Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections

Abstract

Background Antibiotic-resistant infections have high rates of morbidity and mortality and exposure to antibiotics is the crucial risk factor for development of antibiotic resistance. If surgical antibiotic prophylaxis (SAP) increases risk for antibiotic-resistant infections, prophylaxis may cause net harm even if it decreases overall infection rates. Study Design This retrospective cohort study included adults who underwent elective surgical procedures and developed infections within 30 post-operative days. Surgeries from multiple disciplines were included if SAP was considered discretionary by current guidelines. Postoperative antibiotic-resistant infections were defined as positive culture results from any site within 30 post-operative days showing intermediate or non-susceptibility across one or more antibiotic classes. SAP included use of antibiotics within any class and at any dose from one hour before first incision until the end of the operation. Results Among 689 adults with post-operative infections, 338 (49%) had post-operative resistant infections. Use of SAP was not associated with post-operative antibiotic-resistant infections (OR 0.99, 95% CI 0.67–1.46). This result remained robust when the SAP definition was extended to antibiotics given within 4 hours before first incision (OR 0.94, 95% CI 0.63–1.40) and when the follow-up window was narrowed to 14 days (OR 0.82, 95% CI 0.50–1.34). Prior antibiotic-resistant infections were associated with risk for post-operative antibiotic-resistant infections (OR 1.81, 95% CI 1.16–2.83). Conclusion Use of SAP was not associated with risk for post-operative antibiotic resistant infections in a large cohort of patients with post-operative infections. This provides important reassurance regarding use of surgical antibiotic prophylaxis.

Effect of Bifidobacterium breve in Combination With Different Antibiotics on Clostridium difficile

“…Two or more antibiotics are commonly used in combination in clinical therapy to address not only CDI, but also other conditions, such as postoperative infections (Cohen et al, 2017; Guh and Kutty, 2018; Kunutsor et al, 2018; Takoudju et al, 2018). Therefore, some types of antibiotics have to be used in combination even though the combination may exacerbate CDI (or lead to rCDI).…”

Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study

“…The choice of prophylactic antibiotics, dose, timing and duration of therapy play an important role in this reduction, however, remain controversial [ 10 , 11 ]. Surgical antibiotic prophylaxis is meant to reduce postoperative complications, but on the other hand, it increases the risk of antibiotic resistance [ 10 , 13 ]. Antibiotic resistance makes routine orthopedic surgeries more challenging, which can result in physical disabilities and life-threatening infections [ 14 ].…”

Sterilization Procedure for Temperature-Sensitive Hydrogels Loaded with Silver Nanoparticles for Clinical Applications

“…Postoperative infections are a significant source of preventable perioperative morbidity and mortality, being a burden for patients’ quality of life and health care systems [22,23]. Prophylactic antibiotics have been used to prevent nosocomial infections but their effects are often impaired by the development of highly resistance bacterial strains [24,25,26]. To circumvent antibiotic resistance and provide postoperative infection prophylaxis, AgNPs were loaded within the HG as silver ions have strong antimicrobial activity, even against most resistant strains [27,28].…”