Antibiotic prophylaxis adequacy assessment and its influence on surgical site infection in peripheral vascular bypass surgery.

OBJECTIVE: We sought to assess the degree of antibiotic prophylaxis adequacy to our surgical antibiotic prophylaxis protocol among patients who underwent peripheral vascular bypass surgery. MATERIALS AND METHODS: Prospective cohort study. Adequacy to protocol was studied by comparing the different aspects of prophylaxis received by patients to those stipulated in the protocol in force at our hospital. Incidence of surgical wound infection was calculated and the effect of prophylaxis inadequacy on the incidence of surgical wound infection was estimated using the relative risk. RESULTS: The study covered 266 patients. Incidence of surgical site infection (SSI) after the follow-up period was 5.3% (95% Confidence interval [CI]: 3.0-9.4). Overall adequacy to the protocol of antibiotic prophylaxis was 91.0% (95% CI: 87.6-94.4). The most frequent cause of inadequacy to the protocol was time of initiation of antibiotic prophylaxis (94.1%). No relationship was found between SSI and antibiotic prophylaxis inadequacy (relative risk: 2.4; 95% CI: 0.49-12.5; p > 0.05). CONCLUSIONS: Global adequacy to protocol of antibiotic prophylaxis was high. The most frequent cause of inadequacy to the protocol was time of initiation of antibiotic prophylaxis.

OBJETIVO: Buscamos evaluar el grado de adecuación de la profilaxis antibiótica a nuestro protocolo de profilaxis antibiótica quirúrgica entre los pacientes sometidos a cirugía de bypass vascular periférico. MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo. La adecuación al protocolo se estudió comparando los diferentes aspectos de la profilaxis recibida por los pacientes con los estipulados en el protocolo vigente en nuestro hospital. Se calculó la incidencia de infección de herida quirúrgica y se estimó el efecto de la inadecuación de la profilaxis sobre la incidencia de infección de herida quirúrgica mediante el riesgo relativo. RESULTADOS: El estudio abarcó 266 pacientes. La incidencia de infección del sitio quirúrgico (ISQ) tras el periodo de seguimiento fue del 5,3% (intervalo de confianza [IC] del 95%: 3,0-9,4). La adecuación global al protocolo de profilaxis antibiótica fue del 91,0% (IC 95%: 87,6-94,4). La causa más frecuente de inadecuación al protocolo fue el momento de inicio de la profilaxis antibiótica (94,1%). No se encontró relación entre ISQ e inadecuación de la profilaxis antibiótica (riesgo relativo: 2,4; IC 95%: 0,49-12,5; p > 0,05). CONCLUSIONES: La adecuación global al protocolo de la profilaxis antibiótica fue alta. La causa más frecuente de inadecuación al protocolo fue el momento de inicio de la profilaxis antibiótica.

Symptomatic Common Carotid Free-Floating Thrombus in a COVID-19 Patient, Case Report and Literature Review.

Carotid free-floating thrombus is an uncommon entity that usually presents with neurologic symptoms. Crescendo transient ischemic attack is an accepted indication for urgent carotid endarterectomy. COVID-19 is associated with severe thromboembolic complications. We report the case of a 61-year-old man who developed, 2 weeks after the diagnosis of COVID-19, crescendo transient ischemic attack, complicating a large intraluminal floating thrombus within the right common carotid artery. A carotid thromboendarterectomy under local anesthesia, with patch closure was immediately performed without complications. We conducted a literature review to identify cases of common carotid artery thrombus related to COVID-19. Carotid free-floating thrombus in the common carotid artery is exceptional. However, since the beginning of the COVID-19 pandemic, 15 cases have been published.