جستجوی مقالات مرتبط با کلیدواژه "surgical site infections" در نشریات گروه "پزشکی"

Spinal cord stimulation (SCS) is an established treatment modality for neuropathic pain. Published guidelines exist to aid physicians in proper antibiotic use during and after spinal cord stimulation trials and implants. In this brief review, we present and analyze the current antibiotic practice patterns of clinicians.

The study protocol was reviewed and granted an exemption by an Institutional Review Board. The survey queried practice parameters in regards to spinal cord stimulation therapy. The American Society of Regional Anesthesia and Pain Medicine (ASRA) and Society of Interventional Spine (SIS) distributed the survey to their active members by emails with a web link to the survey.

Our results indicate that 82% and 69% of physicians do not utilize nasal swabs for methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA), respectively, prior to SCS trial and implantation. During trials, 47% providers administer a single dose of antibiotics, 35% administer antibiotics for the duration of the trial, and 17% do not administer antibiotics. During implantation, 44% of physicians administer a single dose during the procedure, 11% administer antibiotics up to 24 hours, 24% administer antibiotics between 3-5 days, 14% administer antibiotics for more than 5 days, and 4% do not administer antibiotics.

Our study suggests a portion of pain physicians do not adhere to the Neuromodulation Appropriateness Consensus Committee (NACC) guidelines in regards to antibiotic administration for SCS trial and implantation. Further analysis and surveys would allow insight into common practices. More information and education would be beneficial to optimize peri-procedure antibiotic use to reduce infection risk and decrease antimicrobial resistance.

Surgical antibiotic prophylaxis has been widely used for prevention of surgical site infections (SSI’s). World Health Organization (WHO) global guidelines strongly recommend the administration of pre-operative prophylactic antibiotic, depending on the type of surgery, to reduce SSI’s. However, within Gulf Cooperation Council (GCC) countries, antibiotic resistance has been rising due to unregulated prescribing practice. We aimed to assess adherence to local/international guidelines in the plastic surgery unit of Salmaniya Medical Complex.

This study was a retrospective review of adults’ undergoing plastic surgery between the dates of 1st of January 2019 to 30th of April 2019. Recommendations and guidelines were provided by South Australian Guidelines for Surgical Antimicrobial Prophylaxis, NHS Greater-Glasgow Foundation Trust.  Salmaniya Medical Complex Guidelines were also taken into consideration. This was followed by an implementation of standardized guidelines and a re-assessment period for another four months.

There were 106 patients who met the inclusion/exclusion criteria throughout the primary cohort. With respect to choice and dose of antibiotics, only 21 (19.8%) of the procedures were adherent to global/local guidelines. Similarly, only 11.5% of those cases have met the recommended timing for pre-operative antibiotic administration. After the implementation period, adherence to guidelines regarding choice and time of antibiotic administration has increased to 36.8% and 32.6% respectively. SSI decreased from 1.8% to 0.08%.

Practice in SMC in plastic surgery pre-operative antibiotic prophylaxis shows poor compliance to both local and international guidelines in terms of choice, dose, and time of administration. We were able to significantly improve adherence to international/local practice in both areas by implementing an integrated protocol in liaison with the medical staff involved in the plastic surgery unit and operating theatres.

The current study aimed at describing the incidence, etiology of surgical site infections (SSI), and compliance with antibiotic prophylaxis in cesarean section during a 3.5 years period in a community hospital.
Prospective data were collected to monitor the incidence of SSI and compliance with antibiotic prophylaxis in 450 patients undergoing the procedure from January 2013 to June 2016.
The mean age of the patients was 31.8 years, 14.3% had diabetes mellitus, 4.73% had overweight, and 54.4% of the procedures were elective; also, 69.8% of the procedures had risk index (RI) 0, 26.3% RI 1, and 16 patients had RI 2 and 3. Nine patients with SSI were reported, 8 with superficial incisional and 1 organ-space infections. The pooled infection rate in 2013 was 4.44%, followed by 1.10% in 2014, 1.52% in 2015, and 2.56% in January to June 2016; in addition, 1.04% of the study subjects were RI 0 and 4.50% RI 1. Methicillin-resistant Staphylococcus aureus was identified in 2 patients, and Methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumonia in 1 patient, respectively. Compliance with antibiotic prophylaxis increased from 53.5% in 2013 to 94.9% in January to June 2016.
The current study findings showed the effect of a multidimensional program to prevent surgical site infection in cesarean section, and the need to strengthen it.

Surgical Site Infections (SSIs) are infections of incision or deep tissue at operation sites. These infections prolong hospitalization, delay wound healing, and increase the overall cost and morbidity. This study aimed to investigate anaerobic and aerobic bacteria prevalence in surgical site infections and determinate antibiotic susceptibility pattern in these isolates. One hundred SSIs specimens were obtained by needle aspiration from purulent material in depth of infected site. These specimens were cultured and incubated in both aerobic and anaerobic condition. For detection of antibiotic susceptibility pattern in aerobic and anaerobic bacteria, we used disk diffusion, agar dilution, and E-test methods. A total of 194 bacterial strains were isolated from 100 samples of surgical sites. Predominant aerobic and facultative anaerobic bacteria isolated from these specimens were the members of Enterobacteriaceae family (66, 34.03%) followed by Pseudomonas aeruginosa (26, 13.4%), Staphylococcus aureus (24, 12.37%), Acinetobacter spp. (18, 9.28%), Enterococcus spp. (16, 8.24%), coagulase negative Staphylococcus spp. (14, 7.22%) and nonhemolytic streptococci (2, 1.03%). Bacteroides fragilis (26, 13.4%), and Clostridium perfringens (2, 1.03%) were isolated as anaerobic bacteria. The most resistant bacteria among anaerobic isolates were B. fragilis. All Gram-positive isolates were susceptible to vancomycin and linezolid while most of Enterobacteriaceae showed sensitivity to imipenem. Most SSIs specimens were polymicrobial and predominant anaerobic isolate was B. fragilis. Isolated aerobic and anaerobic strains showed high level of resistance to antibiotics.

Cesarean surgical site infection (SSI) occurs in 3% to 17% of patients who undergo cesarean delivery. SSIs increase postcesarean maternal morbidity and health costs and cause longer hospital stays. Therefore, we designed a study to assess the effects of normal saline and cefazolin irrigation on the incidence of SSIs. In this study, 200 participants were divided into 3 groups with a 2:1:1 ratio. All pregnant women who underwent cesarean after 6 hours passed their rupture of membrane and were admitted to Shariati Hospital of Bandar Abbas were eligible for our study. Patients with immunodeficiency, coagolopathy, allergy to penicillin or cefazolin, history of immunosuppressive drug use, gestational diabetes mellitus or preeclampsia were excluded from the study. Age, gestational age, hours passed from rupture of membrane, the duration of surgery, anemia (Hb < 11), number of vaginal exams and duration of hospitalization were collected from the patients. The SPSS 13 software was used to analyze the collected data and descriptive statistics, one way ANOVA and chi-square were used. A p-value of < 0.05 was considered as significant (clinicaltrials.gov ID= NCT01566734). The mean age of the participants was 25.8 ± 5.6. The incidence of SSIs was 2.5% among all the participants. In this study, 0 patients (0%) of the cefazolin group, 1 patient (2%) of the normal saline group and 4 (4%) of the control group developed SSIs. No significant relation was seen between age, the number of vaginal exams, mean gestational age, duration of surgery, anemia and the type of irrigation. The results of this study show that normal saline or cefazolin irrigation does not decrease the incidence of SSIs. However, these solutions might have a different impact on high-risk patients.