Surgical antibiotic prophylaxis administration practices.

SETTING: A referral hospital in Kavre, Nepal. OBJECTIVES: To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019). DESIGN: This was a retrospective cohort analysis. RESULTS: The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG. CONCLUSION: A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.

LIEU: Un hôpital de référence du district de Kavre, Népal. OBJECTIFS: Évaluer 1) le respect des directives nationales sur les traitements antibiotiques (NATG), plus particulièrement si l'administration d'une antibioprophylaxie chirurgicale (SAP) (dose initiale et nouvelle dose) respectait les directives NATG pour les patients qui y étaient ou non éligibles ; et 2) le développement d'infections du site opératoire (SSI) chez les patients ayant subi une intervention chirurgicale dans le service de Chirurgie Générale (juillet­décembre 2019). MÉTHODE: Il s'agissait d'une analyse de cohorte rétrospective. RÉSULTATS: L'analyse a inclus 846 patients, dont 717 (85%) étaient éligibles à une SAP et 129 (15%) n'y étaient pas éligibles. Parmi ceux qui y étaient éligibles, 708 (99%) ont reçu la dose initiale, alors que 65 (50%) des patients non éligibles n'ont reçu aucune dose. Parmi ceux ayant reçu la dose initiale, 164 (23%) étaient éligibles à une nouvelle dose. Parmi ces derniers, seuls 23 (14%) ont reçu au moins une nouvelle dose et 141 (86%) n'en ont pas reçu. Les directives NATG ont été respectées chez 75% (632/846) des patients. Des SSI ont été observées chez 23 (3%) patients ; pour huit (35%) de ces patients, la SAP n'avait pas été administrée conformément aux directives NATG. CONCLUSION: Un respect global relativement élevé des directives NATG pour l'administration de la SAP a été rapporté. Des recommandations ont été émises pour améliorer le respect de ces directives chez les patients non éligibles à la SAP et chez ceux éligibles à une nouvelle dose.

Treatment outcome of tuberculosis patients detected using accelerated vs. passive case finding in Myanmar.

SETTING: Several projects involving accelerated or active case finding (ACF) of tuberculosis (TB) cases are being implemented in Myanmar. However, there is a concern that patients detected using ACF have poorer TB treatment outcomes than those detected using passive case finding (PCF). OBJECTIVE: To assess differences in the demographics, clinical profile and treatment outcomes of patients detected using ACF and PCF. DESIGN: Retrospective cohort study of TB patients diagnosed and enrolled for treatment during 2014-2016. RESULTS: Of 16 048 patients enrolled, 2226 (16%) were detected using ACF; the treatment success rate (cured and completed) was 88%. A higher proportion of cases detected using ACF were aged 55 years, human immunodeficiency virus (HIV) negative and sputum smear-positive pulmonary TB. After adjusting for differences in demographic and clinical characteristics, we found that treatment outcomes in patients detected using ACF and PCF were not significantly different (adjusted relative risk [aRR] 0.89, 95%CI 0.78-1.00). Male sex, age  55 years, patients with a previous history of TB and HIV positivity were independently associated with unsuccessful outcomes. CONCLUSION: ACF detected a significant proportion of TB cases in study townships; treatment outcomes in cases detected using ACF and those detected using PCF were similar. More tailored interventions are needed to improve treatment outcomes in patients at a higher risk of unsuccessful treatment outcomes.