Preoperative Antibiotics for Dialysis Access Surgery: Are They Necessary?

Gray, Kelsey; Korn, Abraham; Zane, Joshua; Alipour, Hamid; Kaji, Amy H.; Bowens, Nina; Virgilio, Christian de

doi:10.1016/j.avsg.2018.02.004

Cited by 9 publications

(4 citation statements)

References 10 publications

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“…uninfected incisions with no inflammation and/or without entrance into the gastrointestinal GU tracts) single-dose AP coverage for usual skin flora may not be necessary (tables 3 and 4 in supplementary unabridged BPS, https://www.jurology.com). Recent studies of Class I/clean outpatient urologic procedures 14 including minimally invasive surgery for renal and adrenal tumors, 15 arteriovenous fistula, and graft creation, 16 as well as some Class II/clean contaminated procedures, such as ureteroscopy, 17 have not demonstrated a significant benefit of AP. However, groin, and presumably perineal incisions, may confer an increased risk of SSI, and a single-dose AP may be considered for these cases.…”

Section: Class I/clean Proceduresmentioning

confidence: 99%

Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis

et al. 2020

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Purpose: The primary rationale for antimicrobial prophylaxis (AP) is to decrease the incidence of surgical site infection (SSI) and other preventable periprocedural infections, with the secondary goal of reducing antibiotic overuse. This Best Practice Statement (BPS) updates the prior American Urological Association (AUA) BPS and creates a comprehensive and user-friendly reference for clinicians caring for adult patients who are undergoing urologic procedures. Materials and Methods: Recommendations are based on a review of English language peer-reviewed literature from 2006 through October 2018 and were made by consensus by a multidisciplinary panel. The search parameters included timing, re-dosing, and duration of AP across urologic procedures where there was the possibility of SSI. Excluded from the search were the management of infections outside the genitourinary (GU) tract and pediatric procedures. Results: Single-dose AP is recommended for most urologic cases and antimicrobials should only be used when medically necessary, for the shortest duration possible, and not beyond case completion. Surgeons are the most accurate discerners of an SSI, and should use standard definitions to make better calculations of patient risk. The risk classification developed is dependent on the likelihood of developing SSI, and not the associated consequences of SSI. Conclusions: The AUA developed a multi-disciplinary BPS to guide clinicians on the proper usage of AP across urologic procedures and wound classifications. It is recommended that the lowest dose of antimicrobials be administered to decrease the risk of infection and to minimize the risk of drug-resistant organisms.

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Section: Class I/clean Proceduresmentioning

confidence: 99%

Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis

et al. 2020

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“…The benefit of administering surgical antibiotic prophylaxis prior to other dialysis access surgeries has not been consistent. 13 A targeted AMS intervention is to ensure optimal implementation of these practices since one of the concerns is that the indication, choice, dose, administration time, or duration of antibiotic prophylaxis in peritoneal dialysis catheter insertion may be inappropriate, or that antibiotics may be used as surgical prophylaxis without clear indication. 14 , 15 Establishing a dedicated HD surgical prophylaxis improvement project can be a low-hanging AMS fruit.…”

Section: Methods and Resultsmentioning

confidence: 99%

Intermittent hemodialysis: a review of the top antimicrobial stewardship practices to be employed

Shamas,

Khamis,

Eljaaly

et al. 2024

ASHE

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The vulnerability of patients on hemodialysis (HD) to infections is evident by their increased susceptibility to infections in general and to resistant organisms in particular. Unnecessary, inappropriate, or suboptimal antimicrobial prescribing is common in dialysis units. This underscores the need for dedicated antimicrobial stewardship (AMS) interventions that can be implemented both in the inpatient and outpatient settings. In this review, we provide a comprehensive approach for clinicians with the most updated coordinated AMS principles in HD setting in six areas: prevention, diagnosis, treatment, education and empowerment, monitoring, and research.

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“…Previous studies and clinical experience have identified multiple strategies for reducing the rate of infection. The use of strict sterile technique in the surgical environment during arteriovenous access surgery and the administration of prophylactic antibiotics can reduce surgical site infection rates, although prophylactic antibiotic use remains controversial [ 34 , 35 ]. In addition to the aseptic technique, the buttonhole technique should not be used for arteriovenous cannulation due to the high rate of infection [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

et al. 2023

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Background and Objectives: This study was conducted to investigate whether Pseudomonas aeruginosa (PA) infections of arteriovenous grafts (AVGs) recur more frequently than other bacterial infections following treatment with revision. Materials and Methods: Operative procedures, including total excision, subtotal excision, and revision, were performed on 60 patients to treat 65 AVG infections. Final outcomes were classified as no infection recurrence, infection recurrence, and death without prior recurrence. In the competing risk setting, the cumulative incidence was estimated using the cumulative incidence function and Gray’s test, and the associations between outcomes and different variables were estimated using a subdistribution hazard (SDH) model. Results: Comparing AVG infections with and without recurrence, PA infection was not associated with a higher risk of infection recurrence (p = 0.13); however, the first operative procedure type was associated with infection recurrence (p = 0.04). AVGs with PA infection were associated with a higher total number of surgical interventions (p < 0.05) than AVGs without PA infection. Regarding the cumulative incidences of outcomes, for AVGs treated with subtotal excision or revision, the cumulative incidence of recurrent infection was 3.3-fold higher for those with PA infection than without one year after the first surgery. However, when AVGs were treated with revision alone, the cumulative incidence was 4.1-fold. After excluding AVGs treated with total excision, the SDH model was applied, obtaining a hazard ratio for infection recurrence of 16.05 (p = 0.02) for AVGs with PA infection compared with AVGs without PA infection. No other variables were significantly associated with infection recurrence. Conclusions: For subtotal resection and revision, AVGs infected with PA had a higher recurrence rate than those infected with other species. However, revision surgery may aggravate the recurrence rate.

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Preoperative Antibiotics for Dialysis Access Surgery: Are They Necessary?

Cited by 9 publications

References 10 publications

Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis

Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis

Intermittent hemodialysis: a review of the top antimicrobial stewardship practices to be employed

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

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