.

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