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Rodríguez-Fernández M, Trigo-Rodríguez M, Martínez-Baena D, Herrero R, Espíndola-Gómez R, Martínez Pérez-Crespo P, Vela AG, Torres E, García AIA, León EM, Corzo-Delgado JE, Parra-Membrives P, Merchante N. Role of rectal colonization by third-generation cephalosporin-resistant Enterobacterales on the risk of surgical site infection after hepato-pancreato-biliary surgery. Microbiol Spectr 2024:e0087824. [PMID: 39315789 DOI: 10.1128/spectrum.00878-24] [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: 06/07/2024] [Accepted: 08/01/2024] [Indexed: 09/25/2024] Open
Abstract
The impact of third-generation cephalosporin-resistant Enterobacterales (3GCR-E) rectal colonization in the development of subsequent infection after surgery is controversial. In particular, there is a lack of data in the context of hepato-pancreato-biliary (HPB) surgery. The objective of this study was to assess the prevalence of 3GCR-E intestinal carriage among patients undergoing elective HPB resection surgery and its impact on the incidence and etiology of surgical site infections (SSIs). This retrospective cohort study (January 2016-December 2022) was performed at Valme University Hospital (Seville, Spain). The inclusion criteria included (i) 18 years of age or older, (ii) undergoing elective HPB resection surgery, and (iii) availability of a periprocedural surveillance rectal swab culture to detect 3GCR-E. The prevalence of 3GCR-E intestinal carriage at elective HPB resection surgery was assessed, as well as SSI incidence at 30 days and possible associated factors. Two hundred nine patients were included. Eleven (5.3%) patients were colonized by 3GCR-E at baseline. According to 3GCR-E carriage status, 6 (55%) of the carriers developed SSI, whereas this occurred in 50 (25%) of non-carriers (P = 0.033). Likewise, the rates of SSI caused specifically by 3GCR-E were 83% (5 of 6) in 3GCR-E carriers and 6% (3 of 50) in non-carriers (P < 0.001). After multivariate analyses, 3GCR-E colonization at the time of surgery was identified as an independent predictor for developing SSI (adjusted odds ratio 4.63, 95% confidence interval: 1.177-18.232, P = 0.028). Despite a low prevalence of 3GCR-E intestinal carriage at surgery, 3GCR-E rectal colonization is associated with a higher risk of SSI among patients undergoing elective HPB resection surgery, with most SSIs being caused by the colonizing bacteria. IMPORTANCE In this Spanish retrospective cohort study, previous 3GCR-E rectal colonization was associated with a higher risk of SSI after hepato-pancreato-biliary resection surgeries. Most of SSIs were caused by the colonizing bacteria, suggesting a rationale for adapted perioperative antibiotic prophylaxis in known 3GCR-E colonized patients.
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Affiliation(s)
- Miguel Rodríguez-Fernández
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Marta Trigo-Rodríguez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Darío Martínez-Baena
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General, Hospital Universitario de Valme, Sevilla, Spain
| | - Rocío Herrero
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Reinaldo Espíndola-Gómez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Pedro Martínez Pérez-Crespo
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Alberto Gallego Vela
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General, Hospital Universitario de Valme, Sevilla, Spain
| | - Eva Torres
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Ana Isabel Aller García
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Eva M León
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Juan E Corzo-Delgado
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
| | - Pablo Parra-Membrives
- Unidad de Cirugía Hepato-Bilio-Pancreática, Servicio de Cirugía General, Hospital Universitario de Valme, Sevilla, Spain
| | - Nicolás Merchante
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, Sevilla, Spain
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2
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Guisado-Gil AB, Gutiérrez-Urbón JM, Ribed-Sánchez A, Luque-Pardos S, Sánchez-Cadena A, Mejuto B, Jaramillo-Ruiz D, Peñalva G, Cisneros JM. Analysis of the appropriateness of antibiotic prophylaxis in surgical procedures in Spain. Protocol for the "ProA-Q" study. FARMACIA HOSPITALARIA 2023; 47:224-229. [PMID: 37296032 DOI: 10.1016/j.farma.2023.05.002] [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: 02/08/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 06/12/2023] Open
Abstract
Surgical antibiotic prophylaxis is one of the most useful measures to prevent surgical wound infection. OBJECTIVE The aim of this project is to evaluate the appropriateness of the use of antibiotic prophylaxis in surgical procedures performed in Spanish hospitals, both globally and according to the type of surgery performed. METHOD For this purpose, an observational, retrospective, cross-sectional and multicenter study has been designed to collect all the variables that allow the evaluation of the appropriateness of surgical antibiotic prophylaxis by comparing the prescribed treatment, the recommendations included in the local guidelines and the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology and the Spanish Association of Surgeons. Indication, choice of antimicrobial, dose, route and duration of administration, timing, re-dosing and duration of the prophylaxis will be taken into account. The sample will consist of patients who underwent scheduled or emergency surgery, either as inpatients or outpatients, in hospitals in Spain. A sample size of 2,335 patients has been established to estimate, with 95% confidence and 80% power, a percentage of appropriateness that is expected to be around 70%. Differences between variables will be analyzed using Student's t-test, Mann-Whitney U test, Chi-square test, or Fisher's test, as appropriate. The degree of agreement between the antibiotic prophylaxis recommended by the guidelines of the different hospitals and that recommended in the literature will be analyzed by calculating the Cohen's kappa indicator. Binary logistic regression analysis using generalized linear mixed models will be performed to identify possible factors associated with differences in the appropriateness of antibiotic prophylaxis. DISCUSSION The results of this clinical study will allow us to focus on specific surgical areas with higher rates of inappropriateness, identify key points of action and guide future strategies for antimicrobial stewardship programs in the area of antibiotic prophylaxis.
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Affiliation(s)
- Ana Belén Guisado-Gil
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, España
| | | | | | | | - Abraham Sánchez-Cadena
- Servicio de Farmacia, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Beatriz Mejuto
- Servicio de Farmacia, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Didiana Jaramillo-Ruiz
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, España; Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Sevilla, España.
| | - Germán Peñalva
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, España
| | - José Miguel Cisneros
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, España
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3
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Guisado-Gil AB, Gutiérrez-Urbón JM, Ribed-Sánchez A, Luque-Pardos S, Sánchez-Cadena A, Mejuto B, Jaramillo-Ruiz D, Peñalva G, Cisneros JM. [Translated article] Analysis of the appropriateness of antibiotic prophylaxis in surgical procedures in Spain. Protocol for the "ProA-Q" study. FARMACIA HOSPITALARIA 2023; 47:T224-T229. [PMID: 37658007 DOI: 10.1016/j.farma.2023.07.003] [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: 02/08/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 09/03/2023] Open
Abstract
Surgical antibiotic prophylaxis is one of the most useful measures to prevent surgical wound infection. OBJECTIVE The aim of this project is to evaluate the appropriateness of the use of antibiotic prophylaxis in surgical procedures performed in Spanish hospitals, both globally and according to the type of surgery performed. METHOD For this purpose, an observational, retrospective, cross-sectional, and multicentre study has been designed to collect all the variables that allow the evaluation of the appropriateness of surgical antibiotic prophylaxis by comparing the prescribed treatment, the recommendations included in the local guidelines, and the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology and the Spanish Association of Surgeons. Indication, choice of antimicrobial, dose, route and duration of administration, timing, re-dosing, and duration of the prophylaxis will be taken into account. The sample will consist of patients who underwent scheduled or emergency surgery, either as inpatients or outpatients, in hospitals in Spain. A sample size of 2335 patients has been established to estimate, with 95% confidence and 80% power, a percentage of appropriateness that is expected to be around 70%. Differences between variables will be analysed using Student's t-test, Mann-Whitney U test, Chi-square test, or Fisher's test, as appropriate. The degree of agreement between the antibiotic prophylaxis recommended by the guidelines of the different hospitals and that recommended in the literature will be analysed by calculating the Cohen's kappa indicator. Binary logistic regression analysis using generalised linear mixed models will be performed to identify possible factors associated with differences in the appropriateness of antibiotic prophylaxis. DISCUSSION The results of this clinical study will allow us to focus on specific surgical areas with higher rates of inappropriateness, identify key points of action and guide future strategies for antimicrobial stewardship programs in the area of antibiotic prophylaxis.
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Affiliation(s)
- Ana Belén Guisado-Gil
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | | | | | | | - Beatriz Mejuto
- Servicio de Farmacia, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Didiana Jaramillo-Ruiz
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Sevilla, Spain.
| | - Germán Peñalva
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - José Miguel Cisneros
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Matos JAD, Gomes ADS, Lima COGX, Schmaltz CAS, Oliveira CRD, Silva GMD, Carijó JH, Lopes MA, Morais QCD, Brasil PEAAD. Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli. Braz J Infect Dis 2022; 26:102705. [PMID: 36228664 PMCID: PMC9597116 DOI: 10.1016/j.bjid.2022.102705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/29/2022] [Accepted: 09/17/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI. METHODS We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software. RESULTS A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate). CONCLUSIONS There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.
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Affiliation(s)
- Juliana Arruda de Matos
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa em Imunização e Vigilância em Saúde, Rio de Janeiro, RJ, Brazil.
| | - Amanda da Silva Gomes
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil
| | | | - Carolina Arana Stanis Schmaltz
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica em Micobacterioses, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Marilena Aguiar Lopes
- Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, Rio de Janeiro, RJ, Brazil
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Hinojosa Arco LC, Roldán de la Rua JF, Carranque Chaves GÁ, Mora Navas L, de Luna Díaz R, Suárez Muñoz MÁ. Intraoperative gram staining of bile for the prevention of infectious complications in pancreaticoduodenectomy. Cir Esp 2022; 100:472-480. [PMID: 35584762 DOI: 10.1016/j.cireng.2022.05.015] [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: 12/08/2020] [Accepted: 05/14/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Infectious complications play a prominent role in pancreaticoduodenectomy. Their incidence increases in cases with preoperative biliary drainage (PBD), due to the higher risk of bacterobilia. The aim of this study is to evaluate an antibiotherapy protocol based on intraoperative gram staining of bile and its impact on postoperative infectious complications. METHODS A retrospective study analysing the incidence of infectious complications between two groups of 25 consecutive patients undergoing pancreaticoduodenectomy. In group 1, cefazolin prophylaxis was administered to patients without PBD. In cases with PBD a five days antibiotherapy with piperacillin-tazobactam was administered. In group 2, intraoperative gram staining of bile was routinely performed. If no microorganisms were detected, antibiotherapy was limited to cefazolin prophylaxis. If bacterobilia was detected, targeted antibiotherapy was administered for five days. RESULTS The incidence of sepsis and organ/space infection in group 2 was 4% compared to 32% and 24% in group 1 respectively (p < 0.05). No differences were observed in the remaining morbimortality variables. The most prevalent microorganisms in bile were Enterococcus spp. and Klebsiella spp. In postoperative samples, they only appeared in 4% of cases in group 2 (p < 0.05), in favour of S. epidermidis, although they were also prevalent in group 1 (28 and 24% respectively). CONCLUSION Intraoperative gram staining of bile fluid could be a useful tool to conduct personalised antibiotic therapy in pancreaticoduodenectomy and contribute to the control of infectious complications.
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Affiliation(s)
| | | | | | - Laura Mora Navas
- Servicio de Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - Resi de Luna Díaz
- Servicio de Cirugía General y Digestiva, Hospital Virgen de la Victoria, Málaga, Spain
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6
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Hinojosa Arco LC, Roldán de la Rua JF, Carranque Chaves GÁ, Mora Navas L, de Luna Díaz R, Suárez Muñoz MÁ. Intraoperative gram staining of bile for the prevention of infectious complications in pancreaticoduodenectomy. Cir Esp 2021; 100:S0009-739X(21)00181-0. [PMID: 34154833 DOI: 10.1016/j.ciresp.2021.05.004] [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: 12/08/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Infectious complications play a prominent role in pancreaticoduodenectomy. Their incidence increases in cases with preoperative biliary drainage (PBD), due to the higher risk of bacterobilia. The aim of this study is to evaluate an antibiotherapy protocol based on intraoperative gram staining of bile and its impact on postoperative infectious complications. METHODS A retrospective study analysing the incidence of infectious complications between two groups of 25 consecutive patients undergoing pancreaticoduodenectomy. In group 1, cefazolin prophylaxis was administered to patients without PBD. In cases with PBD a five days antibiotherapy with piperacillin-tazobactam was administered. In group 2, intraoperative gram staining of bile was routinely performed. If no microorganisms were detected, antibiotherapy was limited to cefazolin prophylaxis. If bacterobilia was detected, targeted antibiotherapy was administered for five days. RESULTS The incidence of sepsis and organ/space infection in group 2 was 4% compared to 32% and 24% in group 1 respectively (p<0.05). No differences were observed in the remaining morbimortality variables. The most prevalent microorganisms in bile were Enterococcus spp and Klebsiella spp. In postoperative samples, they only appeared in 4% of cases in group 2 (p<0.05), in favour of S. epidermidis, although they were also prevalent in group 1 (28 and 24% respectively). CONCLUSION Intraoperative gram staining of bile fluid could be a useful tool to conduct personalised antibiotic therapy in pancreaticoduodenectomy and contribute to the control of infectious complications.
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Affiliation(s)
| | | | | | - Laura Mora Navas
- Servicio de Microbiología, Hospital Virgen de la Victoria, Málaga, España
| | - Resi de Luna Díaz
- Servicio de Cirugía General y Digestiva, Hospital Virgen de la Victoria, Málaga, España
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7
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Repply to «Antibiotic prophylaxis in inguinal hernia surgery». Enferm Infecc Microbiol Clin 2021. [PMID: 34030904 DOI: 10.1016/j.eimc.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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8
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Fernández-Roldán C, Turiño-Luque JD. Antibiotic prophylaxis in inguinal hernia surgery. ACTA ACUST UNITED AC 2021; 39:365-366. [PMID: 34353521 DOI: 10.1016/j.eimce.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Concepción Fernández-Roldán
- Microbiología y Parasitología Clínica, Especialista en Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Jesús Damián Turiño-Luque
- Microbiología y Parasitología Clínica, Especialista en Cirugía General y Aparato Digestivo, Unidad de Cirugía Mayor Ambulatoria y Corta Estancia, Hospital Regional Universitario de Málaga, Málaga, Spain.
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Del Toro-López MD, Badía-Pérez JM. Reply to "Antibiotic prophylaxis in inguinal hernia surgery". ACTA ACUST UNITED AC 2021; 39:366-367. [PMID: 34353522 DOI: 10.1016/j.eimce.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Affiliation(s)
- María Dolores Del Toro-López
- Unidad Clínica de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla, Sevilla, Spain.
| | - Josep María Badía-Pérez
- Servicio de Cirugía General, Hospital General de Granollers, Universitat Internacional de Catalunya, Catalunya, Spain
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10
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Fernández-Roldán C, Turiño-Luque JD. Antibiotic prophylaxis in inguinal hernia surgery. Enferm Infecc Microbiol Clin 2021. [PMID: 33865635 DOI: 10.1016/j.eimc.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Concepción Fernández-Roldán
- Microbiología y Parasitología Clínica. Especialista en Medicina Interna. Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Jesús Damián Turiño-Luque
- Microbiología y Parasitología Clínica. Especialista en Cirugía General y Aparato Digestivo. Unidad de Cirugía Mayor Ambulatoria y Corta Estancia. Hospital Regional Universitario de Málaga, Málaga, España.
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