scholarly journals Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection

2021 ◽  
Vol 14 (11) ◽  
pp. 1088
Author(s):  
Fauna Herawati ◽  
Rika Yulia ◽  
Heru Wiyono ◽  
Firdaus Kabiru Massey ◽  
Nurlina Muliani ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Surgical Procedures ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Surgical Patients ◽  
Defined Daily Dose ◽  
Site Infection ◽  
Therapeutic Guidelines ◽  
Bed Days ◽  
American Society

Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.

Association of Timely Administration of Prophylactic Antibiotics for Major Surgical Procedures and Surgical Site Infection

2008 ◽  
Vol 206 (5) ◽  
pp. 814-819 ◽  
Author(s):  
Mary T. Hawn ◽  
Kamal M. Itani ◽  
Stephen H. Gray ◽  
Catherine C. Vick ◽  
William Henderson ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Surgical Procedures ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Timely Administration

scholarly journals The Use of Oral Antibiotics to Prevent Surgical Site Infection on Postoperative Modified Radical Mastectomy Patients in Dr. Soetomo General Hospital, Surabaya

2021 ◽  
Vol 56 (1) ◽  
pp. 36
Author(s):  
Norman Hadi ◽  
Hantoro Ishardyanto
Keyword(s):  
Single Dose ◽  
Surgical Site Infection ◽  
General Hospital ◽  
Radical Mastectomy ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Modified Radical Mastectomy ◽  
Significant Difference

Surgical operations on modified radical mastectomy are considered clean procedures by the Centers for Disease Control and Prevention (CDC) wound classification system. Despite this, higher than expected Surgical Site Infection (SSI) rates are reported, varying from 1 % to 26 % across the literature. Some surgeons also prescribe postoperative prophylaxis for postoperative modified radical mastectomy patients to prevent infection despite its lack of proven efficacy. The aim of this study is to analyze the use of oral antibiotics to prevent Surgical Site Infection (SSI) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. This study was double-blinded randomized control trial of 60 postoperative modified radical mastectomy patients (2 groups) during the period of December 2017 to March 2018. Samples were prospectively divided into two groups (random sampling), in group A (n=30) patients received single dose prophylactic antibiotics and continued with oral antibiotics postoperative (Cefadroxil 2 x 500 mg) during 7 days and in group B (n=30) patients received single dose prophylactic antibiotics and continued without postoperative antibiotics (placebo). Both groups were evaluated clinically for surgical site infection up to 30 days. There was no statistically significant difference in both groups {p=1 (p>0.05)}. There was no incidence of surgical site infection in both groups during the 30-day follow-up period (days 3, 7, 14 and 30). There was no difference in the surgical site infection rate among those who received oral postoperative antibiotics prophylactic and without antibiotics (placebo) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required.

scholarly journals Survey of Surgeons Regarding Prophylactic Antibiotic Use in Inguinal Hernia Repair

2018 ◽  
Vol 107 (3) ◽  
pp. 208-211 ◽  
Author(s):  
A. P. MacCormick ◽  
J. A. Akoh
Keyword(s):  
Surgical Site Infection ◽  
Perceived Risk ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Hernia Surgery ◽  
Trust Network ◽  
Surgical Trainees ◽  
Infected Mesh

Purpose: The use of prophylactic antibiotics in the mesh repair of inguinal hernias remains controversial. The aim of this study was to determine the perception of surgeons about surgical site infection and how this affects their clinical practice. Methods: A SurveyMonkey of general surgeons and senior surgical trainees was conducted via the local trust network and the questionnaire was displayed on the website of the Association of Surgeons of Great Britain and Ireland and Association of Surgeons in Training. Results: Eighty-one responses were received from surgeons who perform an average of 75 hernia repairs per year – the majority by open technique. Thirty-six (44.4%) used routine antibiotic prophylaxis, 40 (49.4%) selectively, and five (6.2%) not at all as the five surgeons who did not use antibiotics perceived their surgical site infection rate to be <1% and have never removed an infected mesh from a hernia wound. There was no clear difference between those who use prophylactic antibiotics routinely or selectively as the experience of mesh explantation is similar (56% versus 55% had 2–10 meshes removed respectively). Seventy-seven (95%) of surgeons felt a new specific set of guidelines was required. Conclusion: This study highlights the fact that in the absence of clear guidelines, most surgeons base their use of prophylactic antibiotics on their perceived risk or experience of surgical site infection. There is a strong need for a new set of guidelines to address the use of prophylactic antibiotics in groin hernia surgery.

scholarly journals Prophylactic use of antibiotics as per SIGN 104 guidelines versus routine antibiotic prophylaxis for prevention of surgical site infection in clean and clean contaminated ENT surgical procedures: a comparative study

2019 ◽  
Vol 6 (1) ◽  
pp. 106
Author(s):  
M. Bharath ◽  
J. R. Galagali ◽  
Awadhesh Kumar Mishra ◽  
Ajay Mallick ◽  
E. Nikhilesh
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Surgical Procedures ◽  
Antibiotic Use ◽  
Site Infection ◽  
Significant Difference ◽  
Group A ◽  
Prophylactic Use ◽  
Group B ◽  
Clean Contaminated

<p class="abstract"><strong>Background:</strong> Many clinicians continue to use antibiotic prophylaxis routinely in all surgical procedures, ignoring the guidelines issued by policy makers. In this prospective study we compared the rate of surgical site infection (SSI) in patients who received prophylactic antibiotics as a routine; with the rate of SSI in patients getting antibiotics strictly as per SIGN 104 Guidelines, for clean and clean contaminated procedures.</p><p class="abstract"><strong>Methods:</strong> The study population comprised 235 patients. Group A consisted of 119 patients having 77 (65%) males and 42 (35%) females while Group B had 116 patients - 71 (61%) males and 45 (39%) females. Group A received routine antibiotic prophylaxis in all cases, while Group B received antibiotic prophylaxis as per SIGN 104 guidelines only. Both the groups were followed up for one month post-operatively for SSI and complications.</p><p class="abstract"><strong>Results:</strong> SSI occurred in 2 patients (1.68%) in Group A and in 3 (2.59%) patients in Group B. There was no significant difference in the rate of SSI between the two groups (p=0.68). Procedure wise maximum SSI occurred in tympanoplasty and laryngectomy. Due to infection one case of tympanoplasty had graft failure and one case of laryngectomy had delayed wound healing. No major complications related to infection or antibiotic use occurred in either group.</p><p class="abstract"><strong>Conclusions:</strong> Selective use of antibiotic prophylaxis as per SIGN 104 Guidelines does not lead to increase in SSI in clean and clean contaminated ENT procedures.</p>

scholarly journals PREVALENCE OF SURGICAL SITE INFECTION ASSOCIATED RISK FACTORS IN A TERTIARY CARE HOSPITAL OF VEDANTA INSTITUTE OF MEDICAL SCIENCES

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Amit Ramesh Churi
Keyword(s):  
Surgical Site Infection ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Prophylactic Antibiotics ◽  
Surgical Patients ◽  
Care Hospital ◽  
Site Infection ◽  
Deep Incision ◽  
Surgery Group ◽  
Wide Range

Introduction:  Skin is generally colonised by a wide range of microorganisms that could cause infection. Surgical site infection (SSI) requires evidence of clinical signs and symptoms of infection rather than microbiological evidence alone. SSIs generally affect the superficial tissues, but some more serious infections affect the deeper tissues or other parts of the body manipulated during the surgical procedure.About 5% of patients posted for surgery develop surgical site infections (SSIs), which may cause much morbidity and may sometimes mortality. Treatment of SSIs imposes a substantial financial burden on the health care system. Patients who develop SSI are more likely to spend 60% more time in an Intensive care unit (ICU), they are 5 times as likely to be readmitted and their mortality rate is twice of non-infected patient. But to great surprise 40-60% of these infections are preventable. Material and Methods: A total of 500 patients who had undergone surgical procedure at the teaching hospitalwere studied prospectively. A total of 464(92.8%) elective surgical patients and 36(7.2%) emergency surgical patients were included in the study.Patient information gathered from the data chart, treatment chart and from ward rounds in the hospital. All patients were followed up from the time of admission until the time of discharge and 30 days postoperatively to inspect the incidence of SSI. Wound infection was diagnosed. SSI diagnosed was divided into three categories: Superficial incision SSI, Deep incision SSI and Organ/space SSI. SSI is considered if an infection occurred within 30 days after the operation, if no implant is left in place SSI was considered. Results: In the present study 500 patients were included of which 464(92.8%) were elective surgical patients and 36(7.2%) were emergency surgical patients. Total SSI cases were 41 (8.2%) of which 29 (70.7%) were identified in elective surgery cases and 12 (29.3%) were observed in emergency surgery superficial incision SSI was most prevalent 25 (61%) followed by deep incisional SSI 11(26.8%) and then by organ/space SSI 5(12.2%).Mean age in elective surgery group was 52.4±7.48 and in emergency surgery group was 56.2± 6.78. In elective surgery group there were 296 (63.8%) male and 168 (36.2%) female. In emergency group there were 29 (80.6%) male and 7 (19.4%) female. Prophylactic antibiotics were given to 404 (87.1%) in elective surgery group and 30 (83.3%) in emergency surgery group. SSI rate observed in elective surgery group was 29/464 (6.25%) while in emergency surgery group was 12/36 (33.33%).BMI (Body mass index) in elective surgery group was 28.7 ±2.45and in emergency surgery group was 27.6 ± 2.89. Conclusion: higher incidence of SSI with increasing age of the patient.it was observed that to prevent SSI prophylactic antibiotics should be initiated within one hour before surgical incision. Keywords: SSI, Surgery, Superficial incision SSI, Deep incision SSI, Organ/space SSI

scholarly journals Outcome of Evidence-based Allocation of Single-dose Antibiotic extended to Three-dose Antibiotic Prophylaxis in Surgical Site Infection

2017 ◽  
Vol 03 (02) ◽  
pp. 079-084
Author(s):  
Sangita Jogdand ◽  
Raju Shinde ◽  
Naman Chandrakar
Keyword(s):  
Single Dose ◽  
Surgical Site Infection ◽  
Surgical Procedures ◽  
Age Groups ◽  
Prophylactic Antibiotic ◽  
Evidence Based ◽  
Site Infection ◽  
Excellent Outcome ◽  
Evidence Based Policy ◽  
American Society

Abstract Aim: To study the outcome of evidence-based allocation of single-dose antibiotic extended to three-dose antibiotics prophylaxis in surgical site infection (SSI). Materials and methods: A total of 183 clean surgical procedures in all age groups and of both genders with encountered comorbidities were included in the study. Surgical procedures like inguinal hernia, primary vaginal hydrocele, congenital hernia and hydrocele, fibroadenoma, and other surface swellings were targeted procedures. These procedures were of <1 hour duration and American Society of Anesthesiologists (ASA) grades I and II in study population. Ceftriaxone with sulbactam 1.5 gm was prophylactic antibiotic given 1 hour prior to incision. Excess local signs for inflammation were observed strictly for extension of antibiotics to three doses or multiple doses. Results: Success of evidence-based policy of randomization to single or three doses was 76.5% in all patients, and converting to three doses was 85.7%. Favorable outcome was seen in the patients with comorbidities—76.19% in hypertension, 57.14% in diabetes, and 28.57% in obesity. Only 14.3% of overall patients required extended multiple dose antibiotic therapy, which clearly projects that evidence-based policy implementation was effective in reducing number of doses. Conclusion: Evidence-based flexible antibiotic dose is effective in commonly performed procedures even with comorbidities. Flexibility depending on local signs to modify dose policy gives piece of mind with excellent outcome. Clinical significance: Adopting flexible antibiotic dosing reduces cost of antibiotics therapy with positive mindset for accepting reduced numbers of doses without affecting the outcome of surgical procedure.

scholarly journals Comparison of Infection Rates according to the Period of Prophylactic Antibiotic Use after Surgery in Patients with Distal Radius Fractures

2021 ◽  
Author(s):  
Joonha Lee ◽  
Yohan Lee ◽  
Yong Gil Jo ◽  
Sang Yoon Kang ◽  
Kee Jeong Bae
Keyword(s):  
Surgical Site Infection ◽  
Distal Radius ◽  
Open Reduction ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Distal Radius Fractures ◽  
Site Infection ◽  
Radius Fractures

Purpose: In general orthopedic surgery, the use of prophylactic antibiotics to prevent infection is recommended to be administered within 24 hours. However, there was no analysis on the incidence of surgical site infection according to the duration of use of prophylactic antibiotics for upper extremity fractures. This study aims to derive the appropriate prophylactic antibiotic using time by analyzing the incidence of infection according to the time of prophylactic antibiotic use in distal radius fractures.Methods: We retrospectively analyzed patients who used prophylactic antibiotics among patients who underwent open reduction and internal fixation for distal radius fractures from April 2018 to May 2021. The time of use of prophylactic antibiotics was classified into the 1-day group used, from 1 hour before surgery to 24 hours after the first administration, and the long-term group, continuously administered until discharge after surgery. Demographic characteristics, infection rate, C-reactive protein, risk factors for surgical site infection, and bone union were compared between the two groups.Results: A total of 168 patients were included in the study, 73 in the 1-day group and 95 in the long-term group. Superficial infection occurred in seven patients in the 1-day group and nine in the long-term group, and there was no statistically significant difference in the incidence rates of the two groups (p=0.980). Conclusion: The use of prophylactic antibiotics for 24 hours does not show a significant increase in the infection rate compared to the case of continuous use during open reduction and internal fixation of distal radius fractures.

scholarly journals The Use of Oral Antibiotics to Prevent Surgical Site Infection on Postoperative Modified Radical Mastectomy Patients in Dr. Soetomo General Hospital, Surabaya

2020 ◽  
Vol 56 (1) ◽  
pp. 36
Author(s):  
Norman Hadi ◽  
Hantoro Ishardyanto
Keyword(s):  
Single Dose ◽  
Surgical Site Infection ◽  
General Hospital ◽  
Radical Mastectomy ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Oral Antibiotics ◽  
Modified Radical Mastectomy ◽  
Significant Difference

Surgical operations on modified radical mastectomy are considered clean procedures by the Centers for Disease Control and Prevention (CDC) wound classification system. Despite this, higher than expected Surgical Site Infection (SSI) rates are reported, varying from 1 % to 26 % across the literature. Some surgeons also prescribe postoperative prophylaxis for postoperative modified radical mastectomy patients to prevent infection despite its lack of proven efficacy. The aim of this study is to analyze the use of oral antibiotics to prevent Surgical Site Infection (SSI) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. This study was double-blinded randomized control trial of 60 postoperative modified radical mastectomy patients (2 groups) during the period of December 2017 to March 2018. Samples were prospectively divided into two groups (random sampling), in group A (n=30) patients received single dose prophylactic antibiotics and continued with oral antibiotics postoperative (Cefadroxil 2 x 500 mg) during 7 days and in group B (n=30) patients received single dose prophylactic antibiotics and continued without postoperative antibiotics (placebo). Both groups were evaluated clinically for surgical site infection up to 30 days. There was no statistically significant difference in both groups {p=1 (p>0.05)}. There was no incidence of surgical site infection in both groups during the 30-day follow-up period (days 3, 7, 14 and 30). There was no difference in the surgical site infection rate among those who received oral postoperative antibiotics prophylactic and without antibiotics (placebo) on postoperative modified radical mastectomy patients in Dr. Soetomo General Hospital. Because of the potential adverse events associated with antibiotic use, further evaluation of this practice is required.

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