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

Peel, Trisha; Astbury, Sarah; Cheng, Allen; Paterson, David L.; Buising, Kirsty; Spelman, Tim; Tran‐Duy, An; Steiger, Richard S de

doi:10.1136/bmjopen-2019-033718

Cited by 9 publications

(6 citation statements)

References 61 publications

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“…These are already the most commonly used antibiotics in Brazil, according to a study that included data from ICUs, surgical clinics, and pediatrics from a teaching hospital in 2018 (Da Silva et al, 2021). Surgical sectors can consume more first-generation cephalosporins, as this class is used for surgical prophylaxis (Peel et al, 2019). In 2019, ANVISA issued a warning about the safety profile of fluoroquinolones, discouraging their use (Agência Nacional de Vigilância Sanitária, 2019).…”

Section: Reservementioning

confidence: 99%

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

et al. 2021

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Background: Microbial drug resistance is one of the biggest public health problems. Antibiotic consumption is an essential factor for the emergence and spread of multiresistant bacteria. Therefore, we aimed to analyze the antibiotics consumption in the Intensive Care Unit (ICU), identifying trends in the antibiotics use profile and microbiological isolates throughout the COVID-19 pandemic.Methods: We performed this retrospective observational study in intensive care units of a Brazilian tertiary hospital from January 2019 to December 2020. The primary outcome was antimicrobial consumption in the ICU, measured by defined daily doses (DDDs) per 100 bed-days. As a secondary outcome, bacterial infections (microbiological isolates) were calculated in the same fashion. Outcomes trends were analyzed using Joinpoint regression models, considering constant variance (homoscedasticity) and first-order autocorrelation assumptions. A monthly percent change (MPC) was estimated for each analyzed segment.Results: Seven thousand and nine hundred fifty-three patients had data available on prescribed and received medications and were included in the analyses. Overall, the use of antibiotics increased over time in the ICU. The reserve group (World Health Organization Classification) had an increasing trend (MPC = 7.24) from February to April 2020. The azithromycin consumption (J01FA) increased rapidly, with a MPC of 5.21 from January to April 2020. Polymyxin B showed a relevant increase from March to June 2020 (MPC = 6.93). The peak of the antibiotic consumption of Reserve group did not overlap with the peak of the pathogenic agents they are intended to treat.Conclusion: Overall antimicrobial consumption in ICU has increased in the context of the COVID-19 pandemic. The peaks in the antimicrobial’s use were not associated with the rise of the pathogenic agents they intended to treat, indicating an empirical use, which is especially concerning in the context of treating multidrug-resistant (MDR) infections. This fact may contribute to the depletion of the therapeutic arsenal for MDR treatment.

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Section: Reservementioning

confidence: 99%

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

et al. 2021

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“…8 Moreover, vancomycin remains the first choice of antimicrobial prophylaxis in centers with a high prevalence of MRSA. 9,10 On the other hand, the present survey raised a concern for potential GNB infections, as broader anti-GNB antimicrobial prophylaxis was prescribed in 30% of centers. This choice is in line with several studies pointing out that GNB also became significant causative agents of BSI in solid organ transplant (SOT) recipients, especially within the first days after transplantation.…”

Section: Discussionmentioning

confidence: 86%

A worldwide survey on perioperative antimicrobial prophylaxis for heart transplantation: From theory to clinical practice

Seminari

Ladini

Colaneri

et al. 2023

Transplant Infectious Dis

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Background The aim of our survey was to analyze the current attitudes toward antimicrobial prophylaxis in heart transplanting centers worldwide. Methods The survey was composed of a total of 50 questions, it consisted of four different sections as follows. The first section collected physicians’ personal data and centers’ general characteristics, second assessed the approach to patients colonized with multidrug‐resistant organisms (MDROs), while the third consisted of the infection risk related to cardiovascular devices, and antimicrobial treatment data, the last focused on donor's colonization. Results A total of 56 answers from 26 different countries were collected, mostly from Europe (n = 30) and the USA (n = 16). A first‐generation cephalosporin (58.9%) or a combination therapy with vancomycin (10.7%) were the most frequently prescribed antimicrobial prophylaxis. Roughly 30% of the centers used different antimicrobial prophylaxis,mostly including Gram negative bacteria coverage. The frequency of screening for multidrug resistant Gram‐negative bacteria was higher in Europe, where the percentage of centers providing screening for extended spectrum beta‐lactamase (46.7%) and carbapenem‐resistant Enterobacteriaceae (CRE) (53.3%) was higher than in other geographic area (p = .019; p = .013, respectively). Conclusion This survey highlights a heterogeneity of clinical practice concerning antimicrobial prophylaxis at transplant. The concern for potential Gram‐negative bacteria infection was responsible for broader antimicrobial coverage in 30% of centers.

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“…7 A randomized clinical trial is underway to explore dual routine use of prophylactic cephazolin and vancomycin, given increasing concern about antibiotic-resistant SSI. 38 Further research is recommended, including economic evaluation due to the high cost and burden of SSI, 32 and to explore the reduction in SSI risk we observed with the use of rivaroxaban for VTE prophylaxis. 23 This study has provided evidence of the association between cephalosporin dosing and timing, and the risk of SSI.…”

Section: Discussionmentioning

confidence: 99%

Timing and duration of antibiotic prophylaxis is associated with the risk of infection after hip and knee arthroplasty

et al. 2022

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Aims Antibiotic prophylaxis involving timely administration of appropriately dosed antibiotic is considered effective to reduce the risk of surgical site infection (SSI) after total hip and total knee arthroplasty (THA/TKA). Cephalosporins provide effective prophylaxis, although evidence regarding the optimal timing and dosage of prophylactic antibiotics is inconclusive. The aim of this study is to examine the association between cephalosporin prophylaxis dose, timing, and duration, and the risk of SSI after THA/TKA. Methods A prospective multicentre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKA/THA at one of 19 high-volume Australian public/private hospitals. Data were collected prior to and for one-year post surgery. Logistic regression was undertaken to explore associations between dose, timing, and duration of cephalosporin prophylaxis and SSI. Data were analyzed for 1,838 participants. There were 264 SSI comprising 63 deep SSI (defined as requiring intravenous antibiotics, readmission, or reoperation) and 161 superficial SSI (defined as requiring oral antibiotics) experienced by 249 (13.6%) participants within 365 days of surgery. Results In adjusted modelling, factors associated with a significant reduction in any SSI and deep SSI included: correct weight-adjusted dose (any SSI; adjusted odds ratio (aOR) 0.68 (95% confidence interval (CI) 0.47 to 0.99); p = 0.045); commencing preoperative cephalosporin within 60 minutes (any SSI, aOR 0.56 (95% CI 0.36 to 0.89); p = 0.012; deep SSI, aOR 0.29 (95% CI 0.15 to 0.59); p < 0.001) or 60 minutes or longer prior to skin incision (aOR 0.35 (95% CI 0.17 to 0.70); p = 0.004; deep SSI, AOR 0.27 (95% CI 0.09 to 0.83); p = 0.022), compared to at or after skin incision. Other factors significantly associated with an increased risk of any SSI, but not deep SSI alone, were receiving a non-cephalosporin antibiotic preoperatively (aOR 1.35 (95% CI 1.01 to 1.81); p = 0.044) and changing cephalosporin dose (aOR 1.76 (95% CI 1.22 to 2.57); p = 0.002). There was no difference in risk of any or deep SSI between the duration of prophylaxis less than or in excess of 24 hours. Conclusion Ensuring adequate, weight-adjusted dosing and early, preoperative delivery of prophylactic antibiotics may reduce the risk of SSI in THA/TKA, whereas the duration of prophylaxis beyond 24 hours is unnecessary. Cite this article: Bone Jt Open 2022;3(3):252–260.

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

Cited by 9 publications

References 61 publications

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

Increased Use of Antibiotics in the Intensive Care Unit During Coronavirus Disease (COVID-19) Pandemic in a Brazilian Hospital

A worldwide survey on perioperative antimicrobial prophylaxis for heart transplantation: From theory to clinical practice

Timing and duration of antibiotic prophylaxis is associated with the risk of infection after hip and knee arthroplasty

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