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Sample records for antibiotic prophylaxis

  1. ANTIBIOTIC PROPHYLAXIS ON ESTOMATOLOGY

    OpenAIRE

    Rodríguez Alfaro, Miguel; Responsable de la cátedra de Farmacología de la Facultad de Odontología UNMSM.; Burga Sánchez, Jonny; Catedrático de Farmacología de la Facultad de Odontología UNMSM.; Chumpitaz Cerrate, Víctor; Catedrático de Farmacología de la Facultad de Odontología UNMSM.; Varas Hilario, Roberto; Catedrático de Farmacología de la Facultad de Odontología UNMSM.; Guerra Sanguinetti, Jaime; Cirujano Dentista de la Facultad de Odontología UNMSM.; López Bellido, Roger; Bachiller de la Facultad de Odontología UNMSM.; Zegarra Cuya, Juan; Interno de la Facultad de OdontoIogia UNMSM.

    2014-01-01

    Surgical antibiotic prophylaxis consists in the use of an antimicrobial drug in a preventive way, that must be active against microorganisms that in high frequency causes posterior infections of our surgical wounds and maintain effective tissue concentrations along the surgery procedure and the posterior time when appears the bacteremia. To reach a successful treatment is necessary to have the knowledge of the resident bactemial flora and the pathogenous flora that infects our surgical wounds...

  2. Antibiotic prophylaxis for patients undergoing elective endoscopic ...

    African Journals Online (AJOL)

    Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. M Brand, D Bisoz. Abstract. Background. Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. We set out to assess the current antibiotic prescribing practice among ...

  3. Antibiotic prophylaxis in genitourinary surgery.

    Science.gov (United States)

    Childs, S J; Wood, P D; Kosola, J W

    1981-01-01

    Antibiotic prophylaxis in surgery, particularly genitourinary surgery, has been controversial for years. At best, the results have been more testimonial than scientific because of the failure to observe proper experimental design. A survey of the literature indicates that antibiotic prophylaxis in genitourinary surgery probably has little influence on postoperative fever; it appears to favorably affect the incidence of postoperative bacteriuria and bacteremia in the short term without encouraging nosocomial or resistant infections. The regimen for prophylaxis must be perioperative and continued for no longer than 24 hours postoperatively. Given that antibiotic prophylaxis in elective genitourinary surgery has merit, a comparison between cefazolin and cefotaxime was undertaken. Of 160 evaluable cases, a total of 23 patients had positive cultures within the first nine days; only two occurred within the first five days. When cefazolin and cefotaxime were administered in the same dosage regimen, the infection rate for cefazolin was 19% compared with 10% for cefotaxime.

  4. [Antibiotic prophylaxis in colorectal surgery].

    Science.gov (United States)

    Hrivnák, R; Hanke, I; Hansliánová, M; Kala, Z; Sevcíková, A

    2009-06-01

    Antibiotic (ATB) prophylaxis is generaly recommended in surgery. There is an important role in colorectal surgery especially. Colorectal surgery is associated with a particularly high risk of post-operative infection because of contamination of the wound with faecal bacteria. ATB prophylaxis decreases surgical wound infection, morbidity and mortality as well. Morbidity and mortality are associated with longer hospital stays and increased costs of care. At surgical department of Faculty hospital Brno, during March-June 2008 an 88 patients were operated because of different diagnoses in colorectum. Both an emergent and schedule operations were made. Type of ATBs, time of application before operation, reapplication after operation and surgical site infection (SSI), in - hospital stay were followed up prospectively. SSI were divided into superficial, deep and intraabdominal. Data were analyse statistically. The most used combination of ATBs, almost in 91%, were Cefazoline and Metronidazole. In 50% were time of application till 20 minutes before incision. Only in 17% were time of application in interval 20-30 minutes before incision, which is recommended. We noticed 25 SSI. We prove that patients with SSI has almost two-times longer in-hospital stay. Enterococcus and enterobacterias were the most common etiological agents. ATB prophylaxis is indicated in colorectal surgery. It has to be applied in correct dose and right time before operation to decrease SSI.

  5. Antibiotic prophylaxis in craniotomy : a review

    NARCIS (Netherlands)

    Liu, Weiming; Ni, Ming; Zhang, Yuewei; Groen, Rob J. M.

    The effectiveness of antibiotic prophylaxis (AP) in craniotomies has been clarified through the accumulation of evidence and increased antibiotic knowledge. This paper focuses on the use of AP in craniotomies during different historical periods and collects highly relevant evidence on this issue.

  6. Cardiac surgery antibiotic prophylaxis and calculated empiric antibiotic therapy.

    Science.gov (United States)

    Gorski, Armin; Hamouda, Khaled; Özkur, Mehmet; Leistner, Markus; Sommer, Sebastian-Patrick; Leyh, Rainer; Schimmer, Christoph

    2015-03-01

    Ongoing debate exists concerning the optimal choice and duration of antibiotic prophylaxis as well as the reasonable calculated empiric antibiotic therapy for hospital-acquired infections in critically ill cardiac surgery patients. A nationwide questionnaire was distributed to all German heart surgery centers concerning antibiotic prophylaxis and the calculated empiric antibiotic therapy. The response to the questionnaire was 87.3%. All clinics that responded use antibiotic prophylaxis, 79% perform it not longer than 24 h (single-shot: 23%; 2 doses: 29%; 3 doses: 27%; 4 doses: 13%; and >5 doses: 8%). Cephalosporin was used in 89% of clinics (46% second-generation, 43% first-generation cephalosporin). If sepsis is suspected, the following diagnostics are performed routinely: wound inspection 100%; white blood cell count 100%; radiography 99%; C-reactive protein 97%; microbiological testing of urine 91%, blood 81%, and bronchial secretion 81%; procalcitonin 74%; and echocardiography 75%. The calculated empiric antibiotic therapy (depending on the suspected focus) consists of a multidrug combination with broad-spectrum agents. This survey shows that existing national guidelines and recommendations concerning perioperative antibiotic prophylaxis and calculated empiric antibiotic therapy are well applied in almost all German heart centers. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  7. No. 247-Antibiotic Prophylaxis in Obstetric Procedures.

    Science.gov (United States)

    van Schalkwyk, Julie; Van Eyk, Nancy

    2017-09-01

    To review the evidence and provide recommendations on antibiotic prophylaxis for obstetrical procedures. Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in obstetrical procedures. Published literature was retrieved through searches of Medline and The Cochrane Library on the topic of antibiotic prophylaxis in obstetrical procedures. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and articles published from January 1978 to June2009 were incorporated in the guideline. Current guidelines published by the American College of Obstetrics and Gynecology were also incorporated. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). Implementation of this guideline should reduce the cost and harm resulting from the administration of antibiotics when they are not required and the harm resulting from failure to administer antibiotics when they would be beneficial. RECOMMENDATIONS. Copyright © 2017. Published by Elsevier Inc.

  8. Antibiotic prophylaxis in clean general surgery

    International Nuclear Information System (INIS)

    Ahmed, M.; Asghar, I.; Mansoor, N.

    2007-01-01

    To find out the incidence of surgical site infection in clean general surgery cases operated without prophylactic antibiotics. One hundred and twenty-four clean surgical cases operated without antibiotic prophylaxis between July 2003 and December 2004, were studied and these were compared with similar number of cases who received antibiotics. The data was collected and analyzed using software SPSS (version 10.0). Chi-square and student-t test were used to analyze the association between antibiotics and wound infection. The most frequent operation was repair of various hernias, 69.3% in group A and 75% in group B. More operations were carried out between 21-30 years, 38.7% in group A and 41.9% in group B. Surgical site infection occurred in one patient (0.8%) in each group. Chi-square test (0.636) applied to group A and B showed no association of infection and administration/ no administration of antibiotics (p > 0.25). The t-test applied on group A and B (t=0) also showed no significant difference between administration of antibiotics/ no-antibiotics and infection (p > 0.25). The use of prophylactic antibiotic in clean, non implant and elective cases is unnecessary. (author)

  9. Antibiotic prophylaxis in third molar surgery: a review

    NARCIS (Netherlands)

    Oomens, M.A.E.; Forouzanfar, T.

    2012-01-01

    Objective: Controversy exists about the efficacy of antibiotic prophylaxis in preventing complications after lower third molar surgery. For evidence-based recommendation, a review was performed on clinical trials reporting the use of antibiotic prophylaxis compared with no treatment or placebo with

  10. Antibiotic prophylaxis in third molar surgery: a review

    NARCIS (Netherlands)

    Oomens, M.A.E.; Forouzanfar, T.

    2012-01-01

    Objective Controversy exists about the efficacy of antibiotic prophylaxis in preventing complications after lower third molar surgery. For evidence-based recommendation, a review was performed on clinical trials reporting the use of antibiotic prophylaxis compared with no treatment or placebo with

  11. [Assessment of antibiotic prophylaxis adequacy in rectal surgery].

    Science.gov (United States)

    Del-Moral-Luque, J A; Colás-Ruiz, E; Gil-Yonte, P; Fernández-Cebrián, J M; Villar-Del-Campo, M C; Delgado-Iribarren, A; Valverde-Cánovas, J F; Rodríguez-Caravaca, G

    2017-02-01

    Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection (SSI), so the development of guidelines and assessment of its monitoring is essential. In this study protocol compliance of antibiotic prophylaxis in rectal surgery and the effect of its adequacy in terms of pre-ention of SSI was assessed. Prospective cohort study was conducted from 1 January 2009 to 30 December 2015. The degree of compliance with antibiotic prophylaxis and causes of non-compliance in rectal surgery was evaluated. The incidence of SSI was studied after a maximum period of 30 days of incubation. To assess the effect of prophylaxis non-compliance on SSI the relative risk (RR) adjusted with the aid of a logistic regression model was used. The study covered a total of 244 patients. The patients infected reached 20 cases with a SSI cumulative incidence of 8.2% (CI95%: 4.8-11.6). Antibiotic prophylaxis was indicated in all patients and was administered in 98% of cases, with an overall protocol compliance 92.5%. The principal cause of non-compliance was the choice of antibiotic 55.6% (n=10). The effect of inadequacy of antibiotic prophylaxis on surgical infection was RR=0.58, CI95%: 0.10-4.10 (P>0.05). Compliance with antibiotic prophylaxis was high. No relationship between the adequacy of prophylaxis and incidence of surgical site infection in rectal surgery was found.

  12. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy.

    Directory of Open Access Journals (Sweden)

    Francesco Napolitano

    Full Text Available BACKGROUND: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy and the factors associated with a poor adherence. METHODS: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

  13. Prophylaxis for infective endocarditis: antibiotic sensitivity of dental plaque.

    OpenAIRE

    MacFarlane, T W; McGowan, D A; Hunter, K; MacKenzie, D

    1983-01-01

    The antibiotic sensitivity pattern of bacteria isolated from bacteraemia after dental extraction was compared with that of bacteria isolated from dental plaque samples from the same patient. The results supported the current practice of using penicillin and erythromycin empirically for prophylaxis. The prediction of the most appropriate antibiotic for prophylaxis using dental plaque samples was most accurate when the minimum inhibitory concentration (MIC) of plaque isolates were used. It appe...

  14. Antibiotic prophylaxis for dental implant placement?

    Science.gov (United States)

    Keenan, James R; Veitz-Keenan, Analia

    2015-06-01

    Electronic searches without time or language restrictions were performed in PubMed, Web of Science and the Cochrane Oral Health Group trials Register. A vast manual search was done in many dental implant-related journals. Reference lists were scanned for possible additional studies. Ongoing clinical trials were also searched. Titles and abstracts of the reports identified were read independently by the three authors. Disagreements were resolved by discussion. Rejected studies were recorded with the reasons for exclusion. The inclusion criteria included clinical human studies, either randomised or not, comparing the implant failure/survival rates in any group of patients receiving antibiotic prophylaxis versus not receiving antibiotics prior to implant placement. Case reports and non-human studies were excluded. Implant failure was considered as complete loss of the implant. Data were extracted by the authors. Study risk of bias was assessed. Implant failure and post-operative infection were the outcomes measured, both dichotomous outcomes. Results were expressed using fixed or a random effect model depending on the heterogeneity calculated using an I(2) statistical test. The estimate of relative effect was expressed in risk ratio (RR) with 95% confidence interval. Number needed to treat (NNT) was calculated and sensitivity analysis was performed to detect differences among the studies considered to have high a risk of bias. Fourteen trials were included in the review and evaluated a total of 14,872 implants. Of the fourteen studies included in the review eight were randomised clinical trials, four were controlled clinical trials and two were retrospective studies. Seven studies had both patients and operators/outcome assessors blinded to the tested intervention. Nine studies had short follow-ups; six of them with a follow-up of four months, one of five months and two of six months.The antibiotic regimen was variable: seven studies did not use post-op antibiotics in

  15. Reasonable application of antibiotic prophylaxis in maxillofacial trauma: Literature review

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    Afshin Yadegari Naeeni

    2016-07-01

    Full Text Available Background and Aims: Despite advances in trauma management, treatment of the consequent infections has remained a major challenge. Antibiotic prophylaxis has been widely applied to reduce such infections. Although bacteria are present in most body parts, severe infections after treatment are less frequent in the head and neck of healthy individuals. The aim of the present study was to review the reasonable application of antibiotic prophylaxis in maxillofacial trauma. Materials and Methods: In this review article, PubMed and Google Scholar databases were searched for studies on antibiotic prophylaxis in maxillofacial trauma published during 2000-2014. Conclusion: Antibiotics were not prescribed for tears and small clean wounds in the face and mouth. However, prophylaxis was applied for extensive mouth injuries which involved the facial skin. In case of maxillofacial fractures, 24-hour administration of antibiotics sufficed for compound fractures of the mandible and other parts of the face. Antibiotics were not required in other types of fractures. Prophylaxis should be applied over short pre- or post-operative periods based on the severity and complexity of maxillofacial fractures and their relations with intra- and extraoral environments. Apparently, more detailed studies are warranted to further clarify the subject.

  16. Antibiotic Prophylaxis in Urologic Procedures: A Systematic Review

    NARCIS (Netherlands)

    Bootsma, A. M.; Laguna Pes, M. P.; Geerlings, S. E.; Goossens, A.

    2008-01-01

    Objective: Antibiotic prophylaxis is used to minimize infectious complications resulting from interventions. Side-effects and development of microbial resistance patterns are risks of the use of antibiotics. Therefore, the use should be well considered and based on high levels of evidence. In this

  17. Is Antibiotic Prophylaxis Necessary in Patients Undergoing Ureterolithotripsy?

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    Ali Pasha Meysamie

    2011-08-01

    Full Text Available Transurethral Ureterolithotripsy (TUL is a frequently used procedure in urology departments. Many urologists perform TUL without antibiotic prophylaxis; however the use of chemoprophylaxis before TUL remains a controversial issue in urology. Thisstudy was carried out to assess the safety of omitting antibiotic prophylaxis prior to TUL. In a prospective randomized clinical trial from January 2005 to December 2007, 114 patients with ureteral stones were enrolled; Fifty seven had preoperative antibiotic prophylaxis administered before TUL and fifty seven patients underwent TUL without antibiotic prophylaxis. The rate of postoperative infectious complications (fever, positive blood culture, significant bactriuria, the length of hospital stay and overall stone free rate were compared between the two groups. There was no statistically significant difference between two groups in the operation time, length of hospital stay, postoperative bacteriuria, positive urine culture, postoperative fever and overall success rate of TUL. It appears that the incidence of infectious complications does not increase in patients undergoing TUL without antibiotic prophylaxis if they have negative pre-operative urine culture and antiseptic technique have been performed thorough the procedure.

  18. Algorithm for the management of antibiotic prophylaxis in onychocryptosis surgery.

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    Córdoba-Fernández, Antonio; Ruiz-Garrido, Gloria; Canca-Cabrera, Angela

    2010-12-01

    Antibiotic prophylaxis in nail surgery is not clearly established, and there is scant scientific evidence regarding the need for its use in preventing surgical site infection, hematogenous total joint infection, and infective endocarditis. To propose an algorithm based on the evidence for the management of antibiotic prophylaxis in onychocryptosis surgery. A literature review was performed in Medline, Pubmed, Cochrane database and Scopus and recent prospective studies were examined. The most-current authoritative guidelines together with new classification system of the pathology have been taken into account. In non-risk patients with onychocryptosis stage II or III phenol technique can be used without the need for antibiotics. In stages IV and V, specific antibiotic treatment should be administered before surgery together with partial ablation of nail until the infection is resolved and the process remits to stage II or III. In the case of long-developing onychocryptosis, osteomyelitis should be ruled out, and specific antibiotic treatment besides the preoperative dose should be administered. In high-risk cardiac patients with infective onychocryptosis, the need for prophylaxis for bacterial endocarditis should be considered. Current evidence does not support the use of preoperative antibiotic prophylaxis in onychocrytosis surgery except in special patients with infective onychocryptosis. Published by Elsevier Ltd.

  19. Prospective evaluation of the efficacy of antibiotic prophylaxis before cystoscopy

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    Kamil Cam

    2009-01-01

    Full Text Available Background: The aim of this study was to prospectively compare single-dose intravenous antibiotic prophylaxis vs. no prophylaxis before minor cystoscopic procedures, including punch biopsy and transurethral resection (TUR of small bladder tumors. Materials and Methods: A total of 200 patients with a mean age of 47.3 years old (range: 19-84 years old with initial negative urine cultures were recruited. All patients underwent a diagnostic cystoscopy. Patients were then randomized into 2 groups: o0 ne group that did not receive antibiotics (100 patients and the other group that received antibiotic treatment (100 patients with a single intravenous dose of cefoperazone. All patients had urine analysis and urine cultures on the second day after the operation. Additionally, clinical parameters including fever and dysuria were recorded. In 15% of the patients, incidental additional interventions such as punch biopsy or TUR of a small bladder tumor that were similarly distributed in both groups were performed. Results: In 1 patient from the antibiotic group and 2 patients from the no prophylaxis group, the urine cultures after cystoscopy were positive. No statistically significant difference was observed between these groups based on the microbiological and clinical parameters. Conclusion: The current study provides evidence that no antibiotic prophylaxis is required before diagnostic cystoscopy in patients without bacteriuria. But, the absolute risk of infection was small, suggesting that a much larger study is required.

  20. Antibiotic prophylaxis and complications following prostate biopsies - a systematic review

    DEFF Research Database (Denmark)

    Klemann, Nina; Helgstrand, John Thomas; Brasso, Klaus

    2017-01-01

    beyond a single dose or a one-day regimen. CONCLUSION: Evidence supporting a specific antibiotic regimen for TRUS-gb prophylaxis is scarce. Widespread use of fluoroquinolone prophylaxis may be associated with an increase in resistant Escherichia coli strains, posing a potentially major health issue......INTRODUCTION: Transrectal ultrasound-guided biopsies (TRUS-gb) are associated with both mild and serious complications. Prophylactic antibiotics reduce the risk of septicaemia and mortality; however, no international consensus exists on the timing and duration of antibiotics, including the optimal...... drug strategy. We reviewed the current evidence supporting use of prophylactic antibiotics and the risk of complications following prostate biopsies. METHODS: This review was drafted in accordance with the Prisma Guidelines. The PubMed, Embase and Cochrane databases were searched. RESULTS: A total...

  1. Compliance in Antibiotic Prophylaxis in Orthopaedics and Trauma ...

    African Journals Online (AJOL)

    Background: Surgical site infection is the surgeons' greatest enemy. The fear of this enemy is even heightened in orthopaedic surgical practice, because of the poor resistance of bone to infections and the consequences when such infection occurs, especially in implant surgeries. Antibiotic prophylaxis is one measure of ...

  2. Non-Antibiotic Prophylaxis for Urinary Tract Infections

    NARCIS (Netherlands)

    Beerepoot, Mariëlle; Geerlings, Suzanne

    2016-01-01

    Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in

  3. An Audit of Surgical Antibiotic Prophylaxis at the Veterinary ...

    African Journals Online (AJOL)

    An audit of surgical antibiotic prophylaxis at the Veterinary Teaching Hospital, Ibadan between 2008 and 2011 was conducted to evaluate the level of compliance with standard practices. The study involved retrospective case note audit of surgical procedures performed during the period. A total number of 108 operations ...

  4. Antibiotic surgical prophylaxis increases nasal carriage of antibiotic-resistant staphylococci.

    Science.gov (United States)

    McMurray, Claire L; Hardy, Katherine J; Verlander, Neville Q; Hawkey, Peter M

    2015-12-01

    Staphylococci are a significant cause of hospital-acquired infection. Nasal carriage of Staphylococcus aureus is an important risk factor for infection in surgical patients and coagulase-negative staphylococci (CNS) are a major cause of prosthetic joint infections. The impact that antibiotic surgical prophylaxis has on the nasal carriage of staphylococci has not been studied. Daily nasal swabs were taken from 63 patients who received antibiotic surgical prophylaxis and 16 patients who received no antibiotics. Total aerobic bacterial count, S. aureus and CNS were enumerated by culture from nasal swabs. Representative isolates were typed by staphylococcal interspersed repeat units (SIRU) typing and PFGE, and MICs to nine antibiotics were determined. After antibiotic administration, there was a reduction in S. aureus counts (median - 2.3 log(10)c.f.u. ml(- 1)) in 64.0 % of S. aureus carriers, compared with only a 0.89 log(10)c.f.u. ml(- 1) reduction in 75.0 % of S. aureus carriers who did not receive antibiotics. A greater increase in the nasal carriage rate of meticillin-resistant CNS was observed after antibiotic surgical prophylaxis compared with hospitalization alone, with increases of 16.4 and 4.6 %, respectively. Antibiotic-resistant S. epidermidis carriage rate increased by 16.6 % after antibiotic administration compared with 7.5 % with hospitalization alone. Antibiotic surgical prophylaxis impacts the nasal carriage of both S. aureus and CNS.

  5. Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections.

    Science.gov (United States)

    Cohen, Margot E; Salmasian, Hojjat; Li, Jianhua; Liu, Jianfang; Zachariah, Philip; Wright, Jason D; Freedberg, Daniel E

    2017-11-01

    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. This retrospective cohort study included adults who underwent elective surgical procedures and developed infections within 30 postoperative days. Procedures 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 postoperative days, showing intermediate or nonsusceptibility across 1 or more antibiotic classes. Surgical antibiotic prophylaxis included use of antibiotics within any class and at any dose from 1 hour before first incision until the end of the operation. Among 689 adults with postoperative infections, 338 (49%) had postoperative resistant infections. Use of SAP was not associated with postoperative antibiotic-resistant infections (odds ratio [OR] 0.99; 95% CI 0.67 to 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 to 1.40) and when the follow-up window was narrowed to 14 days (OR 0.82; 95% CI 0.50 to 1.34). Previous antibiotic-resistant infections were associated with risk for postoperative antibiotic-resistant infections (OR 1.81; 95% CI 1.16 to 2.83). Use of SAP was not associated with risk for postoperative antibiotic-resistant infections in a large cohort of patients with postoperative infections. This provides important reassurance regarding use of surgical antibiotic prophylaxis. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Antibiotic prophylaxis in infective endocarditis: Use or abuse?

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    Nisha Thakur

    2012-01-01

    Full Text Available Introduction: The American Heart Association (AHA recommendations for antimicrobial prophylaxis for infective endocarditis (IE are controversial. According to the new guidelines released by the AHA now, the only patients to receive antibiotics will be those at highest risk, i.e. those with a prosthetic heart valve, a history of endocarditis, certain forms of congenital heart disease or valvulopathy after heart transplantation, and only before certain dental procedures. Unfortunately, these guidelines are still based largely on expert opinion, with very little hard evidence to show that antibiotic therapy actually prevents IE. The Hypothesis: The reported incidence of bacteremia during dental intervention ranges from 10% to 100% and, with daily brushing and flossing, from 20% to 68%. Because bacteremia also occurs during brushing and flossing of teeth, why give prophylaxis just for dental procedures? Moreover, the risks of causing adverse or anaphylactic reactions from antibiotics as well as contributing to the nationwide antibiotic resistance problem are issues not to be taken lightly. Evaluation of the Hypothesis: The hypothesis discusses the AHA recommendations for antimicrobial prophylaxis for IE, indicating some inherent limitations associated with it, and stresses upon the fact that these recommendation should also be updated, if not completely changed, to cope up with the advancements in the proper treatment plan.

  7. Antibiotic prophylaxis for episiotomy repair following vaginal birth.

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    Bonet, Mercedes; Ota, Erika; Chibueze, Chioma E; Oladapo, Olufemi T

    2017-11-02

    Bacterial infections occurring during labour, childbirth, and the puerperium may be associated with considerable maternal and perinatal morbidity and mortality. Antibiotic prophylaxis might reduce wound infection incidence after an episiotomy, particularly in situations associated with a higher risk of postpartum perineal infection, such as midline episiotomy, extension of the incision, or in settings where the baseline risk of infection after vaginal birth is high. However, available evidence is unclear concerning the role of prophylactic antibiotics in preventing infections after an episiotomy. To assess whether routine antibiotic prophylaxis before or immediately after incision or repair of episiotomy for women with an uncomplicated vaginal birth, compared with either placebo or no antibiotic prophylaxis, prevents maternal infectious morbidities and improves outcomes. We searched the Cochrane Pregnancy and Childbirth's Trials Register, LILACS, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) on 24 July 2017, and screened reference lists of retrieved studies. We considered randomised controlled trials, quasi-randomised trials, and cluster-randomised trials that compared the use of routine antibiotic prophylaxis for incision or repair of an episiotomy for women with otherwise normal vaginal births, compared with either placebo or no antibiotic prophylaxis. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked them for accuracy. We only found one quasi-randomised trial that met the inclusion criteria and was included in the analysis, therefore, we did not perform a meta-analysis. We included one quasi-RCT (with data from 73 women) in the review. The trial, which was conducted in a public hospital in Brazil, compared oral chloramphenicol 500 mg four times daily for 72 hours after episiotomy repair (N = 34) and no treatment (N = 39). We assessed most of the domains at high

  8. Non-Antibiotic Prophylaxis for Urinary Tract Infections

    OpenAIRE

    Mariëlle Beerepoot; Suzanne Geerlings

    2016-01-01

    Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs co...

  9. Antibiotic prophylaxis in orthognathic surgery: A complex systematic review

    Science.gov (United States)

    Hultin, Margareta; Klinge, Anna; Klinge, Björn; Tranæus, Sofia; Lund, Bodil

    2018-01-01

    Objective In orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the dose and duration of administration. The aim of this complex systematic review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery. Methods Both systematic reviews and primary studies were assessed. Medline (OVID), The Cochrane Library (Wiley) and EMBASE (embase.com), PubMed (non-indexed articles) and Health Technology Assessment (HTA) publications were searched. The primary studies were assessed using GRADE and the systematic reviews by AMSTAR. Results Screening of abstracts yielded 6 systematic reviews and 36 primary studies warranting full text scrutiny. In total,14 primary studies were assessed for risk of bias. Assessment of the included systematic reviews identified two studies with a moderate risk of bias, due to inclusion in the meta-analyses of primary studies with a high risk of bias. Quality assessment of the primary studies disclosed one with a moderate risk of bias and one with a low risk. The former compared a single dose of antibiotic with 24 hour prophylaxis using the same antibiotic; the latter compared oral and intravenous administration of antibiotics. Given the limited number of acceptable studies, no statistical analysis was undertaken, as it was unlikely to contribute any relevant information. Conclusion With respect to antibiotic prophylaxis in orthognathic surgery, most of the studies to date have been poorly conducted and reported. Thus scientific uncertainty remains as to the preferred antibiotic and the optimal duration of administration. PMID:29385159

  10. Antibiotics for the prophylaxis of bacterial endocarditis in dentistry.

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    Glenny, Anne-Marie; Oliver, Richard; Roberts, Graham J; Hooper, Lee; Worthington, Helen V

    2013-10-09

    prophylaxis was received or not. Included case-control studies would need to match people who had developed endocarditis (and who were known to be at increased risk before undergoing an invasive dental procedure preceding the onset of endocarditis) with those at similar risk but who had not developed endocarditis. Outcomes of interest were mortality or serious adverse events requiring hospital admission; development of endocarditis following any dental procedure in a defined time period; development of endocarditis due to other non-dental causes; any recorded adverse events to the antibiotics; and cost implications of the antibiotic provision for the care of those patients who developed endocarditis. Two review authors independently selected studies for inclusion then assessed risk of bias and extracted data from the included study. No randomised controlled trials (RCTs), controlled clinical trials (CCTs) or cohort studies were included. One case-control study met the inclusion criteria. It collected all the cases of endocarditis in the Netherlands over two years, finding a total of 24 people who developed endocarditis within 180 days of an invasive dental procedure, definitely requiring prophylaxis according to current guidelines, and who were at increased risk of endocarditis due to a pre-existing cardiac problem. This study included participants who died because of the endocarditis (using proxies). Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days, and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes. There remains no evidence about whether antibiotic prophylaxis is effective or ineffective against bacterial endocarditis in people at risk who are about to undergo an invasive dental procedure. It is not clear whether the potential harms and costs of

  11. Randomized clinical trial of extended versus single-dose perioperative antibiotic prophylaxis for acute calculous cholecystitis

    NARCIS (Netherlands)

    Loozen, C. S.; Kortram, K.; Kornmann, V. N. N.; van Ramshorst, B.; Vlaminckx, B.; Knibbe, C. A. J.; Kelder, J. C.; Donkervoort, S. C.; Nieuwenhuijzen, G. A. P.; Ponten, J. E. H.; van Geloven, A. A. W.; van Duijvendijk, P.; Bos, W. J. W.; Besselink, M. G. H.; Gouma, D. J.; van Santvoort, H. C.; Boerma, D.

    2017-01-01

    Many patients who have surgery for acute cholecystitis receive postoperative antibiotic prophylaxis, with the intent to reduce infectious complications. There is, however, no evidence that extending antibiotics beyond a single perioperative dose is advantageous. This study aimed to determine the

  12. Antibiotic prophylaxis and inflammatory complications after Cesarean section

    Directory of Open Access Journals (Sweden)

    Hasan Karahasan

    2011-12-01

    Full Text Available Introduction: Gynaecological and obstetric surgeries are high risk operations for the development of postoperative inflammatory complications due to the proximity of the genitourinary tract. The aim of this study was to compare the frequency of inflammatory complications in emergency or elective cases of caesarean sections as well as the frequency of complications related to the method of surgical treatment used.Methods: We analyzed inflammatory complications in 450 caesarean sections, which developed in a one year period from June 1st, 2000. to June 1st 2001. Patients were grouped according to the method of the surgery, and on emergency or elective case. Misgav Ladach or Dorfler surgical methods were used.Results: The most common inflammatory complication was wound infection and the most common risk factors for inflammatory complications were premature rupture of membranes and anemia.Conclusions: Long term use of one antibiotic was the most commonly implemented form of antibiotic prophylaxis.

  13. Is surgical antibiotic prophylaxis necessary for pediatric orchiopexy?

    Science.gov (United States)

    Rensing, A J; Whittam, B M; Chan, K H; Cain, M P; Carroll, A E; Bennett, W E

    2018-02-21

    Surgeons frequently use surgical antibiotic prophylaxis (SAP), despite limited evidence to support its efficacy. Potential adverse events associated with antibiotic use include allergic reaction (including anaphylaxis), Clostridium difficile infection, and selecting for resistant bacteria. Surgical site infections (SSI) are very rare in patients undergoing clean pediatric urologic procedures. Current guidelines are unclear about the efficacy of surgical antibiotic prophylaxis for prevention of SSI in the pediatric population. It was hypothesized that children who received SAP prior to orchiopexy would have no reduction in surgical site infection (SSI) risk but an increased risk of antibiotic-associated adverse events. A retrospective cohort study was conducted of all males aged between 30 days and 18 years who underwent an orchiopexy (ICD-9 CM 62.5) in an ambulatory or observation setting from 2004 to 2015 using the Pediatric Health Information System database. Inpatients and those with concomitant procedures were excluded. Chi-squared or Fisher's exact tests were used to determine the association between SAP and allergic reaction (defined as a charge for epinephrine or ICD-9 diagnosis code for allergic reaction on the date of surgery) and any of the following within 30 days: SSI, hospital readmission or any repeat hospital encounter. Mixed effects logistic regression was performed, controlling for age, race, and insurance, and clustering of similar practice patterns by hospital. A total of 71,767 patients were included: median age was 4.6 years, 61.4% were white, and 49.3% had public insurance; 33.5% received SAP. Of these participants, 996/71,767 (1.4%) had a perioperative allergic reaction and perioperative allergic reaction compared with those who did not receive SAP (P = 0.005). Surgical antibiotic prophylaxis was not associated with decreased rates of SSI, lower hospital readmission, nor a lower chance of a repeat encounter within 30 days. In patients

  14. CT colonography and transient bacteraemia: implications for antibiotic prophylaxis

    Energy Technology Data Exchange (ETDEWEB)

    Ridge, C.A.; Carter, M.R.; Ryan, R.; Hegarty, C.; Malone, D.E. [St Vincent' s University Hospital, Department of Radiology, Dublin 4 (Ireland); Browne, L.P. [Texas Children' s Hospital, Department of Diagnostic Imaging, Houston, TX (United States); Schaffer, K. [St Vincent' s University Hospital, Department of Microbiology, Dublin 4 (Ireland)

    2011-02-15

    To determine the prevalence of transient bacteraemia after CT colonography (CTC). Blood cultures were obtained at 5, 10 and 15 min after CTC from 100 consecutive consenting patients. Blood samples were cultured in both aerobic and anaerobic media and positive blood culture samples were analysed by a microbiologist. Blood culture samples were positive for growth in sixteen patients. All positive blood culture samples were confirmed skin contaminants. There were no cases of significant bacteraemia. The estimated significant bacteraemia rate as a result of CTC is 0-3.7%, based on 95% confidence intervals around extreme results using Wilson's score method. American Heart Association and National Institute for Clinical Excellence guidelines advise that antibiotic prophylaxis before lower gastrointestinal endoscopy is not indicated in patients with at risk cardiac lesions (ARCL) as the risk of a transient bacteraemia leading to infective endocarditis is low. These data show that the prevalence of transient bacteraemia after CTC is also low. It follows that patients with ARCL do not require antibiotic prophylaxis before CTC. (orig.)

  15. CT colonography and transient bacteraemia: implications for antibiotic prophylaxis

    International Nuclear Information System (INIS)

    Ridge, C.A.; Carter, M.R.; Ryan, R.; Hegarty, C.; Malone, D.E.; Browne, L.P.; Schaffer, K.

    2011-01-01

    To determine the prevalence of transient bacteraemia after CT colonography (CTC). Blood cultures were obtained at 5, 10 and 15 min after CTC from 100 consecutive consenting patients. Blood samples were cultured in both aerobic and anaerobic media and positive blood culture samples were analysed by a microbiologist. Blood culture samples were positive for growth in sixteen patients. All positive blood culture samples were confirmed skin contaminants. There were no cases of significant bacteraemia. The estimated significant bacteraemia rate as a result of CTC is 0-3.7%, based on 95% confidence intervals around extreme results using Wilson's score method. American Heart Association and National Institute for Clinical Excellence guidelines advise that antibiotic prophylaxis before lower gastrointestinal endoscopy is not indicated in patients with at risk cardiac lesions (ARCL) as the risk of a transient bacteraemia leading to infective endocarditis is low. These data show that the prevalence of transient bacteraemia after CTC is also low. It follows that patients with ARCL do not require antibiotic prophylaxis before CTC. (orig.)

  16. CT colonography and transient bacteraemia: implications for antibiotic prophylaxis.

    LENUS (Irish Health Repository)

    Ridge, C A

    2012-02-01

    OBJECTIVES: To determine the prevalence of transient bacteraemia after CT colonography (CTC). METHODS: Blood cultures were obtained at 5, 10 and 15 min after CTC from 100 consecutive consenting patients. Blood samples were cultured in both aerobic and anaerobic media and positive blood culture samples were analysed by a microbiologist. RESULTS: Blood culture samples were positive for growth in sixteen patients. All positive blood culture samples were confirmed skin contaminants. There were no cases of significant bacteraemia. The estimated significant bacteraemia rate as a result of CTC is 0-3.7%, based on 95% confidence intervals around extreme results using Wilson\\'s score method. CONCLUSIONS: American Heart Association and National Institute for Clinical Excellence guidelines advise that antibiotic prophylaxis before lower gastrointestinal endoscopy is not indicated in patients with at risk cardiac lesions (ARCL) as the risk of a transient bacteraemia leading to infective endocarditis is low. These data show that the prevalence of transient bacteraemia after CTC is also low. It follows that patients with ARCL do not require antibiotic prophylaxis before CTC.

  17. COMPARISON OF SUBLINGUAL THERAPEUTIC VACCINE WITH ANTIBIOTICS FOR THE PROPHYLAXIS OF RECURRENT URINARY TRACT INFECTIONS

    OpenAIRE

    María Fernanda Lorenzo-Gómez; María Fernanda Lorenzo-Gómez; María Fernanda Lorenzo-Gómez; Bárbara ePadilla-Fernández; María Begoña García-Cenador; Álvaro Julio Virseda Rodríguez; Álvaro Julio Virseda Rodríguez; Isidoro eMartín-García; Alfonso eSánchez-Escudero; Manuel José Vicente-Arroyo; José Antonio Mirón-Canelo

    2015-01-01

    Objective: To evaluate the clinical impact of the prophylactic treatment with sublingual immunostimulation in the prevention of recurrent urinary tract infections (rUTIs) compared with the use of antibiotics.Material and Methods: Retrospective cohort study evaluating the clinical records of 669 women with rUTIs; 339 had a 6-month prophylaxis with antibiotics and 360 had a 3-month prophylaxis with a sublingual bacterial preparation (MV 140-Uromune®). The time after the prophylaxis-period until...

  18. Comparison of sublingual therapeutic vaccine with antibiotics for the prophylaxis of recurrent urinary tract infections

    OpenAIRE

    Lorenzo-G?mez, Mar?a F.; Padilla-Fern?ndez, B?rbara; Garc?a-Cenador, Mar?a B.; Virseda-Rodr?guez, ?lvaro J.; Mart?n-Garc?a, Isidoro; S?nchez-Escudero, Alfonso; Vicente-Arroyo, Manuel J.; Mir?n-Canelo, Jos? A.

    2015-01-01

    Objective: To compare the clinical impact of a prophylactic treatment with sublingual immunostimulation in the prevention of recurrent urinary tract infections (rUTIs) with the use of antibiotics. Material and Methods: Retrospective cohort study evaluating the medical records of 669 women with rUTIs; 339 had a 6-month prophylaxis with antibiotics and 360 a 3-month prophylaxis with a sublingual bacterial preparation (MV 140-Uromune®). The time frame after the prophylaxis-period until the ap...

  19. Efficacy and feasibility of a collaborative multidisciplinary program for antibiotic prophylaxis in clean wound surgery.

    Science.gov (United States)

    Li, Xinyu; Chen, Hong; Zhu, Shenyin; Liu, Yu; Yang, Jiadan; Yuan, Zhe; Yao, Gaoqun; Qiu, Feng

    2018-02-01

    Background Despite national and international guidelines and recommendations, inappropriate prophylactic antibiotic use for clean wound surgery remains a common phenomenon in many Chinese hospitals, causing higher medical costs and bacterial resistance. Objective To improve the prescribing behavior for antibiotic prophylaxis and decrease antibiotic abuse and/or misuse in clean wound surgery. Setting The teaching hospital of a medical university in Southwest China. Methods A collaborative multidisciplinary program involving educational, technical, and administrative strategies was undertaken. It was characterized by a monthly evaluation by clinical pharmacists for randomly selected cases of clean wound surgery, as well as a group discussion attended by correlative personnel, consisting of the administrative staff, experts from the Rational Drug Use Committee, clinical pharmacists and surgeons. Main outcome measure The overall incidence of antibiotic prophylaxis, appropriate antibiotics selection, appropriate initial dosage timing, proper drug combination and the duration of antibiotic prophylaxis were measured. Results from 2009 to 2014, the rate of antibiotic prophylaxis for clean wound surgery declined from nearly 100% to 20-30%. Improvements were also observed in drug selection, timing of the first dose, and dosage and duration for antibiotic prophylaxis. Broad-spectrum antibiotics and enzyme inhibitors have seldom been used after 2011. The medical cost for antibiotics also decreased. Conclusion A collaborative multidisciplinary program, together with a group discussion, is efficient for improving rational antibiotic prophylaxis for clean wound surgery. This study indicates that clinical pharmacists can play a pivotal role in providing the professional evaluation of medical cases, education, and intervention.

  20. Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures.

    Science.gov (United States)

    Suda, Katie J; Henschel, Heather; Patel, Ursula; Fitzpatrick, Margaret A; Evans, Charlesnika T

    2018-01-01

    Guidelines for antibiotics prior to dental procedures for patients with specific cardiac conditions and prosthetic joints have changed, reducing indications for antibiotic prophylaxis. In addition to guidelines focused on patient comorbidities, systematic reviews specific to dental extractions and implants support preprocedure antibiotics for all patients. However, data on dentist adherence to these recommendations are scarce. This was a cross-sectional study of veterans undergoing tooth extractions, dental implants, and periodontal procedures. Patients receiving antibiotics for oral or nonoral infections were excluded. Data were collected through manual review of the health record. Of 183 veterans (mean age, 62 years; 94.5% male) undergoing the included procedures, 82.5% received antibiotic prophylaxis (mean duration, 7.1 ± 1.6 days). Amoxicillin (71.3% of antibiotics) and clindamycin (23.8%) were prescribed most frequently; 44.7% of patients prescribed clindamycin were not labeled as penicillin allergic. Of those who received prophylaxis, 92.1% received postprocedure antibiotics only, 2.6% received preprocedural antibiotics only, and 5.3% received pre- and postprocedure antibiotics. When prophylaxis was indicated, 87.3% of patients received an antibiotic. However, 84.9% received postprocedure antibiotics when preprocedure administration was indicated. While the majority of antibiotics were indicated, only 8.2% of patients received antibiotics appropriately. The primary reason was secondary to prolonged duration. Three months postprocedure, there were no occurrences of Clostridium difficile infection, infective endocarditis, prosthetic joint infections, or postprocedure oral infections. The majority of patients undergoing a dental procedure received antibiotic prophylaxis as indicated. Although patients for whom antibiotic prophylaxis was indicated should have received a single preprocedure dose, most antibiotics were prescribed postprocedure. Dental stewardship

  1. Non-Antibiotic Prophylaxis for Urinary Tract Infections

    Directory of Open Access Journals (Sweden)

    Mariëlle Beerepoot

    2016-04-01

    Full Text Available Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs. Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs compared to placebo. Different lactobacilli strains show different results in the prevention of recurrent UTIs. Intravaginal suppositories with Lactobacillus crispatus in premenopausal women and oral capsules with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in postmenopausal women are promising. Ascorbic acid (vitamin C cannot be recommended for the prevention of UTIs. Cranberries are thought to contain proanthocyanidins that can inhibit adherence of P-fimbriated E. coli to the uroepithelial cell receptors. Cranberry products decreased UTI recurrences about 30%–40% in premenopausal women with recurrent UTIs, but are less effective than low-dose antimicrobial prophylaxis. However, the optimal dose of cranberry product has still to be determined. Initially OM-89, a vaccine with 18 heat-killed E. coli extracts, seemed promising, but this was not confirmed in a recently randomized trial.

  2. Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada

    Directory of Open Access Journals (Sweden)

    Mario A. Brondani

    2013-01-01

    Full Text Available Objectives. This paper discusses the controversies surrounding the antibiotic prophylaxis preceding dental interventions within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? Methods. A synthesis of the available literature regarding antibiotic prophylaxis in dentistry was conducted under the lenses of Kazanjian’s framework for health technology assessment with a focus on economic concerns, population impact, social context, population at risk, and the effectiveness of the evidence to support its use. Results. The papers reviewed show that we have been using antibiotic prophylaxis without a clear and full understanding of its benefits. Although the first guideline for antibiotic prophylaxis was introduced in 1990, it has been revised on several occasions, from 1991 to 2011. Evidence-based clinical guidelines are yet to be seen. Conclusions. Any perceived potential benefit from administering antibiotic prophylaxis before dental procedures must be weighed against the known risks of lethal toxicity, allergy, and development, selection, and transmission of microbial resistance. The implications of guideline changes and lack of evidence for the full use of antibiotic prophylaxis for the teaching of dentistry have to be further discussed.

  3. Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis

    NARCIS (Netherlands)

    van der Meer, J. T.; van Wijk, W.; Thompson, J.; Vandenbroucke, J. P.; Valkenburg, H. A.; Michel, M. F.

    1992-01-01

    Whether antibiotic prophylaxis can prevent bacterial endocarditis is hotly debated. In an attempt to settle this issue, we have assessed the efficacy of prophylaxis for bacterial endocarditis on native valves in a nationwide, case-control study in the Netherlands. Cases were patients with known

  4. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding - an updated Cochrane review

    DEFF Research Database (Denmark)

    Chavez-Tapia, N C; Barrientos-Gutierrez, T; Tellez-Avila, F

    2011-01-01

    Antibiotic prophylaxis seems to decrease the incidence of bacterial infections in patients with cirrhosis and upper gastrointestinal bleeding and is considered standard of care. However, there is no updated information regarding the effects of this intervention....

  5. Review of MRSA screening and antibiotics prophylaxis in orthopaedic trauma patients; The risk of surgical site infection with inadequate antibiotic prophylaxis in patients colonized with MRSA.

    Science.gov (United States)

    Iqbal, H J; Ponniah, N; Long, S; Rath, N; Kent, M

    2017-07-01

    The primary aim of this study was to determine whether orthopaedic trauma patients receive appropriate antibiotic prophylaxis keeping in view the results of their MRSA screening. The secondary aim was to analyse the risk of developing MRSA surgical site infection with and without appropriate antibiotic prophylaxis in those colonized with MRSA. We reviewed 400 consecutive orthopaedic trauma patient episodes. Preoperative MRSA screening results, operative procedures, prophylactic antibiotics and postoperative course were explored. In addition to these consecutive patients, the hospital MRSA database over the previous 5 years identified 27 MRSA colonized acute trauma patients requiring surgery. Of the 400 consecutive patient episodes, 395(98.7%) had MRSA screening performed on admission. However, in 236 (59.0%) cases, the results were not available before the surgery. Seven patient episodes (1.8%) had positive MRSA colonization. Analysis of 27 MRSA colonized patients revealed that 20(74%) patients did not have the screening results available before the surgery. Only 5(18.5%) received Teicoplanin and 22(81.4%) received cefuroxime for antibiotic prophylaxis before their surgery. Of those receiving cefuroxime, five (22.73%) patients developed postoperative MRSA surgical site infection (SSI) but none of those (0%) receiving Teicoplanin had MRSA SSI. The absolute risk reduction for SSI with Teicoplanin as antibiotic prophylaxis was 22.73% (CI=5.22%-40.24%) and NNT (Number Needed to Treat) was 5 (CI=2.5-19.2) CONCLUSION: Lack of available screening results before the surgery may lead to inadequate antibiotic prophylaxis increasing the risk of MRSA surgical site infection. Glycopeptide (e.g.Teicoplanin) prophylaxis should be considered when there is history of MRSA colonization or MRSA screening results are not available before the surgery. Copyright © 2017. Published by Elsevier Ltd.

  6. The role of topical antibiotics used as prophylaxis in surgical site infection prevention.

    LENUS (Irish Health Repository)

    McHugh, S M

    2011-04-01

    Compared with systemic antibiotic therapy, the topical or local delivery of an antibiotic has many potential advantages. However, local antibiotics at the surgical site have received very limited approval in any of the surgical prophylaxis consensus guidelines that we are aware of. A review of the literature was carried out through searches of peer-reviewed publications in PubMed in the English language over a 30 year period between January 1980 and May 2010. Both retrospective and prospective studies were included, as well as meta-analyses. With regard to defining \\'topical\\' or \\'local\\' antibiotic application, the application of an antibiotic solution to the surgical site intraoperatively or immediately post-operatively was included. A number of surgical procedures have been shown to significantly benefit from perioperative topical prophylaxis, e.g. joint arthroplasty, cataract surgery and, possibly, breast augmentation. In obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. The selective use of topical antibiotics as surgical prophylaxis is justified for specific procedures, such as joint arthroplasty, cataract surgery and, possibly, breast augmentation. In selective cases, such as obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. Apart from these specific indications, the evidence for use of topical antibiotics in surgery is lacking in conclusive randomized controlled trials.

  7. The role of topical antibiotics used as prophylaxis in surgical site infection prevention.

    LENUS (Irish Health Repository)

    McHugh, S M

    2012-02-01

    Compared with systemic antibiotic therapy, the topical or local delivery of an antibiotic has many potential advantages. However, local antibiotics at the surgical site have received very limited approval in any of the surgical prophylaxis consensus guidelines that we are aware of. A review of the literature was carried out through searches of peer-reviewed publications in PubMed in the English language over a 30 year period between January 1980 and May 2010. Both retrospective and prospective studies were included, as well as meta-analyses. With regard to defining \\'topical\\' or \\'local\\' antibiotic application, the application of an antibiotic solution to the surgical site intraoperatively or immediately post-operatively was included. A number of surgical procedures have been shown to significantly benefit from perioperative topical prophylaxis, e.g. joint arthroplasty, cataract surgery and, possibly, breast augmentation. In obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. The selective use of topical antibiotics as surgical prophylaxis is justified for specific procedures, such as joint arthroplasty, cataract surgery and, possibly, breast augmentation. In selective cases, such as obese patients undergoing abdominal surgery, topical surgical prophylaxis is also proven to be beneficial. Apart from these specific indications, the evidence for use of topical antibiotics in surgery is lacking in conclusive randomized controlled trials.

  8. Antibiotic prophylaxis to reduce the risk of joint implant contamination during dental surgery seems unnecessary.

    Science.gov (United States)

    Legout, L; Beltrand, E; Migaud, H; Senneville, E

    2012-12-01

    Joint implant infection rates range between 0.5% and 3%. Contamination may be hematogenous, originating in oro-dental infection and, as in endocarditis, antibiotic prophylaxis has been recommended to cover oro-dental surgery in immunodepressed patients with joint implants less than 2 years old, despite the lack of any formal proof of efficacy. In this context, the cost and side effects of such prophylaxis raise the question of its real utility. A search of Pubmed was performed using the following keywords: prosthetic joint infection, dental procedure, antibiotic prophylaxis, hematogenous infection, dental infection, bacteremia, and endocarditis. Six hundred and fifty articles were retrieved, 68 of which were analyzed in terms of orthopedic prosthetic infection and/or endocarditis and oro-dental prophylaxis, as relevant to the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of prosthetic joint infection secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants. Bacteremia of oro-dental origin is more frequently associated with everyday activities such as mastication than with tooth extraction. Isolated cases of prosthetic contamination from dental infection have been reported, but epidemiological studies in joint implant bearers found that absence of antibiotic prophylaxis during oro-dental surgery did not increase the rate of prosthetic infection. The analysis was not able to answer the question of the efficacy of dental antibiotic prophylaxis in immunodepressed patients; however, oro-dental hygiene and regular dental treatment reduce the risk of prosthetic infection by 30%. The present update is in agreement with the conclusions of ANSM expert group, which advised against antibiotic prophylaxis in oro-dental surgery in implant bearers, regardless of implant duration or comorbidity: the associated costs and risks are disproportional to efficacy. LEVEL OF

  9. Approaches for Initial Prostate Biopsy and Antibiotic Prophylaxis.

    Science.gov (United States)

    Ploussard, Guillaume; Scattoni, Vincenzo; Giannarini, Gianluca; Jones, J Stephen

    2015-09-01

    Debate on the optimal technique to use as an initial prostate biopsy (PB) strategy is continually evolving. To review recent advances and current recommendations regarding initial PB and antibiotic prophylaxis. A nonsystematic review of the literature was performed up to October 2014 using the PubMed and Embase databases. Articles were selected with preference for the highest level of evidence in publications within the past 5 yr. The decision to perform PB is still based on an abnormal digital rectal examination or increased prostate0specific antigen (PSA) level without clear consensus about the absolute cutoff. Several biomarkers have been suggested to improve PSA-based PB decision-making and minimize overdiagnosis and overtreatment. The random 12-core transrectal (TR) ultrasound-guided approach remains the standard-of-care technique for PB. A >12-core scheme may be considered as an alternative in a single patient given his clinical features (large volume, low PSA levels). Transperineal biopsies may only be considered as an alternative to the TR route in special situations. Nevertheless, given the increase in antimicrobial resistance, the impact on the post-biopsy sepsis rate should be assessed in well-designed clinical trials. Imaging-guided targeted PB strategies, combined or not with random PBs, may represent the future of prostate cancer diagnosis by reducing the number of PBs and improving decision-making. The 12-core TR scheme remains the standard of care for initial PB. The actual trend for PB strategy, with the aim of avoiding overdiagnosis of very low-risk cancers, could rapidly change our current indications and techniques through new biomarkers and imaging-guided targeted strategies. Nevertheless, the cost-benefit balance of these techniques should be closely assessed in the setting of initial PB strategy. This review highlights current recommendations for prostate biopsy and possible advances in the near future. Copyright © 2015 European Association

  10. [Evaluation of therapeutic trials published apropos of antibiotic prophylaxis in orthopedic surgery].

    Science.gov (United States)

    Doyon, F; Evrard, J; Mazas, F

    1989-01-01

    The authors review all the randomized clinical trials published since 1970 which evaluate the efficacy of antibiotic prophylaxis in orthopaedic surgery. Evaluation of the quality of these trials was based on two clinical and four methodological criteria. They also take into account reports which aim to define the best antibiotic prophylactic protocol, particularly with regard to the duration of treatment. In conclusion, although the majority of trials do not escape criticism, the efficacy of antibiotic prophylaxis in orthopaedic surgery can be considered as demonstrated. The duration of treatment is still an open problem. At the present time, the duration of drainage defines the length of antibiotherapy.

  11. Survey of Intraocular Antibiotics Prophylaxis Practice after Open Globe Injury in China.

    Directory of Open Access Journals (Sweden)

    Bingsheng Lou

    Full Text Available To elucidate the Chinese practice of intraocular antibiotics administration for prophylaxis after open globe injury.A cross-sectional questionnaire survey was performed online by scanning a Quickmark (QR code with smartphones at the 20th Chinese National Conference of Ocular Trauma in November 2014.A total of 153 (30.6% of all participators at the conference responded. Of the respondents, 20.9% were routinely administered with prophylactic intraocular injection of antibiotics at the conclusion of the primary eye repair, and 56.9% were used only in cases with high risk of endophthalmitis development. The intraocular route of delivery was mainly included with intracameral injection (47.9% and intravitreal injection (42.0%. Cephalosporins (53.8% and vancomycin (42.0% were the main choices of antibiotic agents, followed by fluoroquinolones (24.3%, and aminoglycosides (13.4%. Only 21.9% preferred a combination of two or more two drugs routinely. In addition, significantly more respondents from the referral eye hospital (92.7% replied using intraocular antibiotics injection for prophylaxis compared to those respondents from the primary hospital (69.4% (p = 0.001, Fisher's exact test.Intraocular antibiotics injection for post-traumatic endophthalmitis prophylaxis is widely used in China. However, the choice of antibiotic agents and the intraocular route of delivery vary. A well-designed clinical trial is needed to establish a standardized protocol of intraocular antibiotics administration for post-traumatic endophthalmitis prophylaxis.

  12. Antibiotic prophylaxis is not indicated prior to dental procedures for prevention of periprosthetic joint infections

    Science.gov (United States)

    Rademacher, Willem M H; Walenkamp, Geert H I M; Moojen, Dirk Jan F; Hendriks, Johannes G E; Goedendorp, Theo A; Rozema, Frederik R

    2017-01-01

    Background and purpose To minimize the risk of hematogenous periprosthetic joint infection (HPJI), international and Dutch guidelines recommended antibiotic prophylaxis prior to dental procedures. Unclear definitions and contradictory recommendations in these guidelines have led to unnecessary antibiotic prescriptions. To formulate new guidelines, a joint committee of the Dutch Orthopaedic and Dental Societies conducted a systematic literature review to answer the following question: can antibiotic prophylaxis be recommended for patients (with joint prostheses) undergoing dental procedures in order to prevent dental HPJI? Methods The Medline, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs), reviews, and observational studies up to July 2015. Studies were included if they involved patients with joint implants undergoing dental procedures, and either considered HPJI as an outcome measure or described a correlation between HPJI and prophylactic antibiotics. A guideline was formulated using the GRADE method and AGREE II guidelines. Results 9 studies were included in this systematic review. All were rated “very low quality of evidence”. Additional literature was therefore consulted to address clinical questions that provide further insight into pathophysiology and risk factors. The 9 studies did not provide evidence that use of antibiotic prophylaxis reduces the incidence of dental HPJI, and the additional literature supported the conclusion that antibiotic prophylaxis should be discouraged in dental procedures. Interpretation Prophylactic antibiotics in order to prevent dental HPJI should not be prescribed to patients with a normal or an impaired immune system function. Patients are recommended to maintain good oral hygiene and visit the dentist regularly. PMID:28639846

  13. The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery.

    Science.gov (United States)

    Koullouros, Michalis; Khan, Nadir; Aly, Emad H

    2017-01-01

    Surgical site infection (SSI) continues to be a challenge in colorectal surgery. Over the years, various modalities have been used in an attempt to reduce SSI risk in elective colorectal surgery, which include mechanical bowel preparation before surgery, oral antibiotics and intravenous antibiotic prophylaxis at induction of surgery. Even though IV antibiotics have become standard practice, there has been a debate on the exact role of oral antibiotics. The primary aim was to identify the role of oral antibiotics in reduction of SSI in elective colorectal surgery. The secondary aim was to explore any potential benefit in the use of mechanical bowel preparation (MBP) in relation to SSI in elective colorectal surgery. Medline, Embase and the Cochrane Library were searched. Any randomised controlled trials (RCTs) or cohort studies after 1980, which investigated the effectiveness of oral antibiotic prophylaxis and/or MBP in preventing SSIs in elective colorectal surgery were included. Twenty-three RCTs and eight cohorts were included. The results indicate a statistically significant advantage in preventing SSIs with the combined usage of oral and systemic antibiotic prophylaxis. Furthermore, our analysis of the cohort studies shows no benefits in the use of MBP in prevention of SSIs. The addition of oral antibiotics to systemic antibiotics could potentially reduce the risk of SSIs in elective colorectal surgery. Additionally, MBP does not seem to provide a clear benefit with regard to SSI prevention.

  14. Perioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II trial): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Loozen, C.S.; Santvoort, H.C. van; Geloven, A.A. van; Nieuwenhuijzen, G.A.; Reuver, P.R.; Besselink, M.H.G.; Vlaminckx, B.; Kelder, J.C.; Knibbe, C.A.; Boerma, D.

    2017-01-01

    BACKGROUND: The additional value of perioperative antibiotic prophylaxis in preventing infectious complications after emergency cholecystectomy for acute cholecystitis is a much-debated subject in the surgical community. Evidence-based guidelines are lacking, and consequently the use of antibiotic

  15. Perioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II trial): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Loozen, Charlotte S.; van Santvoort, Hjalmar C.; van Geloven, Antoinette A. W.; Nieuwenhuijzen, Grard A. P.; de Reuver, Philip R.; Besselink, Mark H. G.; Vlaminckx, Bart; Kelder, Johannes C.; Knibbe, Catherijne A. J.; Boerma, Djamila

    2017-01-01

    Background: The additional value of perioperative antibiotic prophylaxis in preventing infectious complications after emergency cholecystectomy for acute cholecystitis is a much-debated subject in the surgical community. Evidence-based guidelines are lacking, and consequently the use of antibiotic

  16. Antibiotic prophylaxis for transrectal prostate biopsy-a new strategy

    DEFF Research Database (Denmark)

    Antsupova, Valeria; Nørgaard, Nis; Bisbjerg, Rasmus

    2014-01-01

    TRUBP at a Danish university hospital. The patients were divided into three groups. Group 1 (n = 1220) received ciprofloxacin before TRUBP, Group 2 (n = 240) received a combination of pivmecillinam and amoxicillin/clavulanic acid before TRUBP and Group 3 (n = 1161) received an extended prophylaxis....../clavulanic acid had a significantly lower rate of bacteraemia (0.9%) as compared with Group 1 (1.8%) and Group 2 (3.7%). A significant fall in the proportion of ESBL-producing Enterobacteriaceae was observed from the period when ciprofloxacin was used as prophylaxis (8.1%) compared with the subsequent period when...... pivmecillinam and amoxicillin/clavulanic acid was used (5.9%). CONCLUSIONS: The combination of pivmecillinam and amoxicillin/clavulanic acid is an attractive prophylaxis for TRUBP from a clinical, bacteriological and ecological point of view as compared with ciprofloxacin....

  17. Role of phytotherapy associated with antibiotic prophylaxis in female patients with recurrent urinary tract infections

    Directory of Open Access Journals (Sweden)

    Emanuela Frumenzio

    2013-12-01

    Full Text Available Objective: Aim of this study is to evaluate the efficacy of a phytotherapic which includes Solidago, Orthosiphon and Birch extract (Cistimev® in association with antibiotic prophylaxis in female patients affected by recurrent urinary tract infections (UTIr. Materials and methods: Patients affected by UTIr older than 18 years started a 3-months antibiotic prophylaxis (Prulifloxacin 600 mg, 1 cps/week or Phosphomicyn 1 cachet/week according to antibiogram after urine culture. The patients were divided in 2 groups: Group A: antibiotic prophylaxis plus phytotherapy (1 cps/die for 3 months and Group B: antibiotic prophylaxis alone. Results: 164 consecutive patients were studied: 107 were included in group A (mean age 59 ± 17.3 years and 57 (mean age 61 ± 15.7 in group B. During the treatment period the relapse frequencies between the two groups were not significantly different (p = 0.854: 12/107 (11.21% patients interrupted the treatment for UTIr in group A and 6/57 (10.52% in group B. In the long term follow-up the relapse UTI risk was significant different in the two groups with a relapse risk 2.5 greater in group B than in group A (p < 0.0001. Conclusion: Our study demonstrated that in female patients affected by recurrent UTI, the association between antibiotic prophylaxis and of a phytotherapic which includes Solidago, Orthosiphon and Birch extract reduced the number of UTI in the 12 months following the end of prophylaxis and obtained a longer relapsing time, greatly improving the quality of life of the patients.

  18. Evaluation of antibiotic prophylaxis administration at the orthopedic surgery clinic of tertiary hospital in Jakarta, Indonesia

    Directory of Open Access Journals (Sweden)

    Maksum Radji

    2014-06-01

    Full Text Available Objective: To evaluate the effectiveness of the use of antibiotic prophylaxis in preventing surgical site infections, at orthopedic surgery unit in tertiary hospital, Dr. Mintohardjo Navy Hospital, Jakarta, Indonesia. Methods: This study was a cross-sectional study conducted retrospectively on the orthopedic unit of the Dr. Mintohardjo Navy Hospital, Jakarta, Indonesia between January to December 2012. Assessment of appropriateness of antibiotic prophylaxis was carried out based on the Scottish Intercollegiate Guidelines and The National Guidelines of Antibiotic Usage in Indonesia. Results: A total of 163 samples consisted of men (73% and women (27% with an age range less than 12 years (9.8%, 12-25 years (23.3%, 26-65 years (58.9% and over 65 years (8.0%. The most commonly antibiotic prophylaxis used in this study was ceftriaxone (87.8%, followed by gentamycin (3.7%, cefotaxime (3.7%, cefoporaxone (1.2%, siprofloksasin (1.2%, fosfomycin (0.6%, meropenem (0.6%, and vancomycin (0.6%. Of the 163 patients 8 (4.9% patients developed a surgical site infection of all orthopedic surgical patients who received antibiotic prophylaxis. The pathogens isolated from surgical site infection were Escherichia coli (23.08%, coliform (18.62%, Staphylococcus aureus (18.00%, Pseudomonas aeruginosa (12.15%, and Alkaligenes sp. (9.31%. Conclusions: The Compliance of antibiotics prophylaxis administration at orthopedic surgery unit in Dr. Mintohardjo Naval Hospital has not been in accordance with the guidelines of the national or international standards. Therefore it is necessary to do some improvements to ensure better compliance with standard guidelines.

  19. Analysis of preoperative antibiotic prophylaxis in stented, distal hypospadias repair.

    Science.gov (United States)

    Smith, Jacob; Patel, Ashay; Zamilpa, Ismael; Bai, Shasha; Alliston, Jeffrey; Canon, Stephen

    2017-04-01

    Surgical site infection [SSI] is a risk for any surgical procedure, including hypospadias repair. Prophylactic antibiotic therapy for patients having surgery is often effective in preventing SSIs, but with increasing rates of antibiotic resistance, this practice has been questioned. The objectives of this study are 1) to assess the incidence of SSIs in patients following stented, distal hypospadias repair and 2) to observe for any potential difference in the incidence of SSIs for patients with and without preoperative antibiotic utilization in this setting. We retrospectively reviewed consecutive patients treated with stented, distal hypospadias repair from 2011 to 2014 by three surgeons and compared two groups: patients who received preoperative antibiotics and patients who did not. Patients with a history of previous hypospadias repair were excluded from the study. Two hundred twenty-four subjects were identified. Group 1 (135) received preoperative antibiotic and Group 2 (89) did not receive preoperative antibiotics. There was no statistically significant difference in SSI prevalence with 0 patients in Group 1 and 1 patient in Group 2 having a SSI. Although prophylactic antibiotics prior to hypospadias repair are most often used by pediatric urologists, this study demonstrates further evidence that antibiotics prior to this procedure do not appear to lower the rate of SSI. This study is limited by its retrospective nature and disparate mean follow up in the two cohorts. Surgical site infection does not appear to be decreased by prophylactic antibiotic therapy before distal hypospadias repair.

  20. Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery : an observational study

    NARCIS (Netherlands)

    Hamouda, Khaled; Oezkur, Mehmet; Sinha, Bhanu; Hain, Johannes; Menkel, Hannah; Leistner, Marcus; Leyh, Rainer; Schimmer, Christoph

    2015-01-01

    Background: All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods: Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac

  1. The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis

    NARCIS (Netherlands)

    de Vries, Eefje N.; Dijkstra, Lucia; Smorenburg, Susanne M.; Meijer, R. Peter; Boermeester, Marja A.

    2010-01-01

    ABSTRACT: BACKGROUND: Surgical site infection (SSI) is an adverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS)

  2. Antibiotic prophylaxis for dental treatment after prosthetic joint replacement: exploring the orthopaedic surgeon's opinion

    Directory of Open Access Journals (Sweden)

    Clare M. McNally, MPhil(Dent

    2016-09-01

    Conclusions: Australian orthopaedic surgeons continue to recommend antibiotic prophylaxis for dental treatment. The recording of PJI in relation to dental procedures into clinical registries would enable the development of consistent guidelines between professional groups responsible for the care of this patient group.

  3. Antibiotic Prophylaxis and Resistance in Surgical Site Infection After Immediate Tissue Expander Reconstruction of the Breast.

    Science.gov (United States)

    McCullough, Meghan C; Chu, Carrie K; Duggal, Claire S; Losken, Albert; Carlson, Grant W

    2016-11-01

    A recent survey of plastic surgeons showed that the majority prescribed prophylactic antibiotics after hospital discharge for breast reconstruction. There is no clinical evidence that this practice reduces surgical site infection (SSI) after immediate tissue expander breast reconstruction. Furthermore, multiple studies have suggested that current antibiotic choices may not be appropriately covering the causative organisms of SSI. An institutional breast reconstruction database from January 2005 to December 2011 was queried to identify patients undergoing immediate tissue expander reconstruction of the breast. The bacteriology of the infection, prophylactic and empiric antibiotic use, and antibiotic sensitivities were analyzed. In 557 cases of immediate tissue expander breast reconstruction performed in 378 patients, SSIs were diagnosed in 50 (9.0%) cases. Two hundred patients were given oral antibiotics at discharge; 178 did not receive antibiotics. Surgical site infection developed in 12.0% of patients given oral antibiotics and in 13.5% of those not receiving antibiotics (P = 0.67). Wound culture data were obtained in 34 SSIs. Twenty-nine had positive cultures. The most common offending organisms were methicillin-sensitive (11) and methicillin-resistant (6) Staphylococcus aureus. Despite increased use of postoperative prophylaxis over the years, SSI incidence remained unchanged. However, trends toward increased resistance of SSI organisms to the preoperative and postoperative prophylaxis agents were observed. When first-generation cephalosporins were used as prophylaxis, SSI organisms showed resistance rates of 20.5% (preoperative cefazolin) and 54.5% (postoperative cephalexin). Administration of extended prophylactic antibiotics does not reduce overall risk of SSI after expander-based breast reconstruction but may influence antibiotic resistance patterns when infections occur. The organisms most commonly responsible for SSI are often resistant to cefazolin.

  4. Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints

    Science.gov (United States)

    Sendi, Parham; Uçkay, Ilker; Suvà, Domizio; Vogt, Markus; Borens, Olivier; Clauss, Martin

    2016-01-01

    In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group 'Infection' of Swiss Orthopaedics. Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints. PMID:28529852

  5. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy

    Science.gov (United States)

    Gafter-Gvili, Anat; Fraser, Abigail; Paul, Mical; Vidal, Liat; Lawrie, Theresa A; van de Wetering, Marianne D; Kremer, Leontien CM; Leibovici, Leonard

    2014-01-01

    Background Bacterial infections are a major cause of morbidity and mortality in patients who are neutropenic following chemotherapy for malignancy. Trials have shown the efficacy of antibiotic prophylaxis in reducing the incidence of bacterial infections but not in reducing mortality rates. Our systematic review from 2006 also showed a reduction in mortality. Objectives This updated review aimed to evaluate whether there is still a benefit of reduction in mortality when compared to placebo or no intervention. Search methods We searched the Cochrane Cancer Network Register of Trials (2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), abstracts of conference proceedings and the references of identified studies. Selection criteria Randomised controlled trials (RCTs) or quasi-RCTs comparing different types of antibiotic prophylaxis with placebo or no intervention, or another antibiotic, to prevent bacterial infections in afebrile neutropenic patients. Data collection and analysis Two authors independently appraised the quality of each trial and extracted data from the included trials. Analyses were performed using RevMan 5.1 software. Main results One-hundred and nine trials (involving 13,579 patients) that were conducted between the years 1973 to 2010 met the inclusion criteria. When compared with placebo or no intervention, antibiotic prophylaxis significantly reduced the risk of death from all causes (46 trials, 5635 participants; risk ratio (RR) 0.66, 95% CI 0.55 to 0.79) and the risk of infection-related death (43 trials, 5777 participants; RR 0.61, 95% CI 0.48 to 0.77). The estimated number needed to treat (NNT) to prevent one death was 34 (all-cause mortality) and 48 (infection-related mortality). Prophylaxis also significantly reduced the occurrence of fever (54 trials, 6658 participants; RR 0.80, 95% CI 0.74 to 0.87), clinically documented infection

  6. Antibiotic Prophylaxis for Urinary Tract Infection-Related Renal Scarring: A Systematic Review.

    Science.gov (United States)

    Hewitt, Ian K; Pennesi, Marco; Morello, William; Ronfani, Luca; Montini, Giovanni

    2017-05-01

    Acute pyelonephritis may result in renal scarring. Recent prospective studies have shown a small benefit of antibiotic prophylaxis in preventing symptomatic and febrile urinary tract infections (UTIs), while being underpowered to detect any influence in prevention of renal damage. Review of the literature and a meta-analysis to evaluate the effect of antibiotic prophylaxis on UTI-related renal scarring. Medline, Embase, and Cochrane Controlled Trials Register electronic databases were searched for studies published in any language and bibliographies of identified prospective randomized controlled trials (RCTs) performed and published between 1946 and August 2016. Subjects 18 years of age or younger with symptomatic or febrile UTIs, enrolled in prospective RCTs of antibiotic prophylaxis where 99m Tc dimercaptosuccinic acid scans were performed at entry into the study and at late follow-up to detect new scar formation. The literature search, study characteristics, inclusion and exclusion criteria, and risk of bias assessment were independently evaluated by 2 authors. Seven RCTs (1427 subjects) were included in the meta-analysis. Our results show no influence of antibiotic prophylaxis in preventing renal scarring (pooled risk ratio, 0.83; 95% confidence interval, 0.55-1.26) as did a subanalysis restricted to those subjects with vesicoureteral reflux (pooled risk ratio, 0.79; 95% confidence interval, 0.51-1.24). Limitations include the small number of studies, short duration of follow-up, and insufficient children with high-grade dilating reflux and/or renal dysplasia enrolled in the studies. Antibiotic prophylaxis is not indicated for the prevention of renal scarring after a first or second symptomatic or febrile UTI in otherwise healthy children. Copyright © 2017 by the American Academy of Pediatrics.

  7. Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty.

    Science.gov (United States)

    Skaar, Daniel D; Park, Taehwan; Swiontkowski, Marc F; Kuntz, Karen M

    2015-11-01

    Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints. The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA). On the basis of the authors' interpretation of previous recommendations from the American Dental Association and American Academy of Orthopaedic Surgeons, they compared the following strategies: no prophylaxis, prophylaxis for the first 2 years after arthroplasty, and lifetime prophylaxis. A strategy of foregoing antibiotic prophylaxis before dental visits was cost-effective and resulted in lower lifetime accumulated costs ($11,909) and higher accumulated quality-adjusted life years (QALYs) (12.375) when compared with alternative prophylaxis strategies. The results of Markov decision modeling indicated that a no-antibiotic prophylaxis strategy was cost-effective for dental patients who had undergone THA. These results support the findings of case-control studies and the conclusions of an American Dental Association Council on Scientific Affairs report that questioned general recommendations for antibiotic prophylaxis before dental procedures. The results of cost-effectiveness decision modeling support the contention that routine antibiotic prophylaxis for dental patients with total joint arthroplasty should be reconsidered. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  8. Timing of surgical antibiotic prophylaxis administration: Complexities of analysis

    Directory of Open Access Journals (Sweden)

    Espin Sherry

    2009-06-01

    Full Text Available Abstract Background The timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges. Challenges Two clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different timing classifications in a single case. A formalized protocol was developed for dealing with incomplete, ambiguous and unclear documentation. A hierarchical coding system was implemented for managing cases with multiple antibiotic regimens. Interpretation Researchers who are tracking prophylactic antibiotic timing as an outcome measure should be aware that documentation of antibiotic timing in the patient chart is frequently incomplete and unclear, and these inconsistencies should be accounted for in analyses. We have developed a systematic method for dealing with specific problematic patterns encountered in the data. We propose that the general adoption of a systematic approach to analysis of this type of data will allow for cross-study comparisons and ensure that interpretation of results is on the basis of timing practices rather than documentation practices.

  9. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section.

    Science.gov (United States)

    Smaill, Fiona M; Grivell, Rosalie M

    2014-10-28

    The single most important risk factor for postpartum maternal infection is cesarean section. Although guidelines endorse the use of prophylactic antibiotics for women undergoing cesarean section, there is not uniform implementation of this recommendation. This is an update of a Cochrane review first published in 1995 and last updated in 2010. To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved papers. Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section. Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. The clinically important primary outcomes were wound infection, endometritis, serious maternal infectious complications and adverse effects on the infant. We presented dichotomous data as risk ratios (RR), with 95% confidence intervals (CIs) and combined trials in meta-analyses. We assessed the quality of evidence using the GRADE approach. We identified 95 studies enrolling over 15,000 women. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection (RR 0.40, 95% CI 0.35 to 0.46, 82 studies, 14,407 women), endometritis (RR 0.38, 95% CI 0.34 to 0.42, 83 studies, 13,548 women) and maternal serious infectious complications (RR 0.31, 95% CI 0.20 to 0.49, 32 studies, 6159 women). When only studies that included women undergoing an elective cesarean section were analyzed, there was also a reduction in the incidence of wound infections (RR 0.62, 95% CI 0.47 to 0.82, 17 studies, 3537 women) and endometritis (RR 0.38, 95% CI 0.24 to 0.61, 15 studies, 2502 women) with prophylactic

  10. Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

    Science.gov (United States)

    Kasatpibal, Nongyao; Whitney, Joanne D; Dellinger, E Patchen; Nair, Bala G; Pike, Kenneth C

    Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk. A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome. The effects of antibiotic prophylaxis and potential factors on SSI risk were estimated using multiple logistic regression and were expressed as risk ratios (RRs). A total of 4,078 patients were eligible for analysis. Of these, 180 had an SSI. Mortality rates within and after 30 days were 0.8% and 0.3%, respectively. Improper antibiotic redosing increased the risk of SSI (RR 4.61; 95% confidence interval [CI] 1.33-15.91). Other risk factors were in-patient status (RR 4.05; 95% CI 1.69-9.66), smoking (RR 1.63; 95% CI 1.03-2.55), emergency surgery (RR 1.97; 95% CI 1.26-3.08), colectomy (RR 3.31; 95% CI 1.19-9.23), pancreatectomy (RR 4.52; 95% CI 1.53-13.39), proctectomy (RR 5.02; 95% CI 1.72-14.67), small bowel surgery (RR 6.16; 95% CI 2.13-17.79), intra-operative blood transfusion >500 mL (RR 2.76; 95% CI 1.45-5.26), and multiple procedures (RR 1.40; 95% CI 1.01-1.95). These data demonstrate that failure to redose prophylactic antibiotic during long operations increases the risk of SSI. Strengthening a collaborative surgical quality improvement program may help to eradicate this risk.

  11. Early Gut Microbiota Perturbations Following Intrapartum Antibiotic Prophylaxis to Prevent Group B Streptococcal Disease.

    Directory of Open Access Journals (Sweden)

    Giuseppe Mazzola

    Full Text Available The faecal microbiota composition of infants born to mothers receiving intrapartum antibiotic prophylaxis with ampicillin against group B Streptococcus was compared with that of control infants, at day 7 and 30 of life. Recruited newborns were both exclusive breastfed and mixed fed, in order to also study the effect of dietary factors on the microbiota composition. Massive parallel sequencing of the V3-V4 region of the 16S rRNA gene and qPCR analysis were performed. Antibiotic prophylaxis caused the most marked changes on the microbiota in breastfed infants, mainly resulting in a higher relative abundance of Enterobacteriaceae, compared with control infants (52% vs. 14%, p = 0.044 and mixed-fed infants (52% vs. 16%, p = 0.13 NS at day 7 and in a lower bacterial diversity compared to mixed-fed infants and controls. Bifidobacteria were also particularly vulnerable and abundances were reduced in breastfed (p = 0.001 and mixed-fed antibiotic treated groups compared to non-treated groups. Reductions in bifidobacteria in antibiotic treated infants were also confirmed by qPCR. By day 30, the bifidobacterial population recovered and abundances significantly increased in both breastfed (p = 0.025 and mixed-fed (p = 0.013 antibiotic treated groups, whereas Enterobacteriaceae abundances remained highest in the breastfed antibiotic treated group (44%, compared with control infants (16% and mixed-fed antibiotic treated group (28%. This study has therefore demonstrated the short term consequences of maternal intrapartum antibiotic prophylaxis on the infant faecal microbial population, particularly in that of breastfed infants.

  12. Antibiotic prophylaxis for endoscopic retrograde chlangiopancreatography increases the detection rate of drug-resistant bacteria in bile.

    Science.gov (United States)

    Minami, Tomoyuki; Sasaki, Tamito; Serikawa, Masahiro; Ishigaki, Takashi; Murakami, Yoshiaki; Chayama, Kazuaki

    2014-09-01

    No consensus has yet been reached regarding the utility of antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP). However, there has been little discussion of potential adverse effects of antibiotic use. This study investigated the impact of antibiotic prophylaxis on overall levels of bacterial infiltration of the biliary tract and the prevalence of drug-resistance among that population. Ninety-three patients, from whom intraoperative bile samples were collected after performing ERCP, were assigned to either an antibiotic-prophylaxis group (AP, n = 58) or a no-antibiotic-prophylaxis group (NAP, n = 35). Detection rates of biliary bacteria and antibiotic resistance were determined for each group. Multivariate analysis was also performed to identify risk factors for the development of drug-resistant biliary bacteria. The bile contamination rate was 37.1% for the NAP group and 55.2% for the AP group (P = 0.09). Drug-resistant bacteria were found in 5.7% of the NAP group and 29.3% of the AP group (P = 0.006). Biliary drainage and antibiotic prophylaxis for ERCP were identified as risk factors for the presence of drug-resistant bacteria. Administration of antibiotic prophylaxis prior to ERCP can be a risk factor for the selection of drug-resistant bacteria in the biliary tract. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  13. Antibiotic prophylaxis practice patterns for cataract surgery in India - Results from an online survey.

    Science.gov (United States)

    Kelkar, Aditya S; Chang, David F; Kelkar, Jai A; Mehta, Hetal M; Lahane, Tatyarao; Parekh, Ragini

    2017-12-01

    The aim of this study is to assess the current antibiotic prophylaxis practice patterns for cataract surgery in India. This was a questionnaire-based E-survey carried out at a tertiary eye care center in India. An E-mail invitation to complete an online 20 point questionnaire survey was sent to all members of the All India Ophthalmological Society with valid E-mail addresses using a digital E-mail service. Duplicate entries were prevented. Out of 1228 total respondents (8.2%) who completed the survey 38% reported using routine intracameral (IC) antibiotic prophylaxis. Another 7% place antibiotics in the irrigating solution. Of those using IC antibiotic prophylaxis, 91% adopted this practice within the past 2 years; 92% are using moxifloxacin with 56% using a commercially available moxifloxacin formulation. Those predominantly performing phacoemulsification (43% vs. 25% performing mostly manual small incision cataract surgery, P India. In contrast to the West, intraocular moxifloxacin, which is commercially available in India, is preferred by the vast majority of users.

  14. Antibiotic Therapies in Maxillofacial Surgery in the Context of Prophylaxis

    Science.gov (United States)

    Orzechowska-Wylęgała, Bogusława; Wylęgała, Adam; Buliński, Michał; Niedzielska, Iwona

    2015-01-01

    Objectives. There is no single pattern for preventive action as to the duration and type of antibiotic therapy in maxillofacial surgery. In these circumstances, it appears reasonable to set relevant standards for prophylactic procedures after such surgeries. Methods. Retrospective analysis of bacteriological tests has been carried out as well as a susceptibility evaluation of cultured bacterial and fungal strains to antibiotics over a five-year period in subjects treated at the Cranio-Maxillo-Facial Clinic in Katowice. A total of 726 bacterial and fungal strains were cultured in 484 patients (200 women and 284 males). The age of the patients was 40.2 on average. Results. The most frequent bacteria isolated from the patients were Gram-positive 541 (74.5%). Gram-negative bacteria were present in 177 (24.4%) cases. Fungi of the Candida genus were isolated in eight cases (1.1%). Conclusions. The most often isolated bacteria were Streptococcus mitis and Streptococcus oralis, whose number has grown over the last two years. Empiric therapies should be based on ciprofloxacin and gentamicin. It has been observed that all the Gram-positive bacteria are becoming more resistant to all antibiotics. Ampicillin and imipenem were antibiotics with the steepest resistance reduction while vancomycin showed the lowest resistance drop. PMID:25710028

  15. NICE guideline on antibiotic prophylaxis against infective endocarditis: attitudes to the guideline and implications for dental practice in Ireland.

    LENUS (Irish Health Repository)

    2009-03-28

    To investigate attitudes of Irish dental practitioners, cardiologists and patients with cardiac lesions to the new NICE guideline for antibiotic prophylaxis against infective endocarditis and to determine the implications of this guideline for dental practice in Ireland.

  16. Antibiotic prophylaxis after endoscopic therapy prevents rebleeding in acute variceal hemorrhage: a randomized trial.

    Science.gov (United States)

    Hou, Ming-Chih; Lin, Han-Chieh; Liu, Tsu-Te; Kuo, Benjamin Ing-Tieu; Lee, Fa-Yauh; Chang, Full-Young; Lee, Shou-Dong

    2004-03-01

    Bacterial infection may adversely affect the hemostasis of patients with gastroesophageal variceal bleeding (GEVB). Antibiotic prophylaxis can prevent bacterial infection in such patients, but its role in preventing rebleeding is unclear. Over a 25-month period, patients with acute GEVB but without evidence of bacterial infection were randomized to receive prophylactic antibiotics (ofloxacin 200 mg i.v. q12h for 2 days followed by oral ofloxacin 200 mg q12h for 5 days) or receive antibiotics only when infection became evident (on-demand group). Endoscopic therapy for the GEVB was performed immediately after infection work-up and randomization. Fifty-nine patients in the prophylactic group and 61 patients in the on-demand group were analyzed. Clinical and endoscopic characteristics of the gastroesophageal varices, time to endoscopic treatment, and period of follow-up were not different between the two groups. Antibiotic prophylaxis decreased infections (2/59 vs. 16/61; P actuarial probability of rebleeding was higher in patients without prophylactic antibiotics (P =.0029). The difference of rebleeding was mostly due to early rebleeding within 7 days (4/12 vs. 21/27, P =.0221). The relative hazard of rebleeding within 7 days was 5.078 (95% CI: 1.854-13.908, P <.0001). The multivariate Cox regression indicated bacterial infection (relative hazard: 3.85, 95% CI: 1.85-13.90) and association with hepatocellular carcinoma (relative hazard: 2.46, 95% CI: 1.30-4.63) as independent factors predictive of rebleeding. Blood transfusion for rebleeding was also reduced in the prophylactic group (1.40 +/- 0.89 vs. 2.81 +/- 2.29 units, P <.05). There was no difference in survival between the two groups. In conclusion, antibiotic prophylaxis can prevent infection and rebleeding as well as decrease the amount of blood transfused for patients with acute GEVB following endoscopic treatment.

  17. Antibiotic prophylaxis for transrectal ultrasound biopsy of the prostate in Ireland.

    LENUS (Irish Health Repository)

    Smyth, L G

    2012-03-01

    Prostate cancer is the most common solid cancer affecting men in Ireland. Transrectal ultrasound (TRUS) biopsies of the prostate are routinely performed to diagnose prostate cancer. They are, in general, a safe procedure but are associated with a significant risk of infective complications ranging from fever, urinary tract infection to severe urosepsis. At present, there are no recommended national guidelines on the use of antibiotic prophylaxis to minimise the risk of infective complications post-TRUS biopsy.

  18. Should patients with hip joint prosthesis receive antibiotic prophylaxis before dental treatment?

    Directory of Open Access Journals (Sweden)

    Egil Lingaas

    2010-08-01

    Full Text Available The safety committee of the American Academy of Orthopedic Surgeons (AAOS recommended in 2009 that clinicians should consider antibiotic prophylaxis for all patients with total joint replacement before any invasive procedure that may cause bacteremia. This has aroused confusion and anger among dentists asking for the evidence. The present review deals with different aspects of the rationale for this recommendation giving attention to views both in favor of and against it.

  19. Withholding Preoperative Antibiotic Prophylaxis in Knee Prosthesis Revision: A Retrospective Analysis on Culture Results and Risk of Infection.

    Science.gov (United States)

    Wouthuyzen-Bakker, Marjan; Tornero, Eduard; Claret, Guillem; Bosch, Jordi; Martinez-Pastor, Juan Carlos; Combalia, Andreu; Soriano, Alex

    2017-09-01

    A significant amount of patients undergoing revision surgery of a prosthetic joint turn out to have an infection. Withholding preoperative antibiotic prophylaxis in these patients to optimize culture yield during revision surgery remains a matter of debate. The aim of our study was to determine (1) the rate of positive intraoperative cultures with or without preoperative antibiotic prophylaxis and (2) the incidence of a prosthetic joint infection (PJI) during the follow-up in the 2 groups. Medical files of patients in whom preoperative antibiotic prophylaxis was withheld until culture samples were taken (2007-2010, n = 284) and in whom antibiotic prophylaxis was given during the induction of anesthesia (2010-2013, n = 141) were retrospectively reviewed. The percentage of ≥1 positive cultures was the same in the group without (26%) and with preoperative prophylaxis (27%; P value, .7). PJI was diagnosed during revision surgery according to the Musculoskeletal Infection Society criteria in 6.7% patients not receiving preoperative prophylaxis and in 7.0% receiving it (P value, .79). We found no important differences in the type of microorganisms that were isolated in both groups. During a 3-month follow-up, an early PJI developed in patients undergoing total revision surgery in 6.4% of the nonpreoperative prophylaxis group vs 1.6% in the preoperative prophylaxis group (P value, .1). Preoperative antibiotic prophylaxis does not reduce culture yield in patients undergoing knee revision surgery. Our data show a trend toward a higher PJI rate in the postoperative period of total revision surgery when preoperative prophylaxis is withheld. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. [Large-scale selective antibiotic prophylaxis during the 2004 cholera outbreak in Douala (Cameroon)].

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    Guévart, Edouard; Noeske, Jürgen; Sollé, Jérémie; Mouangue, Antoine; Bikoti, Joseph-Marie

    2007-01-01

    During the 2004 cholera outbreak in Douala, densely populated and poor suburban populations had very poor access to safe drinking water and were at high risk of transmission. The provincial task force thus decided to provide preventive antibiotic treatment of all patient contacts, that is, family members taking care of patients in the hospital and household members of patients or close neighbours living in houses directly adjacent to patients. This retrospective report, based on data from hospitals, local cholera committees, and pharmacies, describes the course of the epidemic, bacteriological monitoring, and antibiotic distribution. Suddenly appearing in January 2004, the outbreak affected 5,020 patients in 8 months. V.cholerae, which was isolated in 111/187 samples, remained susceptible to doxycycline, amoxicillin, and fluoroquinolones. A total of 182,366 persons (35 contacts per patient) received antibiotic treatment. The rate of contacts among new patients fell from 30% to less than 0.2%. Antibiotic prophylaxis was a part of a comprehensive package of community interventions that included health education, disinfection of homes, latrines and wells in all affected households, and bacteriological monitoring. Although it reduces the risk of the disease, mass antibiotic prophylaxis is not recommended against cholera outbreaks, because it does not prevent contamination and is limited by contraindications, costs, and modes of administration. Moreover, it increases the risk of developing resistance. It is impossible to eradicate vibrio from the environment. The individual risk of contracting cholera is not known and it is difficult to assess the impact of a collective prevention strategy. Because the bacteria remains susceptible to antibiotic drugs, a well-targeted antibiotic prophylaxis made it possible to reduce direct human transmission of cholera. This reduction did not affect the overall epidemic, however, because of the massive environmental contamination. The

  1. Antibiotic prophylaxis: different practice patterns within and outside the United States

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    Schwartz SG

    2016-01-01

    Full Text Available Stephen G Schwartz,1 Andrzej Grzybowski,2 Harry W Flynn Jr1 1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Ophthalmology, Poznan City Hospital, Poznan, Poland Abstract: Endophthalmitis remains a rare but important cause of visual loss. Prophylaxis strategies are important to reduce rates of endophthalmitis after cataract surgery, intravitreal injection, and other procedures. There is substantial variability between the US and the rest of the world. During cataract surgery, intracameral antibiotics are commonly used in many nations, especially in Europe, but are less commonly used in the US. A randomized clinical trial from the European Society of Cataract and Refractive Surgeons reported an approximately fivefold reduction in endophthalmitis rates associated with intracameral cefuroxime but these results are controversial. There are no randomized clinical trials regarding endophthalmitis associated with intravitreal injection. Topical antibiotics are commonly used in many nations, but are less commonly used in the US. At this time, there is no global consensus and it appears unlikely that additional major clinical trials will conclusively define the optimal endophthalmitis prophylaxis techniques. Keywords: cataract surgery, endophthalmitis, intracameral antibiotic, intravitreal injection, prophylaxis

  2. Antibiotic prophylaxis in orthopedic surgeries: the results of an implemented protocol

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    Raquel Queiroz

    Full Text Available Though the basic principles of antibiotic prophylaxis have been well established, there is still considerable incorrect usage, including how much is prescribed and especially in the duration of treatment, which is generally superior to what is indicated. The adequate use of these drugs contributes towards decreasing the time of internment of the patient, prevents surgical site infection (SSI, decreasing the development of resistant microorganisms, and towards reduced costs for the hospital pharmacy. A protocol for the use of antibiotic prophylaxis in the Orthopedics and Traumatology Service of the Hospital do Servidor Público Estadual de São Paulo was developed. The objectives of the study were to promote rational antibiotic surgical prophylaxis, through the implantation of a protocol for the use of these drugs in a surgical unit, with the direct contribution of a druggist in collaboration with the Infection Control Committee, to evaluate the adhesion of the health team to the protocol during three distinct periods (daily pre-protocol, early post-protocol and late post-protocol and to define the consumption of antimicrobials used, measured as daily defined dose.

  3. Effect of septoplasty and per-operative antibiotic prophylaxis on nasal flora.

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    Karaman, E; Alimoglu, Y; Aygun, G; Kilic, E; Yagiz, C

    2012-01-01

    Septoplasty is one of the most commonly performed procedures in otolaryngology practice. Prophylactic use of antibiotics is controversial. Disruption of nasal flora may predispose individuals to infection. We investigated the effect of antibiotic prophylaxis and septoplasty on nasal flora. We included 115 consecutive patients who underwent septoplasty because of symptomatic nasal septal deviation. Patients were divided into study and control groups. Study patients received prophylactic parenteral sodium cefazoline twice a day beginning intra-operatively and while the nasal packing remained in the nose for 48 h, and expandable polyvinyl acetate (Merocel) packing covered with antibiotic ointment containing 0.2% nitrofurazone was inserted into each nostril at the end of the operation. Control patients received neither parenteral antibiotic prophylaxis nor antibiotic ointment around the Merocel packs. Both groups received oral prophylactic cefuroxime axetil for 5 d after nasal packing was removed. Nasal flora was determined pre-operatively, post-operatively when nasal packing was removed, and 3 mo after surgery. Study patients were compared to control patients at pack removal and 1 mo after surgery The effect of antibiotic use in septoplasty on nasal flora was as follows: Increased isolation rate of gram-positive rods (p = 0.007), decreased methicillin-sensitive coagulase-negative staphylococci (p = 0.002). Pre-operative and post-operative culture results at 3 mo were compared. The effect of septoplasty on nasal flora was as follows: Decreased coagulase-negative staphylococci (p = 0.05), decreased Klebsiella (p flora. Antibiotics do not protect against S. aureus colonization and contribute to a decrease in normal flora. Antibiotics do not seem to confer benefit in terms of flora changes. Studies investigating flora changes with a longer follow-up should be conducted.

  4. Antibiotic prophylaxis in elective cholecystectomy: protocol adequacy and related outcomes in a retrospective single-centre analysis

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    Gil Rodríguez-Caravaca

    2016-01-01

    Full Text Available Background: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. Methods: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. Results: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%, followed by the moment of initiating its administration (8.9%. The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6. No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0, nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1. Conclusions: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%. No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

  5. Incidence of endophthalmitis and use of antibiotic prophylaxis after intravitreal injections.

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    Cheung, Crystal S Y; Wong, Amanda W T; Lui, Alex; Kertes, Peter J; Devenyi, Robert G; Lam, Wai-Ching

    2012-08-01

    To report the incidence of endophthalmitis in association with different antibiotic prophylaxis strategies after intravitreal injections of anti-vascular endothelial growth factors and triamcinolone acetonide. Retrospective, comparative case series. Fifteen thousand eight hundred ninety-five intravitreal injections (9453 ranibizumab, 5386 bevacizumab, 935 triamcinolone acetonide, 121 pegaptanib sodium) were reviewed for 2465 patients between January 5, 2005, and August 31, 2010. The number of injections was determined from billing code and patient records. The indications for injection included age-related macular degeneration, diabetic macular edema, central and branch retinal vein occlusion, and miscellaneous causes. Three strategies of topical antibiotic prophylaxis were used by the respective surgeons: (1) antibiotics given for 5 days after each injection, (2) antibiotics given immediately after each injection, and (3) no antibiotics given. The primary outcome measures were the incidence of culture-positive endophthalmitis and culture-negative cases of suspected endophthalmitis. Nine eyes of 9 patients with suspected endophthalmitis after injection were identified. Three of the 9 cases had culture-positive results. The overall incidence of endophthalmitis was 9 in 15 895. The incidence of culture-negative cases of suspected endophthalmitis and culture-proven endophthalmitis after injection was 6 in 15 895 and 3 in 15 895, respectively. Taking into account both culture-positive endophthalmitis and culture-negative cases of suspected endophthalmitis, the incidence per injection was 5 in 8259 for patients who were given antibiotics for 5 days after injection, 2 in 2370 for those who received antibiotics immediately after each injection, and 2 in 5266 who received no antibiotics. However, if considering culture-proven endophthalmitis alone, the use of topical antibiotics, given immediately or for 5 days after injection, showed lower rates of endophthalmitis

  6. Surgical site wound infection in relation to antibiotic prophylaxis given before skin incision and after cord clamping during cesarean delivery.

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    Shrestha, B; Marhatha, R; Giri, A; Jaisi, S; Maskey, U

    2014-12-01

    Surgical site infection is one of the most common complications following Lower Segment Cesarean Section, which accounts for prolonged hospital stay thereby increasing expense. Prophylactic antibiotics in cesarean section reduces surgical site infection significantly. The best protection is provided when tissue level of antibiotics are adequate before incision, without prejudice to neonatal infectious morbidity. The objective of this study was to compare the incidence of surgical site wound infection with prophylactic antibiotics given before skin incision and after cord clamping following delivery of baby. This was a prospective, hospital based study, in which hundred cases of cesarean deliveries who received antibiotics prophylaxis one hour before the skin incision were compared with another 100 cases where antibiotic was given after cord clamping following delivery of the baby. Surgical site infection occurred in 3% of women who received antibiotics prophylaxis before skin incision as compared to 6% in whom antibiotic was given after cord clamping. It was statistically not significant (p = 0.465).

  7. Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section.

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    Nabhan, Ashraf F; Allam, Nahed E; Hamed Abdel-Aziz Salama, Mohamed

    2016-06-17

    Post-caesarean section infection is a cause of maternal morbidity and mortality. Administration of antibiotic prophylaxis is recommended for preventing infection after caesarean delivery. The route of administration of antibiotic prophylaxis should be effective, safe and convenient. Currently, there is a lack of synthesised evidence regarding the benefits and harms of different routes of antibiotic prophylaxis for preventing infection after caesarean section. The aim of this review was to assess the benefits and harms of different routes of prophylactic antibiotics given for preventing infectious morbidity in women undergoing caesarean section. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 January 2016) and reference lists of retrieved studies. We included randomised controlled trials (RCTs) comparing at least two alternative routes of antibiotic prophylaxis for caesarean section (both elective and emergency). Cross-over trials and quasi-RCTs were not eligible for inclusion. Two review authors independently assessed trials for inclusion, assessed the risk of bias and extracted data from the included studies. These steps were checked by a third review author. We included 10 studies (1354 women). The risk of bias was unclear or high in most of the included studies.All of the included trials involved women undergoing caesarean section whether elective or non-elective. Intravenous antibiotics versus antibiotic irrigation (nine studies, 1274 women) Nine studies (1274 women) compared the administration of intravenous antibiotics with antibiotic irrigation. There were no clear differences between groups in terms of this review's maternal primary outcomes: endometritis (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.29; eight studies (966 women) (low-quality evidence)); wound infection (RR 0.49, 95% CI 0.17 to 1.43; seven

  8. Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.

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    Alexander M Aiken

    Full Text Available In low-income countries, Surgical Site Infection (SSI is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals.We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design.From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these.Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.

  9. COMPARISON OF SUBLINGUAL THERAPEUTIC VACCINE WITH ANTIBIOTICS FOR THE PROPHYLAXIS OF RECURRENT URINARY TRACT INFECTIONS

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    María Fernanda Lorenzo-Gómez

    2015-06-01

    Full Text Available Objective: To evaluate the clinical impact of the prophylactic treatment with sublingual immunostimulation in the prevention of recurrent urinary tract infections (rUTIs compared with the use of antibiotics.Material and Methods: Retrospective cohort study evaluating the clinical records of 669 women with rUTIs; 339 had a 6-month prophylaxis with antibiotics and 360 had a 3-month prophylaxis with a sublingual bacterial preparation (MV 140-Uromune®. The time after the prophylaxis-period until the appearance of a new infection (assessed by uroculture was scored during one year. Absolute risk reduction (ARR and number needed to treat (NNT were also calculated.Results: All patients (100% treated with antibiotics experienced a new UTI during the scoring period of 12 months, being the mean time free of UTI 29 (±38 days. In the group treated with the bacterial preparation, only 35 (9.7% patients experienced UTI in the same period. Kaplan-Meier curves comparing the accumulated survival (disease-free time between both groups were significant (P < 0.0001. ARR was 90.28 % (87.18-93.38 and NNT 1.1 (1.1-1.1.Conclusions: These results suggest that the treatment with the bacterial preparation reduces rUTIs very effectively, arising as an effective strategy to reduce the frequency of rUTIs. It reduces antibiotic consumption, matching the current recommendations due to the raise of antimicrobial resistance. Randomized, double-blind and placebo-controlled, clinical trials are needed to establish more accurately the clinical impact of this bacterial preparation in patients with rUTIs.

  10. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis.

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    Villatoro, Eduardo; Mulla, Mubashir; Larvin, Mike

    2010-05-12

    Pancreatic necrosis may complicate severe acute pancreatitis, and is detectable by computed tomography (CT). If it becomes infected mortality increases, but the use of prophylactic antibiotics raises concerns about antibiotic resistance and fungal infection. To determine the efficacy and safety of prophylactic antibiotics in acute pancreatitis complicated by CT proven pancreatic necrosis. Searches were updated in November 2008, in The Cochrane Library (Issue 2, 2008), MEDLINE, EMBASE, and CINAHL. Conference proceedings and references from found articles were also searched. Randomised controlled trials (RCTs) comparing antibiotics versus placebo in acute pancreatitis with CT proven necrosis. Primary outcomes were mortality and pancreatic infection rates. Secondary end-points included non pancreatic infection, all sites infection, operative rates, fungal infections, and antibiotic resistance. Subgroup analyses were performed for antibiotic regimen (beta-lactam, quinolone, and imipenem). Seven evaluable studies randomised 404 patients. There was no statistically significant effect on reduction of mortality with therapy: 8.4% versus controls 14.4%, and infected pancreatic necrosis rates: 19.7% versus controls 24.4%. Non-pancreatic infection rates and the incidence of overall infections were not significantly reduced with antibiotics: 23.7% versus 36%; 37.5% versus 51.9% respectively. Operative treatment and fungal infections were not significantly different. Insufficient data were provided concerning antibiotic resistance.With beta-lactam antibiotic prophylaxis there was less mortality (9.4% treatment, 15% controls), and less infected pancreatic necrosis (16.8% treatment group, 24.2% controls) but this was not statistically significant. The incidence of non-pancreatic infections was non-significantly different (21% versus 32.5%), as was the incidence of overall infections (34.4% versus 52.8%), and operative treatment rates. No significant differences were seen with

  11. Dosing antibiotic prophylaxis during cardiopulmonary bypass-a higher level of complexity? A structured review.

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    Paruk, Fathima; Sime, Fekade B; Lipman, Jeffrey; Roberts, Jason A

    2017-04-01

    In highly invasive procedures such as open heart surgery, the risk of post-operative infection is particularly high due to exposure of the surgical field to multiple foreign devices. Adequate antibiotic prophylaxis is an essential intervention to minimise post-operative morbidity and mortality. However, there is a lack of clear understanding on the adequacy of traditional prophylactic dosing regimens, which are rarely supported by data. The aim of this structured review is to describe the relevant pharmacokinetic/pharmacodynamic (PK/PD) considerations for optimal antibiotic prophylaxis for major cardiac surgery including cardiopulmonary bypass (CPB). A structured review of the relevant published literature was performed and 45 relevant studies describing antibiotic pharmacokinetics in patients receiving extracorporeal CPB as part of major cardiac surgery were identified. Some of the studies suggested marked PK alterations in the peri-operative period with increases in volume of distribution (V d ) by up to 58% and altered drug clearances of up to 20%. Mechanisms proposed as causing the PK changes included haemodilution, hypothermia, retention of the antibiotic within the extracorporeal circuit, altered physiology related to a systemic inflammatory response, and maldistribution of blood flow. Of note, some studies reported no or minimal impact of the CPB procedure on antibiotic pharmacokinetics. Given the inconsistent data, ongoing research should focus on clarifying the influence of CPB procedure and related clinical covariates on the pharmacokinetics of different antibiotics during cardiac surgery. Traditional prophylactic dosing regimens may need to be re-assessed to ensure sufficient drug exposures that will minimise the risk of surgical site infections. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  12. The role of Ayurveda management in preventing surgical site infections instead of surgical antibiotic prophylaxis

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    Subhash Yadav

    2017-10-01

    Full Text Available It is probably for the first time in the history of modern surgery that Benign Prostate Hyperplasia (BPH surgery which belongs to ‘clean contaminated’ class and requires at least 3 doses of prophylactic antibiotic as per recommendations by American Urology Association, was done without the use of any as the patient had a history of severe intolerance to them. The case was an 83 year old male patient presenting with acute urinary retention. He was a known case of BPH being managed continuously on Ayurvedic therapy for many years. It was a challenge to conduct the inevitable surgery without any antibiotic prophylaxis. Holmium laser enucleation of prostate (HOLEP was done with Ayurvedic medicine support only without the use of any antibiotic. The post-operative recovery was uneventful. The long term recovery was unusually faster and remarkable. In view of rising antibiotic resistance and World Health Organisation (WHO declaration of arrival of post-antibiotic era, the successful outcome of this case could open new channels of research into Ayurveda, to find out the solution to the worst ever antibiotic crisis of the present time.

  13. [Percutaneous intradiscal oxygen-ozone injection for lumbar disc herniation: no need of perioperative antibiotic prophylaxis].

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    Wei, Chuan-jun; Li, Yan-hao; Chen, Yong; Wang, Jiang-yun; Zeng, Qing-le; Zhao, Jian-bo; Mei, Que-lin

    2007-03-01

    To evaluate the feasibility of no antibiotic administration to prevent infection during the perioperative period of percutaneous intradiscal ozone-injection for treatment of lumbar disc herniation. Seventy-two patients with lumbar disc herniation but normal body temperature as well as normal results of three routine tests (blood, urine, stool) and C-reactive protein (CRP) level were randomly divided into two groups. The patients in prophylaxis group were given cephalothin V(2.0 g) intravenous 30 min before the operation, and the control group did not use any antibiotics. All the patients were injected with 6-10 ml ozone (40 microg/ml) for medical use into the discs with 21G needles under fluoroscopic guidance, followed by 10 ml ozone into the paravertebral space. Three days later the general examinations and CRP measurement were repeated. No infection was found in these patients, nor were any significant differences noted in the results of the examinations between the two groups after controlling in patients with above-normal white blood cell count, neutrophil percentage and CRP level. Prophylaxis antibiotics is not necessary during the perioperative period of percutaneous intradiscal ozone injection for lumbar disc herniation.

  14. Is extended antibiotic prophylaxis necessary after penetrating trauma to the thoracolumbar spine with concomitant intraperitoneal injuries?

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    Pasupuleti, Latha V; Sifri, Ziad C; Mohr, Alicia M

    2014-02-01

    Prolonged courses of broad-spectrum antibiotics are often cited as standard care for the prevention of infectious complications in thoracolumbar or sacral (TLS) fractures following penetrating abdominal trauma. Perforation of a hollow viscus in addition to a TLS fracture is believed to be associated with a high incidence of spine infection. Because over use of antibiotics is associated with an increasing prevalence of multi-drug-resistant organisms, this study seeks to define the actual risk of infection of the spine and need for antibiotics in patients with TLS fractures and intraperitoneal injuries following penetrating trauma. A retrospective review of 67 patients with penetrating abdominal trauma and concomitant TLS fracture was performed. Demographics, level of TLS fracture, associated spinal cord injury (SCI), need for operative intervention, presence of concomitant hollow viscus injury, and type and duration of antibiotic coverage were collected. In addition, associated infectious complications were reviewed. Spine infections were defined as spinal or paraspinal abscess, osteomyelitis of the spine, or meningitis. Intraabdominal infections were defined with imaging studies or positive peritoneal cultures. Sixty-seven patients (mean age of 27 ± 9 years) had an exploratory laparotomy and one or more TLS fractures. Four patients died within 24 h and were excluded from further study. Thirty-eight patients (60%) had one or more hollow viscus injuries, 13 (21%) had solid organ injuries alone and 12 (19%) had a non-therapeutic laparotomy. All patients received perioperative antibiotics; 92% received 48 h or less of antibiotic prophylaxis and 62% received only 24 h of antibiotics. In one patient with an isolated solid organ injury there was a spine infection (1%). In this study, 92% of patients received antibiotics for 48 h or less with no increased incidence of spine infections. Bacterial colonization of the vertebrae was not higher in patients with penetrating

  15. How confident are general dental practitioners in their decision to administer antibiotic prophylaxis? A questionnaire study

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    Brehmer Berndt

    2008-12-01

    Full Text Available Abstract Background Common dental procedures induce bacteremia. To prevent infectious complications from bacteremia in patients with specific medical conditions, antibiotic prophylaxis is considered. Recommendations are often unclear and ambiguous. In a previous study we reported wide variations in general dental practitioners' (GDPs' administrations of antibiotic prophylaxis. We hypothesized that within such a conflicting clinical area, decisions are made with a high level of personal uncertainty. This study examined GDPs' confidence in their decisions and analyzed the extent to which case-related factors might explain individual variations in confidence. Methods Postal questionnaires in combination with telephone interviews were used. The response rate was 51% (101/200. There were no significant differences between respondents and non-respondents regarding sex, age, or place of work. The GDPs were presented to patient cases of different medical conditions, where some should receive antibiotic prophylaxis according to recommendations when performing dental procedures that could cause gingival bleeding. The GDPs assessed on visual analogue scales how confident they were in their decisions. The extent to which case-related factors, medical condition and dental procedure, could explain individual variation in confidence was analyzed. Results Overall the GDPs exhibited high confidence in their decisions regardless of whether they administered antibiotic prophylaxis or not, or whether their decisions were in accordance with recommendations or not. The case-related factors could explain between 30–100% of the individual variation in GDPs' confidence. For 46%, the medical condition significantly explained the individual variation in confidence. However, for most of these GDPs, lower confidence was not presented for conditions where recommendations are unclear and higher confidence was not presented for conditions where recommendations are more clear

  16. Weight Gain and Obesity in Infants and Young Children Exposed to Prolonged Antibiotic Prophylaxis.

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    Edmonson, M Bruce; Eickhoff, Jens C

    2017-02-01

    An association between antibiotic use and excessive weight gain or obesity in healthy infants and young children has been reported, but evidence is inconsistent and based on observational studies of growth in relation to incidental antibiotic exposures. To evaluate whether prolonged antibiotic exposure is associated with weight gain in children participating in a clinical trial of antibiotic prophylaxis to prevent recurrent urinary tract infection. Secondary analysis of data from the Randomized Intervention for Children With Vesicoureteral Reflux Study, a 2-year randomized clinical trial that enrolled participants from 2007 to 2011. All 607 children who were randomized to receive antibiotic (n = 302) or placebo (n = 305) were included. Children with urinary tract anomalies, premature birth, or major comorbidities were excluded from participation. Trimethoprim-sulfamethoxazole or placebo taken orally, once daily, for 2 years. Weight gain as measured by change in weight-for-age z score from baseline to the end-of-study visit at 24 months. Secondary outcomes included weight gain at 6, 12, and 18 months and the prevalence of overweight or obesity at 24 months. Participants had a median age of 12 months (range, 2-71 months) and 558 of 607 (91.9%) were female. Anthropometric data were complete at the 24-month visit for 428 children (214 in the trimethoprim-sulfamethoxazole group and 214 in the placebo group). Weight gain in the trimethoprim-sulfamethoxazole group and the placebo group was similar (mean [SD] change in weight-for-age z score: +0.14 [0.83] and +0.18 [0.85], respectively; difference, -0.04 [95% CI, -0.19 to 0.12]; P = .65). There was no significant difference in weight gain at 6, 12, or 18 months or in the prevalence of overweight or obesity at 24 months (24.8% vs 25.7%; P = .82). Subgroup analyses showed no significant interaction between weight gain effect and age, sex, history of breastfeeding, prior antibiotic use, adherence to study

  17. ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

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    Álvaro Antônio Bandeira FERRAZ

    2015-06-01

    Full Text Available Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

  18. A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor.

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    Sharma, Shiv K; Rogers, Beverly B; Alexander, James M; McIntire, Donald D; Leveno, Kenneth J

    2014-03-01

    It has been suggested that the development of maternal fever during epidural analgesia could be due to intrapartum infection. We investigated whether antibiotic prophylaxis before epidural placement decreases the rate of epidural-related fever. In this double-blind, placebo-controlled trial, 400 healthy nulliparous women requesting epidural analgesia were randomly assigned to receive either cefoxitin 2 g or placebo immediately preceding initiation of epidural labor analgesia. Maternal tympanic temperature was measured hourly, and intrapartum fever was defined as a maternal temperature of ≥38°C. Neonates born to women with fever were evaluated for possible sepsis, and available placentas were evaluated for the presence of neutrophilic inflammation. The primary outcome was maternal fever during epidural analgesia. Thirty-eight percent of women in the cefoxitin group and 40% of women in the placebo group developed fever (P = 0.68). The risk difference (95% confidence interval) for fever ≥38°C during labor (antibiotic versus placebo) was -2.0% (-11.5 to 7.5), and for fever >39°C during labor was -1.5% (-4.7 to 1.7). Approximately half of each study group had placental neutrophilic inflammation, but administration of cefoxitin had no significant effect on any grade of neutrophilic inflammation. Fever developed significantly more often in the women with placental neutrophilic inflammation compared with those without such inflammation (73/158 vs 33/144, P labor epidural analgesia is associated with placental inflammation, but fever and placental inflammation were not reduced with antibiotic prophylaxis. This finding suggests that infection is unlikely to be the cause in its development.

  19. A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

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    Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

    2015-08-01

    This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P protocol group (P protocol significantly decreased the total antibiotic dose used in the perioperative period (P protocol group patients required this additional change in the antibiotic regimen (P protocol based on preoperative kidney function effectively prevents SSIs in patients undergoing open heart surgery.

  20. Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery.

    Science.gov (United States)

    Boonchan, T; Wilasrusmee, C; McEvoy, M; Attia, J; Thakkinstian, A

    2017-01-01

    First-generation cephalosporins (such as cefazolin) are recommended as antibiotic prophylaxis in groin hernia repair, but other broad-spectrum antibiotics have also been prescribed in clinical practice. This was a systematic review and network meta-analysis to compare the efficacy of different antibiotic classes for prevention of surgical-site infection (SSI) after hernia repair. RCTs were identified that compared efficacy of antibiotic prophylaxis on SSI after inguinal or femoral hernia repair from PubMed and Scopus databases up to March 2016. Data were extracted independently by two reviewers. Network meta-analysis was applied to assess treatment efficacy. The probability of being the best antibiotic prophylaxis was estimated using surface under the cumulative ranking curve (SUCRA) analysis. Fifteen RCTs (5159 patients) met the inclusion criteria. Interventions were first-generation (7 RCTs, 1237 patients) and second-generation (2 RCTs, 532) cephalosporins, β-lactam/β-lactamase inhibitors (6 RCTs, 619) and fluoroquinolones (2 RCTs, 581), with placebo as the most common comparator (14 RCTs, 2190). A network meta-analysis showed that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were significantly superior to placebo, with a pooled risk ratio of 0·44 (95 per cent c.i. 0·25 to 0·75) and 0·62 (0·42 to 0·92) respectively. However, none of the antibiotic classes was significantly different from the others. SUCRA results indicated that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were ranked first and second respectively for best prophylaxis. β-Lactam/β-lactamase inhibitors followed by first-generation cephalosporins ranked as the most effective SSI prophylaxis for adult patients undergoing groin hernia repair. © 2017 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

  1. Effect of Antibiotic Prophylaxis on Early-Onset Pneumonia in Cardiac Arrest Patients Treated with Therapeutic Hypothermia

    Directory of Open Access Journals (Sweden)

    Soo Jung Kim

    2016-02-01

    Full Text Available Background: Infectious complications frequently occur after cardiac arrest and may be even more frequent after therapeutic hypothermia. Pneumonia is the most common infectious complication associated with therapeutic hypothermia, and it is unclear whether prophylactic antibiotics administered during this intervention can decrease the development of early-onset pneumonia. We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia. Methods: We retrospectively reviewed the medical records of patients who were admitted for therapeutic hypothermia after resuscitation for out-of-hospital cardiac arrest between January 2010 and July 2015. Patients who died within the first 72 hours or presented with pneumonia at the time of admission were excluded. Early-onset pneumonia was defined as pneumonia that developed within 5 days of admission. Prophylactic antibiotic therapy was defined as the administration of any parenteral antibiotics within the first 24 hours without any evidence of infection. Results: Of the 128 patients admitted after cardiac arrest, 68 were analyzed and 48 (70.6% were treated with prophylactic antibiotics within 24 hours. The frequency of early-onset pneumonia was not significantly different between the prophylactic antibiotic group and the control group (29.2% vs 30.0%, respectively, p = 0.945. The most commonly used antibiotic was third-generation cephalosporin, and the class of prophylactic antibiotics did not influence early-onset pneumonia. Conclusion: Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.

  2. The influence of antibiotic prophylaxis on bacterial resistance in urinary tract infections in children with spina bifida.

    Science.gov (United States)

    Zegers, Sebastiaan Hermanus Johannes; Dieleman, Jeanne; van der Bruggen, Tjomme; Kimpen, Jan; de Jong-de Vos van Steenwijk, Catharine

    2017-01-12

    Bacterial resistance to antibiotics is an increasingly threatening consequence of antimicrobial exposure for many decades now. In urinary tract infections (UTIs), antibiotic prophylaxis (AP) increases bacterial resistance. We studied the resistance patterns of positive urinary cultures in spina bifida children on clean intermittent catheterization, both continuing and stopping AP. In a cohort of 176 spina bifida patients, 88 continued and 88 stopped using AP. During 18 months, a fortnightly catheterized urine sample for bacterial pathogens was cultured. UTIs and significant bacteriuria (SBU) were defined as a positive culture with a single species of bacteria, respectively with and without clinical symptoms and leukocyturia. We compared the percentage of resistance to commonly used antibiotics in the isolated bacteria in both groups. In a total of 4917 cultures, 713 (14.5%) had a positive monoculture, 54.3% of which were Escherichia coli. In the group stopping AP, the resistance percentage to antibiotics in UTI / SBU bacteria was lower than in the group remaining on AP, even when excluding the administered prophylaxis. Stopping antibiotic prophylaxis for urinary tract infections is associated with reduced bacterial resistance to antibiotics in children with spina bifida. ISRCTN ISRCTN56278131 . Registered 20 December 2005.

  3. A prospective placebo-controlled double-blind trial of antibiotic prophylaxis in intraoral bone grafting procedures: A pilot study

    NARCIS (Netherlands)

    Lindeboom, Jerome A. H.; van den Akker, Hans P.

    2003-01-01

    Objective. A pilot study was conducted to assess the efficacy of a single-dose preoperative prophylactic of the penicillin pheneticillin compared with placebo in the antibiotic prophylaxis of surgical wound infections in intra-oral bone grafting procedures. Patients and Methods. Twenty patients (age

  4. Withholding Preoperative Antibiotic Prophylaxis in Knee Prosthesis Revision : A Retrospective Analysis on Culture Results and Risk of Infection

    NARCIS (Netherlands)

    Wouthuyzen-Bakker, Marjan; Tornero, Eduard; Claret, Guillem; Bosch, Jordi; Carlos Martinez-Pastor, Juan; Combalia, Andreu; Soriano, Alex

    Background: A significant amount of patients undergoing revision surgery of a prosthetic joint turn out to have an infection. Withholding preoperative antibiotic prophylaxis in these patients to optimize culture yield during revision surgery remains a matter of debate. The aim of our study was to

  5. Serotypes, genotypes, and antibiotic susceptibility profiles of group B streptococci causing neonatal sepsis and meningitis before and after introduction of antibiotic prophylaxis

    NARCIS (Netherlands)

    Trijbels-Smeulders, Monique A. J. M.; Kimpen, Jan L. L.; Kollée, Louis A. A.; Bakkers, Judith; Melchers, Willem; Spanjaard, Lodewijk; Wannet, Wim J. B.; Hoogkamp-Korstanje, Mieke A. A.

    2006-01-01

    We studied the characteristics of strains isolated from neonates with group B streptococci sepsis and meningitis, before and after the introduction of antibiotic prophylaxis in The Netherlands. In 1999, 1 year after this introduction the serotype and genotype distribution and the susceptibility

  6. Serotypes, genotypes, and antibiotic susceptibility profiles of group B streptococci causing neonatal sepsis and meningitis before and after introduction of antibiotic prophylaxis.

    NARCIS (Netherlands)

    Trijbels-Smeulders, M.A.; Kimpen, J.L.; Kollee, L.A.; Bakkers, J.; Melchers, W.J.; Spanjaard, L.; Wannet, W.J.; Hoogkamp-Korstanje, M.A.

    2006-01-01

    We studied the characteristics of strains isolated from neonates with group B streptococci sepsis and meningitis, before and after the introduction of antibiotic prophylaxis in The Netherlands. In 1999, 1 year after this introduction the serotype and genotype distribution and the susceptibility

  7. Routine antibiotic prophylaxis after normal vaginal birth for reducing maternal infectious morbidity.

    Science.gov (United States)

    Bonet, Mercedes; Ota, Erika; Chibueze, Chioma E; Oladapo, Olufemi T

    2017-11-13

    Infectious morbidities contribute to considerable maternal and perinatal morbidity and mortality, including women at no apparent increased risk of infection. To reduce the incidence of infections, antibiotics are often administered to women after uncomplicated childbirth, particularly in settings where women are at higher risk of puerperal infectious morbidities. To assess whether routine administration of prophylactic antibiotics to women after normal (uncomplicated) vaginal birth, compared with placebo or no antibiotic prophylaxis, reduces postpartum maternal infectious morbidities and improves outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2017), LILACS, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (22 August 2017) and reference lists of retrieved studies. We planned to include randomised or quasi-randomised trials evaluating the use of prophylactic antibiotics versus placebo or no antibiotic prophylaxis. Trials using a cluster-randomised design would have been eligible for inclusion, but we found none.In future updates of this review, we will include studies published in abstract form only, provided sufficient information is available to assess risks of bias. We will consider excluded abstracts for inclusion once the full publication is available, or the authors provide more information.Trials using a cross-over design are not eligible for inclusion in this review. Two review authors conducted independent assessment of trials for inclusion and risks of bias. They independently extracted data and checked them for accuracy, resolving differences in assessments by discussion. They evaluated methodological quality using standard Cochrane criteria and the GRADE approach.We present the summaries as risk ratios (RRs) and mean difference (MDs) using fixed- or random-effect models. For one primary outcome we found considerable heterogeneity and interaction. We explored further using

  8. Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs.

    Science.gov (United States)

    Baldissera-Aradas, J V; Rodríguez-Villamil, L; Blanco-Fernández, R; Pérez-García, C; Viejo de la Guerra, G; González-Rodríguez, I; Mosquera-Madera, J

    2018-01-10

    Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P<.005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was €368.23 versus €33.11 with GP. GP achieved an estimated total savings of €52,273.67. Six patients had to undergo GP to prevent an IC. GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Systematic review of interventions on antibiotic prophylaxis in surgery in Chinese hospitals during 2000-2012.

    Science.gov (United States)

    Sun, Jing

    2013-08-01

    To systematically review intervention studies on antibiotic prophylaxis in clean or clean-contaminated surgery in Chinese hospitals from 2000 to 2012. Published peer reviewed articles, unpublished documents and reports, and gray literature were identified through searching CNKI, CBM, VIP, PubMed (MEDLINE), WHO database, and the official websites of the Ministry of Health of China, provincial health authorities and medical university internal publications. Eighty-two studies were identified. Circulation and localization of central rules, regulations and guidelines; clinical pharmacists' involvement; technical, administrative, and managerial strategies were the mostly adopted interventions. Except one study, all claimed effectiveness of interventions. Limited effects were observed for non-indicated clean surgery. Huge gaps still existed between the international agreed guidelines and the claimed best performance following interventions. The following were critical to have more effective interventions: recognition, acceptance, and enforcement strategies of rules, regulations, and guidelines; intervention persistence and intensity; health information system; removal of health system perverse incentives; patient-doctor relationship; public education; and access to unbiased medicines information. A total 4 of 82 studies were pre-post studies with control; all others were simple pre-post studies without control. Simple measurement of the outcome indicators as an average for pre-post intervention groups and changes in between failed to distinguish the real intervention effect from confounding factors, and failed to adjust underlying trends. Interventions on surgical antibiotic prophylaxis in Chinese hospitals during 2000-2012 brought limited positive effects. There are still huge gaps between the Chinese situation and internationally agreed standards. More advanced study methodologies are needed to have better documentation of evidence of the most effective interventions

  10. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study.

    Science.gov (United States)

    Teillant, Aude; Gandra, Sumanth; Barter, Devra; Morgan, Daniel J; Laxminarayan, Ramanan

    2015-12-01

    The declining efficacy of existing antibiotics potentially jeopardises outcomes in patients undergoing medical procedures. We investigated the potential consequences of increases in antibiotic resistance on the ten most common surgical procedures and immunosuppressing cancer chemotherapies that rely on antibiotic prophylaxis in the USA. We searched the published scientific literature and identified meta-analyses and reviews of randomised controlled trials or quasi-randomised controlled trials (allocation done on the basis of a pseudo-random sequence-eg, odd/even hospital number or date of birth, alternation) to estimate the efficacy of antibiotic prophylaxis in preventing infections and infection-related deaths after surgical procedures and immunosuppressing cancer chemotherapy. We varied the identified effect sizes under different scenarios of reduction in the efficacy of antibiotic prophylaxis (10%, 30%, 70%, and 100% reductions) and estimated the additional number of infections and infection-related deaths per year in the USA for each scenario. We estimated the percentage of pathogens causing infections after these procedures that are resistant to standard prophylactic antibiotics in the USA. We estimate that between 38·7% and 50·9% of pathogens causing surgical site infections and 26·8% of pathogens causing infections after chemotherapy are resistant to standard prophylactic antibiotics in the USA. A 30% reduction in the efficacy of antibiotic prophylaxis for these procedures would result in 120,000 additional surgical site infections and infections after chemotherapy per year in the USA (ranging from 40,000 for a 10% reduction in efficacy to 280,000 for a 70% reduction in efficacy), and 6300 infection-related deaths (range: 2100 for a 10% reduction in efficacy, to 15,000 for a 70% reduction). We estimated that every year, 13,120 infections (42%) after prostate biopsy are attributable to resistance to fluoroquinolones in the USA. Increasing antibiotic

  11. Preoperative antibiotic prophylaxis practice and guideline adherence in Jordan: a multi-centre study in Jordanian hospitals.

    Science.gov (United States)

    Al-Azzam, Sayer I; Alzoubi, Karem H; Mhaidat, Nizar M; Haddadin, Rania D; Masadeh, Majed M; Tumah, Haitham N; Magableh, Arabieh; Maraqa, Noor K

    2012-10-19

    The use of antimicrobial prophylaxis for surgical procedures is one of the measures employed to prevent the development of surgical site infections (SSI). The appropriate choice of antimicrobial agents, dosage regimen, timing, duration and use of intravenous route must be evidence based. This study aimed to assess the practice of surgical antibiotic prophylaxis and adherence of practitioners to the American Society of Health-System Pharmacists (ASHP) guidelines for antimicrobial prophylaxis in surgery and to explore reasons for non-compliance. A cross-sectional study was conducted in 20 Jordanian hospitals from October 2006 to June 2007. A questionnaire was designed to collect information from physicians regarding the practice of surgical antibiotic prophylaxis (SAP), references used for guiding SAP practice, prevalence of surgical site infection (SSI), and causative microorganisms. SAP was employed in almost all surgical departments of hospitals. The improper timing of antimicrobial administration for SAP was attributed to lack of knowledge of the guidelines (46.1%), while the improper antimicrobial choice was ascribed to drug unavailability (61.8%). This study shows that physicians are aware of the importance of antimicrobial prophylaxis before surgical procedures. However, further efforts are needed to ensure the implementation of the standard SAP guidelines in Jordanian hospitals.

  12. A Prospective Korean Multicenter Study for Infectious Complications in Patients Undergoing Prostate Surgery: Risk Factors and Efficacy of Antibiotic Prophylaxis

    Science.gov (United States)

    2014-01-01

    This multicenter study was undertaken to determine the efficacy of antibiotic prophylaxis and identify the risk factors for infectious complications after prostate surgery in Korean patients. A total of 424 patients who underwent surgery of the prostate were reviewed. All patients underwent urinalysis and urine culture preoperatively and postoperatively. Efficacy of antibiotic prophylaxis and risk factors for infectious complications were investigated. Infectious complications were observed in 34.9% of all patients. Factors independently associated with infectious complications were diabetes mellitus (adjusted OR, 1.99; 95% CI, 1.09-3.65, P=0.025) and operation time (adjusted OR, 1.08; 95% CI, 1.03-1.13, P=0.004). Clinicians should be aware of the high risk of infectious complications in patients with diabetes and those who undergo a prolonged operation time. Neither the type nor duration of prophylactic antibiotics resulted in differences in infectious complications. Graphical Abstract PMID:25246747

  13. Audit of antibiotic prophylaxis for surgical patients in three hospital trusts in Tayside. Tayside Area Clinical Audit Commitee.

    Science.gov (United States)

    Davey, P; Napier, A; McMillan, J; Ruta, D

    1999-03-01

    To compare achievement of previously agreed standards for administration of antibiotic prophylaxis for surgical patients in the three acute trusts in Tayside. Angus, Dundee Teaching Hospitals and Perth & Kinross Trusts. Administration of antibiotic prophylaxis and achievement of three general standards of administration. Prospective case note audit. In total, 341 operations were audited. The range of operations performed in each trust was different and the achievement of standards was sensitive to case mix. For example, prophylaxis was given to 82% of all eligible orthopaedic patients but only 64% of eligible patients in obstetrics & gynaecology. Comparison between trusts was therefore confined to six procedures (166 operations) which were performed regularly in all three. There were significant differences between trusts in the rate of administration to patients undergoing operations for which prophylaxis was indicated (from 84% [95% CI 75-92] to 93% [CI 89-98]) and in the proportion of patients in whom prophylaxis was continued for less than 24 hours (from 78% [CI 68-89] to 97% [CI 93-100]). Administration of prophylaxis within two hours of surgery was achieved following more than 95% of operations in all three trusts. However, second doses were given to only five of 44 (11%) of patients whose operations lasted more than two hours. Achievement of standards in all three trusts was good in comparison with recently published audits from other UK and European centres but there was still room for improvement, particularly in administration of second doses for prolonged operations. Regular audit of prophylaxis administration and duration should be implemented. Comparisons between trusts or units should be based on a common set of operations.

  14. Antibiotic prophylaxis for children with sickle cell disease: a survey of pediatric dentistry residency program directors and pediatric hematologists.

    Science.gov (United States)

    Tate, Anupama Rao; Norris, Chelita Kaye; Minniti, Caterina P

    2006-01-01

    The purposes of this study were to: (1) investigate the current clinical practice regarding the use of antibiotic prophylaxis by pediatric dentistry residency program directors and pediatric hematologists for children with sickle cell disease (SCD) requiring dental treatment; and (2) evaluate the perceived relative risk of bacteremia following specific dental procedures, as defined by pediatric dentistry residency program directors and pediatric hematologists. A written survey depicting various clinical scenarios of SCD children requiring common dental procedures was mailed to directors of pediatric dental advanced education programs and distributed to pediatric hematologists attending the 2003 Annual Sickle Cell Disease Association of America conference in Washington, DC. Surveys were returned by 60% (N=34/57) of the pediatric dentistry residency program directors. The surveys were obtained from 51% of pediatric hematologists at the meeting (N=72/140). At least 50% of all respondents recommended prophylaxis for the following clinical situations: dental extractions, treatment under general anesthesia, and status post splenectomy. The perceived risk of infectious complication was highest for extractions, followed by restorative treatment and tooth polishing. Dental residency program directors were more likely (71%, N=24/34) to recommend additional antibiotic therapy for patients taking penicillin prophylaxis if they required an invasive oral surgical procedure. Conversely, only 38% (N=25/66) of pediatric hematologists recommended additional antibiotic therapy (P=.001). Eighty-six percent of dental residency program directors (N=25/29) chose amoxicillin for prophylaxis whereas only 62% of pediatric hematologists (N=36/58) recommended amoxicillin. (P<.05). There is a lack of consensus on the appropriate use of antibiotic prophylaxis in SCD children undergoing dental treatments. Further research and risk/benefit assessment is needed to create a unified approach.

  15. Efficacy assessment of two antibiotic prophylaxis regimens in oral and maxillofacial trauma surgery: preliminary results

    Science.gov (United States)

    Campos, Giordano BP; Lucena, Eudes ES; da Silva, José Sandro P; Gomes, Petrus P; Germano, Adriano R

    2015-01-01

    The study set out to evaluate the efficacy of two antibiotic prophylaxis regimens in patients with facial fractures admitted to the Oral and Maxillofacial Surgery and Traumatology services of the Onofre Lopes University Hospital attached to the Federal University of Rio Grande do Norte in the period from December 2011 to December 2012. The sample consisted of 74 patients divided into two groups, GI with forty-three patients and GII with 32. Both groups received 2 g of cefazolin, 20 minutes before surgery. The postoperative protocol for each group was randomly determined; group I (single dose) received no antibiotics after surgery but group II (24 h dosage) received 1 g of cefazolin every 6 hours for 24 hours. Postoperative infection incidence was 9.3% (seven patients), six patients in Group I and one in Group II. 85% of the infections were in mandibular fractures. Results were presented qualitatively and quantitatively and the Chi square test (taking the value for p to be < 0.05) showed no statistically significant differences in the efficacies of the two regimens in the comparisons made between the cases of fractures in the upper and middle thirds of the face with those in the lower third (mandibular fractures). Considering mandibular fractures alone, Group II proved to be more efficacious with a p value of 0.02. However, to confirm the tendency shown in the mandibular fracture treatments whereby prolonging antibiotic administration for 24 hours appeared to be beneficial, research needs to be done with much larger sample groups. PMID:25932244

  16. Incidence and nature of adverse reactions to antibiotics used as endocarditis prophylaxis.

    Science.gov (United States)

    Thornhill, Martin H; Dayer, Mark J; Prendergast, Bernard; Baddour, Larry M; Jones, Simon; Lockhart, Peter B

    2015-08-01

    Antibiotic prophylaxis (AP) administration prior to invasive dental procedures has been a leading focus of infective endocarditis prevention. However, there have been long-standing concerns about the risk of adverse drug reactions as a result of this practice. The objective of this study was to identify the incidence and nature of adverse reactions to amoxicillin and clindamycin prophylaxis to prevent infective endocarditis. We obtained AP prescribing data for England from January 2004 to March 2014 from the NHS Business Services Authority, and adverse drug reaction data from the Medicines and Healthcare Products Regulatory Agency's Yellow Card reporting scheme for prescriptions of the standard AP protocol of a single 3 g oral dose of amoxicillin or a single 600 mg oral dose of clindamycin for those allergic to penicillin. The reported adverse drug reaction rate for amoxicillin AP was 0 fatal reactions/million prescriptions (in fact 0 fatal reactions for nearly 3 million prescriptions) and 22.62 non-fatal reactions/million prescriptions. For clindamycin, it was 13 fatal and 149 non-fatal reactions/million prescriptions. Most clindamycin adverse drug reactions were Clostridium difficile infections. AP adverse drug reaction reporting rates in England were low, particularly for amoxicillin, and lower than previous estimates. This suggests that amoxicillin AP is comparatively safe for patients without a history of amoxicillin allergy. The use of clindamycin AP was, however, associated with significant rates of fatal and non-fatal adverse drug reactions associated with C. difficile infections. These were higher than expected and similar to those for other doses, durations and routes of clindamycin administration. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  17. Adverse events associated with surgical antibiotic prophylaxis for outpatient circumcisions at US children's hospitals.

    Science.gov (United States)

    Chan, Katherine H; Whittam, Benjamin M; Moser, Elizabeth A S; Cain, Mark P; Bennett, William E

    2017-04-01

    Doctors often use surgical antibiotic prophylaxis (SAP) despite limited evidence to support its efficacy. We sought to determine the association between SAP in children undergoing circumcision and the rate of perioperative adverse events. We performed a retrospective study of males >30 days old and allergic reaction and any of the following within 30 days: penile reoperation, hospital visit, or surgical site infection (SSI). We performed mixed effects logistic regression controlling for age, race, insurance, and clustering of similar practice patterns by hospital. 84,226 patients were included: median age 2.2 years; 61.0% public insurance, 39.6% white. 8944 (10.6%) received SAP. On bivariate analysis, there were no associations between SAP and SSI (0.1% vs. 0.2%, p = 0.5), penile reoperation (0.01% vs. 0.04%, p = 0.4), or hospital visit (5.5% vs. 5.5%, p = 0.8). Patients who received SAP were more likely to have a perioperative allergic reaction than those who did not (3.5% vs. 2.9%, p = 0.0004). On multivariate analysis, those who received SAP had 1.5 times the odds of an allergic reaction (OR 1.5, 95% CI 1.3-1.7; p allergic reactions and hospital visits. Strengths of the study include its large sample size, which enabled detection of rare outcomes with adequate statistical power and the generalizability of our findings to many patients and other types of procedures. Limitations include the lack of outpatient data and the possibility that we could have overestimated the incidence of allergic reactions by including patients who received epinephrine for some other reason. We found no compelling evidence to support the use of SAP in children undergoing circumcision and it was associated with an increased risk of allergic reaction and hospital visits. This study highlights the need for specialty-specific guidelines for pediatric urologic procedures regarding the use of antibiotics for prophylaxis and for vigilant monitoring of practice variation. Copyright

  18. Antibiotic prophylaxis is not indicated prior to dental procedures for prevention of periprosthetic joint infections : A systematic review and new guidelines from the Dutch Orthopaedic and Dental Societies

    NARCIS (Netherlands)

    Rademacher, W.M.H.; Walenkamp, G.H.I.M.; Moojen, D.J.F.; Hendriks, J.G.E.; Goedendorp, T.A.; Rozema, F.R.

    2017-01-01

    Background and purpose — To minimize the risk of hematogenous periprosthetic joint infection (HPJI), international and Dutch guidelines recommended antibiotic prophylaxis prior to dental procedures. Unclear definitions and contradictory recommendations in these guidelines have led to unnecessary

  19. Navel piercing as a cause for Streptococcus viridans endocarditis: case report, review of the literature and implications for antibiotic prophylaxis.

    Science.gov (United States)

    Barkan, Daniel; Abu Fanne, Rami; Elazari-Scheiman, Anat; Maayan, Shlomo; Beeri, Ronen

    2007-01-01

    We describe a case of Streptococcus viridans endocarditis in a 17-year-old female with congenital ventricular septal defect, that followed shortly after performing naval piercing. She was eventually treated with penicillin with complete recovery. We review other cases from the literature of piercing-associated endocarditis, and suggest that individuals at particularly high risk might be considered for antibiotic prophylaxis prior to such procedures. 2007 S. Karger AG, Basel

  20. The Role of Antibiotic Prophylaxis in Reducing Bacterial Contamination of Autologous Bone Graft Collected from Implant Site

    Directory of Open Access Journals (Sweden)

    Rodolfo Mauceri

    2017-01-01

    Full Text Available The aim of this study was to evaluate if antibiotic prophylaxis reduces the bacterial contamination of bone particles collected directly from the burs used for implant site preparation. Thirty-four patients underwent the surgical procedures for a total of 34 implant sites. One 1 gr. tablet of amoxicillin + clavulanic acid was given to the test group 12 hours and 1 hour before the surgery. The control group did not take antibiotic prophylaxis. Bone particles were collected and centrifuged. The suspensions were subjected to serial dilutions and each dilution was examined twice using a spatulation technique in Trypticase Soy Agar (TSA, in Sabouraud Dextrose Agar, and in Mitis Salivarius Agar (MSA. The number of colonies was calculated and the identification of various microorganisms was made. The most represented species, in both groups of patients, belonged to the “oral Streptococci.” For TSA, the test and control groups differed significantly (p = 0.018. Conversely, there was no significant difference for MSA (p = 0.201 and for the number of bacterial species isolated in the samples of the two groups of patients (p = 0.898. The antibiotic prophylaxis reduced, but did not cancel, the risk of infection of the autogenous particulate bone graft. This trial is registered with IRCT2017102537002N1.

  1. The Role of Antibiotic Prophylaxis in Reducing Bacterial Contamination of Autologous Bone Graft Collected from Implant Site.

    Science.gov (United States)

    Mauceri, Rodolfo; Campisi, Giuseppina; Matranga, Domenica; Mauceri, Nicola; Pizzo, Giuseppe; Melilli, Dario

    2017-01-01

    The aim of this study was to evaluate if antibiotic prophylaxis reduces the bacterial contamination of bone particles collected directly from the burs used for implant site preparation. Thirty-four patients underwent the surgical procedures for a total of 34 implant sites. One 1 gr. tablet of amoxicillin + clavulanic acid was given to the test group 12 hours and 1 hour before the surgery. The control group did not take antibiotic prophylaxis. Bone particles were collected and centrifuged. The suspensions were subjected to serial dilutions and each dilution was examined twice using a spatulation technique in Trypticase Soy Agar (TSA), in Sabouraud Dextrose Agar, and in Mitis Salivarius Agar (MSA). The number of colonies was calculated and the identification of various microorganisms was made. The most represented species, in both groups of patients, belonged to the "oral Streptococci." For TSA, the test and control groups differed significantly ( p = 0.018). Conversely, there was no significant difference for MSA ( p = 0.201) and for the number of bacterial species isolated in the samples of the two groups of patients ( p = 0.898). The antibiotic prophylaxis reduced, but did not cancel, the risk of infection of the autogenous particulate bone graft. This trial is registered with IRCT2017102537002N1.

  2. Prospective study of antibiotic prophylaxis for prostate biopsy involving >1100 men.

    LENUS (Irish Health Repository)

    Manecksha, Rustom P

    2012-01-01

    We aimed to compare infection rates for two 3-day antibiotic prophylaxis regimens for transrectal ultrasound-guided prostate biopsy (TRUSgbp) and demonstrate local microbiological trends. In 2008, 558 men and, in 2009, 625 men had TRUSgpb. Regimen 1 (2008) comprised 400 mg Ofloxacin immediately before biopsy and 200 mg 12-hourly for 3 days. Regimen 2 (2009) comprised Ofloxacin 200 mg 12-hourly for 3 days commencing 24 hours before biopsy. 20\\/558 (3.6%) men had febrile episodes with regimen 1 and 10\\/625 (1.6%) men with regimen 2 (P = 0.03). E. coli was the most frequently isolated organism. Overall, 7\\/13 (54%) of positive urine cultures were quinolone resistant and (5\\/13) 40% were multidrug resistant. Overall, 5\\/9 (56%) patients with septicaemia were quinolone resistant. All patients were sensitive to Meropenem. There was 1 (0.2%) death with regimen 1. Commencing Ofloxacin 24 hours before TRUSgpb reduced the incidence of febrile episodes significantly. We observed the emergence of quinolone and multidrug-resistant E. coli. Meropenem should be considered for unresolving sepsis.

  3. Antibiotic Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Data from the ARPEC Project.

    Science.gov (United States)

    De Luca, Maia; Donà, Daniele; Montagnani, Carlotta; Lo Vecchio, Andrea; Romanengo, Marta; Tagliabue, Claudia; Centenari, Chiara; D'Argenio, Patrizia; Lundin, Rebecca; Giaquinto, Carlo; Galli, Luisa; Guarino, Alfredo; Esposito, Susanna; Sharland, Mike; Versporten, Ann; Goossens, Herman; Nicolini, Giangiacomo

    2016-01-01

    Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children's hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions. A 1-day PPS on antibiotic use in hospitalized neonates and children was performed in Italy between October and December 2012 as part of the Antibiotic Resistance and Prescribing in European Children project (ARPEC). Seven institutions in seven Italian cities were involved. The survey included all admitted patients less than 18 years of age present in the ward at 8:00 am on the day of the survey, who had at least one on-going antibiotic prescription. For all patients data about age, weight, underlying disease, antimicrobial agent, dose and indication for treatment were collected. The PPS was performed in 61 wards within 7 Italian institutions. A total of 899 patients were eligible and 349 (38.9%) had an on-going prescription for one or more antibiotics, with variable rates among the hospitals (25.7% - 53.8%). We describe antibiotic prescriptions separately in neonates ( = 30 days to antibiotics for prophylaxis and only 37.2% on those on antibiotics were treated for infection. Penicillins and aminoglycosides were the most prescribed antibiotic classes. In the paediatric cohort, 64.4% of patients were receiving antibiotics for treatment of infections and 35.5% for prophylaxis. Third generation cephalosporins and penicillin plus inhibitors were the top two antibiotic classes. The main reason for prescribing antibiotic therapy in children was lower respiratory tract infections (LRTI), followed by febrile

  4. Evaluation of extended antibiotic prophylaxis in patients undergoing indicated non-cosmetic panniculectomy at the time of gynecologic surgery.

    Science.gov (United States)

    Patibandla, Jay R; Kufel, Christina N; Hopkins, Michael P

    2018-01-08

    Panniculectomy at time of gynecologic surgery is used to improve visualization and prevent major complications in morbidly obese patients. We examine the role of extended antibiotic prophylaxis in prevention of surgical site infections (SSI), specifically based on patient risk factors (hypertension, diabetes, smoking). A prospective cohort study of all women who underwent panniculectomy at the time of gynecologic surgery from September 2014 to March 2016 at a university-affiliated hospital. The EAP cohort received standard antibiotics (cefazolin, 2 g) and continued oral antibiotic (doxycycline) for 10 days afterwards. Patients in this cohort were compared to historical controls from the same institution from 1990 to 2014. Specific attention was paid to the reduction of SSIs in patients with hypertension, diabetes, and a history of smoking. The mean age was 56.0 ± 12.6 years, and mean body mass index 44.5 ± 9.3 kg/m 2 (range 31-63.4 kg/m 2 ). The EAP cohort experienced fewer surgical-site infections overall, however these results were not significantly decreased from the historical controls, (13/56 [23.2%] vs 94/300 [31.3%]; P = 0.469). Though initially promising, extended antibiotic prophylaxis did not reduce surgical site infections in the obese women after indicated non-cosmetic panniculectomy at the time of gynecologic surgery. © 2018 Wiley Periodicals, Inc.

  5. An abscess due to Pasteurella multocida after a cat scratch: Case report and evaluation of antibiotic prophylaxis

    Directory of Open Access Journals (Sweden)

    Yeşim Alpay

    2014-12-01

    Full Text Available Pasteurella multocida has been isolated from 50% to 70% of healthy cats and most commonly associated with acute skin and soft tissue infections following an animal bite or scratch. As the zone and depth of injury can lead to more serious infections such as deep tissue infections, septic arthritis, osteomyelitis. However, no predictive factor showing which wound would be infected. In our case, patient whom applied with abscess after a cat scratch and P. multocida was found as a causative agent. This situation has caused to review us, once more, that which cases should be taken antibiotic pro­phylaxis in addition to immunoprophylaxis (for rabies post-exposure prophylaxis, and anti-tetanus prophylaxis in the first admission. Antibiotic prophylaxis should be used for 3-5 days in selected cases if they include; moderate to severe crushing injuries especially edematous form, less than 8 hours old, bone or joint penetration, hand wounds, especially emphasizes the importance of hand injuries and deep penetrations. J Microbiol Infect Dis 2014; 4(4: 159-161

  6. Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis.

    Science.gov (United States)

    Cahill, Thomas J; Harrison, James L; Jewell, Paul; Onakpoya, Igho; Chambers, John B; Dayer, Mark; Lockhart, Peter; Roberts, Nia; Shanson, David; Thornhill, Martin; Heneghan, Carl J; Prendergast, Bernard D

    2017-06-01

    The use of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) is controversial. In recent years, guidelines to cardiologists and dentists have advised restriction of AP to high-risk groups (in Europe and the USA) or against its use at all (in the UK). The objective of this systematic review was to appraise the evidence for use of AP for prevention of bacteraemia or IE in patients undergoing dental procedures. We conducted electronic searches in Medline, Embase, Cochrane Library and ISI Web of Science. We assessed the methodological characteristics of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology criteria for observational studies and the Cochrane Risk of Bias Tool for trials. Two reviewers independently determined the eligibility of studies, assessed the methodology of included studies and extracted the data. We identified 178 eligible studies, of which 36 were included in the review. This included 10 time-trend studies, 5 observational studies and 21 trials. All trials identified used bacteraemia as an endpoint rather than IE. One time-trend study suggests that total AP restriction may be associated with a rising incidence of IE, while data on the consequences of relative AP restriction are conflicting. Meta-analysis of trials indicates that AP is effective in reducing the incidence of bacteraemia (risk ratio 0.53, 95% CI 0.49 to 0.57, pdental procedures in causing IE and the efficacy of AP in its prevention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji.

    Science.gov (United States)

    Engelman, Daniel; Mataika, Reapi L; Kado, Joseph H; Ah Kee, Maureen; Donath, Susan; Parks, Tom; Steer, Andrew C

    2016-12-01

    Echocardiographic screening for rheumatic heart disease (RHD) can detect subclinical cases; however, adequate adherence to secondary antibiotic prophylaxis (SAP) is required to alter disease outcomes. We aimed to investigate the adherence to SAP among young people with RHD diagnosed through echocardiographic screening in Fiji and to investigate factors associated with adherence. Patients diagnosed with RHD through echocardiographic screening in Fiji from 2006 to 2014 were included. Dates of benzathine penicillin G injections were collected from 76 health clinics nationally from December 2011 to December 2014. Adherence was measured using the proportion of days covered (PDC). Multivariate logistic regression analysis was used to identify characteristics associated with any adherence (≥1 injection received) and adequate adherence (PDC ≥0.80). Of 494 patients, 268 (54%) were female and the median age was 14 years. Overall, 203 (41%) had no injections recorded and just 33 (7%) had adequate adherence. Multivariate logistic regression showed increasing age (OR 0.93 per year, 95% CI 0.87-0.99) and time since diagnosis ≥1.5 years (OR 0.53, 95% CI 0.37-0.79) to be inversely associated with any adherence. Non-iTaukei ethnicity (OR 2.58, 95%CI 1.04-6.33) and urban residence (OR 3.36, 95% CI 1.54-7.36) were associated with adequate adherence, whereas time since diagnosis ≥1.5 years (OR 0.38, 95%CI 0.17-0.83) was inversely associated with adequate adherence. Adherence to SAP after screening in Fiji is currently inadequate for individual patient protection or population disease control. Secondary prevention should be strengthened before further screening can be justified. © 2016 John Wiley & Sons Ltd.

  8. Antibiotic prophylaxis using third generation cephalosporins can reduce the risk of early rebleeding in the first acute gastroesophageal variceal hemorrhage: a prospective randomized study.

    Science.gov (United States)

    Jun, Chung-Hwan; Park, Chang-Hwan; Lee, Wan-Sik; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun; Kim, Sei-Jong; Kim, Young-Dae

    2006-10-01

    Bacterial infection may be a critical trigger for variceal bleeding. Antibiotic prophylaxis can prevent rebleeding in patients with acute gastroesophageal variceal bleeding (GEVB). The aim of the study was to compare prophylactic third generation cephalosporins with on-demand antibiotics for the prevention of gastroesophageal variceal rebleeding. In a prospective trial, patients with the first acute GEVB were randomly assigned to receive prophylactic antibiotics (intravenous cefotaxime 2 g q 8 hr for 7 days, prophylactic antibiotics group) or to receive the same antibiotics only when infection became evident (on-demand group). Sixty-two patients in the prophylactic group and 58 patients in the on-demand group were included for analysis. Antibiotic prophylaxis decreased infection (3.2% vs. 15.5%, p=0.026). The actuarial rebleeding rate in the prophylactic group was significantly lower than that in the on-demand group (33.9% vs. 62.1%, p=0.004). The difference of rebleeding rate was mostly due to early rebleeding within 6 weeks (4.8% vs. 20.7%, p=0.012). On multivariate analysis, antibiotic prophylaxis (relative hazard: 0.248, 95% confidence interval (CI): 0.067-0.919, p=0.037) and bacterial infection (relative hazard: 3.901, 95% CI: 1.053-14.448, p=0.042) were two independent determinants of early rebleeding. In conclusion, antibiotic prophylaxis using third generation cephalosporins can prevent bacterial infection and early rebleeding in patients with the first acute GEVB.

  9. The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia : a multicenter double-blind randomized controlled trial

    NARCIS (Netherlands)

    Aufenacker, Theo J; van Geldere, Dirk; van Mesdag, Taco; Bossers, Astrid N; Dekker, Benno; Scheijde, Edo; van Nieuwenhuizen, Roos; Hiemstra, Esther; Maduro, John H; Juttmann, Jan-Willem; Hofstede, Diederik; van Der Linden, Cunera T M; Gouma, Dirk J; Simons, Maarten P

    2004-01-01

    OBJECTIVE: To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair. SUMMARY BACKGROUND DATA: A recent Cochrane meta-analysis (2003) concluded that "antibiotic prophylaxis for elective

  10. The role of antibiotic prophylaxis in prevention of wound infection after lichtenstein open mesh repair of primary inguinal hernia - A multicenter double-blind randomized controlled trial

    NARCIS (Netherlands)

    Aufenacker, Theo J.; van Geldere, Dirk; van Mesdag, Taco; Bossers, Astrid N.; Dekker, Benno; Scheijde, Edo; van Nieuwenhuizen, Roos; Hiemstra, Esther; Maduro, John H.; Juttmann, Jan-Willem; Hofstede, Diederik; van der Linden, Cunera T. M.; Gouma, Dirk J.; Simons, Maarten P.

    2004-01-01

    Objective: To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair. Summary Background Data: A recent Cochrane meta-analysis (2003) concluded that "antibiotic prophylaxis for elective

  11. Systematic review and meta-analysis of the effectiveness of antibiotic prophylaxis in prevention of wound infection after mesh repair of abdominal wall hernia

    NARCIS (Netherlands)

    Aufenacker, T. J.; Koelemay, M. J. W.; Gouma, D. J.; Simons, M. P.

    2006-01-01

    BACKGROUND: The aim was to determine whether systemic antibiotic prophylaxis prevented wound infection after repair of abdominal wall hernia with mesh. METHODS: This was a systematic review of the available literature identified from multiple databases using the terms 'hernia' and 'antibiotic

  12. Antibiotic prophylaxis to prevent postoperative infectious morbidity in low-risk elective cesarean deliveries: a prospective randomized clinical trial.

    Science.gov (United States)

    Hong, Fanzhen; Zhang, Lei; Zhang, Yuan; Sun, Wenjuan; Hong, Haijie; Xu, Yongping

    2016-01-01

    To determine the effectiveness and cost of antibiotic chemoprophylaxis in reducing infectious morbidity in low-risk women undergoing elective cesarean delivery. A prospective randomized clinical trial was performed at a single tertiary care center in Jinan, China between November 2012 and December 2013. Women were randomized to receive either antibiotic prophylaxis or no antibiotics prior to elective cesarean delivery at term. The infectious morbidity (fever, surgical site infection - SSI, endometritis and urinary tract infection), routine blood tests and hospital costs were measured. Total of 414 women were enrolled into the study; and 202 women received antibiotic chemoprophylaxis and 212 women received no antibiotics. Demographic and clinical characteristics were similar between the two groups. Total of one case in the treatment group and four case in the non-treatment group developed endometritis, giving the postoperative infection rate of 1.2%, which was not statistically significant between the two groups (χ(2) = 1.679, p = 0.195). The secondary outcomes were also not different between the two groups, except the costs of hospitalization, which was significantly higher in the treatment group (p cesarean delivery at term, prophylactic antibiotics did not reduce the risk of postoperative infection, but significantly increased the cost of hospitalization.

  13. Antibiotic prophylaxis for the prevention of surgical site infection after tension-free hernia repair: a Bayesian and frequentist meta-analysis.

    Science.gov (United States)

    Mazaki, Takero; Mado, Kazunari; Masuda, Hideki; Shiono, Motomi

    2013-11-01

    Efficacy of antibiotic prophylaxis for the prevention of surgical site infection (SSI) after open tension-free hernia repair remains controversial. In light of additional data, the aim of this study was to determine whether antibiotic prophylaxis reduces SSI after hernia repair. We conducted a systematic review and meta-analysis to identify randomized controlled trials comparing antibiotic prophylaxis and the subsequent incidence of SSI after inguinal or femoral hernia repair. The primary outcomes measure was the incidence of SSI. Subgroup analysis was evaluated by stratifying the categories of SSI. The meta-analysis was performed using Bayesian and frequentist methods. Twelve studies were included in this meta-analysis; 1,902 patients received antibiotic prophylaxis and the other 1,936 patients were allocated to the control group. Incidence of SSI was 47 (pooled rate 3.0%) in the antibiotic group and 91 (6.0%) in the control group. The number needed to treat to prevent 1 episode of SSI is 41. The Bayesian meta-analysis yielded a significant reduction of SSI in the antibiotic group (odds ratio = 0.49; 95% credible interval 0.25-0.81). Subgroup analysis showed that an antibiotic prophylaxis was beneficial for the prevention of superficial SSI (odds ratio = 0.40; 95% credible interval 0.12-0.98), but not beneficial for prevention of deep SSI (odds ratio = 0.59; 95% credible interval 0.11-3.20). Also, the results were similar to those with frequentist methods. This meta-analysis suggests that antibiotic prophylaxis is efficacious for the prevention of SSI after open mesh hernia repair. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey.

    Science.gov (United States)

    Aiken, A M; Haddow, J B; Symons, N R A; Kaptanis, S; Katz-Summercorn, A C; Debnath, D; Dent, H; Tayeh, S; Kung, V; Clark, S; Gahir, J; Dindyal, S; Farag, S; Lazaridis, A; Bretherton, C P; Williams, S; Currie, A; West, H; Davies, J; Arora, S; Kheraj, A; Stubbs, B M; Yassin, N; Mallappa, S; Garrett, G; Hislop, S; Bhangu, A; Abbey, Y; Al-Shoek, I; Ahmad, U; Sharp, G; Memarzadeh, A; Patel, A; Ali, F; Kaderbhai, H; Knowles, C H

    2013-10-01

    Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection in adult inguinal hernia repair is conflicting. A recent Cochrane review based on 17 randomised trials did not reach a conclusion on this subject. This study aimed to describe the current practice and determine whether clinical equipoise is prevalent. Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of England on their practices and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair. Local prophylaxis guidelines for the participating hospital sites were also determined. The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons, a 93 % response rate. Overall, a large majority of hospital guidelines (22/28) and surgeons' personal beliefs (192/229, 84 %) supported the use of single-dose pre-operative intravenous antibiotic prophylaxis in inguinal hernia repair, although there was considerable variation in the regimens in use. The most widely used regimen was intravenous co-amoxiclav (1.2 g). Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure, although many incorrectly believed that they were following these. In the south-east of England, there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure. It is therefore likely to be extremely difficult to conduct further randomised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure.

  15. Antibiotic prophylaxis for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) related complications in surgical patients.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Koti, Rahul; Wilson, Peter; Davidson, Brian R

    2013-08-19

    Risk of methicillin-resistant Staphylococcus aureus (MRSA) infection after surgery is generally low, but affects up to 33% of patients after certain types of surgery. Postoperative MRSA infection can occur as surgical site infections (SSIs), chest infections, or bloodstream infections (bacteraemia). The incidence of MRSA SSIs varies from 1% to 33% depending upon the type of surgery performed and the carrier status of the individuals concerned. The optimal prophylactic antibiotic regimen for the prevention of MRSA after surgery is not known. To compare the benefits and harms of all methods of antibiotic prophylaxis in the prevention of postoperative MRSA infection and related complications in people undergoing surgery. In March 2013 we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); NHS Economic Evaluation Database (The Cochrane Library); Health Technology Assessment (HTA) Database (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We included only randomised controlled trials (RCTs) that compared one antibiotic regimen used as prophylaxis for SSIs (and other postoperative infections) with another antibiotic regimen or with no antibiotic, and that reported the methicillin resistance status of the cultured organisms. We did not limit our search for RCTs by language, publication status, publication year, or sample size. Two review authors independently identified the trials for inclusion in the review, and extracted data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for comparing binary outcomes between the groups and planned to calculated the mean difference (MD) with 95% CI for comparing continuous outcomes. We planned to perform meta-analysis using both a fixed-effect model and a random-effects model

  16. Antibiotic Prophylaxis Using Third Generation Cephalosporins Can Reduce the Risk of Early Rebleeding in the First Acute Gastroesophageal Variceal Hemorrhage: A Prospective Randomized Study

    OpenAIRE

    Jun, Chung-Hwan; Park, Chang-Hwan; Lee, Wan-Sik; Joo, Young-Eun; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun; Kim, Sei-Jong; Kim, Young-Dae

    2006-01-01

    Bacterial infection may be a critical trigger for variceal bleeding. Antibiotic prophylaxis can prevent rebleeding in patients with acute gastroesophageal variceal bleeding (GEVB). The aim of the study was to compare prophylactic third generation cephalosporins with on-demand antibiotics for the prevention of gastroesophageal variceal rebleeding. In a prospective trial, patients with the first acute GEVB were randomly assigned to receive prophylactic antibiotics (intravenous cefotaxime 2 g q ...

  17. Is Antibiotic Prophylaxis for Percutaneous Radiofrequency Ablation (RFA) of Primary Liver Tumors Necessary? Results From a Single-Center Experience

    International Nuclear Information System (INIS)

    Bhatia, Shivank S.; Spector, Seth; Echenique, Ana; Froud, Tatiana; Suthar, Rekha; Lawson, Ivy; Dalal, Ravi; Dinh, Vy; Yrizarry, Jose; Narayanan, Govindarajan

    2015-01-01

    PurposeThe purpose of this study was to evaluate need for antibiotic prophylaxis for radiofrequency ablation (RFA) of liver tumors in patients with no significant co-existing risk factors for infection.Materials and MethodsFrom January 2004 to September 2013, 83 patients underwent 123 percutaneous RFA procedures for total of 152 hepatocellular carcinoma (HCC) lesions. None of the patients had pre-existing biliary enteric anastomosis (BEA) or any biliary tract abnormality predisposing to ascending biliary infection or uncontrolled diabetes mellitus. No pre- or post-procedure antibiotic prophylaxis was provided for 121 procedures. Data for potential risk factors were reviewed retrospectively and analyzed for the frequency of infectious complications, including abscess formation.ResultsOne patient (1/121 (0.8 %) RFA sessions) developed a large segment 5 liver abscess/infected biloma communicating with the gallbladder 7 weeks after the procedure, successfully treated over 10 weeks with IV and PO antibiotic therapy and percutaneous catheter drainage. This patient did not receive any antibiotics prior to RFA. During the procedure, there was inadvertent placement of RFA probe tines into the gallbladder. No other infectious complications were documented.ConclusionThese data suggest that the routine use of prophylactic antibiotics for liver RFA is not necessary in majority of the patients undergoing liver ablation for HCC and could be limited to patients with high-risk factors such as the presence of BEA or other biliary abnormalities, uncontrolled diabetes mellitus, and large centrally located tumors in close proximity to central bile ducts. Larger randomized studies are needed to confirm this hypothesis

  18. Is Antibiotic Prophylaxis for Percutaneous Radiofrequency Ablation (RFA) of Primary Liver Tumors Necessary? Results From a Single-Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Bhatia, Shivank S., E-mail: sbhatia1@med.miami.edu [University of Miami, Vascular/Interventional Radiology, Department of Radiology, Miller School of Medicine (United States); Spector, Seth, E-mail: sspector@med.miami.edu [University of Miami, Department of Surgery, VA Hospital (Veterans Affairs Medical Center) (United States); Echenique, Ana, E-mail: aechenique@med.miami.edu; Froud, Tatiana, E-mail: tfroud@med.miami.edu; Suthar, Rekha, E-mail: rsuthar@med.miami.edu; Lawson, Ivy, E-mail: i.lawson1@med.miami.edu; Dalal, Ravi, E-mail: rdalal@med.miami.edu [University of Miami, Vascular/Interventional Radiology, Department of Radiology, Miller School of Medicine (United States); Dinh, Vy, E-mail: vdinh@med.miami.edu [VA Hospital (Veterans Affairs Medical Center), Department of Medicine (United States); Yrizarry, Jose, E-mail: jyrizarr@med.miami.edu; Narayanan, Govindarajan, E-mail: gnarayanan@med.miami.edu [University of Miami, Vascular/Interventional Radiology, Department of Radiology, Miller School of Medicine (United States)

    2015-08-15

    PurposeThe purpose of this study was to evaluate need for antibiotic prophylaxis for radiofrequency ablation (RFA) of liver tumors in patients with no significant co-existing risk factors for infection.Materials and MethodsFrom January 2004 to September 2013, 83 patients underwent 123 percutaneous RFA procedures for total of 152 hepatocellular carcinoma (HCC) lesions. None of the patients had pre-existing biliary enteric anastomosis (BEA) or any biliary tract abnormality predisposing to ascending biliary infection or uncontrolled diabetes mellitus. No pre- or post-procedure antibiotic prophylaxis was provided for 121 procedures. Data for potential risk factors were reviewed retrospectively and analyzed for the frequency of infectious complications, including abscess formation.ResultsOne patient (1/121 (0.8 %) RFA sessions) developed a large segment 5 liver abscess/infected biloma communicating with the gallbladder 7 weeks after the procedure, successfully treated over 10 weeks with IV and PO antibiotic therapy and percutaneous catheter drainage. This patient did not receive any antibiotics prior to RFA. During the procedure, there was inadvertent placement of RFA probe tines into the gallbladder. No other infectious complications were documented.ConclusionThese data suggest that the routine use of prophylactic antibiotics for liver RFA is not necessary in majority of the patients undergoing liver ablation for HCC and could be limited to patients with high-risk factors such as the presence of BEA or other biliary abnormalities, uncontrolled diabetes mellitus, and large centrally located tumors in close proximity to central bile ducts. Larger randomized studies are needed to confirm this hypothesis.

  19. Influence of a Shorter Duration of Post-Operative Antibiotic Prophylaxis on Infectious Complications in Patients Undergoing Elective Liver Resection.

    Science.gov (United States)

    Sakoda, Masahiko; Iino, Satoshi; Mataki, Yuko; Kawasaki, Yota; Kurahara, Hiroshi; Maemura, Kosei; Ueno, Shinichi; Natsugoe, Shoji

    Antibiotic prophylaxis has been recommended to reduce post-operative infectious complications. Discontinuation of post-operative antibiotic administration within 24 hours of operation is currently recommended. Many surgeons, however, conventionally tend to extend the duration of prophylactic antibiotic use. In this study, we performed a retrospective analysis to assess the efficacy of extended post-operative antibiotic use in patients who underwent elective liver resection. A total of 208 consecutive patients who underwent liver resection without biliary reconstruction were investigated. Patients were divided into two groups according to the duration of post-operative antibiotic use: Only once after the operation (the post-operative day [POD] 0 group) and until three days after the operation (the POD 3 group). Post-operative complications in the two groups were analyzed and compared. Incisional surgical site infections (SSIs) were observed in 5% of the POD 0 group and 3% of the POD 3 group (p = 0.517). Organ/space SSIs were observed in 2% of the POD 0 group and 3% of the POD 3 group (p = 0.694). Overall infectious complications including SSIs and remote site infections were observed in 12% of the POD 0 group and 11% of the POD 3 group. Multi-variable analyses revealed that the short-term post-operative antibiotic regimen did not confer additional risk for infectious complications. In elective liver resection, the administration of prophylactic antibiotics on the operative day alone appears to be sufficient, because no additional benefit in the incidence of post-operative infectious complications was conferred on patients given antibiotic agents for three days.

  20. National Variability and Appropriateness of Surgical Antibiotic Prophylaxis in US Children's Hospitals.

    Science.gov (United States)

    Sandora, Thomas J; Fung, Monica; Melvin, Patrice; Graham, Dionne A; Rangel, Shawn J

    2016-06-01

    Appropriate use of surgical antibiotic prophylaxis (AP) reduces surgical site infection rates, but prior data suggest variability in use patterns. To assess national variability and appropriateness of AP in pediatric surgical patients. Retrospective cohort study of 31 freestanding children's hospitals in the United States using administrative data from 2010-2013. The study included 603 734 children younger than 18 years who underwent one of the 45 most commonly performed operations. Receipt of surgical AP. Primary outcomes included procedure- and hospital-specific rates of AP use and appropriateness of use based on clinical guidelines and consensus statements. We also assessed rates of Clostridium difficile infection and potential allergic reactions (using epinephrine administration as a surrogate event) after AP receipt. Of the 603 734 eligible patients, the mean (SD) patient age was 4.8 (4.4) years and 384 571 (63.7%) were boys. For the 671 255 operations evaluated, AP was administered for 348 119 (52%) of procedures. Intrahospital variation in AP use by procedure ranged from 11.5% to 100% (median, 78.1%). Overall, AP use was considered appropriate for 64.6% of cases. Appropriate use of AP by hospital varied from 47.3% to 84.4% with large variability by procedure within each hospital. For procedures for which AP was indicated, the median rate of appropriate use by hospital was 93.8%; however, for procedures for which AP was not indicated, the median rate of appropriate use by hospital was 52.0%. The odds of C difficile infection and epinephrine administration were significantly higher among children who received AP (odds ratio, 3.34; 95% CI, 1.66-6.73 and odds ratio 1.97; 95% CI, 1.92-2.02; respectively). There is substantial national variability in the overall and appropriate use of AP for the most commonly performed operations in children both at a procedure and hospital level. A high proportion of AP use is inappropriate, potentially exposing many

  1. Rapid emergence of resistant coagulase-negative staphylococci on the skin after antibiotic prophylaxis

    NARCIS (Netherlands)

    Terpstra, S; Noordhoek, GT; Voesten, HGJ; Degener, JE

    1999-01-01

    One approach for prosthetic vascular surgery is to continue antimicrobial prophylaxis while intravascular lines and catheters are in place. However this may give rise to antimicrobial resistance in the colonizing bacterial flora. We studied 37 patients undergoing vascular surgery, who received

  2. Antibiotic resistance and virulence: Understanding the link and its consequences for prophylaxis and therapy.

    Science.gov (United States)

    Guillard, Thomas; Pons, Stéphanie; Roux, Damien; Pier, Gerald B; Skurnik, David

    2016-07-01

    "Antibiotic resistance is usually associated with a fitness cost" is frequently accepted as common knowledge in the field of infectious diseases. However, with the advances in high-throughput DNA sequencing that allows for a comprehensive analysis of bacterial pathogenesis at the genome scale, including antibiotic resistance genes, it appears that this paradigm might not be as solid as previously thought. Recent studies indicate that antibiotic resistance is able to enhance bacterial fitness in vivo with a concomitant increase in virulence during infections. As a consequence, strategies to minimize antibiotic resistance turn out to be not as simple as initially believed. Indeed, decreased antibiotic use may not be sufficient to let susceptible strains outcompete the resistant ones. Here, we put in perspective these findings and review alternative approaches, such as preventive and therapeutic anti-bacterial immunotherapies that have the potential to by-pass the classic antibiotics. © 2016 WILEY Periodicals, Inc.

  3. Odontogenic bacteria in periodontal disease and resistance patterns to common antibiotics used as treatment and prophylaxis in odontology in Spain.

    Science.gov (United States)

    Maestre, J R; Bascones, A; Sánchez, P; Matesanz, P; Aguilar, Lorenzo; Giménez, M J; Pérez-Balcabao, I; Granizo, J J; Prieto, J

    2007-03-01

    Resistance in streptococci or Gram-negative bacteria is associated with antibiotic consumption. Scarce information exists on the antibiotic susceptibility of bacterial isolates from patients with periodontitis in countries with high antibiotic consumption, as this is an area in which microbiological testing is not performed in daily practice. The present study was undertaken to explore the susceptibility of bacterial isolates in periodontitis to antibiotics prescribed in odontology in Spain as treatment for local infections or prophylaxis for distant focal infections. Periodontal samples were prospectively collected in 48 patients classified by pocket depth of or=4 mm. Species were identified by culture, selecting the five most frequent morphotypes per sample, and polymerase chain reaction (PCR). Susceptibility was determined by E-test. A total of 261 isolates were identified: 72.9% patients had Streptococcus oralis; 70.8% Streptococcus mitis; 60.4% Prevotella buccae; 39.6% Prevotella denticola; 37.5% Fusobacterium nucleatum; 35.4% Prevotella intermedia; 25% Capnocytophaga spp.; 23% Veillonella spp.; 22.9% Prevotella melaninogenica and Streptococcus sanguis; and <20% other species. Streptococcus viridans resistance rates were 0% for amoxicillin, approximately 10% for clindamycin, 9-22% for tetracycline, and for azithromycin ranged from 18.2% for S. sanguis to 47.7% for S. mitis. Prevotella isolates were susceptible to amoxicillin-clavulanic acid, with amoxicillin resistance ranging from 17.1% in P. buccae to 26.3% in P. denticola. Metronidazole resistance was <6% in all Prevotella species, while clindamycin resistance ranged from 0 to 21.1%. beta-Lactamase production was positive in 54.1% Prevotella spp., 38.9% F. nucleatum, 30% Capnocytophaga spp., and 10% Veillonella spp. In this study, amoxicillin-clavulanic acid was the most active antibiotic against all species tested, followed by metronidazole in the case of anaerobes.

  4. Antibiotic prophylaxis for preventing surgical-site infection in plastic surgery: an evidence-based consensus conference statement from the American Association of Plastic Surgeons.

    Science.gov (United States)

    Ariyan, Stephan; Martin, Janet; Lal, Avtar; Cheng, Davy; Borah, Gregory L; Chung, Kevin C; Conly, John; Havlik, Robert; Lee, W P Andrew; McGrath, Mary H; Pribaz, Julian; Young, V Leroy

    2015-06-01

    There is a growing concern for microbial resistance as a result of overuse of antibiotics. Although guidelines have focused on the use of antibiotics for surgery in general, few have addressed plastic surgery specifically. The objective of this expert consensus conference was to evaluate the evidence for efficacy and safety of antibiotic prophylaxis in plastic surgical procedures. THE AUTHORS: searched for existing high-quality systematic reviews for antibiotic prophylaxis in the literature from the MEDLINE, Cochrane Library, and Embase databases. All synonyms for antibiotics were combined with terms for relevant plastic surgery procedures. The searches were not limited by language, and included all study designs. In addition, supplemental hand searches were performed of bibliographies of relevant articles, and extensive "related articles." Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons to reach consensus recommendations. Database searches identified 4300 articles, from which 2042 full-text articles were identified for eligibility. De novo meta-analyses were performed for each plastic surgical category. In total, 67 studies met the inclusion criteria, including nine for breast surgery, 17 for head and neck surgery, 10 for orthognathic surgery, seven for rhinoplasty/septoplasty, 19 for hand surgery, five for skin surgery, and two for abdominoplasty. Systemic antibiotic prophylaxis is recommended for clean breast surgery and for contaminated surgery of the hand or the head and neck. It is not recommended to reduce infection in clean surgical cases of the hand, skin, head and neck, or abdominoplasty.

  5. Fecal carriage of extended-spectrum and AmpC β-lactamase-producing Enterobacteriaceae in surgical patients before and after antibiotic prophylaxis

    DEFF Research Database (Denmark)

    Jakobsen, Lotte; Kuhn, Katrin G; Hansen, Frank

    2016-01-01

    The impact of antibiotic prophylaxis on fecal carriage of ESBL-/AmpC-/carbapenemase-producing Enterobacteriaceae (CPE) was investigated. Patients admitted for elective surgery or diagnostic procedure in a Department of Surgical Gastroenterology (SG) (n= 450) and Orthopedic Surgery (OS) (n= 300...

  6. Antibiotic Prophylaxis Is Associated with Subsequent Resistant Infections in Children with an Initial Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae Infection.

    Science.gov (United States)

    Das, Sibani; Adler, Amanda L; Miles-Jay, Arianna; Kronman, Matthew P; Qin, Xuan; Weissman, Scott J; Burnham, C A; Elward, Alexis; Newland, Jason G; Selvarangan, Rangaraj; Sullivan, Kaede V; Zaoutis, Theoklis; Zerr, Danielle M

    2017-05-01

    The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae We also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistant Escherichia coli and Klebsiella spp. isolated from normally sterile sites of patients aged resistance determinants, and fumC-fimH ( E. coli ) or tonB ( Klebsiella pneumoniae ) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients with E. coli sequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections. Copyright © 2017 American Society for Microbiology.

  7. Third-generation cephalosporins as antibiotic prophylaxis in neurosurgery : What's the evidence?

    NARCIS (Netherlands)

    Liu, Weiming; Neidert, Marian Christoph; Groen, Rob J. M.; Woernle, Christoph Michael; Grundmann, Hajo

    To analyze the role of third-generation cephalosporins as prophylactic antibiotics in neurosurgery. We reviewed the literature for data from randomized controlled trials (RCTs) on third-generation cephalosporins compared to other antibiotic regimen in neurosurgery. End point of the RCTs was the

  8. Current Debate on the Use of Antibiotic Prophylaxis for Cesarean Section

    Science.gov (United States)

    Lamont, Ronald F.; Sobel, Jack; Kusanovic, Juan Pedro; Vaisbuch, Edi; Mazaki-Tovi, Shali; Kim, Sun Kwon; Uldbjerg, Neils; Romero, Roberto

    2010-01-01

    Cesarean delivery is frequently complicated by surgical site infections (SSIs), endometritis and urinary tract infection. Most SSIs occur after discharge from hospital, and are increasingly being used as performance indicators. Worldwide, the rate of cesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics prior to surgical incision. An exception is made for cesarean delivery, where narrow-range antibiotics are administered post umbilical cord clamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision, broad-spectrum antibiotics which result in less maternal morbidity with no disadvantage to the neonate. PMID:21159119

  9. A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: A matched cohort study.

    Science.gov (United States)

    Townley, William A; Baluch, Narges; Bagher, Shaghayegh; Maass, Saskia W M C; O'Neill, Anne; Zhong, Toni; Hofer, Stefan O P

    2015-05-01

    Infections following implant-based breast reconstruction can lead to devastating consequences. There is currently no consensus on the need for post-operative antibiotics in preventing immediate infection. This study compared two different methods of infection prevention in this group of patients. A retrospective matched cohort study was performed on consecutive women undergoing implant-based breast reconstruction at University Health Network, Toronto (November 2008-December 2012). All patients received a single pre-operative intravenous antibiotic dose. Group A received minimal interventions and Group B underwent maximal prophylactic measures. Patient (age, smoking, diabetes, co-morbidities), oncologic and procedural variables (timing and laterality) were collected. Univariate and multivariate logistic regression were performed to compare outcomes between the two groups. Two hundred and eight patients underwent 647 implant procedures. After matching the two treatment groups by BMI, 94 patients in each treatment group yielding a total of 605 implant procedures were selected for analysis. The two groups were comparable in terms of patient and disease variables. Post-operative wound infection was similar in Group A (n = 11, 12%) compared with Group B (n = 9, 10%; p = 0.8). Univariate analysis revealed only pre-operative radiotherapy to be associated with the development of infection (0.004). Controlling for the effect of radiotherapy, multivariate analysis demonstrated that there was no statistically significant difference between the two methods for infection prevention. Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant-based breast reconstructions. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Compliance with guidelines on antibiotic prophylaxis in hip and knee arthroplasty in Italy: results of the GISIO-ISChIA project.

    Science.gov (United States)

    Agodi, Antonella; Auxilia, Francesco; Barchitta, Martina; Cristina, Maria Luisa; Mura, Ida; Nobile, Marta; Pasquarella, Cesira

    2015-01-01

    The Perioperative Antibiotic Prophylaxis (PAP) contributes considerably to the total amount of antibiotics used in hospitals and has been shown to be associated with increase in antibiotic resistance and healthcare costs. The level of compliance with the national guidelines of current practices of PAP for elective hip and knee prosthesis procedures in a network of Italian hospitals (the multicentre Surgical Site Infection surveillance project GISIO-ISChIA), has been evaluated. Compliance of the current prophylactic antibiotic practices with the published national guidelines was assessed for each included operative procedure, considering indication, timing of administration, prescribed antimicrobial agent and total duration of prophylaxis. A total of 14 hospitals and 1285 surgical procedures were included. 99.4% of patients received antimicrobial prophylaxis pre-operatively and 73.0% of patients received PAP within the recommended time period (within 60 minutes before incision). The rate of compliance with discontinuation of PAP within 24 hours after initiation of surgery was 70.2%. Taking into account all doses administered, the antibiotic was chosen appropriately in 57.7% of patients. PAP was performed appropriately, in accordance with national guidelines, in 43.6% of surgical operations. Given the increasing number of replacement procedures in Italy and in Europe, the gap between the evidence-based guidelines and practice must be appropriately addressed in order to improve PAP practices.

  11. Efficacy of Preoperative Oral Antibiotic Prophylaxis for the Prevention of Surgical Site Infections in Patients with Crohn Disease: A Randomized Controlled Trial.

    Science.gov (United States)

    Uchino, Motoi; Ikeuchi, Hiroki; Bando, Toshihiro; Chohno, Teruhiro; Sasaki, Hirofumi; Horio, Yuki; Nakajima, Kazuhiko; Takesue, Yoshio

    2017-10-23

    We investigated the efficacy of oral antimicrobial prophylaxis in patients undergoing surgery for Crohn disease. Although oral antibiotic prophylaxis with mechanical bowel preparation has been recommended for colorectal surgery, the use of this approach remains somewhat controversial. Moreover, the efficacy of this approach for inflammatory bowel disease also remains unclear. This study was conducted as a randomized controlled trial at the Hyogo College of Medicine. The study protocols were registered with the University Hospital Medical Information Network Clinical Trials Registry (000013369). In this study, 335 patients with Crohn disease who were scheduled to undergo intestinal resection with an open approach were randomly assigned to either group A or group B. The patients in group A received both preoperative oral antibiotics and intravenous antimicrobial prophylaxis, and intravenous antimicrobial prophylaxis alone was given to the patients in group B. All patients underwent preoperative mechanical bowel preparation with sodium picosulfate hydrate. The primary endpoint of this study was the incidence of surgical site infection (SSI) according to an intention-to-treat analysis. Although the incidences of overall and organ/space SSI were not significantly different, the incidence of incisional SSI was significantly lower in group A (12/163; 7.4%) than in group B (27/162; 16.6%) (P = 0.01). In the multivariate analysis, the absence of oral antibiotic prophylaxis was an independent risk factor for incisional SSI (odds ratio: 3.3; 95% confidence interval: 1.3-8.3; P = 0.01). Combined oral and intravenous antimicrobial prophylaxis in patients with Crohn disease contributed to the prevention of SSI.

  12. Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections.

    Science.gov (United States)

    Dlamini, Lomangisi D; Sekikubo, Musa; Tumukunde, Janat; Kojjo, Charles; Ocen, Davidson; Wabule, Agnes; Kwizera, Arthur

    2015-04-12

    Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital. We conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis. The risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62-0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39-0.99; P value 0.036). Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis. Pan African Clinical Trial Registry PACTR201311000610495. Date of trial registration: 12(th) August 2013.

  13. Viridans streptococcal (Streptococcus intermedius) mitral valve subacute bacterial endocarditis (SBE) in a patient with mitral valve prolapse after a dental procedure: the importance of antibiotic prophylaxis.

    Science.gov (United States)

    Cunha, Burke A; D'Elia, Alexis A; Pawar, Neha; Schoch, Paul

    2010-01-01

    Subacute bacterial endocarditis (SBE) is an infection of the heart involving damaged valves or endothelium. The most common organisms causing SBE are the viridans streptococci. Viridans streptococci differ in their propensity to cause SBE, which is related to the ability to adhere to damaged heart valves and endothelium, which is a function of extracellular matrix production. Streptococcus intermedius is a member of the S. anginosus group. S. intermedius is one of the many strains of viridans streptococci and a rare cause of SBE. SBE may result following a high-grade, sustained veridans streptococcal bacteremia in patients with predisposing cardiac lesions. Because viridans streptococci are relatively avirulent pathogens in normal hosts, they usually present as SBE. Some strains of viridans streptococci are inherently more virulent (eg, S. intermedius) and clinically resemble S. lugdunensis or S. aureus. We report a case of S. intermedius SBE in a patient with mitral valve prolapse (MVP). Throughout the patient's life, she received antibiotic prophylaxis for dental procedures and never developed SBE. Because of changes in endocarditis prophylaxis guidelines in 2007, recommending no prophylaxis for dental procedures in patients with MVP, she did not receive prophylaxis for a dental procedure 3 months before admission. The change in prophylaxis recommendations was based on the relatively low incidence of endocarditis with certain cardiac lesions. The recommendations were also based on concern for antibiotic resistance from widespread antibiotic use for antibiotic prophylaxis. There has been no appreciable increase in penicillin resistance, and antimicrobial resistance is not an important consideration among the viridans streptococci. The incidence of SBE is not high after dental procedures in patients with MVP, but if SBE occurs, it may result in serious consequence for the patient. In this case, the patient developed S. intermedius, mitral valve SBE complicated by a

  14. Antibiotic prophylaxis with intravenous ceftriaxone and fluoroquinolone reduces infectious complications after transrectal ultrasound-guided prostatic biopsy.

    Science.gov (United States)

    Lee, Chunwoo; You, Dalsan; Jeong, In Gab; Hong, Jun Hyuk; Choo, Myung-Soo; Ahn, Hanjong; Ahn, Tai Young; Kim, Choung-Soo

    2015-06-01

    To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy. The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy. Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003). Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.

  15. Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study.

    LENUS (Irish Health Repository)

    Barry, Peter

    2014-01-01

    To determine the use of intracameral cefuroxime at the end of cataract surgery since the beneficial results were first reported by the European Society of Cataract and Refractive Surgeons Endophthalmitis Study Group in 2006, 250 ophthalmic surgeons affiliated with both public and private hospitals and clinics across Europe were surveyed. The questions regarded their awareness of the results of the ESCRS endophthalmitis study and their current use or non-use of intracameral antibiotics in their cataract procedures. Seventy-four percent of respondents said they always or usually use intracameral antibiotics in their cataract surgery procedures. The most frequently cited reasons for not using cefuroxime or other intracameral antibiotics was the lack of an approved commercial preparation and related anxieties regarding the risk of dilution errors and contamination. More than 90% of respondents said they would use cefuroxime if an approved single-unit dose product were commercially available.

  16. Does antibiotic prophylaxis at implant placement decrease early implant failures? A Cochrane systematic review.

    Science.gov (United States)

    Esposito, Marco; Grusovin, Maria Gabriella; Loli, Vasiliki; Coulthard, Paul; Worthington, Helen V

    2010-01-01

    Marco Esposito is the first author of two of the included studies; however, he was not involved in the quality assessment of these trials. This review is based on a Cochrane systematic review entitled 'Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications' published in The Cochrane Library (see http://www.cochrane.org for more information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane Review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration. To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective. The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2 June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. Meta-analyses were

  17. POOLED ESTIMATES OF INCIDENCE OF ENDOPHTHALMITIS AFTER INTRAVITREAL INJECTION OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS WITH AND WITHOUT TOPICAL ANTIBIOTIC PROPHYLAXIS.

    Science.gov (United States)

    Reibaldi, Michele; Pulvirenti, Alfredo; Avitabile, Teresio; Bonfiglio, Vincenza; Russo, Andrea; Mariotti, Cesare; Bucolo, Claudio; Mastropasqua, Rodolfo; Parisi, Guglielmo; Longo, Antonio

    2018-01-01

    To assess the effect of topical antibiotic prophylaxis on postoperative endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. A systematic literature search was performed from inception to March 2016 using PubMed, Medline, Web of Science, Embase, and the Cochrane Library, to identify articles that reported cases of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. We used a pooled analysis to estimate the incidence of cases of endophthalmitis who developed after injections performed with and without topical antibiotic prophylaxis. We used regression analysis to explore the effects of study characteristics on heterogeneity. From our search of electronic databases, we identified and screened 4,561 unique records. We judged 60 articles to have reported findings for cohorts of patients who met our inclusion criteria, (12 arms of randomized clinical trials, 11 prospective cohort studies, and 37 retrospective cohort studies), which included 244 cases of endophthalmitis and 639,391 intravitreal injections of anti-vascular endothelial growth factor agents. The final pooled estimate endophthalmitis proportions were 9/10,000 (95% confidence interval, 7/10,000-12/10,000) in the antibiotic-treated group and 3/10,000 (95% confidence interval, 2/10,000-5/10,000) in the untreated group. The estimated incidence of endophthalmitis with topical antibiotic prophylaxis was approximated three times the incidence without prophylaxis. Random effects regression showed that none of the study characteristics significantly affected the effect size in either group. Topical antibiotic after intravitreal injection of anti-vascular endothelial growth factor agents is associated with a higher risk of endophthalmitis.

  18. Application of guidelines on preoperative antibiotic prophylaxis in León, Nicaragua

    NARCIS (Netherlands)

    van Disseldorp, J; Slingenberg, E J M H; Matute, A; Delgado, E; Hak, E; Hoepelman, I M

    2006-01-01

    BACKGROUND: To determine adherence to the guideline for preoperative antibiotic use in Nicaragua. METHODS: An observational study in the University Hospital of León, Nicaragua. All surgical patients in the departments of general surgery, orthopaedics, gynaecology and obstetrics, and paediatrics

  19. The effect of perinatal antibiotic prophylaxis on an early onset of symptomatic infections in newborns

    Directory of Open Access Journals (Sweden)

    Szymański Sławomir

    2017-09-01

    Full Text Available Aim. The aim of the study was to evaluate the effectiveness of preventive perinatal antibiotic therapy on the occurrence of an earlysymptomatic infections in newborns. Material and Methods. The studied material consisted of data obtained from medical records of 1,328 born alive infants and their mothers. Advanced parameters were described with appropriate numbers, arithmetic means, standard deviation, median as well as minimum and maximum values. The level of statistical significance was p<0.05. Results. When it comes to 6.62% of newborns, they demonstrated the presence of early signs of infection. The Group B Streptococcus (GBS infection was found in 14 cases, but only in 5 of them pure GBS strains were isolated. E. coli bacteria was reported in 33 neonates, while the other bacteria naming: Enterococcus faecalis, Enterobacteriaceae, taphylococcus epidermidis, Staphylococcus aureus were isolated from 42 newborns. Among 24 newborns showing clinical signs of infection and positive indicators of inflammation in laboratory tests, simultaneously negative results of bacteriological cultures were reported. Conclusions. In connection with the introduction of an obligation to perform tests for GBS, amount of used antibiotics is increasing. However, the effectiveness of intrapartum antibiotic therapy and its prevalence appear to be unsatisfactory. The color of amniotic fluid may have an impact on the occurrence of intrauterine infection, including early symptoms of the GBS infection.

  20. Is antibiotic prophylaxis mandatory after the insertion of levonorgestrel-releasing intrauterine systemin order to decrease the risk of pelvic inflammatory disease?

    Science.gov (United States)

    Munteanu, O; Radulescu, L; Bodean, O; Cirstoiu, C; Secara, D; Cirstoiu, M

    2013-01-01

    This study was undertaken in order to determine if antibiotic prophylaxis is mandatory, after the insertion of levonorgestrel-releasing intrauterine system in order to decrease the risk of pelvic inflammatory disease. We prospectively evaluated 44 patients, admitted in the Bucharest Emergency Hospital between the 1ⁱ of February 2012 and the 1ⁱ of October 2012, in whom the levonorgestrel-releasing intrauterine system was inserted. The patients enrolled were divided into two groups. In group A, a number of 22 patients, received, after the insertion of levonorgestrel-releasing intrauterine system, 875mg Amoxicillin Trihydrate + 125 mg Potassium Clavulanate, a dose every 12 hours for 5 days. Group B was represented by the other 22 patients who did not receive antibiotic prophylaxis. All patients were reevaluated at 4 and 12 weeks after the insertion of levonorgestrel-releasing intrauterine system. During the first 4 weeks after the insertion of levonorgestrel-releasing intrauterine system only two patients, one from group A and one from group B were diagnosed with pelvic inflammatory disease. At a second follow up visit - 12 weeks after the insertion of levonorgestrel-releasing intrauterine system, no other patient was diagnosed with pelvic inflammatory disease. Antibiotic prophylaxis is not mandatory, after the insertion of levonorgestrel-releasing intrauterine system in order to decrease the risk of pelvic inflammatory disease.

  1. Antibiotic prophylaxis for bacterial endocarditis: A study of knowledge of guidelines among dentists participated in the 47th international congress of dentistry

    Directory of Open Access Journals (Sweden)

    Hashemipour M.

    2008-12-01

    Full Text Available "nBackground and Aim: Infective endocarditis is a rare disease resulted in mortality and morbidity in 10-80% of patients. The purpose of present study was to investigate the knowledge of guidelines on antibiotic prophylaxis for bacterial endocarditis in a group of Iranian dentists. "nMaterials and Methods: This was a descriptive study in which the population under study was 205 who were participated in the 47th international congress of dentistry (Tehran-Spring 2007 and they were chosen by census sampling methods. Nameless questionnaires were designed and were given to the dentists to complete. The t-test, χ² and spearman with the SPSS 13.5 program were used in the data analysis. P<0.05 was considered as the level of significance. "nResults: Regarding to the prescribing of prophylactic antibiotic for patients with prosthetic cardiac valves, 94.6% of all answers were correct. Also, the most common procedures in which the prophylaxis antibiotic was distinguished to be necessary were periodontal surgery, scaling, dental extraction and using subgingival cord, respectively. More than half of the dentists (65.8% had chosen amoxicillin as a prophylactic antibiotic. Mean knowledge score was 38.77±12.4. "nConclusion: Results of the present study showed that the knowledge of dentists about prescribing antibiotics for prevention of bacterial endocarditis is relatively low. It was also found that the level of knowledge decreases by passing time from graduation.

  2. Study to identify and rectify the causes of failure to administer Intra partum antibiotic prophylaxis in Group B streptococcus positive

    International Nuclear Information System (INIS)

    Saeed, J.A.

    2015-01-01

    To perform an audit to review and minimize the reasons of failure to administer Intrapartum antibiotic prophylaxis (IAP) to all GBS positive mothers who presented in labor and it?s effect on fetal outcome. Methodology: A review of all the electronic charts at Tawam Hospital during a 6 month period from 6th April till 6th October 2009. It included women who presented in labor with a GBS positive status who needed to receive IAP and their babies blood cultures were performed postnatal. Results: There were 2405 deliveries during this period. Two hundred and nine cases were GBS positive. IAP was given only to 48 patients i.e 23% while 161 (77%) did not receive any treatment. The various reasons documented were patient presented late in active labor were 59%. Medication (Penicillin) was ordered but delayed from pharmacy. Penicillin ordered late or not ordered by the doctor in 14% and 1% were the patients who underwent elective c-section. All the babies had no growth of GBS with blood culture postnatal. Conclusion: The various strategies to improve the rate of administration of IAP which have been discussed above including patient education, patient information leaflet, physician order from antenatal clinic and midwife ordering the IAP need to be addressed and implement a new guideline. (author)

  3. An update on new antibiotic prophylaxis and treatment for urinary tract infections in children.

    Science.gov (United States)

    Delbet, Jean Daniel; Lorrot, Mathie; Ulinski, Tim

    2017-10-01

    This review focuses on the treatment of urinary tract infections (UTI) in children and in particular its recent changes. Areas covered: Acute pyelonephritis, acute cystitis and asymptomatic bacteriuria or asymptomatic infections have to be clearly distinguished. Prompt treatment is required in pyelonephritis and cystitis, but not in asymptomatic bacteriuria or infection, in order to avoid selection of more virulent strains. This concept should be considered even in immunocompromised or bedridden children. In case of pyelonephritis, there should be no delay in beginning the antibiotic treatment in order to decrease the risk of long term complication, such as renal scars. Predisposing conditions for UTI, such as voiding anomalies and urinary tract malformation should be carefully evaluated. Expert opinion: One major concern is the increasing resistance to 3 rd generation cephalosporins. Therefore overconsumption in low-risk settings should be absolutely avoided. The prevalence of infections with E. coli producing extended spectrum ß-lactamase (ESBL) is increasing and pediatricians should be aware about the specific treatment options. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economic factors in different health systems.

  4. Antibiotic prophylaxis at elective cesarean section: a randomized controlled trial in a low resource setting.

    Science.gov (United States)

    Kandil, Mohamed; Sanad, Zakaria; Gaber, Wael

    2014-04-01

    To determine the best time to administer prophylactic antibiotics at Cesarean delivery in order to reduce the postoperative maternal infectious morbidity in a low resource setting. One hundred term primigravidae with singleton pregnancy were recruited and randomly allocated to two equal groups. Each woman received 2 g intravenous Cefazoline. Women in Group I received it prior to skin incision while those in Group II had it immediately after cord clamping. We measured the following outcome parameters: (1) Surgical site wound infection; (2) Endometritis and (3) Urinary tract infection. There was no significant difference in any of the patients' characteristics between both groups. In Group I, three cases developed surgical site infections but four in Group II (p > 0.05). In Group I, the infected cases had Cesarean because of malpresentations while in Group II, two cases had Cesarean because of patients' request, one because of maternal heart disease and one due to intra-uterine growth restriction. Seven and nine cases had urinary tract infection in Groups I and II, respectively, (p > 0.05). Prophylactic antibiotic administration either prior to surgery or after cord clamping is probably equally effective in reducing the postoperative infectious morbidity after Cesarean in low resource settings.

  5. Efficacy of ultra-short single agent regimen antibiotic chemo-prophylaxis in reducing the risk of meningitis in patients undergoing endoscopic endonasal transsphenoidal surgery.

    Science.gov (United States)

    Somma, Teresa; Maraolo, Alberto Enrico; Esposito, Felice; Cavallo, Luigi Maria; Tosone, Grazia; Orlando, Raffaele; Cappabianca, Paolo

    2015-12-01

    The study aims to evaluate the incidence of infectious complications (namely meningitis) within 30 days after endoscopic endonasal transspheinodal neurosurgery (EETS) in patients receiving an ultra-short peri-operative chemo-prophylaxis regimen with 2 doses of 1st generation cephalosporin or macrolide. We retrospectively analyzed the clinical records of 145 patients who received an ultra-short chemoprophylaxis with two doses of an antibiotic, given 30 min before and 8h after EETS, over a 30-month time-frame. Ninety-seven patients (66.89%) received endovenous cefazolin, a 1st generation cephalosporin, administered at a dosage of 1000 mg, and 48 patients (33.10%) with an history of allergy to various agents, received endovenous clarithromycin at a dosage of 500 mg. No case of peri- and post-operative meningitis occurred in patients receiving the 2 doses of antibiotic. Only one patient (0.68%) developed cerebral fluid leakage on the 7th postoperative day, which required the switching to a broad-spectrum antibiotic prophylaxis for one week; this patient received the ultrashort prophylaxis with a macrolide. In addition, 7 patients (4.82%) developed minor infectious complications such as low-grade fever (3 cases, all of them receiving cefazolin), enlarged submandibular and cervical lymphnodes (3 cases, all of them receiving cefazolin), and upper and lower respiratory tract infection (1 case receiving clarithromycin). The cost of this prophylaxis regimen ranged from 7.76 Euro (cefazolin) to 39.54 Euro (clarithromycin). This study suggested that an ultra-short single-antibiotic prophylaxis is a safe, cheap and effective regimen to prevent post-operative meningitis in patients undergoing EETS and who do not require lumbar drainage after surgery. In these patients also the rate of minor infective complications was acceptable when compared with the previous more expensive regimen based on 3rd generation cephalosporin plus aminoglycoside or alone, that could be suitable only

  6. [What's the optimal time of cesarean section antibiotic prophylaxis, before skin incision or after umbilical cord clamping? A prospective randomized study].

    Science.gov (United States)

    Khlifi, A; Kouira, M; Bannour, I; Hachani, F; Kehila, M; Ferhi, F; Bouslama, A; Ben Jazia, K; Fekih, M; Khairi, H

    2016-11-01

    To compare the effect of antibiotics prophylaxis within 30 mins before skin incision (A) and after umbilical cord clamping (C) on the incidence of postoperative infections in patients undergoing elective caesarean section at Farhat Hached university teaching hospital. We conducted a randomised clinical trial evaluating 279 patients undergoing elective caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic (cefazol ® 2g) according to their allotment. They were followed up to detect infection up to 30 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with SPSS version 18.0 using univariate and bivariate analysis. The risk of overall postoperative infection was not significantly lower when prophylaxis was given before skin incision (4.37 % (A) vs 9.85 % (C); P=0.07; OR=0.42 [0.15-1.12]). We also found wound infections to be significantly reduced in the pre-incision group (2.2 % [A] vs 8.45 % [C]; P=0.03; OR=0.24 [0.06-0.88]). However, there was no difference in the endometritis infectious. On the other hand, there was no negative impact on the neonatal features. Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of wound infections. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  7. Early discontinuation of antibiotic prophylaxis in patients with persistent primary vesicoureteral reflux initially detected during infancy: outcome analysis and risk factors for febrile urinary tract infection.

    Science.gov (United States)

    Moriya, Kimihiko; Mitsui, Takahiko; Kitta, Takeya; Nakamura, Michiko; Kanno, Yukiko; Kon, Masafumi; Nishimura, Yoko; Shinohara, Nobuo; Nonomura, Katsuya

    2015-02-01

    We retrospectively assessed the incidence of and risk factors for febrile urinary tract infection in children during active surveillance after early discontinuation of antibiotic prophylaxis. We retrospectively evaluated 9 females and 61 uncircumcised males diagnosed with primary vesicoureteral reflux before age 1 year who had persistent reflux on followup voiding cystourethrogram and were subsequently followed under active surveillance without continuous antibiotic prophylaxis. Patients with secondary vesicoureteral reflux or associated urological abnormality were excluded. Clinical outcomes, including incidence of febrile urinary tract infection and new scar formation, were evaluated. Risk factors for febrile urinary tract infection were also analyzed. Mean age at stopping continuous antibiotic prophylaxis was 21 months, and mean followup was 61 months. During active surveillance 21 patients had febrile urinary tract infection, and the 5-year infection-free rate under active surveillance was 67.5%. One or 2 foci of minimal new scarring developed in 4 of 16 patients who underwent followup dimercapto-succinic acid scan after febrile urinary tract infection. On multivariate analysis dilated vesicoureteral reflux on followup voiding cystourethrogram was the only significant risk factor for febrile urinary tract infection. This study revealed that about two-thirds of patients with persistent vesicoureteral reflux were free of febrile urinary tract infection during 5 years of active surveillance. Those with dilated vesicoureteral reflux on followup voiding cystourethrogram are at significantly greater risk for febrile urinary tract infection. Accordingly active surveillance, especially in patients with nondilated vesicoureteral reflux on followup voiding cystourethrogram, seems to be a safe option even in children who have not yet been toilet trained. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

  8. Effect of antibiotic prophylaxis on Coagulase-negative Staphylococcus virulence factor profiles in patients undergoing cataract surgery.

    Science.gov (United States)

    López, Yolanda; Samudio, Margarita; Fariña, Norma; Castillo, Verónica; Abente, Sonia; Nentwich, Martin M; González-Britez, Nilsa; Laspina, Florentina; Carron, Agustín; Cibils, Diógenes; de Kaspar, Herminia Miño

    2017-08-01

    In this prospective study, multiplex polymerase chain reaction (PCR) was used to identify genes encoding virulence factors (ica, atlE and mecA) in Coagulase-negative Staphylococcus (CNS) isolates from the ocular microbiota of patients undergoing cataract surgery and to investigate possible changes in the CNS profile due to antibiotic prophylaxis. Between 09/2011 and 08/2013, patients undergoing cataract surgery were recruited at the Department of Ophthalmology, National University of Asuncion, Paraguay. In the eye to be operated on, patients received moxifloxacin 0.5 % eye drops four times at the day before surgery and a last drop 1 hour before surgery (T1). The other eye remained as control (T0). Conjunctival swabs were taken from both eyes 1 hour after the last drop. The presence of genes encoding biofilm formation (ica and atlE) and methicillin resistance (mecA) was detected by a multiplex PCR. Of the 162 patients (162 study eyes, 162 fellow eye as control group), 87 (53.7 %) eyes were positive for CNS at T0 yielding 96 CNS isolates; 70 eyes (43.2 %) were positive at T1 yielding 77 CNS isolates. For this study, 43 CNS isolates (44.8 %) from T0 and 45 (64.3 %) from T1 were used. Of the total isolates, 81.8 % (72/88) had at least one virulence factor gene (37/43 from T0 and 35/45 from T1) (p = 0.314). Simultaneous detection of ica and atlE genes was higher in T0 (58.0 %) than T1 (46.7 %), but the difference was not significant (p = 0.28). A high frequency of genes encoding virulence factors was observed in the coagulase-negative Staphylococcus isolates. The use of moxifloxacin did not significantly modify the CNS virulence factor profiles.

  9. Revisões sistemáticas de antibioticoprofilaxia em cesarianas Systematic reviews of antibiotic prophylaxis in cesareans

    Directory of Open Access Journals (Sweden)

    Ana Cristina Marques Martins

    2006-12-01

    Full Text Available O objetivo do trabalho foi analisar a evidência científica disponível sobre os efeitos da antibioticoprofilaxia em cesarianas. As presentes revisões sistemáticas compreenderam um exame detalhado da qualidade do desenho e da execução assim como da heterogeneidade clínica entre os ensaios. A meta-análise dos ensaios placebo-controlados (27 estudos apontou eficácia aproximada de 65% para ambos os desfechos estudados, endometrite e infecção da ferida cirúrgica (IFC, correspondendo a uma queda da incidência de 11% e 5%, respectivamente. As análises de sensibilidade mostraram efeitos sumários semelhantes aos observados para o conjunto dos ensaios. O subgrupo dos 12 ensaios de cesáreas não eletivas indicou benefício importante da antibioticoprofilaxia para ambos os desfechos, correspondente a uma queda de 14% (endometrite e 5% (IFC. Para cesáreas eletivas (dois ensaios, não foi mostrado benefício relevante. A evidência obtida dos ensaios comparativos de doses foi limitada devido a falhas metodológicas importantes e ao pequeno número de pacientes envolvidas (três ensaios. Os ensaios comparativos de antimicrobianos (sete estudos não evidenciaram diferença de eficácia entre os dois esquemas analisados, cefalosporinas de 1ª e de 2ª geração.This study reviews the available evidence on the efficacy of antibiotic prophylaxis in cesarean sections. The study included a detailed analysis of the quality of design and performance and the clinical heterogeneity of selected clinical trials. Meta-analysis of placebo-controlled trials estimated an efficacy of some 65% for the two study endpoints, endometritis and surgical wound infection, corresponding to a decrease in infection rates of some 11% and 5%, respectively. Sensitivity analyses showed summary effects similar to those observed for all studies. Results for the non-elective cesarean sections subgroup (12 studies indicated a relevant benefit for both endpoints, corresponding to

  10. Antibiotics.

    Science.gov (United States)

    Hariprasad, Seenu M; Mieler, William F

    2016-01-01

    The Endophthalmitis Vitrectomy Study (EVS) provided ophthalmologists with evidence-based management strategies to deal with endophthalmitis for the first time. However, since the completion of the EVS, numerous unresolved issues remain. The use of oral antibiotics has important implications for the ophthalmologist, particularly in the prophylaxis and/or management of postoperative, posttraumatic, or bleb-associated bacterial endophthalmitis. One can reasonably conclude that significant intraocular penetration of an antibiotic after oral administration may be a property unique to the newer-generation fluoroquinolones. Prophylactic use of mupirocin nasal ointment resulted in significant reduction of conjunctival flora with or without preoperative topical 5% povidone-iodine preparation. Ocular fungal infections have traditionally been very difficult to treat due to limited therapeutic options both systemically and intravitreally. Because of its broad spectrum of coverage, low MIC90 levels for the organisms of concern, good tolerability, and excellent bioavailability, voriconazole through various routes of administration may be useful to the ophthalmologist in the primary treatment of or as an adjunct to the current management of ocular fungal infections. © 2016 S. Karger AG, Basel.

  11. [Current Situation of Antibiotic Prophylaxis in Obesity and Metabolic Surgery - Data Analysis from the Study for Quality Assurance in Operative Treatment of Obesity in Germany].

    Science.gov (United States)

    Stroh, C; Wilhelm, B; Weiner, R; Ludwig, K; Benedix, F; Knoll, C; Lippert, H; Manger, T; Adipositas, Kompetenznetz

    2016-02-01

    Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities. Georg Thieme Verlag KG Stuttgart · New York.

  12. INFECTION AFTER RADICAL ABDOMINAL HYSTERECTOMY AND PELVIC LYMPHADENECTOMY - PREVENTION OF INFECTION WITH A 2-DOSE PERIOPERATIVE ANTIBIOTIC-PROPHYLAXIS

    NARCIS (Netherlands)

    BOUMA, J

    1993-01-01

    Surgical site-related infections occurred in 21% of 87 consecutive patients undergoing radical hysterectomy with pelvic lymphadenectomy (RHPL) without planned peri-operative prophylaxis. A prospective, randomized double-blind, placebo-controlled study was conducted in 68 consecutive RHPL patients.

  13. Evaluation of the Need for Antibiotic Prophylaxis During Routine Intra-alveolar Dental Extractions in Healthy Patients: A Randomized Double-Blind Controlled Trial.

    Science.gov (United States)

    Sidana, Sunil; Mistry, Yusuf; Gandevivala, Adil; Motwani, Nitesh

    2017-09-01

    The aim of this randomized double-blind controlled trial was to evaluate the role of antibiotics in the perioperative period of dental extractions in healthy patients. The study population included patients visiting the outpatient department of our institute. Four hundred patients were selected and randomly divided into 4 groups and underwent routine dental extraction. In group A, patients were prescribed only anti-inflammatory drugs in the postoperative period. In group B, patients were prescribed antibiotics for 3 days and concomitant anti-inflammatory drugs in the postoperative period only. In group C, patients were prescribed a single dose of antibiotic 1 hour before the extraction procedure with no postoperative antibiotics, and only anti-inflammatory drugs were prescribed in the postoperative period. In group D, patients were prescribed mouthwash starting 15 minutes before the procedure and continuing twice daily for a period of 7 days along with anti-inflammatory drugs in the postoperative period. Patients were asked to follow up on the seventh postoperative day for suture removal and were evaluated for pain, swelling, dry socket, and local signs of infection. The study was approved by the Internal Ethics Review Committee of the institute. No significant differences were seen among the groups with respect to pain (χ 2  [1, N = 171] = 4.939, P = .552), swelling (χ 2 [1, N = 171] = 10.048, P = .347), or postextraction complications. Prophylactic antibiotics are not required during routine dental extractions in healthy patients. The use of antibiotic therapy without appropriate indications can result in the development of resistant organisms. However, a clear trend is seen in which practitioners overprescribe antibiotics as well as medications in general. The current evidence questions the benefits of prophylactic antibiotic therapy for patients undergoing dental extractions. In our opinion, there is no justification for routine antibiotic

  14. Timing of antibiotic prophylaxis in cesarean section: retrospective, difference-in-differences estimation of the effect on surgical-site-infection.

    Science.gov (United States)

    Ben Shoham, Assaf; Bar-Meir, Maskit; Ioscovich, Alexander; Samueloff, Arnon; Wiener-Well, Yonit

    2017-10-26

    Cesarean section (CS) is one of the most common surgical procedures performed worldwide. Surgical-site-infection (SSI) occurs in approximately 5-10% of CS. The benefit of prophylactic antibiotics for prevention of SSI has been demonstrated in the literature. The optimal timing of antibiotic prophylaxis (prior to surgical incision versus after cord clamping) was investigated in recent studies. In January 2014, the Israeli Ministry of Health introduced a national quality measure which monitors the administration of prophylactic antibiotics in CS. The custom clinical practice in our medical center was to administer prophylactic antibiotics immediately after cord clamping. Upon introduction of the national quality measurement program, the practice was changed to administration of antibiotics prior to surgical incision. Our objective was to examine the effect of timing of prophylactic antibiotics administration on the incidence of SSI following CS, in a single medical center that performs a large volume of deliveries, with a low rate of CS. Taking advantage of a discrete change in clinical practice, we used retrospective data and applied difference-in-differences design to estimate the effect of the timing of prophylactic antibiotics administration on SSI rates. The analysis included all CSs performed during 2012-2015 and all hysterectomies conducted during the study period. The coverage rates of prophylactic antibiotics in CS before and after the policy change were 99.10% and 99.03%, respectively. The rates of SSI following CS, before and after the policy change, were 2.63% (n = 2499) and 2.32% (n = 3840), respectively. The rates of SSI following hysterectomy, before and after the policy, change were 6.82% (n = 396) and 7.09% (n = 437), respectively. Difference-in-differences (DID) estimates of the effect of policy change on the incidence of SSI in linear and logistic regression models were not significant (B = -0.6%, p = .64; odds ratio = 0

  15. Postoperative Infection Rates in Patients with a Negative Baseline Urine Culture Undergoing Ureteroscopic Stone Removal: A Matched Case-Control Analysis on Antibiotic Prophylaxis from the CROES URS Global Study

    NARCIS (Netherlands)

    Martov, Alexey; Gravas, Stavros; Etemadian, Masoud; Unsal, Ali; Barusso, Gabriel; D'Addessi, Alessandro; Krambeck, Amy; de la Rosette, Jean

    2015-01-01

    Purpose: To examine the effects of antibiotic prophylaxis on postoperative infection rate in patients with negative urine cultures undergoing ureteroscopy (URS). Patients and Methods: Using the Clinical Research Office of the Endourological Society (CROES) URS Global Study database, patients with a

  16. The efficacy of antibiotic prophylaxis at placement of dental implants: a Cochrane systematic review of randomised controlled clinical trials.

    Science.gov (United States)

    Esposito, Marco; Grusovin, Maria Gabriella; Coulthard, Paul; Oliver, Richard; Worthington, Helen V

    To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective. The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched and several journals were handsearched with no language restriction up to January 2008. Randomised controlled trials (RCTs) with a follow up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement were eligible. Screening of studies, quality assessment and data extraction were conducted in duplicate. Missing information was requested. Outcome measures were: prosthesis and implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Two RCTs were identified: one comparing 2 g of preoperative amoxicillin versus placebo (316 patients) and the other comparing 2 g of preoperative amoxicillin + 500 mg four times a day for 2 days versus no antibiotics (80 patients). The meta-analyses of the two trials showed a statistically significant higher number of patients experiencing implant failures in the group not receiving antibiotics: RR = 0.22 (95% CI 0.06 to 0.86). The number needed to treat (NNT) to prevent one patient having an implant failure is 25 (95% CI 13 to 100), based on a patient implant failure rate of 6% in patients not receiving antibiotics. The other outcomes were not statistically significant, and only two minor adverse events were recorded, one of which was in the placebo group. There is some evidence suggesting that 2 g of amoxicillin given 1 hour preoperatively significantly reduce failures of dental implants placed in ordinary conditions. It remains unclear whether postoperative antibiotics are beneficial, and which is the most effective antibiotic. It might be

  17. Low infection rate after tumor hip arthroplasty for metastatic bone disease in a cohort treated with extended antibiotic prophylaxis

    DEFF Research Database (Denmark)

    Hettwer, Werner H; Horstmann, Peter Frederik; Hovgaard, Thea Bechmann

    2015-01-01

    Background. Compared to conventional hip arthroplasty, endoprosthetic reconstruction after tumor resection is associated with a substantially increased risk of periprosthetic joint infection (PJI), with reported rates of around 10% in a recent systematic review. The optimal duration of antibiotic...

  18. Prevention of Cardiac Implantable Electronic Device Infections: Single Operator Technique with Use of Povidone-Iodine, Double Gloving, Meticulous Aseptic/Antiseptic Measures and Antibiotic Prophylaxis.

    Science.gov (United States)

    Manolis, Antonis S; Melita, Helen

    2017-01-01

    Cardiac implantable electronic device (CIED) implantation is complicated by infection still at a worrisome rate of 2-5%. Since early on during device implantation procedures, we have adopted an infection-preventive technique which has hitherto resulted in effective prevention of infections. Herein we present our results of applying this technique by a single operator in a prospective series of 762 consecutive patients undergoing device implantation. A meticulous search for and treatment of active, occult, or smoldering infection was undertaken preoperatively. An aseptic/antiseptic technique was used for implantation of each device. Skin preparation is thorough with initial cleansing performed with alcohol followed by povidone-iodine 10% solution, which is also used in the wound and inside the pocket. In addition, we routinely use double gloving, and IV antibiotic prophylaxis 1 hour before and for 48 hours afterwards followed by oral antibiotic for 2-3 days after discharge. The skin is closed with absorbable sutures. The study includes 382 patients having a new pacemaker (n = 333) or battery change, system upgrade or lead revision (n = 49), and 380 patients having a new implantable cardioverter-defibrillator (ICD) (n = 296) or device replacement/upgrade/lead revision (n = 84). The pacemaker group, aged 70.2 ± 16.5 years, includes 18% VVI, 49% DDD, 29% VDD, and 4% cardiac resynchronization therapy (CRT) devices. The ICD group, aged 61.3 ± 13.0 years, with a mean ejection fraction of 36 ± 13%, includes 325 ICD and 55 CRT implants. Over 26.6 ± 33.4 months for the pacemaker group and 36.6 ± 38.3 months for the ICD group, infection occurred in one patient in each group (0.26%) having a device replacement. A consistent and strict approach of aseptic/antiseptic technique with the use of double gloving and povidone-iodine solution within the pocket plus a 4-day regimen of antibiotic prophylaxis minimizes infections in CIED implants. © 2016 Wiley Periodicals, Inc.

  19. Antibiotics

    Science.gov (United States)

    Antibiotics are powerful medicines that fight bacterial infections. Used properly, antibiotics can save lives. They either kill bacteria or ... natural defenses can usually take it from there. Antibiotics do not fight infections caused by viruses, such ...

  20. Recombinant protective antigen anthrax vaccine improves survival when administered as a postexposure prophylaxis countermeasure with antibiotic in the New Zealand white rabbit model of inhalation anthrax.

    Science.gov (United States)

    Leffel, Elizabeth K; Bourdage, James S; Williamson, E Diane; Duchars, Matthew; Fuerst, Thomas R; Fusco, Peter C

    2012-08-01

    Inhalation anthrax is a potentially lethal form of disease resulting from exposure to aerosolized Bacillus anthracis spores. Over the last decade, incidents spanning from the deliberate mailing of B. anthracis spores to incidental exposures in users of illegal drugs have highlighted the importance of developing new medical countermeasures to protect people who have been exposed to "anthrax spores" and are at risk of developing disease. The New Zealand White rabbit (NZWR) is a well-characterized model that has a pathogenesis and clinical presentation similar to those seen in humans. This article reports how the NZWR model was adapted to evaluate postexposure prophylaxis using a recombinant protective antigen (rPA) vaccine in combination with an oral antibiotic, levofloxacin. NZWRs were exposed to multiples of the 50% lethal dose (LD(50)) of B. anthracis spores and then vaccinated immediately (day 0) and again on day 7 postexposure. Levofloxacin was administered daily beginning at 6 to 12 h postexposure for 7 treatments. Rabbits were evaluated for clinical signs of disease, fever, bacteremia, immune response, and survival. A robust immune response (IgG anti-rPA and toxin-neutralizing antibodies) was observed in all vaccinated groups on days 10 to 12. Levofloxacin plus either 30 or 100 μg rPA vaccine resulted in a 100% survival rate (18 of 18 per group), and a vaccine dose as low as 10 μg rPA resulted in an 89% survival rate (16 of 18) when used in combination with levofloxacin. In NZWRs that received antibiotic alone, the survival rate was 56% (10 of 18). There was no adverse effect on the development of a specific IgG response to rPA in unchallenged NZWRs that received the combination treatment of vaccine plus antibiotic. This study demonstrated that an accelerated two-dose regimen of rPA vaccine coadministered on days 0 and 7 with 7 days of levofloxacin therapy results in a significantly greater survival rate than with antibiotic treatment alone. Combination of

  1. [Search for bacterial contamination of the aqueous humor during cataract surgery with and without local antibiotic prophylaxis].

    Science.gov (United States)

    Saint-Blancat, P; Burucoa, C; Boissonnot, M; Gobert, F; Risse, J F

    1995-01-01

    Bacterial contamination of anterior chamber at the end of cataract surgery, was compared between two techniques: extracapsular extraction and phacoemulsification. The effectiveness of preoperative antibiotic eyedrops using Norfloxacine 0.3% (Chibroxine) was also evaluated. The study focused on 101 patients grouped according to surgical technique and presence of preoperative antibiotic eyedrops. Conjunctival sampling was made the day prior the surgery, as well as in the operating room, after skin and conjunctival desinfection with povidone iodine in all the patients included in the study. Aqueous humour was collected at the end of surgery. Eight samples out of 101 were positive which represents 7.9% of the cases. In 75% of the cases, the anterior chamber aspirate showed a different germ or non-recurrent germ in the second conjunctival sample. None of the included patients developed endophthalmitis. The two most frequent pathogens were Propionibacterium acnes in 62.5% of the cases, and Staphylococcus epidermidis in 50%. Another pathogen was found in a culture environment: Micrococcus roseus. In two samples, two different bacteria grew: Propionibacterium acnes and Staphylococcus epidermidis. Whatever the surgical technique, no statistically significant bacterial contamination was found. There was no significant statistical difference between patients who had local antibiotic eyedrops and those who did not. This study confirms the poor reliability of local antibiotic eyedrops to prevent surgical contamination. Furthermore performing an anterior chamber aspirate at the end of the surgery for risk patients would help the physician identify the pathogens involved in endophthalmitis in order to begin antibiotic treatment as soon as possible.

  2. Wound Infections Following Implant removal below the knee: the effect of antibiotic prophylaxis; the WIFI-trial, a multi-centre randomized controlled trial.

    Science.gov (United States)

    Backes, Manouk; Dingemans, Siem A; Schep, Niels W L; Bloemers, Frank W; Van Dijkman, Bart; Garssen, Frank P; Haverlag, Robert; Hoogendoorn, Jochem M; Joosse, Pieter; Mirck, Boj; Postma, Victor; Ritchie, Ewan; Roerdink, W Herbert; Sintenie, Jan Bernard; Soesman, Nicolaj M R; Sosef, Nico L; Twigt, Bas A; Van Veen, Ruben N; Van der Veen, Alexander H; Van Velde, Romuald; Vos, Dagmar I; De Vries, Mark R; Winkelhagen, Jasper; Goslings, J Carel; Schepers, Tim

    2015-02-06

    In the Netherlands about 18,000 procedures with implant removal are performed annually following open or closed reduction and fixation of fractures, of which 30-80% concern the foot, ankle and lower leg region. For clean surgical procedures, the rate of postoperative wound infections (POWI) should be less than ~2%. However, rates of 10-12% following implant removal have been reported, specifically after foot, ankle and lower leg fractures. Currently, surgeons individually decide if antibiotics prophylaxis is given, since no guideline exists. This leads to undesirable practice variation. The aim of the study is to assess the (cost-)effectiveness of a single intravenous gift of Cefazolin prior to implant removal following surgical fixation of foot, ankle and/or lower leg fractures. This is a double-blind randomized controlled trial in patients scheduled for implant removal following a foot, ankle or lower leg fracture. Primary outcome is a POWI within 30 days after implant removal. Secondary outcomes are quality of life, functional outcome and costs at 30 days and 6 months after implant removal. With 2 x 250 patients a decrease in POWI rate from 10% to 3.3% (expected rate in clean-contaminated elective orthopaedic trauma procedures) can be detected (Power = 80%, 2-sided alpha = 5%, including 15% lost to follow up). If administration of prophylactic antibiotics prior to implant removal reduces the infectious complication rate, this will offer a strong argument to adopt this as standard practice of care. This will consequently lead to less physical and social disabilities and health care use. A preliminary, conservative estimation suggests yearly cost savings in the Netherlands of € 3.5 million per year. This study is registered at Clinicaltrials.gov ( NCT02225821 ) and the Netherlands Trial Register ( NTR4393 ) and was granted permission by the Medical Ethical Review Committee of the Academic Medical Centre on October 7 2014.

  3. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy--should we reassess our practices for antibiotic prophylaxis?

    Science.gov (United States)

    Steensels, D; Slabbaert, K; De Wever, L; Vermeersch, P; Van Poppel, H; Verhaegen, J

    2012-06-01

    Although the estimate of the incidence of sepsis following transrectal ultrasound-guided prostate biopsy (TRUSPB) is low, fluoroquinolone-resistant infections after prostate biopsy are being increasingly noted. This study was aimed at determining the prevalence of faecal carriage of fluoroquinolone-resistant Escherichia coli strains before TRUSPB and at evaluating potential predisposing risk factors. The incidence of sepsis after prostate biopsy was determined, and our routine practice for antibiotic prophylaxis for TRUSPB was evaluated. A prospective study was conducted in 342 consecutive patients undergoing prostate biopsy between December 2009 and July 2010. Before TRUSPB, a rectal swab was cultured. The correlation between the presence of fluoroquinolone-resistant strains and plausible risk factors was investigated by the use of a questionnaire. Of the 236 patients included, 22.0% (52/236) harboured ciprofloxacin-resistant E. coli strains. The use of fluoroquinolones in the 6 months before biopsy was associated with an increased risk of faecal carriage of fluoroquinolone-resistant E. coli strains (p fluoroquinolone-resistant E. coli strains was an important risk factor for infectious complications after TRUSPB (p fluoroquinolone-resistant E. coli strains (22.0%) before TRUSPB. The use of fluoroquinolones in the previous 6 months before biopsy is a risk factor for faecal carriage of fluoroquinolone-resistant E. coli strains and for infectious complications after TRUSPB. Hence, the universal administration of fluoroquinolones should be reconsidered. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

  4. Impact of intrapartum antimicrobial prophylaxis upon the intestinal microbiota and the prevalence of antibiotic resistance genes in vaginally delivered full-term neonates.

    Science.gov (United States)

    Nogacka, Alicja; Salazar, Nuria; Suárez, Marta; Milani, Christian; Arboleya, Silvia; Solís, Gonzalo; Fernández, Nuria; Alaez, Lidia; Hernández-Barranco, Ana M; de Los Reyes-Gavilán, Clara G; Ventura, Marco; Gueimonde, Miguel

    2017-08-08

    Disturbances in the early establishment of the intestinal microbiota may produce important implications for the infant's health and for the risk of disease later on. Different perinatal conditions may be affecting the development of the gut microbiota. Some of them, such as delivery mode or feeding habits, have been extensively assessed whereas others remain to be studied, being critical to identify their impact on the microbiota and, if any, to minimize it. Antibiotics are among the drugs most frequently used in early life, the use of intrapartum antimicrobial prophylaxis (IAP), present in over 30% of deliveries, being the most frequent source of exposure. However, our knowledge on the effects of IAP on the microbiota establishment is still limited. The aim of the present work was to evaluate the impact of IAP investigating a cohort of 40 full-term vaginally delivered infants born after an uncomplicated pregnancy, 18 of which were born from mothers receiving IAP. Fecal samples were collected at 2, 10, 30, and 90 days of age. We analyzed the composition of the fecal microbiota during the first 3 months of life by 16S rRNA gene sequencing and quantified fecal short chain fatty acids by gas chromatography. The presence of genes for resistance to antibiotics was determined by PCR in the samples from 1-month-old infants. Our results showed an altered pattern of intestinal microbiota establishment in IAP infants during the first weeks of life, with lower relative proportions of Actinobacteria and Bacteroidetes and increased of Preoteobacteria and Firmicutes. A delay in the increase on the levels of acetate was observed in IAP infants. The analyses of specific antibiotic resistance genes showed a higher occurrence of some β-lactamase coding genes in infants whose mothers received IAP. Our results indicate an effect of IAP on the establishing early microbiota during the first months of life, which represent a key moment for the development of the microbiota

  5. Antibioticoprofilaxia em cirurgias de cães e gatos: necessidade e realidade Antibiotic prophylaxis in surgery of dogs and cats: the necessity and the reality

    Directory of Open Access Journals (Sweden)

    Daniel Pontes Braga

    2012-12-01

    Full Text Available A administração profilática de antimicrobianos tem por objetivo evitar a contaminação do ferimento cirúrgico, após exposição a algum micro-organismo e antes da instalação do processo de infecção, devendo alcançar e manter concentrações antimicrobianas inibitórias, no local da incisão, durante todo o procedimento cirúrgico, a fim de evitar o crescimento de patógenos contaminantes. Na medicina veterinária, a antibioticoprofilaxia é claramente aceita como importante medida da redução e controle da incidência de infecções do sítio cirúrgico. Este estudo objetivou avaliar a utilização de antibióticos nos procedimentos cirúrgicos, realizados na clínica cirúrgica de cães e gatos do Hospital Veterinário da Universidade Federal de Viçosa, considerando a sua necessidade e a realidade. A população para o estudo foi constituída dos pacientes submetidos a tratamento cirúrgico, no período de 11 de maio a 11 de novembro de 2007. A utilização de antibióticos nos procedimentos estudados não foi padronizada ou alterada, para realização deste estudo. Assim, concluiu-se que é necessário estabelecer critérios para a antibioticoprofilaxia, bem como sua padronização no Hospital Veterinário da Universidade Federal de Viçosa, para corrigir possíveis falhas no processo de prevenção das infecções do sítio cirúrgico.Antimicrobial prophylaxis aim at preventing surgical wound contamination after the exposure to any microorganism and before infection is established. Inhibitory antimicrobial concentrations should be reached and maintained on the incision throughout the entire surgical procedure in order to prevent microbial growth. In veterinary medicine, antimicrobial prophylaxis is clearly disclosure and accepted as an important action to control and reduce the incidence of surgical wound infection. This study evaluated the use of antibiotics in small animals' surgeries at the Veterinary Hospital of the

  6. Dose-response efficacy of a proprietary probiotic formula of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R for antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea prophylaxis in adult patients.

    Science.gov (United States)

    Gao, Xing Wang; Mubasher, Mohamed; Fang, Chong Yu; Reifer, Cheryl; Miller, Larry E

    2010-07-01

    Standard therapies for antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD) have limited efficacy. Probiotic prophylaxis is a promising alternative for reduction of AAD and CDAD incidence. In this single-center, randomized, double-blind, placebo-controlled dose-ranging study, we randomized 255 adult inpatients to one of three groups: two probiotic capsules per day (Pro-2, n=86), one probiotic capsule and one placebo capsule per day (Pro-1, n=85), or two placebo capsules per day (n=84). Each probiotic capsule contained 50 billion c.f.u. of live organisms (Lactobacillus acidophilus CL1285 +Lactobacillus casei LBC80R Bio-K+ CL1285). Probiotic prophylaxis began within 36 h of initial antibiotic administration, continued for 5 days after the last antibiotic dose, and patients were followed for an additional 21 days. Pro-2 (15.5%) had a lower AAD incidence vs. Pro-1 (28.2%). Each probiotic group had a lower AAD incidence vs. placebo (44.1%). In patients who acquired AAD, Pro-2 (2.8 days) and Pro-1 (4.1 days) had shorter symptom duration vs. placebo (6.4 days). Similarly, Pro-2 (1.2%) had a lower CDAD incidence vs. Pro-1 (9.4%). Each treatment group had a lower CDAD incidence vs. placebo (23.8%). Gastrointestinal symptoms were less common in the treatment groups vs. placebo and in Pro-2 vs. Pro-1. The proprietary probiotic blend used in this study was well tolerated and effective for reducing risk of AAD and, in particular, CDAD in hospitalized patients on antibiotics. A dose-ranging effect was shown with 100 billion c.f.u., yielding superior outcomes and fewer gastrointestinal events compared to 50 billion c.f.u. (ClinicalTrials.gov number NCT00958308).

  7. Tinidazol versus cefazolina na antibioticoprofilaxia de histerectomia vaginal e abdominal Tinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    José Antonio Simões

    2008-11-01

    das mulheres submetidas à histerectomia vaginal sugere que essa infecção deve ser melhor pesquisada e devidamente tratada antes da cirurgia.PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction; Group T (2 g of tinidazole orally, 12 hours before the surgery; or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction. Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12. There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02. BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%, though without statistical significance (p=0.19. CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post

  8. Prevention of severe infectious complications after colorectal surgery using preoperative orally administered antibiotic prophylaxis (PreCaution) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Mulder, Tessa; Kluytmans-van den Bergh, Marjolein F Q; de Smet, Anne Marie G A; van 't Veer, Nils E; Roos, Daphne; Nikolakopoulos, Stavros; Bonten, Marc J M; Kluytmans, Jan A J W

    2018-01-01

    BACKGROUND: Colorectal surgery is frequently complicated by surgical site infections (SSIs). The most important consequences of SSIs are prolonged hospitalization, an increased risk of surgical reintervention and an increase in mortality. Perioperative intravenously administered antibiotic

  9. Documento de consenso sobre la utilización de profilaxis antibiótica en cirugía y procedimientos dentales Consensus document on the use of antibiotic prophylaxis in dental surgery and procedures

    Directory of Open Access Journals (Sweden)

    J.L. Gutiérrez

    2006-06-01

    Full Text Available La profilaxis antibiótica en Odontología tiene como objetivo prevenir la aparición de infección a partir de la puerta de entrada que produce la actuación terapéutica, por lo que se encuentra indicada siempre que exista un riesgo importante de infección, ya sea por las características mismas de la operación o por las condiciones locales o generales del paciente. Sin embargo, los ensayos clínicos con antibióticos en patologías dentarias responden poco a los criterios metodológicos requeridos, y además no son lo suficientemente numerosos. Se presentan los resultados de una conferencia de expertos integrada por los Presidentes de Sociedades Científicas Españolas más representativas que han analizado la bibliografía existente y han aportado sus valiosas experiencias profesionales. Se describen las circunstancias técnicas, se analizan los fundamentos biológicos y farmacológicos y se aplican a las situaciones médicas más representativas. Se concluye que la profilaxis antibiótica en Odontología cuenta con indicaciones bien fundamentadas y precisas, ofreciendo a la comunidad científica internacional un protocolo práctico de actuación.The goal of antibiotic prophylaxis in Odontology is to prevent the onset of infections through the entranceway provided by the therapeutic action, therefore it is indicated providing there is a considerable risk of infection, either because of the characteristics of the operation itself or the patient’s local or general condition. Nonetheless, clinical trials with antibiotics in dental pathologies have had scant regard for the required methodological criteria and, in addition, are not sufficiently numerous. This text presents the results of an expert conference comprising the Presidents of the most representative Scientific Societies in Spain who have analyzed the existing literature and have drawn on their valuable professional experience. It describes the technical circumstances, analyzes the

  10. Antibacterial prophylaxis in neutropenic children with cancer

    Directory of Open Access Journals (Sweden)

    Angelica Barone

    2011-02-01

    Full Text Available During the period of neutropenia due to chemotherapy, patients have high risk of infections. The use of antibiotic prophylaxis to reduce neutropenia-related complications in oncologic patients is still disputed. Recent meta-analysis and clinical trials demonstrated that antibiotic prophylaxis with chinolons reduces fever episodes, bacterial infections and mortality in adult oncologic patients with neutropenia due to chemotherapy for acute leukaemia. In paediatric patients, the only randomized, double-blind, prospective study up till now suggested that Amoxicillin clavulanate may represent an effective prophylactic treatment to reduce fever and infections in oncologic children with neutropenia, with an efficacy statistically demonstrated only in patients with acute leukaemia. Considering the risk of resistances, antibiotic-prophylaxis should be used only in selected patients.

  11. Cefepime versus Ceftriaxone for perioperative systemic antibiotic prophylaxis in elective orthopedic surgery at Bugando Medical Centre Mwanza, Tanzania: a randomized clinical study.

    Science.gov (United States)

    Marwa, Joel M; Ngayomela, Isidor H; Seni, Jeremiah; Mshana, Stephen E

    2015-12-23

    Antimicrobial prophylaxis reduces the incidence of postoperative wound infections especially among patients undergoing orthopedics surgery. However, there is dearth of information on the clinical effectiveness, spectrum limitations and practical contextual information on third and fourth generation cephalosporins. The aim of this study was to evaluate the efficacy and safety of cefepime and ceftriaxone as peri-operative systemic antimicrobial prophylaxis in elective orthopedic surgery in our center. This study was a prospective, randomized, open label comparative clinical study of patients undergoing elective orthopedic procedures at the Bugando Medical Centre (BMC) between June 2014 and February 2015. Two hundred thirty participants were enrolled in the study and randomly assigned into Ceftriaxone regimen (group A) or Cefepime regimen (group B). Participants in ceftriaxone or cefepime group received 50 mg/kg up to 2 g single dose perioperative intravenous infusion at least 30 min before incision. Both groups were followed for 30 days using a Center for Disease Control superficial surgical site infection criterion for the outcome. A two-tailed margin of equivalence was set at 5% analyzed on the intent to treat. All 230 participants were subjected to final analysis with no patient being lost to follow-up. Superficial surgical site infection occurred in 5 out of 117 (4.3%, 0.6 to 7.9 at 95% CI) patients receiving cefepime compared to 3 out of 113 (2.7%, 0.3 to 5.6 at 95% CI) among patients receiving ceftriaxone regimen. The absolute difference of 1.6% (95% Confidence Interval: -6.3 to 3.1), equivocally lies outside the 5% statistically significant margin of presumed clinical equivalence. The difference between cefepime and ceftriaxone in preventing SSIs following elective clean orthopedic surgery was not statistically significant. Pan African Clinical Trial Registry: PACTR201406000803420.

  12. Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial.

    Science.gov (United States)

    Westen, Esther H M N; Kolk, Pascal R; van Velzen, Christine L; Unkels, Regine; Mmuni, Nicholaus S; Hamisi, Alex D; Nakua, Ritha E; Vlek, Anne L M; van Beekhuizen, Heleen J

    2015-01-01

    To investigate the efficacy of a single prophylactic dose of ampicillin combined with metronidazole to prevent postcesarean section infections compared with a multiple day regimen in low-resource settings. An evaluator-blinded randomized, controlled, noninferiority trial. Two rural hospitals in Tanzania. Of 181 enrolled eligible women with an indication for cesarean section, information on 176 was analyzed by intention-to-treat. The women were randomly assigned to either the intervention group who received a single dose of ampicillin and metronidazole, or to the control group who received a multiple-day regimen of ampicillin/amoxicillin and metronidazole. The primary outcome was maternal postcesarean infection. Secondary outcomes were severity of these infections, other maternal complications, and the duration of hospital stay. In the intervention group (n = 89), six women (6.7%) developed a wound infection compared with nine (10.3%) in the control group (n = 87) (difference 3.60; 95% CI -4.65 to 11.85) (p = 0.40). A single dose of prophylactic ampicillin and metronidazole is equally effective as a multiple-day regimen in preventing postcesarean wound infections in low-resource settings, therefore it can be considered as a good strategy in low-resource settings. The reduced quantity of prophylactic antibiotics will reduce costs without increasing the risk of maternal infection. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

  13. Antimicrobial prophylaxis in open lower extremity fractures

    Directory of Open Access Journals (Sweden)

    Amanda Anderson

    2011-02-01

    Full Text Available Amanda Anderson, April D Miller, P Brandon BookstaverClinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USADate of preparation: November 2010Conflict of interest: PBB: Research grant support from Cubist Pharmaceuticals; Merck and Co., Inc.; Astellas US PharmaClinical question: Based on the grade of open fracture, which antibiotic should be selected for antimicrobial prophylaxis, and what is the optimal timing and duration of administration?Results: For Grade I and II open fractures, a first-generation cephalosporin (eg, cefazolin should be administered within 3 hours of initial injury and be continued for 24 hours after initial injury. Grade III open fractures require coverage with an aminoglycoside in addition to a first-generation cephalosporin within 3 hours of initial injury, and antibiotics should be continued for 48–72 hours after initial injury but no more than 24 hours after wound closure. If a fracture is at risk of contamination with clostridium species, such as a farm-related injury, penicillin should be added to the antibiotic regimen.Implementation: Pitfalls to avoid when using antibiotics for infection prophylaxis in open fractures include utilizing cultures immediately postinjury to direct choice of agent for antimicrobial prophylaxis, because infecting pathogens do not typically correlate to pathogens initially cultured after injury; failure to consider patients’ medication allergy history or reconcile allergy records; and failure to obtain a thorough history to determine injury exposure (eg, farm, water.Keywords: open fracture, penicillin, antibiotics, infection

  14. Adesão à antibioticoterapia profilática em crianças com anemia falciforme: um estudo prospectivo Compliance with antibiotic prophylaxis in children with sickle cell anemia: a prospective study

    Directory of Open Access Journals (Sweden)

    Enio Latini Bitarães

    2008-08-01

    Full Text Available OBJETIVO: Avaliar a adesão a antibiótico profilático em crianças com anemia falciforme. MÉTODOS: Estudo prospectivo de 108 crianças (idade entre 3 meses e 4,5 anos, 45% masculino seguidas por 15 meses no Hemocentro de Belo Horizonte. Avaliou-se a adesão por meio de três entrevistas com cuidadores, análise de prontuário médico e atividade antibacteriana em uma amostra de urina em 81 crianças. Os antibióticos foram dispensados gratuitamente. RESULTADOS: Penicilina foi usada em 106 casos (maioria via oral, e eritromicina, dois casos. O antibiótico foi detectado na urina de 56% das crianças; 48% dos cuidadores afirmaram nas entrevistas que nenhuma dose deixou de ser administrada; em 89% dos prontuários médicos, não se registrou falha de adesão. Considerando-se aderente a criança que não apresentasse falhas em nenhum ou em apenas um dos métodos, a taxa de adesão foi de 67%. O grau de concordância entre os três métodos para medir a adesão foi baixo. Não se demonstrou qualquer associação entre a taxa de adesão e o gênero, estado nutricional, renda familiar per capita, nível educacional dos cuidadores ou número de membros da família. CONCLUSÕES: A taxa de adesão à antibioticoterapia profilática foi baixa quando avaliada por meio de questionários e testes urinários, e superestimada quando avaliada pela consulta ao prontuário médico. A adesão deve ser preferencialmente avaliada por vários métodos, pois sua mensuração é complexa. Os resultados do presente estudo sugerem a necessidade de programas educacionais abrangentes para os profissionais de saúde, para as famílias e crianças portadoras de anemia falciforme.OBJECTIVE: To prospectively assess compliance with antibiotic prophylaxis among children with sickle cell anemia. METHODS: A total of 108 children (aged 3 months to 4½ years, 45% male were recruited from the Hematology Center in Belo Horizonte, Brazil, and followed up for 15 months. Data on

  15. Gastrointestinal Prophylaxis in Sports Medicine.

    Science.gov (United States)

    Patel, Akash R; Oheb, Daniel; Zaslow, Tracy L

    Because sports participation at all levels often requires international travel, coaches, athletic trainers, and team physicians must effectively protect athletes from gastrointestinal infections. Traveler's diarrhea is the most common travel-related illness and can significantly interfere with training and performance. A review of relevant publications was completed using PubMed and Google Scholar. Clinical review. Level 5 Results: Enterotoxigenic and enteroaggregative Escherichia coli are the most common bacterial causes of traveler's diarrhea. Traveler's diarrhea generally occurs within 4 days of arrival, and symptoms tend to resolve within 5 days of onset. There are several prophylactic agents that physicians can recommend to athletes, including antibiotics, bismuth subsalicylate, and probiotics; however, each has its own unique limitations. Decision-making should be based on the athlete's destination, length of stay, and intent of travel. Prophylaxis with antibiotics is highly effective; however, physicians should be hesitant to prescribe medication due to the side effects and risks for creating antibiotic-resistant bacterial strains. Antibiotics may be indicated for high-risk groups, such as those with a baseline disease or travelers who have little flexible time. Since most cases of traveler's diarrhea are caused by food and/or water contamination, all athletes should be educated on the appropriate food and water consumption safety measures prior to travel.

  16. Antimicrobial prophylaxis related to otorhinolaryngology elective major surgery

    International Nuclear Information System (INIS)

    Perez Lopez, Gladys; Morejon Garcia, Moises; Alvarez Cespedes, Belkis

    2010-01-01

    INTRODUCTION. Antimicrobial prophylaxis decreases the surgical infections, but its indiscriminate use to favors the increment of infection rates and the bacterial resistance is much more probable in presence of antibiotics. The aim of present research was to evaluate the results of antibiotic prophylaxis in the otorhinolaryngology elective major surgery. METHODS. A retrospective-descriptive research was made on the prophylactic use of antibiotics in this type of surgery in the Otorhinolaryngology Service of the ''Comandant Manuel Fajardo'' during 6 years (2001-2006). Sample included 661 patients and the following variables were studied: sex, age and therapeutic response criteria (satisfactory and non-satisfactory). According to the intervention complexity oral antibiotic or parenteral prophylaxis was administered carrying out a surgical hound site culture. RESULTS. There was a predominance of male sex (54,1%) and the 31 and 62 age group. The 41,90% of patients operated on required antibiotic prophylaxis. The was a 7,9% of surgical wound infections. The more frequent microorganisms were Pseudomonas aeruginosa, Enterobacter and Escherichia. In head and neck oncology surgeries infection average was high (42,3%). Torpid course was due to concurrence of infection risk factors. There were neither adverse events nor severe complications. CONCLUSIONS. In Otorhinolaryngology, antimicrobial prophylaxis works against a wide variety of microorganisms but not in the Oncology surgeries. (author)

  17. Prophylaxis of Venous Thrombosis.

    Science.gov (United States)

    Goldhaber, Samuel Z.

    2001-06-01

    Mechanical measures such as graduated compression stockings and intermittent compression boots are available for venous thrombosis prophylaxis, but compliance may be limited. Plantar venous pneumatic compression devices have attained widespread acceptance by both patients and nurses because of their comfort and compact size, but their track record for efficacy is poor. Inferior vena cava filters prevent pulmonary embolism, but do not halt the thrombotic process or prevent venous thrombosis. Pharmacologic prophylaxis traditionally has relied upon minidose unfractionated heparin; however, re-examination is warranted in the face of increasingly ill and complex patients. My opinion is that small, fixed doses of once-daily low molecular weight heparin will eventually replace minidose unfractionated heparin as the standard pharmacologic prophylaxis regimen for most surgical and medical patients. Prolongation of prophylaxis after hospital discharge should receive increased emphasis. Most patients being transferred to a skilled nursing facility should receive venous thromboembolism prophylaxis. Similarly, most patients undergoing total hip or knee replacement should receive prolonged preventive regimens, with at least 1 month of anticoagulation. Despite advances, certain aspects of venous thrombosis prophylaxis remain problematic. First, a surprisingly high number of hospitalized patients develop venous thrombosis because of failed (rather than omitted) prophylaxis. Second, many patients in intensive care have a combination of peripheral vascular disease and active bleeding (usually gastrointestinal) that precludes mechanical or pharmacologic prophylaxis. Third, neurosurgical patients undergoing craniotomy for brain tumors suffer a high rate of venous thrombosis and major pulmonary embolism despite the routine use of combined mechanical and pharmacologic prophylaxis. My opinion is that these three areas, in addition to the hospital culture of prophylaxis, should receive

  18. Medical dental prophylaxis of endocarditis

    Directory of Open Access Journals (Sweden)

    Regina C. Basilio

    Full Text Available Antibiotics have long been the main reason for the increase in man's longevity. Since their discovery, man has tried to reduce the level of infection by treating with antibiotics. At the same time, prophylactic use has been suggested, although this is controversial. Their routine use is not recommended, and empirical treatments at non-therapeutic doses, and indiscriminately, should be avoided, because they may become dangerous and harmful, causing among other things, the prevalence of resistant microorganisms and the eventual potentiation of an increase in morbid states. Infectious endocarditis is a systemic pathology that can start with a bacteremia, which comes either from dental procedures or/and chronic processes that already existed. Its etiopathogeny consists of a combination of bacteremia and two other factors: Cardiac injury, which can be congenital or/and acquired, and a debilitated immunological system (patients who have transplanted organs, or those who have auto-immune diseases, such as pemphigus vulgaris, systemic lupus erythematosus. The main goal is to prevent or to fight against the transient bacteremia, reducing its intensity and duration, and also to kill the bacteria in at-risk patients. In this way, infectious endocarditis can be prevented; the dental surgeon plays an important role in the prevention of this condition, which joins medical and dental aspects. This can be done by antibiotic prophylaxis. The dentist needs to be acquainted with the medical protocols of the heart health societies.

  19. Economic Evaluation of Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.

    Science.gov (United States)

    Harper, Lorie M; Kilgore, Meredith; Szychowski, Jeff M; Andrews, William W; Tita, Alan T N

    2017-08-01

    To compare the costs associated with adjunctive azithromycin compared with standard cefazolin antibiotic prophylaxis alone for unscheduled and scheduled cesarean deliveries. A decision analytic model was created to compare cefazolin alone with azithromycin plus cefazolin. Published incidences of surgical site infection after cesarean delivery were used to estimate the baseline incidence of surgical site infection in scheduled and unscheduled cesarean delivery using standard antibiotic prophylaxis. The effectiveness of adjunctive azithromycin prophylaxis was obtained from published randomized controlled trials for unscheduled cesarean deliveries. No randomized study of its use in scheduled procedures has been completed. Cost estimates were obtained from published literature, hospital estimates, and the Healthcare Cost and Utilization Project and considered costs of azithromycin and surgical site infections. A series of sensitivity analyses were conducted by varying parameters in the model based on observed distributions for probabilities and costs. The outcome was cost per cesarean delivery from a health system perspective. For unscheduled cesarean deliveries, cefazolin prophylaxis alone would cost $695 compared with $335 for adjunctive azithromycin prophylaxis, resulting in a savings of $360 (95% CI $155-451) per cesarean delivery. In scheduled cesarean deliveries, cefazolin prophylaxis alone would cost $254 compared with $111 for adjunctive azithromycin prophylaxis, resulting in a savings of $143 (95% CI 98-157) per cesarean delivery, if proven effective. These findings were robust to a multitude of inputs; as long as adjunctive azithromycin prevented as few as seven additional surgical site infections per 1,000 unscheduled cesarean deliveries and nine additional surgical site infections per 10,000 scheduled cesarean deliveries, adjunctive azithromycin prophylaxis was cost-saving. Adjunctive azithromycin prophylaxis is a cost-saving strategy in both unscheduled

  20. Antibiotics and Antibiotic Resistance

    Science.gov (United States)

    ... Drugs Resources for You Information for Consumers (Drugs) Buying & Using Medicine Safely Antibiotics and Antibiotic Resistance Antibiotics ... Antibiotic Resistance and Protect Public Health The White House Blog FDA’s Take on the Executive Order and ...

  1. Decreasing candidaemia rate in abdominal surgery patients after introduction of fluconazole prophylaxis*

    DEFF Research Database (Denmark)

    Holzknecht, B J; Thorup, J; Arendrup, M C

    2011-01-01

    Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients...

  2. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery.

    Science.gov (United States)

    Tita, Alan T N; Szychowski, Jeff M; Boggess, Kim; Saade, George; Longo, Sherri; Clark, Erin; Esplin, Sean; Cleary, Kirsten; Wapner, Ron; Letson, Kellett; Owens, Michelle; Abramovici, Adi; Ambalavanan, Namasivayam; Cutter, Gary; Andrews, William

    2016-09-29

    The addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section. In this trial conducted at 14 centers in the United States, we studied 2013 women who had a singleton pregnancy with a gestation of 24 weeks or more and who were undergoing cesarean delivery during labor or after membrane rupture. We randomly assigned 1019 to receive 500 mg of intravenous azithromycin and 994 to receive placebo. All the women were also scheduled to receive standard antibiotic prophylaxis. The primary outcome was a composite of endometritis, wound infection, or other infection occurring within 6 weeks. The primary outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; Pazithromycin group and the placebo group in rates of endometritis (3.8% vs. 6.1%, P=0.02), wound infection (2.4% vs. 6.6%, Pazithromycin was more effective than placebo in reducing the risk of postoperative infection. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; C/SOAP ClinicalTrials.gov number, NCT01235546 .).

  3. Infective Endocarditis in Children — New Approach in Antimicrobial Prophylaxis

    Directory of Open Access Journals (Sweden)

    Togănel Rodica

    2016-06-01

    Full Text Available Infective endocarditis (IE is an infection of the endocardium and/or heart valves with the formation of a thrombus and secondary damage of the involved tissue, with significant mortality and severe complications. The prevention of bacterial endocarditis is of great controversy. Antimicrobial prophylaxis is usable in the prevention of endocarditis by killing bacteria before or after their extension to the damaged endocardium. No human studies offer strong evidence to support the efficacy of antibiotic prophylaxis so far, thus it could be potentially dangerous. Therefore, the European Society of Cardiology (ESC may need to reconsider and update the previous guidelines with the proposal of reducing the prophylactic approach of IE. The 2015 Task Force recommends prophylaxis for highest risk patients undergoing highest risk procedures, focused on prevention rather than prophylaxis of IE, especially in nosocomial endocarditis.

  4. Effect of trimethoprim-sulfamethoxazole prophylaxis on faecal ...

    African Journals Online (AJOL)

    Effect of trimethoprim-sulfamethoxazole prophylaxis on faecal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. ... African Journal of Infectious Diseases ... The Escherichia coli isolates showed a progressive increase in resistance to the tested antibiotics over the 12-month period.

  5. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Westyn Branch-Elliman

    2017-07-01

    Full Text Available The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs. Potential harms associated with combination regimens, including acute kidney injury (AKI and Clostridium difficile infection (CDI, were also considered.Using a multicenter, national Veterans Affairs (VA cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam versus either single agent alone (vancomycin or a beta-lactam and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination with 2,466 (3.5% SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95% than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83. After adjusting for SSI risk, no

  6. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study.

    Science.gov (United States)

    Branch-Elliman, Westyn; Ripollone, John E; O'Brien, William J; Itani, Kamal M F; Schweizer, Marin L; Perencevich, Eli; Strymish, Judith; Gupta, Kalpana

    2017-07-01

    The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs). Potential harms associated with combination regimens, including acute kidney injury (AKI) and Clostridium difficile infection (CDI), were also considered. Using a multicenter, national Veterans Affairs (VA) cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam) versus either single agent alone (vancomycin or a beta-lactam) and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA) status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination) with 2,466 (3.5%) SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95%) than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83). After adjusting for SSI risk, no association

  7. Ciprofloxacin-Ceftriaxone Combination Prophylaxis for Prostate Biopsy; Infective Complications

    Directory of Open Access Journals (Sweden)

    Alper Ozorak

    2014-03-01

    Full Text Available Aim: To present our clinical experience about infective complications due to ultrasound guided transrectal prostate biopsy under ciprofloxacin plus third-generation cephalosporin (Ceftriaxone combination prophylaxis. Material and Method: The 1193 patients that used combination of ceftriaxone 1 g intramuscular 1 hour before biopsy and ciprofloxacin 500 mg twice a day for 5 days after biopsy were included to study. Before biopsy, urine analysis and urinary cultures were not performed routinely. Serious infective complications such as acute prostatitis and urosepsis, causing microorganisms were evaluated. Results: Serious infective complications occurred in (1.3% 16 patients. Fifteen of them had acute prostatitis and urine culture results were positive in 10/15 patients for Escherichia coli. The strains were uniformly resistant to ciprofloxacin. Only 1 patient had urosepsis and his blood and urine cultures demonstrated extended- spectrum %u03B2-lactamase-producing (ESBL Escherichia coli also resistant to ciprofloxacin. Antibiotic treatment-related side effects were not observed in any patient. Discussion: Although there is not a certain procedure, ciprofloxacin is the most common used antibiotic for transrectal prostate biopsy prophylaxis. On the other hand, the incidence of ciprofloxacin resistant Escherichia coli strain is increasing. Thus, new prophylaxis strategies have to be discussed. Ceftriaxone plus ciprofloxacin prophylaxis is safe and can be useable option for prophylaxis of prostate biopsy.

  8. Antimicrobial Prophylaxis in Adults

    OpenAIRE

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

    2011-01-01

    Antimicrobial prophylaxis is commonly used by clinicians for the prevention of numerous infectious diseases, including herpes simplex infection, rheumatic fever, recurrent cellulitis, meningococcal disease, recurrent uncomplicated urinary tract infections in women, spontaneous bacterial peritonitis in patients with cirrhosis, influenza, infective endocarditis, pertussis, and acute necrotizing pancreatitis, as well as infections associated with open fractures, recent prosthetic joint placement...

  9. Post-Exposure Prophylaxis

    Science.gov (United States)

    ... Office of Adolescent Health OAR NIH Office of AIDS Research OCR HHS Office for Civil Rights OFBNP HHS ... Personal Stories Photos PLWHA People Living with HIV/AIDS Podcasts PrEP Pre-Exposure Prophylaxis Prevention PWID People Who Inject Drugs Research Research Agenda Ryan White Ryan White HIV/AIDS ...

  10. Antibiotics for whooping cough (pertussis).

    Science.gov (United States)

    Altunaiji, S; Kukuruzovic, R; Curtis, N; Massie, J

    2007-07-18

    Whooping cough is a highly contagious disease. Infants are at highest risk of severe disease and death. Erythromycin for 14 days is currently recommended for treatment and contact prophylaxis, but is of uncertain benefit. To study the benefits and risks of antibiotic treatment of and contact prophylaxis against whooping cough. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 1, 2007); MEDLINE (January 1966 to March 2007); EMBASE (January 1974 to March 2007). All randomised and quasi-randomised controlled trials of antibiotics for treatment of, and contact prophylaxis against, whooping cough. Three to four review authors independently extracted data and assessed the quality of each trial. Thirteen trials with 2197 participants met the inclusion criteria: 11 trials investigated treatment regimens; 2 investigated prophylaxis regimens. The quality of the trials was variable.Short-term antibiotics (azithromycin for three to five days, or clarithromycin or erythromycin for seven days) were as effective as long-term (erythromycin for 10 to 14 days) in eradicating Bordetella pertussis (B. pertussis) from the nasopharynx (relative risk (RR) 1.02, 95% confidence interval (CI) 0.98 to 1.05), but had fewer side effects (RR 0.66, 95% CI 0.52 to 0.83). Trimethoprim/sulfamethoxazole for seven days was also effective. Nor were there differences in clinical outcomes or microbiological relapse between short and long-term antibiotics. Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis. Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

  11. SINGLE-DOSE CEFAZOLIN PROPHYLAXIS IN ELECTIVE LSCS- A PROSPECTIVE OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Mannasseril Antony Kunjamma

    2017-10-01

    Full Text Available BACKGROUND Surgical site infections are the most common nosocomial infections. Postoperative complications, especially surgical site infections can double the length of time a patient stays in hospital and increase the cost of healthcare. Antibiotic prophylaxis before surgery has evolved over last twenty years and is definitely valuable to reduce postoperative wound infection. Obstetric surgeries are considered as clean contaminated wounds where antibiotic prophylaxis has proven beneficial in preventing postoperative complications, antibiotic resistance and economic burden. But, in countries like India, even a large group of obstetricians are reluctant to follow it. Hence, this study was conducted. The aim of the study is to study the effectiveness of single-dose cefazolin prophylaxis in preventing postoperative complications in patients undergoing elective cesarean compared to postoperative antibiotics. MATERIALS AND METHODS This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Medical College, Kottayam, from January 2014-December 2014. After obtaining permission from the hospital ethical committee for research, hundred patients undergoing elective cesarean in our hospital were selected for the study using strict inclusion and exclusion criteria of which fifty patients received injection cefazolin 2g intravenously one hour before surgery. Remaining fifty patients who were matched for age, parity and body mass index were given cefotaxime and metronidazole pre and postoperatively. All these patients were followed up postoperatively for complications, antibiotic change and duration of hospital stay. Statistical analysis done using suitable software. RESULTS Complications were comparable in those receiving prophylactic cefazolin and those receiving postoperative antibiotics. Both groups required antibiotic change for complications. Patients requiring prolonged hospital stay was comparable in both the

  12. Awareness of need and actual use of prophylaxis: lack of patient compliance in the prevention of bacterial endocarditis

    NARCIS (Netherlands)

    van der Meer, J. T.; van Wijk, W.; Thompson, J.; Valkenburg, H. A.; Michel, M. F.

    1992-01-01

    Antibiotics are given before some medical and dental procedures to patients with congenital or acquired heart disease to prevent endocarditis. The majority of practitioners and patients are aware of the need for this prophylaxis, although in practice prophylaxis is administered infrequently. It is

  13. Routine testing and prophylaxis.

    Science.gov (United States)

    Terry, P B

    1990-03-01

    Routine testing and prophylaxis is considered in terms of haematological disorders, biochemical testing, hormonal testing, screening for gestational diabetes and nutritional deficiencies. Within these headings the place of routine supplementation of pregnant women with iron, vitamins, trace elements and an increased protein/calorie intake is discussed. Screening for haemoglobinopathies, irregular blood group antibodies and gestational diabetes is dealt with in detail. The place for routine prophylaxis with anti-D is considered. Biochemical and hormonal testing is covered with particular reference to the use of biochemical and hormonal assays as placental function tests and their use in assessing fetal well-being. In this respect the use of biochemical and hormonal tests to screen a pregnant population for intrauterine growth retardation is also discussed.

  14. Role of vaccinations and prophylaxis in rheumatic diseases.

    Science.gov (United States)

    Papadopoulou, Despoina; Tsoulas, Christos; Tragiannidis, Athanassios; Sipsas, Nikolaos V

    2015-04-01

    Targeted strategies for reducing the increased risk of infection in patients with autoimmune rheumatic diseases include vaccinations as well as antibiotic prophylaxis in selected patients. However, there are still issues under debate: Is vaccination in patients with rheumatic diseases immunogenic? Is it safe? What is the impact of immunosuppressive drugs on vaccine immunogenicity and safety? Does vaccination cause disease flares? In which cases is prophylaxis against Pneumocystis jirovecii required? This review addresses these important questions to which clinicians and researchers still do not have definite answers. The first part includes immunization recommendations and reviews current data on vaccine efficacy and safety in patients with rheumatic diseases. The second part discusses prophylaxis for Pneumocystis pneumonia. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin

    OpenAIRE

    Robertsson, Otto; Thompson, Olof; W-Dahl, Annette; Sundberg, Martin; Lidgren, Lars; Stefánsdóttir, Anna

    2017-01-01

    Background and purpose Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used...

  16. Prophylaxis against colorectal cancer

    DEFF Research Database (Denmark)

    Bülow, Steffen; Kronborg, O

    1996-01-01

    Colorectal cancer is diagnosed in more than 3000 people every year in Denmark, with a population of 5 million, and 2000 die from this disease every year. The aetiology of the disease is complex, but an increasing number of cancers have been related to genetics and Denmark is contributing with a w...... for colorectal cancer in average-risk persons as well as high-risk groups with precursors of the disease. The present review places Danish contributions within the prophylaxis of colorectal cancer during the last decade in an international context....

  17. Postexposure prophylaxis for HIV.

    Science.gov (United States)

    Chin, Rachel L

    2010-05-01

    Health care workers are at risk for human immunodeficiency virus (HIV) and other infectious pathogens through exposure to blood and body fluids. Antiretroviral medications have been prescribed for postexposure prophylaxis following occupational exposure to the HIV since the early 1990s. This practice has since been extended to nonoccupational situations, such as sexual assaults. The efficacy of prophylactic therapy may be highly time-dependent and should be initiated as soon as possible. Wound care management and referral for social, medical, or advocacy services remain important for all cases. Copyright 2010. Published by Elsevier Inc.

  18. Endocarditis Prophylaxis in Cardiac Patients: Knowledge among General Dental Practitioners in Tabriz

    Directory of Open Access Journals (Sweden)

    Ardeshir Lafzi

    2008-04-01

    Full Text Available

    Background and aims. Dental procedures injuring oral tissues may induce bacterial release to blood stream that can cause infective endocarditis in susceptible patients. The aim of this study was to determine the level of knowledge of general dental practitioners (GDPs in Tabriz, Northwest of Iran, regarding endocarditis prophylaxis in cardiac patients receiving dental treatments.

    Materials and methods. This was a cross-sectional, descriptive, analytical study that included 150 GDPs. All practitioners were given a self-administered questionnaire which consisted of three parts assessing their knowledge of cardiac diseases requiring prophylaxis, dental procedures requiring prophylaxis, and antibiotic regimen for endocarditis prophylaxis. Statistical analysis of data was carried out using independent t-test, one-way ANOVA and chi-square test.

    Results. The level of knowledge among GDPs in three areas of cardiac diseases requiring prophylaxis, dental procedures requiring prophylaxis, and antibiotic regimen for endocarditis prophylaxis were 63.7%, 66.8% and 47.7%, respectively. Their overall level of knowledge regarding endocarditis prophylaxis was 59%. Association of the level of knowledge with age and practice period was statistically significant (P < 0.05. However, the level of knowledge was not significantly associated with gender or university of graduation in either of three areas evaluated (P > 0.05.

    Conclusion. According to our results, the knowledge of endocarditis prophylaxis among GDPs in Tabriz was in a moderate level. Regarding the importance of endocarditis prophylaxis in susceptible patients, it should be more emphasized in the curriculum of dental schools and continuing dental education programs.

  19. Guide for mass prophylaxis of hospital employees in preparation for a bioterrorist attack.

    Science.gov (United States)

    Lee, Jeremy John; Johnson, Shannon John; Sohmer, Michael J

    2009-03-15

    The key elements required for the health-system pharmacist to prepare and implement a hospital-based mass prophylaxis distribution effort for hospital employees are described. A bioterrorist attack may involve multiple jurisdictions which would necessitate a regional response. Pharmacists should collaborate not only with colleagues in their immediate areas, but also with pharmacists and emergency-management planners in neighboring counties and jurisdictions. Pharmacists must also develop antibiotic drug selection protocols and define the quantity needed to maintain hospital operations after a bioterrorist attack. Once the desired antibiotics have been selected and the number of employees has been determined, along with the length of prophylaxis therapy, it should be determined how much money will be needed to purchase and store enough medications to meet the need. Next, provisions must be made to acquire and store the antibiotic cache, with attention paid to cache rotation and packaging and repackaging recommendations. A detailed procedure for the deployment of an antibiotic cache must be developed. This procedure should include job descriptions and job action sheets for deployment team members and plans for receiving and dispensing antibiotics from the Strategic National Stockpile. Once the employee prophylaxis procedure is developed, staff must be educated about it, and exercises should be conducted to identify possible weaknesses in the procedure. Health-system pharmacists should play an active role in designing and implementing an antibiotic prophylaxis plan for employees for a potential bioterrorist attack. Understanding and following procedures provided in the tool kit are critical to their successful readiness.

  20. Tetanus: prophylaxis and treatment of the disease.

    Science.gov (United States)

    ROSS, D E; KRAUT, J J

    1959-05-01

    Cleansing and debridement is paramount in dealing with tetanus-prone wounds (severe crushing injuries, piercing wounds, blisters and burns are outstanding examples, particularly if contaminated with dirt, grass or other debris). Prophylaxis then is relatively easy in persons who have been actively immunized by toxoid injections. For them, a "booster" injection is indicated. Use of antitoxin, however, is hazardous, whether for prophylaxis or for treatment of the disease. Since it may in itself cause severe disease, including anaphylactic reaction and serum sickness, decision to use it must be weighed against the possibility of the development of tetanus in each case. To prepare for use of it, careful history should be taken, with particular reference to sensitivity to horse dander. Dermal tests, and perhaps ophthalmic tests, for sensitivity to the serum should be carried out. Even the tests may be hazardous and precautions should be taken accordingly. If it is decided that the use of antitoxin is necessary even though the patient is sensitive to the material, desensitization must be carried out promptly, with adequate preparation for severe reaction. There is experimental evidence that antibiotics of the tetracycline group, given soon after injury, may have prophylactic effect against tetanus.

  1. Prophylaxis against colorectal cancer

    DEFF Research Database (Denmark)

    Bülow, Steffen; Kronborg, O

    1996-01-01

    Colorectal cancer is diagnosed in more than 3000 people every year in Denmark, with a population of 5 million, and 2000 die from this disease every year. The aetiology of the disease is complex, but an increasing number of cancers have been related to genetics and Denmark is contributing...... with a well-established register of familial adenomatous polyposis and a recently founded register for hereditary nonpolyposis colorectal cancer, both with major international relationships. The Danish tradition of epidemiology and clinical trials has also been demonstrated in population screening trials...... for colorectal cancer in average-risk persons as well as high-risk groups with precursors of the disease. The present review places Danish contributions within the prophylaxis of colorectal cancer during the last decade in an international context....

  2. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors.

    Science.gov (United States)

    Steinberg, James P; Braun, Barbara I; Hellinger, Walter C; Kusek, Linda; Bozikis, Michele R; Bush, Andrew J; Dellinger, E Patchen; Burke, John P; Simmons, Bryan; Kritchevsky, Stephen B

    2009-07-01

    The objective of this study is to determine the optimal timing for surgical antimicrobial prophylaxis (AMP). National AMP guidelines should be supported by evidence from large contemporary data sets. Twenty-nine hospitals prospectively obtained information on AMP from 4472 randomly selected cardiac, hip/knee arthroplasty, and hysterectomy cases. Surgical site infections (SSIs) were ascertained through routine surveillance, using National Nosocomial Infections Surveillance system methodology. The association between the prophylaxis timing and the occurrence of SSI was assessed using conditional logistic regression (conditioning on hospital). One-hundred thirteen SSI were detected in 109 patients. SSI risk increased incrementally as the interval of time between antibiotic infusion and the incision increased (overall association between timing and infection risk P = 0.04). When antibiotics requiring long infusion times (vancomycin and fluoroquinolones) were excluded, the infection risk following administration of antibiotic within 30 minutes prior to incision was 1.6% compared with 2.4% associated with administration of antibiotic between 31 to 60 minutes prior to surgery (OR: 1.74; 95% confidence interval, 0.98-3.04). The infection risk increased as the time interval between preoperative antibiotic and incision increased or if the antibiotic was first infused after incision. Intraoperative redosing (performed in only 21% of long operations) appeared to reduce SSI risk in operations lasting more than 4 hours (OR of 3.08 with no redosing; 95% confidence interval 0.74-12.90), but only when the preoperative dose was given correctly. These data from a large multicenter collaborative study confirm and extend previous observations and show a consistent relationship between the timing of AMP and SSI risk with a trend toward lower risk occurring when AMP with cephalosporins and other antibiotics with short infusion times were given within 30 minutes prior to incision.

  3. Antibiotics in dental implants: A review of literature

    Directory of Open Access Journals (Sweden)

    Hemchand Surapaneni

    2016-01-01

    Full Text Available The routine use of antibiotics in oral implant treatment seems to be widespread. The pre- or post-operative use of antibiotics in conjunction with implant surgery and its correlation with failure and success rates are poorly documented in the literature. The debate regarding overprescription of antibiotics raises the need for a critical evaluation of proper antibiotic coverage in association with implant treatment. The benefits of prophylactic antibiotics are well-recognized in dentistry. However, their routine use in the placement of endosseous dental implants remains controversial. The purpose of this review is to know the efficacy of antibiotic prophylaxis in implant dentistry.

  4. Antibiotic resistance of bacterial biofilms

    DEFF Research Database (Denmark)

    Hoiby, N.; Bjarnsholt, T.; Givskov, M.

    2010-01-01

    A biofilm is a structured consortium of bacteria embedded in a self-produced polymer matrix consisting of polysaccharide, protein and DNA. Bacterial biofilms cause chronic infections because they show increased tolerance to antibiotics and disinfectant chemicals as well as resisting phagocytosis...... to antibiotics. Biofilm growth is associated with an increased level of mutations as well as with quorum-sensing-regulated mechanisms. Conventional resistance mechanisms such as chromosomal beta-lactamase, upregulated efflux pumps and mutations in antibiotic target molecules in bacteria also contribute...... to the survival of biofilms. Biofilms can be prevented by early aggressive antibiotic prophylaxis or therapy and they can be treated by chronic suppressive therapy. A promising strategy may be the use of enzymes that can dissolve the biofilm matrix (e.g. DNase and alginate lyase) as well as quorum...

  5. Adherence of Surgeons to Antimicrobial Prophylaxis Guidelines in a Tertiary General Hospital in a Rapidly Developing Country

    Directory of Open Access Journals (Sweden)

    Ahmed Abdel-Aziz

    2013-01-01

    Full Text Available Objectives. To assess the standard practice of care of surgeons regarding surgical antibiotic prophylaxis, to identify gaps, and to set recommendations. Methods. A retrospective analysis of data obtained from different surgical units in a single center in Qatar over a 3-month period in 2012. A total of 101 patients who underwent surgery and followed regimes for surgical prophylaxis as per hospital guidelines were included in the study. Results. The overall use of antibiotic was 89%, whereas the current practice did not match the recommended hospital protocols in 53.5% of cases. Prolonged antibiotics use (59.3% was the commonest reason for nonadherence followed by the use of an alternative antibiotic to that recommended in the protocol (31.5% and no prophylaxis was used in 9.2% of cases. The rate of compliance was significantly higher among clean surgery than clean contaminated group (P=0.03. Forty-four percent of clean and 65% of clean-contaminated procedures showed noncompliance with the recommended surgical antimicrobial prophylaxis hospital guidelines. Conclusion. Lack of adherence to hospital protocols is not uncommon. This finding remains a challenge to encourage clinicians to follow hospital guidelines appropriately and to consistently apply the surgical antibiotic prophylaxis. The role of clinical pharmacist may facilitate this process across all surgical disciplines.

  6. Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update

    Science.gov (United States)

    Villafuerte-Gutierrez, Paola; Villalon, Lucia; Losa, Juan E.; Henriquez-Camacho, Cesar

    2014-01-01

    Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis. PMID:25525436

  7. Increased incidence of postoperative infections during prophylaxis with cephalothin compared to doxycycline in intestinal surgery

    DEFF Research Database (Denmark)

    Baatrup, Gunnar; Nilsen, Roy M; Svensen, Rune

    2009-01-01

    BACKGROUND: The antibiotics used for prophylaxis during surgery may influence the rate of surgical site infections. Tetracyclines are attractive having a long half-life and few side effects when used in a single dose regimen. We studied the rate of surgical site infections during changing regimen...

  8. Antibiotic policy

    OpenAIRE

    Gyssens, Inge

    2011-01-01

    There is a clear association between antibiotic use and resistance both on individual and population levels. In the European Union, countries with large antibiotic consumption have higher resistance rates. Antibiotic resistance leads to failed treatments, prolonged hospitalisations, increased costs and deaths. With few new antibiotics in the Research & Development pipeline, prudent antibiotic use is the only option to delay the development of resistance. Antibiotic policy consists of prescrib...

  9. Effect of Prophylactic Antibiotic Use in the Development of Antibiotic Resistance in Children with Recurrent Urinary Tract Infections

    Directory of Open Access Journals (Sweden)

    Mehmet Karacı

    2017-09-01

    Full Text Available Aim: Although prophylactic antibiotic treatment is still debatable, it is currently in use in recurrent urinary tract infections (UTIs. In the present study, we aimed to observe if prophylactic antibiotic use had any effect on the development of antibiotic resistance in patients with recurrent UTIs who we followed up in our clinic. Methods: The present study was performed on patients aged between one month and 16 years, who had recurrent UTIs, and were followed up by the Department of Pediatrics at Bülent Ecevit University Medical School. Patient files were retrospectively reviewed, and 50 patients who received antibiotic prophylaxis and 100 patients without prophylaxis were enrolled in the study. Urinary tests, subsequent urinary culture results, and antibiotic resistances were compared between the groups. Results: The mean age was 42.7±44.2 months. The most frequently cultured isolated bacterium was Escherichia coli (E. coli (58.4%. No difference was determined in bacteria in cultures between prophylaxis receivers and non-receivers. Isolation rate of E. coli was higher in urinary cultures in females than in males (p<0.001. When antibiotic resistance of all urinary culture-isolated bacteria was compared between the two groups, there was no statistically significant difference. However, an increased resistance against amoxicillin/clavulanic acid, ceftriaxone, and piperacillin was determined in prophylaxis group in whom E. coli was grown. In this study, general antibiotic resistance was most frequently observed against ampicillin (71.9%. Conclusion: In the present study, we observed that prophylaxis did not contribute so much to resistance other than E. coli. We recommend not preferring antibiotics which have increased resistance in our institution especially in children receiving prophylaxis for empirical treatment.

  10. Vaccine prophylaxis: achievements, problems, perspectives of development

    Directory of Open Access Journals (Sweden)

    Mavrutenkov V.V.

    2016-09-01

    Full Text Available The article presents medical and social aspects of immune prophylaxis of infectious diseases; the history of vaccines and vaccination is presented, as well as perspectives of development of vaccine prophylaxis.

  11. Cotrimoxazole Prophylaxis Compliance Among HIV Exposed Infants ...

    African Journals Online (AJOL)

    Results: The findings showed that 78.7% of the respondents were non compl i ant with cotrimoxazole prophylaxis, 95% had heard about cotrimoxazole prophylaxis and their source of information was the health worker (98%). Though knowledge on the uses of cotrimoxazole prophylaxis stood at sixty percent (60%) only 51% ...

  12. Evidence-Based Use of Perioperative Antibiotics in Otolaryngology.

    Science.gov (United States)

    Patel, Priyesh N; Jayawardena, Asitha D L; Walden, Rachel L; Penn, Edward B; Francis, David O

    2018-01-01

    Objective To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Data Sources PubMed, Embase (OVID), and CINAHL (EBSCO). Review Methods English-language, original research (systematic reviews/meta-analyses, randomized control trials, prospective or retrospective cohort studies, case-control studies, or case series) studies that evaluated the role of perioperative antibiotic use in common otolaryngology surgeries were systematically extracted using standardized search criteria by 2 investigators independently. Conclusions Current evidence does not support routine antibiotic prophylaxis for tonsillectomy, simple septorhinoplasty, endoscopic sinus surgery, clean otologic surgery (tympanostomy with tube placement, tympanoplasty, stapedectomy, and mastoidectomy), and clean head and neck surgeries (eg, thyroidectomy, parathyroidectomy, salivary gland excisions). Antibiotic prophylaxis is recommended for complex septorhinoplasty, skull base surgery (anterior and lateral), clean-contaminated otologic surgery (cholesteatoma, purulent otorrhea), and clean-contaminated head and neck surgery (violation of aerodigestive tract, free flaps). In these cases, antibiotic use for 24 to 48 hours postoperatively has shown equal benefit to longer duration of prophylaxis. Despite lack of high-quality evidence, the US Food and Drug Administration suggests antibiotic prophylaxis for cochlear implantation due to the devastating consequence of infection. Data are inconclusive regarding postoperative prophylaxis for nasal packing/splints after sinonasal surgery. Implications for Practice Evidence does not support the use of perioperative antibiotics for most otolaryngologic procedures. Antibiotic overuse and variability among providers may be due to lack of formal practice guidelines. This review can help otolaryngologists understand current evidence so they can make informed decisions about

  13. Audit of antibiotic use in a Brazilian University Hospital

    Directory of Open Access Journals (Sweden)

    Laura Guimarães Fonseca

    Full Text Available A cohort study was carried out at the Marilia Medical School Hospital. In the first phase the pattern of antibiotic use was evaluated. Antibiotics were prescribed for 55.4% of the patients; antibiotic combinations were used in 43%. Therapeutic use of antibiotics was considered inadequate in 27%. Respiratory and skin infections were the most frequently diagnosed. In up to 31% of the cases the treatment of respiratory infections was considered inadequate. The surgical use of antibiotic prophylaxis was evaluated in the second phase. Prophylaxis was indicated in 73.2% of the surgeries. The antibiotics most used for prophylaxis were first generation cephalosporins. In 78.9% of the surgeries, the antibiotic was correctly chosen. In 15.9% of the surgeries, the initial antibiotic administration was correctly timed. The use of antibiotics in the post-operative period was appropriate in 29.8% of the cases. The independent risk factors for surgical site infection (SSI, as determined by logistic regression analysis adjusted to class of wound risk, were the choice of antibiotic to be used prophylactically and the duration of antibiotic treatment in the post-operative period. Those who received appropriate prophylactic antibiotics had a lower rate of SSI than those who received innapropriated antibiotics [RR=0.49/95%; CI=0.25-0.90]. Patients who received prophylactic antibiotics correctly in the post-operative period had a lower risk of SSI than those who did not [RR=0.21/95%; CI=0.70-0.63]. The mean length of hospital stay was shorter among patients whose prophylactic treatment was correctly employed than among for which it was not [6.1 (±9.8 and 11.1 (±13.5 days, p=0.25].

  14. Cost effectiveness of prophylaxis in dental practice to prevent infective endocarditis.

    Science.gov (United States)

    Gould, I M; Buckingham, J K

    1993-01-01

    BACKGROUND--Although antimicrobial prophylaxis for infective endocarditis (IE) is common practice for many dental procedures, there is little information on whether it represents value for money. A study was performed to evaluate the effectiveness of prophylaxis for all at risk patients in routine dental practice with published data from the United Kingdom. METHODS--The risk of contracting infective endocarditis was calculated from published data to find (for high risk patients) both the annual number of deaths attributable to infective endocarditis and the number of high risk dental procedures performed without prophylaxis. Costs are estimated by examining the notes of 63 patients with proved IE during the decade 1980-90. RESULTS--Such prophylaxis is highly cost effective before dental extractions, but its value for other invasive dental procedures is unproved. It was calculated that, for every 10,000 extractions in at risk patients, appropriate prophylaxis will prevent 5.7 deaths and a further 22.85 cases of non-fatal IE. This represents a saving in the costs of hospital care of 289,600 pounds for 10,000 extractions. CONCLUSION--Prophylaxis to prevent IE in at risk patients undergoing dental extraction is highly cost effective. Net savings each year throughout the United Kingdom, that might be achieved by improving the existing proportion of such patients given antibiotics from its present level of about 50% would amount to 2.5 million pounds and would prevent over 50 deaths. PMID:8038004

  15. Antimicrobial prophylaxis in colorectal surgery: focus on ertapenem

    Directory of Open Access Journals (Sweden)

    Fausto de Lalla

    2009-10-01

    Full Text Available Fausto de LallaLibero Docente of Infectious Diseases, University of Milano, Milano, ItalyAbstract: Despite improvement in infection control measures and surgical practice, surgical site infections (SSIs remain a major cause of morbidity and mortality. In colorectal surgery, perioperative administration of a suitable antimicrobial regimen that covers both anaerobic and aerobic bacteria is universally accepted. In a prospective, double-blind, randomized study ertapenem was recently found to be more effective than cefotetan, a parenteral cephalosporin so broadly used as to be considered as gold standard in the prevention of SSIs following colorectal surgery. In this adequate and well controlled study, the superiority of ertapenem over cefotetan was clearly demonstrated from the clinical and bacteriological points of view. However, data that directly compares ertapenem with other antimicrobial regimen effective in preventing SSIs following colorectal surgery are lacking; furthermore, the possible risk of promotion of carbapenem resistance associated with widespread use of ertapenem prophylaxis as well as the ertapenem effects on the intestinal gut flora are of concern. Further comparative studies of ertapenem versus other widely used prophylactic regimens for colorectal surgery in patients submitted to mechanical bowel preparation versus no preparation as well as further research on adverse events of antibiotic prophylaxis, including emergence of resistance and Clostridium difficile infection, seem warranted.Keywords: colorectal surgery, surgical prophylaxis, ertapenem

  16. Is antibiotic prophylaxis beneficial in acute pancreatitis? - First update

    Directory of Open Access Journals (Sweden)

    Gabriel Rada

    2015-04-01

    Full Text Available Resumen Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos es una actualización del resumen publicado en Agosto de 2014, basado en dos nuevas revisiones sistemáticas aparecidas en Enero y Febrero de 2015. Existe controversia sobre los efectos del uso de antibióticos profilácticos en pacientes con pancreatitis aguda. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 18 revisiones sistemáticas que en conjunto incluyen 19 estudios aleatorizados. Los combinamos mediante un metanálisis y generamos tablas de resumen de resultados utilizando el método GRADE. Concluimos que el uso de antibióticos profilácticos podría disminuir la mortalidad y el tiempo de hospitalización en pacientes con pancreatitis aguda, pero la certeza de la evidencia es baja. La probabilidad que la aparición de nueva evidencia cambie lo que sabemos es alta.

  17. Is antibiotic prophylaxis in nasal packing for anterior epistaxis needed?

    Directory of Open Access Journals (Sweden)

    Francisco Pérez

    2016-03-01

    Full Text Available La epistaxis es un problema extremadamente común que en ocasiones requiere de taponamiento anterior. Usualmente se indican antibióticos de forma concomitante para la prevención de complicaciones infecciosas, aunque el rol de esta medida es controvertido. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos una revisión sistemática que incluye tres estudios primarios, ninguno de ellos controlado y aleatorizado. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si los antibióticos profilácticos disminuyen las complicaciones infecciosas en pacientes con taponamiento nasal por epistaxis anterior porque la certeza de la evidencia es muy baja.

  18. Comparison of moxalactam and cefazolin as prophylactic antibiotics during cesarean section.

    OpenAIRE

    Rayburn, W; Varner, M; Galask, R; Petzold, C R; Piehl, E

    1985-01-01

    Prophylactic antibiotics have been shown to be effective in decreasing the incidence of febrile morbidity associated with cesarean section after labor. However, the relative effectiveness of different single antibiotics has been studied infrequently, and these investigations have been limited by small patient samples. Several new, broad-spectrum antibiotics are now available, and any further benefit from more traditional antibiotics for surgical prophylaxis remains untested. A randomized pros...

  19. Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial

    NARCIS (Netherlands)

    Bosmans, Judith E.; Beerepoot, Mariëlle A. J.; Prins, Jan M.; ter Riet, Gerben; Geerlings, Suzanne E.

    2014-01-01

    Urinary tract infections (UTIs) are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs. To evaluate the cost-effectiveness of cranberry prophylaxis compared to antibiotic

  20. Optimization of prophylaxis for hemophilia A.

    Science.gov (United States)

    Herbert, Robert D; Broderick, Carolyn R; Barnes, Chris; Billot, Laurent; Zhou, Albert; Latimer, Jane

    2018-01-01

    Prophylactic injections of factor VIII reduce the incidence of bleeds and slow the development of joint damage in people with hemophilia. The aim of this study was to identify optimal person-specific prophylaxis regimens for children with hemophilia A. Analytic and numerical methods were used to identify prophylaxis regimens which maximize the time for which plasma factor VIII concentrations exceed a threshold, maximize the lowest plasma factor VIII concentrations, and minimize risk of bleeds. It was demonstrated analytically that, for any injection schedule, the regimen that maximizes the lowest factor VIII concentration involves sharing doses between injections so that all of the trough concentrations in a prophylaxis cycle are equal. Numerical methods were used to identify optimal prophylaxis schedules and explore the trade-offs between efficacy and acceptability of different prophylaxis regimens. The prophylaxis regimen which minimizes risk of bleeds depends on the person's pattern of physical activity and may differ greatly from prophylaxis regimens that optimize pharmacokinetic parameters. Prophylaxis regimens which minimize risk of bleeds also differ from prophylaxis regimens that are typically prescribed. Predictions about which regimen is optimal are sensitive to estimates of the effects on risk of bleeds of factor VIII concentration and physical activity. The methods described here can be used to identify optimal, person-specific prophylaxis regimens for children with hemophilia A.

  1. Optimization of prophylaxis for hemophilia A.

    Directory of Open Access Journals (Sweden)

    Robert D Herbert

    Full Text Available Prophylactic injections of factor VIII reduce the incidence of bleeds and slow the development of joint damage in people with hemophilia. The aim of this study was to identify optimal person-specific prophylaxis regimens for children with hemophilia A.Analytic and numerical methods were used to identify prophylaxis regimens which maximize the time for which plasma factor VIII concentrations exceed a threshold, maximize the lowest plasma factor VIII concentrations, and minimize risk of bleeds.It was demonstrated analytically that, for any injection schedule, the regimen that maximizes the lowest factor VIII concentration involves sharing doses between injections so that all of the trough concentrations in a prophylaxis cycle are equal. Numerical methods were used to identify optimal prophylaxis schedules and explore the trade-offs between efficacy and acceptability of different prophylaxis regimens. The prophylaxis regimen which minimizes risk of bleeds depends on the person's pattern of physical activity and may differ greatly from prophylaxis regimens that optimize pharmacokinetic parameters. Prophylaxis regimens which minimize risk of bleeds also differ from prophylaxis regimens that are typically prescribed. Predictions about which regimen is optimal are sensitive to estimates of the effects on risk of bleeds of factor VIII concentration and physical activity.The methods described here can be used to identify optimal, person-specific prophylaxis regimens for children with hemophilia A.

  2. Antibiotic Agents

    Science.gov (United States)

    ... Superbugs and Drugs" Home | Contact Us General Background: Antibiotic Agents What is an antibacterial and how are ... with the growth and reproduction of bacteria. While antibiotics and antibacterials both attack bacteria, these terms have ...

  3. Antibiotic use among medical specialties in a community hospital.

    Science.gov (United States)

    Jogerst, G J; Dippe, S E

    1981-02-27

    Antibiotic use in a community hospital was evaluated to demonstrate specialty variations. A chart review was performed using the Veterans Administration's "Guidelines for Peer Review" to determine appropriate antibiotic use. Of the 1,054 patients discharged in August 1977, three hundred ten (29.4%) received 479 courses of antibiotics of which two hundred eighty-seven (60%) were considered appropriate. Seventy-two percent of the therapeutic courses and 36% of the prophylactic courses were appropriate. Prophylactic antibiotics were used in 12% of the hospitalized patients and accounted for 33% of the total antibiotics. No notable difference in appropriate antibiotic use was found among general surgeons (73%), internists (72%), orthopedists (71%), and family practitioners (67%). Substantially lower levels were found among urologists (54%), otolaryngologists (44%), and obstetricians (36%). Continued education in proper antibiotic use is needed especially for prophylaxis. Educational programs directed at specific specialties may be the most fruitful way to effect improved overall antibiotic use.

  4. Graft versus host disease prophylaxis

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Graft versus host disease prophylaxis. Cyclosporine -2.5mg/KG IV over 4 hrs q12h. - 5mg/Kg BD orally for 6 months - taper- stop at one year if no GVHD. Methotrexate :INITIAL. day +1- 15mg/m2; day + 3, 6, 11- 10 mg/m2; :CURRENT; day +1-10mg/m2; day + 3,6,11 ...

  5. Patients' request for and emergency physicians' prescription of antimicrobial prophylaxis for anthrax during the 2001 bioterrorism-related outbreak

    Directory of Open Access Journals (Sweden)

    Aber Robert C

    2005-01-01

    Full Text Available Abstract Background Inappropriate use of antibiotics by individuals worried about biological agent exposures during bioterrorism events is an important public health concern. However, little is documented about the extent to which individuals with self-identified risk of anthrax exposure approached physicians for antimicrobial prophylaxis during the 2001 bioterrorism attacks in the United States. Methods We conducted a telephone survey of randomly selected members of the Pennsylvania Chapter of the American College of Emergency Physicians to assess patients' request for and emergency physicians' prescription of antimicrobial agents during the 2001 anthrax attacks. Results Ninety-seven physicians completed the survey. Sixty-four (66% respondents had received requests from patients for anthrax prophylaxis; 16 (25% of these physicians prescribed antibiotics to a total of 23 patients. Ten physicians prescribed ciprofloxacin while 8 physicians prescribed doxycycline. Conclusion During the 2001 bioterrorist attacks, the majority of the emergency physicians we surveyed encountered patients who requested anthrax prophylaxis. Public fears may lead to a high demand for antibiotic prophylaxis during bioterrorism events. Elucidation of the relationship between public health response to outbreaks and outcomes would yield insights to ease burden on frontline clinicians and guide strategies to control inappropriate antibiotic allocation during bioterrorist events.

  6. Vesicoureteral reflux and continuous prophylactic antibiotics

    Directory of Open Access Journals (Sweden)

    Ted Lee

    2017-06-01

    Full Text Available Vesicoureteral reflux (VUR management must be tailored based on the risk for further infections and renal scarring, gender, likelihood of spontaneous resolution, and parental preferences. Because we now understand that sterile VUR is benign and most reflux spontaneously resolves over time, the initial approach in majority of children is non-surgical with continuous antibiotic prophylaxis (CAP and correction of bladder and bowel dysfunction. Despite increasing utilization of CAP over the past four decades, the efficacy of antibiotic prophylaxis has been questioned due to conflicting results of studies plagued with design flaws and inadequate subject sample size. The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR trial, which was designed to address many of the limitations from previous studies, provided much needed answers. In this review, we sought to describe the controversy surrounding VUR management, highlight the results of RIVUR trial, and discuss how the RIVUR findings impact our understanding of CAP in the management of VUR.

  7. WITHDRAWN: Antibiotics for preventing leptospirosis.

    Science.gov (United States)

    Guidugli, Fábio; Castro, Aldemar A; Atallah, Alvaro N

    2009-07-08

    Leptospirosis is an infectious disease transmitted by animals. Death occurs in about five per cent of the patients. In clinical practice, doxycycline is widely used for prevention. To evaluate the effectiveness and safety of any antibiotic regimen versus placebo or other antibiotic regimens in the prophylaxis of leptospirosis. The sources used were: EMBASE, LILACS, MEDLINE, SCISEARCH, The Cochrane Controlled Trials Register, The Cochrane Hepato-Biliary Group Controlled Trials Register, bibliographies of published papers, and personal communication with authors. There were no language or date restrictions in any of the searches. All randomised clinical trials in which antibiotics were used as prophylactic regimen for leptospirosis. People potentially exposed to leptospirosis, such as people in endemic areas during the rainy season, health professionals and other professionals with high risk of infection. Any antibiotic regimen compared with a control group (placebo or another antibiotic regimen). Infection (primary outcome) and adverse events (secondary outcome). Data were independently extracted and methodological quality of each trial was assessed by two reviewers as well as cross-checked. Details of the randomisation (generation and concealment), blinding, and the number of patients lost to follow-up were recorded. The results of each trial were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome. Two trials comparing doxycycline with placebo met the inclusion criteria. We did not find trials comparing doxycycline versus other antibiotics, or other antibiotics versus placebo. One of the trials had excellent methodological quality. In the other trial, the allocation concealment process, generation of allocation sequence, and blinding methods were not described.Of the 1022 participants enrolled, 509 were treated with doxycycline and 513 with placebo. Of these, 940 participants were soldiers included in one trial. The patients assigned to the

  8. Interferon prophylaxis of hepatic carcinoma.

    Science.gov (United States)

    Voiosu, R; Dimitriu, L; Dragomir, P; Eremia, L

    1999-01-01

    The present article reveals the importance of hepatic carcinoma among the other diseases in digestive oncology, and also the importance of a correct designation of these cases. Epidemiology and actual hypothesis on the mechanisms of oncogenesis are discussed. There are reviewed some studies in the literature concerning infection with hepatitis B virus, hepatitis C virus, coinfection (B and C viruses, B and D viruses), the role of interferon prophylaxis in such cases. Also there is present a statistics on chronic viral hepatits, cirrhosis of viral etiology and hepatic carcinoma, diagnosed in patients in "N.Gh.Lupu" Hospital, over two decades.

  9. Treatment of Febrile Neutropenia and Prophylaxis in Hematologic Malignancies: A Critical Review and Update

    Directory of Open Access Journals (Sweden)

    Paola Villafuerte-Gutierrez

    2014-01-01

    Full Text Available Febrile neutropenia is one of the most serious complications in patients with haematological malignancies and chemotherapy. A prompt identification of infection and empirical antibiotic therapy can prolong survival. This paper reviews the guidelines about febrile neutropenia in the setting of hematologic malignancies, providing an overview of the definition of fever and neutropenia, and categories of risk assessment, management of infections, and prophylaxis.

  10. Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin.

    Science.gov (United States)

    Robertsson, Otto; Thompson, Olof; W-Dahl, Annette; Sundberg, Martin; Lidgren, Lars; Stefánsdóttir, Anna

    2017-10-01

    Background and purpose - Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods - Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009-2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results - Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2-2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation - We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.

  11. Antibiotic prescription: An oral physician's point of view

    OpenAIRE

    Patait, Mahendra; Urvashi, N.; Rajderkar, M.; Kedar, S.; Shah, Kinjal; Patait, Reeta

    2015-01-01

    Background: Antibiotics are important in the management and prophylaxis of infections in patients at a risk of experiencing microbial disease. Uses of systemic antibiotics in dentistry are limited since management of acute dental conditions is primarily based upon extraction of teeth or extirpation of the pulp. However, the literature provides evidence of inappropriate prescribing practices by practitioners, due to a number of factors from inadequate knowledge to social factors. Aim: The aim ...

  12. A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt

    Directory of Open Access Journals (Sweden)

    Maha Talaat

    2014-09-01

    Full Text Available Inappropriate antibiotic use leads to increased risk of antibiotic resistance and other adverse outcomes. The objectives of the study were to determine the prevalence and characteristics of antibiotic use in Egyptian hospitals to identify opportunities for quality improvement. A point prevalence survey was conducted in 18 hospitals in March 2011. A total of 3408 patients were included and 59% received at least one antibiotic, with the most significant use among persons <12 years and intensive care unit patients (p < 0.05. Third generation cephalosporin were the most commonly prescribed antibiotics (28.7% of prescriptions. Reasons for antibiotic use included treatment of community—(27% and healthcare-associated infections (11% and surgical (39% and medical (23% prophylaxis. Among surgical prophylaxis recipients, only 28% of evaluable cases received the first dose within two hours before incision and only 25% of cases received surgical prophylaxis for <24 h. The prevalence of antibiotic use in Egyptian hospitals was high with obvious targets for antimicrobial stewardship activities including provision of antibiotic prescription guidelines and optimization of surgical and medical prophylaxis practices.

  13. Preexposure Prophylaxis and Patient Centeredness

    Science.gov (United States)

    Snowden, Jonathan M.; Rodriguez, Maria I.; Jackson, Skyler D.; Marcus, Julia L.

    2016-01-01

    Preexposure prophylaxis has transformed HIV prevention, becoming widespread in communities of gay and bisexual men in the developed world in a short time. There is a broad concern that preexposure prophylaxis will discourage condom use among gay men (i.e., “risk compensation”). This commentary argues for broadening the focus on gay men’s health beyond sexual health to address the holistic health and well-being of gay men. Gay men may benefit from being offered candid, nonjudgmental health promotion/HIV prevention messages not requiring condom use for anal sex. Lessons can be drawn from the family planning movement, which has undergone a similar shift in focus. The principle of patient centeredness supports such a shift in gay men’s health toward the goal of providing men with the knowledge to evaluate various prevention approaches according to the specifics of their life circumstances and health needs. Bringing more nuance to discussions of sexual risk and sexual pleasure could facilitate more universally healthy attitudes regarding sex among gay men, in turn enabling healthier decisions more compatible with men’s own values and preferences. PMID:27387042

  14. Prophylactic Antibiotics Use at IUCD Insertion and Pelvic Infection in ...

    African Journals Online (AJOL)

    Only one had positive preinsertion swab for Chlamydia, and only one client had clinical pelvic inflammatory disease (PID) with negative swab. Conclusion: Pelvic infection with Chlamydia isolation was not common amongst new IUCD insertions to warrant routine antibiotic prophylaxis in Brook Jersey. All cases of pelvic ...

  15. aerobic bacteriological profile and antibiotic resistance of surgical ...

    African Journals Online (AJOL)

    2015-07-06

    Jul 6, 2015 ... Inspite of advances in surgical techniques, better operating room environment, antibiotic prophylaxis, Surgical Site Infections still occurs in significant number of patients. Surgical site infections (SSIs) infections occur within thirty days after the operative procedure (except in case of added implants, when the ...

  16. Perioperative prophylaxis for endophthalmitis after cataract surgery in Iran

    Directory of Open Access Journals (Sweden)

    Marzieh Katibeh

    2015-01-01

    Full Text Available Purpose: To describe prophylactic patterns employed against endophthalmitis after cataract surgery in Iran. Methods: This cross-sectional study included 486 ophthalmologists filling in a self-administered questionnaire during the 20 th Annual Congress of the Iranian Society of Ophthalmology in December 2010, Tehran, working in both private and academic medical centers. Prophylactic measures used preoperatively, intraoperatively and postoperatively and self-reported rates of endophthalmitis were assessed as the main outcome measurements. Results: In the preoperative phase, 75.5% of surgeons used povidone-iodine in the conjunctival sac and 71.4% of them did not use antibiotics. The rate of intraoperative prophylaxis was 61.9% either in the form of intracameral antibiotics or subconjunctival injection (mostly cephazolin or gentamicin. Only 7.8% of participants used intracameral cephalosporins. Postoperative antibiotics [mostly chloramphenicol (57% and ciprofloxacin (28%] were used by 94.2% of surgeons. On average, ten years of practice were required to observe one case of endophthalmitis. Conclusion: The surgeons in present setting used various prophylactic regimens against endophthalmitis after cataract surgery. Setting a local and evidence-based clinical practice guideline seems necessary.

  17. Prescribing Antibiotics

    DEFF Research Database (Denmark)

    Pedersen, Inge Kryger; Jepsen, Kim Sune

    2018-01-01

    The medical professions will lose an indispensable tool in clinical practice if even simple infections cannot be cured because antibiotics have lost effectiveness. This article presents results from an exploratory enquiry into “good doctoring” in the case of antibiotic prescribing at a time when...

  18. Forgotten antibiotics

    DEFF Research Database (Denmark)

    Pulcini, Céline; Bush, Karen; Craig, William A

    2012-01-01

    In view of the alarming spread of antimicrobial resistance in the absence of new antibiotics, this study aimed at assessing the availability of potentially useful older antibiotics. A survey was performed in 38 countries among experts including hospital pharmacists, microbiologists, and infectious...

  19. Antibiotic Resistance

    DEFF Research Database (Denmark)

    Hansen, Malene Plejdrup; Hoffmann, Tammy C; McCullough, Amanda R

    2015-01-01

    Numerous opportunities are available in primary care for alleviating the crisis of increasing antibiotic resistance. Preventing patients from developing an acute respiratory infection (ARI) will obviate any need for antibiotic use downstream. Hygiene measures such as physical barriers and hand...... will greatly improve the use of antibiotics for ARIs. However, used in concert, combinations are likely to enable clinicians and health care systems to implement the strategies that will reduce antimicrobial resistance in the future....... antibiotic prescribing are a major factor in the prescribing for ARIs. Professional interventions with educational components are effective, although they have modest effects, and are expensive. GPs' perceptions - that mistakenly assume as a default that patients want antibiotics for their ARIs - are often...

  20. CURRENT EVIDENCE REGARDING THE EFFICACY OF PROPHYLACTIC ANTIBIOTICS IN THE MANAGEMENT OF FACIAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Anilkumar

    2016-03-01

    Full Text Available Fractures of the facial region are commonly treated by surgeons operating in the head and neck. Antibiotic prophylaxis is used by these surgeons to decrease the rate of infections, however the role of prophylactic antibiotics remains controversial. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery and third molar surgeries. Unfortunately there is little evidence regarding the efficacy of prophylactic antibiotics in the management of facial fractures. In numerous cases no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. The aim of this paper is to present the available evidence regarding the efficacy of prophylactic antibiotics in the management of facial fractures.

  1. TETANUS—Prophylaxis and Treatment of the Disease

    Science.gov (United States)

    Ross, Donald E.; Kraut, J. J.

    1959-01-01

    Cleansing and debridement is paramount in dealing with tetanus-prone wounds (severe crushing injuries, piercing wounds, blisters and burns are outstanding examples, particularly if contaminated with dirt, grass or other debris). Prophylaxis then is relatively easy in persons who have been actively immunized by toxoid injections. For them, a “booster” injection is indicated. Use of antitoxin, however, is hazardous, whether for prophylaxis or for treatment of the disease. Since it may in itself cause severe disease, including anaphylactic reaction and serum sickness, decision to use it must be weighed against the possibility of the development of tetanus in each case. To prepare for use of it, careful history should be taken, with particular reference to sensitivity to horse dander. Dermal tests, and perhaps ophthalmic tests, for sensitivity to the serum should be carried out. Even the tests may be hazardous and precautions should be taken accordingly. If it is decided that the use of antitoxin is necessary even though the patient is sensitive to the material, desensitization must be carried out promptly, with adequate preparation for severe reaction. There is experimental evidence that antibiotics of the tetracycline group, given soon after injury, may have prophylactic effect against tetanus. PMID:13651954

  2. Emicizumab Prophylaxis in Hemophilia A with Inhibitors.

    Science.gov (United States)

    Oldenburg, Johannes; Mahlangu, Johnny N; Kim, Benjamin; Schmitt, Christophe; Callaghan, Michael U; Young, Guy; Santagostino, Elena; Kruse-Jarres, Rebecca; Negrier, Claude; Kessler, Craig; Valente, Nancy; Asikanius, Elina; Levy, Gallia G; Windyga, Jerzy; Shima, Midori

    2017-08-31

    Emicizumab (ACE910) bridges activated factor IX and factor X to restore the function of activated factor VIII, which is deficient in persons with hemophilia A. This phase 3, multicenter trial assessed once-weekly subcutaneous emicizumab prophylaxis in persons with hemophilia A with factor VIII inhibitors. We enrolled participants who were 12 years of age or older. Those who had previously received episodic treatment with bypassing agents were randomly assigned in a 2:1 ratio to emicizumab prophylaxis (group A) or no prophylaxis (group B). The primary end point was the difference in bleeding rates between group A and group B. Participants who had previously received prophylactic treatment with bypassing agents received emicizumab prophylaxis in group C. A total of 109 male participants with hemophilia A with inhibitors were enrolled. The annualized bleeding rate was 2.9 events (95% confidence interval [CI], 1.7 to 5.0) among participants who were randomly assigned to emicizumab prophylaxis (group A, 35 participants) versus 23.3 events (95% CI, 12.3 to 43.9) among those assigned to no prophylaxis (group B, 18 participants), representing a significant difference of 87% in favor of emicizumab prophylaxis (Phemophilia A with inhibitors. (Funded by F. Hoffmann-La Roche and Chugai Pharmaceutical; HAVEN 1 ClinicalTrials.gov number, NCT02622321 .).

  3. Antibodies: an alternative for antibiotics?

    Science.gov (United States)

    Berghman, L R; Abi-Ghanem, D; Waghela, S D; Ricke, S C

    2005-04-01

    In 1967, the success of vaccination programs, combined with the seemingly unstoppable triumph of antibiotics, prompted the US Surgeon General to declare that "it was time to close the books on infectious diseases." We now know that the prediction was overly optimistic and that the fight against infectious diseases is here to stay. During the last 20 yr, infectious diseases have indeed made a staggering comeback for a variety of reasons, including resistance against existing antibiotics. As a consequence, several alternatives to antibiotics are currently being considered or reconsidered. Passive immunization (i.e., the administration of more or less pathogen-specific antibodies to the patient) prior to or after exposure to the disease-causing agent is one of those alternative strategies that was almost entirely abandoned with the introduction of chemical antibiotics but that is now gaining interest again. This review will discuss the early successes and limitations of passive immunization, formerly referred to as "serum therapy," the current use of antibody administration for prophylaxis or treatment of infectious diseases in agriculture, and, finally, recent developments in the field of antibody engineering and "molecular farming" of antibodies in various expression systems. Especially the potential of producing therapeutic antibodies in crops that are routine dietary components of farm animals, such as corn and soy beans, seems to hold promise for future application in the fight against infectious diseases.

  4. Antibiotic Resistance in Children with Recurrent or Complicated Urinary Tract Infection

    Directory of Open Access Journals (Sweden)

    Nidal S Younish

    2009-01-01

    Pediatric urine culture isolates are becoming increasingly resistant to commonly used antibiotics. Empirical treatment with Trimethoprim-Sulfamethoxazole (TMP-SMX or Cephalexin as the initial drug is ineffective. Nitrofurantoin and Nalidixic acid can be considered as the first line antibiotics for prophylaxis and or treatment of patients with recurrent UTI, while Meropenam and Ciprofloxacin can be used empirically in treating patients with complicated UTI. Key words: Antibiotic resistance, Complicated, Recurrent, Urinary tract infection

  5. Antibiotic Safety

    Science.gov (United States)

    ... Antibiotics www.healthsci.tufts.edu Georgia-Pacific Health Smart Institute www.gphealthsmart.com Special thanks to Rhonda ... effectiveness of other medications such as birth control pills? 7. Are there any possible adverse reactions if ...

  6. Prophylactic anti-staphylococcal antibiotics for cystic fibrosis.

    Science.gov (United States)

    Smyth, Alan R; Rosenfeld, Margaret

    2017-04-18

    Staphylococcus aureus causes pulmonary infection in young children with cystic fibrosis. Prophylactic antibiotics are prescribed hoping to prevent such infection and lung damage. Antibiotics have adverse effects and long-term use might lead to infection with Pseudomonas aeruginosa. This is an update of a previously published review. To assess continuous oral antibiotic prophylaxis to prevent the acquisition of Staphylococcus aureus versus no prophylaxis in people with cystic fibrosis, we tested these hypotheses. Prophylaxis:1. improves clinical status, lung function and survival;2. causes adverse effects (e.g. diarrhoea, skin rash, candidiasis);3. leads to fewer isolates of common pathogens from respiratory secretions;4. leads to the emergence of antibiotic resistance and colonisation of the respiratory tract with Pseudomonas aeruginosa. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Companies manufacturing anti-staphylococcal antibiotics were contacted.Most recent search of the Group's Register: 29 September 2016. Randomised trials of continuous oral prophylactic antibiotics (given for at least one year) compared to intermittent antibiotics given 'as required', in people with cystic fibrosis of any disease severity. The authors assessed studies for eligibility and methodological quality and extracted data. We included four studies, with a total of 401 randomised participants aged zero to seven years on enrolment; one study is ongoing. The two older included studies generally had a higher risk of bias across all domains, but in particular due to a lack of blinding and incomplete outcome data, than the two more recent studies. We only regarded the most recent study as being generally free of bias, although even here we were not certain of the effect of the per protocol

  7. Use of Probiotics as Prophylaxis for Postoperative Infections

    Directory of Open Access Journals (Sweden)

    Peter Mangell

    2011-05-01

    Full Text Available Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli may reduce the number of potentially pathogenia bacteria (PPM and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. The use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microbiota in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract. The favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential

  8. Women with recurrent urinary tract infections: antibiotic resistance and non-antibiotic prophylaxis

    NARCIS (Netherlands)

    Beerepoot, M.A.J.

    2013-01-01

    Niet-antibiotische middelen, zoals lactobacillen, kunnen een aanvaardbaar alternatief zijn voor antibiotica om urineweginfecties te voorkomen. Dit concludeert Mariëlle Beerepoot naar aanleiding van twee grote landelijke studies waarin ze onderzoekt of cranberry’s (veenbessen) en lactobacillen

  9. Antivesication by Simultaneous Prophylaxis and Detoxification

    National Research Council Canada - National Science Library

    Kwong, Cecil

    1996-01-01

    Our project DAMD17-93-C-3186 entitled 'Antivesication by Simultaneous Prophylaxis and Detoxification' has been directed toward the development of a new topically applied pretreatment that will prevent...

  10. Reassessment of antibiotic therapy in hospitals.

    Science.gov (United States)

    Lucas, M; Germain, J-M; Rémy, E; Lottin, M; Etienne, M; Czernichow, P; Merle, V

    2017-09-01

    French national guidelines state that antibiotic therapies should be reassessed between 48 and 72hours after treatment initiation and that reassessment of antibiotic therapy (RA) must be recorded in patients' files. To determine whether RA is performed and recorded in patients' files in hospitals in a region of France. Setting: hospitals participating in the National nosocomial infection point- prevalence survey (NPS) in Upper-Normandy, France. Patients included those receiving antibiotic therapy (excluding antibiotic prophylaxis) on NPS day, started in the hospital in which the survey was conducted and ongoing for more than 72hours. Data collected included characteristics of participating hospitals and, for each included patient, characteristics of ward, infection and antibiotic therapy, and mention in the patients' files of explicit or implicit RA. The rate of explicit and implicit RA was calculated and factors associated with explicit or implicit RA were evaluated using a univariate analysis. Thirty-three hospitals representing 87% of hospital beds region-wide were included in the study. In addition, 933 prescriptions were assessed for 724 infections in 676 patients. The overall rate of RA was 67.6% (49.3% of explicit RA and 18.3% of implicit RA). The rate of RA differed significantly according to infection and antibiotic class but not according to hospital or ward characteristics. Our study provides new and reassuring results regarding reassessment of antibiotic therapy. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Pharmacological aspects of the antibiotics used for urological diagnostic procedures.

    Science.gov (United States)

    Mazzei, Teresita; Diacciati, Sara

    2014-10-01

    Surgical antimicrobial prophylaxis is the use of an antibiotic before, during, or shortly after a urological procedure to prevent postoperative infections such as urinary tract or wound infection. The optimal antimicrobial drug must be microbiologically active against the most frequent potential pathogens and have good pharmacological properties. Correct timing of antimicrobial prophylaxis is the first critical issue in determining treatment efficacy. The antibiotic must be administered before the start of the surgical procedure in order to ensure a high tissue level at the time of microbial contamination. If using an oral antibiotic, this must be administered 1-3 hours before the operation and a parenteral antibiotic should be administered at the induction of anaesthesia. The antibiotics potentially useful for antimicrobial prophylaxis are the beta-lactams, cotrimoxazole, fluoroquinolones, and fosfomycin trometamol. The criteria for choosing the optimal antibiotic include an appropriate antimicrobial spectrum, favourable pharmacokinetic parameters (especially good tissue penetration), and elevated safety or tolerability. The use of cotrimoxazole must be restricted due to increasing chemoresistance. Unfortunately fluoroquinolone-based regimens, once the mainstay of prophylaxis guidelines, are increasingly ineffective due to a constant increase in multidrug-resistant (MDR) Gram-negative bacteria. The same concerns apply with regard to the second and third generation cephalosporins that have problems of resistance and, if administered orally, do not sufficiently penetrate prostatic tissue. An appropriate beta-lactam could be an aminopenicillin combined with a beta-lactamase inhibitor. Fosfomycin trometamol can also be a good potential choice due to its elevated activity against MDR Gram-negative bacteria and its favourable pharmacokinetic parameters, including an elevated penetration into prostatic tissue.

  12. Comparative evaluation of prophylactic single-dose intravenous antibiotic with postoperative antibiotics in elective urologic surgery

    Directory of Open Access Journals (Sweden)

    Mohammad K Moslemi

    2010-11-01

    Full Text Available Mohammad K Moslemi1, Seyed M Moosavi Movahed2, Akram Heidari3, Hossein Saghafi2, Mehdi Abedinzadeh41Department of Urology, 2Department of Nephrology, 3Department of Health, Kamkar Hospital, Qom University of Medical Sciences, Qom, Iran; 4Department of Urology, Moradi Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, IranBackground: Unrestricted antibiotic use is very common in Iran. As a result, emergence of resistant organisms is commonplace. Antibiotic prophylaxis in surgery consists of a short antibiotic course given immediately before the procedure in order to prevent development of a surgical site infection. The basic principle of prophylaxis is to maintain effective concentrations of an antibiotic active against the commonest pathogens during the entire surgery.Materials and methods: We prospectively investigated 427 urologic surgery cases in our department between August 2008 and September 2009 (Group1. As reference cases, we retrospectively reviewed 966 patients who underwent urologic surgery between May 2004 and May 2008 (Group 2 who were administered antibiotics without any restriction. Prophylactic antibiotics such as cefazolin were administered intravenously according to our protocol. Postoperative body temperature, peripheral white blood cell counts, urinalysis, and urine culture were checked.Results: To judge perioperative infections, wound condition and general condition were evaluated in terms of surgical site infection, as well as remote infection and urinary tract infection, up to postoperative day 30. Surgical site infection was defined as the presence of swelling, tenderness, redness, or drainage of pus from the wound, superficially or deeply. Remote infection was defined as occurrence of pneumonia, sepsis, or urinary tract infection. Perioperative infection rates (for surgical site and remote infection in Group 1 and Group 2 were nine of 427 (2.6% and 24 of 966 (2.5%, respectively. Surgical

  13. Tooth brushing for oral prophylaxis

    Directory of Open Access Journals (Sweden)

    Haruaki Hayasaki, DDS, PhD

    2014-08-01

    Full Text Available Control of plaque and debris is essential for the prevention of inflammatory periodontal diseases and dental caries, because plaque is the primary etiological factor in the introduction and development of both of these infection-oriented diseases. Plaque removal with a toothbrush is the most frequently used method of oral hygiene. Powered toothbrushes were developed beginning in the 1960s and are now widely used in developed countries. The bristles of a toothbrush should be able to reach and clean efficiently most areas of the mouth, and recently the design of both manual and powered toothbrushes has focused on the ability to reach and clean interproximal tooth surfaces. An individual's tooth brushing behavior, including force, duration, motivation and motion, are also critical to tooth brushing efficacy. Dental floss and the type of toothpaste play additional important roles as auxiliary tools for oral prophylaxis. Dental professionals should help their care-receivers’ meet the requirements of oral hygiene to maintain their QOL. This article reviews these topics.

  14. Prophylaxis of vertical HBV infection.

    Science.gov (United States)

    Pawlowska, Malgorzata; Pniewska, Anna; Pilarczyk, Malgorzata; Kozielewicz, Dorota; Domagalski, Krzysztof

    2016-10-01

    An appropriate management of HBV infection is the best strategy to finally reduce the total burden of HBV infection. Mother-to-child transmission (MTCT) is responsible for more than one third of chronic HBV infections worldwide. Because HBV infection in infancy or early childhood often leads to chronic infection, appropriate prophylaxis and management of HBV in pregnancy is crucial to prevent MTCT. The prevention of HBV vertical transmission is a complex task and includes: universal HBV screening of pregnant women, administration of antivirals in the third trimester of pregnancy in women with high viral load and passive-active HBV immunoprophylaxis with hepatitis B vaccine and hepatitis B immune globulin in newborns of all HBV infected women. Universal screening of pregnant women for HBV infection, early identification of HBV DNA level in HBV-infected mothers, maternal treatment with class B according to FDA antivirals and passive/active anti-HBV immunoprophylaxis to newborns of HBV-positive mothers are crucial strategies for reducing vertical HBV transmission rates. Consideration of caesarean section in order to reduce the risk of vertical HBV transmission should be recommend in HBV infected pregnant women with high viral load despite antiviral therapy or when the therapy in the third trimester of pregnancy is not available.

  15. Cost-Effectiveness of Cranberries vs Antibiotics to Prevent Urinary Tract Infections in Premenopausal Women: A Randomized Clinical Trial

    NARCIS (Netherlands)

    Bosmans, J.E.; Beerepoot, M.A.J.; Prins, J.M.; ter Riet, G.; Geerlings, S.E.

    2014-01-01

    Background: Urinary tract infections (UTIs) are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs. Objective: To evaluate the cost-effectiveness of cranberry prophylaxis

  16. Antibiotic allergy.

    Science.gov (United States)

    Caimmi, S; Caimmi, D; Lombardi, E; Crisafulli, G; Franceschini, F; Ricci, G; Marseglia, G L

    2011-01-01

    Antibiotics are commonly injected during the perioperative period and are responsible of 15 percent of the anaphylactic reactions. Anaphylaxis triggered by antibiotics primarily involves penicillin and cephalosporin. The management of patients with histories of allergic reactions to antibiotics is a common situation in clinical practice. The confirmation or invalidation of the allergic nature of the reported reaction is not based on in vitro tests, but on a rigorous allergological work-up based on detailed analysis of clinical history, skin tests and drug provocation test. Considering a possible cross-reactivity between penicillins, once an immediate penicillin allergy has been diagnosed, skin testing with the alternative molecule (cephalosporin, carbapenem, aztreonam) is mandatory and, if negative, the relevant drug should be given in an appropriate setting at increasing doses.

  17. Antimicrobial prophylaxis in caesarean section delivery.

    Science.gov (United States)

    Liu, Ronghua; Lin, Lin; Wang, Dujuan

    2016-08-01

    Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics. Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients. The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years. The highest proportion of patients were primigravida 72%. Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days. In total, 27% of patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes. Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes. Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.

  18. Treatment and prophylaxis of melioidosis.

    Science.gov (United States)

    Dance, David

    2014-04-01

    Melioidosis, infection with Burkholderia pseudomallei, is being recognised with increasing frequency and is probably more common than currently appreciated. Treatment recommendations are based on a series of clinical trials conducted in Thailand over the past 25 years. Treatment is usually divided into two phases: in the first, or acute phase, parenteral drugs are given for ≥10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. Ceftazidime is the mainstay of acute-phase treatment, with carbapenems reserved for severe infections or treatment failures and amoxicillin/clavulanic acid (co-amoxiclav) as second-line therapy. Trimethoprim/sulfamethoxazole (co-trimoxazole) is preferred for the eradication phase, with the alternative of co-amoxiclav. In addition, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is unaffordable for many in endemic areas of the developing world, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future. Recommendations for prophylaxis following exposure to B. pseudomallei have been made, but the evidence suggests that they would probably only delay rather than prevent the development of infection. Copyright © 2014 The Author. Published by Elsevier B.V. All rights reserved.

  19. Compliance with RSV prophylaxis: Global physicians’ perspectives

    Directory of Open Access Journals (Sweden)

    Kari S Anderson

    2009-07-01

    Full Text Available Kari S Anderson, Victoria M Mullally, Linda M Fredrick, Andrew L CampbellAbbott Laboratories, Abbott Park, IL, USAAbstract: Respiratory syncytial virus (RSV is a significant cause of morbidity in high-risk infants. Palivizumab is proven to prevent serious RSV disease, but compliance with prophylaxis (monthly doses during the RSV season is essential to ensure protection. We invited 453 pediatricians to participate in a survey to identify their perspectives of barriers to compliance and interventions to improve compliance with palivizumab prophylaxis schedules. One hundred physicians from five continents completed the survey, identifying caregiver inconvenience, distance to clinic, cost of prophylaxis, and lack of understanding of the severity of RSV as the most common reasons for noncompliance. They recommended provision of educational materials about RSV, reminders from hospital or clinic, and administration of prophylaxis at home to increase compliance. Globally, physicians recognize several obstacles to prophylaxis compliance. This survey suggests that focused proactive interventions such as empowering caregivers with educational materials and reducing caregiver inconvenience may be instrumental to increase compliance.Keywords: medication adherence, respiratory syncytial virus infections, infant, premature, immunization, passive

  20. Hydrid Antibiotics

    Czech Academy of Sciences Publication Activity Database

    Běhal, Vladislav

    2003-01-01

    Roč. 48, č. 1 (2003), s. 17-25 ISSN 0015-5632 R&D Projects: GA ČR GA204/01/1004 Institutional research plan: CEZ:AV0Z5020903 Keywords : hydrid * antibiotics Subject RIV: EE - Microbiology, Virology Impact factor: 0.857, year: 2003

  1. Combating Antibiotic Resistance

    Science.gov (United States)

    ... in Farm Animals FDA: Cutting-Edge Technology Sheds Light on Antibiotic Resistance For More Information Antibiotics and Antibiotic Resistance Antimicrobial Resistance Information for Consumers and Health Professionals CDC: Get Smart: Know When Antibiotics Work More in Consumer Updates ...

  2. Post-exposure prophylaxis during pandemic outbreaks

    Directory of Open Access Journals (Sweden)

    Fisman David N

    2009-12-01

    Full Text Available Abstract Background With the rise of the second pandemic wave of the novel influenza A (H1N1 virus in the current season in the Northern Hemisphere, pandemic plans are being carefully re-evaluated, particularly for the strategic use of antiviral drugs. The recent emergence of oseltamivir-resistant in treated H1N1 patients has raised concerns about the prudent use of neuraminidase inhibitors for both treatment of ill individuals and post-exposure prophylaxis of close contacts. Methods We extended an established population dynamical model of pandemic influenza with treatment to include post-exposure prophylaxis of close contacts. Using parameter estimates published in the literature, we simulated the model to evaluate the combined effect of treatment and prophylaxis in minimizing morbidity and mortality of pandemic infections in the context of transmissible drug resistance. Results We demonstrated that, when transmissible resistant strains are present, post-exposure prophylaxis can promote the spread of resistance, especially when combined with aggressive treatment. For a given treatment level, there is an optimal coverage of prophylaxis that minimizes the total number of infections (final size and this coverage decreases as a higher proportion of infected individuals are treated. We found that, when treatment is maintained at intermediate levels, limited post-exposure prophylaxis provides an optimal strategy for reducing the final size of the pandemic while minimizing the total number of deaths. We tested our results by performing a sensitivity analysis over a range of key model parameters and observed that the incidence of infection depends strongly on the transmission fitness of resistant strains. Conclusion Our findings suggest that, in the presence of transmissible drug resistance, strategies that prioritize the treatment of only ill individuals, rather than the prophylaxis of those suspected of being exposed, are most effective in reducing

  3. Considerations regarding iodine prophylaxis in radiological accidents

    International Nuclear Information System (INIS)

    Perez, M.R.; Gisone, P.; Rojo, A.M.; Dubner, D.; Bruno, H.

    1995-01-01

    The indication for the blockade of thyroid gland by the administration of stable iodide is the main countermeasure for diminishing the thyroid uptake of radioiodine following radiological accidents with potential release of radioiodine into the environment in order to avoid deterministic effects and to decrease the probability of stochastic effects. Iodine prophylaxis should be considered along with other countermeasures like sheltering indoors, evacuation and control on contaminated foods. In this communication different factors related to accidental situations regarding iodine prophylaxis are evaluated. A therapeutical scheme is proposed in order to be applied in countries of this region. (author). 4 refs

  4. Study of Iodine Prophylaxis Following Nuclear Accidents

    International Nuclear Information System (INIS)

    Sri Widayati; Tedjasari, R. S.; Elfida

    2007-01-01

    Study of iodine prophylaxis following nuclear accidents has been done. Giving stable iodine to a population exposed by I-131 is one of preventive action from internal radiation to the thyroid gland. Stable iodine could be given as Kl tablet in a range of dose of 30 mg/day to 130 mg/day. Improper giving of stable iodine could cause side effect to health, so then some factors should be considered i. e. dose estimation, age, dose of stable iodine to be given, duration of stable iodine prophylaxis and risk of health. (author)

  5. Antibiotic Resistance

    DEFF Research Database (Denmark)

    Munck, Christian

    of antimicrobial resistance: (1) adaptive mutations and (2) horizontal acquisition of resistance genes from antibiotic gene reservoirs. By studying the geno- and phenotypic changes of E. coli in response to single and drug-pair exposures, I uncover the evolutionary trajectories leading to adaptive resistance. I......Bacteria can avoid extinction during antimicrobial exposure by becoming resistant. They achieve this either via adaptive mutations or horizontally acquired resistance genes. If resistance emerges in clinical relevant species, it can lead to treatment failure and ultimately result in increasing...... morbidity and mortality as well as an increase in the cost of treatment. Understanding how bacteria respond to antibiotic exposure gives the foundations for a rational approach to counteract antimicrobial resistance. In the work presented in this thesis, I explore the two fundamental sources...

  6. Evaluation de la pratique de la prophylaxie antithrombotique ...

    African Journals Online (AJOL)

    Mots clés: risque, thrombose veineuse-prophylaxie anti-thrombotique veineuse, Lomé. English Title: Assessment of the practice of venous thrombosis prophylaxis in Sylvanus Olympio Teaching Hospital of Lome. English Abstract. Objective: Evaluate the practice of venous thrombosis prophylaxis in Trauma and orthopedics ...

  7. PIDOTIMOD A NEW EFFICIENT PRODUCT IN IMMUNOLOGICAL PROPHYLAXIS AND IMMUNOLOGICAL THERAPY OF RESPIRATORY INFECTIONS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    A.V. Karaulov

    2008-01-01

    Full Text Available The article contains analysis of results of international trial of pidotimod (imunorix efficiency. pidotimod is a new safe immunomodulator, which is both efficient in prophylactic use and as a medication. At the same time, the drug is capable of intensify the effect of antibiotics and other medications. This fact is confirmed by the results of controlled trials with participation of a large number of patients. pidotimod is ministerial to a faster disappearance of signs and symptoms of infection, anticipating the recovery with reduced administration of associated drugs.Key words: pidotimod, immunomodulator, acute respiratory infections, prophylaxis, treatment.

  8. PROPHYLAXIS OF PNEUMOCOCCAL INFECTION IN CHILDREN HAS POSITIVE EFFECT ON ALL POPULATION

    Directory of Open Access Journals (Sweden)

    M.V. Fedoseenko

    2008-01-01

    Full Text Available Modern data of effectiveness prophylaxis of pneumococcal infection in children younger 1 year old with vaccine is presented in this article. Including of 7 - valency pneumococcal conjugated vaccine (PCV-7 in immunization program of some countries resulted in decrease of morbidity as in vaccinated group, as in all population. It was marked that vaccination with PCV-7 plays important pathogenetic role in termination of hidden forms of disease and prevention of spreading of pneumococcal infection, including the most severe types, hardly treated with antibiotics.Key words: children, pneumococcal infection, vaccination.

  9. Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Judith E Bosmans

    Full Text Available Urinary tract infections (UTIs are common and result in an enormous economic burden. The increasing prevalence of antibiotic-resistant microorganisms has stimulated interest in non-antibiotic agents to prevent UTIs.To evaluate the cost-effectiveness of cranberry prophylaxis compared to antibiotic prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX over a 12 month period in premenopausal women with recurrent UTIs.An economic evaluation was performed alongside a randomized trial. Primary outcome was the number of UTIs during 12 months. Secondary outcomes included satisfaction and quality of life. Healthcare utilization was measured using questionnaires. Missing data were imputed using multiple imputation. Bootstrapping was used to evaluate the cost-effectiveness of the treatments.Cranberry prophylaxis was less effective than TMP-SMX prophylaxis, but the differences in clinical outcomes were not statistically significant. Costs after 12 months in the cranberry group were statistically significantly higher than in the TMP-SMX group (mean difference €249, 95% confidence interval 70 to 516. Cost-effectiveness planes and cost-effectiveness acceptability curves showed that cranberry prophylaxis to prevent UTIs is less effective and more expensive than (dominated by TMP-SMX prophylaxis.In premenopausal women with recurrent UTIs, cranberry prophylaxis is not cost-effective compared to TMP-SMX prophylaxis. However, it was not possible to take into account costs attributed to increased antibiotic resistance within the framework of this randomized trial; modeling studies are recommended to investigate these costs. Moreover, although we based the dosage of cranberry extract on available evidence, this may not be the optimal dosage. Results may change when this optimal dosage is identified.ISRCTN.org ISRCTN50717094.

  10. Prophylaxis after Exposure to Coxiella burnetii

    Centers for Disease Control (CDC) Podcasts

    2008-10-02

    In this podcast, Dr. David Swerdlow discusses prophylaxis after exposure to Coxiella burnetii. It is important to know who should be treated and how they should be treated after an intentional release with possible bioterrorism agents, including Coxiella burnetii.  Created: 10/2/2008 by Emerging Infectious Diseases.   Date Released: 10/2/2008.

  11. Pre-Exposure Prophylaxis (PrEP)

    Science.gov (United States)

    ... Office of Adolescent Health OAR NIH Office of AIDS Research OCR HHS Office for Civil Rights OFBNP HHS ... Personal Stories Photos PLWHA People Living with HIV/AIDS Podcasts PrEP Pre-Exposure Prophylaxis Prevention PWID People Who Inject Drugs Research Research Agenda Ryan White Ryan White HIV/AIDS ...

  12. 21 CFR 872.6290 - Prophylaxis cup.

    Science.gov (United States)

    2010-04-01

    ... agents during prophylaxis (cleaning). The dental handpiece spins the rubber cup holding the polishing agent and the user applies it to the teeth to remove debris. (b) Classification. Class I (general... regulation in part 820 of this chapter, with the exception of § 820.180, with respect to general requirements...

  13. Post exposure prophylaxis against human immunodeficiency virus ...

    African Journals Online (AJOL)

    2015-11-23

    Nov 23, 2015 ... Abstract: Objective: To deter- mine the level of awareness, knowledge and practice of human immunodeficiency virus post ex- posure prophylaxis (HIV PEP) among paediatricians in Nigeria. Methodology: The study was a cross sectional questionnaire- based survey conducted among paediatrcians that ...

  14. Antiemetic Prophylaxis with Metoclopramide or Metoclopramide and ...

    African Journals Online (AJOL)

    Background: Postoperative nausea and vomiting (PONV) remains a significant cause of morbidity among patients undergoing general anaesthesia. Identification of patients at high risk for PONV allows targeting prophylaxis at those who will benefit most from it. This study was conducted in a tertiary hospital with the aim of ...

  15. Post exposure prophylaxis against human immunodeficiency virus ...

    African Journals Online (AJOL)

    Objective: To determine the level of awareness, knowledge and practice of human immunodeficiency virus post exposure prophylaxis (HIV PEP) among paediatricians in Nigeria. Methodology: The study was a cross sectional questionnairebased survey conducted among paediatrcians that attended the Paediatric ...

  16. VENOUS THROMBOEMBOLISM PROPHYLAXIS – THE OTHER ...

    African Journals Online (AJOL)

    Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). In the absence of any guidelines, most of the information available has been provided mainly by the pharmaceutical industry which is an interested party. There have been publications in local journals that lean more on ...

  17. Isoniazid prophylaxis for tuberculosis prevention among HIV ...

    African Journals Online (AJOL)

    Objective: To determine the acceptability, compliance and side effects of isoniazid (INH) prophylaxis against tuberculosis among HIV infected police officers (PO) in Dar es Salaam. Design: A nested study from a prospective follow up of a cohort of police officers. Setting: Dar es Salaam, Tanzania. Subjects: One hundred and ...

  18. Antiviral Prophylaxis and H1N1

    Centers for Disease Control (CDC) Podcasts

    2011-07-14

    Dr. Richard Pebody, a consultant epidemiologist at the Health Protection Agency in London, UK, discusses the use of antiviral post-exposure prophylaxis and pandemic H1N1.  Created: 7/14/2011 by National Center for Emerging Zoonotic and Infectious Diseases (NCEZID).   Date Released: 7/18/2011.

  19. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  20. Benefits of not Prescribing Prophylactic Antibiotics After Third Molar Surgery.

    Science.gov (United States)

    Prajapati, Anchal; Prajapati, Aalap; Sathaye, Swati

    2016-06-01

    The aim of the study is to reinstate the fact that antibiotics are not required as prophylaxis for third molar surgery. So the standard of care after extraction of mandibular third molar surgery for all healthy patients should be a good anti-inflammatory regimen rather than a antibiotic prophylaxis. Surgical removal of impacted mandibular third molar is the most common procedure and many complications are usually encountered in this procedure like-pain, trismus, infection, swelling, inflammation and nerve damage. Now, the question that arises is does the age old practice of prescribing postoperative antibiotics solve these problems or adds on some new. The data collected and analysed in our observational study, however, reinstates that instead, it is the proper aseptic precautions and good anti-inflammatory regimen that are more important than the prophylactic antibiotics (Pasupathy and Alexander in J Craniofac Surg, 2011). Moreover, giving antibiotics means opening up the loopholes to bacterial resistance. A retrospective analysis of the data collected from 40 patients coming to the department of Dental and Implant Surgery, Karamsad, Anand between October 2014 and December 2014, operated for third molar surgery was carried out. Data from 40 patients requiring disimpaction of mandibular third molar was analysed. Postoperatively, only anti-inflammatory medication was prescribed to all the patients. None of the patients showed any of the signs or symptoms of infection.

  1. Antibiotic use in a tertiary healthcare facility in Ghana: a point prevalence survey

    Directory of Open Access Journals (Sweden)

    Appiah-Korang Labi

    2018-01-01

    Full Text Available Abstract Background The global rise and spread of antibiotic resistance is limiting the usefulness of antibiotics in the prevention and treatment of infectious diseases. The use of antibiotic stewardship programs guided by local data on prescribing practices is a useful strategy to control and reduce antibiotic resistance. Our objective in this study was to determine the prevalence and indications for use of antibiotics at the Korle-Bu Teaching Hospital Accra, Ghana. Methods An antibiotic point prevalence survey was conducted among inpatients of the Korle-Bu Teaching Hospital between February and March 2016. Folders and treatment charts of patients on admission at participating departments were reviewed for antibiotics administered or scheduled to be administered on the day of the survey. Data on indication for use were also collected. Prevalence of antibiotic use was determined by dividing the number of inpatients on antibiotics at the time of survey by the total number of patients on admission. Results Of the 677 inpatients surveyed, 348 (51.4%, 95% CI, 47.6–55.2 were on treatment with antibiotics. Prevalence was highest among Paediatric surgery where 20/22 patients (90.9%, 95% CI, 70.8–98.9 were administered antibiotics and lowest among Obstetrics patients with 77/214 (36%, 95% CI, 29.5–42.8. The indications for antibiotic use were 245/611 (40.1% for community-acquired infections, 205/611 (33.6% for surgical prophylaxis, 129/611 (21.1% for healthcare associated infections and 33/611 (5.4% for medical prophylaxis. The top five antibiotics prescribed in the hospital were metronidazole 107 (17.5%, amoxicillin-clavulinic acid 82 (13.4%, ceftriaxone 17(12.1%, cefuroxime 61 (10.0%, and cloxacillin 52 (8.5% respectively. Prevalence of meropenem and vancomycin use was 12(2% and 1 (.2% respectively. The majority of patients 181 (52% were being treated with two antibiotics. Conclusion This study indicated a high prevalence of antibiotic use among

  2. Appropriate VTE prophylaxis is associated with lower direct medical costs.

    Science.gov (United States)

    Amin, Alpesh; Hussein, Mohamed; Battleman, David; Lin, Jay; Stemkowski, Stephen; Merli, Geno J

    2010-11-01

    To calculate and compare the direct medical costs of guideline-recommended prophylaxis with prophylaxis that does not fully adhere with guideline recommendations in a large, real-world population. Discharge records were retrieved from the US Premier Perspective™ database (January 2003-December 2003) for patients aged≥40 years with a primary diagnosis of cancer, chronic heart failure, lung disease, or severe infectious disease who received some form of thromboprophylaxis. Univariate analysis and multivariate regression modeling were performed to compare direct medical costs between discharges who received appropriate prophylaxis (correct type, dose, and duration based on sixth edition American College of Chest Physicians [ACCP] recommendations) and partial prophylaxis (not in full accordance with ACCP recommendations). Market segmentation analysis was used to compare costs stratified by hospital and patient characteristics. Of the 683 005 discharges included, 148,171 (21.7%) received appropriate prophylaxis and 534,834 (78.3%) received partial prophylaxis. The total direct unadjusted costs were $15,439 in the appropriate prophylaxis group and $17,763 in the partial prophylaxis group. After adjustment, mean adjusted total costs per discharge were lower for those receiving appropriate prophylaxis ($11,713; 95% confidence interval [CI], $11,675-$11,753) compared with partial prophylaxis ($13,369; 95% CI, $13,332-$13 406; P<0.01). Appropriate prophylaxis appeared to be associated with numerically lower unadjusted costs than partial prophylaxis, regardless of hospital size, rural/urban location, teaching status, and patient age and gender. This large, real-world analysis suggests that appropriate prophylaxis, in adherence with ACCP guidelines, is potentially cost-saving compared with partial prophylaxis in at-risk medical patients.

  3. Current Evidence regarding Prophylactic Antibiotics in Head and Neck and Maxillofacial Surgery

    Directory of Open Access Journals (Sweden)

    Kilian Kreutzer

    2014-01-01

    Full Text Available Antibiotic prophylaxis is commonly used to decrease the rate of infections in head and neck surgery. The aim of this paper is to present the available evidence regarding the application of antibiotic prophylaxis in surgical procedures of the head and neck region in healthy patients. A systemic literature review based on Medline and Embase databases was performed. All reviews and meta-analyses based on RCTs in English from 2000 to 2013 were included. Eight out of 532 studies fulfilled all requirements. Within those, only seven different operative procedures were analyzed. Evidence exists for the beneficial use of prophylactic antibiotics for tympanostomy, orthognathic surgery, and operative tooth extractions. Unfortunately, little high-level evidence exists regarding the use of prophylactic antibiotics in head and neck surgery. In numerous cases, no clear benefit of antibiotic prophylaxis has been shown, particularly considering their potential adverse side effects. Antibiotics are often given unnecessarily and are administered too late and for too long. Furthermore, little research has been performed on the large number of routine cases in the above-mentioned areas of specialization within the last few years, although questions arising with respect to the treatment of high-risk patients or of specific infections are discussed on a broad base.

  4. Hyaluronic acid derivatives and its polyelectrolyte complexes with gentamicin as a delivery system for antibiotics

    NARCIS (Netherlands)

    ter Boo, Gert-Jan A.; Richards, Robert G.; Moriarty, Thomas F.; Grijpma, Dirk W.; Eglin, David

    2017-01-01

    Repeated administration of gentamicin (Gen) is often necessary to have efficacious pharmacokinetics in both infection prophylaxis and treatment. In order to increase the half-time of Gen sulfate and minimize the dosage, the antibiotic can be grafted to polymers as a prodrug or encapsulated within

  5. Hyaluronic acid derivatives and its polyelectrolyte complexes with gentamicin as a delivery system for antibiotics

    NARCIS (Netherlands)

    ter Boo, G.A.; Richards, R.G.; Moriarty, T.F.; Grijpma, Dirk W.; Eglin, D.

    2016-01-01

    Repeated administration of gentamicin (Gen) is often necessary to have efficacious pharmacokinetics in both infection prophylaxis and treatment. In order to increase the half-time of Gen sulfate and minimize the dosage, the antibiotic can be grafted to polymers as a prodrug or encapsulated within

  6. An Analogue of the Antibiotic Teicoplanin Prevents Flavivirus Entry In Vitro

    NARCIS (Netherlands)

    De Burghgraeve, Tine; Kaptein, Suzanne J. F.; Ayala Nunez, Nilda V.; Mondotte, Juan A.; Pastorino, Boris; Printsevskaya, Svetlana S.; de Lamballerie, Xavier; Jacobs, Michael; Preobrazhenskaya, Maria; Gamarnik, Andrea V.; Smit, Jolanda M.; Neyts, Johan

    2012-01-01

    There is an urgent need for potent inhibitors of dengue virus (DENV) replication for the treatment and/or prophylaxis of infections with this virus. We here report on an aglycon analogue of the antibiotic teicoplanin (code name LCTA-949) that inhibits DENV-induced cytopathic effect (CPE) in a

  7. Surveillance of life-long antibiotics: a review of antibiotic prescribing practices in an Australian Healthcare Network.

    Science.gov (United States)

    Lau, Jillian S Y; Kiss, Christopher; Roberts, Erika; Horne, Kylie; Korman, Tony M; Woolley, Ian

    2017-01-18

    The rise of antimicrobial use in the twentieth century has significantly reduced morbidity due to infection, however it has also brought with it the rise of increasing resistance. Some patients are on prolonged, if not "life-long" course of antibiotics. The reasons for this are varied, and include non-infectious indications. We aimed to study the characteristics of this potential source of antibiotic resistance, by exploring the antibiotic dispensing practices and describing the population of patients on long-term antibiotic therapy. A retrospective cross-sectional study of antibiotic dispensing records was performed at a large university hospital-based healthcare network in Melbourne, Australia. Outpatient prescriptions were extracted from the hospital pharmacy database over a 6 month period in 2014. Medical records of these patients were reviewed to determine the indication for prescription, including microbiology, the intended duration, and the prescribing unit. A descriptive analysis was performed on this data. 66,127 dispensing episodes were reviewed. 202 patients were found to have been prescribed 1 or more antibiotics with an intended duration of 1 year or longer. 69/202 (34%) of these patients were prescribed prolonged antibiotics for primary prophylaxis in the setting of immunosuppression. 43/202 (21%) patients were prescribed long-term suppressive antibiotics for infections of thought incurable (e.g. vascular graft infections), and 34/43 (79%) were prescribed by Infectious Diseases doctors. 66/202 (33%) patients with cystic fibrosis were prescribed prolonged courses of macrolides or fluoroquinolones, by respiratory physicians. There was great heterogeneity noted in indications for prolonged antibiotic courses, as well as antibiotic agents utilised. Our study found that that continuous antibiotic therapy represented only a small proportion of overall antibiotic prescribing at our health network. Prolonged courses of antibiotics were used mainly to

  8. Comparison of Infection and Urosepsis Rates of Ciprofloxacin and Ceftriaxone Prophylaxis before Percutaneous Nephrolithotomy: A Prospective and Randomised Study

    Directory of Open Access Journals (Sweden)

    Abdullah Demirtas

    2012-01-01

    Full Text Available This study aimed at determining the choice and administration duration of ideal antibiotic prophylaxis before percutaneous nephrolithotomy (PNL operation, a treatment modality for nephrolithiasis. The study included 90 patients who had no internal problem, yet had a negative urine culture and underwent a PNL operation. We compared infection rates between ciprofloxacin and ceftriaxone groups and their subgroups. The results showed no statistical difference between ciprofloxacin and ceftriaxone groups in terms of systemic inflammatory response syndrome (SIRS (CIPP=0.306, CTX P=0.334. As a result of this study no statistical difference was observed between ciprofloxacin and ceftriaxone in terms of SIRS. It seems, however, reasonable to choose ceftriaxone, considering antibiotic sensitivity of microorganisms and detection of three cases accepted as urosepsis in the ciprofloxacin group. As there is no difference between short, and long-term prophylactic use of these antibiotics, preference of short-term prophylaxis for patients with no risk of infection will be important to avoid inappropriate antibiotic usage.

  9. [Antibiotic Stewardship 2.0. Individualization of therapy].

    Science.gov (United States)

    Pletz, M W; Tacconelli, E; Welte, T

    2017-07-01

    Antibiotic resistance is a part of bacterial evolution and therefore unavoidable. In the context of missing novel treatment options, the restrictive use of available antibiotics in order to decelerate the spread of resistance is of high importance. This is the aim of Antibiotic Stewardship (ABS). ABS consists of two sides: a structural one and an individual one. The former deals with the formation of ABS teams, the analysis of antibiotic usage and resistance development, and the implementation of certain measures to improve antibiotic use; the latter is reflected by concrete bedside decisions: How can (broad) spectrum antibiotics be spared without harming the patient? This can be achieved, for example, by de-escalation, limiting duration of treatment, and avoiding nonindicated use. Typical nonindicated uses in both in- and outpatients are viral respiratory tract infections, asymptomatic bacteriuria and nonbacterial exacerbations of chronic obstructive pulmonary disease. Furthermore, respiratory colonization in ventilated patients, ventilator-associated tracheobronchitis, "prolonged" perioperative prophylaxis, and contaminated blood cultures reflect situations where antibiotics should be avoided. In the future, ABS will benefit from accelerated pathogen and resistance detection because early adequate treatment not only lowers the usage of antibiotics but can also improve patient outcome.

  10. Decreasing candidaemia rate in abdominal surgery patients after introduction of fluconazole prophylaxis*

    DEFF Research Database (Denmark)

    Holzknecht, B J; Thorup, J; Arendrup, M C

    2011-01-01

    Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients....... The candidaemia rate decreased from 1.5/1000 admissions in the pre-intervention to 0.3/1000 admissions in the post-intervention period (p 0.002). Numbers of BSIs and bed-days remained stable, and numbers of admissions and surgical procedures performed increased during the study period. Fluconazole consumption...... in the two abdominal surgery departments increased from 4.6 to 12.2 defined daily doses per 100 bed-days (p pre- and 2/7 post...

  11. Decreasing candidaemia rate in abdominal surgery patients after introduction of fluconazole prophylaxis*

    DEFF Research Database (Denmark)

    Holzknecht, Barbara; Thorup, Jens Frederik; Arendrup, M C

    2011-01-01

    Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients....... The candidaemia rate decreased from 1.5/1000 admissions in the pre-intervention to 0.3/1000 admissions in the post-intervention period (p 0.002). Numbers of BSIs and bed-days remained stable, and numbers of admissions and surgical procedures performed increased during the study period. Fluconazole consumption...... in the two abdominal surgery departments increased from 4.6 to 12.2 defined daily doses per 100 bed-days (p pre- and 2/7 post...

  12. Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

    LENUS (Irish Health Repository)

    Cawley, D

    2010-10-01

    Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

  13. Historical Review: Problematic Malaria Prophylaxis with Quinine.

    Science.gov (United States)

    Shanks, G Dennis

    2016-08-03

    Quinine, a bitter-tasting, short-acting alkaloid drug extracted from cinchona bark, was the first drug used widely for malaria chemoprophylaxis from the 19th century. Compliance was difficult to enforce even in organized groups such as the military, and its prophylaxis potential was often questioned. Severe adverse events such as blackwater fever occurred rarely, but its relationship to quinine remains uncertain. Quinine prophylaxis was often counterproductive from a public health viewpoint as it left large numbers of persons with suppressed infections producing gametocytes infective for mosquitoes. Quinine was supplied by the first global pharmaceutical cartel which discouraged competition resulting in a near monopoly of cinchona plantations on the island of Java which were closed to Allied use when the Japanese Imperial Army captured Indonesia in 1942. The problems with quinine as a chemoprophylactic drug illustrate the difficulties with medications used for prevention and the acute need for improved compounds. © The American Society of Tropical Medicine and Hygiene.

  14. Fatal rabies despite post-exposure prophylaxis

    OpenAIRE

    D G Deshmukh; A S Damle; J K Bajaj; J B Bhakre; N S Patil

    2011-01-01

    Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on...

  15. Secreted HSP Vaccine for Malaria Prophylaxis

    Science.gov (United States)

    2017-10-01

    AWARD NUMBER: W81XWH-13-2-0098 TITLE: Secreted HSP Vaccine for Malaria Prophylaxis PRINCIPAL INVESTIGATOR: Natasa Strbo CONTRACTING...1. REPORT DATE October 2017 2. REPORT TYPE Annual 3. DATES COVERED 09/30/16-09/29/17 4. TITLE AND SUBTITLE Secreted HSP Vaccine for Malaria...thereby stimulating an avid, antigen specific, cytotoxic CD8 T cell response. Here we developed malaria vaccine that relies on secreted gp96-Ig

  16. Antimicrobial prophylaxis in caesarean section delivery

    OpenAIRE

    Liu, Ronghua; Lin, Lin; Wang, Dujuan

    2016-01-01

    Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section. One of the most important risk factors for postpartum infection is caesarean delivery. Caesarean section shows a higher incidence of infection than vaginal delivery. It is complicated by surgical site infections, endometritis or urinary tract infection. The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital. A pros...

  17. Antibiotic Adjuvants: Rescuing Antibiotics from Resistance.

    Science.gov (United States)

    Wright, Gerard D

    2016-11-01

    Rooted in the mechanism of action of antibiotics and subject to bacterial evolution, antibiotic resistance is difficult and perhaps impossible to overcome. Nevertheless, strategies can be used to minimize the emergence and impact of resistance. Antibiotic adjuvants offer one such approach. These are compounds that have little or no antibiotic activity themselves but act to block resistance or otherwise enhance antibiotic action. Antibiotic adjuvants are therefore delivered in combination with antibiotics and can be divided into two groups: Class I agents that act on the pathogen, and Class II agents that act on the host. Adjuvants offer a means to both suppress the emergence of resistance and rescue the activity of existing drugs, offering an orthogonal strategy complimentary to new antibiotic discovery VIDEO ABSTRACT. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Antibiotic use among older adults on an acute care general surgery service

    Science.gov (United States)

    Pollmann, André S.; Bailey, Jon G.; Davis, Philip J.B.; Johnson, Paul M.

    2017-01-01

    Background Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital. Methods Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines. Results During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Conclusion Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment. PMID:28930045

  19. Antibiotic use among older adults on an acute care general surgery service.

    Science.gov (United States)

    Pollmann, André S; Bailey, Jon G; Davis, Philip J B; Johnson, Paul M

    2017-12-01

    Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital. Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines. During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.

  20. Appropriate Use of Prophylactic Antibiotic Agents in Gynecologic Surgeries at a Midwestern Teaching Hospital.

    Science.gov (United States)

    Uppendahl, Locke; Chiles, Caitlin; Shields, Stephanie; Dong, Fanglong; Kraft, Elizabeth; Duong, Jennifer; Delmore, James

    2018-02-16

    The purpose of this study was to establish compliance with guidelines published by the American College of Obstetricians and Gynecologists (ACOG) regarding prophylactic antibiotic use in gynecologic surgery at our institution, and define areas of improvement to promote antibiotic stewardship. This was a retrospective cohort study at a single, large tertiary care and teaching hospital in Kansas. Patients who underwent inpatient or outpatient gynecologic surgery during 2013 were included. Based on published guidelines for prophylactic antibiotic agents for gynecologic surgery by ACOG, procedures were classified as antibiotic-indicated or antibiotic-not-indicated. Chi-square and Fisher exact test analysis were used to identify factors associated with antibiotic use. Of the 1,735 cases eligible for inclusion, 1,045 (60.2%) had antibiotic agents recommended per guidelines, and appropriate antibiotic agents were given in 1,031 (98.7%) of those cases. In 690 (39.8%) cases, prophylactic antibiotics were either not recommended or the guidelines are not well defined. Of the 690 cases without indication for antibiotic agents, 394 (57.1%) received prophylactic antibiotic agents. Agreement with guidelines varied substantially based on patient age, race, insurance status, area of residence, and if the procedure was a resident case (p gynecologic surgeries for which published guidelines are not well defined. Future studies need to identify strategies to reduce antibiotic use in surgical procedures unlikely to benefit from prophylaxis.

  1. Venous Thromboembolism Disease Prophylaxis in Foot and Ankle Surgery.

    Science.gov (United States)

    Chien, Bonnie Y; Dixon, Tonya; Guss, Daniel; DiGiovanni, Christopher

    2018-04-01

    There are limited data to guide the use of venous thromboembolism disease (VTED) prophylaxis after foot and ankle surgery. Although there is general consensus that the overall risk is lower than after hip or knee replacement, subpopulations of patients may be at relatively heightened risk. Furthermore, existing data are often conflicting regarding the efficacy of prophylaxis, with little acknowledgment of the tradeoffs between VTED prophylaxis and potential complications associated with the use of such medications. This article provides an overview of currently available evidence to guide decision making regarding VTED prophylaxis in patients who undergo foot and ankle surgery. Published by Elsevier Inc.

  2. Prophylactic antibiotics in vesicoureteric reflux: Evidence-based analysis

    Directory of Open Access Journals (Sweden)

    M S Ansari

    2009-01-01

    Full Text Available Objectives: The aim of this review was to systematically examine the available evidence for the effectiveness of prophylactic antibiotics in cases of vesicoureteric reflux (VUR. Materials and Methods: We searched the relevant data on medical management of VUR and the date of last search was June 2008. The search included both randomized controlled trials as well as the nonrandomized trials and the data sources were; MEDLINE, online peer reviewed journals, Cochrane database and abstracts from conference proceedings. Results: Barring few most of the studies published on medical management were nonrandomized. Besides being small in number many of these studies were of poor-quality and poorly designed eventually failing in giving a reliable answer in this regard. Few of the studies suggest that the children with low grade VUR might do well even without antibiotic prophylaxis. Conclusions : In the absence of properly designed, randomized controlled trials and long-term follow-up the question of antibiotic prophylaxis in cases of VUR remains unanswered in large part of it. Whether to give prophylactic antibiotics or not would ultimately need a shared decision-making involving both the treating physician and the parents assessing both the risks and the benefits.

  3. Do antibiotics reduce the frequency of surgical site infections after impacted mandibular third molar surgery?

    Science.gov (United States)

    Susarla, Srinivas M; Sharaf, Basel; Dodson, Thomas B

    2011-11-01

    Surgical removal of impacted third molars remains the most common procedure performed by oral and maxillofacial surgeons. Given the abundance of host bacteria within the operative sites, surgical site infections are among the most common complications of third molar removal, with an estimated frequency of 1% to 30%. In this setting, significant controversy has surrounded the use of prophylactic antibiotics in the surgical management of impacted third molars. This article provides a comprehensive review of the available data on antibiotic prophylaxis in impacted third molar surgery and offers specific recommendations on antibiotic use. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Antibiotic prescription: An oral physician′s point of view

    Directory of Open Access Journals (Sweden)

    Mahendra Patait

    2015-01-01

    Full Text Available Background: Antibiotics are important in the management and prophylaxis of infections in patients at a risk of experiencing microbial disease. Uses of systemic antibiotics in dentistry are limited since management of acute dental conditions is primarily based upon extraction of teeth or extirpation of the pulp. However, the literature provides evidence of inappropriate prescribing practices by practitioners, due to a number of factors from inadequate knowledge to social factors. Aim: The aim was to assess the therapeutic prescription of antibiotics in the dental office. Materials and Methods: In the current study, 42 faculty members of two dental colleges in the same vicinity were included. A questionnaire was drafted and sent to the dentists to collect data pertaining to the conditions in which antibiotics were prescribed and most commonly prescribed antibiotic. Results: During the study period, 42 faculty members from various departments in the institutes were surveyed, of which 41 questionnaires were completely filled. Amoxicillin was the most commonly prescribed antibiotic followed by other amoxicillin combinations; Metronidazole was most widely prescribed antibiotic for anaerobic infections. Conclusion: We have entered an era where cures may be few due to increasing microbial resistance. The biggest force for change will be if all practicing dentists looked at their prescribing and made it more rational.

  5. European guidelines on perioperative venous thromboembolism prophylaxis

    DEFF Research Database (Denmark)

    Venclauskas, Linas; Llau, Juan V; Jenny, Jean-Yves

    2018-01-01

    : In recent years, day surgery and fast-track surgery have experienced a continuous increase in volume. Many procedures are now performed on an outpatient protocol, including general, orthopaedic, oncological, reconstructive or vascular surgery. The management of these patients is safe......). Pharmacological prophylaxis should last a minimum of 7 days (Grade 1B), although in selected cases of fast-track surgery, thromboprophylaxis could be limited to hospitalisation only (Grade 2C) and in specific cases of high-risk procedures, thromboprophylaxis could be extended for up to 4 weeks (Grade 2B)....

  6. Maternal and institutional characteristics associated with the administration of prophylactic antibiotics for caesarean section: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.

    Science.gov (United States)

    Morisaki, N; Ganchimeg, T; Ota, E; Vogel, J P; Souza, J P; Mori, R; Gülmezoglu, A M

    2014-03-01

    To illustrate the variability in the use of antibiotic prophylaxis for caesarean section, and its effect on the prevention of postoperative infections. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. Three hundred and fifty-nine health facilities with the capacity to perform caesarean section. Descriptive analysis and effect estimates using multilevel logistic regression. Coverage of antibiotic prophylaxis for caesarean section. A total of 89 121 caesarean sections were performed in 332 of the 359 facilities included in the survey; 87% under prophylactic antibiotic coverage. Thirty five facilities provided 0-49% coverage and 77 facilities provided 50-89% coverage. Institutional coverage of prophylactic antibiotics varied greatly within most countries, and was related to guideline use and the practice of clinical audits, but not to the size, location of the institution or development index of the country. Mothers with complications, such as HIV infection, anaemia, or pre-eclampsia/eclampsia, were more likely to receive antibiotic prophylaxis. At the same time, mothers undergoing caesarean birth prior to labour and those with indication for scheduled deliveries were also more likely to receive antibiotic prophylaxis, despite their lower risk of infection, compared with mothers undergoing emergency caesarean section. Coverage of antibiotic prophylaxis for caesarean birth may be related to the perception of the importance of guidelines and clinical audits in the facility. There may also be a tendency to use antibiotics when caesarean section has been scheduled and antibiotic prophylaxis is already included in the routine clinical protocol. This study may act as a signal to re-evaluate institutional practices as a way to identify areas where improvement is possible. © 2014 RCOG The World Health Organization retains copyright and all other rights in

  7. Surgical Site Infection in Colorectal Surgery: A Study in Antibiotic Duration.

    Science.gov (United States)

    Dornfeld, Mark; Lovely, Jenna K; Huebner, Marianne; Larson, David W

    2017-09-01

    Despite distant historical studies that demonstrated the adequacy of preoperative antibiotic prophylaxis, current surgical practice continues to use antibiotics for postoperative coverage up to 24 hours. The aim of this study was to evaluate a change in antibiotic prophylaxis duration and its effect on surgical site infection in a high-volume modern colorectal practice. A case-controlled series retrospectively reviewed outcomes through a prospective validated data base. The study was conducted at Mayo Clinic, Rochester, Minnesota. A total of 965 patients were evaluated. Our study analyzed patient outcomes related to surgical site infection comparing cohort 1 (2012-2013), which had the same antibiotic coverage preoperatively up to 24 hours postoperatively, and cohort 2 (2014-2015), which eliminated postoperative doses and relied solely on pre- and intraoperative dosing duration. The primary outcomes of this study are superficial and deep surgical site infection. There were no differences identified for superficial or deep surgical site infection rates between cohorts. Before the change in antibiotic dosing duration (2012-2013), 28 of 493 patients (5.7%) vs after the practice change (2014-2015), 25 of 472 patients (5.3%) were reported to have superficial or deep surgical site infection (p = 0.794). This study is limited by its retrospective design within a single institution. These equivalent results present an opportunity for surgeons to reconsider optimal antibiotic duration and minimize unnecessary antibiotic dosing. See Video Abstract at http://links.lww.com/DCR/A322.

  8. Cost-effectiveness analysis of pharmacokinetic-driven prophylaxis vs. standard prophylaxis in patients with severe haemophilia A.

    Science.gov (United States)

    Iannazzo, Sergio; Cortesi, Paolo A; Crea, Roberto; Steinitz, Katharina; Mantovani, Lorenzo G; Gringeri, Alessandro

    2017-09-01

    : The objective of this study was to assess the cost-effectiveness of pharmacokinetic-driven prophylaxis in severe haemophilia A patients. A microsimulation model was developed to evaluate the cost-effectiveness of pharmacokinetic-driven prophylaxis vs. standard prophylaxis and estimate cost, annual joint bleed rate (AJBR), and incremental cost-effectiveness ratio over a 1-year time horizon for a hypothetical population of 10 000 severe haemophilia A patients. A dose of 30 IU/kg per 48 h was assumed for standard prophylaxis. Pharmacokinetic prophylaxis was individually adjusted to maintain trough levels at least 1 and 5 IU/dl or less. AJBR was estimated on the relationship between factor VIII (FVIII) levels and bleeding rate reported in the literature. Sensitivity analyses were performed to assess the stability of the model and the reliability of results. The FVIII dose was reduced in the 27.8% of patients with a trough level more than 5 IU/dl on standard prophylaxis, with a negligible impact on AJBR (+0.1 bleed/year). The FVIII dose was increased in the 10.6% of patients with trough levels less than 1 IU/dl on standard prophylaxis, with a significant reduction of AJBR (-1.9 bleeds/year). On average, overall, pharmacokinetic-driven prophylaxis was shown to decrease the AJBR from 1.012 to 0.845 with a slight reduction of the infusion dose of 0.36 IU/kg, with total saving of 5 197&OV0556; per patient-year. Pharmacokinetic-driven prophylaxis was preferable (i.e. more effective and less costly) compared with standard prophylaxis, with savings of 31 205&OV0556; per bleed avoided. Pharmacokinetic-driven prophylaxis, accounting for patients' individual pharmacokinetic variability, appears to be a promising strategy to improve outcomes with efficient use of available resources in severe haemophilia A patients.

  9. Antibiotics to prevent complications following tooth extractions.

    Science.gov (United States)

    Lodi, Giovanni; Figini, Lara; Sardella, Andrea; Carrassi, Antonio; Del Fabbro, Massimo; Furness, Susan

    2012-11-14

    The most frequent indications for tooth extractions are dental caries and periodontal infections, and these extractions are generally done by general dental practitioners. Antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. To determine the effect of antibiotic prophylaxis on the development of infectious complications following tooth extractions. The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 25 January 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1948 to 25 January 2012), EMBASE via OVID (1980 to 25 January 2012) and LILACS via BIREME (1982 to 25 January 2012). There were no restrictions regarding language or date of publication. We included randomised double-blind placebo-controlled trials of antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. Two review authors independently assessed risk of bias for the included studies and extracted data. We contacted trial authors for further details where these were unclear. For dichotomous outcomes we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. The quality of the body of evidence has been assessed using the GRADE tool. This review included 18 double-blind placebo-controlled trials with a total of 2456 participants. Five trials were assessed at unclear risk of bias, thirteen at high risk, and none at low risk of bias. Compared to placebo, antibiotics probably reduce the risk of infection in patients undergoing third molar extraction(s) by approximately 70% (RR 0.29 (95% CI 0.16 to 0.50) P antibiotics to prevent one infection following extraction of impacted wisdom teeth. There is evidence that antibiotics may reduce

  10. Attitudes toward infection prophylaxis in pediatric oncology: a qualitative approach.

    Directory of Open Access Journals (Sweden)

    Caroline Diorio

    Full Text Available The risks and benefits of infection prophylaxis are uncertain in children with cancer and thus, preferences should be considered in decision making. The purpose of this report was to describe the attitudes of parents, children and healthcare professionals to infection prophylaxis in pediatric oncology.THE STUDY WAS COMPLETED IN THREE PHASES: 1 An initial qualitative pilot to identify the main attributes influencing the decision to use infection prophylaxis, which were then incorporated into a discrete choice experiment; 2 A think aloud during the discrete choice experiment in which preferences for infection prophylaxis were elicited quantitatively; and 3 In-depth follow up interviews. Interviews were recorded verbatim and analyzed using an iterative, thematic analysis. Final themes were selected using a consensus approach.A total of 35 parents, 22 children and 28 healthcare professionals participated. All three groups suggested that the most important factor influencing their decision making was the effect of prophylaxis on reducing the chance of death. Themes of importance to the three groups included antimicrobial resistance, side effects of medications, the financial impact of outpatient prophylaxis and the route and schedule of administration.Effect of prophylaxis on risk of death was a key factor in decision making. Other identified factors were antimicrobial resistance, side effects of medication, financial impact and administration details. Better understanding of factors driving decision making for infection prophylaxis will help facilitate future implementation of prophylactic regiments.

  11. Knowledge, Attitude and Practice of Post-Exposure Prophylaxis (PEP)

    African Journals Online (AJOL)

    user

    Conclusion: The knowledge of PEP is satisfactory in UCTH, Calabar and issues that need to be addressed in our ... society. KEYWORDS: Knowledge, Attitude, Post-Exposure Prophylaxis Knowledge, Attitude and Practice of post-exposure prophylaxis to HIV. INTRODUCTION ... needles among intravenous drug use.

  12. Antibiotic use in acute pancreatitis: An audit of current practice in a tertiary centre.

    Science.gov (United States)

    Baltatzis, Minas; Mason, J M; Chandrabalan, Vishnu; Stathakis, Panagiotis; McIntyre, Ben; Jegatheeswaran, Santhalingam; Jamdar, Saurabh; O'Reilly, Derek A; Siriwardena, Ajith K

    Intravenous antibiotic prophylaxis is not recommended in acute pancreatitis. According to current international guidelines antibiotics together with further intervention should be considered in the setting of infected necrosis. Appropriate antibiotic therapy particularly avoiding over-prescription is important. This study examines antibiotic use in acute pancreatitis in a tertiary centre using the current IAP/APA guidelines for reference. Data were collected on a consecutive series of patients admitted with acute pancreatitis over a 12 month period. Data were dichotomized by patients admitted directly to the centre and tertiary transfers. Information was collected on clinical course with specific reference to antibiotic use, episode severity, intervention and outcome. 111 consecutive episodes of acute pancreatitis constitute the reported population. 31 (28%) were tertiary transfers. Overall 65 (58.5%) patients received antibiotics. Significantly more tertiary transfer patients received antibiotics. Mean person-days of antibiotic use was 23.9 (sd 29.7) days in the overall study group but there was significantly more use in the tertiary transfer group as compared to patients having their index admission to the centre (40.9 sd 37.1 vs 10.2 sd 8.9; P acute pancreatitis received antibiotics. There is substantial use of antibiotics in acute pancreatitis, in particular in patients with severe disease. Over-use is seen in mild acute pancreatitis. Better consideration must be given to identification of prophylaxis or therapy as indication. In relation to repeated courses of antibiotics in severe disease there must be clear indications for use. Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  13. Supplementary iron dose in pregnancy anemia prophylaxis.

    Science.gov (United States)

    Reddaiah, V P; Raj, P P; Ramachandran, K; Nath, L M; Sood, S K; Madan, N; Rusia, U

    1989-01-01

    This study was conducted to determine the optimum dose of supplemental iron for prophylaxis against pregnancy anemia. One hundred and ten pregnant women were randomly allocated to three groups: Group A receiving equivalent of 60 mg, group B 120 mg and Group C 240 mg, elemental iron as ferrous sulphate daily; the content of folic acid was constant in all the three groups (0.5 mg). These women had at least consumed 90 tablets in 100 +/- 10 days. Blood was drawn at the beginning and at the end of the treatment. Fifty percent were anemic (less than 11 g/100 ml). The hemoglobin levels rose similarly in all groups and the differences were statistically not significant. Fifty-six percent had depleted iron stores (serum ferritin value less than 12 micrograms/l) at the beginning of the study. Following therapy a statistically significant increase in iron stores was observed in group B and C as compared to group A. The difference between group B and C was not significant. The side effects increased with increasing doses of iron; 32.4%, 40.3% and 72% in group A, B and C respectively. Based on these findings, the authors advocate that optimum dose of iron should be 120 mg instead of 60 mg as is currently being used in the National Nutritional Anemia Prophylaxis Programme.

  14. Economic costs of rabies post exposure prophylaxis

    Directory of Open Access Journals (Sweden)

    Ravish Shankaraiah Hardanahalli

    2017-05-01

    Full Text Available Background: The highest financial expenditure for Rabies in any country is the cost of rabies post-exposure prophylaxis. The type of vaccine and route of administration, as well as type of immunoglobulin used, all significantly influences the cost of treatment. Aims & Objective: To analyse the direct and indirect cost of the rabies post exposure prophylaxis. Material & Methods: The study was conducted at anti-rabies clinics of Government Hospital, where PEP is provided free of cost and a private medical college hospital, where PEP is provided for a cost. 290 animal bite victims who completed the PEP were included in the study. After obtaining written informed consent from the study subjects, data regarding socio-demographic profile, details of animal bite exposure, cost incurred for PEP i.e, direct and indirect cost were collected. Results were expressed as proportions, median and inter-quartile range (Q1-Q3. Results: The total median cost incurred by the bite victims for PEP in Government hospitals was Rs.585 with Q1-Q3 of Rs.444-725 and the cost spent by the government was Rs. 1031; whereas the total cost incurred in private hospital was Rs.5200 with Q1-Q3 of Rs.4900-5701.Conclusion: PEP has a significant economic burden to the bite victims, especially for poor people living of the developing World.

  15. Value of prophylactic antibiotics for invasive dental procedures unclear.

    Science.gov (United States)

    Rochlen, Glenn K; Keenan, Analia Veitz

    2014-03-01

    The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the metaRegister of Controlled Trials. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) would be included where available. Due to the low incidence of bacterial endocarditis it was anticipated that few such trials would be found. Cohort and case-control studies were included where suitably matched control or comparison groups had been studied. Two review authors independently selected studies for inclusion then assessed risk of bias and extracted data from the included study. Only one case controlled study met the inclusion criteria. It collected all the cases of endocarditis in the Netherlands over two years, finding a total of 24 people who developed endocarditis within 180 days of an invasive dental procedure, definitely requiring prophylaxis according to current guidelines, and who were at increased risk of endocarditis due to a pre-existing cardiac problem. This study included participants who died because of the endocarditis (using proxies). Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days, and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes. There remains no evidence that antibiotic prophylaxis is either effective or ineffective against bacterial endocarditis in people considered at risk who are about to undergo an invasive dental procedure. It is not clear whether the potential harms and costs of penicillin administration outweigh any beneficial effect. Ethically, practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.

  16. Detection of antibiotic residues in food by Charm II test

    International Nuclear Information System (INIS)

    Addali, Mohamed

    2014-01-01

    Antibiotics are used in food to: -therapy and prophylaxis, -increase the productivity of the food producing animals. The presence of antimicrobial residues: -constitutes a potential human health hazard. has significant impact on international food trade. has implications on technological process in dairy industry. Detection of antibiotic residues is of great interest. It helps protect humans against the effects of such residues, the more it can support the participation of our country in international trade. Charm II test is one of the methods of detection of antimicrobial residues. The tests utilize microbial or antibody receptor assay technology. The sample is incubated with a binding agent (microbial cells with specific receptor sites or with specific antibodies attached) and a tracer (the radio-labeled version of the antibiotic to be detected). The amount of tracer on the binding agent is measured using a scintillation counter and is compared to a pre-determined cut-off or control point. If contaminating antibiotic is present, it will prevent the binding of the tracer by occupying the receptors on the binding agent. The less labeled tracer detected, the more contaminating antibiotic there is present in the sample. This work, carried out at the Radiochemical Laboratory of the National Centre of Nuclear Science and Technology, has two parts: 1/ The first is reserved to a literature review provides an overview on antibiotics and the charm II method. 2/ The second is devoted to the experimental study and presentation of results.

  17. Bacterial adhesion to urethral catheters: role of coating materials and immersion in antibiotic solution.

    Science.gov (United States)

    Cormio, L; La Forgia, P; La Forgia, D; Siitonen, A; Ruutu, M

    2001-09-01

    To determine whether new coating materials (silver and hydrogel) or immersion in antibiotic solution may reduce or prevent bacterial adhesion to urethral catheters. Precut segment of Teflon-, silver- and hydrogel-coated urethral catheters were incubated with two uropathogenic bacterial strains with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI), especially in hospitals. Microbiological analysis showed that the new coating materials (silver and hydrogel) did not reduce bacterial adhesion to urethral catheters, whereas immersion in antibiotic solution yielded a statistically significant (ptobramycin. Immersion in a suitable antibiotic solution may significantly reduce bacterial adhesion to urethral catheters and consequently reduce the risk of UTI in connection with these devices. Although experimental, these findings may be of clinical relevance and provide grounds for further studies in vivo.

  18. Antibiotic overusage and resistance: A cross-sectional survey among pediatric dentists

    Directory of Open Access Journals (Sweden)

    Sapna Konde

    2016-01-01

    Full Text Available Introduction: Most human orofacial infections originate from odontogenic infections and prescribing antibiotics has become a ubiquitous phenomenon. The World Health Organization (WHO has recognized the inappropriate, indiscriminate, and irrational use of antibiotics leading to antibiotic resistance as a global problem. Objective: The objective of this survey is to compare the antibiotic prescription pattern and the awareness of antibiotic resistance among Bachelor of Dental Surgery (BDS practitioners and pediatric dentists. Materials and methods: A hundred BDS practitioners and 100 pediatric dentists included in the study were given a questionnaire containing both open-ended and closed-ended questions. The questionnaire comprised information pertaining to antibiotic prescription for most common oral conditions, commonly prescribed antibiotics, their dosage, etc. Results: The majority of the practitioners prescribed antibiotics for managing oral diseases. On comparing the prescription patterns between the BDS practitioners and pediatric dentists, there was an overprescription in the BDS group for many conditions, which was statistically significant. Amoxicillin was the most commonly prescribed drug in both the groups. In the presence of an anaerobic infection, the most preferred drug was a combination of amoxicillin and clavulanic acid with metronidazole. With regard to the duration of antibiotic prescription, 74% BDS practitioners prescribed antibiotics as a 3-day course and 60% pediatric dentists resorted to a 5-day course, which was statistically significant. The awareness regarding antibiotic prophylaxis and antibiotic resistance was found to be adequate in both the groups. However, there was a general lack of awareness with regard to the guidelines for antibiotic prescribing in both the groups. Conclusion: Practitioners should prescribe antibiotics in accordance with the guidelines to curb antibiotic resistance, an emerging public health

  19. Antibiotic-Resistant Gonorrhea

    Science.gov (United States)

    ... Twitter STD on Facebook Sexually Transmitted Diseases (STDs) Antibiotic-Resistant Gonorrhea Recommend on Facebook Tweet Share Compartir ... Threat Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it. Following the spread ...

  20. Antibiotics and Resistance: Glossary

    Science.gov (United States)

    ... Work Contact Us ABOUT THE ISSUE What is Antibiotic Resistance? General Background Science of Resistance Glossary References ... for Adaptation Genetics and Drug Resistance Reservoirs of Antibiotic Resistance Project (ROAR) INTERNATIONAL CHAPTERS APUA Chapter Network ...

  1. Complex systematic review - Perioperative antibiotics in conjunction with dental implant placement.

    Science.gov (United States)

    Lund, Bodil; Hultin, Margareta; Tranaeus, Sofia; Naimi-Akbar, Aron; Klinge, Björn

    2015-09-01

    The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews. A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed. The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking. Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Clinical pharmacists' review of surgical antimicrobial prophylaxis in a tertiary hospital in Abu Dhabi.

    Science.gov (United States)

    El Hassan, Mohamed; Elnour, Asim Ahmed; Farah, Farah Hamad; Shehab, Abdulla; Al Kalbani, Naama M; Asim, Sahar; Shehab, Omer Abdulla; Abdulla, Rauda

    2015-02-01

    There is a lack of evidence to support standard of care and concordance with surgical antimicrobial prophylaxis (SAP) guidelines in our setting. There is an opportunity for clinical pharmacists to facilitate this process across all surgical disciplines. To assess adherence of surgeons to SAP guidelines. This was a retrospective study of 250 patients who underwent surgery during 2012 in Mafraq Hospital, Abu Dhabi. We evaluated prescribing of SAP, antimicrobial selection, first-dose timing, dose interval, treatment duration and adherence of surgeons to local hospital guidelines. We reviewed 250 patients (193 were male and 57 were female, mean age 36 ± 1.2 years); 54 % had elective operations and 46 % underwent emergency surgery. Adherence to hospital guidelines was 32.1 %. Antimicrobial selection, timing of the first dose, dosage interval and treatment duration were concordant with the hospital guidelines in 26, 31 and 40.3 % of cases, respectively. Main barriers to adherence to hospital guidelines were lack of awareness and education. The present study indicated poor adherence to the SAP guidelines. The timing of administration of SAP was not appropriate in two-thirds of the patients and more than half received more than three doses of SAP inappropriately. Continuing medical education should target antimicrobial prophylaxis (selection, timing and duration), clinical pharmacy antibiotic services and cyclic auditing.

  3. Fungal infections in marrow transplant recipients under antifungal prophylaxis with fluconazole

    Directory of Open Access Journals (Sweden)

    Oliveira J.S.R.

    2002-01-01

    Full Text Available Fungal infection is one of the most important causes of morbidity and mortality in bone marrow transplant (BMT recipients. The growing incidence of these infections is related to several factors including prolonged granulocytopenia, use of broad-spectrum antibiotics, conditioning regimens, and use of immunosuppression to avoid graft-versus-host disease (GvHD. In the present series, we report five cases of invasive mold infections documented among 64 BMT recipients undergoing fluconazole antifungal prophylaxis: 1 A strain of Scedosporium prolificans was isolated from a skin lesion that developed on day +72 after BMT in a chronic myeloid leukemic patient. 2 Invasive pulmonary aspergillosis (Aspergillus fumigatus was diagnosed on day +29 in a patient with a long period of hospitalization before being transplanted for severe aplastic anemia. 3 A tumoral lung lesion due to Rhizopus arrhizus (zygomycosis was observed in a transplanted patient who presented severe chronic GvHD. 4 A tumoral lesion due to Aspergillus spp involving the 7th, 8th and 9th right ribs and local soft tissue was diagnosed in a BMT patient on day +110. 5 A patient with a history of Ph1-positive acute lymphocytic leukemia exhibited a cerebral lesion on day +477 after receiving a BMT during an episode of severe chronic GvHD. At that time, blood and spinal fluid cultures yielded Fusarium sp. Opportunistic infections due to fungi other than Candida spp are becoming a major problem among BMT patients receiving systemic antifungal prophylaxis with fluconazole.

  4. Surveillance of antibiotic consumption using the "focus of infection" approach in 2 hospitals in Ujjain, India.

    Directory of Open Access Journals (Sweden)

    Ashish Pathak

    Full Text Available Antibiotic surveillance initiatives are limited in resource-constrained settings. In the present study, a quantitative comparison of antibiotic use rates for suspected infections in 2 hospitals in India was performed using the "focus of infection" approach to identify targets for quality improvement in antibiotic prescription patterns in hospitalized patients.This observational study was carried out in one teaching and one nonteaching hospital. All the patients with suspected bacterial etiology were included. Data on the prescribed antibiotics and the focus of infection were prospectively collected using a structured questionnaire. Each diagnosis was further reviewed and confirmed by an independent consultant. The prescribed antibiotics were coded according to the World Health Organization Anatomic Therapeutic Classification (ATC index with the defined daily dose (DDD methodology. Focus-specific DDDs were calculated per hundred patient days (DDD/HPD.A total of 6026 patients were included from 72 participating physicians out of available 75 physicians. Overall antibiotic prescribing was higher by 5 percentage points in the teaching hospital (95% than in the nonteaching hospital (90%. Quinolones (ciprofloxacin constituting 86% of DDD/HPD were the highest prescribed class in the teaching hospital, and third-generation cephalosporins (with ceftriaxone and ceftriaxone/sulbactam constituting 40% and 28% of the DDD/HPD, respectively, in the nonteaching hospital. The targets identified for improvement were the following: longer than recommended duration of prophylaxis and lack of distinction between prophylaxis and therapy among surgical patients; irrational antibiotic prescribing in gastroenteritis; overuse of quinolones and lack of use of penicillin in pneumonia; overuse of quinolones and lack of use of doxycycline and macrolides in genital infections; and overreliance on antibiotics for treating skin and soft tissue infections.Providing a

  5. Fatal rabies despite post-exposure prophylaxis

    Directory of Open Access Journals (Sweden)

    D G Deshmukh

    2011-01-01

    Full Text Available Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

  6. Pathophysiology of sepsis and recent patents on the diagnosis, treatment and prophylaxis for sepsis.

    Science.gov (United States)

    Okazaki, Yasumasa; Matsukawa, Akihiro

    2009-01-01

    Despite advances in the development of powerful antibiotics and intensive care unit, sepsis is still life threatening and the mortality rate remains unchanged for the past three decades. Recent prospective trials with biological response modifiers have shown a modest clinical benefit. The pathological basis of sepsis is initially an excessive inflammatory response against invading pathogens, leading to systemic inflammatory response syndrome (SIRS). Evidence reveals that a variety of inflammatory mediators orchestrate the intense inflammation through complicated cellular interactions. More recent data indicate that most septic patients survive this stage and then subjected to an immunoparalysis phase, termed compensatory anti-inflammatory response syndrome (CARS), which is more fatal than the initial phase. Sepsis is a complicated clinical syndrome with multiple physiologic and immunologic abnormalities. In this review, we summarize the recent understandings of the pathophysiology of sepsis, and introduce recent patents on diagnosis, treatment and prophylaxis for sepsis.

  7. Know When Antibiotics Work

    Centers for Disease Control (CDC) Podcasts

    2015-04-15

    This podcast provides a brief background about antibiotics and quick tips to help prevent antibiotic resistance.  Created: 4/15/2015 by Division of Bacterial Diseases (DBD), National Center for Immunization and Respiratory Disease (NCIRD), Get Smart: Know When Antibiotics Work Program.   Date Released: 4/16/2015.

  8. Antibiotic-Associated Diarrhea

    Science.gov (United States)

    ... antibiotic-associated colitis, which can occur after the antibiotic therapy upsets the balance of good and bad bacteria in your intestinal tract. Besides loose stools, C. difficile infection can ... and symptoms of antibiotic-associated diarrhea. These signs and symptoms are common ...

  9. Azithromycin prophylaxis and treatment of murine toxoplasmosis.

    Science.gov (United States)

    Tabbara, Khalid F; Hammouda, Ehab; Tawfik, Abdulkader; Al-Omar, Othman M; Abu El-Asrar, Ahmed M

    2005-03-01

    To evaluate the azithromycin effects alone and in combination with other agents in the prophylaxis and treatment of murine toxoplasmosis. A total of 280 BALB/c mice were included, and 2 x 103 Toxoplasma organisms of the RH strain Toxoplasma gondii strain ATCC50174 were given intraperitoneally to each mouse. In experiment one, 40 animals were given azithromycin 200 milligram/kilogram/daily for 3 days starting the day of inoculation, 40 mice were control. In experiment 2, the treatment was started 48 hours after inoculation and given daily for 3 days: one group received azithromycin 200 milligram/kilogram/day, the second group received pyrimethamine 25 milligram/kilogram/day, and the sulfadiazine 100 milligram/kilogram/day. The third group was control. In experiment 3, 7 groups of animals received one of the following (1) none, (2) azithromycin 200 milligram/kilogram/day, (3) pyrimethamine 25 milligram/kilogram/day and sulfadiazine 100 milligram/kilogram/day, (4) azithromycin and sulfadiazine, (5) azithromycin and pyrimethamine, (6) azithromycin with sulfadiazine and pyrimethamine, (7) sulfadiazine alone. Treatment was initiated 72 hours after inoculation for 3 days. The study was conducted at the Animal Care Facility of King Saud University, Riyadh, Kingdom of Saudi Arabia. Animals that received azithromycin simultaneously with inoculation survived, and all control animals died. All animals died in groups receiving single drug therapy. Animals treated with azithromycin and sulfadiazine showed a survival rate of 40%, sulfadiazine and pyrimethamine 40%, or azithromycin with sulfadiazine and pyrimethamine 95% (p<0.0001). Azithromycin alone was found to be effective in the prophylaxis of murine toxoplasmosis. Combination therapy was effective in the treatment of murine toxoplasmosis.

  10. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

    Science.gov (United States)

    Gower, Emily W; Lindsley, Kristina; Tulenko, Samantha E; Nanji, Afshan A; Leyngold, Ilya; McDonnell, Peter J

    2017-01-01

    Background Endophthalmitis is a severe inflammation of the anterior or posterior (or both) chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection. Objectives To evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery compared with no prophylaxis or other form of prophylaxis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to December 2016),the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We used no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 6 December 2016. We also searched for additional studies that cited any included trials using the Science Citation Index. Selection criteria We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. We included trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic), or postoperative antibiotic prophylaxis for acute endophthalmitis. We excluded studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine or antibiotics for treating acute endophthalmitis after cataract surgery. Data collection and analysis Two review authors independently reviewed abstracts and

  11. Probiotics in the prophylaxis of recurrent urinary tract infections in children

    Directory of Open Access Journals (Sweden)

    Danuta Zwolińska

    2017-09-01

    Full Text Available Recurrent urinary tract infections are a serious clinical problem both in adults and children. Febrile episodes of recurrent urinary tract infections may lead to the formation of renal scars and development of chronic kidney disease. Traditionally, management involved antibiotic prophylaxis introduced after a first febrile episode. Recently, however, the indications for antibiotic therapy have been narrowed down to treat cases of recurrent urinary tract infections and disorders which pose a significant risk for their development. In the current era of the ubiquitous use of antibiotics, bacterial resistance is an increasingly alarming problem, hence the recent search for alternative methods of prophylactic treatment. For many reasons, probiotics appear to be an excellent alternative. The microbiome of the human gastrointestinal tract and urogenital tract consists of a multitude of helpful probiotic bacteria, including the especially beneficial Lactobacillus strain. A significant relationship has been confirmed to exist between infections of the urinary tract and a decreased number of lactobacilli. Their antibacterial properties include their ability to  secrete numerous substances inhibiting the growth of  pathogenic microorganisms and to form a biofilm preventing the adhesion of uropathogens to the epithelium of the urinary tract as well as, indirectly, their immunomodulatory potential. This study is aimed at discussing the existing evidence supporting the effectiveness of probiotics in the prophylaxis of recurrent urinary tract infections, with special emphasis on the paediatric population. Probiotics make an excellent and safe alternative for the traditional prophylactic antibiotic therapy.

  12. Fosfluconazole for Antifungal Prophylaxis in Very Low Birth Weight Infants

    Directory of Open Access Journals (Sweden)

    Daijiro Takahashi

    2009-01-01

    Full Text Available We conducted a retrospective case series study to evaluate the safety of fosfluconazole prophylaxis for preventing invasive fungal infection in VLBW infants with a central vascular access. Fosfluconazole was administered intravenously at a dose of 6 mg/kg everyday during which time a central venous catheter was placed. A total of 23 infants met the criteria for enrollment in our study. No cases of fungal infection were detected during the central venous catheter placement in the group. None of the infants had an elevated β-D-glucan, and all of them were still alive at discharge. Regarding the liver and renal function, no statistically significant differences were observed before and at the end of fosfluconazole prophylaxis. The results of this study demonstrate that fosfluconazole prophylaxis in preventing invasive fungal infection was well tolerated by VLBW infants. This is a first report to describe antifungal prophylaxis using fosfluconazole for VLBW infants.

  13. Stress ulcer prophylaxis in the intensive care unit trial

    DEFF Research Database (Denmark)

    Krag, M; Perner, A; Wetterslev, J

    2017-01-01

    BACKGROUND: In this statistical analysis plan, we aim to provide details of the pre-defined statistical analyses of the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial. The aim of the SUP-ICU trial is to assess benefits and harms of stress ulcer prophylaxis with a proton pump...... inhibitor in adult patients in the intensive care unit (ICU). METHODS: The SUP-ICU trial is an investigator-initiated, international, multicentre, randomised, blinded, parallel-group trial of intravenously pantoprazole 40 mg once daily vs. placebo in 3350 acutely ill adult ICU patients at risk...... prophylaxis is standard of care in ICUs worldwide, but has never been tested in large high-quality randomised placebo-controlled trials. The SUP-ICU trial will provide important high-quality data on the balance between the benefits and harms of stress ulcer prophylaxis in adult critically ill patients....

  14. PrEP (Pre-Exposure Prophylaxis) 101

    Science.gov (United States)

    ... needs from CDC’s HIV Risk Reduction Tool (BETA). Infographics Click on the images below to view and download high resolution infographics dedicated to PrEP (Pre-Exposure Prophylaxis), an HIV ...

  15. [Contemporary view on the role of bacteriophages in evolution of nosocomial strains and prophylaxis of healthcare associated infections].

    Science.gov (United States)

    Zueva, L P; Aslanov, B I; Akimkin, V G

    2014-01-01

    One of the actual problems of contemporary healthcare are healthcare associated infections (HAI). An important aspect of study of HAI problem is the study of evolution of hospital strains causing HAI. The knowledge accumulated to date in the field of bacteria genetics gives evidence on the significant role of phages in the mechanism of virulence obtaining by pathogenic and opportunistic microorganisms. The studies of the authors of this article show that bacteriophages may play a significant role in the formation of virulent properties in hospital conditions that in different hospitals with participation of phages form virulent and antibiotic resistant hospital strains of HAI causative agents. At the same time bacteriophages are effective means for HAI therapy and prophylaxis. Under the condition of mass and irrational use of antibiotics, HAI causative agents form multiple resistance to the existing antibacterial preparations. In this regard bacteriophages as antimicrobial agents become especially actual. To date in Russian and foreign literature considerable material has been accumulated that shows high effectiveness of bacteriophages under the conditions of rational use. The aim of this review is to evaluate contemporary achievements in the field of study of bacteriophage role in evolution of hospital strains and therapy and prophylaxis of healthcare associated infections.

  16. Perception and Practice of Malaria Prophylaxis in Pregnancy among ...

    African Journals Online (AJOL)

    Perception et pratique de la prophylaxie du paludisme pendant la grossesse chez les dispensateurs des soins de santé à Ibadan L\\'étude a évalué la connaissance et la pratique chez les dispensateurs de soins de santé à l\\'égard de concepts courants à l\\'égard de la prophylaxie du paludisme pendant la grossesse.

  17. Is there an improvement of antibiotic use in China? Evidence from the usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals.

    Science.gov (United States)

    Zhou, Wen-Juan; Luo, Zhen-Ni; Tang, Chang-Min; Zou, Xiao-Xu; Zhao, Lu; Fang, Peng-Qian

    2016-10-01

    The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program (NASP), the overall usage and the prophylactic use of antibiotic for type I incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for type I incision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type I incision operations decreased by 16.22% (Pantibiotic therapy for type I incisions was also decreased. Region and bed size were the main determinants on surgical prophylaxis for type I incision. This national analysis of hospitals on antibiotic use and stewardship allows relevant comparisons for bench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.

  18. [Antibiotic stewardship (ABS). Definition, contents, necessity and practice on examples of current clinical-urological controversies].

    Science.gov (United States)

    Schneidewind, L; Kranz, J; Boehm, K; Spachmann, P; Siegel, F; Huck, N; Fritsche, H M

    2016-04-01

    Infectious diseases caused by multi-resistant pathogens are increasing worldwide and are posing a challenge to German urology as well. Furthermore, there is a limited perspective of new antibiotic developments. One way out of this dilemma is a differentiated handling and use of antibiotics (antibiotic stewardship, ABS). The aim of this review is to identify key issues in modern urological antibiotic therapy, which can be considered as exemplary for the whole topic of ABS. This includes a review of the current data of the individual topics, including thought-provoking impulse for future clinical application and research. The research group "infectious diseases" of GeSRU Academics identified the following central topics: excessive use of fluoroquinolones, diagnosis and treatment of urethritis and perioperative antibiotic prophylaxis. Subsequently, we performed a literature research in MEDLINE to uncover controversies and open questions of the individual topics within the meaning of ABS. The analysis of modern antibiotic therapy in urology shows numerous open questions in all quality dimensions of ABS: structural quality (e.g. through improved training of medical staff in the differentiated use of antibiotics), process quality (e.g. by improved adherence to existing infectiological guidelines, here in particular the perioperative prophylaxis and therapy of urethritis) and outcome (e.g. by detection of resistance rates and infection rates). The overarching and common goal is to avoid a post-antibiotic era. ABS programmes and a 10-point plan of the federal government are considered positive political developments in this area but do not release the individual urologist from a personal responsibility as part of his daily routine. A critical analysis of the topic "antibiotic treatment" is essential.

  19. Impact of pharmacist interventions on rational prophylactic antibiotic use and cost saving in elective cesarean section.

    Science.gov (United States)

    Wang, Jingwen; Dong, Mohan; Lu, Yang; Zhao, Xian; Li, Xin; Wen, Aidong

    2015-08-01

    To assess the impact of pharmacist interventions on rational use of prophylactic antibiotics and cost saving in elective cesarean section and the economic outcomes of implementing pharmacist interventions. A pre-to-post intervention design was applied to the practices of prophylactic antibiotic use in the department of gynecology and obstetrics in a Chinese tertiary hospital. Patients admitted during a 3-month period from June to August 2012 and during that from October to December 2012 undergoing elective cesarean section were assigned to the pre-intervention and the post-intervention group, respectively. Pharmacist interventions were performed in the post-intervention group, including obstetrician education, realtime monitoring of clinical records and making recommendations to obstetricians on prophylactic antibiotic prescription based on the criteria set at the beginning of the study. Data from the two groups were then compared to evaluate the outcomes of pharmacist interventions. Cost-outcome analysis was performed to determine the economic effect of implementing pharmacist interventions in preoperative antibiotic prophylaxis. Pharmacist interventions led to significant reductions in antibiotic usage cost/patient-day (p antibiotic cost (p antibiotics (p antibiotic use to the cost of pharmacist time was 27.23 : 1 and the net cost benefit was $65,255.84. This study provides evidence that pharmacist interventions promoted rational use of prophylactic antibiotics and substantial cost saving in elective cesarean section.

  20. Prophylaxis of migraine: general principles and patient acceptance

    Directory of Open Access Journals (Sweden)

    Domenico D’Amico

    2008-12-01

    Full Text Available Domenico D’Amico1, Stewart J Tepper21Headache Center, Department of Neurological Sciences, C Besta Neurological Institute, Milan, Italy; 2Center for Headache and Pain, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USAAbstract: Migraine is a chronic neurological condition with episodic exacerbations. Migraine is highly prevalent, and associated with significant pain, disability, and diminished quality of life. Migraine management is an important health care issue. Migraine management includes avoidance of trigger factors, lifestyle modifications, non-pharmacological therapies, and medications. Pharmacological treatment is traditionally divided into acute or symptomatic treatment, and preventive treatment or prophylaxis. Many migraine patients can be treated using only acute treatment. Patients with severe and/or frequent migraines require long-term preventive therapy. Prophylaxis requires daily administration of anti-migraine compounds with potential adverse events or contraindications, and may also interfere with other concurrent conditions and treatments. These problems may induce patients to reject the idea of a preventive treatment, leading to poor patient adherence. This paper reviews the main factors influencing patient acceptance of anti-migraine prophylaxis, providing practical suggestions to enhance patient willingness to accept pharmacological anti-migraine preventive therapy. We also provide information about the main clinical characteristics of migraine, and their negative consequences. The circumstances warranting prophylaxis in migraine patients as well as the main characteristics of the compounds currently used in migraine prophylaxis will also be briefly discussed, focusing on those aspects which can enhance patient acceptance and adherence.Keywords: migraine, prophylaxis, preventive therapy, acceptance, adherence

  1. Cytomegalovirus Hyper Immunoglobulin for CMV Prophylaxis in Thoracic Transplantation.

    Science.gov (United States)

    Rea, Federico; Potena, Luciano; Yonan, Nizar; Wagner, Florian; Calabrese, Fiorella

    2016-03-01

    Cytomegalovirus (CMV) infection negatively influences both short- and long-term outcomes after cardiothoracic transplantation. In heart transplantation, registry analyses have shown that CMV immunoglobulin (CMVIG) with or without virostatic prophylaxis is associated with a significant reduction in mortality and graft loss versus no prophylaxis, particularly in high-risk donor (D)+/recipient (R)- transplants. Randomized comparative trials are lacking but retrospective data suggest that addition of CMVIG to antiviral prophylaxis may reduce rates of CMV-related events after heart transplantation, including the incidence of acute rejection or chronic allograft vasculopathy. However, available data consistently indicate that when CMVIG is used, it should be administered with concomitant antiviral therapy, and that evidence concerning preemptive management with CMVIG is limited, but promising. In lung transplantation, CMVIG should again only be used with concomitant antiviral therapy. Retrospective studies have shown convincing evidence that addition of CMVIG to antiviral prophylaxis lowers CMV endpoints and mortality. The current balance of evidence suggests that CMVIG prophylaxis reduces the risk of bronchiolitis obliterans syndrome, but a controlled trial is awaited. Overall, the relatively limited current data set suggests that prophylaxis with CMVIG in combination with antiviral therapy appears effective in D+/R- heart transplant patients, whereas in lung transplantation, addition of CMVIG in recipients of a CMV-positive graft may offer an advantage in terms of CMV infection and disease.

  2. Cytomegalovirus Hyper Immunoglobulin for CMV Prophylaxis in Thoracic Transplantation

    Science.gov (United States)

    Rea, Federico; Potena, Luciano; Yonan, Nizar; Wagner, Florian; Calabrese, Fiorella

    2016-01-01

    Cytomegalovirus (CMV) infection negatively influences both short- and long-term outcomes after cardiothoracic transplantation. In heart transplantation, registry analyses have shown that CMV immunoglobulin (CMVIG) with or without virostatic prophylaxis is associated with a significant reduction in mortality and graft loss versus no prophylaxis, particularly in high-risk donor (D)+/recipient (R)− transplants. Randomized comparative trials are lacking but retrospective data suggest that addition of CMVIG to antiviral prophylaxis may reduce rates of CMV-related events after heart transplantation, including the incidence of acute rejection or chronic allograft vasculopathy. However, available data consistently indicate that when CMVIG is used, it should be administered with concomitant antiviral therapy, and that evidence concerning preemptive management with CMVIG is limited, but promising. In lung transplantation, CMVIG should again only be used with concomitant antiviral therapy. Retrospective studies have shown convincing evidence that addition of CMVIG to antiviral prophylaxis lowers CMV endpoints and mortality. The current balance of evidence suggests that CMVIG prophylaxis reduces the risk of bronchiolitis obliterans syndrome, but a controlled trial is awaited. Overall, the relatively limited current data set suggests that prophylaxis with CMVIG in combination with antiviral therapy appears effective in D+/R− heart transplant patients, whereas in lung transplantation, addition of CMVIG in recipients of a CMV-positive graft may offer an advantage in terms of CMV infection and disease. PMID:26900991

  3. The Importance of Perioperative Prophylaxis with Cefuroxime or Ceftriaxone in the Surgical Site Infections Prevention after Cranial and Spinal Neurosurgical Procedures.

    Science.gov (United States)

    Dimovska-Gavrilovska, Aleksandra; Chaparoski, Aleksandar; Gavrilovski, Andreja; Milenkovikj, Zvonko

    2017-09-01

    Introduction Surgical site infections pose a significant problem in the treatment of neurosurgical procedures, regardless of the application of perioperative prophylaxis with systemic antibiotics. The infection rate in these procedures ranges from less than 1% to above 15%. Different antibiotics and administration regimes have been used in the perioperative prophylaxis so far, and there are numerous comparative studies regarding their efficiency, however, it is generally indicated that the choice thereof should be based on information and local specifics connected to the most probable bacterial causers, which would possibly contaminate the surgical site and cause infection, and moreover, the mandatory compliance with the principles of providing adequate concentration of the drug at the time of the anticipated contamination. Objective Comparing the protective effect of two perioperative prophylactic antibiotic regimes using cefuroxime (second generation cephalosporin) and ceftriaxone (third generation cephalosporin) in the prevention of postoperative surgical site infections after elective and urgent cranial and spinal neurosurgical procedures at the University Clinic for Neurosurgery in Skopje in the period of the first three months of 2016. Design of the study Prospective randomized comparative study. Outcome measures Establishing the clinical outcome represented as prevalence of superficial and deep incision and organ/space postoperative surgical site infections. Material and method We analyzed prospectively 40 patients who received parenteral antibiotic prophylaxis with two antibiotic regimes one hour before the routine neurosurgical cranial and spinal surgical procedures; the patients were randomized in two groups, according to the order of admission and participation in the study, alternately, non-selectively, those persons who fulfilled inclusion criteria were placed in one of the two programmed regimes with cefuroxime in the first, and cefotaxime in the

  4. Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics

    OpenAIRE

    Tewary, Kishor; Narchi, Hassib

    2015-01-01

    Urinary tract infection (UTI) is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through infecti...

  5. The action of certain antibiotics and ether on swine enzootic pneumonia.

    Science.gov (United States)

    Huhn, R G

    1971-01-01

    The susceptibility of Mycoplasma hyopneumoniae to the action of three antibiotics and diethyl ether was determined. Infected swine were used in an in vivo sensitivity detection system. The parameter of susceptibility was lesion prophylaxis. In vivo, Mycoplasma hyopneumoniae appeared to be resistant to diethyl ether, tylosin tartrate, and erythromycin, but was susceptible to the action of chlortetracycline. Chlortetracycline was effective in preventing the development of lesions when given at levels which would be practical in commercial swine operations.

  6. [Prophylaxis of Recurrent Venous Leg Ulcer].

    Science.gov (United States)

    Kroeger, K; Storck, M; Kujath, P; Rabe, E; Dissemond, J

    2017-06-01

    Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patients' acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU. Georg Thieme Verlag KG Stuttgart · New York.

  7. DVT prophylaxis: better living through chemistry: affirms.

    Science.gov (United States)

    Pellegrini, Vincent D

    2010-09-07

    Venous thromboembolism remains the most common cause of hospital readmission and death after total joint arthroplasty. The 2008 American College of Chest Physicians (ACCP) guidelines, based on prospective randomized clinical trials with a venography endpoint, endorse the use of low-molecular-weight heparin, fondaparinux, or adjusted dose warfarin (target international normalized ratio, 2.5; range, 2-3) for up to 35 days after total hip arthroplasty (THA) and total knee arthroplasty (TKA). In the past, the ACCP has recommended against the use of aspirin, graduated compression stockings, or venous compression devices as the sole means of prophylaxis, but in 2008 they first recommended the "optimal use of mechanical thromboprophylaxis with venous foot pumps or intermittent pneumatic compression devices" in patients undergoing total joint arthroplasty who "have a high risk of bleeding." When the high risk subsides, pharmacologic thromboprophylaxis is substituted for, or added to, mechanical methods. Fractionated heparins and pentasaccharide are the most effective agents in reducing venographic deep venous thrombosis (DVT) after total joint arthroplasty with residual clot rates rates. Low-intensity warfarin (target international normalized ratio, 2.0) combines safety (bleeding rates exchange for a lower bleeding rate; genetic testing will likely simplify warfarin use and reduce outlier responders. Copyright 2010, SLACK Incorporated.

  8. Antibiotics and Breastfeeding.

    Science.gov (United States)

    de Sá Del Fiol, Fernando; Barberato-Filho, Silvio; de Cássia Bergamaschi, Cristiane; Lopes, Luciane Cruz; Gauthier, Timothy P

    2016-01-01

    During the breastfeeding period, bacterial infections can occur in the nursing mother, requiring the use of antibiotics. A lack of accurate information may lead health care professionals and mothers to suspend breastfeeding, which may be unnecessary. This article provides information on the main antibiotics that are appropriate for clinical use and the interference of these antibiotics with the infant to support medical decisions regarding the discontinuation of breastfeeding. We aim to provide information on the pharmacokinetic factors that interfere with the passage of antibiotics into breast milk and the toxicological implications of absorption by the infant. Publications related to the 20 most frequently employed antibiotics and their transfer into breast milk were evaluated. The results demonstrate that most antibiotics in clinical use are considered suitable during breastfeeding; however, the pharmacokinetic profile of each drug must be observed to ensure the resolution of the maternal infection and the safety of the infant. © 2016 S. Karger AG, Basel.

  9. Diet as prophylaxis and treatment for venous thromboembolism?

    Directory of Open Access Journals (Sweden)

    Cundiff David K

    2010-08-01

    Full Text Available Abstract Background Both prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT and pulmonary emboli (PE with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs showing efficacy, so efficacy trials were never required for FDA approval. In clinical trials of 'high VTE risk' surgical patients before the 1980s, anticoagulant prophylaxis was clearly beneficial (fatal pulmonary emboli (FPE without anticoagulants = 0.99%, FPE with anticoagulants = 0.31%. However, observational studies and RCTs of 'high VTE risk' surgical patients from the 1980s until 2010 show that FPE deaths without anticoagulants are about one-fourth the rate that occurs during prophylaxis with anticoagulants (FPE without anticoagulants = 0.023%, FPE while receiving anticoagulant prophylaxis = 0.10%. Additionally, an FPE rate of about 0.012% (35/28,400 in patients receiving prophylactic anticoagulants can be attributed to 'rebound hypercoagulation' in the two months after stopping anticoagulants. Alternatives to anticoagulant prophylaxis should be explored. Methods and Findings The literature concerning dietary influences on VTE incidence was reviewed. Hypotheses concerning the etiology of VTE were critiqued in relationship to the rationale for dietary versus anticoagulant approaches to prophylaxis and treatment. Epidemiological evidence suggests that a diet with ample fruits and vegetables and little meat may substantially reduce the risk of VTE; vegetarian, vegan, or Mediterranean diets favorably affect serum markers of hemostasis and inflammation. The valve cusp hypoxia hypothesis of DVT/VTE etiology is consistent with the development of VTE being affected directly or indirectly by diet. However, it is less consistent with

  10. Demographics of antibiotic persistence

    DEFF Research Database (Denmark)

    Kollerova, Silvia; Jouvet, Lionel; Steiner, Ulrich

    Persister cells, cells that can survive antibiotic exposure but lack heritable antibiotic resistance, are assumed to play a crucial role for the evolution of antibiotic resistance. Persistence is a stage associated with reduced metabolic activity. Most previous studies have been done on batch...... cultures, rather than the individual level. Here, we used individual level bacteria data to confirm previous studies in how fast cells switch into a persistence stage, but our results challenge the fundamental idea that persistence comes with major costs of reduced growth (cell elongation) and division due...... even play a more prominent role for the evolution of resistance and failures of medical treatment by antibiotics as currently assumed....

  11. Structure of polysaccharide antibiotics

    International Nuclear Information System (INIS)

    Matutano, L.

    1966-01-01

    Study of the structure of antibiotics having two or several sugars in their molecule. One may distinguish: the polysaccharide antibiotics themselves, made up of two or several sugars either with or without nitrogen, such as streptomycin, neomycins, paromomycine, kanamycin, chalcomycin; the hetero-polysaccharide antibiotics made up of one saccharide part linked to an aglycone of various type through a glucoside: macrolide, pigment, pyrimidine purine. Amongst these latter are: erythromycin, magnamycin, spiramycin, oleandomycin, cinerubin and amicetin. The sugars can either play a direct role in biochemical reactions or act as a dissolving agent, as far as the anti-microbe power of these antibiotics is concerned. (author) [fr

  12. [Antibiotic treatments in urology].

    Science.gov (United States)

    Chaussade, H; Sunder, S; Bernard, L; Coloby, P; Guy, L; Karsenty, G; Bastide, C; Bruyère, F

    2013-11-01

    To define prescription modalities for the use of antibiotics in urology. A bibliographic research was performed using the MEDLINE database concerning all the antibiotics usable in urology. Treatments were classified by families; modes of action, indications in urology and adverse events have been detailed. Administrative files for commercial use have been consulted and associated with literature analysis. About 8 classes of antibiotics are usable in urology in a routine use. How they work, indications in urology and adverse events are discussed. Knowing that bacterial resistance to quinilones is increasing dramatically, it seems imperative to control the use of 8 classes of antibiotics. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  13. Antibiotics: Miracle Drugs

    Centers for Disease Control (CDC) Podcasts

    2015-04-16

    The overuse of antibiotics has led to the development of resistance among bacteria, making antibiotics ineffective in treating certain conditions. This podcast discusses the importance of talking to your healthcare professional about whether or not antibiotics will be beneficial if you’ve been diagnosed with an infectious disease.  Created: 4/16/2015 by Division of Bacterial Diseases (DBD), National Center for Immunization and Respiratory Disease (NCIRD), Get Smart: Know When Antibiotics Work Program.   Date Released: 4/16/2015.

  14. The Role of Antibiotic Prophylaxis in the Ureteroscopy Treatment for Ureteral Lithiasis

    Directory of Open Access Journals (Sweden)

    Maier A.

    2014-06-01

    Full Text Available Introduction: One of the most common pathologies in urological praxis is urinary lithiasis. Extracorporeal shock wave lithotripsy (ESWL or frequently retrograde ureteroscopy are modern pathways in the treatment of this kind of pathology. There are certain problems which may develop after the ureteroscopy such as infection with fever complication.

  15. Urological care for children with spina bifida : Individual, tailored and without antibiotic prophylaxis

    NARCIS (Netherlands)

    Zegers, S.H.J.

    2017-01-01

    In our SPIN UTI study, we have focused on the urological problems, urinary tract infections and Quality of Life in spina bifida children. For eighteen months, we have analyzed the diagnosing, treatment and prevention of urinary tract infections in 176 children with spina bifida from Utrecht and

  16. Intravenous immunoglobulin for infectious diseases: back to the pre-antibiotic and passive prophylaxis era?

    Science.gov (United States)

    Bayry, Jagadeesh; Lacroix-Desmazes, Sébastien; Kazatchkine, Michel D; Kaveri, Srini V

    2004-06-01

    The dramatic increase in both the number of novel infectious agents and resistance to antimicrobial drugs has incited the need for adjunct therapies in the war against infectious diseases. Exciting recent studies have demonstrated the use of antibodies in the form of intravenous immunoglobulin (IVIg) against infections. By virtue of the diverse repertoire of immunoglobulins that possess a wide spectrum of antibacterial and antiviral specificities, IVIg provides antimicrobial efficacy independently of pathogen resistance and represents a promising alternative strategy for the treatment of diseases for which a specific therapy is not yet available.

  17. Possibilities of Correction and Prophylaxis of Intestinal Microbiocenosis Disorders in Frequently Ill Children

    Directory of Open Access Journals (Sweden)

    A. N. Surkov

    2013-01-01

    Full Text Available Frequently and protractedly ill children constitute a special for pediatricians group of patients. Acute respiratory infections with severe and frequently relapsing course badly affect children’s health and contribute to the decrease of the functional activity of the immune system. Risk factors of the high prevalence of acute respiratory infections are changes in the immune responses at the background of unfavorable ante- and perinatal conditions, numerous contacts with potential causative agents at the beginning of attendance of infant schools, widespread intra- and inter-family contacts as well as susceptibility to Th2 immune response (allergy and prolonged course of inflammatory process. Etiotropic treatment of acute respiratory infections often includes antibacterial drugs, which, however, have negative effects on intestinal microflora, such as dyspeptic syndrome and antibiotic-induced diarrhea. Intestinal dysbiosis affects homeostasis, leads to significant changes in functional activity of various organs and systems. That is why correction and prophylaxis of intestinal dysbacteriosis is very important in pediatric practice. In this article the main data on epidemiology, pathogenesis, forms, clinical manifestation, diagnostics and treatment of antibiotic-induced diarrhea in children.

  18. Corrosion potential recovery of dental amalgam restorations following prophylaxis.

    Science.gov (United States)

    Sutow, Elliott J; Maillet, J Peggy; Maillet, Wayne A; Hall, Gordon C; Millar, Michele

    2007-07-01

    Dental amalgam restorations are subjected to abrasion during selective prophylaxis that can damage or remove the protective oxide and result in increased rates of corrosion and chemical dissolution of mercury. It was the objective of this research to study the corrosion potential change of dental amalgam restorations to obtain an indication of the time required for in vivo repassivation following prophylaxis. The corrosion potentials of 27 Class I and Class II amalgam restorations were measured pre- and post-prophylaxis using a high impedance voltmeter and a Ag/AgCl micro-reference electrode. Prophylaxis was performed for approximately 2s on each amalgam surface using a slow-speed handpiece with a rubber-cup and commercial abrasive paste. Subjects thoroughly rinsed before the post-prophylaxis corrosion potentials were measured. The data were analyzed using a confidence interval, a t-test and correlation analysis. The pre- and post-prophylaxis mean corrosion potentials were, respectively, -132 (27)mV and -126 (27)mV. The mean of the differences between the pre- and post-prophylaxis corrosion potentials was 6.1 (28)mV, with an associated 95% confidence interval of (-4.8, 17)mV. A t-test showed the mean absolute difference in corrosion potential was less than 50 mV (pamalgam restorations occurred by at most 10-44 min, indicating that the period of elevated corrosion rate and elevated chemical dissolution rate of mercury, due to oxide damage or removal, may be short-lived.

  19. Handling Time-dependent Variables : Antibiotics and Antibiotic Resistance

    NARCIS (Netherlands)

    Munoz-Price, L. Silvia; Frencken, Jos F.; Tarima, Sergey; Bonten, Marc

    2016-01-01

    Elucidating quantitative associations between antibiotic exposure and antibiotic resistance development is important. In the absence of randomized trials, observational studies are the next best alternative to derive such estimates. Yet, as antibiotics are prescribed for varying time periods,

  20. The future of antibiotics

    Science.gov (United States)

    2014-01-01

    Antibiotic resistance continues to spread even as society is experiencing a market failure of new antibiotic research and development (R&D). Scientific, economic, and regulatory barriers all contribute to the antibiotic market failure. Scientific solutions to rekindle R&D include finding new screening strategies to identify novel antibiotic scaffolds and transforming the way we think about treating infections, such that the goal is to disarm the pathogen without killing it or modulate the host response to the organism without targeting the organism for destruction. Future economic strategies are likely to focus on ‘push’ incentives offered by public-private partnerships as well as increasing pricing by focusing development on areas of high unmet need. Such strategies can also help protect new antibiotics from overuse after marketing. Regulatory reform is needed to re-establish feasible and meaningful traditional antibiotic pathways, to create novel limited-use pathways that focus on highly resistant infections, and to harmonize regulatory standards across nations. We need new antibiotics with which to treat our patients. But we also need to protect those new antibiotics from misuse when they become available. If we want to break the cycle of resistance and change the current landscape, disruptive approaches that challenge long-standing dogma will be needed. PMID:25043962

  1. Antibiotic-Resistant Bacteria.

    Science.gov (United States)

    Longenecker, Nevin E.; Oppenheimer, Dan

    1982-01-01

    A study conducted by high school advanced bacteriology students appears to confirm the hypothesis that the incremental administration of antibiotics on several species of bacteria (Escherichia coli, Staphylococcus epidermis, Bacillus sublitus, Bacillus megaterium) will allow for the development of antibiotic-resistant strains. (PEB)

  2. Similar rebleeding rate in 3-day and 7-day intravenous ceftriaxone prophylaxis for patients with acute variceal bleeding.

    Science.gov (United States)

    Lee, Tzong-Hsi; Huang, Chung-Tsui; Lin, Chien-Chu; Chung, Chen-Shuan; Lin, Cheng-Kuan; Tsai, Kuang-Chau

    2016-07-01

    Although prophylactic antibiotics have been recommended for cirrhotic patients with upper gastrointestinal bleeding, the duration of its use remains an inconclusive issue. We designed this study to investigate the duration of antibiotic prophylaxis for cirrhotic patients with acute esophageal variceal bleeding. We enrolled those patients suffering from acute esophageal variceal bleeding and receiving band ligation. They were randomly allocated to two groups to receive prophylactic antibiotics; Group I: receiving intravenous ceftriaxone 500 mg every 12 hours for 3 days, and Group II: same regimen for 7 days. We used rebleeding rate within 14 days as the primary end point and also evaluated the survival rate within 28 days and the amount of transfusion during admission. There were 38 patients in Group I and 33 patients in Group II that completed the study course for analysis. Overall, there was no significant difference in the baseline characteristics between these two groups. There were three patients both in Group I and Group II who developed rebleeding within 14 days (8% vs. 9%, p > 0.99). There was also no difference between Group I and Group II in transfusion amount (2.71 ± 2.84 units vs. 3.18 ± 4.07, p = 0.839) and survival rate in 28 days (100 vs. 97%, p = 0.465). Our small scale study demonstrated that there was no difference in the rebleeding rate between 3-day and 7-day ceftriaxone prophylaxis for cirrhotic patients with acute esophageal variceal bleeding. There was also no difference in 28 day survival rate between these two groups. Copyright © 2016. Published by Elsevier B.V.

  3. Antibiotic-Resistant Gonorrhea (ARG)

    Science.gov (United States)

    ... Twitter STD on Facebook Sexually Transmitted Diseases (STDs) Antibiotic-Resistant Gonorrhea Basic Information Recommend on Facebook Tweet Share Compartir Antibiotic-Resistant Gonorrhea: An Overview Antibiotic resistance is the ...

  4. [Prophylaxis for stress ulcer bleeding in the intensive care unit].

    Science.gov (United States)

    Avendaño-Reyes, J M; Jaramillo-Ramírez, H

    2014-01-01

    The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases "stress ulcer", "stress ulcer bleeding prophylaxis", and "stress-related mucosal bleeding" in combination with "intensive care unit". The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies. Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  5. History of Antibiotics Research.

    Science.gov (United States)

    Mohr, Kathrin I

    2016-01-01

    For thousands of years people were delivered helplessly to various kinds of infections, which often reached epidemic proportions and have cost the lives of millions of people. This is precisely the age since mankind has been thinking of infectious diseases and the question of their causes. However, due to a lack of knowledge, the search for strategies to fight, heal, and prevent the spread of communicable diseases was unsuccessful for a long time. It was not until the discovery of the healing effects of (antibiotic producing) molds, the first microscopic observations of microorganisms in the seventeenth century, the refutation of the abiogenesis theory, and the dissolution of the question "What is the nature of infectious diseases?" that the first milestones within the history of antibiotics research were set. Then new discoveries accelerated rapidly: Bacteria could be isolated and cultured and were identified as possible agents of diseases as well as producers of bioactive metabolites. At the same time the first synthetic antibiotics were developed and shortly thereafter, thousands of synthetic substances as well as millions of soil borne bacteria and fungi were screened for bioactivity within numerous microbial laboratories of pharmaceutical companies. New antibiotic classes with different targets were discovered as on assembly line production. With the beginning of the twentieth century, many of the diseases which reached epidemic proportions at the time-e.g., cholera, syphilis, plague, tuberculosis, or typhoid fever, just to name a few, could be combatted with new discovered antibiotics. It should be considered that hundred years ago the market launch of new antibiotics was significantly faster and less complicated than today (where it takes 10-12 years in average between the discovery of a new antibiotic until the launch). After the first euphoria it was quickly realized that bacteria are able to develop, acquire, and spread numerous resistance mechanisms

  6. Appropriate Antibiotic Therapy.

    Science.gov (United States)

    Allison, Michael G; Heil, Emily L; Hayes, Bryan D

    2017-02-01

    Prescribing antibiotics is an essential component of initial therapy in sepsis. Early antibiotics are an important component of therapy, but speed of administration should not overshadow the patient-specific characteristics that determine the optimal breadth of antimicrobial therapy. Cultures should be drawn before antibiotic therapy if it does not significantly delay administration. Combination antibiotic therapy against gram-negative infections is not routinely required, and combination therapy involving vancomycin and piperacillin/tazobactam is associated with an increase in acute kidney injury. Emergency practitioners should be aware of special considerations in the administration and dosing of antibiotics in order to deliver optimal care to septic patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Are prophylactic antibiotics necessary for urodynamic study?

    Directory of Open Access Journals (Sweden)

    Cenk Gürbüz

    2013-06-01

    Full Text Available The aim of this study was to assess the efficacy of prophylactic fosfomycin tromethamine (FT and ciprofloxacin in preventing bacteriuria caused by urodynamic studies (UDS. A total of 426 adult patients presenting for UDS were enrolled the study. A midstream urine sample was taken 72 hours before and 5 days after the procedure. All patients underwent a standard UDS. The 411 patients who had sterile urine before intervention were included in the study. Patients were randomized into three groups. Group1 received no prophylaxis (n = 133, Group 2 (n = 141 received oral ciprofloxacin (500 mg 1 hour before the procedure, and Group 3 (n = 137 received a single dose of FT approximately 12 hours before the procedure. Bacteriuria was evaluated for each group. Bacteriuria was detected in 3 (2.3%, 6 (4.3% and 3 patients (1.6% in Group 1, Group 2, and Group 3, respectively. The most common identified microorganism was Escherichia coli (E coli in 6 patients (50%. Among the E coli group, extended spectrum beta-lactamase producing E coli was seen in 2 patients (33.3%. Univariate analysis demonstrated that a history of urogenital operation (p < 0.01 and female gender (p < 0.01 were significant risk factors for bacteriuria. On multiple logistic regression analysis, the past urogenital operation history was the only significant independent risk factor for significant bacteriuria after UDS (OR = 14, 95% CI = 1.82–23.8, p = 0.01. The prevalence of bacteriuria after UDS was relatively low in the current study population. Therefore, for most patients, it may be unnecessary to use preventive prophylactic antibiotics. However, our results suggest that in patients with a previous history of urologic surgery, the risk for significant bacteriuria is increased and the use of prophylaxis should be considered.

  8. Stable iodine prophylaxis. Recommendations of the 2nd UK Working Group on Stable Iodine Prophylaxis

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    The Working Group reviewed the revised Who guidance and the information published since 1991 on the risks of thyroid cancer in children from radioiodine and the risks of side effects from stable iodine. In particular, it reviewed data compiled on the incidence of thyroid cancers in children following the accident at the Chernobyl nuclear power plant in 1986. It considered whether the NRPB Earls were still appropriate, in the light of the new data. It also reviewed a range of other recommendations given by the 1st Working Group, concerning the chemical form of stable iodine tablets and practical issues concerning implementation of stable iodine prophylaxis. Finally, it reviewed the Patient Information Leaflet that is required, by law, to be included in each box of tablets and provided suggestions for information to be included in a separate information leaflet to be handed out to the public when stable iodine tablets are distributed.

  9. Deep Vein Thrombosis Prophylaxis: State of the Art.

    Science.gov (United States)

    Lieberman, Jay R

    2018-03-21

    The selection of a prophylaxis regimen to prevent symptomatic pulmonary embolism and deep vein thrombosis is a balance between efficacy and safety. The latest American Academy of Orthopaedic Surgeons guideline recommended that either chemoprophylaxis or mechanical prophylaxis be used after total joint arthroplasty but did not recommend specific agents. However, the latest evidence-based American College of Chest Physicians guideline recommended a variety of chemoprophylaxis and mechanical agents for a minimum of 10 to 14 days after total joint arthroplasty. Risk stratification is the key to the selection of the appropriate prophylaxis regimen for the individual patient, but the optimal risk stratification protocol still needs to be developed. Copyright © 2018. Published by Elsevier Inc.

  10. Biologically rational ways of bone mass loss prophylaxis and treatment

    Directory of Open Access Journals (Sweden)

    A. S. Avrunin

    2015-01-01

    Full Text Available Aim. Based on own and literature date to define biologically rational elements of complex approach to bone mass loss prophylaxis and treatment. Nowadays there are two points of view regarding bone mass loss prophylaxis and treatment. The first favor pharmaceuticals as a basic and physical exercises as additional. According to the second, therapeutic and prophylactic significance of physical exercises in maintenance and development of structural and functional capacities of musculoskeletal system is fundamental. The latter approach correspond to evolutionary formed biological model in that muscles act upon levers - bones that connected by means of joints and provide the movement of the body against gravity. The present work from pathogenethically point of view establish the systemic approach to the bone mass loss prophylaxis and treatment. It is based on physical exercises while additional pharmacotherapy that should aim for optimization of regulatory function of bone cells, first of all osteocytes providing for adaptational reorganisation of bone structures.

  11. Present and future of prophylactic antibiotics for severe acute pancreatitis

    Science.gov (United States)

    Jiang, Kun; Huang, Wei; Yang, Xiao-Nan; Xia, Qing

    2012-01-01

    AIM: To investigate the role of prophylactic antibiotics in the reduction of mortality of severe acute pancreatitis (SAP) patients, which is highly questioned by more and more randomized controlled trials (RCTs) and meta-analyses. METHODS: An updated meta-analysis was performed. RCTs comparing prophylactic antibiotics for SAP with control or placebo were included for meta-analysis. The mortality outcomes were pooled for estimation, and re-pooled estimation was performed by the sensitivity analysis of an ideal large-scale RCT. RESULTS: Currently available 11 RCTs were included. Subgroup analysis showed that there was significant reduction of mortality rate in the period before 2000, while no significant reduction in the period from 2000 [Risk Ratio, (RR) = 1.01, P = 0.98]. Funnel plot indicated that there might be apparent publication bias in the period before 2000. Sensitivity analysis showed that the RR of mortality rate ranged from 0.77 to 1.00 with a relatively narrow confidence interval (P antibiotic prophylaxis. CONCLUSION: Current evidences do not support prophylactic antibiotics as a routine treatment for SAP, but the potentially benefited sub-population requires further investigations. PMID:22294832

  12. Antibiotic resistance in children with complicated urinary tract infection

    International Nuclear Information System (INIS)

    Yildiz, B.; Kural, N.; Yarar, C.; Ak, I.; Akcar, N.

    2007-01-01

    Objective was to determine the resistance of antibiotics for complicated urinary tract infection (UTI), including urinary tract anomaly (UTA), for empirical antibiotic therapy of complicated UTI. Four hundred and twenty two urine isolates were obtained from 113 patients with recurrent UTI, who used prophylactic antibiotics between February 1999 and November 2004 in the Eskisehir Osmangazi University, Eskisehir, Turkey. Reflux was found to be most important predisposing factor for recurrent UTI (31.9%). Renal scar was detected more in patients with UTA than without UTA (59.2% versus 12.4%, p<0.05). Gram-negative organisms were dominant in patients with and without UTA (91.5% and 79.2%). Enterococci and Candida spp. were more prevalent in children with UTA than without UTA (p<0.001). Isolates were significantly more resistant to ampicillin, trimethoprim-sulfamethoxazole, amikacin, co-amoxiclav, ticarcillin-clvalanate and piperacillin-tazobactam in patients with UTA than without UTA. We found low resistance to ciprofloxacin and nitrofurantoin in UTI with and without UTA. Enterococci spp. was highly resistance to ampicillin and amikacin in patients with UTA. Aztreonam, meropenem and ciprofloxacin seemed to be the best choice for treatment of UTI with UTA due to Escherichia coli and Klebsiella spp. Nitrofurantoin and nalidixic acid may be first choice antibiotics for prophylaxis in UTI with and without UTA. The UTI with UTA caused by Enterococci spp. might not benefit from a combination of amikacin and ampicillin, it could be treated with glycopeptides. (author)

  13. The incidence of fluoroquinolone resistant infections after prostate biopsy--are fluoroquinolones still effective prophylaxis?

    Science.gov (United States)

    Feliciano, Joseph; Teper, Ervin; Ferrandino, Michael; Macchia, Richard J; Blank, William; Grunberger, Ivan; Colon, Ivan

    2008-03-01

    Fluoroquinolones have been shown to decrease infective complications after prostate biopsy. However, fluoroquinolone resistance is emerging. We quantified contemporary rates of infective complications and the incidence of fluoroquinolone resistant infections after prostate biopsy under fluoroquinolone prophylaxis. We retrospectively evaluated the records of 1,273 patients who underwent prostate biopsy at New York Harbor Veterans Affairs Hospital from January 2004 to December 2006. Patients received levofloxacin or gatifloxacin. Using the Veterans Affairs computerized patient record system we reviewed all patient visits within 1 month after prostate biopsy. Visits were queried for infective symptoms. Positive cultures were evaluated for resistance patterns. The annual and overall incidence of infective complications and fluoroquinolone resistant infections was calculated. Of 1,273 patients 31 (2.4%) presented with infective symptoms after biopsy. The overall incidence of fluoroquinolone resistant infections was 1.2% (15 cases). When stratified by year, there were statistically significant increases in the incidence of infective complications and fluoroquinolone resistance from 2004 to 2006. Of the positive cultures those from 89% of patients yielded Escherichia coli and 90% were fluoroquinolone resistant. Fluoroquinolone resistant E. coli were also resistant to gentamicin in 22% of cases, trimethoprim/sulfamethoxazole in 44%, piperacillin in 72% and ampicillin in 94%. However, 100% sensitivity was demonstrated for amikacin, ceftazidime and ceftriaxone. Fluoroquinolones are still effective as antibiotic prophylaxis for prostate biopsies but there is an increase in infective complications and fluoroquinolone resistance. When patients present with post-prostate biopsy infective symptoms, almost 50% are associated with fluoroquinolone resistant pathogens. Empirical treatment with ceftriaxone, ceftazidime or amikacin should be initiated until culture specific therapy can

  14. Outcomes of Preexposure Prophylaxis Referrals From Public STI Clinics and Implications for the Preexposure Prophylaxis Continuum.

    Science.gov (United States)

    Bhatia, Ramona; Modali, Laxmi; Lowther, Matthew; Glick, Nancy; Bell, Margo; Rowan, Sarah; Keglovitz, Kristin; Schneider, John

    2018-01-01

    Human immunodeficiency virus preexposure prophylaxis (PrEP) uptake remains low in high-risk populations. Sexually transmitted infection (STI) clinics reach PrEP-eligible persons and may be ideal settings to model PrEP implementation. Consenting PrEP-eligible patients identified at Chicago Department of Public Health STI Clinics were actively referred to PrEP partner sites between June 1, 2015, and May 31, 2016. Outcomes included successful contact by a partner site, linkage to a partner site, and receipt of a PrEP prescription. Bivariable and time to event analyses were conducted to determine significant associations of outcomes. One hundred thirty-seven patients were referred; 126 (92%) were men who have sex with men, and mean age was 29 years. Ninety-eight (72%) were contacted by a PrEP partner, 43 (31%) were linked, and 40 (29%) received a prescription. Individuals aged 25 years and older were more likely to link (odds ratio, 3.10; 95% confidence interval, 1.30-7.41) and receive a PrEP prescription (odds ratio, 2.70; 95% confidence interval, 1.12-6.45) compared with individuals 24 years and younger. The average time between each step was greater for those 24 years and younger compared with those aged 25 years and older for all steps. Time to event analyses revealed that those aged 25 years and older were significantly more likely to receive a prescription compared to those aged 24 years and younger (hazard ratio, 3.62; 95% risk limits, 1.47-8.92). Preexposure prophylaxis active referrals from STI clinics to partner sites are feasible, though drop out was prominent in the initial steps of the continuum. Youth were less likely to link or receive prescriptions, indicating the need for tailored interventions for this vulnerable population.

  15. Improving adherence to venous thromoembolism prophylaxis using multiple interventions

    Directory of Open Access Journals (Sweden)

    Al-Tawfiq Jaffar

    2011-01-01

    Full Text Available Objective : In hospital, deep vein thrombosis (DVT increases the morbidity and mortality in patients with acute medical illness. DVT prophylaxis is well known to be effective in preventing venous thromoembolism (VTE. However, its use remains suboptimal. The objective of this study was to evaluate the impact of quality improvement project on adherence with VTE prophylaxis guidelines and on the incidence of hospital-acquired VTEs in medical patients. Methods : The study was conducted at Saudi Aramco Medical Services Organization from June 2008 to August 2009. Quality improvement strategies included education of physicians, the development of a protocol, and weekly monitoring of compliance with the recommendations for VTE prophylaxis as included in the multidisciplinary rounds. A feedback was provided whenever a deviation from the protocol occurs. Results : During the study period, a total of 560 general internal medicine patients met the criteria for VTE prophylaxis. Of those, 513 (91% patients actually received the recommended VTE prophylaxis. The weekly compliance rate in the initial stage of the intervention was 63% (14 of 22 and increased to an overall rate of 100% (39 of 39 (P = 0.002. Hospital-acquired DVT rate was 0.8 per 1000 discharges in the preintervention period and 0.5 per 1000 discharges in the postintervention period, P = 0.51. However, there was a significant increase in the time-free period of the VTE and we had 11 months with no single DVT. Conclusion : In this study, the use of multiple interventions increased VTE prophylaxis compliance rate.

  16. Efficacy of enalapril in migraine prophylaxis: A randomized, double-blind, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Seyed Ali Sonbolestan

    2013-01-01

    Conclusion: Enalapril may be effective in migraine prophylaxis according to its effect in decreasing the frequency, severity, and duration of headaches. The results support the previous suggestions on usage of ACE inhibitors in migraine prophylaxis.

  17. Increase in prophylaxis of glucocorticoid-induced osteoporosis by pharmacist feedback : a randomised controlled trial

    NARCIS (Netherlands)

    Klop, C; de Vries, F|info:eu-repo/dai/nl/303546670; Vinks, T; Kooij, M J|info:eu-repo/dai/nl/357575695; van Staa, T P|info:eu-repo/dai/nl/304827762; Bijlsma, J W J; Egberts, A C G|info:eu-repo/dai/nl/162850050; Bouvy, M L|info:eu-repo/dai/nl/153182210

    UNLABELLED: The aim of this study was to determine whether feedback by pharmacists to prescribers of patients eligible for glucocorticoid-induced osteoporosis prophylaxis would stimulate the prescribing of osteoporosis prophylaxis. The intervention did not significantly increase the prescribing of

  18. Solving the Antibiotic Crisis.

    Science.gov (United States)

    Wright, Gerard D

    2015-02-13

    Antibiotics are essential for both treating and preventing infectious diseases. Paradoxically, despite their importance as pillars of modern medicine, we are in danger of losing antibiotics because of the evolution and dissemination of resistance mechanisms throughout all pathogenic microbes. This fact, coupled with an inability to bring new drugs to market at a pace that matches resistance, has resulted in a crisis of global proportion. Solving this crisis requires the actions of many stakeholders, but chemists, chemical biologists, and microbiologists must drive the scientific innovation that is required to maintain our antibiotic arsenal. This innovation requires (1) a deep understanding of the evolution and reservoirs of resistance; (2) full knowledge of the molecular mechanisms of antibiotic action and resistance; (3) the discovery of chemical and genetic probes of antibiotic action and resistance; (4) the integration of systems biology into antibiotic discovery; and (5) the discovery of new antimicrobial chemical matter. Addressing these pressing scientific gaps will ensure that we can meet the antibiotic crisis with creativity and purpose.

  19. Stevens-Johnson syndrome associated with Malarone antimalarial prophylaxis.

    Science.gov (United States)

    Emberger, Michael; Lechner, Arno Michael; Zelger, Bernhard

    2003-07-01

    To the best of our knowledge, Stevens-Johnson syndrome (SJS) has not been reported previously as an adverse reaction to Malarone, which is a combination of atovaquone and proguanil hydrochloride used for antimalarial prophylaxis and therapy. We describe a 65-year-old patient who had SJS with typical clinical and histopathological findings associated with the use of Malarone prophylaxis for malaria. This report should alert physicians to this severe cutaneous reaction, and Malarone should be added to the list of drugs that can potentially cause SJS.

  20. Addressing resistance to antibiotics in systematic reviews of antibiotic interventions

    NARCIS (Netherlands)

    Leibovici, Leonard; Paul, Mical; Garner, Paul; Sinclair, David J; Afshari, Arash; Pace, Nathan Leon; Cullum, Nicky; Williams, Hywel C; Smyth, Alan; Skoetz, Nicole; Del Mar, Chris; Schilder, Anne G M; Yahav, Dafna; Tovey, David

    Antibiotics are among the most important interventions in healthcare. Resistance of bacteria to antibiotics threatens the effectiveness of treatment. Systematic reviews of antibiotic treatments often do not address resistance to antibiotics even when data are available in the original studies. This

  1. Fighting antibiotic resistance in the intensive care unit using antibiotics.

    Science.gov (United States)

    Plantinga, Nienke L; Wittekamp, Bastiaan H J; van Duijn, Pleun J; Bonten, Marc J M

    2015-01-01

    Antibiotic resistance is a global and increasing problem that is not counterbalanced by the development of new therapeutic agents. The prevalence of antibiotic resistance is especially high in intensive care units with frequently reported outbreaks of multidrug-resistant organisms. In addition to classical infection prevention protocols and surveillance programs, counterintuitive interventions, such as selective decontamination with antibiotics and antibiotic rotation have been applied and investigated to control the emergence of antibiotic resistance. This review provides an overview of selective oropharyngeal and digestive tract decontamination, decolonization of methicillin-resistant Staphylococcus aureus and antibiotic rotation as strategies to modulate antibiotic resistance in the intensive care unit.

  2. Antibiotics for uncomplicated diverticulitis

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel M; Wille-Jørgensen, Peer

    2012-01-01

    Diverticulitis is an inflammatory complication to the very common condition diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics with reference to the microbiology, extrapolation from trials on complicated intra-abdominal infections and clinical experience....

  3. High Antibiotic Consumption

    DEFF Research Database (Denmark)

    Malo, Sara; José Rabanaque, María; Feja, Cristina

    2014-01-01

    as their exposure to antibiotics. Data on outpatient prescribing of antimicrobials (ATC J01) in 2010 were obtained from a prescription database covering Aragón (northeastern Spain). The antimicrobial consumption at the individual level was analysed both according to the volume of DDD and the number of packages...... purchased per year. Heavy antibiotic users were identified according to Lorenz curves and characterized by age, gender, and their antimicrobial prescription profile. Lorenz curves demonstrated substantial differences in the individual use of antimicrobials. Heavy antibiotic users (5% of individuals...... with highest consumption) were responsible for 21% of the total DDD consumed and received ≥6 packages per year. Elderly adults (≥60 years) and small children (0-9 years) were those exposed to the highest volume of antibiotics and with the most frequent exposure, respectively. Heavy users received a high...

  4. Antibiotic alternatives: the substitution of antibiotics in animal husbandry?

    OpenAIRE

    Cheng, Guyue; Hao, Haihong; Xie, Shuyu; Wang, Xu; Dai, Menghong; Huang, Lingli; Yuan, Zonghui

    2014-01-01

    It is a common practice for decades to use of sub-therapeutic dose of antibiotics in food-animal feeds to prevent animals from diseases and to improve production performance in modern animal husbandry. In the meantime, concerns over the increasing emergence of antibiotic-resistant bacteria due to the unreasonable use of antibiotics and an appearance of less novelty antibiotics have prompted efforts to develop so-called alternatives to antibiotics. Whether or not the alternatives could really ...

  5. Antibiotic resistance in children with recurrent or complicated urinary tract infection.

    Science.gov (United States)

    Younis, N; Quol, K; Al-Momani, T; Al-Awaisheh, F; Al-Kayed, D

    2009-01-01

    Urinary tract infection is certainly one of the most common childhood infections. Emerging resistance to the antibiotics is not unusual. Current hospitalization for children with urinary tract infection is reserved for severe or complicated cases. The aim of the present study was to determine the antibiotic resistance pattern among children with recurrent or complicated urinary tract infection. A retrospective study carried out at Prince Hashem hospital, Zarqa city, eastern Jordan and involved 336 episodes of culture proved urinary tract infection obtained from 121 patients with recurrent UTI, who used prophylactic antibiotics during the period from April 1, 2004 to December 31, 2006. The isolated microorganisms and there antibiotics susceptibility were studied. Seventy three patients (60.3%) were found to have some forms of urinary tract anomaly, significantly more prevalent among male children PUTA were significantly more resistant to most antibiotics tested. Pediatric urine culture isolates are becoming increasingly resistant to commonly used antibiotics. Empirical treatment with Trimethoprim-Sulfamethoxazole (TMP-SMX) or Cephalexin as the initial drug is ineffective. Nitrofurantoin and Nalidixic acid can be considered as the first line antibiotics for prophylaxis and or treatment of patients with recurrent UTI, while Meropenam and Ciprofloxacin can be used empirically in treating patients with complicated UTI.

  6. A Multidisciplinary Evaluation of Prescribing Practices for Prophylactic Antibiotics in Operative and Nonoperative Facial Fractures.

    Science.gov (United States)

    Brooke, Sebastian M; Goyal, Neerav; Michelotti, Brett F; Guedez, Henry Montilla; Fedok, Fred G; Mackay, Donald R; Samson, Thomas D

    2015-11-01

    Evidence supports short-term perioperative prophylaxis for facial fractures. It is unknown, however, whether there is any professional consensus on how to manage these injuries. No multidisciplinary evaluation of the prophylactic antibiotic prescribing patterns for neither operative nor nonoperative facial fractures has been performed. To evaluate the prophylactic antibiotic prescribing patterns of multiple specialties in operative and nonoperative facial fractures. A 14 question anonymous online-based survey was distributed to members of the American Society of Maxillofacial Surgeons (ASMS) and the American Association of Facial Plastic Surgeons to evaluate current practices. 205 respondents, including 89 plastic surgeons, 98 otolaryngologists, 12 oral and maxillofacial surgeons, and 7 with double board certification practicing throughout the United States with ranging experience from 11 to 30 years. As expected, preoperative, perioperative, or postoperative prophylactic antibiotics are either "always" or "sometimes" prescribed, 100% of the time with more varied practice upon further inspection. A total of 85.1% either "always" or "sometimes" use antibiotics while awaiting surgery. Dentate segment fractures are the most frequent type of facial fractures to receive prophylactic antibiotics for both operative (90.5%) and nonoperative (84.1%) fractures. Duration of antibiotic use is more varied with the majority providing 3 to 7 days despite current evidence. First generation cephalosporins alone are prescribed by 49% of respondents, which may not adequately cover oral flora. There is no multidisciplinary consensus for prophylactic antibiotics for specific operative fracture types or nonoperative facial fractures, an area with little published evidence.

  7. National survey of stress ulcer prophylaxis.

    Science.gov (United States)

    Lam, N P; Lê, P D; Crawford, S Y; Patel, S

    1999-01-01

    To determine the rationale for using stress ulcer prophylaxis (SUP) among clinicians; to assess criteria used to define failure of SUP; and to evaluate the decision-making process in the selection of a prophylactic agent. A cross-sectional national mail survey. Random sample of the members of the Society of Critical Care Medicine who identified anesthesiology, surgery, or internal medicine as their primary specialty area. None. None. Questionnaires consisting of multiple-choice and short-answer questions were sent to a simple random sample of 1,268 physicians to assess the current practice of SUP. A total of 328 usable questions were returned, resulting in a response rate of 26%. All percentages reported in the results are based on the total number of responses. The risk factors for SUP that were most commonly identified were burns (91%), shock (90%), and sepsis (88%). These were also risk factors for which the respondents most commonly started SUP. Histamine-2-receptor (H2)-antagonists as a class, were the most commonly used prophylactic agents (67%). The most commonly used agents for SUP were ranitidine (31%), famotidine (24%), sucralfate (24%), and cimetidine (12%). Most respondents selected ranitidine for ease of administration, famotidine because of formulary availability, sucralfate for a better side effects profile, and cimetidine for cost-effectiveness. Eighty-two percent of respondents considered the presence of bright red blood in the nasogastric tube as failure of SUP. In cases where SUP failed, most respondents would add a second agent from a different therapeutic class. Of those respondents who used an H2-antagonist initially, 48% would add sucralfate, 36% would add antacid, and 13% would add omeprazole. Of those respondents who used sucralfate, 77% would add an H2-antagonist when SUP failed. For those respondents who would switch to another agent when the H2-antagonist failed, 52% would change to omeprazole, whereas 67% would change to an H2

  8. MONITOR-GCSF DLBCL subanalysis: Treatment patterns/outcomes with biosimilar filgrastim for chemotherapy-induced/febrile neutropenia prophylaxis.

    Science.gov (United States)

    Gascón, Pere; Krendyukov, Andriy; Höbel, Nadja; Aapro, Matti

    2018-03-01

    Prospective data on the use of granulocyte-colony-stimulating factor (G-CSF) in non-Hodgkin's lymphoma and its aggressive subtypes, including diffuse large B-cell lymphoma (DLBCL), are limited. MONITOR-GCSF is a pan-European, multicenter, prospective, observational study aiming to describe treatment patterns and clinical outcomes in patients receiving biosimilar filgrastim in the prophylaxis of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN). This analysis describes patient characteristics, treatment patterns, and outcomes for 245 patients with stage 3 or 4 DLBCL receiving ≤6 chemotherapy cycles as part of MONITOR-GCSF study, including patients aged ≥65 years and ≥70 years. Outcomes of interest included the incidence of CIN and FN, antibiotic prophylaxis, biosimilar filgrastim prophylaxis, and adverse events (AEs). MONITOR-GCSF included 245 patients with DLBCL. Of these patients, 87 (35.5%) experienced one or more CIN (any grade) episode and 24 (9.8%) experienced FN (any grade). The most frequent AE reported was bone pain (n = 7, 2.9%), followed by arthralgia (n = 2, 0.8%) and back pain (n = 2, 0.8%). In real-life practice, biosimilar filgrastim demonstrated clinical effectiveness and safety in patients with DLBCL. The large percentage of patients aged ≥65 years adds to the evidence on how to best treat older patients with DLBCL receiving myelosuppressive chemotherapy. © 2017 The Authors. European Journal of Haematology Published by John Wiley &Sons Ltd.

  9. Strategies to Minimize Antibiotic Resistance

    Directory of Open Access Journals (Sweden)

    Sang Hee Lee

    2013-09-01

    Full Text Available Antibiotic resistance can be reduced by using antibiotics prudently based on guidelines of antimicrobial stewardship programs (ASPs and various data such as pharmacokinetic (PK and pharmacodynamic (PD properties of antibiotics, diagnostic testing, antimicrobial susceptibility testing (AST, clinical response, and effects on the microbiota, as well as by new antibiotic developments. The controlled use of antibiotics in food animals is another cornerstone among efforts to reduce antibiotic resistance. All major resistance-control strategies recommend education for patients, children (e.g., through schools and day care, the public, and relevant healthcare professionals (e.g., primary-care physicians, pharmacists, and medical students regarding unique features of bacterial infections and antibiotics, prudent antibiotic prescribing as a positive construct, and personal hygiene (e.g., handwashing. The problem of antibiotic resistance can be minimized only by concerted efforts of all members of society for ensuring the continued efficiency of antibiotics.

  10. Calling the shots — post- exposure prophylaxis against viruses

    African Journals Online (AJOL)

    Repro

    and prophylaxis of influenza. Amantadine has been available for many years, but it has activity against influenza A only, and has significant side-effects. The newer neuraminidase inhibitors, zanamivir (administered by inhala- tion) and oseltamivir (orally) have activity against both influenza A and B and have few side-effects ...

  11. Nystatin prophylaxis and treatment in severely immunodepressed patients

    DEFF Research Database (Denmark)

    Gøtzsche, Peter C; Johansen, Helle Krogh

    2014-01-01

    BACKGROUND: Nystatin is sometimes used prophylactically in patients with severe immunodeficiency or in the treatment of fungal infection in such patients, although its effect seems to be equivocal. OBJECTIVES: To study whether nystatin decreases morbidity and mortality when given prophylactically...... for prophylaxis or the treatment of Candida infections in immunodepressed patients....

  12. Risperidone Mono - Therapy as Prophylaxis in Bipolar Affective Disorders

    OpenAIRE

    Trivedi, Mohit; Pinto, Denzil; Safeekh, A.T.

    2004-01-01

    Risperidone has been found to be useful in the treatment of acute bipolar disorders. This is a case report where risperidone mono therapy has been found to be effective in prophylaxis of bipolar affective disorder. The pharmacological and clinical implications of risperidone in the management of BPAD are discussed

  13. Guideline for stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Madsen, Kristian Rørbaek; Lorentzen, Kristian; Clausen, Niels

    2014-01-01

    Stress ulcer prophylaxis (SUP) is commonly used in the intensive care unit (ICU), and is recommended in the Surviving Sepsis Campaign guidelines 2012. The present guideline from the Danish Society of Intensive Care Medicine and the Danish Society of Anesthesiology and Intensive Care Medicine sums...

  14. Post-exposure prophylaxis | Smith | Southern African Journal of HIV ...

    African Journals Online (AJOL)

    Southern African Journal of HIV Medicine. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 2, No 1 (2001) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Post-exposure prophylaxis. C Smith. Abstract.

  15. Knowledge and practice of prophylaxis of deep venous thrombosis ...

    African Journals Online (AJOL)

    Background: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. Objectives: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT).

  16. Knowledge and practice of prophylaxis of deep venous thrombosis ...

    African Journals Online (AJOL)

    2015-09-03

    Sep 3, 2015 ... Background: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. Objectives: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein ...

  17. 3. cotrimoxazole prophylaxis compliance among hiv exposed infants ...

    African Journals Online (AJOL)

    Esem

    Zachariah, R., Scaling up cotrimoxazole prophylaxis in HIV- exposed and HIV- infected children in high -prevalence countries. The. Lancets Journal of infectious diseases, 2007. 7: p. 686- 693. 6. NAC, National strategy for the prevention of. HIV and STIs, in2009: Lusaka. 7. NAC, National guidelines on management and.

  18. Supporting rape survivors to adhere to post-exposure prophylaxis ...

    African Journals Online (AJOL)

    Eleven years after it was first mooted in 1996, the Criminal Law (Sexual Offences and Related Matters) Amendment Act (32 of 2007) came into effect in December 2007. Law-makers proudly lauded sections 28 and 29 of the Act, which set out how post-exposure prophylaxis (PEP) to prevent HIV infection should be made ...

  19. METABOLIC BASIS OF URINARY TRACT INFECTION PROPHYLAXIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    N. B. Kuprienko

    2017-01-01

    Full Text Available The most essential data, predisposing to onset and recurrence of urinary tract infection in children are included in the review. Mineral, carbohydrate and purin metabolism monitoring both in active stage and remission of pyelonephritis is necessary for elaboration individual schemes of primary and secondary prophylaxis of chronic renal disease in children.

  20. Assessment of HIV post-exposure prophylaxis use among health ...

    African Journals Online (AJOL)

    Background: Infection with Human Immunodeficiency Virus is a serious public health problem costing the lives of many people including health workers. Hence, Ethiopia has developed guideline on the prevention of infection in health institutions in July 2004 and also employed the use of post exposure prophylaxis since ...

  1. Knowledge, attitude and practice of Post-Exposure Prophylaxis (PEP)

    African Journals Online (AJOL)

    Knowledge, attitude and practice of Post-Exposure Prophylaxis (PEP) to HIV among doctors in a Nigerian Tertiary Health Institution. RE Agbulu, O Udofia, O Udofia, M Ekott, M Ekott, E Peters, E Peters, KK Imananagha, KK Imananagha, A Oyo-Ita, A Oyo-Ita, PO Agbulu, PO Agbulu, IE Chuku, IE Chuku ...

  2. Venous Thromboembolism Prophylaxis – The Other Side of the Coin ...

    African Journals Online (AJOL)

    Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). In the absence of any guidelines, most of the information available has been provided mainly by the pharmaceutical industry which is an interested party. There have been publications in local journals that lean more on ...

  3. Malaria prophylaxis - the South African viewpoint | Baker | South ...

    African Journals Online (AJOL)

    A consensus meeting was held under the auspices of the Department of National Health and Population Development in September 1991 in order to establish local, current consensus on malaria prophylaxis for the South African traveller within South Africa and neighbouring African countries. The meeting was attended by ...

  4. original article assessment of hiv post-exposure prophylaxis use ...

    African Journals Online (AJOL)

    user

    Background: Infection with Human Immunodeficiency Virus is a serious public health problem costing the lives of many people including health workers. Hence, Ethiopia has developed guideline on the prevention of infection in health institutions in July 2004 and also employed the use of post exposure prophylaxis since ...

  5. Local irrigation of the surgical field with antibiotics in the end of procedure reduces the infection rate in herniated lumbar disc surgery.

    Science.gov (United States)

    Kërveshi, Armend; Halili, Nehat; Kastrati, Bujar; Qosja, Faik; Kabashi, Serbeze; Muçaj, Sefedin

    2014-12-01

    Reported rate of infections after lumbar discectomy is 1%-15 %. This complication may result in disability or even the death. The aim of the study is to assess the rate of infection associated with lumbar discectomies when combined systemic and local antibiotic prophylaxis was employed. In this retrospective study we analyzed all patients operated for herniated lumbar disc from 2009 -2012 in our institute. Beside of receiving systemic prophylaxis with 2g of Cefazoline, all patients had their operative field irrigated at the end of operation with Amikacin sulfate injection. Wound was considered infected when local and systemic signs of infection were revealed and were associated with elevated ESR, leukocytosis and elevated CRP. Assessment of infection is done by neurosurgeon during the hospitalization and later at outpatient's clinic along postoperative course of three months. A total of 604 patients were operated, of those 285 patients (47.2 %) females and 319 males (52.8 %), 12 patients were operated on two levels (1.98 %). Average patient age was 32.5 years (range 20-65 years) Localization of herniated disc was: in L/2-L/3 20 patients or 3.3 %, the L/3-L/4 level 42 patients or 7 % , the L/4 -L /5 262 patients or 43.3 % at the level L/V- S/1 280 patients or 46.3 %. Three patients (0.49%) developed wound infection, two of them superficial infection only with local signs: local pain, redness and leakage. They were treated with oral antibiotics. One with deep wound infection. He presented with local and systemic signs and treated with i.v antibiotics. All the cultures from wound swab revealed staphylococcus aureus. Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only.

  6. Use and prescription of antibiotics in primary health care settings in China.

    Science.gov (United States)

    Wang, Jin; Wang, Pan; Wang, Xinghe; Zheng, Yingdong; Xiao, Yonghong

    2014-12-01

    inpatients in cities, the mean (SD) duration of antibiotic therapy was 10.1 (7.8) days. Of the surgical patients, 98.0% received antibiotics, with 63.8% of these prescriptions for prophylaxis. Antibiotics are frequently prescribed in Chinese primary health care facilities, and a large proportion of these prescriptions are inappropriate. Frequent and inappropriate use of antibiotics in primary health care settings in China is a serious problem that likely contributes to antimicrobial resistance worldwide.

  7. From intermittent antibiotic point prevalence surveys to quality improvement: experience in Scottish hospitals

    Directory of Open Access Journals (Sweden)

    Malcolm William

    2013-01-01

    Full Text Available Abstract Background In 2008, the Scottish Antimicrobial Prescribing Group (SAPG was established to coordinate a national antimicrobial stewardship programme. In 2009 SAPG led participation in a European point prevalence survey (PPS of hospital antibiotic use. We describe how SAPG used this baseline PPS as the foundation for implementation of measures for improvement in antibiotic prescribing. Methods In 2009 data for the baseline PPS were collected in accordance with the European Surveillance of Antimicrobial Consumption [ESAC] protocol. This informed the development of two quality prescribing indicators: compliance with antibiotic policy in acute admission units and duration of surgical prophylaxis. From December 2009 clinicians collected these data on a monthly basis. The prescribing indicators were reviewed and further modified in March 2011. Data for the follow up PPS in September 2011 were collected as part of a national PPS of healthcare associated infection and antimicrobial use developed using ECDC protocols. Results In the baseline PPS data were collected in 22 (56% acute hospitals. The frequency of recording the reason for treatment in medical notes was similar in Scotland (75.9% and Europe (75.7%. Compliance with policy (81.0% was also similar to Europe (82.5% but duration of surgical prophylaxis Conclusions The baseline PPS identified priorities for quality improvement. SAPG has demonstrated that implementation of regularly reviewed national prescribing indicators, acceptable to clinicians, implemented through regular systematic measurement can drive improvement in quality of antibiotic use in key clinical areas. However, our data also show that the ESAC PPS method may underestimate the proportion of surgical prophylaxis with duration

  8. Rationale for a randomized controlled trial comparing two prophylaxis regimens in adults with severe hemophilia A: the Hemophilia Adult Prophylaxis Trial

    Science.gov (United States)

    Ragni, Margaret V

    2011-01-01

    A major goal of comprehensive hemophilia care is to prevent occurrence of bleeds by prophylaxis or regular preventive factor, one or more times weekly. Although prophylaxis is effective in reducing bleeding and joint damage in children, whether it is necessary to continue into adulthood is not known. The purpose of this article is to describe a Phase III randomized controlled trial to evaluate prophylaxis comparing two dose regimens in adults with severe hemophilia A. I hypothesize that adults with mature cartilage and joints are less susceptible to joint bleeds and joint damage, and that once-weekly recombinant factor VIII prophylaxis, with up to two rescue doses per week, is as effective as thrice-weekly prophylaxis in reducing bleeding frequency, but less costly and more acceptable, with higher quality of life. The ultimate goal of this project is to determine whether once-weekly prophylaxis is any worse than thrice-weekly prophylaxis in reducing joint bleeding frequency, while potentially utilizing less factor, at lower cost, leading to a better quality of life. This is an innovative concept, as it challenges the current paradigm of thrice-weekly prophylaxis in adults, which is based on dosing in children. Furthermore, this trial will assess interdose thrombin generation, a novel tissue factor-based assay of hemostasis, to determine if individualized thrombin generation can predict more individualized prophylaxis dosing, which would be practice changing. PMID:21939418

  9. Off-label Usage of Absorbable Beads Containing Antibiotics for Prevention of Surgical Site Infections.

    Science.gov (United States)

    Trujillo, Jeffrey M; Logue, Mary E; Kunkel, Ryan; Demas, Christopher P

    2017-10-01

    Surgical site infections account for about 17% of all nosocomial infections, second only to urinary tract infections. Antibiotic beads deliver high local antibiotic concentrations and maintain low systemic levels. The authors assessed the efficacy of calcium sulfate absorbable antibiotic beads (CSAAB) in the prevention of surgical site infections (SSIs) for complex wound closures. Patient records from the University of New Mexico Hospital (UNMH; Albuquerque, NM) and Dartmouth-Hitchcock Medical Center (DHMC; Lebanon, NH) were retrospectively analyzed from 2004 to 2015. Each patient received CSAAB prophylaxis during operations performed by the principle investigator. Charts were grouped by wound location and category. Outcomes were defined solely by readmission within 30 days for repeat intervention. Zero of the 38 UNMH and 15 of the 104 DHMC patients were readmitted. Data reached statistical significance based on 95% confidence intervals using the binomial distribution. This brief retrospective chart review shows promising use for CSAAB in the prevention of soft tissue SSIs.

  10. Systemic Preoperative Antibiotics with Mandible Fractures: Are They Indicated at the Time of Injury?

    Science.gov (United States)

    Linkugel, Andrew D; Odom, Elizabeth B; Bavolek, Rebecca A; Snyder-Warwick, Alison K; Patel, Kamlesh B

    2018-03-01

    Mandible fractures are the most common result of facial trauma. The proximity of oral flora to the site of both the injury and resulting surgical instrumentation makes managing infection a unique challenge. The benefit of antibiotic prophylaxis at the time of surgical treatment of mandible fractures is well established. However, the routine use of antibiotics between the time of injury and surgery is of unclear benefit. We aim to define the role of antibiotics in the preoperative period: from the time of injury to surgical intervention. Demographic and clinical data were collected retrospectively on all patients who were treated for mandible fracture by the Division of Plastic and Reconstructive Surgery at our institution between 2003 and 2013. The use of both preoperative (between injury and surgery) and perioperative (at the time of surgery) systemic antibiotics was recorded along with the incidence of postoperative infections and other complications. Complete data were available for 269 patients. Of the 216 patients who received preoperative antibiotics, 22 (10%) developed an infection postoperatively. Of the 53 patients who did not receive preoperative antibiotics, 2 (4%) developed infection ( p  = 0.184). Likewise, preoperative antibiotics were not significantly associated with hardware complication rates. In our retrospective review, the use of antibiotics between injury and surgical repair had no impact on postoperative infection rates. These data suggest that preoperative antibiotic use may actually be associated with an increased incidence of postoperative infection. Our results do not support the routine use of antibiotics between injury and surgical repair in patients with mandible fractures.

  11. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections.

    Science.gov (United States)

    Sarkut, Pinar; Kilicturgay, Sadik; Aktas, Hikmet; Ozen, Yilmaz; Kaya, Ekrem

    2017-07-01

    Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of symptomatic gallbladder stones. As infections are rare in uncomplicated LC, it is widely accepted that prophylactic antibiotics need not be administered, and guidelines do not support routine antibiotic prophylaxis during elective LC. However, routine antibiotic prophylaxis for elective LC is still popular in many clinical settings. We investigated this situation in our department. This randomized double-blind controlled study included 570 patients who underwent LC between March 2007 and February 2010. The exclusion criteria were antibiotic intake before surgery, steroid treatment, and the presence of pancreatitis, cholangitis, obstructive jaundice, cephalosporin allergy, or pregnancy. The patients were randomized into three groups. Group 1 (n = 193) received physiologic saline as placebo, Group 2 (n = 191) received a first-generation cephalosporin (cefazolin; 1 g), and Group 3 (n = 186) received a second-generation cephalosporin (cefuroksim aksetil; 750 mg). Bile and epigastric and umbilical port tissue samples were harvested for culture. All patients were observed until the end of the fourth week after surgery. Patient age, sex, weight, American Society of Anesthesiologists (ASA) score, diabetes mellitus, smoking history, history of biliary colic in the past month, length of the hospital stay before the operation, operational findings (acute or chronic cholecystitis), operation duration, use of drainage, type of prophylaxis administered if any, culture results, surgical site infection (SSI) development, and time to SSI development along with associated treatments were evaluated. There was no statistically significant difference between the groups with respect to any of the demographic and clinical features analyzed in this study. The SSI rate was 1.2% in total, and in Groups 1, 2, and 3, it was 1.5%, 1.04%, and 1.07%, respectively. There was no statistical difference

  12. Increased Resistance of Skin Flora to Antimicrobial Prophylaxis in Patients Undergoing Hip Revision Arthroplasty.

    Science.gov (United States)

    Mühlhofer, Heinrich M L; Deiss, Lukas; Mayer-Kuckuk, Philipp; Pohlig, Florian; Harrasser, Norbert; Lenze, Ulrich; Gollwitzer, Hans; Suren, Christian; Prodinger, Peter; VON Eisenhart-Rothe, Rüdiger; Schauwecker, Johannes

    2017-01-01

    Prosthetic joint infection (PJI) remains a major complication after total joint replacement and is the primary indication for revision arthroplasty. Specifically, coagulase-negative Staphylococci (CNS) can cause low-grade infections. Despite the use of cephalosporin-based antimicrobial prophylaxis (AMP) and antiseptic treatment at the surgical site, evidence suggests that a significant number of cases of dermal CNS results in low-grade PJI. Thus, this study examined the bacterial colonization and resistance patterns at the surgical site. We hypothesized that the bacteria developed resistance to antibiotics that are frequently used in primary and revision total hip arthroplasty (THA) procedures. Ninety patients, including 63 primary and 27 revision THA patients, were enrolled in this study. For each patient, a single swab of the skin at the surgical site was subjected to clinical microbiology to assess bacterial colonization. Furthermore, resistance to a sentinel panel of antibiotics (benzylpenicillin, erythromycin, tetracycline, oxacillin, fusidic acid, clindamycin, gentamicin, levofloxacin/moxifloxacin, rifampicin, linezolid and vancomycin) was tested. In 96.7% of the patients, at least one bacterial strain was identified at the surgical site, with CNS strains comprising 93.1% of the total. The sentinel panel showed that 30.7% of the CNS strains exhibited maximal resistance to oxacillin, a commonly used cephalosporin. Additionally, oxacillin resistance increased 1.9-fold (p=0.042) between primary and revision THA. Notably, 8.1% of the CNS stains found on patients undergoing primary THA were resistant to gentamicin, an aminoglycoside, and this rate increased 4.7-fold (p=0.001) for patients undergoing revision THA. CNS strains have significant resistance to standard AMP, particularly in individuals undergoing revision THA. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  13. Efficacy and safety of fosfomycin-trometamol in the prophylaxis for transrectal prostate biopsy. Prospective randomized comparison with ciprofloxacin.

    Science.gov (United States)

    Lista, F; Redondo, C; Meilán, E; García-Tello, A; Ramón de Fata, F; Angulo, J C

    2014-01-01

    Prostate biopsy is the standardized diagnostic method for prostate cancer. However, although there is not a standardized protocol, there are recommendations in order to reduce the incidence of complications. The objective of the present work is to assess the efficacy and safety of antibiotic prophylaxis in the prostate biopsy by comparing two antibiotic regimes: two doses of fosfomycin-trometamol 3g (FMT) every 48 hours with 10 doses of oral ciprofloxacin 500 mg every 12 hours during 5 days. Randomized prospective study was performed with 671 patients who had undergone to walking transrectal ultrasound guided prostate biopsy. Patients of group A (n=312) were treated with ciprofloxacin, and patients of group B (n=359) with FMT. Efficacy and tolerability of two prophylactic regimes were compared. Urine culture was carried out at 2 weeks after biopsy. Initially, patients with asymptomatic bacteriuria were not treated with antibiotics; urine culture was repeated after 1 month, persistent bacteriuria was treated according to antibiogram. No differences between groups were found in age (P=.78), cancer presence (P=.9) or number of biopsy cylinders (P=.93). The mean number of cores obtained was 11.3 ± 3.25 (range 6-20). Digestive intolerance was observed for 9 patients (2.9%) of group A and 10 patients (2.8%) in group B. One patient (.3%) of group A showed severe allergic reaction. In total, 167 patients (24.6%) had complications: 16 (2.4%) fever, 47 (6.9%) hemospermia, 81 (11.9%) hematuria, 7 (1%) rectal bleeding and 16 (2.4%) urinary retention. No statistically differences between groups were observed (27.6% vs. 22.6%; P=.17). However, hemospermia was more frequent in group A (9.9% vs. 4.5%; P=.006). Bacteriuria after biopsy was detected in 44 patients (6.6%), being more frequent in group B patients (4.2% vs. 8.6%; P=.02) although a higher number of second treatment cycles were not needed (53.9% vs. 29%; P=.17). The likelihood of resistance to ciprofloxacin in patients

  14. Allergy to cephalosporin antibiotics in children

    Directory of Open Access Journals (Sweden)

    Atanasković-Marković Marina

    2003-01-01

    Full Text Available A particular problem is the safety of administering cephalosporins to penicillin-allergic children, because cephalosporin allergenic determinants have not been properly identified. Cephalosporin antibiotics are widely used to treat common infections and are often the first-line prophylaxis before many types of surgery. So the arm of this study is to determine the frequency of allergic reactions of anaphylactic type to cephalosporins and their cross-reactivity with penicillins. At University Children’s Hospital in Belgrade a group of 1,170 children with suspected anaphylactic allergic reaction to penicillins and/or cephalosporins were tested for the last eight years. Skin tests were performed with standard concentration of penicillins and cephalosporins. In children where skin tests were negative single-blind placebo-controlled challenges were performed. In case of positive skin tests further examinations were interrupted and the children were considered allergic to that drug. The frequency of anaphylactic allergic reactions to cephalosporins is 0.2 % to 17 %, and depends on cephalosporins generation. The cross-reactivity between cephalosporins and penicillins is 0.1 % to 14.5 %, and among cephalosporins is 0 % to 11.7 %.

  15. The multifaceted roles of antibiotics and antibiotic resistance in nature

    Directory of Open Access Journals (Sweden)

    Saswati eSengupta

    2013-03-01

    Full Text Available Antibiotics are chemotherapeutic agents, which have been a very powerful tool in the clinical management of bacterial diseases since the 1940s. However, benefits offered by these magic bullets have been substantially lost in subsequent days following the widespread emergence and dissemination of antibiotic resistant strains. While it is obvious that excessive and imprudent use of antibiotics significantly contributes to the emergence of resistant strains, antibiotic-resistance is also observed in natural bacteria of remote places unlikely to be impacted by human intervention. Both antibiotic biosynthetic genes and resistance-conferring genes have been known to evolve billions of years ago, long before clinical use of antibiotics. Hence it appears that antibiotics and antibiotics resistance determinants have some other roles in nature, which often elude our attention because of overemphasis on the therapeutic importance of antibiotics and the crisis imposed by the antibiotic-resistance in pathogens. In the natural milieu, antibiotics are often found to be present in subinhibitory concentrations acting as signalling molecules supporting quorum sensing and biofilm formation. They also play an important role in the production of virulence factors and influence host-parasite interactions (e.g., phagocytosis, adherence to the target cell and so on. The evolutionary and ecological aspects of antibiotics and antibiotic-resistance in the naturally occurring microbial community are little understood. Therefore, the actual role of antibiotics in nature warrants in-depth investigations. Studies on such an intriguing behaviour of the microorganisms promise insight into the intricacies of the microbial physiology and are likely to provide some lead in controlling the emergence and subsequent dissemination of antibiotic resistance. This article highlights some of the recent findings on the role of antibiotics and genes that confer resistance to antibiotics in

  16. Tetracycline Antibiotics and Resistance.

    Science.gov (United States)

    Grossman, Trudy H

    2016-04-01

    Tetracyclines possess many properties considered ideal for antibiotic drugs, including activity against Gram-positive and -negative pathogens, proven clinical safety, acceptable tolerability, and the availability of intravenous (IV) and oral formulations for most members of the class. As with all antibiotic classes, the antimicrobial activities of tetracyclines are subject to both class-specific and intrinsic antibiotic-resistance mechanisms. Since the discovery of the first tetracyclines more than 60 years ago, ongoing optimization of the core scaffold has produced tetracyclines in clinical use and development that are capable of thwarting many of these resistance mechanisms. New chemistry approaches have enabled the creation of synthetic derivatives with improved in vitro potency and in vivo efficacy, ensuring that the full potential of the class can be explored for use against current and emerging multidrug-resistant (MDR) pathogens, including carbapenem-resistant Enterobacteriaceae, MDR Acinetobacter species, and Pseudomonas aeruginosa. Copyright © 2016 Cold Spring Harbor Laboratory Press; all rights reserved.

  17. Therapeutic Targeting of CPT-11 Induced Diarrhea: A Case for Prophylaxis

    Science.gov (United States)

    Swami, Umang; Goel, Sanjay; Mani, Sridhar

    2014-01-01

    CPT-11 (irinotecan), a DNA topoisomerase I inhibitor is one of the main treatments for colorectal cancer. The main dose limiting toxicities are neutropenia and late onset diarrhea. Though neutropenia is manageable, CPT-11 induced diarrhea is frequently severe, resulting in hospitalizations, dose reductions or omissions leading to ineffective treatment administration. Many potential agents have been tested in preclinical and clinical studies to prevent or ameliorate CPT-11 induced late onset diarrhea. It is predicted that prophylaxis of CPT-11 induced diarrhea will reduce sub-therapeutic dosing as well as hospitalizations and will eventually lead to dose escalations resulting in better response rates. This article reviews various experimental agents and strategies employed to prevent this debilitating toxicity. Covered topics include schedule/dose modification, intestinal alkalization, structural/chemical modification, genetic testing, anti-diarrheal therapies, transporter (ABCB1, ABCC2, BCRP2) inhibitors, enzyme (β-glucuronidase, UGT1A1, CYP3A4, carboxylesterase, COX-2) inducers and inhibitors, probiotics, antibiotics, adsorbing agents, cytokine and growth factor activators and inhibitors and other miscellaneous agents. PMID:23597015

  18. An investigation on the level of dental senior students knowledge about endocarditis prophylaxis incases with cardiac disease receiving dental treatment

    Directory of Open Access Journals (Sweden)

    Fakhraee AH

    2004-02-01

    cardiac"ndiseases, dental procedures requiring endocarditis prophylaxis and antibiotic diets.

  19. Evaluation of prophylactic antibiotic administration in general surgery division of a teaching hospital in north of Iran

    Directory of Open Access Journals (Sweden)

    Paniz Yousefi

    2016-01-01

    Full Text Available Surgical site infections are one of the most important post-surgery complications. Antimicrobial prophylaxis has been used routinely in surgeries to reduce infection incidence. However, inappropriate selection of antimicrobial agents or dosing can develop antimicrobial resistance, serious adverse reactions and prolong hospitalization. Current study aimed to examine prophylactic antibiotic prescription in surgeries in a teaching hospital in Sari, Mazandaran and evaluate level of adherence to the international guidelines. Between January 2015 to May 2015, 104 patients in general surgery ward were selected and enrolled in the study. The prophylactic antibiotics, dosage, timing and duration of administration were collected by reviewing patients’ records and compared to the existing guidelines. Prophylactic antibiotic was given to 85.5% of patients. Prescribed antibiotics were cefazolin (46.1%, metronidazole (24%, ceftriaxone (12.5%, ciprofloxacin (1.9% and vancomycin (0.96%. Most of the patients (62.9% received an inappropriate and delayed timing. Proper antibiotic dosage was seen in 45.2% of patients. All patients received post-operative prophylactic antibiotic. Main antibiotics include cefazolin (41.3%, metronidazole (33.7%, ceftriaxone (31.7% and clindamycin (20.2%. Only 10 (21.9% patients received cefazolin or vancomycin for a total duration of 48 hours or less. Surgical wound infection occurred in 17 (16.3% patients during hospital stay. Adherence to antimicrobial prophylaxis guidelines was completely achieved in 14.4% of cases. Results of this study signified that adherence to existing guidelines was poor and the most common mistakes were over usage, inappropriate dosage and choosing of antibiotics.

  20. Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results.

    Science.gov (United States)

    Al-Mayahi, Mohamed; Cian, Anais; Lipsky, Benjamin A; Suvà, Domizio; Müller, Camillo; Landelle, Caroline; Miozzari, Hermès H; Uçkay, Ilker

    2015-11-01

    Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. Case-control study of adult patients hospitalized with orthopedic infections. Among 2740 episodes of orthopedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1-3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even a single pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; χ²-test, p = 0.01) and skin commensals (17/74 vs. 274/2350; p = 0.01) compared to episodes without preceding prophylaxis. Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  1. Improving antibiotic use in daily hospital practice : The antibiotic checklist

    NARCIS (Netherlands)

    van Daalen, F.V.

    2018-01-01

    Better use of current antibiotic agents is necessary to help control antimicrobial resistance (AMR). Antibiotic stewardship programs (ASPs) are introduced to coordinate activities to measure and improve appropriate antibiotic use in daily hospital practice. This thesis shows how the introduction of

  2. Gallstone Formation Prophylaxis after Bariatric Surgery: Experience in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Bassam Ahmed Al-Mutlaq

    2017-12-01

    Full Text Available Background: The incidence of gallstones formation association with the obesity epidemic and rapid weight loss is dramatically increasing in recent years. Therefore, the aim of the review of literature was to discuss the gallstone formation prophylaxis and weight loss procedure with especial focus to the available related literature from Saudi Arabia. Methods: A review of the literature was made using the most common electronic sources including: electronic database, EMBASE, MEDLINE search using keywords: gallstones, bariatric surgery, weight loss, and Saudi Arabia. The major outcomes gained were related with the different procedure associated with bariatric surgeries to find out possible predictive factors for the development of gallstone and prevention measures. Conclusion: Although there a gap in literature from Saudi Arabia, the real movement towards a more conservative attitude in the gallstone formation prophylaxis after bariatric surgery needs more physicians to be involved to face the increasing biliary complications.

  3. Prophylaxis of postoperative hypocalcemia in patients with diffuse toxic goiter

    Directory of Open Access Journals (Sweden)

    M. B. Gudieva

    2016-01-01

    Full Text Available In recent years, the surgical treatment of DTG includes extirpation of the thyroid gland that can lead to the development of postoperative hypocalcemia, which causes of development are under study. Up to now, there are no clear recommendations for prophylaxis of postoperative hypocalcemia. In this connection, it is actually to carry out additional research to explore the methods of prophylaxis of postoperative hypocalcemia. The study involved 57 patients with diffuse toxic goiter, who had extirpation of the thyroid gland in period from 2010 until 2015. According to results of the performed study, it has been shown that prophylactic administration of preparations of calcium and vitamin D reduces the risk of postoperative hypocalcemia for patients with vitamin D deficiency.

  4. Prophylaxis of venous thrombosis in patients with spontaneous intracerebral bleeding

    Directory of Open Access Journals (Sweden)

    Emanuele Rezoagli

    2011-08-01

    Full Text Available Spontaneous intracerebral haemorrhage (SIH represents a severe clinical event that is associated with high rates of mortality and morbidity. Only a minority of SIH patients receive surgical treatment, whereas the majority are treated conservatively. Venous thromboembolism (VTE is one of the most common complications in SIH patients and a potential cause of death. Because of the lack of adequate evidences from the literature, the risk to benefit ratio of pharmacologic prophylaxis of VTE, represented on the one hand by hematoma enlargement and/or rebleeding and on the other hand by an expected reduction of the risk of VTE, remains controversial. Mechanical prophylaxis is a potentially safer alternative, but the efficacy of this approach is uncertain. In the absence of specific clinical guidelines containing clear-cut recommendations, physicians have insufficient tools to assist their therapeutic decisions.

  5. Prophylaxis of postoperative thromboembolism with low molecular weight heparins

    DEFF Research Database (Denmark)

    Jørgensen, L N; Wille-Jørgensen, P; Hauch, O

    1993-01-01

    To evaluate the thromboprophylactic use of low molecular weight heparins (LMWHs), publications from 27 orthopaedic trials and 35 studies of patients undergoing general or gynaecological surgery were scrutinized and subjected to a partial meta-analysis. In orthopaedic surgery, LMWHs were superior ...... with the former. Compared with unfractionated heparin, LMWHs did not reduce the postoperative mortality rate, nor did they cause haemorrhage. LMWHs provide safe and efficient prophylaxis by administration once daily....

  6. Stress ulcer prophylaxis in critical illness: a Canadian survey.

    Science.gov (United States)

    Shears, Melissa; Alhazzani, Waleed; Marshall, John C; Muscedere, John; Hall, Richard; English, Shane W; Dodek, Peter M; Lauzier, François; Kanji, Salmaan; Duffett, Mark; Barletta, Jeffrey; Alshahrani, Mohammed; Arabi, Yaseen; Deane, Adam; Cook, Deborah J

    2016-06-01

    Stress ulcer prophylaxis (SUP) using histamine-2-receptor antagonists has been a standard of care in intensive care units (ICUs) for four decades. Proton pump inhibitors (PPIs) are increasingly used despite apparently lower background rates of gastrointestinal bleeding and growing concerns about PPI-associated complications. Our objective was to understand the views and prescribing habits amongst Canadian physicians regarding SUP in the ICU and to gauge interest in a future randomized-controlled trial (RCT). We created a short self-administered survey about SUP for critically ill adults, evaluated its clinical sensibility, and pilot tested the instrument. We surveyed all physician members of the Canadian Critical Care Trials Group (CCCTG) by e-mail and sent reminders three and five weeks later. We received 94 of 111 (85%) surveys from the validated respondent pool between May and June, 2015. Respondents reported use of SUP most commonly in patients 1) receiving invasive mechanical ventilation (62, 66%), 2) expected to be ventilated for ≥ two days (25, 27%), or 3) receiving mechanical ventilation but nil per os (NPO) (20, 21%). Stress ulcer prophylaxis is discontinued when patients no longer receive mechanical ventilation (75%), no longer are NPO (22%), or are discharged from the ICU (19%). Stress ulcer prophylaxis involves PPIs in 68% of centres. Most respondents endorsed the need for a large rigorous RCT of PPI vs placebo to understand the risks and benefits of this practice. Stress ulcer prophylaxis is reportedly used primarily for the duration of mechanical ventilation. The CCCTG physicians believe that a placebo-controlled RCT is needed to evaluate the effectiveness and safety of contemporary SUP with PPIs.

  7. Terrestrial Rabies and Human Postexposure Prophylaxis, New York, USA

    Centers for Disease Control (CDC) Podcasts

    2010-03-15

    This podcast describes a 10-year study of the use of postexposure prophylaxis (PEP) for rabies in New York State. CDC's Dr. Brett Petersen discusses the prevalence of rabies in the United States and how the study lends support to recent changes in the recommended PEP protocol.  Created: 3/15/2010 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/15/2010.

  8. Acyclovir prophylaxis predisposes to antiviral-resistant recurrent herpetic keratitis.

    Science.gov (United States)

    van Velzen, Monique; van de Vijver, David A M C; van Loenen, Freek B; Osterhaus, Albert D M E; Remeijer, Lies; Verjans, Georges M G M

    2013-11-01

    Long-term acyclovir (ACV) prophylaxis, recommended to prevent recurrent herpes simplex virus type 1 (HSV-1) ocular disorders, may pose a risk for ACV-refractory disease due to ACV resistance. We determined the effect of ACV prophylaxis on the prevalence of corneal ACV-resistant (ACV(R)) HSV-1 and clinical consequences thereof in patients with recurrent HSV-1 keratitis (rHK). Frequencies of ACV(R) viruses were determined in 169 corneal HSV-1 isolates from 78 rHK patients with a history of stromal disease. The isolates' ACV susceptibility profiles were correlated with clinical parameters to identify risk factors predisposing to ACV(R) rHK. Corneal HSV-1 isolates with >28% ACV(R) viruses were defined as ACV(R) isolates. Forty-four isolates (26%) were ACV-resistant. Multivariate analyses identified long-term ACV prophylaxis (≥12 months) (odds ratio [OR] 3.42; 95% confidence interval [CI], 1.32-8.87) and recurrence duration of ≥45 days (OR 2.23; 95% CI, 1.02-4.87), indicative of ACV-refractory disease, as independent risk factors for ACV(R) isolates. Moreover, a corneal ACV(R) isolate was a risk factor for ACV-refractory disease (OR 2.28; 95% CI, 1.06-4.89). The data suggest that long-term ACV prophylaxis predisposes to ACV-refractory disease due to the emergence of corneal ACV(R) HSV-1. ACV-susceptibility testing is warranted during follow-up of rHK patients.

  9. Current perspectives in HIV post-exposure prophylaxis

    Directory of Open Access Journals (Sweden)

    Sultan B

    2014-10-01

    Full Text Available Binta Sultan,1,2 Paul Benn,1 Laura Waters1 1Department of Genitourinary Medicine, Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK; 2Centre for Sexual Health and HIV Research, University College London, London, UK Abstract: The incidence of human immunodeficiency virus (HIV infection continues to rise among core groups and efforts to reduce the numbers of new infections are being redoubled. Post-exposure prophylaxis (PEP is the use of short-term antiretroviral therapy (ART to reduce the risk of acquisition of HIV infection following exposure. Current guidelines recommend a 28-day course of ART within 36–72 hours of exposure to HIV. As long as individuals continue to be exposed to HIV there will be a role for PEP in the foreseeable future. Nonoccupational PEP, the vast majority of which is for sexual exposure (PEPSE, has a significant role to play in HIV prevention efforts. Awareness of PEP and its availability for both clinicians and those who are eligible to receive it are crucial to ensure that PEP is used to its full potential in any HIV prevention strategy. In this review, we provide current evidence for the use of PEPSE, assessment of the risk of HIV transmission, indications for PEP, drug regimens, and management of patients started on PEP. We summarize national and international guidelines for the use of PEPSE. We explore the place of PEP within the wider strategy of reducing HIV incidence rates in the era of treatment as prevention and pre-exposure prophylaxis. We also consider the implications of recent data from interventional and observational studies demonstrating significant reductions in the risk of HIV transmission within a serodiscordant relationship if the HIV-positive partner is taking effective ART upon PEP guidelines. Keywords: post-exposure prophylaxis, pre-exposure prophylaxis, treatment as prevention, human immunodeficiency virus

  10. Stress ulcer prophylaxis in the intensive care unit

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Møller, Morten H

    2016-01-01

    PURPOSE OF REVIEW: Stress ulcer prophylaxis (SUP) is considered standard of care in the majority of critically ill patients in the ICU. In this review, we will present the current evidence for the use of SUP in ICU patients, including data on the prevalence of gastrointestinal bleeding and the ba......-quality randomized controlled trials and systematic reviews assessing benefits and harms of SUP in ICU patients are highly warranted....

  11. PROPHYLAXIS OF VITAMIN AND MINERAL DEFICITS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    O. V. Stennikova

    2012-01-01

    Full Text Available Nowadays one of the most pressing problems of prophylactic pediatrics is the provision of children with vitamins and minerals. In the article we review physiological role of calcium, vitamin D and iron, prevalence and clinical presentations of respective deficits in childhood. We also provide with variants of dietary prophylaxis using various products enriched with vitamins and microelements adjusted to average daily norms of calcium, vitamin D and iron consumption.

  12. Bacterial cheating limits antibiotic resistance

    Science.gov (United States)

    Xiao Chao, Hui; Yurtsev, Eugene; Datta, Manoshi; Artemova, Tanya; Gore, Jeff

    2012-02-01

    The widespread use of antibiotics has led to the evolution of resistance in bacteria. Bacteria can gain resistance to the antibiotic ampicillin by acquiring a plasmid carrying the gene beta-lactamase, which inactivates the antibiotic. This inactivation may represent a cooperative behavior, as the entire bacterial population benefits from removing the antibiotic. The cooperative nature of this growth suggests that a cheater strain---which does not contribute to breaking down the antibiotic---may be able to take advantage of cells cooperatively inactivating the antibiotic. Here we find experimentally that a ``sensitive'' bacterial strain lacking the plasmid conferring resistance can invade a population of resistant bacteria, even in antibiotic concentrations that should kill the sensitive strain. We observe stable coexistence between the two strains and find that a simple model successfully explains the behavior as a function of antibiotic concentration and cell density. We anticipate that our results will provide insight into the evolutionary origin of phenotypic diversity and cooperative behaviors.

  13. Risk of surgical site infection in paediatric herniotomies without any prophylactic antibiotics: A preliminary experience

    Directory of Open Access Journals (Sweden)

    Dhananjay Vaze

    2014-01-01

    Full Text Available Background: Different studies underline the use of pre-operative antibiotic prophylaxis in clean surgeries like herniotomy and inguinal orchiopexy. But, the meta-analyses do not recommend nor discard the use of prophylactic pre-operative antibiotics. The scarcity of controlled clinical trials in paediatric population further vitiates the matter. This study assessed the difference in the rate of early post-operative wound infection cases in children who received single dose of pre-operative antibiotics and children who did not receive antibiotics after inguinal herniotomy and orchiopexy. Materials and Methods: This randomised prospective study was conducted in Paediatric Surgery department of PGIMER Chandigarh. Out of 251 patients, 112 patients were randomised to the case group and 139 were ascribed to the control group. The patients in control group were given a standard regimen of single dose of intravenous antibiotic at the time of induction followed by 3-4 days of oral antibiotic. Case group patients underwent the surgical procedure in similar manner with no antibiotic either at the time of induction or post-operatively. Results: The incidence of surgical site infection in case group was 3.73 % and that in control group was 2.22%. The observed difference in the incidence of surgical site infection was statistically insignificant (P value = 0.7027. The overall infection rate in case and control group was 2.89%. Conclusions: Our preliminary experience suggests that there is no statistically significant difference in the proportion of early post-operative wound infection between the patients who received single dose of pre-operative antibiotics and the patients who received no antibiotics after inguinal herniotomy and orchiopexy. The risk of surgical site infection in paediatric heriotomies does not increase even if the child′s weight is less than his/her expected weight for age.

  14. Mechanisms of Antibiotic Resistance

    Science.gov (United States)

    Munita, Jose M.; Arias, Cesar A.

    2015-01-01

    Emergence of resistance among the most important bacterial pathogens is recognized as a major public health threat affecting humans worldwide. Multidrug-resistant organisms have emerged not only in the hospital environment but are now often identified in community settings, suggesting that reservoirs of antibiotic-resistant bacteria are present outside the hospital. The bacterial response to the antibiotic “attack” is the prime example of bacterial adaptation and the pinnacle of evolution. “Survival of the fittest” is a consequence of an immense genetic plasticity of bacterial pathogens that trigger specific responses that result in mutational adaptations, acquisition of genetic material or alteration of gene expression producing resistance to virtually all antibiotics currently available in clinical practice. Therefore, understanding the biochemical and genetic basis of resistance is of paramount importance to design strategies to curtail the emergence and spread of resistance and devise innovative therapeutic approaches against multidrug-resistant organisms. In this chapter, we will describe in detail the major mechanisms of antibiotic resistance encountered in clinical practice providing specific examples in relevant bacterial pathogens. PMID:27227291

  15. Antibiotic resistance in Salmonella

    NARCIS (Netherlands)

    Vo, A.T.T.

    2007-01-01

    Immediately after their introduction in the beginning of the fourties of the previous century, the agents used to combat infectious diseases caused by bacteria were regarded with suspicion, but not long thereafter antibiotics had the status of miracle drugs. For decades mankind has lived under the

  16. Antibiotic resistance reservoirs

    NARCIS (Netherlands)

    Versluis, Dennis

    2016-01-01

    One of the major threats to human health in the 21st century is the emergence of pathogenic bacteria that are resistant to multiple antibiotics, thereby limiting treatment options. An important route through which pathogens become resistant is via acquisition of resistance genes from environmental

  17. Antibiotics in laboratory medicine

    National Research Council Canada - National Science Library

    Lorian, Victor

    2005-01-01

    ... in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in the USA Library of Congress Cataloging-in-Publication Data Antibiotics in laboratory medicine / [edited by] Victor Lorian. - 5th ed...

  18. Resistance-resistant antibiotics.

    Science.gov (United States)

    Oldfield, Eric; Feng, Xinxin

    2014-12-01

    New antibiotics are needed because drug resistance is increasing while the introduction of new antibiotics is decreasing. We discuss here six possible approaches to develop 'resistance-resistant' antibiotics. First, multitarget inhibitors in which a single compound inhibits more than one target may be easier to develop than conventional combination therapies with two new drugs. Second, inhibiting multiple targets in the same metabolic pathway is expected to be an effective strategy owing to synergy. Third, discovering multiple-target inhibitors should be possible by using sequential virtual screening. Fourth, repurposing existing drugs can lead to combinations of multitarget therapeutics. Fifth, targets need not be proteins. Sixth, inhibiting virulence factor formation and boosting innate immunity may also lead to decreased susceptibility to resistance. Although it is not possible to eliminate resistance, the approaches reviewed here offer several possibilities for reducing the effects of mutations and, in some cases, suggest that sensitivity to existing antibiotics may be restored in otherwise drug-resistant organisms. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Antibiotic therapy of cholera*

    Science.gov (United States)

    Lindenbaum, John; Greenough, William B.; Islam, M. R.

    1967-01-01

    Recent clinical trials having established the value of tetracycline as an adjunct to fluid and electrolyte replacement in cholera treatment, a controlled trial of antibiotic therapy was conducted in Dacca on 318 adults hospitalized for cholera. The effects of 4 antibiotics orally administered in varying dosage schedules were studied. Cholera therapy with tetracycline or chloramphenicol caused a highly significant reduction in the duration of diarrhoea and of positive culture, in stool volume, and in intravenous fluid requirement as compared with the results in controls who received intravenous fluid therapy only. Streptomycin was also effective, but to a lesser degree; paromomycin was of little value. The severity of dehydration on admission was significantly related to subsequent duration of diarrhoea regardless of whether antibiotics were given. Increasing age was associated with more prolonged purging in patients receiving antibiotics. Increasing the dose of tetracycline to 2 to 3 times that usually administered, or prolonging treatment from 2 to 4 days, did not enhance the therapeutic results. The effect of tetracycline was apparent within a few hours of administration. Bacteriological relapses were seen after discontinuation of therapy in all treatment groups, but were not due to the development of resistant bacteria. PMID:4865453

  20. Antibiotic resistance reservoirs

    NARCIS (Netherlands)

    Versluis, Dennis

    2016-01-01

    One of the major threats to human health in the 21st century is the emergence of pathogenic bacteria that are resistant to multiple antibiotics, thereby limiting treatment options. An important route through which pathogens become resistant is via acquisition of resistance genes from

  1. Late-onset CMV disease following CMV prophylaxis.

    LENUS (Irish Health Repository)

    Donnelly, C

    2012-02-01

    BACKGROUND: Cytomegalovirus (CMV) is the most common opportunistic infection after solid-organ transplantation, increasing morbidity and mortality. Three months of oral valganciclovir have been shown to provide effective prophylaxis. Late-onset CMV disease, occurring after the discontinuation of prophylaxis, is now increasingly recognised. AIMS: To investigate the incidence and the time of detection of CMV infections in liver transplant recipients who received CMV prophylaxis. METHODS: Retrospective review of 64 high- and moderate-risk patients with 1 year of follow-up. RESULTS: The incidence of CMV infection was 12.5%, with 4.7% disease. All cases of symptomatic CMV disease were of late-onset. CONCLUSIONS: The incidence of CMV infections in this study was low compared with literature reports; however, the late-onset disease is an emerging problem. Detection of late-onset disease may be delayed because of less frequent clinic follow-up visits. Increased regular laboratory monitoring may allow earlier detection at the asymptomatic infection stage.

  2. WHO's new recommendations about iodine prophylaxis at nuclear catastrophes

    International Nuclear Information System (INIS)

    Paile, Wendla

    1999-01-01

    WHO has prepared new advice about using stable iodine as protection against emission of radioactive iodine from nuclear catastrophes. The experiences from Chernobyl show that the risk for thyroid gland cancer after emission of radio-iodine is significant. The risk of serious side effects of stable iodine as single dose is stated to be minimal. Stable iodine is a safe, effective remedy for protecting the thyroid gland against radioactive iodine. It is recommended to adjust different criteria for iodine prophylaxis for new-born, children, young people and adults older than 40 years. For children of the age up to 18 years iodine prophylaxis should be considered at 10 mGy thyroid gland doses, and for young adults at 100 mGy. For adults of 40 years or more the cancer risk of radioactive iodine is very low and iodine prophylaxis is unnecessary provided that the expected does not exceed 5 Gy. The new information about risk and advantage must be considered in planning for distribution and storage of stable iodine. WHO also commends that everybody has the possibility to buy it in a pharmacy. (EHS)

  3. Hernia, mesh, topical antibiotics, especially gentamycin: Seeking the evidence for perfect outcome…

    Directory of Open Access Journals (Sweden)

    Hakan eKulacoglu

    2015-02-01

    Full Text Available Inguinal hernia repair is a clean surgical procedure and SSI rate is generally below 2%. Antibiotic prophylaxis is not routinely recommended, but it may be a good choice for institutions with high rates of wound infection (>5 %. Typical prophylaxis is the intravenous application of first or second generation cephalosporins before the skin incision. However, SSI rate remains more than 2% in many centers in spite of intravenous antibiotic prohylaxis. Even a 1% SSI rate may be unacceptable for the surgeons who specifically deal with hernia surgery. A hernia center targets to be a center of excellence not only in respect of recurrence rate but also for other postoperative outcomes, therefore a further measure is required for an excellent result regarding infection control. Topical gentamycin application in combination with preoperative single dose intravenous antibiotic may be a useful to obtain this perfect outcome. Data about this subject is not complete and high grade evidence has not been cumulated yet. Prospective randomized controlled trials can make our knowledge more solid about this subject and help the ssurgeons who seek perfect outcome regarding infection control in inguinal hernia surgery.

  4. Impact of using prophylactic antibiotic on prevention of wound infection in inguinal herniorrhaphy

    International Nuclear Information System (INIS)

    Akhtar, K.; Khan, Z.; Bhatti, A.M.; Mahmood, K.

    2015-01-01

    To compare the effect of antibiotic prophylaxis with placebo in prevention of wound infection amongst patients undergoing clean open inguinal herniorrhaphy (without mesh). Study Design: Randomized Controlled Trial. Place and Duration of Study: Pakistan Air Force Hospital, Faisal Base Karachi from October 2009 to November 2011. Material and Methods: One hundred and fifty patients undergoing inguinal herniorrhaphy were included and randomly assigned to one of the two groups using random numbers table. Group A patients were given intravenous antibiotic while those in Group B were given equal volume of normal saline just before the induction of anaesthesia. Patients from both groups were observed for the presence of wound infection. Results: Total seven cases (4.7%) of surgical site infection were detected; two cases (2.7%) occurred in group A whereas five cases (6.7%) occurred in group B. The low frequency of post-operative wound infection was seen in group A as compared to group B but the difference was statistically insignificant. Conclusion: Antibiotic prophylaxis has no significant effect on prevention of wound infection in inguinal herniorrhaphy. (author)

  5. Antibiotic Resistance in Foodborne Pathogens

    OpenAIRE

    Walsh, Ciara; Duffy, Geraldine

    2013-01-01

    Wide-spread antibiotic resistance among bacterial pathogens is now a serious public health issue and multi-antibiotic resistance has been reported in many foodborne pathogens including Salmonella and E. coli. A study to determine antibiotic resistance profiles of a range of Salmonella and Verocytotoxigenic E.coli (VTEC) isolated from Irish foods revealed significant levels of antibiotic resistance in the strains. S. typhimurium DT104 were multiantibiotic resistant with 97% resistant to 7 anti...

  6. Profilaxis antimicrobiana en cirugía mayor electiva otorrinolaringológica Antimicrobial prophylaxis related to otorhinolaryngology elective major surgery

    Directory of Open Access Journals (Sweden)

    Gladys Pérez López

    2010-06-01

    Full Text Available INTRODUCCIÓN. La profilaxis antimicrobiana disminuye las infecciones quirúrgicas, pero su empleo indiscriminado favorece el incremento de las tasas de infección, pues la resistencia bacteriana es mucho más probable en presencia de antibióticos. El objetivo de esta investigación fue evaluar los resultados de la antibioticoprofilaxis en la cirugía mayor electiva otorrinolaringológica. MÉTODOS. Se realizó una investigación retrospectiva-descriptiva del uso profiláctico de antibióticos en cirugía mayor electiva en el Servicio de Otorrinolaringología del Hospital «Comandante Manuel Fajardo», durante 6 años (2001-2006. El universo estuvo constituido por 661 pacientes y se estudiaron variables como sexo, edad y criterios de respuesta terapéutica (satisfactorio e insatisfactorio. Según la envergadura de la intervención, se administró antibioticoprofilaxis oral o parenteral y se realizó cultivo del sitio de la herida quirúrgica. RESULTADOS. Predominó el sexo masculino (54,1 % y el grupo etario de 31 a 62 años. Requirió profilaxis antibiótica el 41,90 % de los pacientes operados. Ocurrió un 7,9 % de infecciones de la herida quirúrgica. Los microorganismos más frecuentemente aislados fueron Pseudomonas aeruginosa, Enterobacter y Escherichia coli. En las cirugías oncológicas de cabeza y cuello, el promedio de infecciones fue elevado (42,3 %. La evolución tórpida se debió a la concurrencia de factores de riesgo de infección. No se reportaron eventos adversos ni complicaciones graves. CONCLUSIONES. En otorrinolaringología, la profilaxis antimicrobiana funciona contra una amplia gama de microorganismos, pero no ocurre así en las cirugías oncológicas.INTRODUCTION. Antimicrobial prophylaxis decreases the surgical infections, but its indiscriminate use to favors the increment of infection rates and the bacterial resistance is much more probable in presence of antibiotics. The aim of present research was to evaluate the

  7. When and How to Take Antibiotics

    Science.gov (United States)

    ... Contact Us General Background: When & How to take Antibiotics When should you take antibiotics? What is the proper dosage? How safe are antibiotics? How does a physician decide which antibiotic to ...

  8. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications.

    Science.gov (United States)

    Esposito, Marco; Worthington, Helen V; Loli, Vassiliki; Coulthard, Paul; Grusovin, Maria Gabriella

    2010-07-07

    Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis, for patients with reduced host-response, when surgery is performed in infected sites, in cases of extensive and prolonged surgical interventions and when large foreign materials are implanted. To minimise infections after dental implant placement various prophylactic systemic antibiotic regimens have been suggested. More recent protocols recommended short term prophylaxis, if antibiotics have to be used. With the administration of antibiotics adverse events may occur, ranging from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria. The use of prophylactic antibiotics in implant dentistry is controversial. To assess the beneficial or harmful effects of systemic prophylactic antibiotics at dental implant placement versus no antibiotic/placebo administration and, if antibiotics are of benefit, to find which type, dosage and duration is the most effective. The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to 2nd June 2010. Several dental journals were handsearched. There were no language restrictions. Randomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of various prophylactic antibiotic regimens versus no antibiotics to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc). Screening of eligible studies, assessment of the methodological quality of the

  9. Antibiotics for leptospirosis.

    Science.gov (United States)

    Brett-Major, David M; Coldren, Rodney

    2012-02-15

    Leptospirosis has a wide-ranging clinical and public health impact. Leptospira are globally distributed. Case attack rates are as high as 1:4 to 2:5 persons in exposed populations. In some settings mortality has exceeded 10% of infected people. The benefit of antibiotic therapy in the disease has been unclear. We sought to characterise the risks and benefits associated with use of antibiotic therapy in the management of leptospirosis. We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded regardless of study language. This was augmented by a manual search. The last date of search was November, 2011. To be included in assessment of benefits, trials had to specifically assess the use of antibiotics in a randomised clinical trial. A broad range of study types were incorporated to seek potential harms. Included trials were systematically abstracted, as were excluded studies for the purposes of assessing harms. Analyses were conducted in accordance with The Cochrane Handbook and practices of The Cochrane Hepato-Biliary Group. Seven randomised trials were included.  Four trials with 403 patients compared an antibiotic with placebo or no intervention. Three trials compared at least one antibiotic regimen with another antibiotic regimen. The trials all had high risk of bias. The trials varied in the severity of leptospirosis among trial patients. The ability to group data for meta-analysis was limited. While all four trials that compared antibiotics with placebo reported mortality and used parenteral penicillin, there were no deaths in two of them. Since odds ratio calculations cannot employ zero-event trials, only two trials contributed to this estimate. The number of deaths were 16/200 (8.0%) in the antibiotic arm versus 11/203 (5.4%) in the placebo arm giving a fixed-effect OR 1.56 (95% CI 0.70 to 3.46). The

  10. Antibiotic alternatives: the substitution of antibiotics in animal husbandry?

    Science.gov (United States)

    Cheng, Guyue; Hao, Haihong; Xie, Shuyu; Wang, Xu; Dai, Menghong; Huang, Lingli; Yuan, Zonghui

    2014-01-01

    It is a common practice for decades to use of sub-therapeutic dose of antibiotics in food-animal feeds to prevent animals from diseases and to improve production performance in modern animal husbandry. In the meantime, concerns over the increasing emergence of antibiotic-resistant bacteria due to the unreasonable use of antibiotics and an appearance of less novelty antibiotics have prompted efforts to develop so-called alternatives to antibiotics. Whether or not the alternatives could really replace antibiotics remains a controversial issue. This review summarizes recent development and perspectives of alternatives to antibiotics. The mechanism of actions, applications, and prospectives of the alternatives such as immunity modulating agents, bacteriophages and their lysins, antimicrobial peptides, pro-, pre-, and synbiotics, plant extracts, inhibitors targeting pathogenicity (bacterial quorum sensing, biofilm, and virulence), and feeding enzymes are thoroughly discussed. Lastly, the feasibility of alternatives to antibiotics is deeply analyzed. It is hard to conclude that the alternatives might substitute antibiotics in veterinary medicine in the foreseeable future. At the present time, prudent use of antibiotics and the establishment of scientific monitoring systems are the best and fastest way to limit the adverse effects of the abuse of antibiotics and to ensure the safety of animal-derived food and environment.

  11. Antibiotic Alternatives: The Substitution of Antibiotics in Animal Husbandry?

    Directory of Open Access Journals (Sweden)

    Guyue eCheng

    2014-05-01

    Full Text Available It is a common practice for decades to use of sub-therapeutic dose of antibiotics in food-animal feeds to prevent animals from diseases and to improve production performance in modern animal husbandry. In the meantime, concerns over the increasing emergence of antibiotic-resistant bacteria due to the unreasonable use of antibiotics and an appearance of less novelty antibiotics have prompted efforts to develop so-called alternatives to antibiotics. Whether or not the alternatives could relly replace antibiotics remains a controversial issue. This review summarizes recent development and perspectives of alternatives to antibiotics. The mechanism of actions, applications, and prospectives of the alternatives such as immunity modulating agents, bacteriophages and their lysins, antimicrobial peptides, pro-, pre- and synbiotics, plant extracts, inhibitors targeting pathogenicity (bacterial quorum sensing, biofilm and virulence, and feeding enzymes are thoroughly discussed. Lastly, the feasibility of alternatives to antibiotics is deeply analyzed. It is hard to conclude that the alternatives might substitute antibiotics in veterinary medicine in the foreseeable future. At the present time, prudent use of antibiotics and the establishment of scientific monitoring systems are the best and fastest way to limit the adverse effects of the abuse of antibiotics and to ensure the safety of animal-derived food and environment.

  12. Selection of antibiotic resistance at very low antibiotic concentrations.

    Science.gov (United States)

    Sandegren, Linus

    2014-05-01

    Human use of antibiotics has driven the selective enrichment of pathogenic bacteria resistant to clinically used drugs. Traditionally, the selection of resistance has been considered to occur mainly at high, therapeutic levels of antibiotics, but we are now beginning to understand better the importance of selection of resistance at low levels of antibiotics. The concentration of an antibiotic varies in different body compartments during treatment, and low concentrations of antibiotics are found in sewage water, soils, and many water environments due to natural production and contamination from human activities. Selection of resistance at non-lethal antibiotic concentrations (below the wild-type minimum inhibitory concentration) occurs due to differences in growth rate at the particular antibiotic concentration between cells with different tolerance levels to the antibiotic. The minimum selective concentration for a particular antibiotic is reached when its reducing effect on growth of the susceptible strain balances the reducing effect (fitness cost) of the resistance determinant in the resistant strain. Recent studies have shown that resistant bacteria can be selected at concentrations several hundred-fold below the lethal concentrations for susceptible cells. Resistant mutants selected at low antibiotic concentrations are generally more fit than those selected at high concentrations but can still be highly resistant. The characteristics of selection at low antibiotic concentrations, the potential clinical problems of this mode of selection, and potential solutions will be discussed.

  13. Environmental pollution by antibiotics and by antibiotic resistance determinants

    International Nuclear Information System (INIS)

    Martinez, Jose Luis

    2009-01-01

    Antibiotics are among the most successful drugs used for human therapy. However, since they can challenge microbial populations, they must be considered as important pollutants as well. Besides being used for human therapy, antibiotics are extensively used for animal farming and for agricultural purposes. Residues from human environments and from farms may contain antibiotics and antibiotic resistance genes that can contaminate natural environments. The clearest consequence of antibiotic release in natural environments is the selection of resistant bacteria. The same resistance genes found at clinical settings are currently disseminated among pristine ecosystems without any record of antibiotic contamination. Nevertheless, the effect of antibiotics on the biosphere is wider than this and can impact the structure and activity of environmental microbiota. Along the article, we review the impact that pollution by antibiotics or by antibiotic resistance genes may have for both human health and for the evolution of environmental microbial populations. - The article reviews the current knowledge on the effects that pollution by antibiotics and antibiotic resistance genes may have for the microbiosphere.

  14. Environmental pollution by antibiotics and by antibiotic resistance determinants

    Energy Technology Data Exchange (ETDEWEB)

    Martinez, Jose Luis, E-mail: jlmtnez@cnb.csic.e [Departamento de Biotecnologia Microbiana, Centro Nacional de Biotecnologia, Consejo Superior de Investigaciones Cientificas, Darwin 3, Cantoblanco, 28049 Madrid, and CIBERESP (Spain)

    2009-11-15

    Antibiotics are among the most successful drugs used for human therapy. However, since they can challenge microbial populations, they must be considered as important pollutants as well. Besides being used for human therapy, antibiotics are extensively used for animal farming and for agricultural purposes. Residues from human environments and from farms may contain antibiotics and antibiotic resistance genes that can contaminate natural environments. The clearest consequence of antibiotic release in natural environments is the selection of resistant bacteria. The same resistance genes found at clinical settings are currently disseminated among pristine ecosystems without any record of antibiotic contamination. Nevertheless, the effect of antibiotics on the biosphere is wider than this and can impact the structure and activity of environmental microbiota. Along the article, we review the impact that pollution by antibiotics or by antibiotic resistance genes may have for both human health and for the evolution of environmental microbial populations. - The article reviews the current knowledge on the effects that pollution by antibiotics and antibiotic resistance genes may have for the microbiosphere.

  15. [Mood disorder after malaria prophylaxis with mefloquine (two case reports)].

    Science.gov (United States)

    Oueriagli Nabih, F; Touhami, M; Laffinti, A; Abilkacem, L

    2011-10-01

    Mefloquine (Lariam) is the drug of choice as malaria prophylaxis for travel to chloroquine-resistant areas. Severe neuropsychiatric side effects are rare. We report two clinical cases of mood disorders: mania and a major depressive episode with psychotic characteristics in two patients with mefloquine antimalarial prophylaxis. FIRST CLINICAL CASE: A 31-year-old man had taken mefloquine at a rate of 250mg/week as malaria prophylaxis for his mission in Democratic Republic of Congo. He developed mania with psychotic symptoms after taking five tablets of 250mg of mefloquine. He exhibited an elevated mood and also developed delusions of grandeur, reference and persecution, with auditory hallucinations. The physical examination and the blood laboratory tests were normal. The patient was treated with an atypical neuroleptic (olanzapine 20mg/d) leading to a complete resolution of symptomatology at the end of 3 weeks. SECOND CLINICAL CASE: A 27-year-old man presented a major depressive episode with psychotic symptoms after 1 week on his return from a stay in Democratic Republic of Congo, where he had taken mefloquine during 6 months as malaria prophylaxis (250mg/week). His physical examination and investigations (full blood test, serology and MRN) were normal. The patient was treated with clomipramine (150mg/d) and olanzapine (20mg/d). The outcome was favorable after 4 weeks. Mefloquine is widely accepted as a safe and effective treatment and a prophylactic agent for chlorquine-resistant malaria. Common neuropsychiatric adverse effects of mefloquine can occur in up to 40% of patients, such as dizziness, sleep disturbances, anorexia, ataxia, and fatigue. Other more serious adverse reactions are rare. They are represented primarily by panic attacks, convulsions, acute psychosis, paranoid delusions, suicidal ideation, disorders of mood: major depressive episode and the manic excitation. The incidence of such neuropsychiatric effects is 1/10,000 to 1/15,000 during the

  16. Prophylaxis of infection and effects on osseointegration using a tobramycin-periapatite coating on titanium implants--an experimental study in the rabbit.

    Science.gov (United States)

    Moojen, Dirk Jan F; Vogely, H Charles; Fleer, André; Nikkels, Peter G J; Higham, Paul A; Verbout, Abraham J; Castelein, René M; Dhert, Wouter J A

    2009-06-01

    No options are available for local antibiotic delivery from uncemented implants. By loading a porous titanium implant with a biomimetic HA-coating (PeriApatite, PA) with antibiotics, we could obtain adequate local antibiotic concentrations and reduce infection susceptibility. This study investigated the efficacy of a tobramycin-loaded PA-coated titanium foam implant in preventing infection, as well as the effects on osseointegration. In 72 New Zealand White rabbits, an uncoated (Ti), PA-coated (PA), or Tobramycin-PA-coated (PA-tobra) titanium foam rod was implanted intramedullary in the left tibiae after contamination of the implant bed with none (control), 10(3), 10(4) or 10(5) CFU Staphylococcus aureus. PA-tobra implants were loaded with 2.4 mg tobramycin. After 28 days analysis was done by bacteriology, histopathology and histomorphometry. Six percent of the contaminated PA-tobra rabbits were infected, whereas this was 53 and 67% for PA and Ti, respectively (p tobramycin to PA-coated titanium foam implants appears to be an effective local antibiotic strategy for uncemented implants for infection prophylaxis and has a beneficial effect on implant fixation, which will result in improved long-term implant survival. Copyright 2008 Orthopaedic Research Society

  17. Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery

    DEFF Research Database (Denmark)

    Friis, Esbern; Hørby, John; Sørensen, Lars Tue

    2004-01-01

    Hematoma and bruising (sugillation) are frequent problems after operations for primary breast cancer. In the present study we evaluated the influence of various methods of perioperative thromboembolic prophylaxis on the postoperative incidence of hematoma and suggilation. From June 1994 through...... thrombosis, pulmonary embolism, wound hematoma, and sugillation were recorded, and 17 variables with a potential influence on complications were analyzed by logistic regression analysis. Heparin prophylaxis compared to prophylaxis with TED stockings was significantly and independently associated...

  18. Optimal Timing of Surgical Antimicrobial Prophylaxis with Cefuroxim: Challenging the WHO Guidelines with 121,000 Prospectively Followed Patients

    Science.gov (United States)

    Widmer, Andreas F; Troillet, Nicolas; Thurneysen, Maurus; Atkinson, Andrew; Dangel, Marc; Kuster, Stefan P; Marschall, Jonas

    2017-01-01

    Abstract Background Surgical antimicrobial prophylaxis (SAP) is standard of care in clean surgery involving implants and in clean-contaminated surgical procedures. Timing of application of the antibiotic remains a debate: WHO recently extended the time prior to incision from 60 to 120 minutes, while CDC considers the availabdata insufficient to provide evidence-based guideline for timing. In addition, studies to date included different types of antibiotics with different T ½. Therefore, we prospectively followed 250’000 patients to further define the optimal timing for SAP Methods The Swiss national center for infection prevention (www.swissnoso.ch) started surveillance for surgical site infection (SSI) in 2009. Currently, 172 institutions participate throughout Switzerland, with routine postdicharge surveillance (adherence >90%) and on-site quality audits by a physician or infection control practitioner. The data collection includes age, sex, type of surgery, timing of SAP in minutes prior to incision, BMI, ASA score, antimicrobial agent. Inclusion criteria for this study were: adult patients undergoing cardiac surgery, orthopedic or abdominal surgery, antimicrobial prophylaxis with cefuroxime only (+metronidazole for abdominal surgery) and pathogen identified in cases of SSI was cefuroxime-susceptible. Data were analyzed using a generalized additive model (GAM) to allow non-parametric fits with relaxed assumptions on the actual relationship between response and predictor Results Of the 258’481 patients in the national SSI surveillance database 121’645 fulfilled the inclusion criteria (38% of patients did not require SAP, 18% had surgery with contaminated or dirty wounds, 2.7% were <18 years and data on timing and class of antibiotic were missing in 5.7%). The lowest risk of SSI was observed with application of SAP 0–30min prior incision, even after adjustment for age, sex, ASA score, type of surgery, BMI, and T1/2. (Figure, CI95 in blue

  19. Antibiotic use and microbiome function.

    Science.gov (United States)

    Ferrer, Manuel; Méndez-García, Celia; Rojo, David; Barbas, Coral; Moya, Andrés

    2017-06-15

    Our microbiome should be understood as one of the most complex components of the human body. The use of β-lactam antibiotics is one of the microbiome covariates that influence its composition. The extent to which our microbiota changes after an antibiotic intervention depends not only on the chemical nature of the antibiotic or cocktail of antibiotics used to treat specific infections, but also on the type of administration, duration and dose, as well as the level of resistance that each microbiota develops. We have begun to appreciate that not all bacteria within our microbiota are vulnerable or reactive to different antibiotic interventions, and that their influence on both microbial composition and metabolism may differ. Antibiotics are being used worldwide on a huge scale and the prescription of antibiotics is continuing to rise; however, their effects on our microbiota have been reported for only a limited number of them. This article presents a critical review of the antibiotics or antibiotic cocktails whose use in humans has been linked to changes in the composition of our microbial communities, with a particular focus on the gut, oral, respiratory, skin and vaginal microbiota, and on their molecular agents (genes, proteins and metabolites). We review the state of the art as of June 2016, and cover a total of circa 68 different antibiotics. The data herein are the first to compile information about the bacteria, fungi, archaea and viruses most influenced by the main antibiotic treatments prescribed nowadays. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. The Comprehensive Antibiotic Resistance Database

    Science.gov (United States)

    McArthur, Andrew G.; Waglechner, Nicholas; Nizam, Fazmin; Yan, Austin; Azad, Marisa A.; Baylay, Alison J.; Bhullar, Kirandeep; Canova, Marc J.; De Pascale, Gianfranco; Ejim, Linda; Kalan, Lindsay; King, Andrew M.; Koteva, Kalinka; Morar, Mariya; Mulvey, Michael R.; O'Brien, Jonathan S.; Pawlowski, Andrew C.; Piddock, Laura J. V.; Spanogiannopoulos, Peter; Sutherland, Arlene D.; Tang, Irene; Taylor, Patricia L.; Thaker, Maulik; Wang, Wenliang; Yan, Marie; Yu, Tennison

    2013-01-01

    The field of antibiotic drug discovery and the monitoring of new antibiotic resistance elements have yet to fully exploit the power of the genome revolution. Despite the fact that the first genomes sequenced of free living organisms were those of bacteria, there have been few specialized bioinformatic tools developed to mine the growing amount of genomic data associated with pathogens. In particular, there are few tools to study the genetics and genomics of antibiotic resistance and how it impacts bacterial populations, ecology, and the clinic. We have initiated development of such tools in the form of the Comprehensive Antibiotic Research Database (CARD; http://arpcard.mcmaster.ca). The CARD integrates disparate molecular and sequence data, provides a unique organizing principle in the form of the Antibiotic Resistance Ontology (ARO), and can quickly identify putative antibiotic resistance genes in new unannotated genome sequences. This unique platform provides an informatic tool that bridges antibiotic resistance concerns in health care, agriculture, and the environment. PMID:23650175

  1. Prescribing antibiotics in general practice:

    DEFF Research Database (Denmark)

    Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

    Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how......) and the Danish Microbiology Database (performed microbiological testing). We will assess and quantify the use of microbiological testing prior to antibiotic prescription. Furthermore we will investigate associations between GP characteristics, use of microbiological investigations and description patterns...

  2. The benefit of low dose prophylaxis in the treatment of hemophilia: a focus on China.

    Science.gov (United States)

    Wu, Runhui; Luke, Koon Hung

    2017-11-01

    Currently full dose prophylaxis is the standard of care in the treatment of hemophilia (World Federation of Hemophilia). However, the high costs prevent the use of standard or intermediate dose prophylaxis in China and other developing countries. Low dose prophylaxis would be a viable alternative treatment. At present global research data on the use of low dose prophylaxis is limited. Areas covered: Since 2007, China has been developing low dose prophylaxis as a high priority (90 % of moderate and severe hemophilia boys suffer joint disease by age 6 - 9). 11 studies were successfully conducted and published results showing evidence of the benefits of low dose prophylaxis to reduce joint bleeding. This new knowledge has been implemented into clinical practice in China. However the long-term outcome of arthropathy remains unclear and obstacles in execution exist. Expert commentary: In 2016, the first phenotype-based individualized prophylaxis study using four escalating low dose regimens on severe Chinese hemophilia A boys (China Individualized Prophylaxis Study (CHIP China)) launched. Using the previously published and imminent CHIP data, the goal for China is to establish an effective escalating low dose prophylaxis protocol for use in China as a standard of care.

  3. Reactivation of coccidioidomycosis despite antifungal prophylaxis in solid organ transplant recipients.

    Science.gov (United States)

    Keckich, David W; Blair, Janis E; Vikram, Holenarasipur R; Seville, Maria Teresa; Kusne, Shimon

    2011-07-15

    Coccidioidomycosis is an airborne infection caused by the fungus Coccidioides, which is endemic to the southwestern United States. Cell-mediated immunity is required for the control of this infection, and some patients such as organ transplant recipients, who lack such immunity, have a high risk of severe, disseminated, or relapsed infection with high mortality. Previously latent coccidioidal infection can reactivate after transplantation. Antifungal prophylaxis has substantially decreased the risk of reactivated coccidioidomycosis after transplantation in these patients. We conducted a retrospective review of all patients with coccidioidomycosis who underwent solid organ transplantation at our center to identify factors for recrudescent coccidioidomycosis (despite antifungal prophylaxis) after transplantation. Between June 1999 and June 2009, 100 patients with previous coccidioidomycosis underwent solid organ transplantation at our institution. Ninety-four (94%) received anticoccidioidal prophylaxis after transplantation. The six patients who did not receive such prophylaxis did not experience reactivated coccidioidomycosis. Five patients who received anticoccidioidal prophylaxis experienced reactivated infection. All five patients survived with further antifungal treatment. Among patients who experienced recrudescent infection despite antifungal prophylaxis, African American race was an identified risk factor. Pretransplant dissemination may be a risk factor for reactivated coccidioidomycosis, but this finding was not statistically significant. Whether nonadherence to prophylaxis played a small or large role is uncertain. Antifungal prophylaxis effectively suppressed recrudescent coccidioidomycosis after solid organ transplantation for the large majority of patients with a history of coccidioidomycosis before transplantation. Strict lifelong adherence to antifungal prophylaxis is imperative.

  4. Correlation of venous thromboembolism prophylaxis and electronic medical record alerts with incidence among surgical patients.

    Science.gov (United States)

    Ramanathan, Rajesh; Lee, Nathaniel; Duane, Therese M; Gu, Zirui; Nguyen, Natalie; Potter, Teresa; Rensing, Edna; Sampson, Renata; Burrows, Mandy; Banas, Colin; Hartigan, Sarah; Grover, Amelia

    2016-11-01

    Venous thromboembolism events are potentially preventable adverse events. We investigated the effect of interruptions and delays in pharmacologic prophylaxis on venous thromboembolism incidence. Additionally, we evaluated the utility of electronic medical record alerts for venous thromboembolism prophylaxis. Venous thromboembolisms were identified in surgical patients retrospectively through Core Measure Venous ThromboEmbolism-6-6 and Patient Safety Indicator 12 between November 2013 and March 2015. Venous thromboembolism pharmacologic prophylaxis and prescriber response to electronic medical record alerts were recorded prospectively. Prophylaxis was categorized as continuous, delayed, interrupted, other, and none. Among 10,318 surgical admissions, there were 131 venous thromboembolisms; 23.7% of the venous thromboembolisms occurred with optimal continuous prophylaxis. Prophylaxis, length of stay, age, and transfer from another hospital were associated with increased venous thromboembolism incidence. Compared with continuous prophylaxis, interruptions were associated with 3 times greater odds of venous thromboembolism. Delays were associated with 2 times greater odds of venous thromboembolism. Electronic medical record alerts occurred in 45.7% of the encounters and were associated with a 2-fold increased venous thromboembolism incidence. Focus groups revealed procedures as the main contributor to interruptions, and workflow disruption as the main limitation of the electronic medical record alerts. Multidisciplinary strategies to decrease delays and interruptions in venous thromboembolism prophylaxis and optimization of electronic medical record tools for prophylaxis may help decrease rates of preventable venous thromboembolism. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Prophylactic antibiotics for endoscopy-associated peritonitis in peritoneal dialysis patients.

    Directory of Open Access Journals (Sweden)

    Hsin-Hsu Wu

    Full Text Available INTRODUCTION: Continuous ambulatory peritoneal dialysis (CAPD peritonitis may develop after endoscopic procedures, and the benefit of prophylactic antibiotics is unclear. In the present study, we investigated whether prophylactic antibiotics reduce the incidence of peritonitis in these patients. PATIENTS AND METHODS: We retrospectively reviewed all endoscopic procedures, including esophagogastroduodenoscopy (EGD, colonoscopy, sigmoidoscopy, cystoscopy, hysteroscopy, and hysteroscopy-assisted intrauterine device (IUD implantation/removal, performed in CAPD patients at Chang Gung Memorial Hospital, Taiwan, between February 2001 and February 2012. RESULTS: Four hundred and thirty-three patients were enrolled, and 125 endoscopies were performed in 45 patients. Eight (6.4% peritonitis episodes developed after the examination. Antibiotics were used in 26 procedures, and none of the patients had peritonitis (0% vs. 8.1% without antibiotic use; p=0.20. The peritonitis rate was significantly higher in the non-EGD group than in the EGD group (15.9% [7/44] vs. 1.2% [1/81]; p<0.005. Antibiotic use prior to non-EGD examinations significantly reduced the endoscopy-associated peritonitis rate compared to that without antibiotic use (0% [0/16] vs. 25% [7/28]; p<0.05. Peritonitis only occurred if invasive procedures were performed, such as biopsy, polypectomy, or IUD implantation, (noninvasive procedures, 0% [0/20] vs. invasive procedures, 30.4% [7/23]; p<0.05. No peritonitis was noted if antibiotics were used prior to examination with invasive procedures (0% [0/10] vs. 53.8% [7/13] without antibiotic use; p<0.05. Although not statistically significant, antibiotics may play a role in preventing gynecologic procedure-related peritonitis (antibiotics, 0% [0/4] vs. no antibiotics, 55.6% [5/9]; p=0.10. CONCLUSION: Antibiotic prophylaxis significantly reduced endoscopy-associated PD peritonitis in the non-EGD group. Endoscopically assisted invasive procedures, such

  6. An Evidence-Based Protocol for Antibiotic Use Prior to Cystoscopy Decreases Antibiotic Use without Impacting Post-Procedural Symptomatic Urinary Tract Infection Rates.

    Science.gov (United States)

    Gregg, Justin R; Bhalla, Rohan G; Cook, J Paul; Kang, Caroline; Dmochowski, Roger; Talbot, Thomas R; Barocas, Daniel A

    2018-04-01

    Symptomatic urinary tract infection is a complication of office based cystourethroscopy. Studies are mixed regarding the efficacy of antibiotic prophylaxis to prevent urinary tract infections. Our aim was to develop and evaluate an evidence-based protocol that reduces unnecessary antibiotic use while avoiding an increase in urinary tract infections. We created a clinic antibiogram based on all urology office visits performed during a 2-year period. Bacterial resistance rates, institutional risk related data and clinical guidelines were applied to create a protocol for antibiotic administration before cystourethroscopy. We then analyzed 1,245 consecutive patients without a renal transplant who underwent outpatient cystourethroscopy, including 610 after protocol initiation. Urinary tract infection rates and antibiotic use were analyzed for an association with the protocol change using the Fisher exact test. Cultures had an overall 20% rate of resistance to fluoroquinolones, representing 40% of the cultures that grew Escherichia coli. Before the protocol change 602 of 635 patients (94.8%) received a preprocedural antibiotic compared to 426 of 610 (69.9%) after protocol initiation (p urinary tract infection prior to the protocol change while 16 (2.6%) had a urinary tract infection after the change (p = 0.69). Regarding resistance, fluoroquinolone resistant organisms grew in the cultures of 12 of 19 patients (63.2%) with a urinary tract infection before the protocol change compared to 5 of 16 (31.3%) with a urinary tract infection after the change. Recent antibiotic administration, hospitalization and chronic catheterization were associated with urinary tract infection in the entire cohort (all p ≤0.01). A local antibiogram with infection related risk data effectively risk stratifies patients before cystourethroscopy, decreasing the use of antibiotics without increasing the rate of symptomatic urinary tract infection. Copyright © 2018 American Urological Association

  7. Bacterial fitness shapes the population dynamics of antibiotic-resistant and -susceptible bacteria in a model of combined antibiotic and anti-virulence treatment

    Science.gov (United States)

    Ternent, Lucy; Dyson, Rosemary J.; Krachler, Anne-Marie; Jabbari, Sara

    2015-01-01

    Bacterial resistance to antibiotic treatment is a huge concern: introduction of any new antibiotic is shortly followed by the emergence of resistant bacterial isolates in the clinic. This issue is compounded by a severe lack of new antibiotics reaching the market. The significant rise in clinical resistance to antibiotics is especially problematic in nosocomial infections, where already vulnerable patients may fail to respond to treatment, causing even greater health concern. A recent focus has been on the development of anti-virulence drugs as a second line of defence in the treatment of antibiotic-resistant infections. This treatment, which weakens bacteria by reducing their virulence rather than killing them, should allow infections to be cleared through the body׳s natural defence mechanisms. In this way there should be little to no selective pressure exerted on the organism and, as such, a predominantly resistant population should be less likely to emerge. However, before the likelihood of resistance to these novel drugs emerging can be predicted, we must first establish whether such drugs can actually be effective. Many believe that anti-virulence drugs would not be powerful enough to clear existing infections, restricting their potential application to prophylaxis. We have developed a mathematical model that provides a theoretical framework to reveal the circumstances under which anti-virulence drugs may or may not be successful. We demonstrate that by harnessing and combining the advantages of antibiotics with those provided by anti-virulence drugs, given infection-specific parameters, it is possible to identify treatment strategies that would efficiently clear bacterial infections, while preventing the emergence of antibiotic-resistant subpopulations. Our findings strongly support the continuation of research into anti-virulence drugs and demonstrate that their applicability may reach beyond infection prevention. PMID:25701634

  8. Bacterial fitness shapes the population dynamics of antibiotic-resistant and -susceptible bacteria in a model of combined antibiotic and anti-virulence treatment.

    Science.gov (United States)

    Ternent, Lucy; Dyson, Rosemary J; Krachler, Anne-Marie; Jabbari, Sara

    2015-05-07

    Bacterial resistance to antibiotic treatment is a huge concern: introduction of any new antibiotic is shortly followed by the emergence of resistant bacterial isolates in the clinic. This issue is compounded by a severe lack of new antibiotics reaching the market. The significant rise in clinical resistance to antibiotics is especially problematic in nosocomial infections, where already vulnerable patients may fail to respond to treatment, causing even greater health concern. A recent focus has been on the development of anti-virulence drugs as a second line of defence in the treatment of antibiotic-resistant infections. This treatment, which weakens bacteria by reducing their virulence rather than killing them, should allow infections to be cleared through the body׳s natural defence mechanisms. In this way there should be little to no selective pressure exerted on the organism and, as such, a predominantly resistant population should be less likely to emerge. However, before the likelihood of resistance to these novel drugs emerging can be predicted, we must first establish whether such drugs can actually be effective. Many believe that anti-virulence drugs would not be powerful enough to clear existing infections, restricting their potential application to prophylaxis. We have developed a mathematical model that provides a theoretical framework to reveal the circumstances under which anti-virulence drugs may or may not be successful. We demonstrate that by harnessing and combining the advantages of antibiotics with those provided by anti-virulence drugs, given infection-specific parameters, it is possible to identify treatment strategies that would efficiently clear bacterial infections, while preventing the emergence of antibiotic-resistant subpopulations. Our findings strongly support the continuation of research into anti-virulence drugs and demonstrate that their applicability may reach beyond infection prevention. Copyright © 2015 The Authors. Published by

  9. Surveillance of antibiotic resistance

    Science.gov (United States)

    Johnson, Alan P.

    2015-01-01

    Surveillance involves the collection and analysis of data for the detection and monitoring of threats to public health. Surveillance should also inform