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Unterfrauner I, Bragatto-Hess N, Studhalter T, Farshad M, Uçkay I. General skin and nasal decolonization with octenisan® set before and after elective orthopedic surgery in selected patients at elevated risk for revision surgery and surgical site infections-a single-center, unblinded, superiority, randomized controlled trial (BALGDEC trial). Trials 2024; 25:461. [PMID: 38978089 PMCID: PMC11229206 DOI: 10.1186/s13063-024-08173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/05/2023] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The preoperative body surface and nasal decolonization may reduce the risk of surgical site infections (SSI) but yields conflicting results in the current orthopedic literature. METHODS We perform a single-center, randomized-controlled, superiority trial in favor of the preoperative decolonization using a commercial product (octenidine® set). We will randomize a total number of 1000 adult elective orthopedic patients with a high risk for SSI and/or wound complications (age ≥ 80 years, chronic immune-suppression, American Society of Anesthesiologists score 3-4 points) between a decolonization (octenisan® wash lotion 1 × per day and octenisan® md nasal gel 2-3 × per day; during 5 days) and no decolonization. Decolonized patients will additionally fill a questionnaire regarding the practical difficulties, the completeness, and the adverse events of decolonization. The primary outcomes are SSI and revision surgeries for postoperative wound problems until 6 weeks postoperatively (or 1 year for surgeries with implants or bone). Secondary outcomes are unplanned revision surgeries for non-infectious problems and all adverse events. With 95% event-free surgeries in the decolonization arm versus 90% in the control arm, we formally need 2 × 474 elective orthopedic surgeries included during 2 years. DISCUSSION In selected adult orthopedic patients with a high risk for SSI, the presurgical decolonization may reduce postoperative wound problems, including SSI. TRIAL REGISTRATION ClinicalTrial.gov NCT05647252. Registered on 9 December 2022. PROTOCOL VERSION 2 (5 December 2022).
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Affiliation(s)
- Ines Unterfrauner
- Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Nadja Bragatto-Hess
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Studhalter
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- Medical Direction, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Ilker Uçkay
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Yadeta DA, Manyazewal T, Demessie DB, Kleive D. Incidence and predictors of postoperative complications in Sub-Saharan Africa: a systematic review and meta-analysis. FRONTIERS IN HEALTH SERVICES 2024; 4:1353788. [PMID: 38784705 PMCID: PMC11112115 DOI: 10.3389/frhs.2024.1353788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024]
Abstract
Background Postoperative complications remain a significant challenge, especially in settings where healthcare access and infrastructure disparities exacerbate. This systematic review and meta-analysis aimed to determine the pooled incidence and risk factors of postoperative complications among patients undergoing essential surgery in Sub-Saharan Africa (SSA). Method PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, and Google Scholar were searched from January 2010 to November 2022 for completed studies reporting the incidence and risk factors associated with postoperative complications among patients undergoing essential surgery in SSA. Severity of postoperative complications was ranked based on the Clavien-Dindo classification system, while risk factors were classified into three groups based on the Donabedian structure-process-outcome quality evaluation framework. Studies quality was appraised using the JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI), and data were analyzed using Comprehensive Meta-Analysis (CMA) software. The study protocol adhered to the PRISMA guidelines and was registered in PROSPERO (CRD42023414342). Results The meta-analysis included 19 studies (10 cohort and 9 cross-sectional) comprising a total of 24,136 patients. The pooled incidence of postoperative complications in SSA was 20.2% (95% CI: 18.7%-21.8%), with a substantial heterogeneity of incidence observed. The incidence varied from 14.6% to 27.5% based on the Clavien-Dindo classification. The random-effects model indicated significant heterogeneity among the studies (Q = 54.202, I = 66.791%, p < 0.001). Contributing factors to postoperative complications were: structure-related factors, which included the availability and accessibility of resources, as well as the quality of both the surgical facility and the hospital.; process-related factors, which encompassed surgical skills, adherence to protocols, evidence-based practices, and the quality of postoperative care; and patient outcome-related factors such as age, comorbidities, alcohol use, and overall patient health status. Conclusion The meta-analysis reveals a high frequency of postoperative complications in SSA, with noticeable discrepancies among the studies. The analysis highlights a range of factors, encompassing structural, procedural, and patient outcome-related aspects, that contribute to these complications. The findings underscore the necessity for targeted interventions aimed at reducing complications and improving the overall quality of surgical care in the region. Systematic Reviews Registration https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42023414342).
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Affiliation(s)
- Daniel Aboma Yadeta
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Dereje Bayissa Demessie
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Uçkay I, Bomberg H, Risch M, Müller D, Betz M, Farshad M. Broad-spectrum antibiotic prophylaxis in tumor and infected orthopedic surgery-the prospective-randomized, microbiologist-blinded, stratified, superiority trials: BAPTIST Trials. Trials 2024; 25:69. [PMID: 38243311 PMCID: PMC10799415 DOI: 10.1186/s13063-023-07605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/26/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The perioperative antibiotic prophylaxis with 1st or 2nd generation cephalosporins is evidence-based in orthopedic surgery. There are, however, situations with a high risk of prophylaxis-resistant surgical site infections (SSI). METHODS We perform a superiority randomized controlled trial with a 10% margin and a power of 90% in favor of the broad-spectrum prophylaxis. We will randomize orthopedic interventions with a high risk for SSI due to selection of resistant pathogens (open fractures, surgery under therapeutic antibiotics, orthopedic tumor surgery, spine surgery with American Society of Anesthesiologists (ASA) score ≥ 3 points) in a prospective-alternating scheme (1:1, standard prophylaxis with cefuroxime versus a broad-spectrum prophylaxis of a combined single-shot of vancomycin 1 g and gentamicin 5 mg/kg parenterally). The primary outcome is "remission" at 6 weeks for most orthopedic surgeries or at 1 year for surgeries with implant. Secondary outcomes are the risk for prophylaxis-resistant SSI pathogens, revision surgery for any reason, change of antibiotic therapy during the treatment of infection, adverse events, and the postoperative healthcare-associated infections other than SSI within 6 weeks (e.g., urine infections or pneumonia). With event-free surgeries to 95% in the broad-spectrum versus 85% in the standard prophylaxis arm, we need 2 × 207 orthopedic surgeries. DISCUSSION In selected patients with a high risk for infections due to selection of prophylaxis-resistant SSI, a broad-spectrum combination with vancomycin and gentamycin might prevent SSIs (and other postoperative infections) better than the prophylaxis with cefuroxime. TRIAL REGISTRATION ClinicalTrial.gov NCT05502380. Registered on 12 August 2022. Protocol version: 2 (3 June 2022).
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Affiliation(s)
- Ilker Uçkay
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Unit for Clinical and Applied Research, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
- Infection Control, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Hagen Bomberg
- Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Markus Risch
- Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Daniel Müller
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Michael Betz
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Vierra M, Rouhani Ravari M, Soleymani Sardoo F, Shogan BD. Tailored Pre-Operative Antibiotic Prophylaxis to Prevent Post-Operative Surgical Site Infections in General Surgery. Antibiotics (Basel) 2024; 13:99. [PMID: 38275328 PMCID: PMC10812803 DOI: 10.3390/antibiotics13010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The average American today undergoes three inpatient and two outpatient surgical procedures during one's life, each of which carries with it a risk of post-operative infection. It has long been known that post-operative infections cause significant morbidity in the immediate peri-operative period, but recent evidence suggests that they can have long-term consequences as well, increasing a patient's risk of infectious complications in unrelated surgeries performed months or even years later. While there are several theories on the origin of this association, including bacterial colonization of a post-operative infectious wound site, antimicrobial resistance from curative courses of antibiotics, subclinical immunosuppression, or the creation of an inflammatory "pathobiome" following an infectious insult, it is ultimately still unclear why patients who experience a single post-operative infection seem to be at a significantly higher risk of experiencing subsequent ones. Regardless, this association has significant implications for the routine use of pre-operative antibiotic prophylaxis. Indeed, while the prescription of antibiotics pre-operatively has dramatically reduced the rate of post-operative infections, the chosen prophylaxis regimens are typically standardized according to national guidelines, are facing increasing antimicrobial resistance patterns, and have been unable to reduce the risk of post-operative infection to acceptably low levels for certain surgeries. As a result, some clinicians have speculated that tailoring pre-operative antibiotic prophylaxis according to a patient's prior infectious and operative history could improve efficacy and further reduce the rate of post-operative infections. The purpose of this review is to describe the evidence for the link between multiple post-operative infections and explore the efficacy of individualized pre-operative prophylaxis.
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Affiliation(s)
- Mason Vierra
- Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA;
| | - Mohsen Rouhani Ravari
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Fatemeh Soleymani Sardoo
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
| | - Benjamin D. Shogan
- Department of Surgery, The University of Chicago Medicine, Chicago, IL 60637, USA; (M.R.R.); (F.S.S.)
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Zhu D, Luo Q. Effectiveness of nursing intervention in the operating room to prevent wound infections in patients undergoing orthopaedic surgery: A meta-analysis. Int Wound J 2023; 20:4103-4111. [PMID: 37433641 PMCID: PMC10681532 DOI: 10.1111/iwj.14304] [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: 06/12/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/13/2023] Open
Abstract
Surgical site wound infection is one of the most common postoperative complications in orthopaedic clinical practice. This study employed a meta-analysis approach to comprehensively evaluate the effect of operating room nursing interventions on the prevention of surgical site wound infections in orthopaedic surgical patients. A computer search was conducted using PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang databases from the inception of each database until May 2023 for randomised controlled trials (RCTs) that investigated the application of operating room nursing interventions in orthopaedic surgery. Two reviewers independently screened the literature, extracted data, and assessed study quality. The meta-analysis was conducted using Stata 17.0. A total of 29 studies involving 3567 patients were included, with 1784 patients in the intervention group, and 1783 patients in the control group. The results of the meta-analysis showed that compared with the control group, the use of operating room nursing interventions significantly reduced the incidence of surgical site wound infection after orthopaedic surgery (2.85% vs. 13.24%; odds ratio: 0.18, 95% confidence interval: 0.14-0.25; p < 0.001). Current evidence suggests that operating room nursing interventions reduce the incidence of surgical site wound infections. However, owing to the limited number and low quality of the studies, more high-quality, large-sample RCTs are needed to further verify these findings.
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Affiliation(s)
- Dan Zhu
- Department of Bone TraumatologyThe National Hospital of Enshi Autonomous PrefectureEnshiChina
| | - Qinghua Luo
- Department of ProctologyThe National Hospital of Enshi Autonomous PrefectureEnshiChina
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Rowan NJ, Kremer T, McDonnell G. A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 878:162976. [PMID: 36963674 DOI: 10.1016/j.scitotenv.2023.162976] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/23/2023] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally proposed in 1957, remains widely used for defining the disinfection and sterilization of contaminated re-usable medical devices and surgical instruments. Screening PubMed and Scopus databases using a PRISMA guiding framework generated 272 relevant publications that were used in this review. Findings revealed that there is a need to evolve how medical devices are designed, and processed by cleaning, disinfection (and/or sterilization) to mitigate patient risks, including acquiring an infection. This Spaulding Classification remains in use as it is logical, easily applied and understood by users (microbiologists, epidemiologists, manufacturers, industry) and by regulators. However, substantial changes have occurred over the past 65 years that challenge interpretation and application of this system that includes inter alia emergence of new pathogens (viruses, mycobacteria, protozoa, fungi), a greater understanding of innate and adaptive microbial tolerance to disinfection, toxicity risks, increased number of vulnerable patients and associated patient procedures, and greater complexity in design and use of medical devices. Common cited examples include endoscopes that enable non- or minimal invasive procedures but are highly sophisticated with various types of materials (polymers, electronic components etc), long narrow channels, right angle and heat-sensitive components and various accessories (e.g., values) that can be contaminated with high levels of microbial bioburden and patient tissues after use. Contaminated flexible duodenoscopes have been a source of several significant infection outbreaks, where at least 9 reported cases were caused by multidrug resistant organisms [MDROs] with no obvious breach in processing detected. Despite this, there is evidence of the lack of attention to cleaning and maintenance of these devices and associated equipment. Over the last few decades there is increasing genomic evidence of innate and adaptive resistance to chemical disinfectant methods along with adaptive tolerance to environmental stresses. To reduce these risks, it has been proposed to elevate classification of higher-risk flexible endoscopes (such as duodenoscopes) from semi-critical [contact with mucous membrane and intact skin] to critical use [contact with sterile tissue and blood] that entails a transition to using low-temperature sterilization modalities instead of routinely using high-level disinfection; thus, increasing the margin of safety for endoscope processing. This timely review addresses important issues surrounding use of the Spaulding classification system to meet modern-day needs. It specifically addresses the need for automated, robust cleaning and drying methods combined with using real-time monitoring of device processing. There is a need to understand entire end-to-end processing of devices instead of adopting silo approaches that in the future will be informed by artificial intelligence and deep-learning/machine learning. For example, combinational solutions that address the formation of complex biofilms that harbour pathogenic and opportunistic microorganisms on the surfaces of processed devices. Emerging trends are addressed including future sustainability for the medical devices sector that can be enabled via a new Quintuple Helix Hub approach that combines academia, industry, healthcare, regulators, and society to unlock real world solutions.
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Affiliation(s)
- N J Rowan
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Department of Nursing and Healthcare, Technological University of the Shannon Midwest Mideast, Athlone Campus, Ireland; SFI-funded CURAM Centre for Medical Device Research, University of Galway, Ireland.
| | - T Kremer
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
| | - G McDonnell
- Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
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Retrospective Longitudinal Study on Changes in Atmospheric Pressure as a Predisposing Factor for Odontogenic Abscess Formation. Dent J (Basel) 2023; 11:dj11020042. [PMID: 36826187 PMCID: PMC9955754 DOI: 10.3390/dj11020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
In our retrospective longitudinal study based on the data from 292 patients, we wanted to investigate whether there was an association between weather conditions and the occurrence of odontogenic abscesses (OA) requiring hospitalization. In the adult group (249 patients), the incidence of severe OA was highest in winter (32.9%) during January (11.6%), with the most common localizations being the perimandibular (35.7%) and submandibular (23.3%) regions. We found that changes in mean daily atmospheric pressure five days before hospitalization showed a positive association with the occurrence of OA, especially pressure variations greater than 12 hPa. Atmospheric pressure changes two and five days before hospitalization were also found to be moderate predictors of complications during treatment. Antibiogram analysis revealed resistance of streptococci to clindamycin in 26.3%. In the pediatric group, OA were also most frequent in winter (30.2%), and the perimandibular region (37.2%) and the canine fossa (20.9%) were the most frequent abscess localizations, while an association with meteorological parameters was not demonstrated. Clinical experience teaches us that weather change influences the occurrence of severe OA requiring hospitalization, which we confirmed in this research. To our knowledge, our study is the first to provide a threshold and precise time frame for atmospheric pressure changes.
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Akram F, Imtiaz M, Haq IU. Emergent crisis of antibiotic resistance: A silent pandemic threat to 21 st century. Microb Pathog 2023; 174:105923. [PMID: 36526035 DOI: 10.1016/j.micpath.2022.105923] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
Antibiotic resistance has become an indispensably alarming menace to the global community. The primary factors are overuse and abuse of antibiotics, lack of novel medicines under development, the health care industry's focus on profit, and the absence of diagnostic testing prior to the prescription of antibiotics. Additionally, over the past few decades, the main factors contributing to the global spread of antibiotic resistance have been the overuse of antibiotics in livestock and other animals, drug efficacy, development of fewer new vaccines, environmental toxicity, transmission through travel, and lack of funding for healthcare research and development. These factors have accelerated resistance in microorganisms through structural and functional modifications in bacteria such as reduced drug permeability, increased efflux pumps, enzymatic antibiotic modification, and change in drug target, intracellular infection, and biofilm creation. There has been an increase in resistance during the pandemic and among cancer patients due to improper prescriptions. A number of modern therapeutic alternatives have been developed to curb widespread antibiotic resistance such as nanoparticle, bacteriophage, and antimicrobial biochemical approaches. It is high time to explore new alternatives to curtail enormous increase in resistant pathogens which could be an incurable global confrontation. This review highlights the complete insight on the global drivers of resistance along with the modes of action and impacts, finally discussing the latest therapeutic alternatives.
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Affiliation(s)
- Fatima Akram
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan.
| | - Memoona Imtiaz
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan
| | - Ikram Ul Haq
- Institute of Industrial Biotechnology, Government College University, Lahore, 54000, Pakistan; Pakistan Academy of Sciences, Islamabad, Pakistan
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Han B, Shen S, Yang F, Wang X, Gao W, Zhang K. Exploring antibiotic resistance load in paddy-upland rotation fields amended with commercial organic and chemical/slow release fertilizer. Front Microbiol 2023; 14:1184238. [PMID: 37125153 PMCID: PMC10140351 DOI: 10.3389/fmicb.2023.1184238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/24/2023] [Indexed: 05/02/2023] Open
Abstract
Agricultural fertilization caused the dissemination of antibiotic resistance genes (ARGs) in agro-ecological environment, which poses a global threat to crop-food safety and human health. However, few studies are known about the influence of different agricultural fertilization modes on antibiotic resistome in the paddy-upland rotation soils. Therefore, we conducted a field experiment to compare the effect of different fertilization (chemical fertilizer, slow release fertilizer and commercial organic fertilizer replacement at various rates) on soil antibiotic resistome in paddy-upland rotation fields. Results revealed that a total of 100 ARG subtypes and 9 mobile genetic elements (MGEs) occurred in paddy-upland rotation soil, among which MDR-ARGs, MLSB-ARGs and tet-ARGs were the dominant resistance determinants. Long-term agricultural fertilization remarkably facilitated the vertical accumulation of ARGs, in particular that bla ampC and tetO in relative abundance showed significant enrichment with increasing depth. It's worth noting that slow release fertilizer significantly increased soil ARGs, when comparable to manure with 20% replacing amount, but chemical fertilizer had only slight impact on soil ARGs. Fertilization modes affected soil microbial communities, mainly concentrated in the surface layer, while the proportion of Proteobacteria with the highest abundance decreased gradually with increasing depth. Furthermore, microbial community and MGEs were further proved to be essential factors in regulating the variability of ARGs of different fertilization modes by structural equation model, and had strong direct influence (λ = 0.61, p < 0.05; λ = 0. 55, p < 0.01). The results provided scientific guidance for reducing the spreading risk of ARGs and control ARG dissemination in agricultural fertilization.
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Affiliation(s)
- Bingjun Han
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China
| | - Shizhou Shen
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China
- Dali, Yunnan, Agro-Ecosystem, National Observation and Research Station, Dali, China
| | - Fengxia Yang
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China
- Dali, Yunnan, Agro-Ecosystem, National Observation and Research Station, Dali, China
- *Correspondence: Fengxia Yang,
| | - Xiaolong Wang
- School of Environmental Science and Engineering, Nankai University, Tianjin, China
| | - Wenxuan Gao
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China
| | - Keqiang Zhang
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China
- Dali, Yunnan, Agro-Ecosystem, National Observation and Research Station, Dali, China
- Keqiang Zhang,
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Femistina versus Canephron as a prevention of urinary tract infections after midurethral sling surgery - Non-inferiority study. Eur J Obstet Gynecol Reprod Biol 2022; 277:71-76. [PMID: 36027670 DOI: 10.1016/j.ejogrb.2022.08.009] [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: 05/15/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Urinary tract infection (UTI) is relatively common post-operative complication following midurethral sling placement (MUS), even in cases where intraoperative antibiotic prophylaxis was given. The primary aim of this study was to investigate the non-inferiority of Femistina as compared with Canephron in reducing symptomatic UTI in first six months following surgery. STUDY DESIGN A sample size of 144 patients per group was established, to provide at least 90% power to demonstrate the non-inferiority of phytodrug Femistina versus Canephron as a prevention of post-MUS urinary tract infection. RESULTS Women suffering from stress urinary incontinence and mixed urinary incontinence (MUI) with predominant SUI symptoms as confirmed by urodymamics (n = 320) were randomized in a 1:1 ratio to Femistina (40 mg, oral, twice daily for 20 days) or Canephron (3 × 5 ml taken orally-three times daily for 4 weeks). Both groups were homogenous for age, type of operation (only TOT outside-in) and severity of illness as indicated by ICIQ-SF questionnaire. We found that symptoms of UTI were significantly lower in patients receiving Femistina. During first 6 months after surgery UTI was confirmed in only 10 patients receiving Femistina (6,25%) when compared to 25 (15,63%) subjects receiving Canephron, p < 0.007. CONCLUSION Femistina is not inferior to Canephron in preventing lower urinary tract infection after midurethral sling surgery.
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Is Previous Postoperative Infection an Independent Risk Factor for Postoperative Infection after Second Unrelated Abdominal Operation? J Am Coll Surg 2022; 235:285-292. [PMID: 35839404 PMCID: PMC9298533 DOI: 10.1097/xcs.0000000000000222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Infections after abdominal surgery remain a significant problem. Although preoperative antibiotic prophylaxis is a primary strategy used to reduce postoperative infections, it is typically prescribed based on standardized protocols, without attention to previous infection or antibiotic history. Patients with a previous infection after surgery may be at higher risk for infectious complications after subsequent operations owing to antibiotic resistance. We hypothesized that a previous postoperative infection is a significant risk factor for the development of infection after a second unrelated surgery. STUDY DESIGN We performed a retrospective study of patients who had undergone 2 unrelated abdominal operations at a tertiary care center from 2012 to 2018. Clinical variables and microbiological culture results were abstracted. Univariate and multivariable regression models were constructed. RESULTS Of 758 patients, 15.0% (n = 114) developed an infection after the first operation. After the second operation, 22.8% (n = 26) of those with a previous infection developed another infection, whereas the incidence of an infection after the second operation was only 9.5% (n = 61) in patients who did not develop an infection after the first operation. Multivariable analysis demonstrated that previous infection (odds ratio 2.49, 95% CI 1.46 to 4.25) was associated with future infection risk. Microbiological analysis found that infections after the second surgery were significantly more likely to be antibiotic resistant than infections after the first surgery (82.3% vs 64.1%; p = 0.036). Strikingly, 49% of infections after the second surgery were resistant to the antibiotic prophylaxis given at the time of incision. CONCLUSIONS Previous postoperative infection is an independent risk factor for a subsequent postoperative infection and is associated with resistance to standard prophylaxis. Individualization of antibiotic prophylaxis in patients with a previous postoperative infection is warranted.
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Hu F, Zhang T, Liang J, Xiao J, Liu Z, Dahlgren RA. Impact of biochar on persistence and diffusion of antibiotic resistance genes in sediment from an aquaculture pond. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:57918-57930. [PMID: 35355188 DOI: 10.1007/s11356-022-19700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
Aquaculture sediments are a purported sizable pool of antibiotic resistance genes (ARGs). However, the pathways for transmission of ARGs from sediments to animals and humans remain unclear. We conducted an ARG survey in sediments from a bullfrog production facility located in Guangdong, China, and simulated zebrafish breeding systems were constructed, with or without biochar addition in sediments, to explore the effects of biochar on ARGs and their precursors of the sediment and zebrafish gut. After 60 days, 6 subtypes of ARGs and intI1 were detected, with sediments harboring more ARGs than zebrafish gut. The addition of biochar reduced the abundance of ARGs in the sediment and zebrafish gut, as well as suppressed the horizontal transmission of ARGs from sediment to zebrafish gut. Network analysis and partial least squares path modeling revealed that ARG enrichment was mainly affected by bacterial groups dominated by Nitrospirae, Gemmatimonades, Chloroflexi, and Cyanobacteria and intI1. Our findings provide insights into the transmission of ARGs from sediment to animals and highlight the efficacy of biochar amendments to aquaculture sediments to reduce the transmission of ARGs.
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Affiliation(s)
- Fengjie Hu
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, People's Republic of China
| | - Taiping Zhang
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, People's Republic of China.
- The Key Lab of Pollution Control and Ecosystem Restoration in Industry Clusters, Ministry of Education, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou, 510006, People's Republic of China.
| | - Jinni Liang
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, People's Republic of China
| | - Jiahui Xiao
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, People's Republic of China
| | - Zidan Liu
- School of Environment and Energy, South China University of Technology, Guangzhou, 510006, People's Republic of China
| | - Randy A Dahlgren
- Department of Land, Air and Water Resources, University of California, Davis, CA, 95616, USA
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13
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Vippadapu P, Gillani SW, Thomas D, Ahmed F, Gulam SM, Mahmood RK, Menon V, Abdi S, Rathore HA. Choice of Antimicrobials in Surgical Prophylaxis - Overuse and Surgical Site Infection Outcomes from a Tertiary-Level Care Hospital. Front Pharmacol 2022; 13:849044. [PMID: 35496271 PMCID: PMC9044486 DOI: 10.3389/fphar.2022.849044] [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: 01/05/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: This study was aimed to describe the choice of Surgical Antimicrobial Prophylaxis at a tertiary-level care hospital in United Arab Emirates. It also associated the choice between two leading antimicrobials for the SAP to the site of surgery. Methods: A descriptive drug use evaluation was performed retrospectively to study choices of antimicrobials in surgical antibiotic prophylaxis. An analytical cross-sectional study design was used to develop a hypothesis regarding the choice of ceftriaxone. Data were collected from the medical records of Hospital from July 2020 to December 2020. Results were presented in numbers and percentages. Results: SAP data were collected from 199 patients, of which 159 were clean or clean-contaminated. Dirty surgeries (18) needed a higher level of antimicrobials as there were infections to be treated. For other surgeries with no infection, overuse of antimicrobials was found regarding the choice of antimicrobials. Surgical antibiotic Prophylaxis was administered within the recommended time prior to surgeries. Ceftriaxone was preferred over cefuroxime in all types of surgeries based on the timing of Surgical Antibiotic Prophylaxis, wound classification, and the surgical site. A statistically significant association for choice of ceftriaxone over cefuroxime was found regarding surgical sites (p-value <0.05). About 99% of the patients were prescribed discharge antimicrobials when 158 (80%) surgeries were clean or clean-contaminated. Conclusion: Overuse of antimicrobials was found in surgical antimicrobial prophylaxis. Ceftriaxone was preferred more than cefuroxime in all types of surgeries. No surgical site infections were reported. A follow-up comparative study is recommended to decrease antimicrobial use without increasing risk of surgical site infection.
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Affiliation(s)
- Prasanna Vippadapu
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Syed Wasif Gillani
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Dixon Thomas
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Fiaz Ahmed
- Thumbay University Hospital, Ajman, United Arab Emirates
| | - Shabaz Mohiuddin Gulam
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.,Thumbay University Hospital, Ajman, United Arab Emirates
| | - Rana Kamran Mahmood
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.,ResponsePlus Medical, Abu Dhabi, United Arab Emirates
| | - Vineetha Menon
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Semira Abdi
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates.,Dubai Pharmacy College, Dubai, United Arab Emirates
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14
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Epidemiology and prediction of multidrug-resistant bacteria based on hospital level. J Glob Antimicrob Resist 2022; 29:155-162. [DOI: 10.1016/j.jgar.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/23/2022] [Accepted: 03/05/2022] [Indexed: 11/18/2022] Open
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15
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Menz BD, Charani E, Gordon DL, Leather AJM, Moonesinghe SR, Phillips CJ. Surgical Antibiotic Prophylaxis in an Era of Antibiotic Resistance: Common Resistant Bacteria and Wider Considerations for Practice. Infect Drug Resist 2021; 14:5235-5252. [PMID: 34908856 PMCID: PMC8665887 DOI: 10.2147/idr.s319780] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/19/2021] [Indexed: 01/19/2023] Open
Abstract
The increasing incidence of antimicrobial resistance (AMR) presents a global crisis to healthcare, with longstanding antimicrobial agents becoming less effective at treating and preventing infection. In the surgical setting, antibiotic prophylaxis has long been established as routine standard of care to prevent surgical site infection (SSI), which remains one of the most common hospital-acquired infections. The growing incidence of AMR increases the risk of SSI complicated with resistant bacteria, resulting in poorer surgical outcomes (prolonged hospitalisation, extended durations of antibiotic therapy, higher rates of surgical revision and mortality). Despite these increasing challenges, more data are required on approaches at the institutional and patient level to optimise surgical antibiotic prophylaxis in the era of antibiotic resistance (AR). This review provides an overview of the common resistant bacteria encountered in the surgical setting and covers wider considerations for practice to optimise surgical antibiotic prophylaxis in the perioperative setting.
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Affiliation(s)
- Bradley D Menz
- SA Pharmacy, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Esmita Charani
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.,National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
| | - David L Gordon
- Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Division of Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Andrew J M Leather
- Centre for Global Health and Health Partnerships, School of Population Health and Environmental Science, Kings College London, London, UK
| | - S Ramani Moonesinghe
- Centre for Perioperative Medicine, UCL Division of Surgery and Interventional Science, London, UK.,UCL Hospitals NIHR Biomedical Research Centre, London, UK
| | - Cameron J Phillips
- SA Pharmacy, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.,Flinders Health & Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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16
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Rigby BE, Malott K, Hetzel SJ, Soukup JW. Incidence and Risk Factors for Surgical Site Infections Following Oromaxillofacial Oncologic Surgery in Dogs. Front Vet Sci 2021; 8:760628. [PMID: 34733910 PMCID: PMC8558237 DOI: 10.3389/fvets.2021.760628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022] Open
Abstract
Antibiotic stewardship in veterinary medicine is essential to help prevent resistant bacterial infections. Critical evaluation into the benefits of prophylactic use of antibiotics during veterinary surgical procedures is under reported and additional investigation is warranted. The objectives of this paper were to determine the incidence of surgical site infection in dogs that underwent oromaxillofacial oncologic surgery and to identify risk factors for the development of surgical site infection. In this retrospective cohort study including 226 dogs surgically treated for oromaxillofacial tumors between January 1, 1997 and December 31, 2018, the incidence of surgical site infection was determined to be 7.5%. Univariable logistical regression models were used to evaluate potential risk factors for development of surgical site infections including signalment, tumor type, antibiotic protocol, time under anesthesia, location of surgical procedure (dental suite vs. sterile operating room), specific comorbidities, and surgical margins obtained. Anesthetic events lasting greater than 6 h were significantly associated with development of infection. Signalment, comorbidities, administration of anti-inflammatory and immunosuppressive medications, tumor type, histological margin evaluation, surgical procedure location, and antibiotic protocols were not significant contributors to development of infection. Use of antibiotic therapy in this cohort was not protective against development of infection and may not be routinely indicated for all oromaxillofacial oncologic surgeries despite common promotion of its use and the contaminated nature of the oral cavity. Anesthetic time significantly contributed towards the development of infection and use of perioperative antibiotics for surgical procedures lasting >6 h may be routinely warranted.
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Affiliation(s)
- Brittney E Rigby
- Department of Surgical Science, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States
| | - Kevin Malott
- Department of Surgical Science, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, United States
| | - Jason W Soukup
- Department of Surgical Science, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States
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17
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Nanayakkara AK, Boucher HW, Fowler VG, Jezek A, Outterson K, Greenberg DE. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward. CA Cancer J Clin 2021; 71:488-504. [PMID: 34546590 DOI: 10.3322/caac.21697] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
Infection is the second leading cause of death in patients with cancer. Loss of efficacy in antibiotics due to antibiotic resistance in bacteria is an urgent threat against the continuing success of cancer therapy. In this review, the authors focus on recent updates on the impact of antibiotic resistance in the cancer setting, particularly on the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). This review highlights the health and financial impact of antibiotic resistance in patients with cancer. Furthermore, the authors recommend measures to control the emergence of antibiotic resistance, highlighting the risk factors associated with cancer care. A lack of data in the etiology of infections, specifically in oncology patients in United States, is identified as a concern, and the authors advocate for a centralized and specialized surveillance system for patients with cancer to predict and prevent the emergence of antibiotic resistance. Finding better ways to predict, prevent, and treat antibiotic-resistant infections will have a major positive impact on the care of those with cancer.
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Affiliation(s)
- Amila K Nanayakkara
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amanda Jezek
- Infectious Diseases Society of America, Arlington, Virginia
| | - Kevin Outterson
- CARB-X, Boston, Massachusetts
- Boston University School of Law, Boston, Massachusetts
| | - David E Greenberg
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
- Department of Microbiology, University of Texas Southwestern, Dallas, Texas
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18
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Edwards-Jones V. In vitro studies of a silver surgical site dressing, Primaseal ™ post-op silver dressing, and its activity against common wound pathogens. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Suranigi SM, Ramya SR, Sheela Devi C, Kanungo R, Najimudeen S. Risk factors, bacteriological profile and outcome of surgical site infections following orthopaedic surgery. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:171-177. [PMID: 34540151 PMCID: PMC8408022 DOI: 10.18502/ijm.v13i2.5976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Surgical site infection (SSI) is a challenge for the surgeon. Incidence of SSI reported in literature varies from 0.5% to 15%. Severity of SSI ranges from superficial skin infection to life-threatening condition like septicaemia. It is responsible for increased morbidity, mortality, and economic burden to the hospital in general, and the patient in particular. The aim of this study was to assess the risk factors, bacteriological profile, length of hospitalization, and cost due to orthopaedic SSI in patients admitted to a tertiary care hospital. Materials and Methods: This was a prospective case control study. Cases were diagnosed based on CDC definition of nosocomial SSI. All cases were assessed preoperatively, intraoperatively and postoperatively, according to type of surgery, wound class, duration of operation, antimicrobial prophylaxis, use of drain, preoperative hospital stay, causative micro organism, total hospital stay, readmission rates and cost incurred. Age, sex and surgical procedure matched controls without SSI, were also assessed. Chi-square test and Fisher’s exact test were used for analysis. P= <0.05 was considered significant. Results: Out of 1023 patients, 47 cases had SSI, with a rate of 4.6%. Cigarette smoking was a risk factor for SSI (P = 0.0035). The most common etiologic agents were Acinetobacter baumannii and Staphylococcus aureus. Incidence of readmission among SSI cases was more compared to controls (P= 0.0001). Costs attributable to SSI (Indian Rupees) was Rs 32,542 (17,054 to 87,514) which was significantly more than those without SSI (P= <0.001). Conclusion: Despite latest surgical amenities, meticulous sterilization protocols and pre-operative antibiotic prophylaxis, SSI continues to be present in healthcare settings. The increase in duration of hospital stay due to SSI adds to additional burden to an already resource-constrained healthcare system.
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Affiliation(s)
| | - S R Ramya
- Department of Microbiology, Subbaiah Institute of Medical Sciences, Shivamogga, Karnataka, India
| | - C Sheela Devi
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Reba Kanungo
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Syed Najimudeen
- Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India
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20
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Gordon J, Álvarez-Narváez S, Peroni JF. Antimicrobial Effects of Equine Platelet Lysate. Front Vet Sci 2021; 8:703414. [PMID: 34490395 PMCID: PMC8416987 DOI: 10.3389/fvets.2021.703414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
The development of antimicrobial resistant bacteria and the lack of novel antibiotic strategies to combat those bacteria is an ever-present problem in both veterinary and human medicine. The goal of this study is to evaluate platelet lysate (PL) as a biological alternative antimicrobial product. Platelet lysate is an acellular platelet-derived product rich in growth factors and cytokines that is manufactured via plateletpheresis and pooled from donor horses. In the current study, we sought to define the antimicrobial properties of PL on select gram-positive and gram-negative bacteria. Results from an end-point in vitro assay showed that PL did not support bacterial growth, and in fact significantly reduced bacterial content compared to normal growth media. An in vitro assay was then utilized to further determine the effects on bacterial growth dynamics and showed that all strains exhibited a slower growth rate and lower yield in the presence of PL. The specific effects of PL were unique for each bacterial strain: E. coli and P. aeruginosa growth was affected in a concentration-dependent manner, such that higher amounts of PL had a greater effect, while this was not true for S. aureus or E. faecalis. Furthermore, the onset of exponential growth was delayed for E. coli and P. aeruginosa in the presence of PL, which has significant clinical implications for developing a dosing schedule. In conclusion, our findings demonstrate the potential value of PL as a broad-spectrum antimicrobial that would offer an alternative to traditional antibiotics for the treatment of bacterial infection in equine species.
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Affiliation(s)
- Julie Gordon
- Department of Large Animal Medicine, Veterinary Medical Center, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - Sonsiray Álvarez-Narváez
- Athens Veterinary Diagnostic Laboratory, Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
| | - John F Peroni
- Department of Large Animal Medicine, Veterinary Medical Center, College of Veterinary Medicine, University of Georgia, Athens, GA, United States
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21
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Xu Y, Li H, Shao Z, Li X, Zheng X, Xu J. Fate of antibiotic resistance genes in farmland soil applied with three different fertilizers during the growth cycle of pakchoi and after harvesting. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2021; 289:112576. [PMID: 33865023 DOI: 10.1016/j.jenvman.2021.112576] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
The increasing prevalence of antibiotic resistance genes (ARGs) in the soil environment poses a serious threat to crop safety and even public health. In this study, the fate of ARGs in the soil was investigated during the growth period of pakchoi and after harvesting with the application of different kinds of fertilizers. The result showed that increasing rate of soil ARGs during the growth period of pakchoi followed the order of composted manure > commercial fertilizer > mineral fertilizer. After harvesting, soil ARGs abundance treated with mineral fertilizer, commercial fertilizer or composted manure significantly increased by 0.63, 3.19 and 8.65 times (p < 0.05), respectively, compared with the non-fertilized soil. The ARGs abundance in the pakchoi treated with composted manure was significantly higher than that of treatments with mineral fertilizer and commercial organic fertilizer. These findings indicated the application of composted pig manure would significantly increase the pollution load of ARGs in farmland soil and plant, and also promote the proliferation of farmland ARGs. Principal component analysis suggested that bacterial communities might have a significant influence on ARGs changes during the growth period of pakchoi. Network analysis further indicated ARGs changes may be mainly related to their host bacteria (including Gammaproteobacteria, Flavobacteriia and Bacilli). The results provided a proper method and useful information on reducing transmission risk of ARGs and control the propagation of ARGs in agricultural activities.
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Affiliation(s)
- Yan Xu
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, 300191, China
| | - Houyu Li
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, 300191, China
| | - Zhenlu Shao
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, 300191, China; College of Water Conservancy and Civil Engineering, Shandong Agricultural University, Taian, 271018, China
| | - Xiaochen Li
- College of Water Conservancy and Civil Engineering, Shandong Agricultural University, Taian, 271018, China
| | - Xiangqun Zheng
- Agro-Environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, 300191, China
| | - Jian Xu
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China.
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22
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Buonavoglia A, Leone P, Solimando AG, Fasano R, Malerba E, Prete M, Corrente M, Prati C, Vacca A, Racanelli V. Antibiotics or No Antibiotics, That Is the Question: An Update on Efficient and Effective Use of Antibiotics in Dental Practice. Antibiotics (Basel) 2021; 10:550. [PMID: 34065113 PMCID: PMC8151289 DOI: 10.3390/antibiotics10050550] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
The antimicrobial resistance (AMR) phenomenon is an emerging global problem and is induced by overuse and misuse of antibiotics in medical practice. In total, 10% of antibiotic prescriptions are from dentists, usually to manage oro-dental pains and avoid postsurgical complications. Recent research and clinical evaluations highlight new therapeutical approaches with a reduction in dosages and number of antibiotic prescriptions and recommend focusing on an accurate diagnosis and improvement of oral health before dental treatments and in patients' daily lives. In this article, the most common clinical and operative situations in dental practice, such as endodontics, management of acute alveolar abscesses, extractive oral surgery, parodontology and implantology, are recognized and summarized, suggesting possible guidelines to reduce antibiotic prescription and consumption, maintaining high success rates and low complications rates. Additionally, the categories of patients requiring antibiotic administration for pre-existing conditions are recapitulated. To reduce AMR threat, it is important to establish protocols for treatment with antibiotics, to be used only in specific situations. Recent reviews demonstrate that, in dentistry, it is possible to minimize the use of antibiotics, thoroughly assessing patient's conditions and type of intervention, thus improving their efficacy and reducing the adverse effects and enhancing the modern concept of personalized medicine.
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Affiliation(s)
- Alessio Buonavoglia
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Patrizia Leone
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Antonio Giovanni Solimando
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Rossella Fasano
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Eleonora Malerba
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Marcella Prete
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | | | - Carlo Prati
- Endodontic Clinical Section, Department of Biomedical and NeuroMotor Sciences, Dental School, University of Bologna, 40125 Bologna, Italy;
| | - Angelo Vacca
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
| | - Vito Racanelli
- Unit of Internal Medicine “Guido Baccelli”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, 70124 Bari, Italy; (A.B.); (P.L.); (A.G.S.); (R.F.); (E.M.); (M.P.); (A.V.)
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23
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Rohrer F, Maurer A, Noetzli H, Gahl B, Limacher A, Hermann T, Bruegger J. Prolonged antibiotic prophylaxis use in elective orthopaedic surgery - a cross-sectional analysis. BMC Musculoskelet Disord 2021; 22:420. [PMID: 33957917 PMCID: PMC8101240 DOI: 10.1186/s12891-021-04290-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose Surgical antibiotic prophylaxis (SAP) prevents surgical site infections (SSI). In orthopaedic surgery, the use of prolonged SAP (PSAP) has been reported in daily routine, despite guidelines advising against it. Therefore, we asked: What is the proportion of PSAP use, defined as administration of SAP ≥24 h after elective orthopaedic surgery? Are there patient- and surgery-related predictors of PSAP use? Methods This cross-sectional analysis investigated 1292 patients who underwent elective orthopaedic surgery including total joint arthroplasties at one Swiss centre between 2015 and 2017. Patient comorbidities, surgical characteristics and occurrence of SSI at 90 days in PSAP group were compared to the SAP group (< 24 h post-operative). Results PSAP use was 12% (155 of 1292). Patient-related factors associated with PSAP compared to the SAP group included older age (63 vs. 58y; p < 0.001), higher BMI (29 vs. 27 kg/m2; p < 0.001), ASA classification ≥3 (31% vs. 17%; p < 0.001) and lung disease (17% vs. 9%; p = 0.002). Surgery-related factors associated with PSAP were use of prosthetics (62% vs. 45%; p < 0.001), surgery of the knee (65% vs. 25%; p < 0.001), longer surgery duration (87 vs. 68 min; p < 0.001) and presence of drains (90% vs. 65%; p < 0.001). All four SSI occurred in the SAP group (0 vs. 4; p = 1.0). Surgeons administered PSAP with varying frequencies; proportions ranged from 0 to 33%. Conclusion PSAP use and SSI proportions were lower than reported in the literature. Several patient- and surgery-related factors associated with PSAP use were identified and some were potentially modifiable. Also, experienced surgeons seemed to implement differing approaches regarding the duration of SAP administration.
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Affiliation(s)
- Felix Rohrer
- Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland. .,Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland.
| | - Anita Maurer
- Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland.,University of Bern, 3012, Bern, Switzerland
| | - Hubert Noetzli
- University of Bern, 3012, Bern, Switzerland.,Orthopaedie Sonnenhof, 3006, Bern, Switzerland
| | - Brigitta Gahl
- Clinical Trials Unit (CTU) Bern, University of Bern, 3012, Bern, Switzerland
| | - Andreas Limacher
- Clinical Trials Unit (CTU) Bern, University of Bern, 3012, Bern, Switzerland
| | - Tanja Hermann
- Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland.,Stiftung Lindenhof, Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, 3010, Bern, Switzerland
| | - Jan Bruegger
- Department of Internal Medicine, Sonnenhofspital, 3006, Bern, Switzerland.,University of Zurich, 8006, Zurich, Switzerland
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Oddos C, Bardonneau G, Petit L, Biais M, Carrie C. Are third-generation cephalosporins still an option for empirical antibiotic therapy in critically ill trauma patients with early ventilator or hospital-acquired pneumonia? Anaesth Crit Care Pain Med 2021; 40:100833. [PMID: 33746076 DOI: 10.1016/j.accpm.2021.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Claire Oddos
- Anaesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France
| | - Guillaume Bardonneau
- Anaesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France
| | - Laurent Petit
- Anaesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France
| | - Matthieu Biais
- Anaesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France; Univ. Bordeaux Segalen, 33000 Bordeaux, France
| | - Cédric Carrie
- Anaesthesiology and Critical Care Department, CHU Pellegrin, 33000 Bordeaux, France.
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Skender K, Singh V, Stalsby-Lundborg C, Sharma M. Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study. PLoS One 2021; 16:e0245902. [PMID: 33503028 PMCID: PMC7840031 DOI: 10.1371/journal.pone.0245902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. Aim To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Methods Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Results Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Conclusion Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.
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Affiliation(s)
- Kristina Skender
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Vivek Singh
- Department of Orthopedic, Ruxmaniben Deepchand Medical College, Ujjain, India
| | - Cecilia Stalsby-Lundborg
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Megha Sharma
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
- * E-mail:
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Miranda D, Mermel LA, Dellinger EP. Perioperative Antibiotic Prophylaxis: Surgeons as Antimicrobial Stewards. J Am Coll Surg 2020; 231:766-768. [DOI: 10.1016/j.jamcollsurg.2020.08.767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
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Svenningsen R, Kulseng-Hanssen S, Kråkenes EBC, Schiøtz HA. Is antibiotic prophylaxis necessary in mid-urethral sling surgery? Int Urogynecol J 2020; 32:629-635. [PMID: 32617638 PMCID: PMC7902329 DOI: 10.1007/s00192-020-04408-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
Introduction and hypothesis Antibiotic prophylaxis is commonly used when implanting a mid-urethral sling (MUS) for female stress urinary incontinence. Use of antibiotics may lead to adverse events and the development of antibiotic resistance. This study compared a variety of outcomes after MUS surgery with and without antibiotic prophylaxis using data from the national Norwegian Female Incontinence Registry. Methods Preoperative and 6–12 months postoperative subjective and objective data from 28,687 patients who received MUS surgery from 1998 through 2017 were extracted from the registry. Categorical outcomes were compared between women with or without antibiotic prophylaxis using chi-square test for independence. Primary outcome was incidence of postoperative surgical site infection (SSI). Secondary outcomes were incidence of tape exposure, de novo or persistent urgency urinary incontinence, postoperative pain > 3 months, subjective and objective cure rates, and patient satisfaction. Results Antibiotic prophylaxis was used in 9131 and not used in 19,556 patients. SSIs and prolonged postoperative pain occurred significantly more often without antibiotic prophylaxis. Subjective and objective cure rates were significantly higher and tape exposures significantly lower in women not receiving prophylactic antibiotics. There were no significant differences in other outcomes. Conclusions Antibiotic prophylaxis resulted in fewer women developing postoperative infections or prolonged postoperative pain after MUS surgery, but did not offer protection against tape exposure. The differences in cure rates were small and probably without clinical relevance. If a small increase in surgical site infections is accepted, the routine use of antibiotic prophylaxis can probably be omitted.
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Affiliation(s)
- Rune Svenningsen
- Department of Gynecology, Oslo University Hospital, Ullevål, PO Box 4956 Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway. .,The Norwegian Female Incontinence Registry, Oslo University Hospital, Ullevål, Oslo, Norway.
| | - Sigurd Kulseng-Hanssen
- The Norwegian Female Incontinence Registry, Oslo University Hospital, Ullevål, Oslo, Norway
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Are Prophylactic Postoperative Antibiotics Necessary after Masculinizing Mastectomy with Free Nipple Graft? A Single-institution Retrospective Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2615. [PMID: 32095415 PMCID: PMC7015610 DOI: 10.1097/gox.0000000000002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/13/2019] [Indexed: 11/26/2022]
Abstract
Antibiotic overuse, particularly in the postoperative period, has contributed substantially to increased rates of antibiotic resistance. Despite insufficient evidence to support prolonged prophylactic antibiotics following the majority of plastic surgery operations, and societal recommendations against the practice, many surgeons continue to perpetuate this cycle. Regarding "newer" operations, wherein minimal data pertaining to antibiotic use have been published, decision-making is often based on historical tradition. As such, continued communication of relevant data is essential to inform best practice guidelines. The aim of this case series was to report postoperative outcomes following chest masculinization with free nipple grafts performed according to a strict antibiotic protocol, which restricted prophylaxis to a single preoperative dose, in the absence of specific risk factors indicating a need for postoperative antibiotics. In this case series featuring 62 consecutive patients undergoing chest reconstruction with 124 free nipple grafts, there were no nipple losses or nipple graft infection events.
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Zaha DC, Bungau S, Uivarosan D, Tit DM, Maghiar TA, Maghiar O, Pantis C, Fratila O, Rus M, Vesa CM. Antibiotic Consumption and Microbiological Epidemiology in Surgery Departments: Results from a Single Study Center. Antibiotics (Basel) 2020; 9:antibiotics9020081. [PMID: 32069828 PMCID: PMC7168146 DOI: 10.3390/antibiotics9020081] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
The spectrum and antibiotic sensitivity of isolated strains vary between departments, hospitals, countries; the discrepancies are related to the use and dosage of these antibiotics. The purpose of our research was to compare the type of pathogens and the susceptibility of the isolated strains, as well as the use of antibiotics in the surgical departments of the Emergency Clinical County Hospital, Oradea, Romania; for one year, all the patients admitted to the mentioned sections were monitored. Antibiotic sensitivity of isolated strains was expressed using cumulative antibiogram. The total consumption of antibiotics was 479.18 DDD/1000 patient-days in the surgical sections. The most commonly used drugs were cephalosporins third and first generation, and clindamycin. Infections of wounds, urinary tract and fluids were most commonly diagnosed, and the most isolated was Escherichia coli, followed by Staphylococcus aureus and Enterococcus faecalis. The most commonly prescribed antimicrobial was ceftriaxone, but its sensitivity was low. This study revealed that the intake of antimicrobials in the surgical sections is increased and the comparison of antimicrobial prescriptions, sensitivity rates, and the spectrum of isolated pathogens showed differences between antimicrobials.
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Affiliation(s)
- Dana Carmen Zaha
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (D.C.Z.); (D.U.); (C.M.V.)
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
- Correspondence: ; Tel.: +40-726-776-588
| | - Diana Uivarosan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (D.C.Z.); (D.U.); (C.M.V.)
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania;
| | - Teodor Andrei Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (T.A.M.); (O.M.); (C.P.)
| | - Octavian Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (T.A.M.); (O.M.); (C.P.)
| | - Carmen Pantis
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (T.A.M.); (O.M.); (C.P.)
| | - Ovidiu Fratila
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (O.F.); (M.R.)
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (O.F.); (M.R.)
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (D.C.Z.); (D.U.); (C.M.V.)
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Indication for an additional postoperative antibiotic treatment after surgical incision of serious odontogenic abscesses. J Craniomaxillofac Surg 2020; 48:229-234. [PMID: 32111509 DOI: 10.1016/j.jcms.2020.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/03/2019] [Accepted: 01/22/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Serious abscesses of an odontogenic origin occur frequently in the oral and maxillofacial surgery departments. Rapid surgical incision and drainage constitutes the most important therapeutic action. However, additional surgical therapy and supplementary administration of antibiotics is often carried out, such that the efficiency of this supplementary therapeutic option has been questioned. METHODS All patients with severe odontogenic infections who received surgical treatment under general anaesthesia were recruited to this retrospective study. We determined whether they received additional antibiotic therapy on the ward and if it was possible to improve therapeutic outcomes using this option. RESULTS A total of 258 patients with a severe odontogenic infection between January 2008 and August 2014 were included. The most frequent infection observed was a submandibular abscess (56%), followed by a perimandibular abscess (18%) and a submental abscess (9%). About 65% of the patients were treated with antibiotics in addition to surgery. The median CRP level prior to surgical treatment was 87.8 mg/l (Q1: 40.3 mg/l; Q3: 143.5 mg/l) in patients who were administered an additional antibiotic and 83.8 mg/l (Q1: 37.3 mg/l; Q3: 135.0 mg/l) in those who received no antibiotic treatment after surgery. The postoperative median CRP levels were 116.5 mg/l (Q1: 52.1 mg/l; Q3: 159.3 mg/l) and 106.5 mg/l (Q1: 40.6 mg/l; Q3: 152.6 mg/l), respectively. Neither the preoperative CRP level (p = 0.546) nor the postoperative CRP level (p = 0.450) differed significantly between the groups. But patients who received additional antibiotic therapy had a significantly longer hospital stay (median: 6 days; range: 1-22 days) than patients who had no additional antibiotic therapy (median: 4 days; range: 1-19 days) (p = 0.002). CONCLUSIONS This study did not show an improvement in the therapeutic outcome with administration of supplementary antibiotics in addition to surgery. Thus, surgically incising an abscess is the most important therapeutic action and administration of antibiotics must be critically scrutinised.
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Berrondo C, Ahn JJ, Shnorhavorian M. Pre-operative skin antisepsis with chlorhexidine gluconate baths and wipes does not prevent postoperative surgical site infection in outpatient pediatric urologic inguinal and scrotal surgery. J Pediatr Urol 2019; 15:652.e1-652.e7. [PMID: 31564588 DOI: 10.1016/j.jpurol.2019.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To reduce surgical site infections (SSI), many institutions utilize pre-operative antisepsis with chlorhexidine gluconate (CHG) baths and/or wipes. CHG reduces bacterial colonization of the skin, but it is unclear whether this reduces SSI, and current guidelines from the American College of Surgeons, the Centers for Disease Control, and the World Health Organization do not support this practice. There are several factors that increase the risk of SSI in adults, but there is limited understanding of these factors in pediatric patients. OBJECTIVES The primary objectives were to describe the proportion of pediatric patients undergoing hernia/hydrocele repair and/or orchiopexy who develop a postoperative (postop) SSI and to determine whether pre-operative CHG baths/wipes were associated with SSI. The secondary objectives were to identify other factors associated with SSI and to estimate the cost of CHG baths/wipes in this population. STUDY DESIGN Pre-operative antisepsis with CHG baths/wipes was implemented at the authors institution in 2006. The authors performed a retrospective cohort study of patients aged 0-18 years undergoing hernia/hydrocele repair and/or orchiopexy by a pediatric urologist at their institution before (2004) and after (2008) the introduction of CHG. The authors compared the proportion of patients with SSI in the no CHG and CHG groups and evaluated for factors associated with SSI. Statistical analysis included Wilcoxon rank-sum test, Chi-squared test, and Fisher's exact test. The cost of CHG baths and wipes was estimated using institutional fees in 2018 US dollars. RESULTS A total of 543 patients met inclusion criteria, 203 in the no CHG group and 340 in the CHG group. The overall rate of SSI was 0.92%. There was no association between use of CHG and SSI. No patient or peri-operative factors were associated with development of SSI. There were no CHG-associated adverse events. The cost of materials was estimated at $3.29/patient ($1118.60 for 340 cases in 2008) in 2018 US dollars. DISCUSSION SSI is not common in pediatric patients undergoing hernia/hydrocele repair or orchiopexy. In the present study, pre-operative antisepsis with CHG baths/wipes is not associated with a reduction in SSI and carries additional cost. CONCLUSIONS To the authors knowledge, this is the first study to evaluate the use of pre-operative antisepsis with CHG baths/wipes in an exclusively pediatric population. In the study, CHG baths/wipes add cost with no clear benefit for reducing SSI in pediatric patients undergoing hernia/hydrocele repair and/or orchiopexy.
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Affiliation(s)
- Claudia Berrondo
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA.
| | - Jennifer J Ahn
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA
| | - Margarett Shnorhavorian
- Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA
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Abstract
PURPOSE OF REVIEW To outline key points for perioperative ICU optimization of nutrition, airway management, blood product preparation and transfusion, antibiotic prophylaxis and transport. RECENT FINDINGS Optimization entails glycemic control for all, with specific attention to type-1 diabetic patients. Transport-related adverse events may be averted with surgery in the ICU. If moving the patient is unavoidable, transport guidelines should be followed and hemodynamic optimization, airway control, and stabilization of mechanical ventilation ensured before transport. Preinduction preparation includes assessment of the airway and the provision of high-flow oxygen to prolong apneic oxygenation. Postintubation, a protective positive ventilation strategy should be employed. Ideal transfusion thresholds are 7 g/dl for hemodynamically stable adult patients, 8 g/dl in orthopedic or cardiac surgery patients as well as those with underlying cardiovascular disease. Higher transfusions thresholds may be required in specific disease states. Antimicrobial prophylaxis within 120 min of incision prevents most surgical site infections. Antibiotic therapy depends on the antibiotics being received in the ICU, the time elapsed since ICU admission, local epidemiology and the type of surgery. Tailored antimicrobial regimens may be continued periprocedurally. If more than 70% of the nutritional requirement cannot be met enterally, parenteral nutrition should be initiated within 5-7 days of surgery or earlier if the patient is malnourished. SUMMARY ICU patients who require surgery may benefit from appropriate perioperative management.
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Rafael D, Andrade F, Martinez-Trucharte F, Basas J, Seras-Franzoso J, Palau M, Gomis X, Pérez-Burgos M, Blanco A, López-Fernández A, Vélez R, Abasolo I, Aguirre M, Gavaldà J, Schwartz S. Sterilization Procedure for Temperature-Sensitive Hydrogels Loaded with Silver Nanoparticles for Clinical Applications. NANOMATERIALS 2019; 9:nano9030380. [PMID: 30845683 PMCID: PMC6474025 DOI: 10.3390/nano9030380] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 12/18/2022]
Abstract
Hydrogels (HG) have recognized benefits as drug delivery platforms for biomedical applications. Their high sensitivity to sterilization processes is however one of the greatest challenges regarding their clinical translation. Concerning infection diseases, prevention of post-operatory related infections is crucial to ensure appropriate patient recovery and good clinical outcomes. Silver nanoparticles (AgNPs) have shown good antimicrobial properties but sustained release at the right place is required. Thus, we produced and characterized thermo-sensitive HG based on Pluronic® F127 loaded with AgNPs (HG-AgNPs) and their integrity and functionality after sterilization by dry-heat and autoclave methods were carefully assessed. The quality attributes of HG-AgNPs were seriously affected by dry-heat methods but not by autoclaving methods, which allowed to ensure the required sterility. Also, direct sterilization of the final HG-AgNPs product proved more effective than of the raw material, allowing simpler production procedures in non-sterile conditions. The mechanical properties were assessed in post mortem rat models and the HG-AgNPs were tested for its antimicrobial properties in vitro using extremely drug-resistant (XDR) clinical strains. The produced HG-AgNPs prove to be versatile, easy produced and cost-effective products, with activity against XDR strains and an adequate gelation time and spreadability features and optimal for in situ biomedical applications.
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Affiliation(s)
- Diana Rafael
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
- Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Fernanda Andrade
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-180 Porto, Portugal.
- INEB-Instituto Nacional de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen 208, 4200-180 Porto, Portugal.
| | - Francesc Martinez-Trucharte
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
| | - Jana Basas
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Joaquín Seras-Franzoso
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
| | - Marta Palau
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Xavier Gomis
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain.
| | - Marc Pérez-Burgos
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
| | - Alberto Blanco
- Orthopedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Passeig de la Vall d'Hebron 129-139, 08035 Barcelona, Spain.
| | - Alba López-Fernández
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Passeig de la Vall d'Hebron 129-139, 08035 Barcelona, Spain.
| | - Roberto Vélez
- Orthopedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Passeig de la Vall d'Hebron 129-139, 08035 Barcelona, Spain.
| | - Ibane Abasolo
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
- Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Màrius Aguirre
- Orthopedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
| | - Joan Gavaldà
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Simó Schwartz
- Drug Delivery and Targeting Group, Molecular Biology and Biochemistry Research Centre for Nanomedicine (CIBBIM-Nanomedicine), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain.
- Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Instituto de Salud Carlos III, 28029 Madrid, Spain.
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Yang J, Yang H. Effect of Bifidobacterium breve in Combination With Different Antibiotics on Clostridium difficile. Front Microbiol 2018; 9:2953. [PMID: 30564210 PMCID: PMC6288195 DOI: 10.3389/fmicb.2018.02953] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022] Open
Abstract
While combinations of probiotics with antibiotics have exhibited beneficial and adverse effects in the treatment of Clostridium difficile infection (CDI), no substantive explanation has been provided for these effects. In this study, C. difficile ATCC 9689 (CD) was treated with Bifidobacterium breve (YH68) in combination with five different antibiotics to explore the effects of the different combinations on C. difficile. Cell-free culture supernatant (CFCS) of YH68 was combined with metronidazole (MTR), vancomycin (VAN), clindamycin (CLI), ceftazidime (CAZ) or ampicillin (AMP) to treat CD. The plate counting method was used to determine the growth and spore production of CD, and cell damage was assessed by the measurement of extracellular ATP levels with a luminescence-based kit. The production of toxin A/B was measured with an ELISA kit. The gene expression levels of tcdA and tcdB in CD were evaluated by real-time qPCR. The CFCS of YH68 (3 × 109 CFU/mL) at 0.25 times the minimal inhibitory concentration (MIC) (0.25YH68) in combination with the five antibiotics exerted stronger inhibitory effects on the growth and spore production of CD than the same antibiotics in the absence of 0.25YH68, except 0.25YH68&MTR&, 0.25YH68&MTR&CAZ, and 0.25YH68&VAN&CLI. However, treatment with 0.25YH68&VAN, 0.25YH68&, 0.25YH68&MTR&CAZ, 0.25YH68&VAN&CAZ, 0.25YH68&VAN&, and 0.25YH68&CAZ& resulted in increased cell damage. In addition, the different combinations, except 0.25YH68&CLI, 0.25YH68&MTR& and 0.25YH68&VAN&CLI, dramatically reduced the production of toxin A/B in comparison with the effects of the same antibiotics in the absence of 0.25YH68. The gene expression levels of tcdA and tcdB in CD were lowered upon treatment with 0.25YH68 in combination with MTR, CLI, CAZ, MTR&CAZ, MTR&, CLI&CAZ, and CLI&, whereas the levels were enhanced by 0.25YH68 in combination with VAN, AMP, MTR&CLI, VAN&CLI, VAN&, and CAZ&. In summary, YH68 in combination with specific antibiotics could enhance the inhibitory effects of antibiotics against CD. In addition, the antagonistic effects between some antibiotics could be weakened by YH68.
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Affiliation(s)
| | - Hong Yang
- State Key Laboratory of Microbial Metabolism, School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
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Duclos G, Pastene B, Depeyre F, Meresse Z, Cassir N, Martin-Loeches I, Einav S, Zieleskiewicz L, Leone M. Surgical antimicrobial prophylaxis in intensive care unit (ICU) patients: a preliminary, observational, retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:402. [PMID: 30498729 DOI: 10.21037/atm.2018.09.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical antimicrobial prophylaxis (SAP) is supported by evidence-based guidelines. Nevertheless, SAP guidelines do not cover all clinical scenarios. To our knowledge, no information is available regarding SAP in the critically ill patients. We designed a retrospective, observational and preliminary study which the objective was to describe our professional practices in intensive care unit (ICU) patients requiring SAP. Methods All patients admitted for more than 48 h in the ICU and requiring surgery were retrospectively included from January 1st to December 31, 2016. We collected data related to infection, colonization and antimicrobial treatments pre- and post-operatively. We assessed the compliance of SAP to guidelines. Results Among 41 included patients, 13 (32%) were treated for an ongoing infection and 21 (51%) received at least one antibiotic during the ICU stay. Seven (17%) were colonized. Twenty-one (51%) patients received SAP according to guidelines. Thirteen postoperative infections including 1 surgical site infection were reported. For 10 (24%) patients, the ongoing antimicrobial treatment was continued in the operating room. No surgical site infection and 1 lung infection was reported. In 3 (7%) patients, no SAP was administered and 1 episode of bacteremia was noted. Three (7%) patients had their ongoing treatment changed in the operating room. Two of them developed a lung infection. The other patients were assessed individually due to complex conditions. Conclusions These preliminary data showed a large heterogeneity in the management of SAP in the ICU, suggesting the need for specific guidelines based on clinical trials.
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Affiliation(s)
- Gary Duclos
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France
| | - Bruno Pastene
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France
| | - Fanny Depeyre
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France
| | - Zoé Meresse
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France
| | - Nadim Cassir
- Unité de Recherche sur les Maladie Infectieuses et Tropicales Émergentes, Aix Marseille Université, Marseille, France
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care, St James's University Hospital and Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Sharon Einav
- General Intensive Care Unit, Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Laurent Zieleskiewicz
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Service d'Anesthésie et de Réanimation, Aix Marseille Université, Marseille, France
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Does microbial colonisation of a neck drain predispose to surgical site infection: clean vs clean-contaminated procedures. Eur Arch Otorhinolaryngol 2018. [DOI: 10.1007/s00405-018-4921-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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