Appropriateness of Antibiotic Prophylaxis for Major Surgery in Korea

2007 ◽  
Vol 28 (8) ◽  
pp. 997-1002 ◽  
Author(s):  
Won Suk Choi ◽  
Joon Young Song ◽  
Jung Hae Hwang ◽  
Nam Soon Kim ◽  
Hee Jin Cheong
Keyword(s):  
Antibiotic Prophylaxis ◽  
Initial Dose ◽  
Medical Records ◽  
Colon Surgery ◽  
Major Surgery ◽  
Antibiotic Administration ◽  
Surgical Incision ◽  
Duration Of Surgery ◽  
Tertiary Hospitals ◽  
Gyeonggi Province

Objective.To determine the appropriateness of antibiotic prophylaxis regimens for major surgery in Korea.Design.Retrospective study using a written survey for each patient who underwent arthroplasty, colon surgery, or hysterectomy.Setting.Six tertiary hospitals in Seoul and Gyeonggi Province.Patients.From each hospital, a maximum of 150 patients who underwent each type of surgery were randomly chosen for the study.Results.Of 2,644 eligible patients, 1,914 patients were included in the analysis; 677 of these patients underwent arthroplasty, 578 underwent colon surgery, and 659 underwent hysterectomy. Nineteen patients were excluded from the analyses of the class and number of antibiotics used for prophylaxis because they underwent multiple surgeries at different sites. For each of the 1,895 remaining patients, antibiotic prophylaxis involved a mean ( ± SD) of 2.8 ± 0.9 classes of antibiotics. The most commonly prescribed agents were cephalosporins (prescribed for 1,875 [98.9%] of the patients) and aminoglycosides (1,404 [74.1%]). A total of 1,574 (83.1%) of patients received at least 2 classes of antibiotics simultaneously. Only 15 (0.8%) of 1,895 patients received antibiotic prophylaxis in accordance with published guidelines. Of 506 patients for whom the initial dose of antibiotics was evaluated, 374 (73.9%) received an appropriate initial dose. Of the 1,676 patients whose medical records included information about antibiotic administration relative to the time of surgery, only 188 (11.2%) received antibiotic prophylaxis an hour or less before the surgical incision was made. Of the 1,748 patients whose medical records included information about duration of surgery, antibiotic prophylaxis was discontinued 24 hours or less after surgery for only 3 (0.2%) of the patients.Conclusion.Most patients who had major surgery in Korea received inappropriate antibiotic prophylaxis. Measures to improve the appropriateness of antibiotic prophylaxis are urgently required.

scholarly journals CROSS–SECTIONAL STUDY OF SURGICAL PROPHYLACTIC ANTIBIOTIC ADMINISTRATION IN MARZOEKI MAHDI HOSPITAL, BOGOR, INDONESIA

2017 ◽  
Vol 10 (11) ◽  
pp. 87
Author(s):  
Nisa Najwa Rokhmah ◽  
Retnosari Andrajati ◽  
Maksum Radji
Keyword(s):  
Antibiotic Prophylaxis ◽  
Medical Records ◽  
Prophylactic Antibiotic ◽  
Cross Sectional Study ◽  
Antibiotic Administration ◽  
National Guidelines ◽  
Cross Sectional ◽  
Surgical Antibiotic Prophylaxis ◽  
Rational Use Of Antibiotics ◽  
Surgical Clinic

  Objective: This study was conducted to evaluate the prophylactic antibiotic administration in the surgical clinic of Dr. H. Marzoeki Mahdi Hospital, Bogor, Indonesia.Methods: The data were assessed from the medical records of all patients who underwent surgery from January to December 2013 retrospectively. Antibiotic prophylaxis was assessed based on the Scottish Intercollegiate Guidelines and the National Guidelines of Antibiotic Usage, which includes the type, time, and duration of prophylactic administration of antibiotics.Results: A total of 577 patients were included in this study, consisting of 202 men and 375 women. The most frequently performed surgery is a common surgery 347 (60.1%), followed by obstetric operations 176 (30.5%), and orthopedic surgery 54 (9.4%). In this study, all patients received prophylactic antibiotics before surgery. Cefotaxime (87.8%) was the most commonly used antibiotics for surgical prophylaxis. Of the 577 patients, only 1.1% of patients reported with surgical site infection (SSI).Conclusion: This study shows that adherence to the guidelines of surgical antibiotic prophylaxis is still very low. Therefore, efforts should be made to increase the compliance of using antibiotic prophylaxis in accordance with standard guidelines to improve the rational use of antibiotics.

scholarly journals 808. Appropriate Use of Cephalotin Before and After Implementation of a Cardiac Surgery Antibiotic Prophylaxis Protocol in Guatemala

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S498-S498
Author(s):  
Herberth G Maldonado ◽  
Brooke M Ramay ◽  
Lourdes A Sandoval
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Patient Characteristics ◽  
Appropriate Use ◽  
Surgical Incision ◽  
Protocol Implementation ◽  
Delayed Sternal Closure ◽  
Hospitalization Costs ◽  
Duration Of Surgery ◽  
Before And After

Abstract Background The appropriate use of Surgical Antibiotic Prophylaxis (SAP) contributes to reducing the prevalence of Surgical Site Infections (SSI). Inappropriate use increases the risk of SSIs, hospitalization costs and potentially contributes to the emergence of antimicrobial resistance. We aimed to compare the appropriate use before and after implementing a SAP protocol in our institution Methods We conducted a retrospective chart review in patients older than 18 undergoing elective cardiac surgery with cardiopulmonary bypass using cephalotin as SSI prophylaxis. We excluded patients who received other antimicrobials for prophylaxis, those undergoing non-elective surgery, and patients with delayed sternal closure. We identified SSIs according to the Centers for Disease Prevention and Control criteria. We evaluated if appropriate dosing (2g-3g) and timing ( >60 min.) occurred before the surgical incision, if redosing was administered, and if prophylaxis was administered > 48 hours. We evaluated before and after implementation of the protocol (August 2016-July 2017; October 2017-2018) Results The study included 262 and 285 patients before and after protocol implementation, respectively. Patient characteristics were similar between comparator groups (Table 1). We found that 1.1% of patients vs. 63% of patients had appropriate dosing before the surgical incision, before and after protocol implementation, respectively (p < 0.05). There was no difference in appropriate redosing when the duration of surgery was greater than 4 hours and no difference in inappropriate prophylaxis administration > 48 hours after protocol implementation. A total of 8 SSIs were identified in each group, with no statistical difference in the incidence, length of stay, or clinical outcome between comparator groups Table 1. Patient Characteristics and Appropriate use of Cephalotin Before and After Implementation of a Cardiac Surgery Antibiotic Prophylaxis Protocol in Guatemala Conclusion Based on our findings, implementing a local guideline-protocol for SAP resulted in significant improvement of pre-surgical antimicrobial dosing. We observed continual unnecessary administration of antibiotic prophylaxis in the postoperative period that needs more proactive interventional pharmacy-guided strategies such as automatic stops or audits width feedback. Disclosures Lourdes A. Sandoval, Master of Science in Pharmacovigilance and Pharmacoepidemiology, Abbott (Employee)

Cefotaxime prophylaxis in major non-contaminated head and neck surgery: one-dayvs.seven-day therapy

1993 ◽  
Vol 107 (1) ◽  
pp. 30-32 ◽  
Author(s):  
Erkan Mustafa ◽  
Aslan Tahsin
Keyword(s):  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Major Surgery ◽  
Double Blind Study ◽  
Antibiotic Administration ◽  
Double Blind ◽  
Perioperative Antibiotic Prophylaxis

AbstractPatients who undergo major surgery of head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if seven days of antibiotic administration would be more effective than one day. A prospective randomized double blind study was designed. Patients were randomly assigned to receive cefotaxime sodium for either 24 hours or seven days. In each case, the drug was administered intramuscularly, beginning one to two hours pre-operatively and continued for the prescribed period. Sixty patients were included in the trial. Of 30 patients assigned to one day of perioperative prophylaxis, wound infection developed in four (13 per cent). Of 30 patients assigned to seven days of perioperative antibiotic prophylaxis, wound infection developed in three (10 per cent) (P>0.05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours post-operatively can be achieved in patients who undergo major head and neck surgery.

Timing of Antibiotic Prophylaxis for Preventing Surgical Site Infections in Foot and Ankle Surgery

2016 ◽  
Vol 38 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Direk Tantigate ◽  
Eugene Jang ◽  
Mani Seetharaman ◽  
Peter C. Noback ◽  
A. M. Heijne ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Multivariate Logistic Regression Analysis ◽  
Surgical Site Infections ◽  
Wound Complications ◽  
Optimal Timing ◽  
Antibiotic Administration ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
Duration Of Surgery

Background: Surgical site infections (SSIs) are one of the most troublesome complications after foot and ankle surgery. Previous literature has emphasized the significance of appropriate timing of antibiotic prophylaxis. However, the optimal timing of antibiotic prophylaxis for SSI prevention is still inconclusive. Our study aimed to investigate the optimal timing of antibiotic administration and to elucidate the risk factors for SSIs in foot and ankle surgery. Methods: A retrospective review of 1933 foot and ankle procedures in 1632 patients from January 1, 2011, through August 31, 2015, was performed. Demographic data; type, amount, and timing of antibiotic administration; incision; and closure time were recorded. Subsequent wound infection and incision and drainage procedure (I&D) within 30 days and 90 days were documented. Outcomes and demographic variables were compared between procedures in which antibiotics were administered less than 15 minutes and between 15 to 60 minutes prior to incision. A total of 1569 procedures met inclusion criteria. Results: There were 17 cases (1.1%) of subsequent wound infection, of which 6 required a subsequent I&D within 30 days. There were 63 additional cases (4%) of wound complications, which did not meet SSI criteria. When comparing SSI and non-SSI groups, the only significant independent predictors were longer surgeries and nonambulatory surgeries (both P < .05). Stepwise multivariate logistic regression analysis demonstrated that 91.8% of the risk of an SSI could be predicted by ASA score and length of surgery alone. Conclusion: In foot and ankle surgeries, the timing of intravenous antibiotic prophylaxis did not appear to play a significant role in the risk of SSI. Host factors and duration of surgery appear to have played a much larger role in SSI than the timing of antibiotic prophylaxis. Level of Evidence: Level III, retrospective comparative study.

Morbidity of in-hospital purulent-septic infections of adults patients after different types of endovascular cardiosurgical operations

2020 ◽  
pp. 13-19
Author(s):  
Viktor Ivanovich Sergevnin ◽  
Larisa Gennadievna Kudryavtseva ◽  
Anna Igorevna Zolotukhina
Keyword(s):  
Medical Records ◽  
Heart Surgery ◽  
Surgical Intervention ◽  
Heart Rhythm ◽  
Community Acquired Pneumonia ◽  
Short Term ◽  
Intervention Community ◽  
Duration Of Surgery ◽  
Different Types ◽  
Low Incidence

An estimate of the incidence of nosocomial purulent-septic infections (GSI) of adult patients after various types of closed heart surgery according to the results of a study of medical records of 3275 patients is presented. It was established that the incidence rate of typical GSI after endovascular cardiac surgery was 3.1, with prenosological forms — 3.9 per 1000 operations. The main clinical options for postoperative GSI were infections in the field of surgical intervention, community-acquired pneumonia, urinary tract infection and bloodstream infection. There were no statistically significant differences between the incidence of GSI after stenting of the coronary arteries, operations for heart rhythm disturbances, stenosis of the carotid artery and other operations. The low incidence of GSI after closed heart surgery is due to the short duration of surgery, as well as the absence or short-term resuscitation of patients.

scholarly journals Perioperative Cumulative Fluid Balance and Its Association with an Increase in Costs after Major Surgery

2018 ◽  
Vol 7 (9) ◽  
pp. 227
Author(s):  
Tak Oh ◽  
Jung-Won Hwang ◽  
Young-Tae Jeon ◽  
Sang-Hwan Do
Keyword(s):  
Fluid Balance ◽  
Medical Records ◽  
Hospital Costs ◽  
Perioperative Period ◽  
Major Surgery ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Total Input ◽  
Estimated Blood Loss ◽  
Cumulative Fluid Balance

Positive fluid balance (FB) during the perioperative period may increase the incidence of postoperative complications, which may lead to longer hospitalization and higher hospital costs. However, a definitive association between positive FB and hospital costs has not yet been established. This retrospective observational study examined the association between perioperative FB and hospital costs of patients who underwent major surgical procedures. Medical records of patients who underwent major surgery (surgery time >2 h, estimated blood loss >500 mL) from January 2010 to December 2017 were analyzed to determine the associations between calculated FB (%, total input fluid—output fluid in liter/weight (kg) at admission) and total hospital cost ($). The analysis included medical data of 7010 patients. Multivariable linear regression analyses showed that a 1% increase in FB in postoperative day (POD) 0 (24 h), 0–1 (48 h), 0–2 (72 h), and 0–3 (96 h) significantly increased the total cost by $967.8 (95% confidence interval [CI]: 803.4–1132.1), $688.8 (95% CI: 566.3–811.2), $591 (95% CI: 485.7–696.4), and $434.2 (95% CI: 349.4–519.1), respectively (all p < 0.001). Perioperative cumulative FB was positively associated with hospital costs of patients who underwent major surgery.

scholarly journals Trend and Factors Associated with Repeat Computed Tomography Examinations in Tertiary Hospitals: Linked Health Administrative Data in Western Australia

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ninh Ha
Keyword(s):  
Ct Scan ◽  
Western Australia ◽  
Age Groups ◽  
Ct Scanning ◽  
Major Surgery ◽  
Factors Associated ◽  
Inappropriate Use ◽  
Tertiary Hospitals ◽  
Picture Archiving And Communication ◽  
Hospital Morbidity

IntroductionComputed tomography (CT) has become an essential part of clinical practice. However, repeat CT scans has raised a concern about unnecessary exposure to ionising radiation and waste of health care resource. While substantial effort is underway to reduce inappropriate use of diagnostic imaging tests including CT, little evidence of any change in repeat CT use and its associated factors. Objectives and ApproachThis study aimed to measure trend in repeat CT use and identify factors associated with repeat CT use in tertiary hospitals in Western Australia (WA). This study used WA linked administrative records from hospital morbidity, emergency department presentations, and picture archiving and communication system datasets to capture all tertiary hospitalisations and number of CT use during the admission from 2003 to 2015. Multivariate logistic regression was used to examine trend and determine characteristics associated with repeat CT, for admissions with and without major surgery during hospitalisation. ResultsAmong 303,439 admissions with CT scan 11.9% had repeat CT scan in the same anatomic areas. While the probability of repeat CT among admission with surgery remained unchanged over the study period, its counterpart significantly reduced about 4% per year. Regardless of surgical status, repeat CT scanning was significantly lower among females, Indigenous and older age groups but higher among people living in rural and remote areas. We found that admissions for circulatory conditions, injuries, cancer or multimorbidity had significantly higher probability of having repeat CT. Conclusion / ImplicationsThis study indicates that clinical factors such as cancer, injury and multimorbidity are factors contributing to repeat CT. A reduction of repeat CT over the study period among admissions without surgical procedure suggests a potential reduction of unnecessary CT scan, although further study is needed to fully capture whether this is an actual change in practice.

scholarly journals Antibiotic prophylaxis for surgical procedures: a scoping review

2021 ◽  
Vol 45 ◽  
pp. 1
Author(s):  
Eva Brocard ◽  
Ludovic Reveiz ◽  
Jean-Philippe Régnaux ◽  
Veronica Abdala ◽  
Pilar Ramón-Pardo ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Systematic Reviews ◽  
Scoping Review ◽  
First Generation ◽  
Evidence Base ◽  
Current Evidence ◽  
Cochrane Library ◽  
Antibiotic Administration ◽  
Significant Difference ◽  
Surgical Antibiotic Prophylaxis

Objectives. To map the current evidence on surgical antibiotic prophylaxis (SAP) administration and identify knowledge gaps in the literature available in this field. Methods. The PubMed, Cochrane Library, Epistemonikos, and Health Systems Evidence databases were searched from January 2015 to March 2020 for systematic reviews published in English, French, Portuguese, and Spanish. Results. Eighty-three systematic reviews were included, the quality of the reviews was assessed using AMSTAR 2, and data were extracted for all primary outcomes. Perioperative antibiotic administration, the use of first generation cephalosporins, and surgical site infection (SSI) were the most commonly reported for timing of antibiotic administration, drug class, and primary outcome, respectively. Findings showed that, overall, SAP may reduce SSIs compared with a placebo or with no SAP. Results suggested that intraoperative SAP may lower SSI, while postoperative SAP did not show a statistically significant difference. Conclusions. Findings have confirmed the role of SAP in reducing postoperative SSI across various surgeries and do not support the use of antibiotics after surgery to prevent infections. The findings of this scoping review have enhanced the evidence base that can inform decisions regarding the development of global guidelines for the prevention of SSI. However, high-quality systematic reviews and research reflecting diverse populations and settings are needed.

scholarly journals Effect of a single preoperative dose of oral antibiotic to reduce the incidence of surgical site infection following below-knee dermatological flap and graft repair

2019 ◽  
pp. 28-35 ◽  
Author(s):  
Helena Rosengren ◽  
Clare Heal ◽  
Petra Buettner
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Controlled Trial ◽  
Study Groups ◽  
High Dose ◽  
Antibiotic Administration ◽  
Oral Antibiotic ◽  
Site Infection ◽  
Double Blind

Background: Surgical site infection (SSI) rates for below-knee dermatological surgery are unacceptably high, particularly following complex flap and graft closures. The role of antibiotic prophylaxis for these surgical cases is uncertain. Objective: To determine whether SSI following complex dermatological closures on the leg could be reduced by antibiotic prophylaxis administered as a single oral preoperative dose. Methods: A total of 115 participants were randomized to 2 g of oral cephalexin or placebo 40-60 minutes prior to surgical incision in a prospective, randomized, double-blind, placebo-controlled trial at a primary care skin cancer clinic in North Queensland, Australia. Results: Overall 17/55 (30.9%) controls and 14/55 (25.5%) intervention participants developed infection (P = 0.525). There was no difference between the study groups in adverse symptoms that could be attributed to high-dose antibiotic administration (P = 1).

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