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Results for “Antibiotic Prophylaxis”

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PubMed1976

[Antibiotic prophylaxis in intensive care patients].

132 intensive care patients who did not show symptoms of bacterial infection upon admission were subdivided at random into two groups. 69 patients (37 males, 32 females) were given antibiotic prophylaxis with penicillins or cephalosporins and the remaining 63 patients (37 males, 26 females) did not receive any antibiotic prophylaxis. The average age and the median duration of treatment in the intensive care unit was the same for both groups. 1. Antibiotic prophylaxis neither reduced the infection rate nor the mortality. 2. Pleuropulmonary infections were not influenced in respect to incidence, mortality or time of occurrence by antibiotic prophylaxis. 3. The percentage of patients with gram-negative tracheal flora increased significantly from the third day of antibiotic prophylaxis onwards in comparison with those patients without antibiotic prophylaxis. 4. The incidence of, and mortality attributable to septicaemia was not influenced by antibiotic prophylaxis, but septicaemia in patients receiving antibiotic prophylaxis was significantly delayed. From the seventh day on, septicaemia was found more frequently in patients given antibiotic prophylaxis than in patients receiving none. 5. Patients receiving antibiotic prophylaxis acquired significantly fewer urinary tract infections. However, from the fifth day on, there was no difference between the two groups in regard to the rate of incidence of significant bacteriuria. 6. Morbidity and mortality from peritonitis was not influenced by antibiotic prophylaxis. 7. The organisms causing infections in patients who received antibiotic prophylaxis mostly belonged to the enterobacteriaceae, pseudomonas and candida species which were resistant to the antibiotics given prophylactically. The organisms causing infection in the group not receiving antibiotic prophylaxis were coagulase-positive staphylococci in about 50% of the cases, followed by the enterobacteriaceae and pseudomonas species; the resistance patterns towards the tested antibiotics were characteristic of these groups of organisms. 8. Fever proved to be a reliable parameter in establishing the presence or absence of infection. The mean rectal temperature showed a significant difference in medical patients from the second day, in surgical patients from the third day and im polytraumatized patients from the fourth day on, whereas the mean leucocyte counts did not differ significantly in patients with or without infection. 9. Environmental bacteriological studies in the vicinity of the group of patients given antibiotic prophylaxis showed significantly more gram-negative bacteria than in the group without. However, when the groups were subdivided into intubated and non-intubated patients, a significant rise in environmental gram-negative bacteria was found only in intubated patients receiving antibiotic prophylaxis, whereas no such influence of antibiotic prophylaxis was apparent in the non-intubated patients...

Anti-Bacterial Agents↗

PubMed2026

A randomized study of antibiotic prophylaxis after hypospadias repair in children.

BACKGROUND AND OBJECTIVE: Antibiotic resistance is a challenge in contemporary world. Urethroplasty for hypospadias is one of the most common urological surgeries performed around the world, yet, there is still no consensus on the use of antibiotics pre- and post-operatively. Our objective was to analyze the effectiveness of antibiotic prophylaxis and therapy before, during, and after hypospadias repair in children. METHODS: A prospective randomized trial was carried out including patients with coronal hypospadias who underwent urethroplasty performed by one surgeon. Urethral catheters were used in all cases for 10 days. Study participants were randomly assigned in a 1:1:1 ratio to receive a single intraoperative administration of antibiotics (Group I); an intraoperative antibiotic prophylaxis and antibiotic therapy for 10 days until the removal of urethral catheter (Group II); no antibiotic administration (Group III). Randomization was performed using computer-generated permuted blocks with randomly varying block sizes, prepared by an independent statistician. The results were analyzed using the analysis of variance (ANOVA). The following criteria were compared: postoperative functional complications, such as: urethral fistula, stenosis, diverticulum; wound infection symptoms: hyperemia of surgical site, pain during palpation, and symptomatic urinary tract infection. RESULTS: A total of 300 patients were included in the study. Two patients (2%) in Group I, two patients (2%) in Group II, and four patients (4%) in Group III had urethral fistulas, requiring surgery 6 months after primary repair, yet without statistical difference between groups. We found no significant difference in frequency of symptomatic UTIs between three groups (p = 0.182). CONCLUSION: There is no effect of antibiotic prophylaxis and therapy on the frequency of postoperative surgical and infectious complications after urethroplasty for coronal hypospadias repair in children.

Humans↗

PubMed1999

Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP).

BACKGROUND AND STUDY AIMS: Considerable controversy exists regarding the role of antibiotic prophylaxis prior to endoscopic retrograde cholangiopancreatography (ERCP), in that various studies of antibiotic prophylaxis have reached conflicting conclusions. The aim of this meta-analysis is to synthesize the data in order to determine whether antibiotic prophylaxis reduces the rate of occurrence of bacteremia and/or the rate of sepsis/cholangitis among patients undergoing ERCP. PATIENTS AND METHODS: Clinical trials were selected via Medline and Pubmed using subject words and textwords "ERCP", "antibiotic" and "antibiotic prophylaxis". Summary estimates of the risk ratios for the outcomes of bacteremia and sepsis/cholangitis were calculated. RESULTS: After 49 abstracts had been reviewed, seven randomized placebo-controlled trials of antibiotic prophylaxis prior to ERCP were identified. Upon further review, two studies were excluded because patients received antibiotics before and after the ERCP. Four studies reported on the clinical outcome of bacteremia. Five studies reported on the clinical outcome of sepsis/cholangitis. The summary relative risk of the association between antibiotic prophylaxis and bacteremia was 0.39 (95% CI, 0.12-1.29). For sepsis/cholangitis the summary relative risk was 0.91 (95 % CI, 0.39-2.15). CONCLUSIONS: Antibiotic prophylaxis prior to ERCP may reduce the incidence of bacteremia but this has little clinical relevance. Prophylaxis does not substantially reduce the incidence of sepsis/cholangitis and thus the routine use of antibiotic prophylaxis cannot be recommended.

Antibiotic Prophylaxis↗

PubMed2005

Spondylodiscitis after lumbar microdiscectomy: effectiveness of two protocols of intraoperative antibiotic prophylaxis in 1167 cases.

The role of antibiotic prophylaxis in preventing postoperative lumbar spondylodiscitis is still controversial in medical, ethical, economic, and legal terms. The aim of this retrospective study was to evaluate the efficacy of two intraoperative antibiotic prophylaxis protocols in a large series of lumbar microdiscectomies performed in two different neurosurgical centres. We reviewed the outcome of 1167 patients operated on for a lumbar disc herniation with microsurgical technique, in order to detect the incidence of postoperative spondylodiscitis. Group A included 450 patients operated on in a 3-year period in the Neurosurgical Division of the University Hospital of Ancona; group P consisted of 717 patients operated on in a 4-year period in the Neurosurgical Division of the Sandro Pertini Hospital of Rome. In both groups intraoperative antibiotics for prophylaxis were administered, whereas postoperative prophylaxis was not performed. Protocol of group A: single intravenous dose of cefazoline 1 g at induction of general anesthesia and generous washing with saline solution and irrigation with a solution containing rifamicin at the end of microsurgical procedure. Protocol of group P: single-dose of intravenous ampicillin 1000 mg and sulbactam 500 mg at induction of anesthesia and generous irrigation with saline solution at the end of microsurgical procedure. A diagnosis of postoperative spondylodiscitis was made in three out of 450 patients in group A (0.67%) and in 5 out of 717 patients in group P (0.69%). In all cases, treatment consisted of rigid thoraco-lumbar orthesis and 4- to 6-week administration of amoxicillin/clavulanate compound (500/125 mg). The low incidence of postoperative spondylodiscitis obtained with both our protocols seems to confirm that intraoperative antibiotic prophylaxis is associated with the same rate of discitis of prolonged prophylaxis usually still adopted in many centres, but is more advantageous both in terms of welfare and comfort for patients and in economic terms. However, at the moment it is not possible identify the ideal antibiotic for this purpose. It seems to be reasonable to search for the solution through large multicenter prospective studies.

Anti-Bacterial Agents↗

PubMedDate not supplied

Antibiotic prophylaxis.

The use of antibiotic prophylaxis has long been established to prevent the development of invasive infections. In many settings, it is currently considered to be the standard of care to administer antibiotics prior to surgical procedures. The aim is to decrease the load of organisms at the site of manipulation and therefore minimize the appearance of local as well as distant infection. With the increasing number of antimicrobial agents available on the market, physicians are often faced with a dilemma when trying to decide which agent to use. This review addresses the current recommendations of antimicrobial prophylaxis in surgical procedures, in the prevention of infective endocarditis, as well as the prophylaxis required following exposure to highly infective bacteria.

Antibiotic Prophylaxis↗

PubMed1998

Antibiotic prophylaxis after basilar skull fractures: a meta-analysis.

Antibiotic prophylaxis after basilar skull fractures remains controversial. Previous studies have not clearly delineated the utility of prophylactic antibiotics in this setting. We undertook this study to determine if antibiotic prophylaxis after basilar skull fractures prevented meningitis. We performed a formal systematic review of previously published studies after a computerized search with use of the MEDLINE data base (1970-1996). Fourteen studies were identified, and 12 studies met the criteria for inclusion. Study design and quality were assessed by two independent investigators with use of a predetermined protocol. A total of 1,241 patients with basilar skull fractures were included; 719 patients received antibiotics, and 522 patients did not receive antibiotics. Overall results suggest that antibiotic prophylaxis did not prevent meningitis among patients with basilar skull fractures (odds ratio [OR] = 1.15; 95% confidence interval [CI] = 0.68-1.94; P = .678). Patients with basilar skull fractures and cerebrospinal fluid leakage were analyzed separately (OR = 1.34; 95% CI = 0.75-2.41; P = .358), as were children (OR = 1.04; 95% CI = 0.07-14.90; P = 1.000). Antibiotic prophylaxis after basilar skull fractures does not appear to decrease the risk of meningitis.

Antibiotic Prophylaxis↗

PubMed2002

[Tenotoxic potential of fluoroquinolones in the choice of surgical antibiotic prophylaxis in ophthalmology].

PURPOSE: Fluoroquinolones are mainly used in ophthalmic antibiotic prophylaxis because of their broad spectrum activity and good ocular diffusion. But a single oral dose of fluoroquinolones can result in a serious source of tendinopathy and tendon rupture, especially in patients 60 years and older. It seems very important to investigate tendon toxicity of fluoroquinolones to improve the risk-benefit ratio in ophthalmologic antibiotic prophylaxis. MATERIAL: and methods: The intrinsic tenotoxic potential of four fluoroquinolones (pefloxacin, ofloxacin, ciprofloxacin, levofloxacin) was directly evaluated on living adherent tendon cells in microplates. Cell viability and reactive oxygen species production was evaluated using neutral red, alamar blue, and dichlorofluorescin diacetate tests. RESULTS: Results showed a loss of viability associated with free radical production depending on fluoroquinolone molecules. Pefloxacin appeared more tenotoxic but no study has confirmed its efficacy in surgical antibiotic prophylaxis and its use in the patient who is 60 years and older could be disputed. Ciprofloxacin is highly toxic with a low ocular diffusion and seems to be inappropriate for antibiotic prophylaxis. Ofloxacin and levofloxacin are less cytotoxic, associated with good ocular diffusion and a broad antibacterial spectrum. CONCLUSION: Ofloxacin and levofloxacin seem to be good alternatives for improving the risk-benefit ratio in surgical antibiotic prophylaxis in patients 60 years and older.

Achilles Tendon↗

PubMed2002

Antibiotic prophylaxis before peritoneal dialysis catheter insertion.

The use of antibiotic prophylaxis before peritoneal dialysis (PD) catheter insertion has been a matter of great interest for both the surgical and the nephrology community. No uniform consensus exists on the timing, duration, or choice of antibiotic prophylaxis. The exact incidence of early postoperative peritonitis is unknown. The impact of the use of antibiotic prophylaxis in the prevention of early PD peritonitis and in long-term catheter survival is not clear. In that respect, many retrospective and prospective studies have been undertaken in the past, and they have shown conflicting results. Based on extensive data from the surgical and nephrology literature, and also based on our experience, we present a review of the use of antibiotic prophylaxis before peritoneal dialysis catheter insertion.

Anti-Bacterial Agents↗

PubMed1997

The role of antibiotic prophylaxis in severe acute pancreatitis.

OBJECTIVE: To assess the impact of intravenous (IV) antibiotic prophylaxis on the incidence of pancreatic infection and the mortality rate in severe acute pancreatitis. DESIGN: Restropective review of a cohort of 180 patients with severe acute pancreatitis. SETTING: A tertiary referral center in Sacramento, Calif. INTERVENTION: The use of IV antibiotic prophylaxis evolved during 3 periods from no antibiotics in 50 patients (1982-1989), to nonprotocol use in 55 patients (1990-1992), to a 4-week course of imipenem-cilastatin sodium (1993-1996) given to 75 patients having Acute Physiology and Chronic Health Evaluation (APACHE) II scores greater than 6 and pancreatic necrosis (> 15% of the gland), peripancreatic necrosis, or peripancreatic collection. MAIN OUTCOME MEASURES: Pancreatic infection and mortality. RESULTS: Without antibiotic prophylaxis, the incidence of pancreatic infection was 76% (38/50). Intravenous antibiotic prophylaxis reduced the infection rate of 45% (25/55) (P = .03). The imipenem-cilastatin protocol further reduced the infection rate to 27% (20/75) (P = .04). The mortality rates showed only a decreasing trend, from 16% (1982-1989) to 7% (1990-1992) to 5% (1993-1996) (P = .11). Patients with sterile severe acute pancreatitis had a mortality rate of 2% (2/97); whereas 17% (14/83) of patients with infection succumbed to the disease. Patients developing infection within the first 4 weeks from the onset of illness had mortality rates ranging from 19% to 40%, compared with 0% to 8% for those who became infected after 4 weeks. No patient with pancreatic infection developing after 4 weeks died with the imipenem-cilastatin protocol. CONCLUSIONS: Intravenous antibiotic prophylaxis significantly reduced the infection rate in severe acute pancreatitis, with only a trend toward improved survival. A prospective, randomized, double-blind multicenter trial comparing the efficacy of different types and/or combinations of antibiotic prophylaxis in severe acute pancreatitis is indicated.

Acute Disease↗

PubMed2005

Impact of local guidelines and an integrated dispensing system on antibiotic prophylaxis quality in a surgical centre.

Surgical antibiotic prophylaxis is effective in preventing postoperative wound infections. Guidelines are designed to optimize antimicrobial use in this setting. The aim of this study was to assess antibiotic use in surgical prophylaxis in a surgical hospital before and after the implementation of both local antibiotic prophylaxis guidelines and a specific medication set for various surgical procedures. The appropriateness of surgical antibiotic prophylaxis increased from 50.9% in the pre-implementation stage to 94.9% in the postimplementation stage (P<0.001). The implementation of a multidisciplinary protocol and design of medication sets helped to improve the practice of surgical antibiotic prophylaxis.

Antibiotic Prophylaxis↗

PubMed2002

Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding.

BACKGROUND: Bacterial infections are a frequent complication in patients with cirrhosis and gastrointestinal bleeding. Antibiotic prophylaxis seems to decrease the incidence of bacterial infections. Oral antibiotics, active against enteric bacteria, have been most often used as antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding. OBJECTIVES: This review aims to evaluate the effects of antibiotic prophylaxis in the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding. SEARCH STRATEGY: Electronic searches on The Cochrane Hepato-Biliary Group Controlled Trials Register (May 2001), The Cochrane Library (Issue 2, 2001), EMBASE (1980-2001), and MEDLINE (1966-2001); handsearching the references of all identified studies; contacting the first author of each included trial. SELECTION CRITERIA: Randomised clinical trials comparing different types of antibiotic prophylaxis with placebo, no intervention, or another antibiotic to prevent bacterial infections in cirrhotic patients with gastrointestinal bleeding. DATA COLLECTION AND ANALYSIS: Two reviewers independently appraised the quality of each trial and extracted the data from the included trials. Relative risks (RR) or average differences, with their 95% confidence intervals (CI) were estimated. The reviewers assumed an intention to treat basis for the outcome measures. MAIN RESULTS: Eight trials evaluated the effects of antibiotic prophylaxis compared with placebo or no antibiotic prophylaxis in 864 patients. A significant beneficial effect on decreasing mortality (RR 0.73, 95% CI 0.55 to 0.95) and the incidence of bacterial infections (RR 0.40, 95% CI 0.32 to 0.51) was observed. No serious adverse events were reported. The trials showed no significant heterogeneity. Three additional trials evaluated the effects of antibiotics compared with a different regimen of antibiotics in 503 patients. Data could not be combined as each trial used different interventions. None of the examined antibiotic regimens was superior to the control regimen regarding mortality or the incidence of bacterial infections. REVIEWER'S CONCLUSIONS: Antibiotic prophylaxis for cirrhotic inpatients with gastrointestinal bleeding is efficacious in reducing the number of deaths and bacterial infections, are well tolerated, and should be advocated.

Antibiotic Prophylaxis↗

PubMed2002

Prescribing practice for antibiotic prophylaxis for cesarean section in a teaching hospital in Brazil.

BACKGROUND: The contribution of antibiotic prophylaxis to reduce surgical wound infection and endometritis after cesarean section is well-known. Despite the knowledge about the effectiveness of antibiotic prophylaxis with this procedure, the administrative regimens are often inappropriate. METHODS: The use of antibiotic prophylaxis in cesarean section was evaluated in a reference school hospital. Data were collected from medical records, and they correspond to the 9-month observation during 1995 and 1996. RESULTS: The cesarean section rate was 26.4% in this period. The total procedures observed was 587. Antibiotic prophylaxis was prescribed in 358 procedures (61%). Cephalothin was the most prescribed drug (98.6%), with a regimen of 2 g intravenously after clamping of the umbilical cord and 2 more doses of 1g every 6 hours. Antibiotic prophylaxis was indicated more frequently in patients younger than 30 years and in those with rupture of membranes for more than 6 hours; such differences were significant (P <.05 and P <.00001, respectively). CONCLUSION: The prescribers met the hospital guidelines for antibiotic prophylaxis in only 37.1% of the cesarean sections performed.

Adult↗

PubMed1999

Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial.

BACKGROUND AND STUDY AIMS: The most frequent complication reported for percutaneous endoscopic gastrostomy (PEG) is peristomal wound infection which occurs in as many as 30 % of patients. In the studies published so far, the question of whether antibiotic prophylaxis reduces the incidence of peristomal wound infection has remained controversial. We therefore conducted a prospective, randomized trial to determine whether antibiotic prophylaxis can reduce the incidence of peristomal wound infection associated with PEG. PATIENTS AND METHODS: During a 2-year-period a total of 347 patients (251 men, 96 women; mean age 60.2+/-5) were included in our study. In all cases, a 9-French gauge Freka gastrostomy tube was inserted using the "pull" technique. The patients were randomly assigned to three different treatment groups (group 1, antibiotic prophylaxis with 2 g cefotaxime; group 2, antibiotic prophylaxis with 4g piperacillin plus 0.5g tazobactam; group 3, no antibiotic prophylaxis). For a period of one week after gastrostomy, the peristomal area was evaluated using a wound score. According to the score, peristomal infections were classified as being of degree I-IV. Infections of up to degree III were regarded as minor, while an infection of degree IV was defined as a severe complication. RESULTS: PEG tubes were successfully placed in 336/347 patients (97 %). Of the 336 patients, 29 were excluded because of incomplete follow up (dropout rate 9%). Cases included were: in group 1, n = 101; in group 2, n = 100, and in group 3, n = 106. There was no mortality related to PEG insertion. There were five instances of severe complications (1.6%). Patients who received antibiotic prophylaxis had mean daily combined wound scores that were significantly lower than those of patients without antibiotic prophylaxis (P < 0.01). The control group (no antibiotic prophylaxis) exhibited significantly more peristomal wound infections of degree III (n = 8) than antibiotic prophylaxis group 1 (n = 0, P < 0.001) or antibiotic prophylaxis group 2 (n = 1, P < 0.012). Three patients in group 3 (no antibiotic prophylaxis) and one patient in group 2 developed peritonitis. CONCLUSIONS: Severe wound infections requiring medical or endoscopic intervention are very rare events after PEG insertion. Antibiotic prophylaxis significantly reduces the risk of peristomal wound infection associated with PEG insertion. Antibiotic prophylaxis, therefore, is to be recommended as a general measure in percutaneous endoscopic gastrostomy.

Antibiotic Prophylaxis↗

PubMed1999

Prescribing practice for antibiotic prophylaxis for 3 commonly performed surgeries in a teaching hospital in Brazil.

BACKGROUND: The contribution of antibiotic prophylaxis to reduce surgical wound infection for some procedures is well known. In spite of extensive knowledge about the effectiveness of antibiotic prophylaxis, its administrative regimens are often inappropriate. METHODS: Antibiotic prophylaxis was evaluated in a university-affiliated community teaching hospital. Data were collected from medical records of patients undergoing cholecystectomy, hysterectomy, and herniorrhaphy during a 9-month observation period. A total of 598 procedures were observed. Data were collected about the patient, the surgery, and the antibiotic prophylaxis. RESULTS: Based on the existing guidelines, the choice to use the prophylactic antibiotic was correct in 75% of the cases. Of these cases, only 3% of the patients received the recommended regimen according to the proposed procedure. It was verified that antibiotic prophylaxis was performed more frequently in patients undergoing open cholecystectomy than laparoscopic cholecystectomy (P =.004). In 46% of the cholecystectomies, more than 4 doses were administered. In hysterectomy, a single dose was used in 54% of the patients, and the antibiotic was administered preoperatively in 80% of the cases. Prophylactic antibiotics were used in 47% of herniorrhaphies. CONCLUSION: The surgeons infrequently met the hospital guideline for antibiotic prophylaxis, and compliance varied by type of procedure.

Anti-Bacterial Agents↗

PubMed2003

[Evidence-based antibiotic prophylaxis in aseptic orthopedic surgery].

Disagreement exists on the topic of antibiotic prophylaxis in aseptic orthopedic surgery. No evidence on the usefulness of prophylactic antibiotic administration exists with regard to non-complex aseptic surgeries without placement of osteosynthetic material. Likewise, no undisputed evidence exists on the usefulness of antibiotic prophylaxis with regard to aseptic orthopedic surgeries involving placement of osteosynthetic material. However, the majority of experts agree on antibiotic prophylaxis in the latter cases. In contrast clear evidence does exist regarding the usefulness of antibiotic prophylaxis with first- or second-generation cephalosporins for surgeries of the hip involving fracture treatment or prosthetic replacement. The prophylactic use of glycopeptides should be confined to cases of high MRSA or MRSE risk. Administration of prophylactic antibiotics should precede incision time by around 30 min and tourniquet inflation by at least 10 min. Antibiotic administration may be repeated in the OR when surgery lasts longer than 3 h. The use of local antibiotics in bone cement has not proven useful as a prophylactic measure.

Anti-Bacterial Agents↗

PubMed2004

Antibiotic prophylaxis in dialysis patients undergoing invasive dental treatment.

BACKGROUND AND AIMS: The role of antibiotic prophylaxis for invasive dental procedures in patients on dialysis therapy is unclear. We examined current clinical practice in Australia and New Zealand and compared our findings to a systematic review of the current literature. METHODS: Australian and New Zealand nephrology units were surveyed with regard to their use of antibiotic prophylaxis for dental procedures. A systematic review of the literature was performed by using an online web-based search engine (PubMed) using the key words: renal patients, dental and antibiotic prophylaxis. RESULTS: Forty-one per cent of respondents do not routinely give antibiotic prophylaxis to haemodialysis patients prior to dental surgery, but a majority (53%) would consider antibiotic prophylaxis if the patient had a synthetic arteriovenous fistula. CONCLUSIONS: The majority of clinicians follow the American Heart Association (AHA) guidelines with a single oral preoperative dose of 2 g amoxycillin or 600 mg clindamycin if patients are allergic to penicillin. From the literature and the data obtained by questionnaire, it would appear that renal patients receiving haemodialysis in Australia and New Zealand receive antibiotic prophylaxis prior to invasive dental procedures. The standard single dose of 2 g amoxycillin orally or 600 mg clindamycin orally 1 h preoperatively, as recommended by the AHA, is most frequently used. Peritoneal dialysis patients generally do not receive a prophylactic dose of antibiotics.

Antibiotic Prophylaxis↗

PubMed1999

Preoperative microbiologic screening and antibiotic prophylaxis in pulmonary resection operations.

BACKGROUND: Pulmonary resection is associated with considerable risk of infection, so antibiotic prophylaxis has become routine practice in pulmonary operations. We studied two standard flash antibiotic prophylaxis regimens and matched them to preoperatively acquired microorganisms. METHODS: In 120 patients scheduled for elective pulmonary resection, aspirates were taken separately from the left and the right lung using a double-lumen tube. Then the patients received either 1.5 g of sulbactam plus ampicillin (n = 60; group 1) or 2 g of cefazolin (n = 60; group 2) intravenously as a single-shot antibiotic prophylaxis according to a prospective randomized sequence. When bacteria were found in the aspirates, both antibiotics were tested for susceptibility. The patients were monitored for the first 3 postoperative days with regard to bronchopulmonary infections. RESULTS: Fifty-eight pathogens were isolated from the 120 patients. The cultured bacteria did not differ significantly between the two groups. In group 1 all found bacteria were susceptible to the used antibiotic prophylaxis, whereas in group 2 eight of the 25 found bacteria were not susceptible to antibiotic prophylaxis. Postoperatively, group 2 showed significantly more signs of bronchopulmonary infections than the group 1 and subsequently needed additional antibiotics more often. Intensive care unit stay was longer in patients of group 2 and costs were higher for these patients. CONCLUSIONS: Preoperative microbiologic examination could be helpful to evaluate efficacy of the antibiotic prophylaxis regimen. Sulbactam plus ampicillin was significantly more effective than cefazolin.

Ampicillin↗

PubMed1999

Prosthetic joints, dental treatment, and antibiotic prophylaxis.

Dentists should be familiar with the newest antibiotic prophylaxis recommendations for joint prosthesis patients undergoing dental treatment. The guidelines identify physical conditions that place joint patients at the highest risk for joint sepsis. They also stratify dental procedures into higher- and lower-risk categories. Combining these two groupings clarifies the dentist's strategy for antibiotic prophylaxis regimens, which are greatly simplified. Of notable importance is the elimination of posttreatment antibiotic dosing. A large group of patients who do not require antibiotic prophylaxis prior to dental treatment are also identified by the guidelines. Every dentist must use clinical judgment, knowledge of the patient, and consultation with the attending physician to determine the appropriate treatment plan.

Antibiotic Prophylaxis↗