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PubMed2004

Controversies in antibiotic prophylaxis in urology.

Antibiotic prophylaxis in urologic surgery remains controversial. However, progress has been made and some of the controversies have been answered. Firstly, it is important to underline that urologic diagnostic and therapeutic procedures can induce surgical site infections (SSIs), bacteriuria, pyelonephritis and septicaemia in a substantial number of patients, too great to be neglected. Secondly, as patients are different and have various risk factors, a careful assessment of the patient and its individual risk is crucial. Thirdly, the same procedure may be totally different from one individual to another and they can rarely be grouped as standard procedures. A floating level of invasiveness is followed by a variation of the risk of infection. Fourthly, the pathogens and their susceptibility pattern vary extensively in Europe so that no clear-cut recommendations as for the choice of antibiotics can be given. Basic principles of antibiotic prophylaxis in terms of timing, mode of administration and length of regiment apply for urologic interventions. Thus, clean operations will usually not require antimicrobial prophylaxis except for those including the implant of a prosthetic device, while clean-contaminated will benefit from preventive antimicrobials. It is the task of the urologists to carefully assess each individual patient and procedure to opt for an optimal prophylaxis.

Antibiotic Prophylaxis↗

PubMed1994

A reevaluation of antibiotic prophylaxis in laparoscopic cholecystectomy.

Antibiotic prophylaxis for cholecystectomy, although somewhat controversial, is nevertheless a routine component of surgical care. With the advent of laparoscopic cholecystectomy, this routine practice of antibiotic prophylaxis needs to be reevaluated. The present investigation was undertaken to determine the incidence of postsurgical infection in patients receiving antibiotic prophylaxis compared with patients receiving chlorhexidine gluconate scrub the evening before surgery. A total of 448 patients were enrolled in the study. Thirty-two of these patients were excluded because of the presence of intrinsic risk factors for infection. Two hundred twenty-eight patients received antibiotic prophylaxis, and 188 patients were enrolled in the non-antibiotic group. A total of 14 infections occurred in the antibiotic prophylaxis group, whereas no infections occurred in the chlorhexidine group. These results suggest that meticulous antiseptic skin cleansing is sufficient for prevention of postsurgical infection following laparoscopic cholecystectomy. Antibiotic prophylaxis should be used only in those patients exhibiting intrinsic risk factors, such as cholecystitis.

Administration, Cutaneous↗

PubMedDate not supplied

Antibiotic prophylaxis in dentistry.

Antibiotic prophylaxis for the prevention of infective endocarditis related to dental therapy is a widespread therapeutic intervention. Recently, updated and revised guidelines on this treatment modality have been set forth in the form of consensus statements. It is evident that the risk of spontaneous bacteremia is much greater in a diseased oral cavity than it is in a healthy oral cavity. Perhaps most important in the prevention of infective endocarditis is early identification of at-risk patients and prompt referral to oral health specialists for comprehensive evaluation and treatment. The judicious use of antibiotic prophylaxis for prevention of infective endocarditis, in conjunction with optimal oral health care, should serve to minimize the adverse effects of antibiotic therapy and at the same time reduce the significant morbidity and mortality associated with these infections.

Antibiotic Prophylaxis↗

PubMed2002

Intrapartum antibiotic prophylaxis 1: relative effects of recommended antibiotics on gram-negative pathogens.

OBJECTIVE: To assess whether the antibiotic chosen for intrapartum antibiotic prophylaxis affects the subsequent exposure of the neonate to ampicillin-resistant gram-negative bacteria. METHODS: We performed a randomized clinical trial of ampicillin versus penicillin for intrapartum antibiotic prophylaxis. Genital tract cultures for Enterobacteriaceae were obtained at study entry and 8-36 hours postpartum. Organisms were isolated, identified, and tested for ampicillin susceptibility. RESULTS: The ampicillin (n = 175) and penicillin (n = 177) groups, respectively, did not differ in rates of ampicillin-resistant Escherichia coli at entry (25% versus 22%, P =.57) or postpartum (36% versus 38%, P =.64). Similarly, groups did not differ in rates of ampicillin-resistant Enterobacteriaceae at entry (38% versus 32%, P =.23) or postpartum (51% versus 55%, P =.46). However, postpartum culture rates of resistant Escherichia coli were higher than entry culture rates for both the ampicillin (36% versus 25%, P =.026) and penicillin (38% versus 22%, P <.001) groups. Postpartum culture rates of resistant Enterobacteriaceae were also higher than entry culture rates for both the ampicillin (51% versus 38%, P <.001) and penicillin (55% versus 32%, P <.001) groups. Results were similar when considering only women who received two or more doses and no additional antibiotics. CONCLUSION: Intrapartum antibiotic prophylaxis with either ampicillin or penicillin increases exposure of neonates to ampicillin-resistant Enterobacteriaceae.

Adolescent↗

PubMed1998

[Is there an indication for general perioperative antibiotic prophylaxis in laparoscopic plastic hernia repair with implantation of alloplastic tissue?].

The implantation of alloplastic material in laparoscopically operated groin hernias is usually connected with perioperative prophylaxis by antibiotics. We doubted the usefulness of the general application in these operations. Therefore we made a prospective randomized study in 80 patients, beginning since April 1996. 40 of them received perioperatively antibiotics, other 40 ones remained without antibiotics. These 80 patients underwent an unilateral hernioplasty and were without major anaesthesiologic risk. Both the groups were statistically comparable. As a result, no patient of both the groups suffered from an infectious complication. Thus, we can recommend the laparoscopic implantation of alloplastic meshes in "simple hernias" without perioperative antibiotic prophylaxis. In risk patients, antibiotics should still given further.

Adult↗

PubMed2005

Improvement of surgical antibiotic prophylaxis: a prospective evaluation of personalized antibiotic kits.

This prospective study compared personalized surgical antibiotic prophylaxis kits (SAPKs) with freely prescribed antibiotics. SAPKs use significantly enhanced national guidelines on surgical antibiotic prophylaxis application (82% vs 41%, P < 0.001), and result in limited errors in terms of antibiotic choice (3% vs 28%, P < 0.001), timing of administration (12% vs 24%, P = 0.003) and prophylaxis duration (1.5% vs 22%, P < 0.001), thereby demonstrating their effectiveness.

Adult↗

PubMed2006

Antibiotic prophylaxis: current recommendations.

Antibiotic prophylaxis consists of a brief course of antibiotics initiated preoperatively in order to decrease the risk of postoperative wound infection in the patient with a clean wound. The antibiotic should be started within 60 minutes before skin incision and continued for not more than 24 hours. Antibiotic therapy is indicated for the contaminated or dirty wound. In open fractures, antibiotics should be started as soon as possible after injury and continued for 3 days (type I and II fractures) or 5 days (type III). This treatment should be combined with local therapy consisting of antibiotic-impregnated polymethylmethacrylate beads. Although the utility of antibiotics in low-velocity gunshot wounds is controversial, high-velocity gunshot wounds should be treated with 48 to 72 hours of antibiotic therapy.

Anti-Bacterial Agents↗

PubMed1998

Routine perioperative antibiotic prophylaxis in renal transplantation.

BACKGROUND: Perioperative antibiotic prophylaxis may prevent infection following renal transplantation but it also contributes to development of resistant microorganisms. With refined surgical techniques, improved graft preservation, and immunosuppressive monitoring during recent decades one can question the present use of perioperative antibiotic prophylaxis. We retrospectively evaluated the incidence of infection in our renal transplant centre where antibiotic prophylaxis is not routinely used in renal recipients. Concurrently we performed a survey of perioperative antibiotic use to establish the current world-wide practice. METHODS: Infection episodes were evaluated from records of 448 adult renal transplant recipients (January 1994 to August 1996) at our centre. A questionnaire was mailed to 103 centres addressing the number of kidney transplantations in 1995, donor source (living vs cadaveric) and details on use of perioperative antibiotic prophylaxis. RESULTS: Single-centre study. Renal transplantation was performed without antibiotic prophylaxis in 377 patients (84%). Thirteen patients (3.4%) had early postoperative infections, nine with urinary-tract infection tended to have urinary catheter for a longer period than those without infection (5.0 +/- 2.7 vs 3.4 +/- 1.4 days, P = 0.27) and cadaveric kidney recipients to have higher incidence of infections (4.5 vs 1.5% P = 0.14). All infection episodes were successfully treated. The infection incidence in 71 (16%) 'high-risk' patients selected for antibiotic treatment was 4.2%. World-wide survey. Data were obtained from 101 centres in five continents representing 10532 renal transplants. Ninety centres (89%) used perioperative antibiotic prophylaxis. CONCLUSION: The infection incidence in patients who did not receive perioperative antibiotic prophylaxis was the same as in a small group of selected patients who received prophylaxis. The incidence was lower than usually reported in the literature. In contrast perioperative antibiotic prophylaxis is given to all patients in almost 90% of transplant centres worldwide. A reduction of prophylactic antibiotic use is encouraged.

Adult↗

PubMed1980

[Antibiotic prophylaxis in general surgery].

In their discussion of the problem of antibiotic prophylaxis in general surgery the authors maintain that routine-like antibiotic prophylaxis is not indicated in general surgery, but is superfluous and even harmful. So-called "b ind prophylaxis" is senseless and there is no "total prophylaxis". Antibiotic prophylaxis can be successful when it is selective, aimed, adapted to the individual subject and the antibiotic reaches an effective concentration at the appropriate moment not only in the serum but also in the tissues. Infection can be of exogenous and of endogenous origin. Prevention of exogenous infections does not depend upon antibiotic treatment. Antibiotic prophylaxis is contra-indicated when the operation is performed o a clean region. The problem of antibiotic prophylaxis in the course of operations of the bile duct, the stomach, the intestine and pancreas. during appendectomy and colorectal operations is discussed in detail. Post-operative infections of the respiratory tract cannot be prevented by antibiotic prophylaxis. Finally, the authors try to find an answer to the problem when and how antibiotic prophylaxis should be applied, what antibiotic should be used for how long and in what doses.

Anti-Bacterial Agents↗

PubMed2002

Comparative analysis of two regimens of antibiotic prophylaxis in elective colorectal surgery.

BACKGROUND: Antibiotic prophylaxis has greatly reduced the rate of postoperative infectious complications since its utilization in the elective colorectal surgery in the last several decades. Although the need of its application is indisputable, the optimal duration of antibiotic prophylaxis is still on debate. AIM: The aim of the present study was to compare two regimens of antibiotic prophylaxis with different duration. MATERIALS AND METHODS: A retrospective clinical study was conducted of 190 patients that underwent elective surgery for colorectal carcinoma in the Clinic between January 1997 and June 2000. The patients were divided into two groups according to the regimen of antibiotic prophylaxis. Group 1 (n = 92) patients received a 24-hour antibiotic prophylaxis and Group 2 (n = 98) had a prolonged antibiotic cover that lasted 5 days. The antibiotic prophylaxis was conducted with a third generation cefalosporin and metronidazole. RESULTS: Of all 190 patients 92 were in Group 1 and 98 in Group 2. Postoperative infectious wound complications were found in 14 (15.2%) patients from Group 1 and in 25 (25.5%) patients from Group 2. The difference did not reach statistical significance (P > 0.05). CONCLUSION: The results of the study show no advantage of the prolonged over short-term antibiotic prophylaxis. Based on the study findings the authors suggest that a 24-hour antibiotic prophylaxis should be recommended for the lower rate of side effects and lower cost.

Adult↗

PubMed1995

Dermatologists and antibiotic prophylaxis: a survey.

BACKGROUND: Antibiotic prophylaxis is frequently used for the prevention of infection at a distant site such as the heart valve or prosthetic joint. However, there are no published data describing how dermatologists manage patients "at risk". OBJECTIVE: The purpose of this study is to document prophylactic antibiotic use by dermatologists. METHODS: A total of 211 randomly selected community dermatologists and 69 academic dermatologic surgeons were surveyed by questionnaire to determine whether they would provide antibiotic prophylaxis in 20 different clinical situations. RESULTS: This survey showed that under certain circumstances, almost all dermatologists provide antibiotic prophylaxis to prevent infection at a distant site. However, many dermatologists use antibiotics in settings with relatively little or no indication and confuse a prophylactic regimen with treatment of a superficial infection. CONCLUSION: This survey underscores the need for education and research into the prophylactic management of patients "at risk" who undergo dermatologic surgical procedures.

Academic Medical Centers↗

PubMed1981

Antibiotic prophylaxis in genitourinary surgery.

Antibiotic prophylaxis in surgery, particularly genitourinary surgery, has been controversial for years. At best, the results have been more testimonial than scientific because of the failure to observe proper experimental design. A survey of the literature indicates that antibiotic prophylaxis in genitourinary surgery probably has little influence on postoperative fever; it appears to favorably affect the incidence of postoperative bacteriuria and bacteremia in the short term without encouraging nosocomial or resistant infections. The regimen for prophylaxis must be perioperative and continued for no longer than 24 hours postoperatively. Given that antibiotic prophylaxis in elective genitourinary surgery has merit, a comparison between cefazolin and cefotaxime was undertaken. Of 160 evaluable cases, a total of 23 patients had positive cultures within the first nine days; only two occurred within the first five days. When cefazolin and cefotaxime were administered in the same dosage regimen, the infection rate for cefazolin was 19% compared with 10% for cefotaxime.

Adult↗

PubMed1984

Wound infection rates following preoperative versus intraoperative commencement of antibiotic prophylaxis.

The effect of antibiotic prophylaxis initiated one hour prior to contamination or at the time of contamination was evaluated in a randomized blind study using a guinea pig model of surgical wound infection. Would infection, defined as accumulation of pus draining spontaneously or after opening of the wound, developed in 135 guinea pigs after intraincisional contamination before wound closure with 10(7) Escherichia coli plus 10(8) Bacteroides fragilis. Antibiotic prophylaxis with gentamicin plus clindamycin significantly reduced the wound sepsis rate from 82% in the control group of 61 animals to 19% in the two treated groups of 68 and 67 animals (p less than 0.001). However, the timing of antibiotic prophylaxis did not influence wound sepsis rates, rectal temperature during the postoperative period, or bacterial recovery from wound infections.

Animals↗

PubMed2005

Cost-effectiveness of defending against bioterrorism: a comparison of vaccination and antibiotic prophylaxis against anthrax.

BACKGROUND: Weaponized Bacillus anthracis is one of the few biological agents that can cause death and disease in sufficient numbers to devastate an urban setting. OBJECTIVE: To evaluate the cost-effectiveness of strategies for prophylaxis and treatment of an aerosolized B. anthracis bioterror attack. DESIGN: Decision analytic model. DATA SOURCES: We derived probabilities of anthrax exposure, vaccine and treatment characteristics, and their costs and associated clinical outcomes from the medical literature and bioterrorism-preparedness experts. TARGET POPULATION: Persons living and working in a large metropolitan U.S. city. TIME HORIZON: Patient lifetime. PERSPECTIVE: Societal. INTERVENTION: We evaluated 4 postattack strategies: no prophylaxis, vaccination alone, antibiotic prophylaxis alone, or vaccination and antibiotic prophylaxis, as well as preattack vaccination versus no vaccination. OUTCOME MEASURES: Costs, quality-adjusted life-years, life-years, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: If an aerosolized B. anthracis bioweapon attack occurs, postexposure prophylactic vaccination and antibiotic therapy for those potentially exposed is the most effective (0.33 life-year gained per person) and least costly (355 dollars saved per person) strategy, as compared with vaccination alone. At low baseline probabilities of attack and exposure, mass previous vaccination of a metropolitan population is more costly (815 million dollars for a city of 5 million people) and not more effective than no vaccination. RESULTS OF SENSITIVITY ANALYSIS: If prophylactic antibiotics cannot be promptly distributed after exposure, previous vaccination may become cost-effective. LIMITATIONS: The probability of exposure and disease critically depends on the probability and mechanism of bioweapon release. CONCLUSIONS: In the event of an aerosolized B. anthracis bioweapon attack over an unvaccinated metropolitan U.S. population, postattack prophylactic vaccination and antibiotic therapy is the most effective and least expensive strategy.

Anthrax↗

PubMed1992

[Antibiotic prophylaxis in surgery. Results of a 4-year personal case series].

A prospective study of surgical infections in our Department of Surgery in the years 1986-1989 is reported. 2719 patients entered the study: they represent the total number of patients operated in the above said period (628 urgent and 2091 elective operations). As suggested in 1964 by Altmeier, surgical procedures were classified in four groups according to the potential risk of intraoperative contamination. For every septic complication observed pertinent cultures were performed and responsible pathogens identified. We present our protocol of antibacterial prophylaxis which distinguishes antibiotics given as "ultra short term", "short term", "antibiotic prophylaxis". The results obtained and particularly the total number of infections (3.9%), and the percentage of infections in group 3 (4.6%) and in group 4 (23.1%) procedures validate the usefulness of antibiotic prophylaxis in these patients. In group 1 and group 2 patients the usefulness of antibiotic prophylaxis seems very doubtful.

Aged↗

PubMed1993

The role of antibiotic prophylaxis for tubal microsurgery.

OBJECTIVES: Antibiotic prophylaxis is effective in preventing postoperative wound infections and pelvic cellulitis for a variety of gynecologic procedures. Though frequently used, there is no uniform agreement and little data descriptive of the efficacy of antibiotic prophylaxis for infertility surgery. The purpose of the present study was to determine the incidence of postoperative infection-related complications after microsurgical tubal repair for infertility and to assess the possible role (if any) of antibiotic prophylaxis for tubal surgery. DESIGN: Retrospective; non-comparative; descriptive. MATERIALS AND METHODS: Three hundred and forty-eight tubal procedures were performed over a 3 1/2 year period and included tubal reanastomosis (n = 194), distal salpingostomy (n = 107), fimbrioplasty (n = 15), and tubal reimplantation and cornual isthmic anastomosis (n = 32). All procedures were performed under general anesthesia using standard microsurgical techniques. No prophylactic antibiotics were given. When used, the operating microscope was not draped. Patients were monitored postoperatively for any infection-related complications to include postoperative febrile morbidity, wound infections, and pelvic cellulitis. A computer search of discharge diagnoses and chart review was made to determine the postoperative outcome and hospital course. RESULTS: There were 3 cases of febrile morbidity without localizing signs (0.8%), 3 wound infections (0.8%), 2 incisional seromas (0.5%), and one case of pelvic cellulitis (0.2%). There were no cases of bacteremia, septic shock, or septic pelvic vein thrombophlebitis. All patients responded promptly to incisional drainage or combination antibiotic therapy. CONCLUSION: Data of the present study suggest that the incidence of infection-related complications after tubal surgery without antibiotic prophylaxis is very low. These data suggest that for tubal microsurgery where hemostasis is precise and tissue handling gentle, prophylactic antibiotics may not be necessary. Antimicrobials for prophylaxis, in these circumstances, may offer no advantage in reducing infectious complications that are already extremely low and may in fact cause unfavorable selective processes on endogenous flora and untoward side effects in selected individuals.

Adult↗

PubMed1998

Antibiotic prophylaxis.

During the past 30 years, antibiotic prophylaxis has proved of enormous efficacy in reducing the incidence of surgical wound infections, postoperative morbidity and mortality, the duration of the postoperative period, and the overall cost of surgical treatment. In this paper, the timing and route of administration of antibiotic prophylaxis as well as the dosage and duration, the indications for antibiotic prophylaxis, the importance of the alterations of the delayed hypersensitivity response, and the value of antibiotic prophylaxis for prevention of postoperative septic complications in anergic patients are analyzed. The possibility of combining antibiotic prophylaxis with immunoprophylaxis for high-risk patients is also analyzed.

Antibiotic Prophylaxis↗

PubMed1987

Changing concepts in obstetric antibiotic prophylaxis.

The evolution of antibiotic prophylaxis in cesarean section is traced from the discovery of sulfa compounds in the 1940s to the present. Prolonged courses of antibiotics, initiated before the surgical incision, have given way to shorter, three-dose and even single-dose regimens administered after clamping of the umbilical cord. Several factors have been proposed to help identify patients at greatest risk of infection. Guidelines for antibiotic prophylaxis are reviewed. The effects of antibiotics on host flora are described, and the implications of bacterial resistance for selection of a prophylactic agent, particularly with respect to induction of the Richmond-Sykes type I beta-lactamase enzyme, are discussed.

Anti-Bacterial Agents↗