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Kühl N, Vollenberg R, Meier JA, Ullerich H, Schulz MS, Rennebaum F, Laleman W, Froböse NJ, Praktiknjo M, Peiffer K, Fischer J, Trebicka J, Gu W, Tepasse PR. Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study. J Clin Med 2024; 13:1438. [PMID: 38592264 PMCID: PMC10934434 DOI: 10.3390/jcm13051438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Liver transplant recipients often require endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications, which can lead to infections. This retrospective single-center study aimed to identify risk factors for infectious complications following ERCP in liver transplant patients. Methods: A retrospective analysis was conducted on 285 elective ERCP interventions performed in 88 liver transplant patients at a tertiary care center. The primary endpoint was the occurrence of an infection following ERCP. Univariable and multivariable regression analyses, Cox regression, and log-rank tests were employed to assess the influence of various factors on the incidence of infectious complications. Results: Among the 285 ERCP interventions, isolated anastomotic stenosis was found in 175 cases, ischemic type biliary lesion (ITBL) in 103 cases, and choledocholithiasis in seven cases. Bile duct interventions were performed in 96.9% of all ERCPs. Infections after ERCP occurred in 46 cases (16.1%). Independent risk factors for infection included male sex (OR 24.19), prednisolone therapy (OR 4.5), ITBL (OR 4.51), sphincterotomy (OR 2.44), cholangioscopy (OR 3.22), dilatation therapy of the bile ducts (OR 9.48), and delayed prophylactic antibiotic therapy (>1 h after ERCP) (OR 2.93). Additionally, infections following previous ERCP interventions were associated with an increased incidence of infections following future ERCP interventions (p < 0.0001). Conclusion: In liver transplant patients undergoing ERCP, male sex, prednisolone therapy, and complex bile duct interventions independently raised infection risks. Delayed antibiotic treatment further increased this risk. Patients with ITBL were notably susceptible due to incomplete drainage. Additionally, a history of post-ERCP infections signaled higher future risks, necessitating close monitoring and timely antibiotic prophylaxis.
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Affiliation(s)
- Norman Kühl
- University of Münster, 48149 Münster, Germany;
| | - Richard Vollenberg
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Jörn Arne Meier
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Hansjörg Ullerich
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Martin Sebastian Schulz
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Florian Rennebaum
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Wim Laleman
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Neele Judith Froböse
- Institute of Medical Microbiology, University Hospital Muenster, 48149 Münster, Germany;
| | - Michael Praktiknjo
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Kai Peiffer
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Julia Fischer
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Jonel Trebicka
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Wenyi Gu
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
| | - Phil-Robin Tepasse
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany; (R.V.); (J.A.M.); (H.U.); (M.S.S.); (F.R.); (W.L.); (M.P.); (K.P.); (J.F.); (J.T.); (W.G.)
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Leem G, Sung MJ, Park JH, Kim SJ, Jo JH, Lee HS, Ku NS, Park JY, Bang S, Park SW, Song SY, Chung MJ. Randomized Trial of Prophylactic Antibiotics for Endoscopic Retrograde Cholangiopancreatography in Patients With Biliary Obstruction. Am J Gastroenterol 2024; 119:183-190. [PMID: 37713527 PMCID: PMC10758346 DOI: 10.14309/ajg.0000000000002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
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).
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Affiliation(s)
- Galam Leem
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
| | - Min Je Sung
- Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea;
| | - Ji Hoon Park
- Division of Gastroenterology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Gyeonggi-do, Korea;
| | - So Jeong Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea;
| | - Jung Hyun Jo
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
| | - Hee Seung Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
| | - Nam Su Ku
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jeong Youp Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
| | - Seung Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
| | - Si Young Song
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
- Institute of Gastroenterology Research, Yonsei University College of Medicine, Seoul, Korea;
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Forster K, Klein F, Simon N, Chhatwal P, Ziesing S, Heidrich B, Solbach P. Cultivation-based characterization of biliary microbiota in bile samples collected during routine endoscopic retrograde cholangiography: 10 years of experience at a tertiary center. Eur J Gastroenterol Hepatol 2023; 35:1159-1167. [PMID: 37577778 DOI: 10.1097/meg.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Bile has long been considered sterile. Recent studies show that bacteria can frequently be detected in bile and certain bacterial species are associated with bile duct-associated liver disease. OBJECTIVES To detect bacterial species and antibiotic resistance in bile in bile duct-associated liver disease. METHODOLOGY To evaluate microbiological findings of bile samples obtained during ERCP at a tertiary center from 2009 to 2019. RESULTS There were 1885 bile samples from 992 patients examined by cultural microbiological analysis. Germs were detected in 91% of the samples. Most bile samples (n) were obtained from patients who had undergone liver transplantation (LTX; n = 556), followed by patients with primary sclerosing cholangitis (PSC; n = 287). Enterococci were detected in 67% of samples, followed by E. coli (32.2%) and Klebsiella (28.2%). Of 1151 enterococci detected, 13.1% were vancomycin (VRE)s and of 216 staphylococci detected, 10% were ORSA. The proportion of VRE increased with the number of tests performed during ERCPs ( P < 0.01; chi-square) and increased 2.5-fold over 10 years, whereas the detection of ORSA remained stable. Patients with cholecystolithiasis were significantly more likely to have evidence of VRE in bile compared to LTX and PSC patients ( P = 0.02, P < 0.01; chi-square). The most abundant bacterial genera showed highly statistically significant differences in their levels of liver enzymes and c-reactive protein ( P < 0.001). CONCLUSION Knowledge of the bacterial composition of bile in various bile duct-associated liver diseases may allow more targeted antibiotic use in the future.
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Affiliation(s)
- Kilian Forster
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School
| | - Friederike Klein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School
| | | | - Patrick Chhatwal
- Institute of Medical Microbiology and Hospital Hygiene, Hannover Medical School
| | - Stefan Ziesing
- Institute of Medical Microbiology and Hospital Hygiene, Hannover Medical School
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School
- Institute of Medical Microbiology and Hospital Hygiene, Hannover Medical School
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover
| | - Philipp Solbach
- Department of Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany
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Hastier-De Chelle A, Onana-Ndong P, Olivier R, Bentellis I, Pioche M, Rivory J, Gonzalez JM, Bailly L, Piche T, Ponchon T, Brochard C, Coron E, Barthet M, Vanbiervliet G. Impact of antibiotic prophylaxis and conditioning modalities in per-oral endoscopic myotomy for esophageal motor disorders. Scand J Gastroenterol 2022; 57:1522-1530. [PMID: 35850618 DOI: 10.1080/00365521.2022.2097892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS No recommendation regarding antibiotic prophylaxis and preparation modalities are available for patients with esophageal motor disorders who benefit from Per-Oral Endoscopic Myotomy (POEM). The aim of our study was to evaluate their impact on the POEM's safety. PATIENTS AND METHODS This study was a comparative and multicentric retrospective analysis of a database prospectively collected. Patients over 18 years old with esophageal motor disorders confirmed by prior manometry, who underwent POEM were included. The primary endpoint was the occurrence of adverse events, as classified by Cotton, based on whether or not antibiotic prophylaxis was administered. RESULTS A total of 226 patients (median age 52.9 ± 19.12 years [18-105], 116 women [51.3%]) were included. The indication for POEM was mainly type 2 achalasia (n = 135, 60.3%). Antibiotic prophylaxis was administered to 170 patients (75.2%) during 3.93 ± 3.46 days [1-21]. The overall adverse events rate was 9.3% (n = 21). Antibiotic prophylaxis was associated with the occurrence of adverse events (p = .003), but had no impact on their severity (p = .238). Antibiotic prophylaxis didn't influence the effectiveness of POEM (1 [0-4] vs 1 [0-9], p = .231). The use of a liquid diet in the 48 h prior to the procedure was significantly associated with a lower adverse events rate (3.1% vs 6.19%, p = .0002). CONCLUSION The antibiotic prophylaxis during POEM does not prevent adverse events, had no impact on their severity and the efficacy of the procedure. A liquid diet before the procedure should be systematically proposed.
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Affiliation(s)
| | - Philippe Onana-Ndong
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Raphaël Olivier
- Institut des maladies de l'appareil digestif, Hôpital Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Imad Bentellis
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Mathieu Pioche
- Gastro-entérologie, Hôpital Édouard Herriot, Hospices civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Gastro-entérologie, Hôpital Édouard Herriot, Hospices civils de Lyon, Lyon, France
| | - Jean Michel Gonzalez
- Gastro-entérologie, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, France
| | - Laurent Bailly
- Direction de L'Information Médicale, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Thierry Piche
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Thierry Ponchon
- Gastro-entérologie, Hôpital Édouard Herriot, Hospices civils de Lyon, Lyon, France
| | - Charlène Brochard
- Gastro-entérologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Emmanuel Coron
- Institut des maladies de l'appareil digestif, Hôpital Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marc Barthet
- Gastro-entérologie, Hôpital Nord, Assistance Publique des hôpitaux de Marseille, Marseille, France
| | - Geoffroy Vanbiervliet
- Gastro-entérologie, Hôpital L'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France
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Chung WTG, Shafi H, Seah J, Purnima P, Patun T, Kam KQ, Seah VXF, Ong RYL, Lin L, Choo RSM, Lingegowda P, Lim CLL, Chung JS, Chua NGSY, Lee TH, Yap MY, Ng TM, Somani J. National surgical antibiotic prophylaxis guideline in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022. [DOI: 10.47102/annals-acadmedsg.2022273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction: Institutional surgical antibiotic prophylaxis (SAP) guidelines are in place at all public hospitals in Singapore, but variations exist and adherence to guidelines is not tracked consistently. A national point prevalence survey carried out in 2020 showed that about 60% of surgical prophylactic antibiotics were administered for more than 24 hours. This guideline aims to align best practices nationally and provides a framework for audit and surveillance.
Method: This guideline was developed by the National Antimicrobial Stewardship Expert Panel’s National Surgical Antibiotic Prophylaxis Guideline Development Workgroup Panel, which comprises infectious diseases physicians, pharmacists, surgeons and anaesthesiologists. The Workgroup adopted the ADAPTE methodology framework with modifications for the development of the guideline. The recommended duration of antibiotic prophylaxis was graded according to the strength of consolidated evidence based on the scoring system of the Singapore Ministry of Health Clinical Practice Guidelines.
Results: This National SAP Guideline provides evidence-based recommendations for the rational use of antibiotic prophylaxis. These include recommended agents, dose, timing and duration for patients undergoing common surgeries based on surgical disciplines. The Workgroup also provides antibiotic recommendations for special patient population groups (such as patients with β-lactam allergy and patients colonised with methicillin-resistant Staphylococcus aureus), as well as for monitoring and surveillance of SAP.
Conclusion: This evidence-based National SAP Guideline for hospitals in Singapore aims to align practices and optimise the use of antibiotics for surgical prophylaxis for the prevention of surgical site infections while reducing adverse events from prolonged durations of SAP.
Keywords: Antibiotic prophylaxis duration, antimicrobial resistance, antimicrobial stewardship, hospital-acquired infection, surgical site infections
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Affiliation(s)
| | | | | | | | | | | | | | | | - Li Lin
- Ng Teng Fong General Hospital, Singapore
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Merchan MFS, de Moura DTH, de Oliveira GHP, Proença IM, do Monte Junior ES, Ide E, Moll C, Sánchez-Luna SA, Bernardo WM, de Moura EGH. Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis of randomized controlled trials. World J Gastrointest Endosc 2022; 14:718-730. [PMID: 36438881 PMCID: PMC9693690 DOI: 10.4253/wjge.v14.i11.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/22/2022] [Accepted: 10/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prophylactic use of antibiotics in endoscopic retrograde cholangiopancreatography (ERCP) is still controversial.
AIM To assess whether antibiotic prophylaxis reduces the rates of complications in patients undergoing elective ERCP.
METHODS This systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A comprehensive search of multiple electronic databases was performed. Only randomized controlled trials were included. The outcomes analyzed included bacteremia, cholangitis, sepsis, pancreatitis, and mortality. The risk of bias was assessed by the Cochrane revised Risk-of-Bias tool for randomized controlled trials. The quality of evidence was assessed by the Grading of Recommendation Assessment, Development, and Evaluation. Meta-analysis was performed using the Review Manager 5.4 software.
RESULTS Ten randomized controlled trials with a total of 1757 patients that compared the use of antibiotic and non-antibiotic prophylaxis in patients undergoing elective ERCP were included. There was no significant difference between groups regarding incidence of cholangitis after ERCP [risk difference (RD) = -0.02, 95% confidence interval (CI): -0.05, 0.02, P = 0.32], cholangitis in patients with suspected biliary obstruction (RD = 0.02, 95%CI: -0.08 to 0.13, P = 0.66), cholangitis on intravenous antibiotic prophylaxis (RD = -0.02, 95%CI: -0.05 to 0.01, P = 0.25), septicemia (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.25), pancreatitis (RD = -0.02, 95%CI: -0.06 to 0.01, P = 0.19), and all-cause mortality (RD = 0.00, 95%CI: -0.01 to 0.01, P = 0.71]. However, the antibiotic prophylaxis group presented a 7% risk reduction in the incidence of bacteremia (RD= -0.07, 95%CI: -0.14 to -0.01, P = 0.03).
CONCLUSION The prophylactic use of antibiotics in patients undergoing elective ERCP reduces the risk of bacteremia but does not appear to have an impact on the rates of cholangitis, septicemia, pancreatitis, and mortality.
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Affiliation(s)
- Maria Fernanda Shinin Merchan
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Igor Mendonça Proença
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Epifanio Silvino do Monte Junior
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Edson Ide
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Caroline Moll
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Sergio A Sánchez-Luna
- Department of Internal Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL 35233, United States
| | - Wanderley Marques Bernardo
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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Bianchini S, Rigotti E, Monaco S, Nicoletti L, Auriti C, Castagnola E, Conti G, Galli L, Giuffrè M, La Grutta S, Lancella L, Lo Vecchio A, Maglietta G, Petrosillo N, Pietrasanta C, Principi N, Tesoro S, Venturini E, Piacentini G, Lima M, Staiano A, Esposito S. Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:279. [PMID: 35203881 PMCID: PMC8868062 DOI: 10.3390/antibiotics11020279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/26/2023] Open
Abstract
Surgical site infections (SSIs), i.e., surgery-related infections that occur within 30 days after surgery without an implant and within one year if an implant is placed, complicate surgical procedures in up to 10% of cases, but an underestimation of the data is possible since about 50% of SSIs occur after the hospital discharge. Gastrointestinal surgical procedures are among the surgical procedures with the highest risk of SSIs, especially when colon surgery is considered. Data that were collected from children seem to indicate that the risk of SSIs can be higher than in adults. This consensus document describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. The following surgical procedures were analyzed: (1) gastrointestinal endoscopy; (2) abdominal surgery with a laparoscopic or laparotomy approach; (3) small bowel surgery; (4) appendectomy; (5) abdominal wall defect correction interventions; (6) ileo-colic perforation; (7) colorectal procedures; (8) biliary tract procedures; and (9) surgery on the liver or pancreas. Thanks to the multidisciplinary contribution of experts belonging to the most important Italian scientific societies that take care of neonates and children, this document presents an invaluable reference tool for perioperative antibiotic prophylaxis in the paediatric and neonatal populations.
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Affiliation(s)
- Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Erika Rigotti
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (G.P.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Luisa Galli
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Mario Giuffrè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90141 Palermo, Italy;
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Via D. Montesano 49, 80131 Naples, Italy; (A.L.V.); (A.S.)
| | - Giuseppe Maglietta
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | | | - Carlo Pietrasanta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, NICU, 20122 Milan, Italy;
| | | | - Simonetta Tesoro
- Division of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Giorgio Piacentini
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37124 Verona, Italy; (E.R.); (G.P.)
| | - Mario Lima
- Paediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Via D. Montesano 49, 80131 Naples, Italy; (A.L.V.); (A.S.)
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (S.M.); (L.N.)
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8
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Hakuta R, Nakai Y, Hamada T, Nomura Y, Saito T, Takahara N, Mizuno S, Kogure H, Moriya K, Koike K. Use of proton pump inhibitors and cholangitis complicated with multi-drug resistant bacteria. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:230-238. [PMID: 34382333 DOI: 10.1002/jhbp.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multidrug-resistant bacteria (MDRB) has rapidly spread worldwide and become a serious problem. Proton pump inhibitors (PPIs) are a class of commonly prescribed medications, but recent studies have suggested the increased risk of infection with MDRB in PPI users. We evaluated the association between PPI use and incidence of cholangitis with MDRB. METHODS Consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2010 and August 2019 were included in this retrospective study. The incidence of cholangitis with MDRB was compared between regular and non-regular PPI users. RESULTS A total of 1224 regular PPI users and 1528 non-regular PPI users were identified. There was no clinically significant difference in age and sex between the groups. Indication of ERCP was different between the groups. The number of ERCP sessions during the study periods was higher in regular PPI users. The incidence of cholangitis with MDRB was significantly higher in regular PPI users (3.0% vs 1.1%; P < .001). Multivariable-adjusted odds ratio for cholangitis with MDRB comparing regular PPI users to non-regular users was 2.19 (95% confidence interval 1.20-4.00; P = .01). CONCLUSIONS Regular PPI use was associated with a higher risk of cholangitis with MDRB.
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Affiliation(s)
- Ryunosuke Hakuta
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Nomura
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomotaka Saito
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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9
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Deutsch L, Matalon S, Phillips A, Leshno M, Shibolet O, Santo E. Older age, longer procedures and tandem endoscopic-ultrasound as risk factors for post-endoscopic retrograde cholangiopancreatography bacteremia. World J Gastroenterol 2020; 26:6402-6413. [PMID: 33244201 PMCID: PMC7656206 DOI: 10.3748/wjg.v26.i41.6402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/16/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinically significant post-endoscopic retrograde cholangiopancreatography (ERCP) bacteremia (PEB) occurs in up to 5% of cases, while antibiotic prophylaxis is recommended only when an ERCP is unlikely to achieve complete biliary drainage. However, the current recommendations may not cover all potential risk factors for PEB.
AIM To identify novel risk factors for PEB and evaluate appropriateness of antibiotic prophylaxis.
METHODS A retrospective study of 1082 ERCP procedures performed between January 2012 - December 2013 in a single tertiary medical center. Data collection included: Demographic and clinical characteristics such as pre and post procedure antibiotic treatment and bacterial blood cultures. Exclusion criteria were: (1) Age < 18 years; (2) Positive bacterial blood culture before ERCP; (3) Scheduled antibiotic treatment prior to ERCP; (4) Hospitalization longer than 14 d before ERCP; and (5) missing critical data. Stepwise Logistic Regression analysis and Decision Tree algorithms were used for prediction modeling of PEB.
RESULTS A total of 626 ERCPs performed in 434 patients were included. Mean age 66.49 ± 15.4 years and 46.5% were males. PEB prevalence was 3.7%. Antibiotic prophylaxis was administrated in 139/626 (22.2%) cases but was indicated according to the guidelines only in 44/626 (7%) cases. In all the PEB cases, prophylaxis was deemed not indicated. A stepwise logistic regression [receiver operating characteristic (ROC), 0.766], identified 3 variables as independent risk factors for PEB: Age at ERCP ≥ 75 years (OR, 3.780, 95%CI: 1.519-9.408, P = 0.004); Tandem EUS/ERCP with fine needle aspiration (FNA) (OR, 14.528, 95%CI: 3.571-59.095, P < 0.001); ERCP duration longer than 60 min (OR, 5.396, 95%CI: 1.86-15.656, P = 0.002). In a decision tree model (ROC, 0.778) the probability for PEB without any risk factors was 1% regardless of prophylaxis administration.
CONCLUSION The prevalence of PEB in our study is similar to previous reports, despite the fact that antibiotic prophylaxis was administrated more readily than recommended. ERCP duration longer than 60 min, tandem EUS-ERCP with FNA and age above 75 years are significant risk factors for PEB. These factors should be further evaluated as indications for prophylactic antibiotic treatment before ERCP.
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Affiliation(s)
- Liat Deutsch
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Shay Matalon
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Gastroenterology, Assaf Harofe Medical Center, Zeriffin 70300, Israel
| | - Adam Phillips
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Moshe Leshno
- Faculty of Management, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oren Shibolet
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Erwin Santo
- The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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The Relative Role of Bile Bacterial Isolation on Outcome in Stent-Bearing Patients Undergoing Pancreatoduodenectomy. J Gastrointest Surg 2020; 24:2269-2276. [PMID: 31506893 DOI: 10.1007/s11605-019-04388-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/28/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biliary stenting leads to antimicrobial-resistant (AMR) microorganism retrievement in bile cultures. However, the impact of intraoperative bile colonizations on post-pancreaticoduodenectomy complications remains unclear. Aims of our study were to characterize the bile flora of stented patients in comparison with postoperative cultures and to analyze whether patterns of drug resistance affected postoperative outcomes. METHODS We analyzed records from stent-bearing pancreaticoduodenectomy patients at 3 European centers. Intra- and postoperative cultures were compared and classified as multidrug sensitive (MDS), multidrug resistant (MDR), and extensively drug resistant (XDR). Thirty-day complications were graded according to international standards. RESULTS Out of 270 patients, intraoperative cultures were positive in 219 (81.1%) cases. In 36.7%, MDS species were isolated; in 35.9%, MDR; and in 8.5%, XDR species. A solid correspondence between the species isolated intra- and postoperatively (p < 0.001) was observed. Intraoperative MDR/XDR isolation was associated with an increased rate of surgical (p = 0.043) and infectious complications (p = 0.030), but not severe complication rate (p = 0.973). Postoperative MDR/XDR isolation was associated with higher risk of major complications (45.6% vs. 15.8%, p < 0.001), postoperative pancreatic fistula (p < 0.001), and post-pancreatectomy hemorrhage (p = 0.002). By multivariate analysis, intraoperative AMR isolation was associated with high likelihood of postoperative AMR infections. However, only in 43/121 cases, intraoperative MDR/XDR microorganisms turned into the occurrence of postoperative infections. CONCLUSION Intraoperative AMR isolates do not translate into severe outcomes, despite being significantly associated with surgical and infectious complications.
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11
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Kietpeerakool C, Chumworathayi B, Thinkhamrop J, Ussahgij B, Lumbiganon P. Antibiotics for infection prevention after excision of the cervical transformation zone. Cochrane Database Syst Rev 2017; 1:CD009957. [PMID: 28109160 PMCID: PMC6464760 DOI: 10.1002/14651858.cd009957.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Excision of the transformation zone of the cervix is the most commonly used approach to treat cervical precancerous lesions (cervical intraepithelial neoplasia (CIN)) to reduce the risk of developing cervical cancer. As the excision of the transformation zone leaves a raw area on the cervix, there is a risk of infection following the procedure. The incidence of infection after cold knife conization (CKC) is 36%, whereas the incidence for large loop excision of the transformation zone (LLETZ, also known as loop electrical excision procedure (LEEP)) is much lower (0.8% to 14.4%). Prophalytic antibiotics may prevent an infection developing and are often prescribed for CKC. However, there are no formal recommendations regarding the use of prophylactic antibiotics for infection prevention in women undergoing surgical excisional treatment for cervical precancerous lesions. OBJECTIVES To evaluate the effectiveness and safety of antibiotics for infection prevention following excision of the cervical transformation zone. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE, Embase, LILACS to May 2016. We also checked registers of clinical trials, citation lists of included studies, key textbooks and previous systematic reviews for potentially relevant studies SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of prophylactic antibiotics versus a placebo or no treatment in women having excision of the cervical transformation zone, regardless of the type of surgical excisional method used. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently selected potentially relevant trials, extracted data, and assessed risk of bias, compared results and resolved disagreements by discussion. We contacted investigators for additional data, where possible. MAIN RESULTS Of the 370 records that we identified as a result of the search (excluding duplicates), we regarded six abstracts and titles as potentially relevant studies. Of these six studies, three met the inclusion criteria involving 708 participants; most trials were at moderate or high risk of bias (risk mainly due to lack of blinding and high rate of incomplete data). We did not identify any ongoing trials. Although all included studies had been published in peer-reviewed journals at the time of the search and data extraction, numerical data regarding the outcome measured in one trial involving 77 participants were insufficient for inclusion in a meta-analyses.The difference in the rates of prolonged vaginal discharge or presumed cervicitis (one study; 348 participants; risk ratio (RR), 1.29; 95% confidence interval (CI) 0.72 to 2.31; low-quality evidence) and severe vaginal bleeding (two studies; 638 participants; RR 1.21; 95% CI 0.52 to 2.82; very low-quality evidence) among the two comparison groups did not reach the level for clinically important effect. In addition, there was no difference in adverse events related to antibiotics i.e. nausea/vomiting, diarrhoea, and headache among the two comparison groups (two studies; 638 participants; RR 1.69; 95% CI 0.85 to 3.34; very low-quality evidence). There were no differences in the incidence of fever (RR, 2.23; 95% CI 0.20 to 24.36), lower abdominal pain (RR, 1.03; 95% CI 0.61 to 1.72), unscheduled medical consultation (RR 2.68, 95% CI 0.97 to 7.41), and additional self-medication (RR 1.22; 95% CI 0.56 to 2.67) between the two comparison groups (one study; 290 participants; low to very low-quality evidence). AUTHORS' CONCLUSIONS As only limited data are available from three trials with overall moderate to high risk of bias, there is insufficient evidence to support use of antibiotics to reduce infectious complications following excision of the cervical transformation zone. In addition, there were minimal data about antibiotic-related adverse events and no information on the risk of developing antibiotic resistance. Antibiotics given for infection prevention after excision of the cervical transformation zone should only be used in the context of clinical research, to avoid unnecessary prescription of antibiotics and to prevent further increases in antibiotic resistance.
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Affiliation(s)
- Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Bandit Chumworathayi
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Jadsada Thinkhamrop
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Butsakorn Ussahgij
- Khon Kaen UniversityMedical Library, Faculty of Medicine123 Mittraparp HighwayKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Ellett J, Prasad MM, Purves JT, Stec AA. Post-surgical infections and perioperative antibiotics usage in pediatric genitourinary procedures. J Pediatr Urol 2015; 11:358.e1-6. [PMID: 26271822 DOI: 10.1016/j.jpurol.2015.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/06/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Post-surgical infections (PSIs) are a source of preventable perioperative morbidity. No guidelines exist for the use of perioperative antibiotics in pediatric urologic procedures. OBJECTIVE This study reports the rate of PSIs in non-endoscopic pediatric genitourinary procedures at our institution. Secondary aims evaluate the association of PSI with other perioperative variables, including wound class (WC) and perioperative antibiotic administration. STUDY DESIGN Data from consecutive non-endoscopic pediatric urologic procedures performed between August 2011 and April 2014 were examined retrospectively. The primary outcome was the rate of PSIs. PSIs were classified as superficial skin (SS) and deep/organ site (D/OS) according to Centers for Disease Control and Prevention guidelines, and urinary tract infection (UTI). PSIs were further stratified by WC1 and WC2 and perioperative antibiotic usage. A relative risk and chi-square analysis compared PSI rates between WC1 and WC2 procedures. RESULTS A total of 1185 unique patients with 1384 surgical sites were reviewed; 1192 surgical sites had follow-up for inclusion into the study. Ten total PSIs were identified, for an overall infection rate of 0.83%. Of these, six were SS, one was D/OS, and three were UTIs. The PSI rate for WC1 (885 sites) and WC2 (307 sites) procedures was 0.34% and 2.28%, respectively, p < 0.01. Relative risk of infection in WC2 procedures was 6.7 (CI 1.75-25.85, p = 0.0055). The rate of infections in WC1 procedures was similar between those receiving and not receiving perioperative antibiotics (0.35% vs. 0.33%). All WC2 procedures received antibiotics. DISCUSSION Post-surgical infections are associated with significant perioperative morbidity. In some studies, PSI can double hospital costs, and contribute to hospital length of stay, admission to intensive care units, and impact patient mortality. Our study demonstrates that the rate of PSI in WC1 operations is low, irrespective of whether the patient received perioperative antibiotics (0.35%) or no antibiotics (0.33%). WC2 operations were the larger source of morbidity with an infection rate of 2.28% and a 6.7 fold higher increase in relative risk. CONCLUSIONS WC1 procedures have a rate of infection around 0.3%, which is independent of the use of perioperative antibiotics. WC2 procedures have a higher rate of infection, with a relative risk of 6.7 for the development of PSI, and should be the target of guidelines for periprocedural prophylaxis.
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Affiliation(s)
- Justin Ellett
- Medical University of South Carolina, Department of Urology, Charleston, SC, USA
| | - Michaella M Prasad
- Medical University of South Carolina, Department of Urology, Charleston, SC, USA
| | - J Todd Purves
- Medical University of South Carolina, Department of Urology, Charleston, SC, USA
| | - Andrew A Stec
- Medical University of South Carolina, Department of Urology, Charleston, SC, USA.
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13
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Lawing CR, Lin FC, Dahners LE. Local Injection of Aminoglycosides for Prophylaxis Against Infection in Open Fractures. J Bone Joint Surg Am 2015; 97:1844-51. [PMID: 26582614 PMCID: PMC4642229 DOI: 10.2106/jbjs.o.00072] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the efficacy of local wound cavity injections of aqueous aminoglycosides (gentamicin and tobramycin), in conjunction with systemic antibiotics, to lower the prevalence of infection in patients with open fractures. METHODS Three hundred and fifty-one open fractures were identified by Current Procedural Terminology codes 11011 and 11012. Data on patient demographic characteristics, injury characteristics, infection, and fracture union were obtained from the electronic medical records. Patients in the control group (183 fractures) received systemic antibiotics only. Patients in the intervention group (168 fractures) received, in addition to systemic antibiotics, a locally administered aminoglycoside (2 mg/mL) at the time of the index surgical procedure. At the discretion of the attending surgeon, some wounds also received postoperative irrigations of aqueous aminoglycoside (n = 34). For wounds that could not be closed and wounds that received postoperative irrigations, negative pressure dressings were used. RESULTS The deep and superficial infection rate in the control group was 19.7% (thirty-six of 183 fractures), but it was significantly lower (p = 0.010) in the intervention group at 9.5% (sixteen of 168 fractures). When comparing only the deep infections, the infection rate in the control group was 14.2% (twenty-six of 183 fractures) compared with 6.0% (ten of 168 fractures) in the intervention group (p = 0.011). After multivariate analysis to adjust for possible confounding factors, the administration of local antibiotics was found to be an independent predictor of lower infection rates in both deep and superficial infections (odds ratio, 2.6 [95% confidence interval, 1.2 to 5.6]; p = 0.015) and deep infections only (odds ratio, 3.0 [95% confidence interval, 1.1 to 8.5]; p = 0.034). The use of local antibiotics did not have an impact on nonunion rate (p = 0.881), with a type-I error rate of α = 0.05 and 0.8 power. CONCLUSIONS This study suggests that local aqueous aminoglycoside administration as an adjunct to systemic antibiotics may be effective in lowering infection rates in open fractures; further research with higher-level research designs are needed.
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Affiliation(s)
- Cheryl Reese Lawing
- Department of Orthopaedics, The University of North Carolina at Chapel Hill, Campus Box 7055, Chapel Hill, NC 27599. E-mail address for C.R. Lawing: . E-mail address for L.E. Dahners:
| | - Feng-Chang Lin
- Department of Biostatistics, The University of North Carolina at Chapel Hill, 160 North Medical Drive, Brinkhous-Bullitt Building, 2nd Floor, Campus Box 7064, Chapel Hill, NC 27599
| | - Laurence E. Dahners
- Department of Orthopaedics, The University of North Carolina at Chapel Hill, Campus Box 7055, Chapel Hill, NC 27599. E-mail address for C.R. Lawing: . E-mail address for L.E. Dahners:
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