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Farrell MS, Agapian JV, Appelbaum RD, Filiberto DM, Gelbard R, Hoth J, Jawa R, Kirsch J, Kutcher ME, Nohra E, Pathak A, Paul J, Robinson B, Cuschieri J, Stein DM. Surgical and procedural antibiotic prophylaxis in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2024; 9:e001305. [PMID: 38835633 PMCID: PMC11149119 DOI: 10.1136/tsaco-2023-001305] [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: 11/03/2023] [Accepted: 04/11/2024] [Indexed: 06/06/2024] Open
Abstract
The use of prophylactic measures, including perioperative antibiotics, for the prevention of surgical site infections is a standard of care across surgical specialties. Unfortunately, the routine guidelines used for routine procedures do not always account for many of the factors encountered with urgent/emergent operations and critically ill or high-risk patients. This clinical consensus document created by the American Association for the Surgery of Trauma Critical Care Committee is one of a three-part series and reviews surgical and procedural antibiotic prophylaxis in the surgical intensive care unit. The purpose of this clinical consensus document is to provide practical recommendations, based on expert opinion, to assist intensive care providers with decision-making for surgical prophylaxis. We specifically evaluate the current state of periprocedural antibiotic management of external ventricular drains, orthopedic operations (closed and open fractures, silver dressings, local, antimicrobial adjuncts, spine surgery, subfascial drains), abdominal operations (bowel injury and open abdomen), and bedside procedures (thoracostomy tube, gastrostomy tube, tracheostomy).
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Affiliation(s)
| | | | - Rachel D Appelbaum
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dina M Filiberto
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rondi Gelbard
- Department of Surgery, University of Alabama at Birmingham Center for Health Promotion, Birmingham, Alabama, USA
| | - Jason Hoth
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Randeep Jawa
- Stony Brook University, Stony Brook, New York, USA
| | | | - Matthew E Kutcher
- Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Eden Nohra
- University of Colorado Boulder, Boulder, Colorado, USA
| | - Abhijit Pathak
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jasmeet Paul
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Bryce Robinson
- Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Joseph Cuschieri
- Surgery at ZSFG, University of California San Francisco, San Francisco, California, USA
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Hu Y, Yan A, Jiang F. Effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics for wound infections following major surgery for head and neck cancer: A meta-analysis. Int Wound J 2023; 20:4151-4158. [PMID: 37483017 PMCID: PMC10681415 DOI: 10.1111/iwj.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023] Open
Abstract
A meta-analysis examination was implemented to review the effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics (PAs) management for surgical site wound infections (SSWIs) following major surgery (MS) for head and neck cancer (H&NC). A comprehensive literature examination till May 2023 was done and 1296 interrelated examinations were reviewed. The six elected examinations, enclosed 4293 personals with MS for H&NC were in the utilized examinations' starting point, 1722 of them were utilizing Clindamycin, and 2571 were utilizing Ampicillin-Sulbactam. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequence of Clindamycin compared with Ampicillin-Sulbactam as PAs management for SSWIs following MS for H&NC by the dichotomous approach and a fixed or random model. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam (OR, 2.65; 95% CI, 1.40-5.02, p = 0.003) in personals with MS for H&NC. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam in personals with MS for H&NC. However, caution needs to be taken when interacting with its values because there was a low sample size of some of the chosen examinations and a low number of examinations found for the comparisons in the meta-analysis.
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Affiliation(s)
- Yue Hu
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Aihui Yan
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Feifei Jiang
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
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Mestrallet P, Yanni A, Roman A, Rodriguez A, Bouland C, Javadian R, Konopnicki D, Dequanter D. Antibiotic Use in Patients Undergoing Complex Clean-Contaminated Head and Neck Surgery: A Prospective Study. J Int Soc Prev Community Dent 2023; 13:349-355. [PMID: 37876581 PMCID: PMC10593369 DOI: 10.4103/jispcd.jispcd_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 10/26/2023] Open
Abstract
Aims and Objectives Oncological surgery of the upper aerodigestive tract is a complex procedure and often includes neck dissection and flap reconstruction. It can be complicated by severe surgical site infection (SSI) leading to flap necrosis, delayed wound healing, and increasing mortality and morbidity. The purpose of this study is to perform a systematic descriptive analysis and to evaluate the effect of our adapted antibiotic regimen strategy on postoperative outcomes. Materials and Methods A prospective cohort analysis of 47 patients undergoing major clean-contaminated head and neck surgery was conducted at the Cervicomaxillofacial Surgery Department (Saint-Pierre Hospital), between 2019 and 2022. The patients were divided into two groups: group I, which received a short-term postoperative antibiotic regimen for 24 h, and group II, which received a more extended postoperative antibiotic course for more than 24 h. Antibioprophylaxy amoxicillin and clavulanate were administered intravenously 30-60 min before making the incision. The antibiotic regimen was continued after surgery. The prognostic significance of the antibiotic regimen on postoperative outcomes, including clinical signs of infection and biological markers such as white blood cells count, and C-reactive protein levels was evaluated using univariate analysis. Results Eighteen patients developed SSIs. All of these infections were grade 2 and were treated with antibiotics. After univariate analysis, only a history of hypothyroidism seems to be a predictor of SSI (P = 0.038). No significant difference was found in terms of onset and hospital stay when we compared the patients who received antibiotics for 24 h or more. Moreover, the rate of multidrug-resistant bacteria was not different in both groups. Conclusions Our results suggest that postoperative antibiotics for more than 24 h do not confer benefit in terms of SSI. Oncological patients undergoing complex clean-contaminated head and neck surgery are often suffering from infectious complications and, despite the absence of guidelines, practicians should consider these findings in their decision-making.
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Affiliation(s)
- Pierre Mestrallet
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine Yanni
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Roman
- Department of Intensive Care, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngolology-Head & Neck Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Cyril Bouland
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Rokneddine Javadian
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Deborah Konopnicki
- Department of Infectious Diseases, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Didier Dequanter
- Department of Stomatology-Maxillofacial Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Otolaryngolology-Head & Neck Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Liu MY, Challa M, McCoul ED, Chen PG. Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis. Laryngoscope 2022; 133:1086-1091. [PMID: 35904127 DOI: 10.1002/lary.30329] [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: 04/04/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery. METHODS A break-even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR. RESULTS Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability. CONCLUSION In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery. LEVEL OF EVIDENCE N/A Laryngoscope, 2022.
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Affiliation(s)
- Matthew Y Liu
- Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Megana Challa
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Philip G Chen
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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