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1.
Cochrane Database Syst Rev ; 9: CD005360, 2019 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-31557310

RESUMO

BACKGROUND: Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative antibiotics have been found to be useful in lowering infection rates in other surgical groups, yet there is no consensus on the use of prophylactic antibiotics for breast cancer surgery. This is an update of a Cochrane Review first published in 2005 and last updated in 2014. OBJECTIVES: To determine the effects of prophylactic (pre- or perioperative) antibiotics on the incidence of surgical site infection (SSI) after breast cancer surgery. SEARCH METHODS: For this fourth update, in August 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase; and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials of pre- and perioperative antibiotics for patients undergoing surgery for breast cancer. Primary outcomes were rates of surgical site infection (SSI) and adverse reactions. DATA COLLECTION AND ANALYSIS: Three review authors independently examined the title and abstracts of all studies identified by the search strategy, then assessed study quality and extracted data from those that met the inclusion criteria. We contacted study authors to obtain missing information. We evaluated the certainty of evidence using the GRADE approach. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: A total of 11 randomised controlled trials (2867 participants) were included in the review. No new studies were identified in this update. All studies included breast cancer patients and were based in the hospital setting. Ten studies evaluated preoperative antibiotic compared with no antibiotic or placebo. One study evaluated perioperative antibiotic compared with placebo or no antibiotic. Pooling of the results demonstrated that prophylactic antibiotics administered preoperatively probably reduce the incidence of SSI for patients undergoing breast cancer surgery without reconstruction (pooled risk ratio (RR) 0.67, 95% confidence interval (CI) 0.53 to 0.85; moderate certainty evidence). Anticipated absolute effects were calculated for the outcome incidence of SSI; 105 per 1000 for the none or placebo group and 71 per 1000 (95% CI 56 to 89) for the preoperative antibiotic prophylaxis group. Analysis of the single study comparing perioperative antibiotic with no antibiotic was inconclusive for incidence of SSI (RR 0.11, 95% CI 0.01 to 1.95; very low certainty evidence). No studies presented separate data for patients who underwent reconstructive surgery at the time of removal of the breast tumour.Secondary outcomes were not consistently included in the studies investigating preoperative antibiotic prophylaxis. It is very uncertain whether there is a difference in incidence of adverse events between the treatment and no treatment or placebo groups (10 studies, 2818 participants); very low certainty evidence downgraded one level for serious risk of bias, one level for serious inconsistency and one level for serious imprecision. It is unclear whether there is a difference in time to onset of infection between the treatment and no treatment or placebo groups (4 studies, 1450 participants); low certainty evidence downgraded one level for serious risk of bias and one level for serious inconsistency. It is unclear whether there is a difference in rates of readmission to hospital between the treatment and placebo groups (3 studies, 784 participants); low certainty evidence downgraded one level for serious inconsistency and one level for serious risk of bias. It is unclear whether there is a difference in cost of care between the treatment and no treatment or placebo groups (2 studies, 510 participants); low certainty evidence downgraded one level for serious risk of bias and one level for serious inconsistency. No analysable secondary outcome data were reported for the single study evaluating perioperative antibiotics. AUTHORS' CONCLUSIONS: Prophylactic antibiotics administered preoperatively probably reduce the risk of SSI in patients undergoing surgery for breast cancer. However, it is very uncertain whether there is an effect on incidence of adverse events. Furthermore, the effects on time to onset of infection, readmission to hospital and cost of care remain unclear. Further studies are required to establish the best protocols for clinical practice.


Assuntos
Antibioticoprofilaxia , Neoplasias da Mama/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Feminino , Humanos , Mastectomia , Cuidados Pré-Operatórios/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cicatrização
2.
Ann Agric Environ Med ; 26(3): 462-467, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559804

RESUMO

INTRODUCTION: The epidemic of human immunodeficiency virus has had a tremendous effect on the epidemic of tuberculosis. Together with the spread of HIV, a great increase has been observed in morbidity due to tuberculosis, both in endemic countries and in those where earlier, as a result of treatment, the frequency of occurrence of tuberculosis had decreased. In 2018, the WHO data demonstrated that the EECA region was the only region worldwide where the epidemics of HIV was still rapidly increasing. The EECA region still struggles with a serious epidemic of tuberculosis. MATERIAL AND METHODS: Materials and method. The research method applied was comparative analysis of the results of own study and studies by other researchers, concerning the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS when treated with isoniazid. RESULTS: Results. In own study, it was found that primary morbidity among patients administered isoniazid significantly decreased within 5 years. Incidence rates of primary morbidity were significantly lower than among patients who had not received isoniazid. Relevant studies conducted worldwide, in many cases differed from own study with respect to both the results and approach to the problem, by country or selection of the type of patients participating in the study. However, in all studies, isoniazid was generally a safe and well-tolerated drug, without special side-effects. CONCLUSIONS: Conclusions. All studies analyzed concerning the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS treated with isoniazid, confirmed the effectiveness of this drug. In the compared studies, applied isoniazid preventive therapy showed no difference in effectiveness according to its duration. Analyzed studies showed similar effectiveness also with respect to a decrease in mortality among patients with TB/HIV/AIDS.


Assuntos
Antibioticoprofilaxia/métodos , Antituberculosos/administração & dosagem , Infecções por HIV/complicações , Isoniazida/administração & dosagem , Tuberculose/prevenção & controle , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Tuberculose/etiologia , Adulto Jovem
3.
Vestn Oftalmol ; 135(3): 109-112, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31393454

RESUMO

Despite the lack of convincing data on the effectiveness of antibiotic therapy in the prevention of Post-Injection Endophthalmitis (PIE), the use of topical antibiotics for intravitreal injections is still a common practice. Frequent, monthly use of antibiotics results in changes of the composition of conjunctival flora and spontaneous mutations of bacteria, and leads to selective survival of resistant and virulent strains that can cause serious damage inside the eye.


Assuntos
Infecções Oculares Bacterianas , Administração Tópica , Antibacterianos , Antibioticoprofilaxia , Resistência Microbiana a Medicamentos , Humanos , Injeções Intravítreas
4.
Rev. méd. panacea ; 8(2): 73-77, mayo-ago. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1016002

RESUMO

Objetivo: Identificar las bacterias presentes en superficies inertes del área de cirugía y conocer su respectiva sensibilidad antibiótica según corresponda. Materiales y métodos: Estudio observacional, descriptivo, transversal, prospectivo. Investigación para identificar microorganismos patógenos en superficies inanimadas del Hospital Regional de Ica. Se procedió a las tomas de muestra humedeciendo el hisopo en el caldo cerebro corazón y luego sembrado en agar sangre 5%, agar Mac Conkey y agar manitol salado, incubándolos durante 24 horas a 37ºC, tinción de Gram, pruebas de catalasa y oxidasa. Se realizó la primera lectura dentro de las 24 horas. Resultados: Estafilococus coagulasa negativo se aislaron en el lavadero, coche de medicación, mesa de comer, coche de curación de cirugía B y mesa de comer. Bacillus sp. se aislaron en pared y mesa de comer de Cirugía General. Staphylococsus aureus se aislaron en coche de medicación y coche de curación. Pseudomonas sp. Se aisló en mesa de comer de Cirugía General. El Staphylococcus aureus es resistente a la mayoría de antibióticos que usualmente se utiliza en el departamento de cirugía general del Hospital Regional de Ica. La Psudomona Sp. es resistente a antibióticos que usualmente se utiliza en el servicio de cirugía general, aunque es sensible a algunos antibióticos utilizados en este servicio. Conclusiones: Se encontraron gérmenes en superficies inanimadas que están en intimo contacto con pacientes del departamento de cirugía del Hospital Regional de Ica que pone en riesgo a contraer infecciones intrahospitalarias. El Staphylococcus aureus presenta mayor resistencia antibiótica que la Pseudomona Sp. (AU)


Objective: To identify the bacteria present in inert surfaces of the surgery area and to know their respective antibiotic sensitivity as appropriate. Materials and methods: Observational, descriptive, cross-sectional, prospective study. Research to identify pathogenic microorganisms on inanimate surfaces of the Regional Hospital of Ica. The samples were taken by moistening the swab in the brain heart broth and then seeded on 5% blood agar, Mac Conkey agar and salted mannitol agar, incubating them for 24 hours at 37 ° C, Gram stain, catalase and oxidase tests. The first reading was made within 24 hours. Results: Staphylococcus coagulase negative were isolated in the laundry, medication car, eating table, surgery B healing car and eating table. Bacillus sp. They were isolated in the wall and table of eating of General Surgery. Staphylococcus aureus were isolated in medication car and healing car. Pseudomonas sp. It was isolated on a General Surgery table. Staphylococcus aureus is resistant to most antibiotics that is usually used in the general surgery service of the Regional Hospital of Ica. And Psudomona Sp. Is resistant to antibiotics that is usually used in the general surgery service, although it is sensitive to some antibiotics used in this service. Conclusions: Germs were found on inanimate surfaces that are in intimate contact with patients of the surgical departament of the Regional Hospital of Ica, which puts them at risk of contracting nosocomial infections. Staphylococcus aureus has greater antibiotic resistance than Pseudomona Sp. (AU)


Assuntos
Humanos , Salas Cirúrgicas , Bactérias , Análise Bacteriológica , Antibioticoprofilaxia , Epidemiologia Descritiva , Estudos Transversais , Estudos Prospectivos , Estudo Observacional
6.
Stud Health Technol Inform ; 264: 1833-1834, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438366

RESUMO

To prevent healthcare-associated infections, there are a range of clinical practices that should be followed. For example, appropriate administration of prophylactic antibiotics [process] is essential to reduce risks of surgical site infections post-operatively [outcome]. Monitoring adherence to these processes provides insights into potential causes of infection. The Victorian Healthcare Associated Infection Surveillance System (VICNISS) captures process data in the same system as outcome data, thereby providing integrated data to support quality improvement within healthcare and reduce the burden of healthcare-associated infections.


Assuntos
Antibioticoprofilaxia , Infecção Hospitalar , Antibacterianos , Humanos , Melhoria de Qualidade , Infecção da Ferida Cirúrgica
7.
Medicine (Baltimore) ; 98(34): e16964, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441901

RESUMO

BACKGROUND: Hysteroscopic procedures were widely applied but the clinical effects of antibiotic prophylaxis for these operations were not specifically addressed. In current study, we aimed to investigate the role of prophylactic antibiotics in hysteroscopic procedures by meta-analysis. METHODS: We conducted literature retrieval in electronic databases, including MEDLINE, EMBASE, and Cochrane Central, to identify relevant randomized controlled trials (RCTs) investigating the clinical effects of antibiotic prophylaxis for hysteroscopic procedures. The postoperative infection rate was selected for pooled estimation. The I index statistic was used to assess heterogeneity. Publication bias was evaluated using funnel plots and Egger test. Sensitivity analysis based on different subcategories was conducted to examine the stability of the main results. RESULTS: Four RCTs including 2221 patients were identified for the final quantitative analysis. Pooled estimation indicated no significant difference in infection rate between the antibiotic prophylaxis group and control group (test for OR: Z = 0.50, P = .616; 95% CI: 0.987-1.008). Sensitivity analysis based on surgical procedure, antibiotic application, follow-up time and administration time revealed similar results. CONCLUSION: Based on current objective evidence, we conclude that antibiotic prophylaxis exhibits no clinical benefit for hysteroscopic procedures. Therefore, it is not recommended. Meanwhile, more high-quality RCTs are needed to support our conclusion.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Histeroscopia/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Humanos
8.
Medicine (Baltimore) ; 98(26): e16241, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261586

RESUMO

BACKGROUND: The application of antibiotic prophylaxis for hepatectomy remains uncertain. This research aims to evaluate different antibiotic prophylaxis strategies for hepatectomy based on network meta-analysis. METHODS: Literature retrieval was conducted in globally recognized databases, namely, MEDLINE, EMBASE and Cochrane Central, to address relative randomized controlled trials (RCTs) investigating antibiotic prophylaxis strategies for hepatectomy. Relative parametric data, including surgical site infection (SSI), remote site infection (RSI) and total infection (TI), were quantitatively pooled and estimated based on the Bayesian theorem. The values of surface under the cumulative ranking curve (SUCRA) probabilities regarding each parameter were calculated and ranked. Node-splitting analysis was performed to test the inconsistency of the main results, and publication bias was assessed by examining the funnel plot symmetry. Additional pairwise meta-analyses were performed to validate the differences between respective strategies at the statistical level. RESULTS: After a detailed review, a total of 5 RCTs containing 4 different strategies were included for the network meta-analysis. The results indicated that the application of no antibiotics possessed the highest possibility of having the best clinical effects on SSI (SUCRA, 0.56), RSI (SUCRA, 0.46) and TI (SUCRA, 0.61). Moreover, node-splitting analysis and funnel plot symmetries illustrated no inconsistencies in the current study. Additional pairwise meta-analyses determined that additional and long-duration applications had no clinical benefit. CONCLUSION: Based on current evidence, we concluded that antibiotic prophylaxis did not reveal clinical benefit in hepatectomy. However, more relative trials and statistical evidence are still needed.


Assuntos
Antibioticoprofilaxia/métodos , Hepatectomia , Humanos , Meta-Análise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Urologe A ; 58(7): 809-820, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31263939

RESUMO

Both the demographic shift and progress in medicine are resulting in an increasingly longer life expectancy. It is presumed that a mean age of 90 years will be achieved within the next decade in many countries. Thus, geriatric medicine, which is committed to the specific needs of older, often frail and frequently comorbid patients, is becoming increasingly more important. The prevalence of infections of the genitourinary tract increases with age, simultaneously, a critical and conscious use of antibiotics is required in terms of antimicrobial treatment. The intention of the present review is to make the reader aware of the specific characteristics of urinary tract infections and asymptomatic bacteriuria in the older patient population in terms of epidemiology, spectrum of pathogens and resistance as well as the indications for and performance of antimicrobial treatment.


Assuntos
Antibacterianos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Bacteriúria/tratamento farmacológico , Humanos , Resultado do Tratamento
10.
J Surg Oncol ; 120(4): 639-645, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31297827

RESUMO

BACKGROUND AND OBJECTIVES: Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT). METHODS: All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications. RESULTS: We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors. CONCLUSION: Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.


Assuntos
Antibioticoprofilaxia/efeitos adversos , Drenagem/efeitos adversos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Combinação Piperacilina e Tazobactam/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Antibacterianos/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , Prognóstico , Infecção da Ferida Cirúrgica/etiologia
11.
Arch Esp Urol ; 72(6): 554-559, 2019 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-31274119

RESUMO

INTRODUCTION AND OBJECTIVES: To evaluate the efficacy of antibiotic prophylaxis as well as the cleaning/disinfection procedures to prevent urinary tract infection in patients undergoing office flexible cystoscopy. METHODS: A prospective, randomized study was performed between June 2015 to May 2016 including every patient who underwent flexible cystoscopy at the Urology outpatient unit. Patients with temporary or permanent urinary stents were excluded from the study as well as procedures that involved bladder biopsies. A total of 251 patients were recruited. Urinary culture was collected in all of the patients before and after the procedure. Patients were randomized in two groups: Antibiotic prophylaxis versus no prophylaxis. Antibiotic prophylaxis consisted in 4 doses of Norfloxacin ( 400mg ): twice a day during two days. Three different cleaning/ disinfection methods were used: manual adasport (5% peracetic acid), manual oxide (instrunet sporicidal; Inibsa) and washing machine (Olympus, mini ETD 2). Demographic characteristics such as gender and age were collected during the study. Relationship between antibiotic prophylaxis, type of cleaning/disinfection procedure, demographic characteristics and positive urinary culture after procedure were analysed. Measures to avoid bias: Randomization. RESULTS: Urinary culture before cystoscopy was negative in 231 patients (92.4%), positive in 19 (7.6%) and not valid in 1. After randomization, 129 patients were included in Group 1(no prophylaxis) and 117 in Group 2 (antibiotic prophylaxis), 5 patients dropped from the study. After-procedure culture was negative in 224 patients (91.1%) and positive in 22 (8.9%). There was no statistical significance between urine culture results before and after cystoscopy and the demographic characteristics collected. Furthermore, no statistical differences were seen between urine culture after cystoscopy and cystoscope cleaning method ( p = 0.7), or between urine culture and type of cleaning with or without antibiotic prophylaxis ( p = 0.5, p = 0.9 ). CONCLUSIONS: None of the analyzed variables influenced the positivity of urine culture after flexible cystoscopy. Routine antibiotic prophylaxis should not be further recommended.


Assuntos
Antibioticoprofilaxia , Infecções Urinárias , Antibacterianos , Cistoscópios , Cistoscopia , Humanos , Pacientes Ambulatoriais , Estudos Prospectivos
12.
Coluna/Columna ; 18(2): 134-137, June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011943

RESUMO

ABSTRACT Objectives: Despite the use of systemic antibiotic prophylaxis, infection is still a challenge for spine surgeons, with high morbidity and mortality, long hospitalization, delayed rehabilitation, and a greater number of interventions. The purpose of this cross-sectional retrospective case-control study was to compare the incidence of postoperative infection in individuals who received a systemic antibiotic as the sole prophylactic method with those who received vancomycin in the operative wound in association with systemic antibiotic prophylaxis in spinal surgery. Methods: We evaluated 2694 medical records of individuals submitted to posterior spinal surgery in the thoracolumbar segment in the period from January 2012 to June 2017, 1360 in the treatment group and 1334 in the control group. Results: Nineteen (1.39%) of the treatment group progressed with surgical site infection, compared to 42 (3.14%) of the control group. Conclusions: There was a significant reduction in the postoperative infection rate with the use of vancomycin (p=0.0379). Level of Evidence III; Case-Control Study.


RESUMO Objetivos: Apesar do uso de antibioticoprofilaxia sistêmica, a infecção ainda constitui um desafio para os cirurgiões de coluna, com alta morbimortalidade, longo período de internação, retardo na reabilitação e maior número de intervenções. O propósito deste estudo transversal retrospectivo tipo caso-controle foi comparar a incidência de infecção pós-operatória nos indivíduos que receberam antibiótico sistêmico como único método profilático aos que receberam Vancomicina na ferida operatória em associação com antibiótico sistêmico em cirurgias na coluna vertebral. Métodos: Foram avaliados 2694 prontuários de indivíduos submetidos à cirurgia de coluna por via posterior no segmento toracolombar no período de janeiro de 2012 a Junho de 2017, sendo 1360 no grupo tratamento e 1334 no grupo controle. Resultados: Dezenove (1,39%) do grupo tratamento evoluíram com infecção do sítio cirúrgico, em comparação com 42 (3.14%) do grupo controle. Conclusão: Houve redução significativa na taxa de infecção pós-operatória com o uso da Vancomicina (p=0,0379). Nível de Evidência III; Estudo de Caso-Controle.


RESUMEN Objetivos: A pesar del uso de profilaxis con antibióticos sistémicos, la infección todavía constituye un desafío para los cirujanos de columna, con alta morbimortalidad, largo período de internación, retraso en la rehabilitación y mayor número de intervenciones. El propósito de este estudio transversal retrospectivo tipo caso-control fue comparar la incidencia de infección postoperatoria en los individuos que recibieron antibiótico sistémico como único método profiláctico a los que recibieron vancomicina en la herida operatoria en asociación con antibiótico sistémico en cirugías de la columna vertebral. Métodos: Se evaluaron 2694 prontuarios de individuos sometidos a cirugía de columna por vía posterior en el segmento toracolumbar en el período de enero de 2012 a junio de 2017, siendo 1360 en el grupo tratamiento y 1334 en el grupo control. Resultados: Diecinueve (1,39%) del grupo de tratamiento evolucionó con infección del sitio quirúrgico, en comparación con 42 (3,14%) del grupo control. Conclusiones: Hubo reducción significativa en la tasa de infección postoperatoria con el uso de la vancomicina (p = 0,0379). Nivel de Evidencia III; Estudio de Caso-Control.


Assuntos
Humanos , Coluna Vertebral , Vancomicina , Antibioticoprofilaxia , Infecção
13.
Bone Joint J ; 101-B(6_Supple_B): 9-15, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31146571

RESUMO

AIMS: The aims of this study were to characterize antibiotic choices for perioperative total knee arthroplasty (TKA) and total hip arthroplasty (THA) prophylaxis, assess antibiotic allergy testing efficacy, and determine rates of prosthetic joint infection (PJI) based on perioperative antibiotic regimen. PATIENTS AND METHODS: We evaluated all patients undergoing primary TKA or THA at a single academic institution between January 2004 and May 2017, yielding 29 695 arthroplasties (22 705 patients), with 3411 arthroplasties in 2576 patients (11.5%) having undergone preoperative allergy testing. A series of institutional databases were combined to identify allergy consultation outcomes, perioperative antibiotic regimen, and infection-free survivorship until final follow-up. RESULTS: Among 2576 allergy-tested patients, 2493 patients (97%) were cleared to use cephalosporins. For the entire cohort, 28 174 arthroplasties (94.9%) received cefazolin and 1521 (5.1%) received non-cefazolin antibiotics. Infection-free survivorship was significantly higher among arthroplasties receiving cefazolin compared with non-cefazolin antibiotics, with 0.06% higher survival free of infection at one month, 0.56% at two months, 0.61% at one year, and 1.19% at ten years (p < 0.001). Overall, the risk of PJI was 32% lower in patients treated with cefazolin after adjusting for the American Society of Anesthesiologists (ASA) classification, joint arthroplasty (TKA or THA), and body mass index (BMI; p < 0.001). The number needed to treat with cefazolin to prevent one PJI was 164 patients at one year and 84 patients at ten years. Therefore, potentially 6098 PJIs could be prevented by one year and 11 905 by ten years in a cohort of 1 000 000 primary TKA and THA patients. CONCLUSION: PJI rates are significantly higher when non-cefazolin antibiotics are used for perioperative TKA and THA prophylaxis, highlighting the positive impact of preoperative antibiotic allergy testing to increase cefazolin usage. Given the low rate of true penicillin allergy positivity, and the readily modifiable risk factor that antibiotic choice provides, we recommend perioperative testing and clearance for all patients presenting with penicillin and cephalosporin allergies. Cite this article: Bone Joint J 2019;101-B(6 Supple B):9-15.


Assuntos
Antibacterianos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Cefalosporinas/uso terapêutico , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Adulto , Idoso , Antibioticoprofilaxia , Cefazolina/uso terapêutico , Hipersensibilidade a Drogas/prevenção & controle , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/prevenção & controle
14.
Rozhl Chir ; 98(4): 137-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31159546

RESUMO

The paper describes the basic sources and principles of antibiotic therapy in contemporary medicine in which the ability to treat bacterial infections may be lost. The main reason for that is the increasing resistance of bacterial pathogens to antibiotics. A possible solution is to implement a comprehensive program of antibiotic stewardship incorporating adequate consideration of indication and selection of antimicrobial agents including appropriate duration and way of administration. Another important component of the comprehensive approach to bacterial resistance and antibiotic therapy is adequately applied antibiotic prophylaxis in surgery.


Assuntos
Antibacterianos , Anti-Infecciosos , Antibioticoprofilaxia , Humanos
15.
J Shoulder Elbow Surg ; 28(6S): S13-S31, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196506

RESUMO

The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. Over 800 international experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology were assembled to form a consensus workgroup. The following proceedings on the prevention of periprosthetic shoulder infection come from 16 questions evaluated by delegates from the shoulder section.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Artroplastia do Ombro/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Prótese de Ombro/efeitos adversos , Antibacterianos/administração & dosagem , Cimentos para Ossos , Consenso , Humanos , Assistência Perioperatória , Infecções Relacionadas à Prótese/etiologia , Reoperação , Fatores de Risco , Articulação do Ombro/cirurgia
17.
BMC Public Health ; 19(1): 797, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226974

RESUMO

BACKGROUND: Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana. METHODS: Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units. RESULTS: Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples. CONCLUSION: We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions.


Assuntos
Antibacterianos/uso terapêutico , Centro Cirúrgico Hospitalar , Adolescente , Adulto , Idoso , Antibioticoprofilaxia/estatística & dados numéricos , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Estudos Transversais , Feminino , Gana , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Lakartidningen ; 1162019 Mar 26.
Artigo em Sueco | MEDLINE | ID: mdl-31192383

RESUMO

Surgical site infections (SSIs) in dermatologic surgery are rare, but when they do occur they can cause unnecessary suffering in patients, delayed healing, and result in poor scar cosmesis. The etiology and pathogenesis of SSIs in dermatologic surgery are not completely understood and most current preventative measures lack strong scientific evidence. Focusing on dermatologic surgery, this article provides an updated overview of the subject with data summarizing relevant studies.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Infecção da Ferida Cirúrgica , Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Desinfetantes/administração & dosagem , Luvas Cirúrgicas , Humanos , Fatores de Risco , Esterilização , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
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