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Purpose: This study aims to evaluate the effectiveness of two prophylactic strategies in preventing shunt infections in pediatric patients undergoing ventriculoperitoneal shunt surgery. Methods: This retrospective study included pediatric patients who underwent ventriculoperitoneal shunt surgery between 2017 and 2024. Patients were divided into two groups based on the prophylactic method used: Group 1 (VS) where the shunt was washed with vancomycin solution before placement, and Group 2 (TVP) where vancomycin powder was applied to the subgaleal and subcutaneous tissues after shunt placement. Data collected included age, gender, preoperative CRP values, operation length, hospitalization duration, wound site problems, and rates of early (within 3 days) and late (within 36 months) postoperative infections and shunt revisions. Results: Data from 56 pediatric patients were analyzed. The TVP group had significantly lower rates of early postoperative infections compared to the VS group (3.3% vs. 26.9%, p < 0.05). Late postoperative infections were also lower in the TVP group (3.3% vs. 30.7%, p < 0.05). Shunt revision was required in 26.9% of patients in the VS group, but none in the TVP group (p < 0.05). Wound site problems were a critical factor, with all patients experiencing wound site infections also developing early postoperative infections (p < 0.05). Conclusion: The use of subgaleal topical vancomycin powder is a promising prophylactic method in ventriculoperitoneal shunt surgery, particularly for pediatric patients who are prone to skin problems, as it effectively avoids systemic toxic effects while reducing infection rates and the need for shunt revisions. [ABSTRACT FROM AUTHOR]

Anti-CD19 chimeric antigen receptor (CAR) T-cell and anti-CD20 bispecific antibody therapies (BsAbs) are rapidly moving to earlier treatment lines for patients with B-cell non-Hodgkin lymphoma (B-NHL). The rapid pace of the advancement of these T-cell-engaging therapies is juxtaposed by a lack of a comprehensive understanding of the scope and kinetics of immunodeficiency following these treatments. We review emerging studies detailing the safety and efficacy of CD19 CAR-T and CD20 BsAbs in earlier lines for B-NHL, as well as a discussion of the limited knowledge of immune recovery following these treatments. We integrate the limited consensus prevention and management recommendations, advocating that the management of secondary immunodeficiency following these transformative therapies is an urgent unmet need in immune oncology research. A collaboration between hematologists/oncologists and immunologists in the management of these patients is critical to optimize patient care. [ABSTRACT FROM AUTHOR]

Spinal and paraspinal infections (SPIs) are a potential complication following traumatic spinal column injury, and we sought to determine the association of antibiotic prophylaxis on SPI development following a spinal gunshot wound (GSW). A single-center retrospective cohort study was performed on adults who sustained a GSW to the spinal column over 11 y. Patients were excluded if they died within 24 h or had a mechanism other than GSW. Antibiotic use and injury patterns were analyzed. A total of 330 patients were included in analysis. Most were male (88%), Black (79%), and averaged 27 y old. Mortality was 4%. Prophylactic antibiotics were administered in 65%; and median duration was 5 d. Nine patients (2.7%) developed SPI. Hollow viscus injury (HVIs) (66.7% versus 23.1%, P < 0.001), primarily colon injuries (55.6% versus 12.5%, P < 0.001), were independently associated with SPI. Antibiotic use was not associated with a decrease in SPI (3% versus 2%; P = 0.41). Of the patients who developed SPI, seven received 3 d of antibiotics or less, and this was not statistically significant (P = 0.49). Patients with HVIs have a higher incidence of SPI, following spinal GSW. Although antibiotic use and duration did not have a statistically significant association with SPI, no patient, even with HVIs, who received 4 or more days of antibiotics developed an infection. Due to the low incidence of SPI, a multicenter trial may help determine the optimal duration of prophylactic antibiotics. However, we recommend a maximum of 4 d of antibiotics for SPI prophylaxis following GSW. • Spinal and paraspinal infections (SPIs) are rare after spinal gunshot wounds. • Prolonged courses of antibiotics are often given to ameliorate the risk of SPI. • Patients with hollow viscus injury (HVI) have higher incidence of SPI. • We recommend 4 d of antibiotics if associated with HVI, no more than 24 h. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of prophylactic antibiotics on early infectious complications after central venous access device (VAD) placement in children with cancer. Background: Despite the frequency of VAD procedures in children, the effectiveness of prophylactic antibiotics for reducing infectious complications is unknown. Methods: This was a retrospective cohort study of children with cancer undergoing central VAD placement identified in the Pediatric Health Information System database between 2017 and 2021. The primary outcome was the rate of early infectious complications (composite surgical site infections, central line-associated bloodstream infections, and bacteremia). Multivariable logistic regression was used to evaluate factors associated with early infection, and heterogeneity of treatment effect of prophylactic antibiotics was compared across subgroups. Results: A total of 9216 patients were included (6058 ports and 3158 tunneled lines). Prophylactic antibiotics were associated with lower early infectious complications overall [1.3% vs 2.4%; odds ratio (OR): 0.55 (95% CI: 0.39-0.79), P < 0.001], an effect demonstrated for tunneled lines (OR: 0.59, 95% CI: 0.41-0.84) but not ports (OR: 3.01, 95% CI: 0.66-13.78). On multivariate analysis, prophylactic antibiotics (OR: 0.67, 95% CI: 0.45-0.97) and solid tumors (OR: 0.38, 95% CI: 0.22-0.64) were associated with reduced odds of early infections, whereas tunneled lines (OR: 20.78, 95% CI: 9.83-43.93) and acute myelogenous leukemia (OR: 2.37, 95% CI: 1.58-3.57) had increased odds. Conclusions: Prophylactic antibiotics are associated with reduced early infectious complications after central VAD placement overall. Despite recommendations from multiple national organizations against prophylactic antibiotics, these findings suggest a benefit in children with malignancy undergoing tunneled line placement. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion We evaluated the incidence of and risk factors for postoperative infections after robotic‐assisted radical prostatectomy (RARP) according to the type and duration of prophylactic antibiotic administration.A total of 1038 patients underwent RARP at our institution from 2010 to 2021; 1026 patients (201 in the cefazolin [CEZ] group and 825 in the ampicillin/sulbactam [ABPC/SBT] group) were analyzed, and 12 who used other antibiotics were excluded. The primary endpoint was the incidence of urinary tract infection (UTI), surgical site infection (SSI), and remote infection (RI). T‐tests, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed. Multivariate logistic regression analysis was performed to evaluate the effect of type and duration of prophylactic antibiotic administration.The incidence of UTI was 2.5% (5/201) in the CEZ group and 3.2% (26/825) in the ABPC/SBT group, with no significant difference between groups (p = 0.622). The rates of SSI and RI were comparable between groups (p = 0.680 and 0.906, respectively). Although the duration of antimicrobial therapy was longer in the ABPC/SBT group (p < 0.001), there was no significant difference in the incidence of UTI/SSI/RI after PSM and IPTW (all p > 0.05). Multivariate logistic regression analysis showed that neither the type of antibiotic nor the duration of administration affected the incidence of UTI/SSI/RI.The risk of postoperative UTI/SSI/RI after RARP did not change with the type and duration of antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the utility of prophylactic antibiotics before pyloromyotomy for the prevention of Surgical Site Infections (SSI) among children with Infantile Hypertrophic Pyloric Stenosis (IHPS). Methods: A systematic search of PubMed, Scopus, Embase, and Web of Science databases was performed to identify papers published till 30th July 2024. The main outcome of interest was the incidence of SSIs. The relative risk (RR) with 95% confidence interval (CI) was calculated using a random effects model. The I2 statistic was used to calculate the heterogeneity. The Newcastle–Ottawa-Scale (NOS) was used to assess the methodological quality of the included studies. Results: Five studies, published between 1999 and 2024, were included in this systematic review and meta-analysis. The risk of developing SSI among those treated was RR = 0.97, 95% CI 0.53 to 1.78, with I2 = 0%, indicating no incremental benefit of administration of prophylactic antibiotics. A sensitivity analysis was performed by excluding the database studies. Results from this analysis (RR = 0.79, 95% CI 0.29 to 2.20, I2 = 0%) demonstrated that no significant difference was observed after excluding studies with large sample sizes. All included studies were of good methodological quality as assessed with the NOS. Conclusion: The findings of this review demonstrate no incremental benefit of the administration of prophylactic antibiotics before pyloromyotomy in preventing SSIs in children with IHPS. However, randomized, double-blinded, placebo-controlled trials need to be conducted in the future before any definite conclusions are drawn in this regard. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac disease is a leading cause of maternal morbidity and mortality during pregnancy. Effective management strategies are crucial for improving outcomes in this high-risk population. Aim: This study aimed to evaluate the outcomes of pregnant women with cardiac disease managed at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, to refine treatment protocols. Methods: A prospective cohort study was conducted over one year, enrolling 35 pregnant women with either congenital or acquired heart diseases. Participants underwent regular monitoring with echocardiography, and data were collected on maternal and perinatal outcomes, including delivery methods and postpartum complications. Results: The study highlights significant maternal and perinatal complications in pregnant women with cardiac disease, with anemia (31.4%) and preterm birth (25.7%) as prevalent issues. The findings underscore the need for careful monitoring and management tailored to the severity of cardiac dysfunction to improve outcomes for both mothers and newborns. Conclusion: Effective cardiac and obstetric management in a tertiary care setting allowed for predominantly vaginal deliveries and highlighted the importance of echocardiography in monitoring. Recommendation: Tailored antibiotic prophylaxis and comprehensive postpartum contraceptive counseling should be integrated into care protocols for pregnant women with cardiac disease. [ABSTRACT FROM AUTHOR]

Background Surgical site infection (SSI) is one of the most severe complications of spinal fusion surgery that lead to increased morbidity and mortality rates. Prophylactic antibiotic usage is one of the methods that reduce the possibility of SSI in this procedure. The aim of this study was to determine the effect of local subfascial teicoplanin usage on radiologic and functional outcomes and compare it to the effect of vancomycin on surgical outcomes in patients who underwent decompression with posterior instrumentation (DPI) for lumbar spinal stenosis (LSS). Methods Medical charts of patients with LSS who received DPI and met the study criteria were divided into three groups: the teicoplanin group included patients who underwent DPI with local teicoplanin before closure, the vancomycin group included patients who underwent DPI with local vancomycin, and the control group included patients who underwent DPI without any local prophylactic antibiotics. Results A total of 101 patients were included in the study. No significant differences were found among groups regarding demographics, follow-up, and clinical and functional outcomes. No significant differences were observed among groups regarding postoperative improvements in SF-36-MCS, SF-36-PCS, Oswestry Disability Index, and Visual Analog Scale (VAS; p > 0.05). In the teicoplanin and vancomycin groups, the SSI rate was lower than that in the control group (2/35, 1/34, and 5/32, respectively, p = 0.136) without statistical significance; however, the postoperative fusion volume was significantly higher in the teicoplanin group when compared to the other groups (3.35 ± 1.08, 2.68 ± 1.17, and 2.65 ± 1.28 cm3 , respectively, p = 0.007). Conclusions Although its cost is relatively higher, teicoplanin was a good alternative to vancomycin in preventing SSIs with a higher fusion rate, but no superiority was observed regarding other outcomes. [ABSTRACT FROM AUTHOR]

Background: Recommendations for cardiac surgery advocate for antibiotic prophylaxis for up to 48 hour after surgery. However, recent reports found a significant reduction in surgical site infection with extended duration. We evaluated the effect of the type of prophylactic antibiotics and administration durations on the postoperative surgical site infection rate following cardiac surgery in adults. Methods: An investigator-initiated randomized controlled trial was conducted from 2018 to 2022 on adult patients undergoing cardiac surgery. Patients were randomized into four groups based on antibiotic treatment type and duration: 24 h cefazolin, 24 h cefuroxime, 48 h cefazolin, and 48 h cefuroxime. The primary outcome was the rate of surgical site infections within 90 days of surgery. Results: A total of 568 patients were included in this study. The four groups had similar baseline characteristics, including age, sex, EuroSCORE II, and baseline HbA1c. A total of 75 patients developed infection within 90 days postoperative. The overall infection rate was not statistically different across the four groups (p = 0.193). The efficacy of cefazolin and cefuroxime in reducing infection was comparable (p = 0.901). Extended prophylaxis was associated with a significantly reduced overall infection rate within 90 days postoperatively compared to 24-h prophylaxis (10.2% vs. 16.3%; risk ratio = 0.62, 95% confidence interval: 0.40–0.96, p = 0.032). Conclusion: Using cefazolin or cefuroxime for 48 h instead of 24 h was more effective in reducing the overall surgical site infections rate up to 90 days after surgery. [ABSTRACT FROM AUTHOR]

Aim: Patients with inborn errors of immunity (IEI) have a higher frequency of infections and long-term antibiotic usage. We aimed to assess the effects of immunoglobulin replacement therapy (IgRT) on infection rates, antibiotic usage, and treatment outcomes in patients with IEI. Methods: We retrospectively analyzed demographic data, infection frequency, antibiotic prescriptions, and IgRT in 122 IEI patients between March 2014 and September 2023. Specific IEI diagnoses were made following the European Society for Immunodeficiencies criteria. Results: The median age of patients was 29 years [interquartile range (IQR): 23-40], with 54.1% being male. The median age at diagnosis was 25 years (IQR: 13-36), with a diagnostic delay of 96 months (IQR: 24-180). IgRT was administered to 74.5% of patients, with a median treatment duration of 20 years (IQR: 10-33.5). Antibiotic use was higher in patients receiving IgRT (median: 27, IQR: 16-42) compared to those not on IgRT (median: 14, IQR: 8-22; p

OBJECTIVES: To assess the effects of antibiotics delivered via the respiratory tract in preventing ventilator-associated pneumonia (VAP). DATA SOURCES: We searched PubMed, Scopus, the Cochrane Library, and ClinicalTrials.gov for studies published in English up to October 25, 2023. STUDY SELECTION: Adult patients with mechanical ventilation of over 48 h and receiving inhaled or instilled antibiotics (with control group) to prevent VAP were included. DATA EXTRACTION: Two independent groups screened studies, extracted the data, and assessed the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty/quality of the evidence. Results of a random-effects model were reported for overall and predefined subgroup meta-analyses. The analysis was primarily conducted on randomized controlled trials, and observational studies were used for sensitivity analyses. DATA SYNTHESIS: Seven RCTs with 1445 patients were included, of which six involving 1283 patients used nebulizers to deliver antibiotics. No obvious risk of bias was found among the included RCTs for the primary outcome. Compared with control group, prophylactic antibiotics delivery via the respiratory tract significantly reduced the risk of VAP (risk ratio [RR], 0.69 [95% CI, 0.53-0.89]), particularly in subgroups where aminoglycosides (RR, 0.67 [0.47-0.97]) or nebulization (RR, 0.64 [0.49-0.83]) were used as opposed to other antibiotics (ceftazidime and colistin) or intratracheal instillation. No significant differences were observed in mortality, mechanical ventilation duration, ICU and hospital length of stay, duration of systemic antibiotics, need for tracheostomy, and adverse events between the two groups. Results were confirmed in sensitivity analyses. CONCLUSIONS: In adult patients with mechanical ventilation for over 48 h, prophylactic antibiotics delivered via the respiratory tract reduced the risk of VAP, particularly for those treated with nebulized aminoglycosides. [ABSTRACT FROM AUTHOR]

Aim: Patients with inborn errors of immunity (IEI) have a higher frequency of infections and long-term antibiotic usage. We aimed to assess the effects of immunoglobulin replacement therapy (IgRT) on infection rates, antibiotic usage, and treatment outcomes in patients with IEI. Methods: We retrospectively analyzed demographic data, infection frequency, antibiotic prescriptions, and IgRT in 122 IEI patients between March 2014 and September 2023. Specific IEI diagnoses were made following the European Society for Immunodeficiencies criteria. Results: The median age of patients was 29 years [interquartile range (IQR): 23-40], with 54.1% being male. The median age at diagnosis was 25 years (IQR: 13-36), with a diagnostic delay of 96 months (IQR: 24-180). IgRT was administered to 74.5% of patients, with a median treatment duration of 20 years (IQR: 10-33.5). Antibiotic use was higher in patients receiving IgRT (median: 27, IQR: 1642) compared to those not on IgRT (median: 14, IQR: 8-22; p<0.001). Patients with bronchiectasis had lower baseline immunoglobulin G, CD19+, and natural killer cell counts, with more frequent antibiotic use, though hospitalization rates were similar to those without bronchiectasis. Immunoglobulin replacement therapy use was higher in the bronchiectasis group (61.5%, p<0.001). No significant differences in antibiotic use or hospitalization rates were observed between intravenous and subcutaneous IgRT groups. Conclusion: Patients with IEI face significant respiratory infections despite IgRT and prophylactic antibiotics. Bronchiectasis is a key risk factor for increased antibiotic use. Early diagnosis and personalized treatment are crucial in reducing infection burden and improving outcomes in this population. [ABSTRACT FROM AUTHOR]

OBJECTIVE Previous studies have shown an association between alteplase for line clearance and central line–associated bloodstream infections (CLABSIs). The objective of this study was to evaluate the use of post-alteplase antibiotics as a CLABSI reduction strategy in pediatric intensive care unit (PICU) patients. METHODS This was a single center, retrospective, observational study evaluating PICU patients from January 1, 2014, through August 1, 2021, conducted at a tertiary academic PICU. Included in this study were critically ill patients who had 1 or more central venous lines (CVLs) requiring alteplase for line clearance. The primary objective was incidence of CLABSI occurrence post alteplase administration for CVL clearance, with or without targeted single-dose antibiotics (piperacillin-tazobactam or vancomycin) post alteplase. Secondary outcomes included evaluation of total alteplase administrations and risk factors associated with CLABSI occurrence. RESULTS Two hundred fifty patients were included, with 156 receiving alteplase only, 82 piperacillintazobactam, and 12 vancomycin, and with median ages of 2.8, 3.8, and 3.8 years, respectively. Seven CLABSIs occurred in the alteplase-only group, with 0 incidences in both the piperacillin-tazobactam (exact OR, 0.12; exact 95% CI, <0.01–0.59; p < 0.01) and vancomycin (exact OR, 1.20; exact 95% CI, 0.03–9.80; p = 1.00) groups. Patients in the piperacillin-tazobactam group achieved statistical significance for CLABSI risk factors that may benefit by decreasing CLABSI incidence (p values <0.01–0.02). CONCLUSIONS Alteplase use has been associated with CLABSIs. Providing a single dose of post-alteplase antibiotics targeting the most likely site-specific pathogens may reduce the incidence of CLABSIs. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the need for prophylactic antibiotic treatment prior to combined intracavitary and interstitial (hybrid) brachytherapy for gynecologic cancer. A total of 105 gynecologic cancer patients received 405 brachytherapy sessions, including 302 sessions of intracavitary brachytherapy and 103 sessions of hybrid brachytherapy. Prophylactic antibiotics were administered before 35% of the hybrid brachytherapy sessions. The incidence of postbrachytherapy fever and the frequency of subsequent antibiotic use for infection were compared between treatment groups. Among patients treated with hybrid brachytherapy, fever ≥37.5°C occurred in 16.4% of those not receiving prophylactic antibiotics and 16.7% of those receiving prophylactic antibiotics (P  > 0.05). Similarly, fever ≥38.0°C occurred in 4.9% of patients not receiving prophylactic antibiotics and 2.4% of those receiving prophylactic antibiotics (P  > 0.05). Additional antibiotics were used to treat postbrachytherapy infections in 4.8% of the group receiving prophylactic antibiotics and 0% of those not receiving prophylactic antibiotics, again without statistically significant difference. There were also no significant differences in posttreatment fever incidence and antibiotics use for infection between intracavitary brachytherapy and hybrid brachytherapy sessions. In conclusion, the incidences of infection and fever are low following hybrid brachytherapy, so prophylactic antibiotics are generally unnecessary. [ABSTRACT FROM AUTHOR]

Background & aim: The use of antibiotic prophylaxis in the treatment of burns is a controversial issue. Many specialists start antibiotic treatment after the patient is admitted to prevent infection, while in most cases, antibiotic use is not necessary. The aim of the present study was to determine the relationship between the use of antibiotic prophylaxis on mortality, infection and drug resistance in burn patients without sepsis symptoms admitted to Amir al-Momenin Burn Injury Hospital. Methods: The present analytical-cross-sectional study was conducted in 2020-2021 at Amir al-Momenin Burn Injury Hospital, Shiraz, Iran. 2982 patients were included in the study. Patients' information, results of bacterial culture and antibiotic resistance of isolated isolates were extracted from burn patients' registry system and health information system. Descriptive statistics and the collected data were presented in tabular form. Quantitative data were summarized as mean and standard deviation and qualitative data as frequency and percentage graphs. Statistical analysis was analyzed for the association of results using paired t-test and chi-square. The level of statistical significance in all tests was considered P≤0.05. Results: Antibiotic resistance in hospitalized patients with prophylaxis treatment was 54.30%. The rate of mortality and re-hospitalization of patients in patients with no antibiotic prophylaxis was zero; In addition, the blood, liver and kidney factors of the patients were within the normal range. There was no significant difference between platelet levels, alkaline phosphatase serum level, alanine aminotransferase, blood urea nitrogen level and its ratio to creatinine (P≥0.05) on the first day of hospitalization and at the time of discharge. On the other hand, there was a significant difference between the levels of white blood cells, neutrophils and albumin (P

Utilization of antibiotics for endoscopic dacryocystorhinostomy (endo-DCR) is largely dependent on individual surgeon preference. This study aimed to investigate prescribing practices of pre-, peri-, and postoperative antibiotics and effects on postoperative infection rates in patients who underwent endo-DCR. A retrospective chart review of institutional data at two academic centers of endo-DCR cases from 2015–2020 was performed. Postoperative infection rates for patients who received pre-, peri-, and postoperative antibiotics, individually or in combination, and those who did not, were compared via odds ratio and ANOVA linear regression. 331 endo-DCR cases were included; 22 cases (6.6%) had a postoperative infection. There was no significant difference in the infection rates between patients without an active preoperative dacryocystitis who received different permutations of peri- and postoperative antibiotics. Patients who received preoperative antibiotics within two weeks of surgery for preexisting acute dacryocystitis, but did not receive peri- or postoperative antibiotics, had a higher rate of postoperative infections (p = 008). Our data suggest antibiotics may be beneficial only when patients have a recent or active dacryocystitis prior to surgery. Otherwise, our data do not support the routine use of antibiotic prophylaxis in endo-DCR. [ABSTRACT FROM AUTHOR]

Objective: To investigate the therapeutic and prophylactic use of antibiotics in dentistry in two countries. Methods: This study used questionnaires to examine the prescribing habits of dentists in Italy (9th country in Europe for systemic antibiotic administration) and Albania an Extra European Union Country. A total of 1300 questionnaires were sent to Italian and Albanian dentists. Results: In total, 180 Italian and 180 Albanian dentists completed the questionnaire. Penicillin use was higher in Italy (96.6 %) than Albania (82.8 %). Only 26.1 % of Italian dentists and 32 % of Albanian dentists followed the national guidelines for antibiotic administration. Conclusions: Dentists tend to overprescribe antibiotics for treating existing conditions or as prophylaxis. They also highlighted a lack of adherence to established guidelines for antibiotic use. In addition, factors such as age, nationality, and sex appeared to influence the choice of antibiotics. Clinical significance: Recently, the growth of antibiotic-resistant bacteria has become a global concern. The authors of this article highlight how dentists often prescribe antibiotics without a real need. Limiting the use of antibiotics in this category may help mitigate antibiotic resistance.

Abstract Background The role of prophylactic antibiotics in preventing ventilator-associated pneumonia (VAP) in patients undergoing invasive mechanical ventilation (IMV) remains unclear. This network meta-analysis compared the efficacy and safety of antibiotic prophylaxis in preventing VAP in an IMV population in intensive-care units (ICUs). Methods We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to December 2021, to identify relevant studies assessing the impact of prophylactic antibiotics on the incidence of VAP, the mortality, and the duration of ICU stays and hospitalization to perform a meta-analysis. Results Thirteen studies (2144 patients) were included, 12 of which were selected for the primary analysis, which revealed that treatment with prophylactic antibiotics resulted in a lower VAP rate compared with control groups [risk ratio (RR) = 0.62]. Bayesian network meta-analysis indicated that aerosolized tobramycin and intravenous ampicillin–sulbactam presented the greatest likelihood being the most efficient regimen for reducing VAP. Conclusions Antibiotic prophylaxis may reduce the incidence of VAP, but not the mortality, for adult patients undergoing IMV in ICUs. Tobramycin via nebulization and ampicillin–sulbactam via intravenous administration presented the greatest likelihood of being the most efficient regimen for preventing VAP. However, well-designed randomized studies are warranted before definite recommendations can be made.

Background: Surgical site infections (SSIs) remain a significant concern in complex surgeries, leading to increased morbidity and healthcare costs. The effectiveness of prophylactic antibiotic regimens in reducing SSIs incidence in such procedures requires further investigation. Methods: This prospective randomized controlled trial involved 100 participants undergoing complex surgeries, divided into groups receiving either broadspectrum or targeted prophylactic antibiotics. The study evaluated SSI incidence, the impact of surgical complexity, procedure duration, patient comorbidities, and hospital stay durations. Results: The incidence of SSIs did not significantly differ between the broadspectrum (16%) and targeted antibiotic (10%) groups (p=0.45). Complex surgeries had a higher SSI rate (20%) compared to less complex (6%) procedures (p=0.03). Significant risk factors for SSIs included age over 60 years (OR=2.3, p=0.03), diabetes (OR=3.5, p<0.001), and surgeries lasting longer than 3 hours (OR=4.0, p<0.001). Patients with SSIs had longer hospital stays (12.4 days) compared to those without infections (6.9 days, p<0.001). Conclusion: The choice between broad-spectrum and targeted prophylactic antibiotics did not significantly influence SSI rates in complex surgeries. The study emphasizes the importance of considering surgical complexity, patient age, comorbidities, and procedure duration as factors in SSI risk management. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The incidence of postendoscopic retrograde cholangiopancreatography (ERCP) infections is reported to be up to 18% in patients with biliary obstruction. Antibiotic prophylaxis may reduce the risk of infectious complications after ERCP; however, the clinical value of prophylactic antibiotics in ERCP remains controversial. METHODS: We conducted a double-blind, placebo-controlled, randomized trial to investigate whether the use of prophylactic antibiotics would reduce infectious complications after ERCP in patients with biliary obstruction. We randomly assigned patients in a 1:1 ratio to receive either a single dose of 1 g intravenous cefoxitin or normal saline as a placebo 30 minutes before undergoing ERCP. The primary outcome was the incidence of infectious complications after ERCP. RESULTS: We enrolled 378 patients, and 189 patients were assigned to each group. The risk of infectious complications after ERCP was 2.8% (5 of 176 patients) in the antibiotic prophylaxis group and 9.8% (17 of 173 patients) in the placebo group (risk ratio, 0.29; 95% confidence interval [CI], 0.11-0.74, P = 0.0073). The incidence rates of bacteremia were 2.3% (4 of 176 patients) and 6.4% (11 of 173 patients), respectively (risk ratio, 0.36; 95% CI, 0.12-1.04; P = 0.0599). The incidence rate of cholangitis was 1.7% (3 of 176 patients) in the antibiotic prophylaxis group and 6.4% (11 of 173 patients) in the placebo group (risk ratio, 0.27; 95% CI, 0.08-0.87; P = 0.0267). DISCUSSION: Antibiotic prophylaxis before ERCP in patients with biliary obstruction resulted in a significantly lower risk of infectious complications, especially cholangitis, than placebo (ClinicalTrials.gov trial number NCT02958059). [ABSTRACT FROM AUTHOR]

The current study is designed to evaluate the efficacy of pre-operative prophylactic antibiotic for prevention of bacteremia after surgical removal of impacted mandibular third molar SRIMTM. The study was carried out as an open clinical trial. Fifty patients who fulfilled the criteria were included. Twenty five randomly selected patients (study group) were administered two grams oral dose of amoxicillin trihydrate, one hour prior to the procedure. Twenty five patients (control group) were not administered any antibiotic prior to the procedure. All patients underwent surgical removal of impacted mandibular third molar through intraoral approach under local anesthesia. Blood culture for detection of aerobic and anaerobic micro-organisms was done for all 50 patients. Eleven out of the twenty five patients (44%) in the control group showed positive growth, including mixed growth (aerobic and anaerobic). Seven patients showed purely anaerobic, 2 patients purely aerobic and two mixed growth. In the study (antibiotic) group, 7 out of the 25 patients (28%) showed positive growth, including mixed growth. Three patients showed purely anaerobic, 2 patients purely aerobic and 2 mixed type of growth. The study suggests that the judicious use of antibiotic prophylaxis, in conjunction with optimal oral health care serves to minimize the adverse effects of antibiotic therapy; and at the same time reduce the significant morbidity and mortality associated with systemic infections that might occur due to bacteremia resulting from surgical procedures of the oral cavity. [ABSTRACT FROM AUTHOR]

Retrograde pyelography (RP) is performed for examination of upper urinary tract cancers and hydronephrosis. Although urinary tract infections (UTI) are known to be complicated by the examination, there are few reports on the frequency of occurrence and prophylactic antibiotics. The incidence of UTI and febrile UTI (f-UTI) and patient background information were compared in 388 patients who underwent RP at our hospital from January 2018 to December 2022. We also examined the administration of pre-RP antibiotics. Of the 388 patients who underwent RP, 27 (6.9%) had UTI and 17 (4.4%) had f-UTI. Of the 27 UTI cases, 25 (92.6%) were pyelonephritis; 20 (74.0%) were hospitalized and 2 (7.4%) presented with septic shock and were managed in the intensive care unit. When comparing the background of patients with UTI, no significant differences were found in the present study, but when limited to the 17 cases of f-UTI, the presence of hydronephrosis before RP and not prescribing antibiotics before RP were associated with significantly higher incidence of f-UTI (p = 0.019, p = 0.036, respectively). Especially for patients without pyuria and bacteriuria before RP, prescribing antibiotics before RP resulted in 0 cases of f-UTI (p = 0.020). This retrospective study showed that the presence of hydronephrosis before RP and not prescribing prophylactic antibiotics before RP are risk factors for f-UTI. [ABSTRACT FROM AUTHOR]

Objectives: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow‐up, 6–24 months after surgery. Design: A retrospective cohort study of prospectively collected data. Setting: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013–2019. Participants: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow‐up visit. Main Outcome Measures: The effect of PA use on TM healing rate at follow‐up and postoperative infection within 6 weeks of surgery. Results: In the study group (n = 1665) 86.2% had a healed TM at follow‐up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs. Conclusion: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB); however, the benefit for other AUGIB patients remains undetermined. We aimed to compare the clinical outcomes between patients with AUGIB with and without prophylactic antibiotics to identify the population that requires this therapy. METHODS: Patients with AUGIB admitted between 1st January 2019 and 31st December 2021 in the Emergency Department of Peking Union Medical College Hospital were enrolled. Patients were divided into the antibiotic and non-antibiotic groups. The primary outcome was in-hospital mortality, and the secondary outcome was the onset of new infection. The risk factors for mortality and infection were analyzed, and stratification analysis of prophylactic antibiotics was performed. Continuous data were analyzed using the t-test or nonparametric rank sum test, and categorical data were analyzed using the Chi-square test or Fisher's exact test. Indicators with significant differences between the groups were included for logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 392 individuals were included, among them, 281 patients received prophylactic antibiotics, and 111 patients did not receive prophylactic antibiotics. The mortality rates were significantly lower in the antibiotic group than in the non-antibiotics group (6.41% vs. 17.12%, P=0.001). The risk factors for infection were varicose veins (P=0.045) and endotracheal intubation (P=0.005) in the prophylactic antibiotic group, and endoscopic treatment (P=0.010) in the non-prophylactic antibiotic group. Stratified analyses showed that patients with age ≥ 65 years, endotracheal intubation, endoscopic treatment, and AUGIB of variceal etiologies benefited from prophylactic antibiotics. CONCLUSION: AUGIB patients may benefit from prophylactic antibiotics to decrease mortality, especially those aged ≥ 65 years and those with endotracheal intubation, endoscopic treatment, and variceal etiologies. [ABSTRACT FROM AUTHOR]

The importance of administrating prophylactic antibiotics prior to a surgical procedure is well established. Given the difficulty in diagnosing shoulder periprosthetic infections, which are more indolent in nature, some advocate holding prophylactic antibiotics prior to obtaining cultures as there is a concern antibiotics may lead to a false negative culture result. The purpose of this study is to determine whether administration of antibiotics prior to obtaining cultures in revision shoulder arthroplasty influences culture yield. This was a retrospective analysis of revision shoulder arthroplasty cases performed at a single institution between 2015 and 2021. During the study period, each surgeon had a standardized protocol that dictated whether antibiotics were given or held prior to each revision surgery. Each case was categorized into either a Preculture antibiotic group, if antibiotics were administered prior to incision, or a Postculture antibiotic group if antibiotics were administered after incision and obtaining cultures. The International Consensus Meeting (ICM) scoring criteria provided by the Musculoskeletal Infection Society was used to categorize the probability of periprosthetic joint infection for each case. Culture positivity was calculated as the ratio of positive cultures and total number of cultures obtained. One hundred twenty-four patients met inclusion criteria. There were 48 patients in the Preculture group and 76 patients in the Postculture group. No significant difference in patient demographics or ICM criteria (P =.09) was observed between the 2 groups. With regard to culture positivity, there was no difference between the Preculture antibiotic group and the Postculture antibiotic group (16% vs. 15%, P =.82, confidence interval = 8%-25% vs. 10%-20%, respectively). In the setting of revision shoulder arthroplasty, timing of antibiotic administration did not significantly influence culture yield. This study supports the use of prophylactic antibiotics prior to obtaining cultures in revision shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Background and Aim: Non-therapeutic antibiotic use is associated with the current decrease in antibiotic therapeutic efficiency and the emergence of a wide range of resistant strains, which constitutes a public health risk. This study aimed to evaluate the use of Saccharomyces cerevisiae var. boulardii RC009 as a nutritional feed additive to substitute the prophylactic use of antibiotics and improve the productive performance and health of post-weaning piglets. Materials and Methods: Four regular nutritional phases were prepared. Post-weaning pigs (21-70 days old) received one of two dietary treatments: T1-basal diet (BD-control group) with in-feed antibiotics as a prophylactic medication (one pulse of Tiamulin in P3 and one pulse of Amoxicillin in P4); and T2-BD without in-feed antibiotics but with Saccharomyces boulardii RC009 (1 × 1012 colony forming unit/T feed). The feed conversion ratio (FCR), total weight gain (TWG-kg), and daily weight gain (DWG-kg) were determined. A post-weaning growth index (GI) was calculated and animals (160 days old) from each treatment were analyzed at the abattoir after sacrifice for carcass weight and respiratory tract lesions. Results: Pigs consuming probiotics had higher TWG and DWG than the control group. The group of animals with low body weight obtained the same results. Saccharomyces boulardii administration decreased diarrhea, and FCR reduction was related to a GI improvement. A significant increase in carcass weight and muscle thickness reduction was observed in animals received the probiotic post-weaning. Conclusion: Saccharomyces boulardii RC009, a probiotic additive, was found to improve the production parameters of pigs post-weaning and enhance their health status, indicating that it may be a promising alternative to prophylactic antibiotics.

Antimicrobial stewardship in dentistry and antibiotic prophylaxis for tooth extraction have been areas of concern in Japan, with limited research available. This cross-sectional study utilized the regional health insurance claims database in Japan to examine antibiotic prescription trends by dentists, including antibiotic regimens, timing of prescription, and days of supply for prophylactic antibiotic use during tooth extraction. Antibiotic prophylaxis for patients with prosthetic heart valves was also investigated. Antibiotic prescriptions by dentists decreased by 7% in 2019 compared to those in 2015, with third-generation cephalosporins still accounting for 48.5% in 2019. Amoxicillin prescription increased 3.9 times in 2019, although it only accounted for 8.4% of all antibiotic prescriptions. In 2019, amoxicillin was prescribed for 17.1% of all prophylactic antibiotics associated with tooth extraction, and 80% of prophylactic antibiotics were prescribed for 3 days or more, with 85% prescribed on the day of the procedure. However, only 60–70% of patients with prosthetic heart valves received antibiotic prophylaxis. Despite the increasing trend after the implementation of the National Action Plan on antimicrobial resistance, the proportion of amoxicillin prescriptions in dentistry remains low. Antimicrobial stewardship issues related to long-term prescription and timing of administration of prophylactic antibiotics for tooth extraction should be addressed. Dentists must recognize the risks associated with high-risk patients with prosthetic heart valves who require antibiotic prophylaxis, and physicians providing valve replacement therapy should inform patients of the requirement for prophylaxis before invasive dental procedures. [ABSTRACT FROM AUTHOR]

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Background: Laparoscopic cholecystectomy (LC) is the standard modality of treatment for cholelithiasis and is associated with lesser complications than its open counterpart. Surgical site infections (SSIs) can lead to significant morbidity and mortality and are limited in clean and clean-contaminated wounds by the use of antibiotic prophylaxis. Studies have shown beneficial effects of prophylaxis in cases of open cholecystectomy but their effect in laparoscopic surgery is not well implanted. Materials and methods: All the patients fulfilling the inclusion criteria were divided into 2 groups. One of the groups received postoperative prophylactic antibiotics and one did not. Both the groups were assessed for early and late surgical site infections and the outcomes were later compared. Results: The mean ages of the patients were 39.9±14.8/38.9±12.9 in non antibiotic and antibiotic groups respectively . The age distribution was almost similar in both the groups. No cases with early or late surgical site infections or their complications were found in any of the two groups. There was no significant difference in the length of stay in the hospital in both the groups (p=0.75). Duration of drain placement after the surgery was also similar (p=0.50). Conclusion: In our study no post operative SSIs or infectious complications were present in any of the groups. Even though these findings do not seem to be statistically significant, the similarities between the two groups and the absence of infectious cases in both of them shows that the infection rates are already very low in these patients and using prophylactic antibiotics does not seem to be rational. [ABSTRACT FROM AUTHOR]

Background: The role of prophylactic antibiotics in preventing ventilator-associated pneumonia (VAP) in patients undergoing invasive mechanical ventilation (IMV) remains unclear. This network meta-analysis compared the efficacy and safety of antibiotic prophylaxis in preventing VAP in an IMV population in intensive-care units (ICUs). Methods: We searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to December 2021, to identify relevant studies assessing the impact of prophylactic antibiotics on the incidence of VAP, the mortality, and the duration of ICU stays and hospitalization to perform a meta-analysis. Results: Thirteen studies (2144 patients) were included, 12 of which were selected for the primary analysis, which revealed that treatment with prophylactic antibiotics resulted in a lower VAP rate compared with control groups [risk ratio (RR) = 0.62]. Bayesian network meta-analysis indicated that aerosolized tobramycin and intravenous ampicillin–sulbactam presented the greatest likelihood being the most efficient regimen for reducing VAP. Conclusions: Antibiotic prophylaxis may reduce the incidence of VAP, but not the mortality, for adult patients undergoing IMV in ICUs. Tobramycin via nebulization and ampicillin–sulbactam via intravenous administration presented the greatest likelihood of being the most efficient regimen for preventing VAP. However, well-designed randomized studies are warranted before definite recommendations can be made. [ABSTRACT FROM AUTHOR]

Abstract Background Invasive gastrointestinal surgery may be performed as an open or endoscopic procedure, such as laparoscopic semi-colon surgery, laparoscopic appendectomy, laparoscopic gastrectomy, and anal surgery, among other such operations. Regardless of the approach, the operative procedure interferes with the patient’s gastrointestinal tract, necessitating the rational use of prophylactic antibiotics to improve treatment outcomes and minimize postoperative infections. Objective To investigate the prophylactic and postoperative antibiotic usage in patients who underwent invasive gastrointestinal surgery, and to identify factors associated with postoperative infection. Design This descriptive, cross-sectional study included 112 patients who underwent invasive gastrointestinal surgery at the Department of Gastroenterology, Thong Nhat Hospital. We conducted a cross-sectional study in all inpatients aged 18 years and older, who underwent invasive gastrointestinal surgery between January 2020 and December 2020. We recorded patient characteristics, the administration and appropriateness of antibiotics, as well as treatment outcomes. The appropriateness of prophylactic and postoperative antibiotic usage was assessed based on 2015 Vietnamese national guideline for antibiotic use. Multivariable logistic regression analysis was used to determine the factors associated with postoperative infection. Results Patients’ mean age was 59.7 ± 17.2 years. Most surgeries (89.3%) were clean-contaminated procedures. The rates of appropriate types of antibiotics selected, doses, and overall rates of appropriateness of antibiotic prophylaxis were 68.0%, 76.4% and 54.7%, respectively. Of the patients investigated, 34.8% had at least one sign of postoperative infection; the overall appropriate rate of postoperative antibiotic was 38.5%. Old age was associated with postoperative infection and longer length of hospitalization. Conclusion Implementation of the guidelines recommended for the prophylactic and therapeutic use of antibiotics is essential to improve treatment outcomes.

Background and objectives: The accepted method for preventing surgical site infections during orthopedic surgery, including arthroplasty, is prophylactic systemic antibiotics. There is sufficient data to support its effectiveness in avoiding or decreasing surgical site infection. Controversial issues with this method include the timing of administration, the appropriate antibiotics to utilize, and the appropriate antibiotic duration. Methods: The study compared the effects of three intravenous doses of Ceftriaxone 1 g over three days (group 2 n = 65) vs three hours (group 1 n = 65), was conducted on patients who were scheduled for orthopaedic operations with a particular exclusion and was followed up for a year. Results: In groups 1 and 2, 65 patients each received antibiotics for one day and three days, respectively. There were 45 men and 15 women in group 2, compared to 40 men and 20 women in group 1. The patients' ages ranged from five to seventy. The patients in groups 1 and 2 were, on average, 32.5 and 36 years old, respectively. Both groups reported regional edema, redness, and soreness at the surgical site for the first 48 hours after the procedure. These side effects eventually disappeared on their own. Both groups exhibited no signs of localized inflammation, infection, or pus production at a subsequent check-up. Conclusion: In neither group did any of the cases experience any infection. The study is a step in developing policies about the use of antibiotics in our nation and shows the value of antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Ventilator-associated pneumonia is one of the commonest complications encountered in intubated patients: its incidence ranges from 20% to 60%, with higher incidences seen in patients with polytrauma. Ventilator-associated pneumonia can result in poor neurological outcomes upon discharge, longer duration of mechanical ventilation and prolonged intensive care unit stays. The use of systemic antibiotics has been proposed as one method to reduce this complication. However, its effectiveness remains to be determined, and concerns about bacterial resistance hinder its use. This study aims to evaluate the effects of systemic antibiotics on early ventilator-associated pneumonia prevention. Methods: This is a single-centred retrospective cohort study, using data in the local trauma registry from 2015 to 2020. Patients aged ⩾18 years who suffered from injury to the head or trunk and were intubated within 12 h of hospitalization were evaluated for early ventilator-associated pneumonia to determine the effectiveness of systemic antibiotics on the incidence of ventilator-associated pneumonia and to identify other risk factors for ventilator-associated pneumonia in patients suffering from trauma. Result: A total of 250 patients were recruited; 59 of them met the criteria for early onset ventilator-associated pneumonia. Early use of broad-spectrum antibiotics with potent anaerobic coverage was found to be protective for early onset ventilator-associated pneumonia (adjusted odds ratio = 0.228, p = 0.044). Increasing age and severe thoracic or abdominal injury were also found to be strong non-modifiable predictors for the development of early onset ventilator-associated pneumonia. Conclusion: Use of systemic antibiotics with potent anaerobic coverage within 3 h of injury was found to prevent early onset ventilator-associated pneumonia in those intubated within 12 h of injury. However, a large-scale randomized control trial may be needed to further evaluate its benefit and its potential side effects, most notably the risk of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background and Aims: Non-therapeutic antibiotic use is associated with the current decrease in antibiotic therapeutic efficiency and the emergence of a wide range of resistant strains, which constitutes a public health risk. This study aimed to evaluate the use of Saccharomyces cerevisiae var. boulardii RC009 as a nutritional feed additive to substitute the prophylactic use of antibiotics and improve the productive performance and health of post-weaning piglets. Materials and Methods: Four regular nutritional phases were prepared. Post-weaning pigs (21-70 days old) received one of two dietary treatments: T1-basal diet (BD-control group) with in-feed antibiotics as a prophylactic medication (one pulse of Tiamulin in P3 and one pulse of Amoxicillin in P4); and T2-BD without in-feed antibiotics but with Saccharomyces boulardii RC009 (1 × 1012 colony forming unit/T feed). The feed conversion ratio (FCR), total weight gain (TWG-kg), and daily weight gain (DWG-kg) were determined. A post-weaning growth index (GI) was calculated and animals (160 days old) from each treatment were analyzed at the abattoir after sacrifice for carcass weight and respiratory tract lesions. Results: Pigs consuming probiotics had higher TWG and DWG than the control group. The group of animals with low body weight obtained the same results. Saccharomyces boulardii administration decreased diarrhea, and FCR reduction was related to a GI improvement. A significant increase in carcass weight and muscle thickness reduction was observed in animals received the probiotic post-weaning. Conclusion: Saccharomyces boulardii RC009, a probiotic additive, was found to improve the production parameters of pigs post-weaning and enhance their health status, indicating that it may be a promising alternative to prophylactic antibiotics. [ABSTRACT FROM AUTHOR]

Objective: Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery. Methods: A break‐even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR. Results: Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability. Conclusion: In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery. Level of Evidence: NA Laryngoscope, 133:1086–1091, 2023 [ABSTRACT FROM AUTHOR]

Summary: Background: It is not clear whether Viridans Group Streptococcal Infective Endocarditis (VGS-IE) among individuals at high risk is more frequent following bacteraemia caused by invasive dental procedures (IDPs) than after daily bacteraemia caused by chewing and tooth brushing. The aim of this nested study was to assess if VGS-IE was temporally associated with IDPs in a national cohort of individuals at high risk. Methods: This nested case-control and case-crossover study was based on a Swedish national cohort study of 76,762 individuals at high risk of IE due to complex congenital heart disease, prosthetic heart valve or previous IE. Participants were living in Sweden between July 1st, 2008 and January 1st, 2018. The frequency of IDPs during the 3 months before VGS-IE was calculated and compared to controls (sampled 1:10). A case-crossover study was conducted to account for residual confounders. Participants were identified using the national patient register, and IDPs were identified using the national dental health register. Findings: 98,247 IDPs were carried out in the cohort during the study period: 624 occasions of oral surgery, 44,190 extractions and 53,433 sessions of subgingival scaling. The study could not confirm that IDPs were more common among cases (4.6%) than controls (4.1%), OR = 1.22 [95% Confidence Interval (CI) 0.64–2.3], or during case- (3.3%) than reference periods (3.8%), OR = 0.89 [95% CI: 0.68–1.17]. Restricting the analysis to the period when cessation of antibiotic prophylaxis for the prevention of IE in Swedish dentistry was recommended, from the 1st of October 2012 to the 1st of January 2018, did not alter the results of the case-control study: OR 0.64, 95% CI: 0.20–2.09, or the case-crossover study: OR 0.58, 95% CI: 0.15–2.19. Interpretation: The study could not confirm that VGS-IE is associated with IDPs among individuals at high risk. A study with larger sample size could clarify whether there is a lack of association. The finding of a small (

Background. Prescribing prophylactic antibiotics before surgery is a way to prevent infection at the surgical site. This study aimed to compare the pattern of prescribing prophylactic antibiotics with the standard instructions in the general surgery ward of Shahid Sadoughi Hospital in Yazd, Iran. Methods. A descriptive cross-sectional design was employed to conduct the study. The sample was selected through random stratified sampling method using Morgan and Krejcie sampling table. Descriptive statistics, including frequency, frequency percentage, mean, standard deviation, and Chi-square were used for data analysis in the Statistical Package for the Social Sciences (SPSS) software version 23. Results. Out of 236 cases reviewed, 27.1% met the practice guidelines regarding the time, 39.4% regarding the type of preoperative prophylaxis, and 58% with respect to the duration of the prescribed postoperative antibiotics (up to 24 hours after surgery). Conclusion. The most important reasons for the inconsistency of prophylactic antibiotics with the standard guideline include the inappropriate timing of prophylactic antibiotics and the use of antibiotics not recommended in the clinical guidelines. Informing and educating the public on the content of the notification instructions, establishing a monitoring system, and increasing the participation level of the hospital pharmacy in the distribution of medicine can be effective in prescribing prophylactic antibiotics.

Introduction: Pancreaticoduodenectomy (PD) remains a complex surgical procedure with infectious complications affecting nearly 50% of patients. Patients who undergo biliary drainage with stent placement prior to neoadjuvant treatment (NAT) reportedly have higher infection rates following PD. The aim of the current study is to evaluate the differences in postoperative infectious complication rates based on the duration of post operative prophylactic antibiotics in patients with indwelling metal biliary stent who had NAT. Methods: A retrospective institutional pancreatic cancer database was queried for patients who had a metal biliary stent placed prior to NAT initiation, followed by subsequent PD between 2014 and 2021. Duration of postoperative prophylactic antibiotics was defined as short (SC: ≤ 24 h) or extended (EC: > 24 h–7 days). The primary outcome of interest was surgical site infection (SSI). Results: Two hundred and ninety-five (n = 295) patients were identified of which the majority (n = 205, 69.5%) received a short course of antibiotics postoperatively. Baseline characteristics were similar between the two cohorts including age, sex, BMI, and comorbidity index. EC patients received more NAT cycles (4 vs. 3, p < 0.001) and underwent an open PD more frequently (61.8% vs. 41.0%, p < 0.001). SSI occurred in 64 (21.7%) patients; SC cohort: 54, 26.3% vs. EC cohort:10, 11.1%, (p = 0.003). Additionally, the SC cohort demonstrated a higher incidence of major complications (Clavien-Dindo ≥ 3: 51 [24.9%] vs. 13 [14.4%], p = 0.045). On the logistic regression model examining factors associated with SSI, higher BMI (continuous variable) was associated with increased odds of SSI (OR: 1.05 [95%CI: 1.00, 1.10, p = 0.040), while EC was protective (OR: 0.36 [95%CI: 0.17, 0.75], p = 0.007). Conclusions: These data suggest that an extended course of perioperative antibiotic correlates with reductions in SSI and major morbidity following PD in patients with a metallic biliary stent placed prior to NAT course. These results require validation in a future randomized clinical trial examining a larger cohort of patients with further emphasis on the types of perioperative antibiotics administered. [ABSTRACT FROM AUTHOR]

Whether to use antibiotics to prevent surgical site infection in elective inguinal tension‐free hernia repair has been controversial. To systematically evaluate the effect of prophylactic antibiotic application in elective inguinal tension‐free hernia repair, we identified all published randomised controlled trials of the effect of prophylactic antibiotic application on elective inguinal tension‐free hernia repair were collected by computer retrieval from the China National Knowledge Infrastructure; VIP Database; Wanfang Database; China Biomedical Literature Database; and PubMed, EMBASE and Cochrane Library databases. Meta‐analysis was performed by RevMan 5.3 software. The meta‐analysis showed that the total incidence of surgical site infections [P = 0.003] and the incidence of superficial surgical site infections [P = 0.004] in the antibiotic group (AG) were lower than those in the non‐antibiotic group (NAG). There was no significant difference in the total incidence of postoperative infections [P = 0.06], deep surgical site infections [P = 0.26] and seroma [P = 0.52] between the AG and the NAG. Based on current evidence, the application of prophylactic antibiotics in elective inguinal tension‐free hernia repair can prevent the total incidence of surgical site infections and that of superficial surgical site infections but cannot prevent the total incidence of postoperative infection events, incidence of deep surgical site infections and incidence of seroma. [ABSTRACT FROM AUTHOR]

Aims: Infections are common complications after stroke and associated with unfavourable outcomes. We aimed to evaluate the efficacy and safety of prophylactic antibiotics for post‐acute stroke infection. Methods: We searched PubMed, Embase, the Cochrane Library, SinoMed, China National Knowledge Infrastructure, WanFang Data, China Science and Technology Journal Database, and clinical trial register platforms from inception to 15 February 2022. We included randomized clinical trials that evaluated the efficacy and safety of prophylactic antibiotics. Primary outcomes were mortality rate and incidence of pneumonia. The pooled risk ratio (RR) and mean differences with 95% confidence interval (CI) were calculated using the random or fixed‐effect model depending on heterogeneity. The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations. Results: Twelve studies (4809 participants) were included. There was no significant difference in the mortality rate (12 trials, n = 4740, RR 1.03 [95% Cl: 0.91–1.16], high‐quality evidence), incidence of pneumonia (7 trials, n = 4352, RR 0.94 [95% CI: 0.79–1.11], high‐quality evidence) and the incidence of adverse events between the prophylactic antibiotics and control groups. Prophylactic antibiotics significantly reduced the incidence of infections (8 trials, n = 4517, RR 0.72 [95% CI: 0.58–0.89], moderate‐quality evidence) and urinary tract infections (7 trials, n = 4352, RR 0.39 [95% CI: 0.3–0.49], moderate‐quality evidence). None of the subgroup analyses showed a significant difference in mortality or the incidence of pneumonia. Conclusion: For acute stroke patients, prophylactic antibiotics were significantly associated with fewer incidences of any infections and urinary tract infections without significant differences in mortality rate and pneumonia. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic joint infection (PJI) remains one of the most devastating complications following total joint arthroplasty. Appropriate prophylactic antimicrobial administration and antibiotic stewardship are major factors impacting the risk of PJI in total hip arthroplasty (THA). The purpose of our study was to evaluate whether cefazolin administration was superior to noncefazolin antibiotics in prevention of PJI after primary THA. Material and methods: A review of 9910 patients undergoing primary THA from 2013 to 2019 at a single institution was conducted. The primary outcome was PJI within 90 days of surgery. The Musculoskeletal Infection Society definition of PJI was used for this analysis. Groups were those receiving cefazolin + expanded gram-negative antimicrobial prophylaxis (EGNAP) and those receiving an alternative to cefazolin + EGNAP. Chi-square tests were conducted to determine statistical significance. Multivariate logistic regression was performed to eliminate confounders. Results: 9028 patients received cefazolin + EGNAP, and 882 patients received an alternative to cefazolin + EGNAP. PJI rate using the Musculoskeletal Infection Society criteria was 0.82% (81/9910). PJI rate in the cefazolin + EGNAP group was 0.75% (68/9028). In the group receiving an alternative to cefazolin + EGNAP, the PJI rate was 1.47% (13/882). This difference was statistically significant (P = .023). On multivariate analysis, the odds ratio for developing PJI when an alternative to cefazolin was used was 2.05 (P = .022). When comparing alternatives, there remained a statistically significant increased PJI rate when the alternative used was clindamycin (odds ratio 2.65, P = .007). Conclusion: Our data demonstrate that in the presence of EGNAP in THA, there was a higher PJI rate when clindamycin was given as an alternative to cefazolin. The number of THA patients receiving alternatives to cefazolin must be minimized. Level of Evidence: III, Retrospective Cohort Study.

Abstract Background This study investigated the efficacy of first-generation (cefazolin) and third-generation (ceftizoxime) prophylactic antibiotics in patients undergoing cardiac surgery and the incidence of surgical site infections, hospitalizations, and medical costs. Methods All adult patients (≥ 20 years) undergoing cardiac surgery at one hospital from January 01, 2009, to December 31, 2016, were included in this study. A single prophylactic antibiotic was administered at a dose of 1 g within one hour of the surgical incision and for three days after surgery at eight-hour intervals. After propensity score matching, 194 patients in each antibiotic prophylaxis group (first-generation vs third-generation) were analyzed. Among the 388 patients, the incidence of surgical site infections was compared according to the type of prophylactic antibiotic, and risk factors were evaluated by chi-squared tests followed by multivariate logistic regression analysis. Results The incidence of deep surgical site infections was significantly lower in the first-generation group (5.7%) than in the third-generation group (16.5%). The pathogens isolated from the surgical infection sites were similarly distributed in both groups. However, the prevalence of highly infectious gram-positive bacteria was more than that of gram-negative bacteria (67% vs 23%). The preoperative hospitalization duration, mean operation time, and ventilator use time were similar in both groups, but the postoperative hospitalization duration was significantly shorter in the first-generation group (25.5 days) than in the third-generation group (29.8 days). In addition, the medical costs were lower in the first-generation group (20,594 USD) than in the third-generation group (26,488 USD). Conclusion In conclusion, the first-generation prophylactic antibiotic was better than the third-generation in reducing surgical site infection rates, hospitalization length, and medical expenditures.

BackgroundSurgical site infections (SSI) poses significant risk following spinal instrumentation surgery. The 2013 North American Spine Society (NASS) Evidence-Based Clinical Guidelines found that the incidence of SSI in spine surgery ranged from 0.7-10%, with higher rates with medical comorbidities. National guidelines currently recommend first-generation cephalosporins as first line prophylaxis. Due to an increase in MRSA cases in our institution, a combined antibiotic strategy using vancomycin IV, standard prophylactic antibiotics, and vancomycin powder was implemented for all spinal instrumentation surgeries.MethodsAll spinal instrumentation surgeries performed at this institution from 2013-2016 were identified. Chart review was then performed to identify the inclusion and exclusion criteria, demographic data, diagnosis, type of surgery performed, and bacterial culture results. Rates of SSI, as defined by the Center for Disease Control (CDC), were calculated and antibiotic resistance was determined. As control, SSIs were identified and reviewed from 2010, prior to the implementation of the combined strategy.ResultsOne thousand and seventy four subjects were identified in the combined cohort. Mean age was 52.3 years, 540 males (50.2%), 534 females (49.8%). There were 960 primary surgeries (89.4%), 114 cases revision surgeries (10.6%). Cervical myelopathy (27.9%), lumbar stenosis (16.2%), lumbar spondylolisthesis (14.0%), and scoliosis (pediatric and adult)/deformity (13.7%) were leading diagnoses. The standard prophylactic antibiotic was cefazolin IV in 524 cases (48.8%), gentamicin IV in 526 cases (49.0%), vancomycin powder was used in 72.3% of cases. Four SSI cases out of 1,074 were identified (0.37%), 3 deep and 1 superficial, with no antibiotic resistance. In the control group, there were 11 infections of 892 cases (1.23%). There were significantly lower rates of SSI in the combined group versus control (P=0.05).ConclusionsThe combined antibiotic strategy led to low SSI rates in this retrospective case control study. Limitations of this study include retrospective design and small sample size. A large multicenter randomized clinical trial may provide further insight in the effectiveness of this strategy. Level of evidence 3. Clinical relevance: the combined antibiotic protocol may be considered in institutions with concern for SSI and methicillin resistant infections associated with spinal instrumentation surgeries.

BackgroundOptimal antibiotic prophylaxis duration in head and neck clean-contaminated free-flap cases is unknown.MethodsA systematic review/meta-analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus databases.ResultsOf the 3755 searched articles, 5 articles were included for a total of 861 patients. The recipient surgical site infection risk was significantly higher in patients receiving prophylactic antibiotics for ≤24 hours compared to >24 hours (relative risk [RR] 1.56; 95% confidence interval [CI] 1.13-2.14). In the post hoc multivariate analysis based on available individual-level data on 697 patients from 3 studies, the risk of surgical site infection for ≤24 hours versus >24 hours was not significant after adjusting for antibiotic type (RR 1.09; 95% CI 0.78-1.55). When compared to ampicillin-sulbactam, patients who received clindamycin prophylaxis had an increased likelihood of recipient surgical site infection (RR 2.85; 95% CI 1.95-4.17).ConclusionLess than or equal to 24 hours of antibiotic prophylaxis in head and neck clean-contaminated free-flap is likely sufficient but a strong conclusion remains elusive. Clindamycin prophylaxis increases the risk of recipient surgical site infection. Further prospective trials are necessary to clarify.

Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan Surgical site infections (SSIs) remain one of the most common serious surgical complications and are the second most frequent healthcare-associated infection. Patients with SSIs have a significantly increased postoperative length of hospital stay, hospital expenses, and mortality risk compared with patients without SSIs. The prevention of SSI requires the integration of a range of perioperative measures, and approximately 50% of SSIs are preventable through the implementation of evidence-based preventative strategies. Several international guidelines for SSI prevention are currently available worldwide. However, there is an urgent need for SSI prevention guidelines specific to Japan because of the differences in the healthcare systems of Japan versus western countries. In 2018, the Japan Society for Surgical Infection published SSI prevention guidelines for gastroenterological surgery. Although evidence-based SSI prevention guidelines are now available, it is important to consider the appropriateness of these guidelines depending on the actual conditions in each facility. A systemic inflammatory host response is a hallmark of bacterial infection, including SSI. Therefore, blood inflammatory markers are potentially useful in SSI diagnosis, outcome prediction, and termination of therapeutic intervention. In this review, we describe the current guideline-based perioperative management strategies for SSI prevention, focusing on gastroenterological surgery and the supplemental utility of blood inflammatory markers. [ABSTRACT FROM AUTHOR]

Objective: Obstetric anal sphincter injures (OASIS) have long‐term implications on women's health. Administration of antibiotic prophylaxis and treatment following OASIS repair is controversial. We conducted a national survey to provide data about practice routines regarding antibiotic prophylaxis and treatment following OASIS repair in Israeli labor and delivery units. Methods: A national survey was performed among obstetricians and gynecologists from 24 university‐affiliated delivery centers within the jurisdiction of the Israeli Ministry of Health during 2020. Representatives from each center completed the "Google form" electronic survey. For each questionnaire item, the most common answer was chosen to represent the center's answer. Results: The number of physicians who responded per center varied from 1 to 14 (median, 3.5). Preoperative and postoperative antibiotic treatment was given in 75% and 92% of the centers, respectively. While most centers (58.3%) recommend pelvic floor physical therapy on release, recommendations about functional radiologic tests vary. In all centers, there is a designated clinic for postpartum follow‐up of OASIS. Most centers (83%) allow trial of vaginal delivery in the subsequent pregnancy, on an individual basis. Conclusion: Heterogeneity exists in managing OASIS in Israel, particularly regarding administration of antibiotics. Further studies are needed to examine the consequences of different management protocols. Synopsis: Our national survey demonstrates that despite guidelines, management of obstetric anal sphincter injuries in Israel lacks consistency, specifically regarding administration of preoperative and postoperative antibiotics. [ABSTRACT FROM AUTHOR]