Activity of Commonly Used Antimicrobial Prophylaxis Regimens against Pathogens Causing Coronary Artery Bypass Graft and Arthroplasty Surgical Site Infections in the United States, 2006–2009

Berríos-Torres, Sandra I.; Yi, Sarah H; Bratzler, Dale W.; Ma, Allen; Mu, Yi; Zhu, Liping; Jernigan, John A.

doi:10.1017/s0195941700035219

Cited by 17 publications

(25 citation statements)

References 31 publications

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“…Resistant Gram-positive organisms are the most common cause of SSIs following joint replacement surgery in Australia and are associated with poorer outcomes 14 22–24. These resistant Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), other methicillin-resistant Staphylococcus species and Enterococcus species, cause over 50% of all culture-positive infections in Australia, which is similar to international reports 22 25–33…”

Section: Introductionsupporting

confidence: 57%

Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial

et al. 2019

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IntroductionResistant Gram-positive organisms, such as methicillin-resistant staphylococci, account for a significant proportion of infections following joint replacement surgery. Current surgical antimicrobial prophylaxis guidelines recommend the use of first-generation or second-generation cephalosporin antibiotics, such as cefazolin. Cefazolin, however, does not prevent infections due to these resistant organisms; therefore, new prevention strategies need to be examined. One proposed strategy is to combine a glycopeptide antibiotic with cefazolin for prophylaxis. The clinical benefit and cost-effectiveness of this combination therapy compared with usual therapy, however, have not been established.Methods and analysisThis randomised, double-blind, parallel, superiority, placebo-controlled, phase 4 trial will compare the incidence of all surgical site infections (SSIs) including superficial, deep and organ/space (prosthetic joint) infections, safety and cost-effectiveness of surgical prophylaxis with cefazolin plus vancomycin to that with cefazolin plus placebo. The study will be performed in patients undergoing joint replacement surgery. In the microbiological sub-studies, we will examine the incidence of SSIs in participants with preoperative staphylococci colonisation (Sub-Study 1) and incidence of VRE acquisition (Sub-Study 2). The trial will recruit 4450 participants over a 4-year period across 13 orthopaedic centres in Australia. The primary outcome is the incidence of SSI at 90 days post index surgery. Secondary outcomes include the incidence of SSI according to joint and microorganism and other healthcare associated infections. Safety endpoints include the incidence of acute kidney injury, hypersensitivity reactions and all-cause mortality. The primary and secondary analysis will be a modified intention-to-treat analysis consisting of all randomised participants who undergo eligible surgery. We will also perform a per-protocol analysis.Ethics and disseminationThe study protocol was reviewed and approved by The Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/102) on 9 July 2018. Study findings will be disseminated in the printed media, and learnt forums.Trial registration numberACTRN12618000642280

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Section: Introductionsupporting

confidence: 57%

Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial

et al. 2019

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“…Antimicrobial prophylaxis in surgery is one of the most effective measures for preventing surgical site infections [7]. However, concerns arise about the appropriateness of currently recommended regimens for joint replacement surgery, as recent studies indicate that they may have inadequate activity against a substantial proportion of bacteria involved in surgical site infections, ranging from 54% to 68% [22,23,37,38]. The shifts in microbial aetiology observed in our investigation argue in favour of reassessing antimicrobial prophylaxis strategies.…”

Section: Discussionmentioning

confidence: 77%

Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

Benito

Franco

Ribera

et al. 2016

Clinical Microbiology and Infection

173

125

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It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.

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“…There is also concern that antibiotics for surgical prophylaxis were given for more than one day (97.4%), which is against current guidance as this can increase AMR rates [57,58]; however, this is similar to the situation seen in other countries [36,46,59]. The threat of surgical site infections should not be ignored while following guidelines [60,61]. A number of studies have highlighted that even in the most documented evidence-based area of practice, physicians are inclined to prescribe antibiotics for more than 24 hours [62].…”

Section: Discussionmentioning

confidence: 99%

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

Saleem

Hassali

Versporten

et al. 2019

Expert Review of Anti-infective Therapy

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Objective:In line with the recent global action plan for antimicrobial resistance, the first time such a comprehensive survey has been undertaken in Pakistan, sixth most populous country. Method:This point prevalence survey (PPS) was conducted in 13 hospitals among 7 different cities of Pakistan. The survey included all inpatients receiving an antibiotic on the day of PPS. A web-based application was used for data entry, validation, and reporting as designed by the University of Antwerp. Results:Out of 1954 patients, 1516 (77.6%) were treated with antibiotics. Top three most reported indications for antibiotic use were prophylaxis for obstetrics or gynaecological indications (16.5%) and gastrointestinal indications (12.6%) and lower respiratory tract infections (12.0%). Top three most commonly prescribed antibiotics were ceftriaxone (35.0%), metronidazole (16.0%) and ciprofloxacin (6.0%). Out of total indications, 34.2% of antibiotics were prescribed for community-acquired infections (CAI), 5.9% for healthcare-associated infections (HAI), and 57.4% for either surgical or medical prophylaxis. Of total surgical prophylaxis, 97.4% of antibiotics were given for more than one day. Conclusion:Study concluded that unnecessary prophylactic antibiotic use is extremely high and broad-spectrum prescribing is common. There is a considerable need to work on a national action plan of Pakistan on antibiotic resistance.

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Activity of Commonly Used Antimicrobial Prophylaxis Regimens against Pathogens Causing Coronary Artery Bypass Graft and Arthroplasty Surgical Site Infections in the United States, 2006–2009

Cited by 17 publications

References 31 publications

Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial

Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial

Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

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