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Ahmed NJ, Haseeb A, AlQarni A, AlGethamy M, Mahrous AJ, Alshehri AM, Alahmari AK, Almarzoky Abuhussain SS, Mohammed Ashraf Bashawri A, Khan AH. Antibiotics for preventing infection at the surgical site: Single dose vs. multiple doses. Saudi Pharm J 2023; 31:101800. [PMID: 38028220 PMCID: PMC10661588 DOI: 10.1016/j.jsps.2023.101800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background Surgical site infections are common and expensive infections that can cause fatalities or poor patient outcomes. To prevent these infections, antibiotic prophylaxis is used. However, excessive antibiotic use is related to higher costs and the emergence of antimicrobial resistance. Objectives The present meta-analysis aimed to compare the effectiveness of a single dosage versus several doses of antibiotics in preventing the development of surgical site infections. Methods PubMed was used to find clinical trials evaluating the effectiveness of a single dosage versus several doses of antibiotics in avoiding the development of surgical site infections. The study included trials that were published between 1984 and 2022. Seventy-four clinical trials were included in the analysis. Odds ratios were used to compare groups with 95% confidence intervals. The data were displayed using OR to generate a forest plot. Review Manager (RevMan version 5.4) was used to do the meta-analysis. Results Regarding clean operations, there were 389 surgical site infections out of 5,634 patients in a single dose group (6.90%) and 349 surgical site infections out of 5,621 patients in multiple doses group (6.21%) (OR = 1.11, lower CI = 0.95, upper CI = 1.30). Regarding clean-contaminated operations, there were 137 surgical site infections out of 2,715 patients in a single dose group (5.05%) and 137 surgical site infections out of 2,355 patients in multiple doses group (5.82%) (OR = 0.87, lower CI = 0.68, upper CI = 1.11). Regarding contaminated operations, there were 302 surgical site infections out of 3,262 patients in a single dose group (9.26%) and 276 surgical site infections out of 3,212 patients in multiple doses group (8.59%) (OR = 1.11, lower CI = 0.84, upper CI = 1.47). In general, there were 828 surgical site infections out of 11,611 patients in a single dose group (7.13%) and 762 surgical site infections out of 11,188 patients in multiple doses group (6.81%) (OR = 1.05, lower CI = 0.93, upper CI = 1.20). The difference between groups was not significant. Conclusion The present study showed that using a single-dose antimicrobial prophylaxis was equally effective as using multiple doses of antibiotics in decreasing surgical site infections.
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Affiliation(s)
- Nehad J. Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullmoin AlQarni
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah, Saudi Arabia
| | - Manal AlGethamy
- Department of Infection Prevention & Control Program, Alnoor Specialist Hospital Makkah, Makkah, Saudi Arabia
| | - Ahmad J. Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ahmed M. Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Abdullah K Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | | | - Amer H. Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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AlFawaz AA, Safar AH, Al-Mukhaizeem A, Kamal E, Alloush M, Hanbal E. Risk Factors for Wound Infections after Vascular Surgery: Kuwait Experience. Med Princ Pract 2022; 31:392-398. [PMID: 35588708 PMCID: PMC9485949 DOI: 10.1159/000525158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/08/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Wound infections represent a serious complication after vascular surgery particularly after vascular reconstructive procedures. We aimed to identify risk factors predisposing patients to these complications. METHODS This was a retrospective review of open vascular surgical procedures performed between April 2014 and March 2019 in Kuwait. Patient demographics, procedures performed and their indications, and post-operative outcomes were collected and analyzed. Patients with pre-operative active infections were excluded from the analysis. Statistical analysis was performed, and odds ratios (ORs) and relative risks were calculated for the outcomes of interest. Fisher's exact test and two-tailed t test were used where appropriate. RESULTS 391 patients were identified. The majority (54%) presented with chronic limb threatening ischemia. The mean age was 58 (±10) years, with a male predominance (76%). Wound infection occurred in 53 (14%) patients. The most commonly isolated organism was Staphylococcus aureus (47%). Diabetes (OR 8.03, 95% CI: 1.9142-33.7439, p = 0.0044), hypertension (OR 2.38, 95% CI: 1.2960-4.3684, p = 0.0052), ischemic heart disease (OR 2.30, 95% CI: 1.4349-4.6987, p = 0.0016), hyperlipidemia (OR 2.12, 95% CI: 1.0305-4.3620, p = 0.0412), and chronic renal failure (OR 2.55, 95% CI: 1.0181-6.4115, p = 0.0457) were all found to be significantly associated with the development of post-operative wound infections in vascular surgery patients. CONCLUSION Diabetes, hypertension, ischemic heart disease, hyperlipidemia, and chronic renal failure were associated with post-operative wound infections. Anticipation of wound complications in patients with these risk factors may aid early diagnosis and treatment.
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Affiliation(s)
- Abdullah A. AlFawaz
- Department of Surgery, Faculty of Medicine, Kuwait University Health Sciences Centre, Jabriya, Kuwait
- Department of Surgery, Vascular Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
- *Abdullah A. AlFawaz,
| | - Ali H. Safar
- Department of Surgery, General Surgical Residency, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ali Al-Mukhaizeem
- Department of Surgery, General Surgical Residency, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Emad Kamal
- Department of Surgery, Vascular Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Mohammed Alloush
- Department of Surgery, Vascular Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ebrahim Hanbal
- Department of Surgery, Vascular Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
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Chambers D, Worthy G, Myers L, Weatherly H, Elliott R, Hawkins N, Sculpher M, Eastwood A. Glycopeptide vs. non-glycopeptide antibiotics for prophylaxis of surgical site infections: a systematic review. Surg Infect (Larchmt) 2011; 11:455-62. [PMID: 20815758 DOI: 10.1089/sur.2009.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients receive prophylactic antibiotics against surgical site infections (SSIs) before or during many procedures. Glycopeptide antibiotics are effective against most strains of methicillin-resistant Staphylococcus aureus (MRSA), but their wider use risks increasing resistance. Our objective was to review the evidence for clinical effectiveness that might help to determine whether there is a threshold of MRSA prevalence at which switching from non-glycopeptide to glycopeptide antibiotic prophylaxis might be justified. METHODS We performed a systematic review of randomized trials comparing a glycopeptide with an alternative antibiotic regimen for SSI prophylaxis in adults undergoing clean or clean-contaminated surgical procedures. The evidence was used to inform development of a decision-analytic model. We subsequently updated the review to May 2008. RESULTS Fourteen studies were identified that provided evidence concerning clinical effectiveness. The studies were too heterogeneous clinically for meta-analysis. Only one of 12 trials found that glycopeptides reduced SSIs significantly at 30 days compared with non-glycopeptide antibiotics. Of the two trials that reported on MRSA infection, neither found a significant difference between glycopeptide and comparator drugs. CONCLUSIONS This systematic review did not find any evidence to support the use of glycopeptides in preference to other antibiotics for the prevention of MRSA infections and SSIs. The limitations of the evidence make it difficult to identify a threshold at which a switch from non-glycopeptide to glycopeptide prophylaxis should be recommended. Given the difficulties of addressing this issue through randomized trials, further research should focus on hospital infection control policies, MRSA screening, and the isolation and treatment of anyone infected with MRSA prior to surgery.
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Abstract
Prosthetic graft infection is a devastating complication of vascular surgery that occurs in 3%-5% of clean prosthetic procedures. Staphylococci are the most frequently isolated pathogens, and thus surgical prophylaxis regimens often include vancomycin. However, the efficacy of these regimens in ensuring a required concentration of antibiotic is uncertain. This study aimed to determine if a continuous vancomycin infusion regimen administered perioperatively as surgical prophylaxis for vascular procedures maintained an adequate serum concentration. Thirty-four consecutive patients undergoing a vascular procedure requiring a prosthetic graft or patch were given vancomycin prophylaxis. Each patient received a loading dose calculated according to body weight 12 hours before surgery. A 24-hour continuous infusion was then started, based on calculated creatinine clearance. Serum vancomycin concentrations were checked on induction of anesthesia, 2 hours postoperatively, and at the end of the infusion. Perioperative fluid administration and blood loss were recorded. An estimated creatinine clearance was repeated on the second postoperative day. Of the 34 patients recruited, 7 did not have the anticipated procedure and 6 patients had incomplete sample collection. Twenty-one patients with complete sample collection were analyzed. The target concentration (10-25 mg/L) was achieved in 81% of all samples. All patients achieved the target concentration at 1 or more time points. The regimen employed provided appropriate concentrations at the time of intervention. No potentially toxic concentrations or adverse reactions to vancomycin were encountered. Vancomycin given as a continuous infusion delivers adequate serum concentration. Long-term graft infection rates are needed to show a clinical effect.
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Atahan E, Gul M, Ergun Y, Eroglu E. Vascular Graft Infection by Staphylococcus aureus: Efficacy of Cefazolin, Teicoplanin and Vancomycin Prophylaxis Protocols in a Rat Model. Eur J Vasc Endovasc Surg 2007; 34:182-7. [PMID: 17481929 DOI: 10.1016/j.ejvs.2007.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 03/03/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Prophylactic efficiencies of cefazolin, teicoplanin and vancomycin in a dacron graft infection model caused by methicillin-susceptible (MSSA) or -resistant Staphylococcus aureus (MRSA) were investigated. DESIGN Prospective, randomized, controlled animal study. MATERIALS AND METHODS Infections were established subcutaneously in the back of rats by implantation of Dacron prostheses followed by topical inoculation onto grafts of MSSA or MRSA. Experimental groups were as follows: Uncontaminated group (control), MSSA- or MRSA-contaminated and untreated groups, MSSA- or MRSA-contaminated groups treated with cefazolin, teicoplanin or vancomycin by one of three regimens (one day, two days, or three days regimen). Grafts were removed 7 days after the implantation and evaluated by using sonication and quantitative blood agar culture. RESULTS Contaminated groups demonstrated graft infections. Cefazolin, teicoplanin and vancomycin profoundly prevented the graft infections in MSSA- or MRSA-contaminated groups. For each antibiotic regimen, the most effective prevention was achieved by the drugs given as three days regimen. For MSSA and MRSA, the order of the effectiveness was as follows: teicoplanin>vancomycin>cefazolin. CONCLUSION As a prophylactic agent, teicoplanin seems to be more effective than vancomycin and cefazolin against vascular graft infections caused by MSSA and MRSA in rats.
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Affiliation(s)
- E Atahan
- Department of Cardiovascular Surgery, School of Medicine, Kahramanmaras Sutcu Imam University, 46100, Turkey.
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Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: A systematic review and meta-analysis. J Vasc Surg 2007; 46:148-55. [PMID: 17606135 DOI: 10.1016/j.jvs.2007.02.065] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 02/27/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral arterial reconstruction. METHODS All randomized controlled trials (RCTs) evaluating measures intended to reduce or prevent infection in arterial surgery were identified through searches of the Cochrane Peripheral Vascular Diseases Group specialized trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), and reference lists of relevant articles. Two authors independently selected and assessed the quality of included trials. Relative risk (RR) was used as a measure of effect for each dichotomous outcome. RESULTS The study included 34 RCTs. Of these, 22 were trials of prophylactic systemic antibiotics, 3 of rifampicin-bonded grafts, 3 of preoperative skin antisepsis, 2 of suction wound drainage, 2 of minimally invasive in situ bypass techniques, and individual trials of intraoperative glove change and wound closure techniques. Wound infection or early graft infection outcomes were recorded in all trials. Only two trials, both of rifampicin bonding, followed up graft infection outcomes to 2 years. Prophylactic systemic antibiotics reduced the risk of wound infection (RR, 0.25; 95% confidence interval [CI], 0.17 to 0.38) and early graft infection in a fixed-effect model (RR, 0.31; 95% CI, 0.11 to 0.85, P = .02). Antibiotic prophylaxis for >24 hours appeared to be of no added benefit (RR, 1.28; 95% CI, 0.82 to 1.98). There was no evidence that prophylactic rifampicin bonding to Dacron grafts reduced graft infection at 1 month (RR, 0.63; 95% CI, 0.27 to 1.49), or 2 years (RR, 1.05; 95% CI, 0.46 to 2.40). There was no evidence of a beneficial or detrimental effect on rates of wound infection with suction groin wound drainage (RR, 0.96; 95% CI, 0.50 to 1.86) or from preoperative bathing with antiseptic agents compared with unmedicated bathing (RR, 0.97; 95% CI, 0.70 to 1.36). CONCLUSIONS There is clear evidence of the benefit of prophylactic broad-spectrum antibiotics for vascular reconstruction. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.
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Affiliation(s)
- Andrew H Stewart
- Department of Vascular Surgery, Gloucestershire Royal Hospital, Great Western Road, Gloucester, United Kingdom
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Abstract
BACKGROUND Arterial reconstructions with prosthetic graft materials or vein are susceptible to infection with a resultant high patient mortality and risk of limb loss. To reduce the risk of infection effective perioperative measures are essential. OBJECTIVES To determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral arterial reconstruction. SEARCH STRATEGY We searched the Cochrane Peripheral Vascular Diseases Group trials register (last searched May 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 2, 2006), and reference lists of relevant articles. SELECTION CRITERIA All randomised controlled trials (RCTs) evaluating measures intended to reduce or prevent infection in arterial surgery. DATA COLLECTION AND ANALYSIS AS and PSE independently selected and assessed the quality of included trials. Relative risk was used as a measure of effect for each dichotomous outcome. MAIN RESULTS Thirty-five RCTs were included. Of these, 23 were trials of prophylactic systemic antibiotics, three of rifampicin-bonded grafts, three of preoperative skin antisepsis, two of suction wound drainage, two of minimally invasive in situ bypass techniques, and individual trials of intraoperative glove change and wound closure techniques. Wound infection or early graft infection outcomes were recorded in all trials. Only two trials, both of rifampicin bonding, followed up graft infection outcomes to two years. Trials of antibiotics versus placebo were of highest quality with six double-blind studies of the ten included. Prophylactic systemic antibiotics reduced the risk of wound infection (Relative Risk (RR) 0.25, 95% Confidence Interval (CI) 0.17 to 0.38) and early graft infection in a fixed-effect model (RR 0.31, 95% CI 0.11 to 0.85, P = 0.02). Antibiotic prophylaxis for greater than 24 hours appears to be of no added benefit (RR 1.28, 95% CI 0.82 to 1.98). There was no evidence that prophylactic rifampicin bonding to dacron grafts reduced graft infection at either one month (RR 0.63, 95% CI 0.27 to 1.49) or two years (RR 1.05, 95% CI 0.46 to 2.40). There was no evidence of a beneficial or detrimental effect on rates of wound infection with suction groin-wound drainage (RR 0.96 95% CI 0.50 to 1.86) or of any benefit from a preoperative bathing or shower regimen with antiseptic agents over unmedicated bathing (RR 0.97, 95% CI 0.70 to 1.36). AUTHORS' CONCLUSIONS There is clear evidence of the benefits of prophylactic broad spectrum antibiotics. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.
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Affiliation(s)
- A Stewart
- Dolphin House, Department of Vascular Surgery, Bristol Royal Infirmary, Bristol, UK BS2 8HW.
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Turgut H, Sacar S, Kaleli I, Sacar M, Goksin I, Toprak S, Asan A, Cevahir N, Tekin K, Baltalarli A. Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidis graft infection. BMC Infect Dis 2005; 5:91. [PMID: 16242027 PMCID: PMC1274316 DOI: 10.1186/1471-2334-5-91] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2005] [Accepted: 10/21/2005] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study was to investigate the in vivo efficacy of local and systemic antibiotic prophylaxis in the prevention of Staphylococcus (S.) epidermidis graft infection in a rat model and to evaluate the bacterial adherence to frequently used prosthetic graft materials. Methods Graft infections were established in the subcutaneous tissue of 120 male Wistar rats by implantation of Dacron/ePTFE grafts followed by topical inoculation with 2 × 107 CFUs of clinical isolate of methicillin-resistant S. epidermidis. Each of the graft series included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received systemic prophylaxis with teicoplanin or levofloxacin and two contaminated groups that received teicoplanin-soaked or levofloxacin-soaked grafts. The grafts were removed 7 days after implantation and evaluated by quantitative culture. Results There was significant bacterial growth inhibition in the groups given systemic or local prophylaxis (P < 0.05). Methicillin-resistant S. epidermidis had greater affinity to Dacron graft when compared with ePTFE graft in the untreated contaminated groups (P < 0.05). Conclusion The study demonstrated that the usage of systemic or local prophylaxis and preference of ePTFE graft can be useful in reducing the risk of vascular graft infections caused by staphylococcal strains with high levels of resistance.
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Affiliation(s)
- Huseyin Turgut
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Suzan Sacar
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ilknur Kaleli
- Department of Microbiology and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Mustafa Sacar
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ibrahim Goksin
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Semra Toprak
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Nural Cevahir
- Department of Microbiology and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Koray Tekin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ahmet Baltalarli
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
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Vardakas KZ, Soteriades ES, Chrysanthopoulou SA, Papagelopoulos PJ, Falagas ME. Perioperative anti-infective prophylaxis with teicoplanin compared to cephalosporins in orthopaedic and vascular surgery involving prosthetic material. Clin Microbiol Infect 2005; 11:775-7. [PMID: 16153250 DOI: 10.1111/j.1469-0691.2005.01177.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A meta-analysis of randomised controlled trials evaluated the effectiveness and safety of teicoplanin compared to first- or second-generation cephalosporins for perioperative anti-infective prophylaxis in orthopaedic and vascular surgery involving prosthetic material. No differences were found between teicoplanin and cephalosporins with respect to the development of infection at the site of surgery or in remote areas of the body. In addition, there were no significant differences in reported adverse effects or mortality. These findings indicate that both regimens are equally effective in preventing post-operative infections in orthopaedic and vascular surgery involving prosthetic materials.
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Scientific surgery. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.1999.01262.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Earnshaw JJ. Methicillin-resistant Staphylococcus aureus: vascular surgeons should fight back. Eur J Vasc Endovasc Surg 2002; 24:283-6. [PMID: 12323168 DOI: 10.1053/ejvs.2002.1705] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is now the commonest cause of serious vascular wound and graft infection in the U.K., and vascular departments in many other countries are similarly affected. There are no randomised trials that provide information about how to deal with this epidemic. There are, however, a number of clinical series that provide data that can be used to mount a logical and coherent response to the problem of preventing and managing MRSA infection. The risks and problems are different in every hospital and co-operation with local microbiologists is essential in creating individual protocols. Stratifying the risk to each patient is the first step; established antiseptic and surgical procedures are usually adequate as primary prevention. Studies into the role of targeted antibiotic therapy and isolation techniques are needed.
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Affiliation(s)
- J J Earnshaw
- Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, U.K
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Abstract
The commonest and most dangerous infective complication in vascular surgery is prosthetic graft infection. Despite the use of routine systemic antibiotic prophylaxis, graft infection occurs after 3-5% of all prosthetic vascular reconstructions. Infection is associated with a high rate of major morbidity and mortality, with significant time and cost implications. Management can be difficult and the outcome is often disappointing. Data from Italian Registry of Prosthetic Graft Infections show that the commonest site of infection is the aorto-femoral district and that involved bacteria are usually gram-positive in early and low-grade infections and gram-negative in late and high-grade infections. Results are poor, with a mortality rate of 15% for elective surgery and of 60% for emergency interventions. We report the results of a multicenter randomized controlled trial of rifampicin-bonded Dacron grafts in aorto-femoral surgery, in which our Department was involved. Data demonstrate a reduction in total early wound and graft infection rates, and 2-year results show a small, non-significant reduction in graft infection (1.7% in study group, 2.3% in control group). The same results were obtained in two other multicenter trials.
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Affiliation(s)
- C Pratesi
- Scuola di Specializzazione in Chirurgia Vascolare, University of Florence, Italy. Correspondence: Professor Carlo Pratesi, Cattedra di Chirurgia Vascolare, Ospedale di Careggi, Viale Morgagni 85, 50134 Firenze, Italy
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Urbanová E. Selective medium for primary isolation of members of the tribe Proteeae. Folia Microbiol (Praha) 2001; 44:629-34. [PMID: 11097023 DOI: 10.1007/bf02825652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A selective Proteeae medium (SPM) for isolation and preliminary detection of species of genera Proteus, Morganella, and Providencia was evaluated. The SPM contains tryptose phosphate agar with phenolphthalein monophosphate (as substrate for phosphatase activity), bile salts and polymyxin B (as inhibitors). The selectivity of the SPM was tested by the ecometric method of quality assurance of culture media. Fourteen reference cultures of enterobacteria and fifty-four strains of Proteeae were tested for their absolute growth index (AGI). Ninety-five percent of tested Proteeae strains display an AGI above 2.5. The detected phosphatase activity proved to be able to discriminate colonies of members of the tribe Proteeae. The ability of SPM for primary isolation of members of Proteeae was tested on food and clinical material and 94 strains were isolated. In addition, the SPM was employed in routine practice of clinical microbiology. From 1016 clinical samples (stool, urine, vaginal and urethral swabs), 57 strains of Proteeae were detected by the SPM in contrast to 35 strains by the routine procedure. The difference amounts to nearly 40%.
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Affiliation(s)
- E Urbanová
- Faculty of Science, Masaryk University, Brno, Czech Republic.
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Byrne DJ. Antibiotic prophylaxis in vascular surgery. J Hosp Infect 1999; 43:322-3. [PMID: 10658815 DOI: 10.1016/s0195-6701(99)90435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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