A prospective surveillance of surgical site infections: Study for efficacy of preoperative antibiotic prophylaxis

2012 ◽  
Vol 6 (12) ◽  
Author(s):  
Wassef M. A.
Keyword(s):  
Antibiotic Prophylaxis ◽  
Surgical Site Infections ◽  
Prospective Surveillance ◽  
Preoperative Antibiotic Prophylaxis

Effect of Preoperative Antibiotic Prophylaxis on Surgical Site Infections Complicating Cardiac Surgery

2014 ◽  
Vol 35 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Renato Finkelstein ◽  
Galit Rabino ◽  
Tania Mashiach ◽  
Yaron Bar-El ◽  
Zvi Adler ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Medical Center ◽  
Surgical Site Infections ◽  
Control Program ◽  
Risk Category ◽  
Infection Control Program ◽  
Preoperative Antibiotic Prophylaxis ◽  
Preoperative Hospital Stay ◽  
Preoperative Prophylaxis

Objective.To evaluate the effect of an optimized policy for antibiotic prophylaxis on surgical site infection (SSI) rates in cardiac surgery.Design.Prospective cohort study.Setting.Tertiary medical center in Israel.Methods.SSIs were recorded during a 10-year study period and ascertained through routine surveillance using the National Healthcare Safety Network (NHSN) methodology. Multivariable analyses were conducted to determine which significant covariates, including the administration of preoperative prophylaxis, affected these outcomes.Results.A total of 2,637 of 3,170 evaluated patients were included, and the overall SSI rate was 8.4%. A greater than 50% reduction in SSI rates was observed in the last 4 years of the study. Overall and site-specific infection rates were similar for patients receiving cefazolin or vancomycin. SSIs developed in 206 (8.1%) of the 2,536 patients who received preoperative prophylaxis (within 2 hours of the first incision) compared with 14 (13.9%) of 101 patients who received antibiotic prophylaxis at a different time (P= .04; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.0–3.3). After accounting for covariates, preoperative hospital stay (5 days or more), an NHSN risk category (2 or 3), age (60 years or more), surgeon's role, and the period of measurement were significantly associated with SSIs. Emergency surgery, age, surgeon's role, and nonpreoperative prophylaxis were found to be independent predictors of superficial SSI.Conclusions.We observed a progressive and significant decrease in SSI rates after the implementation of an infection control program that included an optimized policy of preoperative prophylaxis in cardiac surgery.

The Impact of Vancomycin and Cefazolin as Standard Preoperative Antibiotic Prophylaxis on Surgical Site Infections Following Instrumented Spinal Fusion

Spine ◽  
2019 ◽  
Vol 44 (6) ◽  
pp. E366-E371 ◽  
Author(s):  
Wylie Y. Lopez ◽  
Sean M. Rider ◽  
Kenneth Nwosu ◽  
Erick R. Kazarian ◽  
Justin A. Blucher ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Spinal Fusion ◽  
Surgical Site Infections ◽  
Preoperative Antibiotic Prophylaxis ◽  
The Impact

scholarly journals POSTOPERATIVE SURGICAL SITE INFECTION AND PROFILE OF MICROORGANISM IN ELECTIVE LAPAROTOMIES

2020 ◽  
Vol 7 (2) ◽  
pp. 189-198
Author(s):  
Mushtaq Ali ◽  
Mohd. Nadeem Khan ◽  
Pankaj Kumar
Keyword(s):  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Culture Technique ◽  
Resistance Patterns ◽  
Skin Antisepsis ◽  
Preoperative Antibiotic Prophylaxis ◽  
Culture And Sensitivity ◽  
Health Care Associated Infection

Laparotomy is one of the most common surgical procedures done by a surgeon. It is performed both as elective and an emergency procedure. Laparotomy procedures are prone to post-operative complications such as pain, fever, wound infection, wound dehiscence, incisional hernia, etc. The rate of these complications depends on preoperative antibiotic prophylaxis, skin antisepsis, control of contamination and surgical skills. SSI is the most common health-care-associated infection and is a cause of one-third of post-operative deaths. A prudent antibiotic prophylaxis and post-operative antibiotic management should be done. For successful management knowledge is necessary regarding the possible pathogens and their antibiotic resistance patterns. The aim of the study is to find out the incidence of SSI in elective laparotomies and to find out the type of pathogenic organism causing wound infection. This prospective observational study was conducted on 180 patients who had undergone elective laparotomy after taking an informed consent.Asterile swab for culture and sensitivity was taken Pre-operatively from incision site and sent to laboratory for assessment with normal culture technique. Repeat swabs for culture and sensitivity was done for patients with post-operative wound infection. Patients were followed up for 1 month. Out of 180 cases incidence of the SSI was seen in 17 cases of elective laparotomy (9.4%). Out of 17 SSI swab specimens 2 (11.8%) were Gram positive involving CONS pathogen, 13 (64.7%) were Gram negative involving E. coli, K.pneumoniae and Pseudomonas (41.2%, 29.4%, 5.9%) while no growth was observed in 11.8% specimens. SSIs were unaffected by demographic or operative variables. Surgical site infections were instrumental in prolonging the duration of hospital stay. Tigecycline and colistin were found to be 100 % sensitive for all the pathogens.

scholarly journals 1989. Impact of Pharmacist-Led β-Lactam Allergy Clarification Interview on Optimizing Preoperative Antibiotic Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S667-S667
Author(s):  
Shaina Kwiatkowski ◽  
Surafel Mulugeta ◽  
Susan L Davis ◽  
Rachel Kenney ◽  
James Kalus ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Kidney Injury ◽  
Surgical Site Infections ◽  
Allergic Reactions ◽  
Post Intervention ◽  
Decision Algorithm ◽  
Allergy Testing ◽  
Clostridioides Difficile ◽  
Quasi Experimental ◽  
Preoperative Antibiotic Prophylaxis

Abstract Background Patients with reported β-lactam allergies (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSI), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview in the preoperative setting. Methods This single-center, IRB-approved, quasi-experimental study compared surgical patients with a BLA between November 2017 and March 2018 (pre-intervention) vs. November 2018 and March2019. From November 2018 to March 2019, a pharmacist performed BLA clarification phone interviews for patients scheduled for a surgical procedure. Based on the allergy history and decision algorithm, first-line antibiotics, alternative antibiotics, or an allergy testing referral were recommended and documented in the EHR. The allergy label was updated as well. The primary outcome was the use of β-lactams preoperatively. Secondary outcomes included 30-day SSI and CDI, AKI, allergic reactions, allergy labels updated or removed, time to incision, and vancomycin doses administered. Results 87 patients were included in the study; 50 (57%) and 37 (43%) in the pre- and post-group, respectively. Most common surgeries: orthopedic 41 (47%), neurosurgery 17 (20%). In the post-group, all EHR BLA labels were updated after interview. 23 patients were referred for allergy testing, 12 (52%) completed BLA testing, and 7 BLA allergies were removed. 76% of pharmacy antibiotic recommendations were accepted (figure). Cefazolin use significantly increased from 28% to 65% post-intervention, P = 0.001; vancomycin use also increased from 19 (38%) to 22 (59%), P = 0.047. Time to incision decreased by a median of 8 minutes (P = 0.484). SSI occurred in 5 (10%) patients in the pre-group only, P = 0.051. All of these were associated with alternative antibiotics. Incidence of AKI and CDI were similar between the groups (P > 0.05). No allergic reactions occurred in either group. Conclusion Clarifying reported BLA in the perioperative setting significantly increased β-lactam preoperative use without negative clinical sequelae. Disclosures All authors: No reported disclosures.

scholarly journals Variation in practice for preoperative antibiotic prophylaxis: a survey from an academic tertiary referral center in the United States

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nikhil Ailaney ◽  
Elizabeth Zielinski ◽  
Michelle Doll ◽  
Gonzalo M. Bearman ◽  
Stephen L. Kates ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Best Practice ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
The United States ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Anesthesia Providers ◽  
Preoperative Antibiotic Prophylaxis

Abstract Background Antibiotic surgical prophylaxis is a core strategy for prevention of surgical site infections (SSI). Despite best practice guidelines and known efficacy of antibiotic prophylaxis in decreasing SSI risk, there is often wide variation in its use. This study was designed to determine the individual perspectives of perioperative providers at an academic tertiary referral center regarding their knowledge of preoperative antibiotic choice, dosing, and timing. Methods A prospective survey was conducted amongst surgical and anesthesia team members involved in preoperative antibiotic decision making. The survey addressed ten key principles relating to preoperative antibiotic use, including antibiotic choice, timing and rate of infusion, and dosing. The survey was distributed among orthopaedic surgeons, residents, and anesthesia providers at their respective monthly service line meetings between August 2017 to June 2019. The data was stored and analyzed in a Microsoft Excel worksheet. Results A total of 73 providers completed the survey. Twenty-two (30 %) of the providers agreed and 47 (64 %) disagreed that both vancomycin and cefazolin are equally effective for antibiotic prophylaxis. As for antibiotic choice in patients with penicillin allergies, 37 (51 %) agreed with vancomycin, 21 (29 %) agreed with clindamycin, and 15 (21 %) disagreed with both alternatives. When providers were surveyed regarding the appropriateness of standard versus weight adjusted dosing, 67 (92 %) agreed that vancomycin should be weight adjusted and 63 (86 %) agreed that cefazolin should be weight adjusted. Conclusions There is no clear consensus amongst providers for which antibiotic to administer for antibiotic prophylaxis despite existing guidelines. Discrepancy also exists between orthopaedic surgery and anesthesia providers in regards to appropriate antibiotic choice for patients with reported penicillin allergies. Institutions should implement evidence-based protocols for preoperative antibiotic prophylaxis and continue to prospectively monitor compliance in order to identify any inconsistencies that could result in inappropriate antibiotic prophylaxis for patients.

scholarly journals A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 768
Author(s):  
Yoann Varenne ◽  
Stéphane Corvec ◽  
Anne-Gaëlle Leroy ◽  
David Boutoille ◽  
Mỹ-Vân Nguyễn ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Surgical Site Infections ◽  
Implant Removal ◽  
Pelvic Bone ◽  
Resistance Pattern ◽  
Cure Rate ◽  
Implant Retention ◽  
The Impact

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

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