Adherence to international antimicrobial prophylaxis guidelines in cardiac surgery: a Jordanian study demonstrates need for quality improvement. Antibiotic prophylaxis for cardiac surgery in Australia. The value of routine antibiotic prophylaxis in mandibular third molar surgery: acute-phase protein levels as indicators of infection. The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients: a randomized trial. Cefotaxime in the Prophylaxis of Otorhinolaryngological Cancer Surgery Prospective comparison of perioperative antibiotic management protocols in oncological head and neck surgery. Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102. Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery. Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand [Antibiotic prophylaxis with ++vancomycin in corrective surgery with alloplastic material]. Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center Role of Prophylactic Antibiotics in Laparoscopic Cholecystectomy.
BACKGROUND Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection ( SSI ) . Inappropriate antimicrobial prophylaxis , such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen , can increase the prevalence of antibiotic resistant strains , prolong hospital stay , cause adverse reactions , and negatively affect an institution 's pharmacy budget for antibiotics . In developing countries such as Jordan , where the role of clinical pharmacists is still in its primary stages , the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement . OBJECTIVE To assess the degree of adherence to international guidelines for antimicrobial prophylaxis practice in cardiac surgery performed at Queen Alia Heart Institute ( QAHI ) in Amman , Jordan , as part of an attempt to determine opportunities for clinical pharmacist intervention . METHODS For a total of 236 patients who were admitted for cardiac surgery to QAHI - the only official referral hospital for cardiac patients in Jordan - between November 19 , 2006 , and January 22 , 2007 , the antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were assessed against 3 international guidelines using a pre-tested , structured clinical data collection form that was completed by 2 of the authors who work at QAHI . The study design was prospect i ve . All patients who were scheduled for surgery were monitored daily during their inpatient stay until discharge and then were tracked in the outpatient clinic for 2 months following surgery . Data regarding antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were collected during the patient 's inpatient stay ; data collection was performed periodically thereafter as data became available until the end of the 2-month follow-up . The 3 guidelines agreed that ( a ) antimicrobial prophylaxis should be given to all patients undergoing cardiac surgeries ; ( b ) the first- or second-generation cephalosporins ( cefazolin or cefuroxime ) are the antibiotics of choice , and vancomycin use is reserved for cases of allergy to beta-lactams or if presumed or known methicillin-resistant Staphylococcus aureus ( MRSA ) colonization is present ; ( c ) the timing of the first dose should be within 60 minutes prior to the skin incision ; and ( d ) the duration of antimicrobial prophylaxis should not be longer than 48 hours . RESULTS Adherence to all antimicrobial prophylaxis guidelines was not achieved for any study patients . For the 6 evaluated criteria , ( 1 ) indication : in 100 % of patients the appropriate decision was made to use antimicrobial prophylaxis in concordance with guidelines ; ( 2 ) choice : only 1.7 % of patients received the antibiotic of choice ; ( 3 ) duration : 39.4 % of patents received antimicrobial prophylaxis for a total duration of 48 hours or less in concordance with guidelines , and for 58.9 % of patients , duration was longer than recommended ; ( 4 ) dose : 27.9 % of patients received an appropriate dose ; ( 5 ) dosing interval : only 13.0 % of patients received an appropriate dosing interval , and none of the doses of antimicrobial prophylaxis used at induction of anesthesia was repeated in operations that lasted longer than the half-life of the antibiotic used ; and ( 6 ) timing : 99.1 % of patients received antimicrobial prophylaxis dose within 60 minutes prior to skin incision as recommended by guidelines , but 97.0 % of patients received an unnecessary midnight dose of intravenous antibiotic the night before surgery . CONCLUSION Study findings indicate that adherence to international guidelines for antimicrobial prophylaxis is far from optimal in QAHI , leading to the inappropriate administration of many antibiotics . Developing local hospital guidelines , as well as giving the clinical pharmacist a central role in the administration , monitoring , and intervention of antimicrobial prophylaxis may improve the current practice OBJECTIVE To evaluate national practice for antibiotic prophylaxis in cardiac surgery with respect to the use of protocol s , agent selection and duration of administration . DESIGN , SETTING AND PARTICIPANTS Two point-prevalence surveys of intensive care units in 24 public and 27 private hospitals performing cardiac surgery in Australia , conducted in 2004 and 2008 , using a structured telephone question naire of the attending senior intensive care clinician in each unit . MAIN OUTCOME MEASURES Existence of a protocol in the unit for antibiotic prophylaxis , specific antibiotic agents used and their duration of administration . RESULTS Between 2004 and 2008 , reported protocol use increased from 58 % to 80 % ( P = 0.02 ) , while concordance with version 13 of the Australian Therapeutic guidelines : antibiotic for both choice of agent and timing ( duration of administration ) remained around 10 % . Use of multiple agents was common , as was continued antibiotic administration after completion of surgery . Over 4 years , the proportion of cardiac surgical units reporting  vancomycin administration  for routine valve surgery prophylaxis doubled to 62 % ( P < 0.001 ) . CONCLUSION Despite an increase in reported protocol use for antibiotic prophylaxis in cardiac surgery , concordance with national antibiotic guidelines remained low , with duration of antibiotic administration deviating most from recommendations . Prophylactic  vancomycin  use appears to have increased substantially in recent years . Clinical implementation of recommended perioperative cardiac surgical antibiotic prophylaxis may not occur until supported by evidence from either a large prospect i ve r and omised study or st and ardised national surveillance of cardiac surgical site infection rates Postoperative infections in the oral region are usually caused by anaerobic bacteria . While some authors cl aim that routine antibiotic prophylaxis is necessary after third molar surgery , others do not recommend this practice . The major subject of controversy is what constitutes postoperative infection . Previous studies that have examined the benefit of routine antibiotic prophylaxis have used several clinical symptoms ( pain , swelling , and trismus ) as indicators of infection ; however , these clinical symptoms may be vague and unreliable , and can not be evaluated scientifically . As a result , their use has only sparked more debate in this area of research . The present study assessed the value of routine antibiotic prophylaxis in impacted m and ibular third molar surgery using acute-phase protein levels as potential indicators of early and late postoperative infection . Specifically , serum levels of C-reactive protein and alpha-1 antitrypsin were measured preoperatively and postoperatively in patients who received either prophylactic antibiotics or placebos . The results revealed no statistically significant difference between treated and control patients in terms of incidence of postoperative infection BACKGROUND Quality improvement collaboratives are used to improve health care quality , but their efficacy remains controversial . OBJECTIVE To assess the effects of a quality improvement collaborative on preoperative antimicrobial prophylaxis . DESIGN Longitudinal cluster r and omized trial , with the quality improvement collaborative as the intervention . SETTING United States . PARTICIPANTS 44 acute care hospitals , each of which r and omly sample d approximately 100 selected surgical cases ( cardiac , hip or knee replacement , and hysterectomy ) at both the baseline and remeasurement phases . INTERVENTION All hospitals received a comparative feedback report . Hospitals r and omly assigned to the intervention group ( n = 22 ) participated in a quality improvement collaborative comprising 2 in-person meetings led by experts , monthly teleconferences , and receipt of supplemental material s over 9 months . MEASUREMENTS Change in the proportion of patients receiving at least 1 antibiotic dose within 60 minutes of surgery ( primary outcome ) and change in the proportions of patients given any antibiotics , given antibiotics for 24 hours or less , given an appropriate drug , and given a single preoperative dose and receipt of any of the 5 measures ( secondary outcome ) . RESULTS The groups did not differ in the change in proportion of patients who received a properly timed antimicrobial prophylaxis dose ( -3.8 percentage points [ 95 % CI , -13.9 to 6.2 percentage points ] ) after adjustment for region , hospital size , and surgery type . Similarly , the groups did not differ in individual measures of antibiotic duration ; use of appropriate drug ; receipt of a single preoperative dose ; or an all-or-none measure combining timing , duration , and selection . LIMITATIONS Hospitals volunteered for the effort , thereby result ing in selection for participants who were motivated to change . Implementation of the surgical infection prevention measure reporting requirements by the Centers for Medicare & Medicaid Services and The Joint Commission may have motivated improvement in prophylaxis performance . CONCLUSION At a time of heightened national attention toward measures of antimicrobial prophylaxis performance , the trial did not demonstrate a benefit of participation in a quality improvement collaborative over performance feedback for improvement of these measures The problem of which antibiotic to choose and the optimal duration of its administration in the prophylaxis of otorhinolaryngological surgery for cancer has not been satisfactorily resolved . Subjects suffering from cancer of the upper airways or digestive tract , who are often smokers and drinkers , have a population of Gram-positive or Gram-negative anaerobes and Gram-negative aerobes ( predominantly Pseudomonas , Proteus and Escherichia coli ) in addition to their usual oropharyngeal flora .  Antibacterial monotherapy has little chance of success against all of these organisms , which are liable to become pathogenic in the event of surgery . Drug combinations would be costly and could result in selection of resistant strains . Accordingly , it is generally recommended that either monotherapy with a newer 13-lactam or a combination of a penicillin and imidazole be used , knowing that not all of the potential pathogens will be covered , but that the most resistant anaerobes in the postoperative period will be effectivelyerased and that a second antibiotic can be used in the event of the sudden occurrence of a specific infection . The optimum duration of antibiotic administration has not been determined for this area of surgery ; 8 days ' treatment is excessively long and 24 hours ( the usual duration of st and ard prophylaxis ) is insufficient because one is dealing with a highly infectious type of surgery in a very septic medium . Tumours are often necrosed in an environment which already has an abundance of potentially pathogenic organisms ; surgery is long ( average duration is 4 hours ) and exposes a large operation area to contamination : i.e. the neck and frontal thorax if a musculo-cutaneous flap has been prepared . Third generation cephalosporins similar to cefotaxime have already been the subject of studies as antibiotic prophylaxis in this indication ( Gehanno & Moisy in press ; Johnson et al. 1983 ) . The aim of the present multicentre study was to determine the optimum duration of administration of cefotaxime OBJECTIVES The adequate perioperative antibiotic prophylaxis in head and neck cancer surgery is an important and easy applicable tool to decrease nosocomial morbidity and mortality by reducing the rate of infections . In the study a strictly perioperative antibiosis is compared with an extended postoperative prophylactic antibiosis . We aim to clarify the value of postoperative prophylactic antibiosis for the recovery and clinical course of patients . MATERIAL AND METHODS In this prospect i ve study 75 consecutive patients , who underwent major oncological head and neck surgery were included and divided in three groups , each containing 25 patients . The first group received peri- and postoperative antibiotic prophylaxis ( POAP ) from the day of operation until the fifth day postoperatively . The second group was treated with perioperative antibiotic prophylaxis ( PEAP ) only . The third group received perioperative antibiotic prophylaxis and increased local antiseptic care ( PAPAC ) . General anamnestic data was collected , as well as duration of hospitalisation , stay on intensive care unit , rate and type of infections , surgical closure of the tracheostomy , and postoperative blood parameters . RESULTS There were no statistically significant differences in general diseases or extent of surgery between the groups . There were statistically significant fewer patients suffering from surgical site infections in subjects with POAP ( n = 1 ) in comparison to PEAP ( n = 9 ; p = 0.011 ) and PAPAC ( n = 9 ; p = 0.011 ) . In contrast , other nosocomial infections ( pneumonia , urinary tract infection , sepsis ) did not decrease under a prolonged antibiotic prophylaxis . CONCLUSION Based on findings of the study , we recommend an extended postoperative antibiotic prophylaxis for patients undergoing major oncological head and neck surgery One known complication of induced abortion is upper genital tract infection , which is relatively uncommon in the current era of safe , legal abortion . Currently , rates of upper genital tract infection in the setting of legal induced abortion in the United States are generally less than 1 % . R and omized controlled trials support the use of prophylactic antibiotics for surgical abortion in the first trimester . For medical abortion , treatment-dose antibiotics may lower the risk of serious infection . However , the number-needed-to-treat is high . Consequently , the balance of risk and benefits warrants further investigation . Perioperative oral doxycycline given up to 12 h before a surgical abortion appears to effectively reduce infectious risk .  Antibiotics that are continued after the procedure for extended duration s meet the definition for a treatment regimen rather than a prophylactic regimen . Prophylactic efficacy of antibiotics begun after abortion has not been demonstrated in controlled trials . Thus , the current evidence supports pre-procedure but not post-procedure antibiotics for the purpose of prophylaxis . No controlled studies have examined the efficacy of antibiotic prophylaxis for induced surgical abortion beyond 15 weeks of gestation . The risk of infection is not altered when an intrauterine device is inserted immediately post-procedure . The presence of Chlamydia trachomatis , Neisseria gonorrhoeae or acute cervicitis carries a significant risk of upper genital tract infection ; this risk is significantly reduced with antibiotic prophylaxis . Women with bacterial vaginosis ( BV ) also have an elevated risk of post-procedural infection as compared with women without BV ; however , additional prophylactic antibiotics for women with known BV has not been shown to reduce their risk further than with use of typical pre-procedure antibiotic prophylaxis . Accordingly , evidence to support pre-procedure screening for BV is lacking . Neither povidone-iodine nor chlorhexidine have been shown to alter the risk of infection when used as cervicovaginal preparation . However , chlorhexidine appears to be more effective than povidone iodine at reducing bacteria within the vagina . The Society of Family Planning recommends the routine use of antibiotic prophylaxis , preferably with doxycycline , before surgical abortion . Use of treatment doses of antibiotics with medical abortion may decrease the rare risk of serious infection but universal requirement for such treatment has not been established OBJECTIVE Use of single-dose antibiotic prophylaxis is associated with reduced antibiotic resistance , lower costs , and fewer problems with drug toxicity and superinfections . We tested the hypothesis that single doses of cefazolin are as effective as a 24-hour regimen of cefazolin in preventing surgical site infections in adults undergoing cardiac procedures . METHODS This r and om , prospect i ve , clinical study included 838 adult patients undergoing elective coronary artery bypass grafting , valve operations , or both . These patients were r and omly given a single dose of cefazolin ( 2 g ) or a 24-hour treatment ( 2-g initial dose , followed by 1 g every 8 hours ) . Investigators blinded to the drug regimen diagnosed wound infections according to Centers for Disease Control and Prevention criteria . Patient clinical and demographic characteristics were noted , with follow-up for 12 postoperative months . The primary objective was to compare the incidence of surgical infections between groups up to 12 months postoperatively . RESULTS A total of 419 patients received single-dose cefazolin , and another 419 received the 24-hour treatment . Surgical site infection occurred in 35 ( 8.3 % ) patients receiving single doses and 15 ( 3.6 % ) patients administered the 24-hour treatment ( P = .004 ) . We identified no differences between groups for mortality or duration of hospitalization ( preoperative hospitalization , intensive care unit stay , and hospitalization after surgical intervention ) . The microorganisms isolated showed a similar distribution in both groups . The germs isolated were gram-positive cocci in 86 % of the surgical site infections . CONCLUSIONS Single-dose cefazolin used as antibiotic prophylaxis in cardiac surgery is associated with a higher surgical site infection rate than the 24-hour , multiple-dose cefazolin regimen Background No data currently exist about use of antibiotics to prevent surgical site infections ( SSI )  among patients undergoing appendectomy in Thail and . We therefore examined risk factors , use , and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy . Methods From July 1 , 2003 to June 30 , 2004 we conducted a prospect i ve cohort study in eight hospitals in Thail and . We used the National Nosocomial Infection Surveillance ( NNIS ) system criteria to identify SSI associated with appendectomy . We used logistic regression analysis to obtain relative risk estimates for predictors of SSI . Results Among 2139 appendectomy patients , we identified 26 SSIs , yielding a SSI rate of 1.2 infections/100 operations . Ninety-two percent of all patients ( 95 % CI , 91.0–93.3 ) received antibiotic prophylaxis . Metronidazole and gentamicin were the two most common antibiotic agents , with a combined single dose administered in 39 % of cases . In 54 % of cases , antibiotic prophylaxis was administered for one day . We found that a prolonged duration of operation was significantly associated with an increased SSI risk . Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively . Compared with no antibiotic prophylaxis , SSI relative risks for combined single-dose of metronidazole and gentamicin , one-day prophylaxis , and multiple-day antibiotic prophylaxis were 0.28 ( 0.09–0.90 ) , 0.30 ( 0.11–0.88 ) and 0.32 ( 0.10–0.98 ) , respectively . ConclusionS ingle-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively The authors report a controlled series of 40 patients treated for recidivating inguinal hernia and laparocele with the implant of alloplastic material . Short-term prophylaxis with vancomycin was performed in all cases . The antibiotic was found to be well tolerated at the doses used and this was associated with a good clinical success rate . The use of vancomycin in prophylaxis for this type of surgery is considered a rational choice and the use of short-term prophylaxis reduces the risks linked to possible collateral effects Purpose In this double-blind prospect i ve r and omized trial , our objective was to investigate the effect of antibiotic prophylaxis in patients undergoing elective inguinal hernia surgery with mesh repair in a large-volume tertiary referral trauma center . Methods Eligible patients were assigned r and omly to either an antibiotic prophylaxis group or a control group . Patients in the prophylaxis group were given 1 g cefazolin by IV bolus injection whereas the placebo control group received an equal volume of sterile saline preoperatively . A Lichtenstein repair was done in all cases . The patients were examined for surgical site infection ( SSI ) and other postoperative local complications before discharge , and reexamined 3 , 5 , 7 , and 30 days after discharge . Results Groups were well matched for age , sex , coexisting diseases , ASA scores , type of hernia , type of anesthesia , duration of surgery . Incidence of infection was 7 % in the control group ( 7/100 ) and 5 % in the prophylaxis group ( 5/100 ) ( P = 0.38 ) . All the infections were superficial and responded well to drainage and proper antibiotic therapy . All other postoperative complications were similar in the two groups . Conclusions In our setting s antibiotic prophylaxis has no significant effect on the incidence of SSI in elective repair of inguinal hernias with mesh . The most effective way to reduce the incidence of infection in prosthetic repair may be a specific center for treatment of abdominal wall hernias BACKGROUND Antibiotic prophylaxis is routinely administered in laparoscopic cholecystetomy but its role is debatable . METHODS From January 2004 to August 2008 , 417 patients were r and omized into 208 in antibiotic group ( AG ) and 209 in non antibiotic group ( NAG ) . AG received one dose each of injection ciprofloxacin ( 200 mg ) and metronidazole ( 500 mg ) preoperatively . NAG was given only intravenous fluids . Besides routine care , all underwent abdominal sonography and liver function tests at least once during the 30 postoperative days . RESULT Age , sex and co-morbidity distribution were similar in both the groups . One patient who was on weekly 5 mg methotraxate ( NAG ) had erythema around umbilical port . Other three having umbilical discharge recovered without antibiotics . Nine patients had subhepatic collection ( 5 AG and 4 NAG ) . One from NAG underwent re-laparoscopy and drainage . Ten patients had fever . Two from AG had basal lung collapse and were given antibiotics . CONCLUSION Antibiotic prophylaxis is not needed for laparoscopic cholecystectomy
There was no advantage of regimens lasting > 48 h post-operation .
In the comparison of glycopeptides versus β-lactams , an advantage of glycopeptides was observed when comparators were given for similar duration and for β-lactams when given for a longer duration than the glycopeptides .
There was no significant advantage of high antibiotic dosing .
Evidence supports second- or third-generation cephalosporins for cardiac surgery prophylaxis and points at a possible advantage of prophylaxis prolongation up to 48 h post-operatively
BACKGROUND Antibiotic prophylaxis is recommended in cardiac surgery .
Current debate concerns the type of antibiotic(s ) , dosing and the duration of prophylaxis .