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Zhang T, Lian X, Chen Y, Cai B, Xu J. Clinical Outcome of Postoperative Surgical Site Infection in Patients with Posterior Thoracolumbar and Lumbar Instrumentation. J Hosp Infect 2022; 128:26-35. [PMID: 35788013 DOI: 10.1016/j.jhin.2022.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Postoperative surgical site infection (SSI) is associated with greater rates of disability, especially in instrumented spinal surgeries. The management of implant-associated surgical site infections (SSI) is challenging. We analyzed the data from our hospital databases to assess the incidence and characteristics related to postoperative surgical site infection (SSI) after posterior thoracolumbar and lumbar instrumentation. METHODS Patient demographics, infection characteristics, details of treatment, and perioperative factors were reviewed (Jan 2010 to Dec 2020). The Oswestry disability index (ODI), Patient Health Questionnaire-9 (PHQ-9), and Visual Analog Scale (VAS) scores for back and leg pain were analyzed preoperatively and postoperatively until last follow-up. RESULTS Of the 27,881 procedures collected from the databases, 521 were diagnosed with SSI (1.8%), and 191(36.7%) received at least one revision surgery for SSI. Infection rate was significantly higher in patients with lumbar spinal stenosis than those with scoliosis or kyphosis (P<0.01). Methicillin-sensitive Staphylococcus aureus (43.4%) was the most commonly isolated pathogen. The rate of complication secondary to antibiotics treatment was 7.8%, and long-term antibiotic suppression was reported in 15.2% of patients. Instrumentation was retained in 175 patients (91.6%) and all SSIs were controlled without recurrence during the follow-up. CONCLUSION Analysis of 27,881 patients showed an average SSI rate of 1.8%. Patients with deep wound SSI can be successfully treated in most cases with retention of instrumentation. Early diagnosis, positive revision surgery with strict irrigation, thorough debridement, and a long-term course of antibiotics are critical for eradicating infection, retaining implants, decreasing morbidity, and achieving wound healing.
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Affiliation(s)
- Tao Zhang
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
| | - Xiaofeng Lian
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
| | - Yuanyuan Chen
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China.
| | - Bin Cai
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
| | - Jianguang Xu
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
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Orelio CC, van Hessen C, Sanchez-Manuel FJ, Aufenacker TJ, Scholten RJ. Antibiotic prophylaxis for prevention of postoperative wound infection in adults undergoing open elective inguinal or femoral hernia repair. Cochrane Database Syst Rev 2020; 4:CD003769. [PMID: 32315460 PMCID: PMC7173733 DOI: 10.1002/14651858.cd003769.pub5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Inguinal or femoral hernia is a tissue protrusion in the groin region and has a cumulative incidence of 27% in adult men and of 3% in adult women. As most hernias become symptomatic over time, groin hernia repair is one of the most frequently performed surgical procedures worldwide. This type of surgery is considered 'clean' surgery with wound infection rates expected to be lower than 5%. For clean surgical procedures, antibiotic prophylaxis is not generally recommended. However after the introduction of mesh-based hernia repair and the publication of studies that have high wound infection rates the debate as to whether antibiotic prophylaxis is required to prevent postoperative wound infections started again. OBJECTIVES To determine the effectiveness of antibiotic prophylaxis in reducing postoperative (superficial and deep) wound infections in elective open inguinal and femoral hernia repair. SEARCH METHODS We searched several electronic databases: Cochrane Registry of Studies Online, MEDLINE Ovid, Embase Ovid, Scopus and Science Citation Index (search performed on 12 November 2019). We also searched two trial registers and the reference list of included studies. SELECTION CRITERIA We included randomised controlled trials comparing any type of antibiotic prophylaxis versus placebo or no treatment for preventing postoperative wound infections in adults undergoing inguinal or femoral open hernia repair surgery (tissue repair and mesh repair). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed risk of bias. We separately analysed results for two different surgical methods (herniorrhaphy and hernioplasty). Several studies revealed infection rates that were higher than the expected 5% for clean surgery and we therefore divided studies into two subgroups: high infection risk environments (≥ 5% infection rate); and low infection risk environments (< 5% infection rate). We performed meta-analyses with random-effects models. We analysed three outcomes: superficial surgical site infections (SSSI); deep surgical site infections (DSSI); and all postoperative wound infections (SSSI + DSSI). MAIN RESULTS In this review update we identified and included 10 new studies. In total, we included 27 studies with 8308 participants in this review. It is uncertain whether antibiotic prophylaxis as compared to placebo (or no treatment) prevents all types of postoperative wound infections after herniorrhaphy surgery (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.56 to 1.33; 5 studies, 1865 participants; very low quality evidence). Subgroup analysis did not change these results. We could not perform meta-analyses for SSSI or DSSI as these outcomes were not reported separately. Twenty-two studies related to hernioplasty surgery (total of 6443 participants) and we analysed three outcomes: SSSI; DSSI; SSSI + DSSI. Within the low infection risk environment subgroup, antibiotic prophylaxis as compared to placebo probably makes little or no difference for the outcomes 'prevention of all wound infections' (RR 0.71, 95% CI 0.44 to 1.14; moderate-quality evidence) and 'prevention of SSSI' (RR 0.71, 95% CI 0.44 to 1.17, moderate-quality evidence). Within the high infection risk environment subgroup it is uncertain whether antibiotic prophylaxis reduces all types of wound infections (RR 0.58, 95% CI 0.43 to 0.77, very low quality evidence) or SSSI (RR 0.56, 95% CI 0.41 to 0.77, very low quality evidence). When combining participants from both subgroups, antibiotic prophylaxis as compared to placebo probably reduces the risk of all types of wound infections (RR 0.61, 95% CI 0.48 to 0.78) and SSSI (RR 0.60, 95% CI 0.46 to 0.78; moderate-quality evidence). Antibiotic prophylaxis as compared to placebo probably makes little or no difference in reducing the risk of postoperative DSSI (RR 0.65, 95% CI 0.26 to 1.65; moderate-quality evidence), both in a low infection risk environment (RR 0.67, 95% CI 0.11 to 4.13; moderate-quality evidence) and in the high infection risk environment (RR 0.64, 95% CI 0.22 to 1.89; low-quality evidence). AUTHORS' CONCLUSIONS Evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces the risk of postoperative wound infections after herniorrhaphy surgery. Evidence of moderate quality shows that antibiotic prophylaxis probably makes little or no difference in preventing wound infections (i.e. all wound infections, SSSI or DSSI) after hernioplasty surgery in a low infection risk environment. Evidence of low quality shows that antibiotic prophylaxis in a high-risk environment may reduce the risk of all wound infections and SSSI, while evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces DSSI after hernioplasty surgery.
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Affiliation(s)
- Claudia C Orelio
- Diakonessenhuis Utrecht, Research Support, Bosboomstraat 1, Utrecht, Netherlands, 3582 KE
| | - Coen van Hessen
- Diakonessenhuis Utrecht, Liesbreukcentrum Nederland, Bosboomstraat 1, Utrecht, Netherlands, 3582 KE
| | | | | | - Rob Jpm Scholten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Cochrane Netherlands, Room Str. 6.126, P.O. Box 85500, Utrecht, Netherlands, 3508 GA
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Radotra I, Onyekwelu O, Gesakis K, Srinivasan J. Current practises in primary breast augmentation: a continental European vs UK primary survey. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-016-1253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zanotto AR, Heineck I, Ferreira MB. Antibiotic Prophylaxis in Cholecystectomies in a Teaching Hospital in Brazil. Ann Pharmacother 2016; 40:2003-7. [PMID: 17047141 DOI: 10.1345/aph.1h165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Medical literature reports that adequate prophylaxis with antibiotics can reduce the incidence of postoperative infections. Objective: To investigate the impact of adopting multiple practices for improving the rational use of antibiotic prophylaxis in patients undergoing cholecystectomy and evaluate, during 2 periods, compliance with the hospital Drug Committee's recommendation and guidelines published in the medical literature. Methods: Data were collected from patients' medical records at the Hospital de Clíniacas de Porto Alegre (HCPA), Brazil, in 2003. We evaluated 222 procedures as set by guidelines published in the literature and the hospital's recommendation. Results: In 24.5% of the cases, the choice of whether to use the prophylactic antibiotic was not made according to the guidelines. The choice of the antibiotic agent, prophylaxis duration, dose administered, and time for administration was appropriate in 95%, 80.5%, 100%, and 81.8% of cases, respectively. A significant improvement in guideline compliance was observed since multiple practices were adopted to improve the rational use of antibiotic prophylaxis. Conclusions: Compliance with the guidelines for antibiotic prophylaxis for cholecystectomy, in combination with a greater integration among the professionals involved in the HCPA Infection Control Service, resulted in a more appropriate use of these prophylactic agents. Improving physicians' awareness of the importance of meeting guidelines is critical and will benefit patients and the hospital as a whole.
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Busch CJ, Knecht R, Münscher A, Matern J, Dalchow C, Lörincz BB. Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study. Eur Arch Otorhinolaryngol 2015; 273:2805-11. [DOI: 10.1007/s00405-015-3856-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/07/2015] [Indexed: 11/24/2022]
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Hosoglu S, Sunbul M, Erol S, Altindis M, Caylan R, Demirdag K, Ucmak H, Mendes H, Geyik MF, Turgut H, Gundes S, Doyuk EK, Aldemir M, Dokucu AI. A National Survey of Surgical Antibiotic Prophylaxis in Turkey. Infect Control Hosp Epidemiol 2015; 24:758-61. [PMID: 14587938 DOI: 10.1086/502127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AbstractObjective:To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures.Design:A cross-sectional, country-wide survey.Setting:Thirty-six hospitals in 12 cities in Turkey.Participants:Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest.Methods:A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures.Results:Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426–3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890–8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95, 0.225–0.772; P < .001) were associated with inappropriate prophylaxis.Conclusion:Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.
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Pons-Busom M, Aguas-Compaired M, Delás J, Eguileor-Partearroyo B. Compliance with Local Guidelines for Antibiotic Prophylaxis in Surgery. Infect Control Hosp Epidemiol 2015; 25:308-12. [PMID: 15108728 DOI: 10.1086/502397] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjectives:To describe the development and implementation of a local protocol for antibiotic prophylaxis in surgery and to assess compliance with these guidelines using a computer-based system.Design:One 5-week prospective period (phase 1) followed by three 1-week, cross-sectional assessments (phases 2, 3, and 4).Setting:Pharmacy of a 350-bed acute care teaching hospital in Barcelona, Spain.Methods:In phase 1, 395 forms for antibiotic prescribing delivered to the pharmacy were reviewed. Nonadherence was defined as the prescription of an antibiotic (or doses) different from what the protocol specified. In phases 2, 3, and 4, antibiotic prescribing forms for all elective procedures (630 patients) performed during 1-week periods were analyzed.Results:A total of 1,047 patients (mean age, 58.9 ± 17.3 years) were included. Cefazolin was administered in 41% of procedures. Overall compliance with antibiotic prescribing forms was 83.3%. There was a statistically significant increase in compliance with guidelines throughout the four phases of the study, from 80.3% in phase 1 to 87.8% in phase 4 (P < .042), as well as adherence to completing forms for surgical procedures, from 51% in phase 2 to 77.6% in phase 4 (P < .001). The main reason for non-adherence was that some procedures had not been included in the protocol in phase 2.Conclusion:Surgeons sensitized to the implementation of local antibiotic prophylaxis guidelines showed a high degree of compliance with them, using both the procedure established for antibiotic prescribing and the antimicrobials recommended for particular operations.
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Aiken AM, Haddow JB, Symons NRA, Kaptanis S, Katz-Summercorn AC, Debnath D, Dent H, Tayeh S, Kung V, Clark S, Gahir J, Dindyal S, Farag S, Lazaridis A, Bretherton CP, Williams S, Currie A, West H, Davies J, Arora S, Kheraj A, Stubbs BM, Yassin N, Mallappa S, Garrett G, Hislop S, Bhangu A, Abbey Y, Al-Shoek I, Ahmad U, Sharp G, Memarzadeh A, Patel A, Ali F, Kaderbhai H, Knowles CH. Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey. Hernia 2013; 17:657-64. [PMID: 23543332 PMCID: PMC3788180 DOI: 10.1007/s10029-013-1061-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Abstract
Purpose Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection in adult inguinal hernia repair is conflicting. A recent Cochrane review based on 17 randomised trials did not reach a conclusion on this subject. This study aimed to describe the current practice and determine whether clinical equipoise is prevalent. Methods Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of England on their practices and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair. Local prophylaxis guidelines for the participating hospital sites were also determined. Results The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons, a 93 % response rate. Overall, a large majority of hospital guidelines (22/28) and surgeons’ personal beliefs (192/229, 84 %) supported the use of single-dose pre-operative intravenous antibiotic prophylaxis in inguinal hernia repair, although there was considerable variation in the regimens in use. The most widely used regimen was intravenous co-amoxiclav (1.2 g). Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure, although many incorrectly believed that they were following these. Conclusion In the south-east of England, there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure. It is therefore likely to be extremely difficult to conduct further randomised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure.
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Affiliation(s)
- A M Aiken
- c/o National Centre for Bowel Research and Surgical Innovation, 1st Floor Abernathy Building, 2 Newark St, Whitechapel, London, E1 2AT, UK
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Acuna SA, Angarita FA, Escallon J, Tawil M, Torregrosa L. Determining the use of prophylactic antibiotics in breast cancer surgeries: a survey of practice. BMC Surg 2012; 12:18. [PMID: 22937833 PMCID: PMC3496625 DOI: 10.1186/1471-2482-12-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/18/2012] [Indexed: 12/12/2022] Open
Abstract
Background Prophylactic antibiotics (PAs) are beneficial to breast cancer patients undergoing surgery because they prevent surgical site infection (SSI), but limited information regarding their use has been published. This study aims to determine the use of PAs prior to breast cancer surgery amongst breast surgeons in Colombia. Methods An online survey was distributed amongst the breast surgeon members of the Colombian Association of Mastology, the only breast surgery society of Colombia. The scope of the questions included demographics, clinical practice characteristics, PA prescription characteristics, and the use of PAs in common breast surgical procedures. Results The survey was distributed amongst eighty-eight breast surgeons of whom forty-seven responded (response rate: 53.4%). Forty surgeons (85.1%) reported using PAs prior to surgery of which >60% used PAs during mastectomy, axillary lymph node dissection, and/or breast reconstruction. Surgeons reported they targeted the use of PAs in cases in which patients had any of the following SSI risk factors: diabetes mellitus, drains in situ, obesity, and neoadjuvant therapy. The distribution of the self-reported PA dosing regimens was as follows: single pre-operative fixed-dose (27.7%), single preoperative dose followed by a second dose if the surgery was prolonged (44.7%), single preoperative dose followed by one or more postoperative doses for >24 hours (10.6%), and single preoperative weight-adjusted dose (2.1%). Conclusion Although this group of breast surgeons is aware of the importance of PAs in breast cancer surgery there is a discrepancy in how they use it, specifically with regards to prescription and timeliness of drug administration. Our findings call for targeted quality-improvement initiatives, such as standardized national guidelines, which can provide sufficient evidence for all stakeholders and therefore facilitate best practice medicine for breast cancer surgery.
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Affiliation(s)
- Sergio A Acuna
- Department of Surgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Abstract
BACKGROUND The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH METHODS We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline using the following terms: #1 antibiotic* OR antimicrob* OR anti infecti* OR antiinfecti*; #2 prophyla* OR prevent*; #3 #1 AND #2; #4 clean AND (surgery OR tech* OR proced*); #5 herni*; #6 (wound infection) AND #4; #7 #3 AND (#4 or #5 or #6). National Research Register, ISI-Web, DARE, Scirus, TRIPDATABASE, NHS EED, reference list of the included studies and web of clinical trials register (www.controlled-trials.com and clinicaltrials.gov) were checked to identify further studies. SELECTION CRITERIA Only randomised clinical trials were included. DATA COLLECTION AND ANALYSIS In the present review, we searched for eligible trials in October 2011. This revealed four new included trials, so seventeen trials are included in the meta-analysis. Eleven of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorrhaphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A fixed effects model was used in the analysis. MAIN RESULTS The total number of patients included was 7843 (prophylaxis group: 4703, control group: 3140). Overall infection rates were 3.1% and 4.5% in the prophylaxis and control groups, respectively (OR 0.64, 95% CI 0.50 - 0.82). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 2.4% and 4.2% in the prophylaxis and control groups, respectively (OR 0.56, 95% CI 0.38 - 0.81). AUTHORS' CONCLUSIONS Based on the results of this systematic review the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Neither can the administration be recommended against when high rates of wound infection are observed.
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Ozgun H, Ertugrul BM, Soyder A, Ozturk B, Aydemir M. Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention. Int J Surg 2009; 8:159-63. [PMID: 20026001 DOI: 10.1016/j.ijsu.2009.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 10/16/2009] [Accepted: 12/08/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study was aimed to determine the propriety of perioperative antimicrobial prophylaxis, to evaluate the effects of a training intervention on correction. METHODS This prospective educational intervention study was performed on clean, clean-contaminated, and contaminated wounds in elective procedures. The accuracy of the antimicrobial prophylaxis was analyzed according to international guidelines. The outcome measures were appropriateness of prophylactic antibiotic indication, choice, dose and duration; and cost of inappropriate administration. RESULTS Before the intervention, 312 procedures were recorded compared with 322 after the intervention. Total compliance rate decreased from 34.3% to 28.5% after the intervention, though insignificantly (p=0.59). Educational training intervention did not change the rate of inappropriate antibiotic choice statistically, and prolonged antibiotic use was significantly higher after the intervention (p=0.01). The positive impact of the intervention was observed in decreased "not indicated but administered" rate (p=0.009) and absence of procedures with "indicated but not administered" and "inappropriate antibiotic dose" which also decreased significantly (both p<0.001). The total cost of irrational antibiotic use was US$26,230.20. CONCLUSIONS Although this educational intervention study achieved improvements in indications, choice, and dosing of surgical antimicrobial prophylaxis, it failed to improve prolonged use and total compliance rate, and to lower the costs sufficiently. It will probably provide better results by means of compulsory measures for surgeons to comply with available protocols and guidelines, as well as education programs, in order to change the antibiotic utility habits on surgical prophylaxis and to achieve accurate prophylactic administrations.
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Affiliation(s)
- Hedef Ozgun
- Department of General Surgery, Adnan Menderes University, 09100 Aydin, Turkey.
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Abstract
BACKGROUND The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH STRATEGY In the present review, we searched for eligible trials in august 2006, using the search terms below. This revealed four new included trials (total of twelve). We searched the Cochrane Colorectal Cancer Group specialized register, by crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search were performed in Medline and Embase was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies. SELECTION CRITERIA Only randomized clinical trials were included. DATA COLLECTION AND ANALYSIS Twelve randomized clinical trials were identified. Six of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis. MAIN RESULTS The total number of patients included was 6705 (treatment group: 4128, control group: 2577). Overall infection rates were 2.9% and 3.9% in the prophylaxis and control groups, respectively (OR 0.64, 95%CI 0.48 - 0.85). The subgroup of patients with herniorrhaphy had infection rates of 3.5% and 4.9% in the prophylaxis and control groups, respectively (OR 0.71, 95% CI 0.51 - 1.00). The subgroup of patients with hernioplasty had infection rates of 1.4% and 2.9% in the prophylaxis and control groups, respectively (OR 0.48, 95% CI 0.27 - 0.85). AUTHORS' CONCLUSIONS Based on the results of this meta-analysis the administration of antibiotic prophylaxis for elective inguinal hernia repair cannot be universally recommended. Nevertheless, its administration cannot either be recommended against when high rates of wound infection are observed.
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Affiliation(s)
- F J Sanchez-Manuel
- General Yagüe Hospital, General and Digestive Surgery, Avenida del Cid s/n, Castilla y Leon, Burgos, Spain, 09005.
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Terzi C. Antimicrobial prophylaxis in clean surgery with special focus on inguinal hernia repair with mesh. J Hosp Infect 2006; 62:427-36. [PMID: 16406199 DOI: 10.1016/j.jhin.2005.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Accepted: 09/19/2005] [Indexed: 12/21/2022]
Abstract
Until recently, antimicrobial prophylaxis was thought to be unnecessary for clean surgery except when a foreign body is implanted or the presence of infection poses a significant risk to patients. However, the results of several trials support extending the administration of antimicrobial prophylaxis to other types of clean surgery such as inguinal hernia repair or breast surgery. A recent Cochrane meta-analysis concluded that antimicrobial prophylaxis for inguinal hernia repair with or without mesh cannot be recommended or discarded. Resolution of this problem is important because inguinal hernia repair with mesh is one of the most common procedures in general surgery, and antibiotic consumption for preventive purposes is becoming a serious problem due to the risk of contribution to development of bacterial resistance and the significant increase in healthcare costs. This review will document clinical trials and meta-analyses on clean surgery, and will focus on inguinal hernia repair with mesh.
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Affiliation(s)
- C Terzi
- University Department of Surgery, Dokuz Eylul Hospital, Izmir, Turkey.
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Abstract
BACKGROUND The use of antibiotic prophylaxis for hernia repair is currently a controversial issue given the disparity among study results in this area. OBJECTIVES The objective of this systematic review was to clarify the effectiveness of antibiotic prophylaxis in reducing postoperative wound infection rates in elective open inguinal hernia repair. SEARCH STRATEGY Searches in the Cochrane Colorectal Cancer Group specialized register were conducted crossing the terms herni* and inguinal or groin and the terms antimicr* or antibiot* , as free text and MeSH terms. A similar search in Medline (WebSPIRS from Silver Platter, January/1966 to March/2004) and Embase (1976 to December/2003) was conducted using the following terms: #1 antibiotic* or antimicrob* or anti infecti* or antiinfecti*; #2 prophyla* or prevent*; #3 #1 and #2; #4 clean and (surgery or tech* or proced*); #5 herni*; #6 (wound infection) and #4; #7 #3 and (#4 or #5 or #6). Reference lists of the included studies were checked to identify additional studies. SELECTION CRITERIA Only randomized clinical trials were included. DATA COLLECTION AND ANALYSIS Eight randomized clinical trials were identified. Three of them used prosthetic material for hernia repair (hernioplasty) whereas the remaining studies did not (herniorraphy). Pooled and subgroup analysis were conducted depending on whether prosthetic material was or not used. A random effects model was used in the analysis. MAIN RESULTS The total number of patients included was 2907 (treatment group: 1421, control group: 1486). Overall infection rates were 2.88% and 4.3% in the prophylaxis and control groups, respectively (OR 0.65, 95%CI 0.35 - 1.21). The subgroup of patients with herniorrhaphy had infection rates of 3.78% and 4.87% in the prophylaxis and control groups, respectively (OR 0.84, 95%CI 0.53 - 1.34). The subgroup of patients with hernioplasty had infection rates of 1.2% and 3,3% in the prophylaxis and control groups, respectively (OR 0.28, 95%CI 0.02 - 3.14). REVIEWERS' CONCLUSIONS Based on the results of this meta-analysis, there was no clear evidence that routine administration of antibiotic prophylaxis for elective inguinal hernia repair reduced infection rates.
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Romero M, Fernando Compañ A, Díez M, Candela A, Marco J, Medrano J, María Aranaz J, Teresa Gea M. ¿Es necesaria la profilaxis antibiótica en la cirugía protésica de la hernia inguinal? Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Prado MAMB, Lima MPJS, Gomes IDRH, Bergsten-Mendes G. The implementation of a surgical antibiotic prophylaxis program: the pivotal contribution of the hospital pharmacy. Am J Infect Control 2002; 30:49-56. [PMID: 11852418 DOI: 10.1067/mic.2002.118409] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although surgical site infection rates have decreased with the prophylactic use of antibiotics, the inappropriateness of surgical antibiotic prophylaxis is still a worldwide problem. Various strategies have been used to address this problem. This study describes the implementation of a perioperative antibiotic prophylaxis protocol that emphasizes the contribution of the pharmacist. METHODS A descriptive study design was used to evaluate the impact of the protocol on the appropriateness of prophylaxis in a private university hospital. The surgical antibiotic prophylaxis of all surgeries was evaluated for 1 month before and 1 month after the implementation of the protocol. RESULTS The appropriateness of the indication for prophylaxis rose from 56.4% to 100% and that of the postoperative maintenance prophylactic antibiotics rose from 21.9% to 95.7%. The cost of the perioperative antibiotic prophylaxis per surgery decreased 40.5%. CONCLUSION The implementation of a cost-effective perioperative antibiotic prophylaxis protocol was the result of a multidisciplinary effort. The hospital pharmacist participated in education activities as part of the discussion groups on the perioperative antibiotic prophylaxis protocol that involved all participants and in managerial actions that optimized the process of ordering, dispensing, administering, and documenting the perioperative antibiotic prophylaxis.
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Affiliation(s)
- Maria Aparecida M B Prado
- Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
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