Posts filed under ‘Profilaxis Antibiótica en Cirugía – PAC’

JULY 2018 – Risk Factors for Surgical Site Infection After Cholecystectomy

Background.

There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy.

Methods.

A retrospective cohort of commercially insured persons aged 18–64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI.

Results.

Surgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P < .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27–1.96), open approach with (HR, 4.29; 95% CI, 2.45–7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96–8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74–8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87–13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection.

Conclusions.

Acute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx036/3044173

PDF (CLIC en PDF)

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July 15, 2018 at 4:00 pm

Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections.

Open Orthop J. November 30, 2016 V.10 P.636-645.

Mirza YH1, Tansey R1, Sukeik M2, Shaath M3, Haddad FS1.

Author information

1 Department of Trauma and Orthopaedics, University of College London Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.

2 Department of Trauma and Orthopaedics, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.

3 Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunay’s Road, Crumpsall, M8 5RB, United Kingdom.

Abstract

An increasing demand for lower limb arthroplasty will lead to a proportionate increase in the need for revision surgery. A notable proportion of revision surgery is secondary to periprosthetic joint infections (PJI). Diagnosing and eradicating PJI can form a very difficult challenge. An important cause of PJI is the formation of a bacterial biofilm on the implant surface. Our review article seeks to describe biofilms; their definitions and formation, common causative bacteria, prophylactic and therapeutic antibiotic therapy.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398090/pdf/TOORTHJ-10-636.pdf

May 31, 2018 at 12:58 pm

The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review.

J Clin Microbiol. September 2017 V.55 N.9 P.2765-2774.

Wouthuyzen-Bakker M1, Benito N2, Soriano A3.

Author information

1 Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands m.wouthuyzen-bakker@umcg.nl

2 Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

3 Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Abstract

Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group (P = 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively (P = 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648712/pdf/zjm2765.pdf

May 31, 2018 at 12:54 pm

Antimicrobial prophylaxis in caesarean section delivery.

Exp Ther Med. August 2016 V.12 N.2 P.961-964.

Liu R1, Lin L1, Wang D1.

Author information

1 Department of Obstetrics, People’s Hospital of Linyi, Linyi, Shandong 276000, P.R. China.

Abstract

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% 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.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950587/pdf/etm-12-02-0961.pdf

February 9, 2018 at 1:16 pm

Recommendations for prevention of surgical site infection in adult elective arthroplasty.

Medicina (B Aires). 2017;77(2):143-157.

[Article in Spanish]

Chuluyán JC1, Vila A2, Chattás AL3, Montero M3, Pensotti C4, Tosello C5, Sánchez M6, Vera Ocampo C7, Kremer G8, Quirós R8, Benchetrit GA9, Pérez CF10, Terusi AL11, Nacinovich F12.

Author information

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. álvarez, Argentina. E-mail: jcchulu@gmail.com

2 Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.

3 Hospital General de Agudos Dr. Pirovano, Argentina.

4 Clínica Monte Grande, Buenos Aires, Argentina.

5 Hospital de Clínicas José de San Martín, UBA, Buenos Aires, Argentina.

6 Hospital Italiano de Buenos Aires, Argentina.

7 Sanatorio Dupuytren, Argentina.

8 Hospital Universitario Austral, Argentina.

9 Instituto de Investigaciones Médicas A. Lanari, UBA, Buenos Aires, Argentina.

10 Policlínico del Docente-Centro Médico Huésped, Argentina.

11 Instituto César Milstein, Argentina.

12 Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina.

Abstract

Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality.

These recommendations are aimed at:

(i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and

(ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.

PDF

http://www.medicinabuenosaires.com/PMID/28463223.pdf

September 25, 2017 at 7:35 am

Recommendations for prevention of surgical site infection in adult elective arthroplasty.

Medicina (B Aires). 2017;77(2):143-157.

[Article in Spanish]

Chuluyán JC1, Vila A2, Chattás AL3, Montero M3, Pensotti C4, Tosello C5, Sánchez M6, Vera Ocampo C7, Kremer G8, Quirós R8, Benchetrit GA9, Pérez CF10, Terusi AL11, Nacinovich F12.

Author information

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. álvarez, Argentina. E-mail: jcchulu@gmail.com

2 Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.

3 Hospital General de Agudos Dr. Pirovano, Argentina.

4 Clínica Monte Grande, Buenos Aires, Argentina.

5 Hospital de Clínicas José de San Martín, UBA, Buenos Aires, Argentina.

6 Hospital Italiano de Buenos Aires, Argentina.

7 Sanatorio Dupuytren, Argentina.

8 Hospital Universitario Austral, Argentina.

9 Instituto de Investigaciones Médicas A. Lanari, UBA, Buenos Aires, Argentina.

10 Policlínico del Docente-Centro Médico Huésped, Argentina.

11 Instituto César Milstein, Argentina.

12 Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina.

Abstract

Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality. These recommendations are aimed at:

(i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and

(ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.

PDF

http://www.medicinabuenosaires.com/PMID/28463223.pdf

August 31, 2017 at 3:49 pm

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

Microbiome. August 8, 2017 V.5 N.1 P.93.

Nogacka A1, Salazar N1, Suárez M2, Milani C3, Arboleya S1,4, Solís G2, Fernández N2, Alaez L1, Hernández-Barranco AM1, de Los Reyes-Gavilán CG1, Ventura M3, Gueimonde M5.

Author information

1 Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias. Consejo Superior de Investigaciones Científicas (IPLA-CSIC), Ctra. Infiesto s/n, 33300, Villaviciosa, Asturias, Spain.

2 Pediatrics Service, Hospital Universitario Central de Asturias, SESPA, Oviedo, Asturias, Spain.

3 Laboratory of Probiogenomics, Department of Life Sciences, University of Parma, Parma, Italy.

4 Current address: APC Microbiome Institute, University College Cork. Cork, Ireland & Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland.

5 Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias. Consejo Superior de Investigaciones Científicas (IPLA-CSIC), Ctra. Infiesto s/n, 33300, Villaviciosa, Asturias, Spain. mgueimonde@ipla.csic.es

Abstract

BACKGROUND:

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.

RESULTS:

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.

CONCLUSIONS:

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-induced host homeostasis. Understanding the impact of IAP in the gut microbiota development is essential for developing treatments to minimize it, favoring a proper gut microbiota development in IAP-exposed neonates.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549288/pdf/40168_2017_Article_313.pdf

August 22, 2017 at 3:43 pm

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