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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 684] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
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Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Kim HW, Kim CO, Jeong SJ, Han SH, Choi JY, Kim MJ, Choi YH, Im SG, Yeom JS, Park YS, Song YG, Choi HJ, Peck KR, Kang CI, Kim HY, Kim YK, Lee SS, Park DW, Kim YA, Choi SH, Kim JM. Comparison of the Incidence and Clinical Characteristics of Gram-positive and Gram-negative Surgical Site Infections after Gastric Surgery. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hye Won Kim
- Department of Internal Medicine, Yonsei University Collegeof Medicine, Severance Hospital, Seoul, Korea
| | - Chang Oh Kim
- Department of Internal Medicine, Yonsei University Collegeof Medicine, Severance Hospital, Seoul, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University Collegeof Medicine, Severance Hospital, Seoul, Korea
| | - Sang Hoon Han
- Department of Internal Medicine, Yonsei University Collegeof Medicine, Severance Hospital, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University Collegeof Medicine, Severance Hospital, Seoul, Korea
| | - Min-Ja Kim
- Department of Internal Medicine, University College of Medicine, Anam Hospital, Seoul, Korea
| | - Young-Hwa Choi
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Seung Guan Im
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Yoon-Soo Park
- Department of Internal Medicine, Gachon University School of medicine, Gil Medical Center, Incheon, Korea
| | - Young Goo Song
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hee-Jung Choi
- Department of Internal Medicine, Ewha Womans University School of Medicine, Mok-Dong Hospital, Seoul, Korea
| | - Kyong Ran Peck
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Cheol-In Kang
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Hyo-Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Christian Hospital, Wonju, Korea
| | - Young-Keun Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju Christian Hospital, Wonju, Korea
| | - Seung Soon Lee
- Department of Internal Medicine, Hallym University College of Medicine, Sacred Heart Hospital, Anyang, Korea
| | - Dae-Won Park
- Department of Internal Medicine, Korea University College of Medicine, Ansan Hospital, Ansan, Korea
| | - Yeon-A Kim
- Department of Internal Medicine, Konyang University College of Medicine, Konyang University Hospital, Daejeon, Korea
| | - Suk-Hoon Choi
- Department of Internal Medicine, Hanil General Hospital, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University Collegeof Medicine, Severance Hospital, Seoul, Korea
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Yamashita S, Yamaguchi H, Sakaguchi M, Satsumae T, Yamamoto S, Shinya F. Longer-term diabetic patients have a more frequent incidence of nosocomial infections after elective gastrectomy. Anesth Analg 2000; 91:1176-81. [PMID: 11049905 DOI: 10.1097/00000539-200011000-00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Diabetes mellitus (DM) is one of the risk factors for the development of postoperative nosocomial infections in surgical patients. We conducted this retrospective study to elucidate the perioperative risk factors for postoperative nosocomial infections in diabetic patients undergoing elective gastrectomy. Chart review was performed on diabetic and nondiabetic patients undergoing elective gastrectomy for gastric malignancy from January 1992 through April 1999. Fourteen of the 83 diabetic patients, and 23 of the 284 nondiabetic patients developed postoperative nosocomial infections. Statistical comparisons of multiple variables were made between patients with and without postoperative nosocomial infections. In diabetic patients, univariate analysis showed that longer-term DM (especially longer than 10 yr) was associated with a significantly increased risk for postoperative nosocomial infections. Multiple logistic regression analysis showed that DM lasting longer than 10 yr was an independent risk factor for postoperative nosocomial infections (odds ratio, 6.8; 95% confidence interval, 1.7 to 27.1). In nondiabetic patients, similar analysis showed that age was an independent risk factor for postoperative nosocomial infections. We conclude that patients with longer-term DM had a significantly greater incidence of postoperative nosocomial infections after elective gastrectomy. IMPLICATIONS Postoperative nosocomial infection is one of the major problems in diabetic patients. This study demonstrated that postoperative nosocomial infections were more common in patients undergoing elective gastrectomy if they had diabetes mellitus longer than 10 yr.
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Affiliation(s)
- S Yamashita
- Departments of Anesthesia and Critical Care Medicine and Surgery, Iwaki Kyoritsu General Hospital, Uchigo, Iwaki, Fukushima, Japan
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Schardey HM, Joosten U, Finke U, Staubach KH, Schauer R, Heiss A, Kooistra A, Rau HG, Nibler R, Lüdeling S, Unertl K, Ruckdeschel G, Exner H, Schildberg FW. The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg 1997; 225:172-80. [PMID: 9065294 PMCID: PMC1190646 DOI: 10.1097/00000658-199702000-00005] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A prospective, randomized, double-blind, placebo controlled multicenter trial was undertaken in 205 patients treated with total gastrectomy for gastric malignancies to evaluate whether local antimicrobial measures reduce the incidence of esophagojejunal anastomotic leakage. SUMMARY BACKGROUND DATA Anastomotic leakage of the esophagojejunostomy is always a septic complication of total gastrectomy for gastric malignancies, but it never has been attempted to prevent this complication with the administration of topical antimicrobial agents during the critical phase of anastomotic wound healing. METHODS To evaluate the efficacy and safety of topical decontamination, the study was carried out as a prospective, randomized, double-blind and placebo-controlled clinical multicenter trial in patients with total gastrectomy for gastric cancer. Patients received either placebo or decontamination with polymyxin B (100 mg), tobramycin (80 mg), vancomycin (125 mg), and amphotericin B (500 mg) four times per day orally from the day before the operation until the seventh postoperative day. All patients received a perioperative intravenous prophylaxis with cefotaxime 2 x 2 g. Other interventions including the administration of antibiotics and fluids, were not affected by the study protocol. RESULTS Of 260 patients who were randomized, total gastrectomy was not carried out in 55 patients. They dropped out of the study. Patients receiving an esophagojejunostomy were observed until day 42, when they were discharged from the clinic or died. An intention-to-treat analysis of the data was carried out. Among the 103 recipients of placebo, there were 11 (10.6%) with an anastomotic leakage of the esophagojejunostomy, and among the 102 recipients of decontamination, there were 3 (2.9%) with an anastomotic leakage of the esophagojejunostomy (p = 0.0492). Pulmonary infections were observed in 23 patients (22.3%) receiving placebo and in 9 patients (8.8%) who were decontaminated (p = 0.02). There were 11 deaths (10.6%) among the recipients of placebo and 5 deaths (4.9%) among the recipients of decontamination (p = 0.1). CONCLUSIONS Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy.
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Affiliation(s)
- H M Schardey
- Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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De Champs C, Rouby D, Guelon D, Sirot J, Sirot D, Beytout D, Gourgand JM. A case-control study of an outbreak of infections caused by Klebsiella pneumoniae strains producing CTX-1 (TEM-3) beta-lactamase. J Hosp Infect 1991; 18:5-13. [PMID: 1679072 DOI: 10.1016/0195-6701(91)90088-p] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In July 1984 Klebsiella pneumoniae producing beta-lactamase CTX-1(TEM-3) (K. pneumoniae-CTX-1) spread from an Intensive Care Unit (ICU) throughout the hospitals of Clermont-Ferrand, France, and were isolated in four other hospitals of the region. A retrospective case control study was conducted in the ICU to characterize the risk factors for nosocomial infection with this organism. The cases were the 74 patients who had had K. pneumoniae-CTX-1 isolated from one or more clinical samples between July 1984 and December 1987. They were compared with 74 controls for host risk factors, underlying disease, procedures and antibiotic treatment. The monthly incidence of infection/colonization varied from 0% to 14.6%. The mortality rate attributable to this organism was 0.26% during the study period. The duration of stay of cases was longer than that of controls. More cases than controls had ventilatory assistance. However, the predominant risk factor was emergency abdominal surgery. Before K. pneumoniae-CTX-1 was isolated, cases received quinolones and trimethoprim sulphamethoxazole more often than controls. However, only 15% of cases had received third generation cephalosporins while at the onset of K. pneumoniae-CTX-1 infection colonization, 32 patients were no longer being given antibiotics. The use of antibiotic prophylaxis by, for example, selective digestive tract decontamination should be considered in patients at high risk of infection.
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Affiliation(s)
- C De Champs
- Laboratoire de Bactério-Virologie, Faculté de Médecine, Hôpital Saint-Jacques, Clermont-Ferrand, France
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Sjöstedt S, Levin P, Kager L, Malmborg AS, Bergman U. Hospital and catchment area antibiotic utilization and bacterial sensitivity in primary infections following gastric surgery in Huddinge, Sweden. Eur J Clin Pharmacol 1990; 39:211-6. [PMID: 2257854 DOI: 10.1007/bf00315098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The relationship between hospital and catchment area utilization of antimicrobial agents and the antibiotic sensitivity of bacteria isolated from primary infections has been studied after 750 gastric operations performed between 1972 and 1986 at the Huddinge University Hospital. Over 80% of the antibiotics were used in the catchment area. Penicillins (G and V) overall were the most commonly used drugs and comprised 37% of the total antibiotic consumption in 1977-1986. Narrow-spectrum antibiotics dominated throughout the period under investigation. No change in the bacterial resistance to antimicrobial agents was found over time. Many strains of Klebsiella/Enterobacter and E. coli resistant to ampicillin and tetracyclines were recovered throughout the period under investigation. No aerobic Gram-negative bacteria were resistant to gentamicin. All Bacteroides strains except two were sensitive to cefoxitin. Tetracyclines and ampicillin/amoxycillin were mainly used in the catchment area, and cefoxitin and aminoglycosides were almost exclusively used in the hospital. Antimicrobial agents primarily used for out-patients in the catchment area seemed to have more influence on the susceptibility of microorganisms isolated from post-operative infections than agents primarily used in the hospital.
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Affiliation(s)
- S Sjöstedt
- Department of Surgery, Huddinge University Hospital, Karolinska Institute, Sweden
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