PubMed · 13481572
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I WILLNER. 1957. Modern problems in tuberculosis control.. https://pubmed.ncbi.nlm.nih.gov/13481572/
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BACKGROUND: The need to administer antibiotic prophylaxis (ABP) during laparoscopic cholecystectomy (LC) is still a matter of significant controversy. The purpose of this study was to resolve this issue by performing a meta-analysis of the available randomized controlled trials (RCT) on this topic. METHODS: Papers identified via a systematic literature search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes were abstracted and summarized across studies. The outcome measures were the rates of all perioperative infections, the rates of surgical site infections, and the rates of infections at other sites. Results were examined for 974 patients randomized to ABP or placebo prior to LC in six RCT published from 1997 to 2001. RESULTS: The cumulative rates of all infections were 2.8% in the ABP group and 4.4% in the placebo group. The pooled odds ratio (OR) (95% confidence interval [CI]) was 0.69 (0.34-1.43; p = 0.32). The cumulative rates of surgical site infections were 2.1% in the ABP group and 2.9% in the placebo group. The pooled OR (95% CI) was 0.82 (0.36-1.86; p = 0.63). The cumulative rates of infections at other sites were 0.7% in the ABP group and 1.5% in the placebo group. Pooled OR (95% CI) was 0.82 (0.18-1.90; p = 0.37). No significant heterogeneity was found in any data pooling. CONCLUSIONS: Based on the available evidence, there appears to be no need to administer routine ABP to low-risk patients during LC. However, the number of patients enrolled to date into RCT is insufficient to avoid a type II error. A large and well-designed trial is urgently needed to find a conclusive answer to this question.
BACKGROUND AND OBJECTIVE: The use of risk indexes, originally developed in the US for the assessment of SSI risk, is an useful instrument that must be analyzed according to each specific procedure. The addition of other possible SSI risk factors, like the use of perioperative antibiotic prophylaxis, could improve the predictive value of these indexes. The aim of this study was to determine the SSI incidence rate for craniotomy in patients admitted to the Neurosurgical Unit of the Hospital Clinic of Barcelona (Spain), to assess the use of standard NNIS and SENIC indexes, and to assess the possible effect of the addition of a new risk factor (adequate or inadequate use of perioperative antibiotic prophylaxis) to these indexes. PATIENTS AND METHOD: Risk factors for SSI were assessed following common standard definitions and procedures (CDC-NNIS) over a three-year period (1999-2001). NNIS and SENIC risk indexes were calculated. The effect of the addition of a new variable, namely perioperative antibiotic prophylaxis adequate (0 points) or inappropriate/no prophylaxis (1 point) on these indexes (modified indexes NNISa and SENICa) was also assessed. Statistical analysis included both parametric and non-parametric standard tests. RESULTS: The study included a total of 203 patients undergoing a craniotomy procedure (40% of all neurosurgical procedures). The overall SSI incidence rate was 6.8% (14 patients developed SSI). The cut-off point (75 percentile) for the duration of the procedure was 180 minutes instead of the commonly US reported 240 minutes. Patients who develop SSI had a trend towards having shorter operation times. For those patients in the lower risk groups, the SSI incidence rate was: NNIS (0, 1): 6.9%; SENIC (0, 1): 6.2%. If the modified indexes were used, the SSI incidence rate was: NNISa (0, 1): 4.2%; SENICa (0, 1): 4.9%. When NNIS and SENIC indexes, both standard and modified (NNISa and SENICa), were compared, no statistically significant differences between infected and non-infected patients were observed. CONCLUSIONS: When applied to a health system other than the US, SENIC and NNIS indexes could be useful if adapted to each specific situation and procedure. The added value of a new risk factor (perioperative antibiotic prophylaxis) on standard NNIS and SENIC indexes shows a slight improvement in their prediction rate for SSI in patients undergoing craniotomy, mainly in those patients at lower risk for developing superficial SSI.
Postoperative endophthalmitis remains a serious clinical problem in ophthalmology, with an incidence of approximately 0.5%. Prognosis is largely determined by the virulence of the offending organism. The Endophthalmitis Vitrectomy Study (EVS) was a prospective, randomized trial comparing various diagnostic and treatment modalities in cases of endophthalmitis that followed cataract surgery. The EVS found that vitrectomy was only beneficial for patients presenting with very poor visual acuity and that intravenous antibiotic treatments had no additional benefit, compared with intravitreal antibiotic therapy alone. However, weaknesses of the EVS leave these conclusions open to modification in the future. Preoperative application of povidone-iodine preparation to the skin and conjunctiva is the only proven endophthalmitis prophylaxis. Endophthalmitis may be chronic and may follow glaucoma surgery and intravitreal injection of gas and drugs. The EVS did not study these issues, although they are associated with specific features that may require alterations in patient management.