Protective effect of intraoperative re-dose of prophylactic antibiotics on surgical site infection in diabetic patients: a retrospective cohort study

Abstract

Background: Surgical site infection (SSI) has a high incidence in diabetic surgical patients. Preoperative antibiotic prophylaxis followed by an intraoperative re-dose was a common strategy in diabetic prolonged procedures. However, there were lacking studies on the relative benefits of this strategy on SSI. Our study aimed to clarify the effect of intraoperative re-dose of prophylactic antibiotics on SSI in diabetic patients. Methods: A total of 1,840 diabetic patients with prolonged surgeries were included and Cefazolin was the only type of antibiotic prophylaxis. We assessed the relationship between intraoperative re-dose of cefazolin and 30-day incidence of SSI using a retrospective cohort study method. Results: There were 361 diabetic cases with preoperative antibiotics only and 1,479 cases with pre-plus intraoperative antibiotics, in which 60 subjects suffered from SSI. Pre-plus intraoperative prophylaxis group had a lower rate of SSI in the overall and subgroup analyses when compared with preoperative only group. Operation location, combined with hypertension, poor blood glucose control, high WBC count and ASA score >2 were significantly associated with an increased risk of SSI for diabetic surgical patients (all P<0.05). Intraoperative re-dose of prophylactic antibiotics was statistically related to a lower incidence rate of SSI than preoperative prophylaxis alone (crude RR =0.47; 95% CI, 0.27-0.82; P<0.01), while the association remained significant even after adjusting the potential confounders (adjusted RR =0.51; 95% CI, 0.29-0.90; P=0.02). Conclusions: For diabetic patients, intraoperative re-dose of prophylactic antibiotics may be an independent protective factor for the prevention of SSI. A specific perioperative antibiotics injection strategy should be encouraged for diabetic patients with prolonged surgeries to minimize the possibility of SSI.

Protocol based Surgical Antimicrobial Prophylaxis in Endo-Urologic Surgeries: An Attempt to Convince the Surgeons to Follow the Guidelines

“…20 Study in Italy found only moderate compliance with this recommendation. 21 Whereas 86% adherence to timing of administration prior to incision was noted in study of Berrondo et al 22 SAP was administered 90 min in Bertschi D et al23, De Jong et al 24 study, and was administered 60 minutes before surgery in Kasatpibal et al 25 and Zhang X et al 26 study, In our study non-compliance in pre-op dose timing was seen in only one unit, that was due to some administrative issues and was later on resolved.…”

“…Poor adherence to antibiotic prophylaxis recommendations has been shown in other studies with similar results. 26,27 We tried to evaluate the reasons for non-compliance and it was noted that knowledge gaps, overcautious attitude of the surgeons, fear of losing faith by the patients, and non-availability of the desired drug in the hospital inventory were few of the reasons for the same. One of the most critical reasons noted was the lack of local evidence from the hospital.…”

Role of mechanical and oral antibiotic bowel preparation in children with Hirschsprung’s disease undergoing colostomy closure and pull-through

“…Accordingly, it is suggested that bowel cleansing can be safely omitted in colonic surgery without inducing a higher complication rate. However, results from other studies suggest that the use of MOABP is associated with more favorable outcomes (30)(31)(32)(33)(34). The largest study involves three large retrospective cohort studies of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), targeting colectomy data (32,35,36).…”

Oral GLP-1 Analogue Ameliorates Obesity-Induced Diabetes In Db/Db Mouse

“…However, there are still problems with the aforementioned treatments. For those patients whose condition is not improved by oral medication, bariatric surgery can only be used in a small number of people [9][10][11], and interventional administration of insulin injection also brings endless torment. Reverse-engineer would replace the surgery to nd less invasive and more equivalent therapeutics.…”