Antimicrobial Prophylaxis in Adults

Enzler, Mark J.; Berbari, Elie F.; Osmon, Douglas R.

doi:10.4065/mcp.2011.0012

Cited by 178 publications

(120 citation statements)

References 120 publications

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“…Although appropriate AP plays a pivotal role in reducing the rate of SSIs [10], other factors that impact SSI rates should not be ignored. Antibiotic prophylaxis should never substitute for good medical practices, such as those of infection prevention and control.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

Antimicrobial Stewardship: A Call to Action for Surgeons

Sartelli

Duane

Catena

et al. 2016

Surgical Infections

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Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients.Keywords: antibiotic prophylaxis; intra-abdominal infection; necrotizing soft tissue infection; surgical site infection; trauma A lthough most surgeons are aware of the problem of antimicrobial resistance, most underestimate this problem in their own hospital. Surgeons should always optimize antimicrobial management to maximize clinical outcome and minimize emergence of antimicrobial resistance. The necessity of formalized systematic approaches to the optimization of antibiotic therapy in the setting of surgical units worldwide, both for elective and emergency admissions, has become increasingly urgent.In 2013, a Cochrane review was published to estimate the effectiveness of professional interventions in antibiotic stewardship for hospital inpatients and to evaluate the impact of these interventions on reducing the incidence of antimicrobial resistance or Clostridium difficile infection [1]. The results showed that interventions to reduce excessive antibiotic prescribing to hospital inpatients were able to reduce antimicrobial resistance and hospitalacquired infections (HAIs), improving clinical outcome. The meta-analysis supported the use of restrictive interventions when the need is urgent, but suggested that persuasive and restrictive interventions are equally effective after six months.

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Section: Antibiotic Prophylaxismentioning

confidence: 99%

Antimicrobial Stewardship: A Call to Action for Surgeons

Sartelli

Duane

Catena

et al. 2016

Surgical Infections

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“…The selection of antibiotic should be taken into consideration for its safety, cost-effectiveness, and active against commonly encountered pathogens based on the type of procedures which will be guided by local resistance patterns [12][13][14]. Usually first and second-generation cephalosporins are appropriate prophylaxis for most procedures, although coverage of anaerobes is necessary for colon and some gynecologic surgery [12].…”

Section: Introductionmentioning

confidence: 99%

“…However, contaminated or dirty wounds are already infected and need therapeutic pre-operative antibiotics not for prophylactic purposes [12,14,15] The intention of perioperative prophylaxis is to attain therapeutic levels of antibiotic agents in the tissues at the time of microbial contamination. Therefore timing of administration is critical in order to ensure effective drug levels, as both early and late administration are associated with increased infection rates [12,17].…”

Section: Introductionmentioning

confidence: 99%

Timing of Prophylactic Antibiotic Administration in Elective Surgical Patients at Jimma University Teaching Hospital: South West Ethiopia

Jisha¹

2016

J Anesth Clin Res

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Study objective: To evaluate the timing of prophylactic antibiotic administration in elective surgical patients, and anesthetists' opinion regarding this issue.Design: Prospective, facility based cross-sectional study was employed. Setting: Jimma university teaching hospital (JUTH)Patient: Elective surgical patients and anesthesia professional of the hospital.Measurement: Data were collected prospectively from all elective surgical patients (except emergency, obstetric cases) and interred in predesigned forms as per existing protocol in JUTH from February 01 to March 30, 2014. The time of antibiotic prophylactic administration in respect to incision time was analyzed and descriptive result was presented as percentages of total responses.Main results: Prophylactic antibiotics was given before skin incision for 107 (79.9%) patients and 27 (20.1%) after skin incision. However; only 75 (56%) patients were get administered within proper time (60minutes) and the mean time of preoperative administration was 66+24 minutes. Prophylactic antibiotic medication was continued for >24 hours in 95% cases and re-dosing were not given for six surgical procedures which lasted >3 hours.Out of 26, only 71% anesthetists could mention the recommended time of antibiotic prophylaxis administration. About 21(80.8%) of anesthetists agreed that its surgeon's responsibility for preoperative antibiotic selection and shared with nurses for preoperative administration. Anesthetists assume that they are responsible for confirmation of pre-incision administration and repeat administration during prolonged surgery. They indicated training was inadequate and deemed necessary in 77% of participants. Conclusion:The timing of prophylactic antibiotic administration was below the standard of practice. Hospital administration and infection control officer should work to improve compliance in accordance with published evidence-based guidelines.

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“…4,13,14 For the genitourinary tract, fluoroquinolones, cephalosporins and aminoglycosides have been recommended for antibiotic prophylaxis because of their prolonged half-life, relatively broad spectrum of action, minimal side effects and low price. 9,15 However, the risk of nephrotoxicity associated with aminoglycosides limits their use when other active agents are available. Both fluoroquinolones and cephalosporins have proven useful in antibiotic prophylaxis 10,16 without apparent differences in efficacy between these two antibiotic classes.…”

mentioning

confidence: 99%

Antibiotic prophylaxis in retrograde ureteroscopy: what strategy should we adopt?

Pricop,

Dorobăț,

Puia

et al. 2103

GERMS

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Background Retrograde ureteroscopy as a minimally invasive treatment of ureteral calculi can be complicated by the occurrence of urinary tract infections. Fever is considered the main indicator of such postoperative complications and we aimed to study its incidence in patients with and without preoperative antibiotic prophylaxis.Methods We included all patients who underwent retrograde ureteroscopy for ureteric stones in the Iași and Tg Mureș Urology Clinics from 2009 to 2012. Data were statistically analyzed using the EpiInfo 7 software. Indicative of a statistically significant difference was a p value <0.05.Results We recorded fever in a total of 108 cases, accounting for 22.83% of all subjects in the study. Group 1 included patients who received antibiotic prophylaxis; 48 of 147 (32.65%) were febrile, compared with Group 2 (no antibiotic prophylaxis), where we recorded febrile syndrome in 60 (18.40%) cases, p=0.0009. Comparing the two groups based on calculus size, for stones with diameters of 0.6-0.8 cm 38.71% of patients were febrile in Group 1, compared with 10.88% in Group 2 (p=0.0008). Secondary ureterohydronephrosis did not statistically influence the frequency of fever in any of the studied groups.Conclusion Less than half of all febrile patients had positive urine cultures, which may point to other causes, such as noninfectious factors (aseptic kidney inflammation). This study did not prove the efficiency of preoperative antibiotic prophylaxis; however, based on the clinical experience of the past 120 years, infectious complications are known to be associated with urological maneuvers and prophylaxis could be indicated.

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Antimicrobial Prophylaxis in Adults

Cited by 178 publications

References 120 publications

Antimicrobial Stewardship: A Call to Action for Surgeons

Antimicrobial Stewardship: A Call to Action for Surgeons

Timing of Prophylactic Antibiotic Administration in Elective Surgical Patients at Jimma University Teaching Hospital: South West Ethiopia

Antibiotic prophylaxis in retrograde ureteroscopy: what strategy should we adopt?

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