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Dropkin BM, Kaufman MR. Antibiotics and Inflatable Penile Prosthesis Insertion: A Literature Review. Sex Med Rev 2020; 9:174-180. [PMID: 32631811 DOI: 10.1016/j.sxmr.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Antibiotic stewardship is now a priority for the urologic community. Perioperative antibiotic use at the time of inflatable penile prosthesis (IPP) insertion has become a topic of interest. OBJECTIVES To review the literature available to inform the practice of antibiotic administration before, during, and after IPP insertion. METHODS We performed a literature review based on a search for the terms "Antibiotics" and "Penile Prosthesis" in the PubMed database. Manuscripts were individually reviewed for relevance to the administration of antibiotics in conjunction with IPP insertion. Best practice statements and guidelines from stakeholder organizations were also reviewed. RESULTS The benefits of preoperative antibiotic prophylaxis have been well studied in the orthopedic and general surgery literature, but a dearth of studies are available in the specific context of IPP insertion. High-quality retrospective studies have demonstrated reduced infection rates with the use of antibiotic-impregnated or antibiotic-coated IPPs. Limited research on the use of postoperative antibiotics after IPP insertion has actually not demonstrated a benefit from this very common practice. Indeed, the broader surgical literature suggests a net harm from continued postoperative antibiosis. A 2017 guideline recommendation from the Center for Disease Control and Prevention states that additional prophylactic antibiotics should not be administered after procedures deemed clean or clean-contaminated. CONCLUSION The benefits of single-dose preoperative antibiotics and the use of antibiotic-impregnated or antibiotic-coated IPPs are well established. Postoperatively, the available IPP and broader surgical literature does not reflect a benefit from the administration of additional antibiotics and demonstrates higher rates of antibiotic-associated adverse events and the emergence of drug resistance. In average-risk patients undergoing IPP insertion, contemporary data suggest that it is safe for postoperative antibiotics to be withheld. Dropkin BM, Kaufman MR. Antibiotics and Inflatable Penile Prosthesis Insertion: A Literature Review. Sex Med 2021;9:174-180.
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Affiliation(s)
- Benjamin M Dropkin
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Melissa R Kaufman
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Krispinsky AJ, Shedlofsky LB, Kaffenberger BH. The frequency of low‐risk morbilliform drug eruptions observed in patients treated with different classes of antibiotics. Int J Dermatol 2019; 59:647-655. [DOI: 10.1111/ijd.14703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Andrew J. Krispinsky
- Division of Dermatology Department of Internal Medicine The Ohio State University Columbus OH USA
| | | | - Benjamin H. Kaffenberger
- Division of Dermatology Department of Internal Medicine The Ohio State University Columbus OH USA
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3
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Martinez E, Sahni S, Cheema MA, Iftikhar A. Vancomycin-induced coronary artery spasm: a case of Kounis syndrome. BMJ Case Rep 2018; 2018:bcr-2017-222846. [PMID: 29348285 DOI: 10.1136/bcr-2017-222846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Kounis syndrome defined as the appearance of acute coronary syndrome in the context of an allergic reaction is a relatively rare phenomenon. There are three variants of this syndrome in which the patient presents with symptoms of an acute chest. Herein, we describe a case of an 83-year-old woman who demonstrated type I variant of Kounis syndrome in response to vancomycin administration. After initialisation of vancomycin, she became unresponsive and an ECG demonstrated ST changes consistent with inferior-lateral myocardial infarction. Once allergic stimulus was removed, ECG normalised. Differential diagnosis includes, myocardial infarctions, angina as well as intravascular stent thrombosis, which must all be ruled out. The patient was monitored and discharged soon thereafter.
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Affiliation(s)
- Eric Martinez
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, USA
| | - Sonu Sahni
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, USA
| | - Muhammad Ai Cheema
- Department of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital Queens, New York, USA
| | - Asma Iftikhar
- Department of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital Queens, New York, USA
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4
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Cook DJ, Barbara DW, Singh KE, Dearani JA. Penicillin skin testing in cardiac surgery. J Thorac Cardiovasc Surg 2014; 147:1931-5. [PMID: 24530197 DOI: 10.1016/j.jtcvs.2014.01.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/31/2013] [Accepted: 01/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Penicillin is the most commonly reported allergy in cardiac surgical patients and a history of penicillin allergy frequently results in the use of vancomycin for antibiotic prophylaxis. However, clinical history is unreliable and true allergy is rare. Penicillin allergy testing has the potential to reduce vancomycin use and indirectly the potential for selection of vancomycin-resistant organisms, a national priority. METHODS After the publication of the 2007 Society of Thoracic Surgeons practice guideline report, we initiated a penicillin allergy testing service for cardiac surgical patients in 2009. We sought to determine the true incidence of penicillin allergy in the tested population, whether testing availability reduced vancomycin use in those tested, and if vancomycin use was reduced in the entire cardiac surgical population as a whole. RESULTS A total of 276 patients were skin tested for allergy to penicillin or cephalosporin. Testing recommended no penicillin use in 13.8% of those tested giving a true penicillin allergy incidence of 0.9%. Only 24 of the 276 patients tested (9%) received vancomycin. However, given the small percentage of the total population that underwent allergy testing, the overall use of vancomycin in the cardiac surgery practice was not reduced in the posttesting period. CONCLUSIONS The true rate of contraindication to penicillin in a cardiac surgical population is very low. Penicillin allergy testing can reduce vancomycin use in the tested population, but better means of conducting the testing and making the results available are necessary to reduce unnecessary vancomycin use in a broader cardiac surgical population.
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Affiliation(s)
- David J Cook
- Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minn.
| | - David W Barbara
- Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minn
| | - Karen E Singh
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Va
| | - Joseph A Dearani
- Department of Surgery, College of Medicine, Mayo Clinic, Rochester, Minn
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Hsieh MH, Wildenfels P, Gonzales ET. Surgical antibiotic practices among pediatric urologists in the United States. J Pediatr Urol 2011; 7:192-7. [PMID: 20537590 DOI: 10.1016/j.jpurol.2010.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 05/04/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE We hypothesized that there are practice variations in the use of surgical antibiotics by pediatric urologists in the United States. MATERIALS AND METHODS A 31-question online survey was distributed to members of the Society of Pediatric Urology. The questionnaire examined physician preferences for surgical antibiotic use, including indications, antibiotic selection, timing of administration, and duration. RESULTS 189 pediatric urologists responded to the survey. >85% of responders give antibiotics before open pyeloplasty, after hypospadias repair (when a urethral catheter is left in place), or perioperative or postoperative antibiotics for open neoureterocystostomy or bladder reconstructive surgery. >90% of responders do not give postoperative antibiotics to children who have undergone circumcisions, simple chordee repairs, herniorrhapies, or hydrocelectomies. For all other open, laparoscopic, and endoscopic operations, use of antibiotics varied significantly. Diverse opinions exist regarding antibiotic use, including the importance of costs, potential adverse reactions, reduction in infection risk, and antibiotic resistance. There are major differences in gentamicin dosing and timing of administration of perioperative antibiotics. CONCLUSIONS Perioperative and postoperative antibiotics are widely used by pediatric urologists. However, there is significant practice variation in surgical antibiotic administration with regards to most areas of pediatric urology, in particular laparoscopic, endoscopic and hypospadias surgery.
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Affiliation(s)
- Michael H Hsieh
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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6
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Post-mortem diagnosis of anaphylaxis: A difficult task in forensic medicine. Forensic Sci Int 2010; 204:1-5. [PMID: 20684869 DOI: 10.1016/j.forsciint.2010.04.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/23/2010] [Accepted: 04/25/2010] [Indexed: 12/21/2022]
Abstract
The lack of reliable laboratory biomarkers and common standard definitions of signs and symptoms represents the main problem for clinicians when a suspected anaphylactic event must be diagnosed, while a post-mortem diagnosis of anaphylaxis is often a very difficult task in forensic medicine. Significant necroscopic signs as well as the data reported from witnesses or medical records may be absent, biological fluids as blood or urine may be unavailable or under thanatological modifications. The aim of this review is to focus on the diagnostic difficulties with which coroners and forensic pathologists have to cope when a confirmation of anaphylactic death is required by judicial authorities. Investigation methods for a prudent forensic diagnosis of anaphylactic death as well as the need of new potential laboratory or histological investigation techniques coming from immunological research are discussed too.
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Woods B, Sladen R. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth 2009; 103 Suppl 1:i57-65. [DOI: 10.1093/bja/aep271] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Engelman R, Shahian D, Shemin R, Guy TS, Bratzler D, Edwards F, Jacobs M, Fernando H, Bridges C. The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part II: Antibiotic choice. Ann Thorac Surg 2007; 83:1569-76. [PMID: 17383396 DOI: 10.1016/j.athoracsur.2006.09.046] [Citation(s) in RCA: 253] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 09/02/2006] [Accepted: 09/14/2006] [Indexed: 12/31/2022]
Affiliation(s)
- Richard Engelman
- Baystate Medical Center, Division of Cardiac Surgery, 759 Chestnut St, Springfield, MA 01199, USA.
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10
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Alphonso N, Anagnostopoulos PV, Scarpace S, Weintrub P, Azakie A, Raff G, Karl TR. Perioperative antibiotic prophylaxis in paediatric cardiac surgery. Cardiol Young 2007; 17:12-25. [PMID: 17244387 DOI: 10.1017/s1047951107000066] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2006] [Indexed: 11/05/2022]
Affiliation(s)
- Nelson Alphonso
- Paediatric Heart Center, University of California San Francisco Children's Hospital, San Francisco, California 94143-0117, USA
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11
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Movahed MR, Kasravi B, Bryan CS. Prophylactic use of vancomycin in adult cardiology and cardiac surgery. J Cardiovasc Pharmacol Ther 2004; 9:13-20. [PMID: 15094964 DOI: 10.1177/107424840400900i103] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The recent appearance of Staphylococcus aureus and Staphylococcus epidermidis strains that have reduced susceptibility to vancomycin, and the spread of vancomycin-resistant enterococci, raise the specter of endovascular infections that will be difficult or impossible to cure with available drugs. We review issues concerning the prophylactic use of vancomycin in adult cardiology and cardiac surgery with special attention to dosing and indications. There is no indication for the routine use of prophylactic vancomycin in pacemaker implantations, cardiac catheterization, and transesophageal echocardiography. In institutions with a high incidence of methicillin-resistant S. aureus and S. epidermidis, vancomycin may be used for antibiotic prophylaxis in place of cephalosporins for pacemaker or defibrillator implantation. The strongest evidence in support of the prophylactic use of vancomycin is during cardiac surgeries, particularly valvular surgeries in institutions with a high prevalence of methicillin-resistant S. aureus and S. epidermidis. When vancomycin is used prior to open heart surgery, the dose should be 15 mg/kg rather than the standard 1 g dose that is often recommended in the literature and used by 85% of institutional pharmacists who responded to our survey. Cardiologists and cardiac surgeons should assume leadership roles in promoting its responsible use.
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Affiliation(s)
- Mohammad-Reza Movahed
- Department of Medicine, Division of Cardiology, University of California-Irvine Medical Center, Building 53, Route 81, Room 100, 101 The City Drive South, Orange, CA 92868-4080, USA.
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12
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Helou S, Bastien O, Vandenesch F, Ninet J, Lehot JJ. [Antibiotic prophylaxis in cardiac surgery: practice patterns]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21:241-4. [PMID: 11963391 DOI: 10.1016/s0750-7658(02)00577-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the prescription patterns in French and foreign centres for antibiotic prophylaxis in cardiac surgery. MATERIAL AND METHODS Phone and written surveys concerned 64 French and 70 foreign centres. It focused on the first injection, the duration of treatment and the recommended agents. RESULTS 87% of the French centres and 67% of the foreign centres answered the questionnaire. The first injection took place at anaesthesia induction in all French centres but during administration of premedication in 11% of foreign centres (p < 0.05). The duration of prophylaxis was restricted to the intraoperative period only in 20% and 15% of centres, respectively (ns), as specified by the recommendations. No French centres carried on the antibiotics more than 48 h versus 11% of foreign centres (p < 0.05). Cephalosporines of the second generation were prescribed in 84 and 49% of centres, respectively (p < 0.05). The combination of two antibiotics was less frequent in France than in foreign countries (5 versus 17%, p < 0.01). In absence of betalactamin allergy glycopeptides were not utilized in France versus 8% in foreign countries (p < 0.05). In case of allergy vancomycin was used in 66% of French and 42% of foreign centres. CONCLUSION The French recommendations may have influenced favourably the antibiotic choice but the prophylaxis duration was too long in most of the non French European centres.
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Affiliation(s)
- S Helou
- Service d'anesthésie-réanimation, hôpital cardiovasculaire et pneumologique Louis Pradel, BP Lyon Montchat, 69394 Lyon, France
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13
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Bertolissi M, Bassi F, Cecotti R, Capelli C, Giordano F. Pruritus: a useful sign for predicting the haemodynamic changes that occur following administration of vancomycin. Crit Care 2002; 6:234-9. [PMID: 12133184 PMCID: PMC125312 DOI: 10.1186/cc1495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2002] [Accepted: 04/03/2002] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the haemodynamic changes that follow the appearance of pruritus during vancomycin administration. METHODS We studied 50 patients scheduled for coronary artery bypass surgery, and we compared data from patients who exhibited pruritus with those from patients who did not. After the monitoring devices had been positioned, vancomycin (15 mg/kg) was continuously infused at a constant rate over 30 min, before induction of anaesthesia. Haemodynamic profiles were recorded before vancomycin infusion (time point 1); at 15 (time point 2) and 30 min (time point 3) after the beginning of vancomycin infusion; and 15 min after vancomycin infusion had been stopped (time point 4). At each time arterial and mixed venous blood samples were drawn to calculate the shunt fraction (Qsp/Qt). RESULTS In patients who exhibited pruritus (group A, n = 17) at time point 3 versus time point 1, systemic vascular resistance index (SVRI) and arterial oxygen tension (PaO2) decreased significantly; cardiac index (CI), stroke volume index (SVI) and Qsp/Qt increased significantly; and mean systemic pressure and heart rate were stable. Those changes were observed only in patients not treated with a beta-blocker before surgery, whereas no change occurred in patients treated with the drug. In the patients who were free from pruritus (group B, n = 28), we did not observe any significant change. CONCLUSION The appearance of pruritus during vancomycin administration indicates that SVRI is declining, thus exposing the patient to risk for hypotension. Therapy with a beta-blocker appears to confer protection against this hemodynamic reaction.
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Affiliation(s)
- Massimo Bertolissi
- Second Department of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera, S, Maria della Misericordia, Udine, Italy.
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Whitworth JM, Thomas I, Peltz SA, Sullivan BC, Wolf AH, Cytryn AS. Vancomycin-induced linear IgA bullous dermatosis (LABD). J Am Acad Dermatol 1996; 34:890-1. [PMID: 8621822 DOI: 10.1016/s0190-9622(96)90073-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report the eleventh case of vancomycin-induced linear IgA disease. Our case is unusual because symptoms developed within minutes of administration of the drug. We discuss the pathogenesis and review the literature.
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Affiliation(s)
- J M Whitworth
- Dermatology Service, University of Medicine and Dentistry of New Jersey, Newark, USA
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15
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Rosenberg JM, Wahr JA, Smith KA. Effect of vancomycin infusion on cardiac function in patients scheduled for cardiac operation. J Thorac Cardiovasc Surg 1995; 109:561-4. [PMID: 7877319 DOI: 10.1016/s0022-5223(95)70289-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patients scheduled for cardiac operation often receive vancomycin before the operation to decrease postoperative staphylococcal wound infections. In animal studies, vancomycin depressed cardiac function approximately 15%. Because of the potentially serious consequences of myocardial depression in patients undergoing cardiac operation, we examined the effect of vancomycin infusion on cardiac hemodynamics in patients scheduled for cardiac operation. Patients who were scheduled for cardiac operation and vancomycin prophylaxis were enrolled in our study. After baseline cardiac output, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure were measured, 1 gm of vancomycin HCl was infused over 1 hour. Cardiac output, mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure were measured at 15, 30, 60, 90, and 120 minutes after the start of the infusion. In the 46 patients that completed the study, no significant change was observed in cardiac output or systemic vascular resistance at any time when compared with baseline. Mean arterial pressure increased significantly (p = 0.03) between baseline (90.8 +/- 2.4 standard error of mean) and 90 minutes (94.1 +/- 2.4 standard error of mean). One patient had a transient 30% fall in mean arterial pressure and systemic vascular resistance with facial flushing during the infusion. In conclusion, we found that vancomycin infusion over 1 hour in patients before cardiac operation is safe and not associated with cardiac depression.
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Affiliation(s)
- J M Rosenberg
- Department of Anesthesiology, University of Michigan Hospitals, Ann Arbor 48109-0048
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Raoult D, Lévy PY. [The role of new molecules in surgical antibiotic prophylaxis]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1994; 13:S173-8. [PMID: 7778807 DOI: 10.1016/s0750-7658(05)81795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The preoperative administration of a new antibiotic for antimicrobial prophylaxis is questionable because of the methodological difficulties to demonstrate its efficiency and benefits in decreasing the postoperative infectious complications. As their rate is very low, especially in clean surgery, the number of patients to be included in a comparative trial is very high. Most studies assessed only small groups and therefore any extrapolation for clinical practice is of limited value. Because of their therapeutic efficiency the fluoroquinolones are often recommended for antimicrobial prophylaxis. However, the rapid occurrence of resistances, directly related to their prescription should invite the prescribers to be cautions. They should be contra-indicated as long as an alternative of similar efficiency is existing, in case of bacteraemia, when an administration of more than 48 hours in required or when the intra-hospital resistance rate exceeds 10 p. 100.
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Affiliation(s)
- D Raoult
- Laboratoire de Bactériologie, CHU La Timone, Marseille
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Lehot JJ, Celard M, Etienne J, Brun Y, Bastien O, Fleurette J, Estanove S. [Antibiotic prophylaxis in heart surgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1994; 13:S78-87. [PMID: 7778817 DOI: 10.1016/s0750-7658(05)81780-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Cardiac surgery enters mainly into the class I of Altemeier ("clean surgery"). However, many factors may explain an intraoperative contamination: surgery of long duration, extra-corporeal circulation, aspiration of blood and air, immunodepression...). In fact, the infectious risk decreases from about 25% with placebo to 5% with prophylactic antibiotics. The staphylococcal infections are the most frequent (mediastinitis, endocarditis, parietal infections...). Cephalosporins, particularly of second-generation type (cefamandole, cefuroxime), perform better than antistaphylococcal penicillins. The combination with an amino-side may be used when Gram negative bacilli infection prevalence is high. Vancomycin is efficient but hypotension and renal impairment have been reported. Therefore, vancomycin is used in patients allergic to cephalosporins, when a high prevalence of methicillin-resistant Staphylococcus or enterococci infections is reported, or when the patient has recently received broad-spectrum antimicrobial therapy. The antibiotic doses must take into account the haemodilution due to extracorporeal circulation and the necessity to obtain sufficient serum concentrations throughout surgery. A prophylaxis of more than 48 hours is not associated with an improved outcome. In cardiac transplantation a prophylaxis is essential, but is still questioned during the insertion of pace-markers. In any case, the antibiotic prophylaxis must take into account the bacterial prevalence of each institution.
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Affiliation(s)
- J J Lehot
- Département d'Anesthésie-Réanimation, Hôpital Cardiovasculaire Louis-Pradel, BP Lyon-Montchat
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Baraka A, Taha S, Bijjani A, Arab W, Meshefedjian G. Administration of vancomycin during cardiopulmonary bypass. Anaesthesia 1992; 47:1086-7. [PMID: 1489041 DOI: 10.1111/j.1365-2044.1992.tb04213.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Vancomycin was given during cardiopulmonary bypass to 12 anaesthetised patients undergoing open heart surgery. Injection of vancomycin 1 g within 60 s via the venous inlet of the oxygenator resulted in a moderate and transient decrease of mean arterial pressure. This minimal reaction may be attributed to dilution of vancomycin by the extracorporeal circuit volume, to the bypassing of the lungs which are a major site of storage of vasoactive substances, or to the maintenance of adequate perfusion flow during cardiopulmonary bypass. The results suggest that the haemodynamic adverse reactions to vancomycin, given as antibiotic prophylaxis, may be decreased by its administration after initiation of cardiopulmonary bypass.
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Affiliation(s)
- A Baraka
- Department of Anesthesiology, American University of Beirut, Lebanon
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