Use of Antimicrobial Drugs in General Hospitals. II. Analysis of Patterns of Use

Shapiro, Mervyn; Townsend, Timothy R.; Rosner, Bernard; Kass, Edward H.

doi:10.1093/infdis/139.6.698

Cited by 69 publications

(35 citation statements)

References 8 publications

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“…Considering the proven ability of prophylaxis with other antimicrobial agents to select for antibiotic-resistant organisms (1,24,37), it is likely that quinolone prophylaxis will demonstrate a similar propensity. Since perioperative antibiotic prophylaxis accounts for one-third of all antibiotic use among hospitalized patients (21,40), it exerts considerable selective pressure upon the important pathogens causing nosocomial infections within an institution.…”

Section: Resultsmentioning

confidence: 99%

Comparative prophylactic efficacies of ciprofloxacin, ofloxacin, cefazolin, and vancomycin in experimental model of staphylococcal wound infection

Kernodle

Kaiser

1994

Antimicrob Agents Chemother

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Recent shifts in the species and antibiotic resistance patterns of bacteria causing nosocomial infections present new challenges for providing effective prophylaxis in surgery. Traditional regimens lack activity against methicillin-resistant staphylococci and many gram-negative species causing nosocomial infections. The new fluoroquinolones exhibit in vitro activity against many emerging surgical wound pathogens. To determine the potential of this class of antimicrobial agents for use in surgery, we compared the prophylactic efficacies of ciprofloxacin and ofloxacin with those of cefazolin and vancomycin in a guinea pig model of abscess formation. Four Staphylococcus aureus strains, one Staphylococcus epidermidis strain, and one Staphylococcus haemolyticus strain were evaluated. Vancomycin was the most effective prophylactic agent, exhibiting in vivo activity against all strains which was superior or equivalent to those of all other agents tested. Cefazolin was the least effective agent and surpassed the two quinolones in prophylactic efficacy against only one organism, a quinolone-and methicillin-resistant strain of S. aureus. The two quinolones provided excellent protection against infection with all but the quinolone-resistant isolate. The in vivo emergence of quinolone resistance among quinolonesusceptible isolates was not detected. The methicillin-resistant, quinolone-susceptible S. epidermidis and S. haemolyticus isolates were extremely susceptible to prophylaxis, exhibiting 50% infective doses above 4 x 106 CFU for seven of the eight antibiotic-strain combinations. We conclude that ciprofloxacin and ofloxacin may be effective antistaphylococcal agents in surgery. The role of these agents remains to be defined, and the definition should include consideration of an adverse effect upon antibiotic resistance patterns of organisms causing nosocomial infections.The magnitude of the problem of surgical wound infections in the United States, as many as 920,000 infections annually (45), underscores the need for improved perioperative prophylaxis. While most surgeons use cephalosporins, the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci as surgical wound pathogens in many institutions (34, 38) has prompted a search for alternative prophylactic regimens. Although vancomycin use in neurologic, cardiothoracic, and vascular surgery (5,16,18,19,29,41,44)

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Section: Resultsmentioning

confidence: 99%

Comparative prophylactic efficacies of ciprofloxacin, ofloxacin, cefazolin, and vancomycin in experimental model of staphylococcal wound infection

Kernodle

Kaiser

1994

Antimicrob Agents Chemother

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“…The Spanish prevalence survey recorded an overall prophylaxis prevalence figure of 16-9 % in non-infected patients (including nonsurgical patients) (20). Other hospital-based studies report prophylaxis rates (incidence) in surgical patients between 5 and 30% (4,(21)(22)(23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

“…Part of the responsibility for this phenomenon rests upon the irrational use of antibiotics (1)(2)(3), and a considerable part of the antibiotics prescribed in the hospital are for prophylaxis (3,4). Since a large number of hospital-acquired infections occur either in the operation wound or as a direct consequence of a surgical procedure (5), the issue of prophylaxis is particularly sensitive in surgery.…”

Section: Introductionmentioning

confidence: 99%

National study on the utilization of prophylactic antibiotics in surgery, Belgium, 1986

Mertens

Verbist

Gordts³

et al. 1989

Epidemiol. Infect.

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SUMMARYDuring the last week of May 1986, a 1-week prospective study on antibiotic utilization in surgical patients was held in 104 (42%) of the 247 Belgian acute care hospitals. All surgical patients with a post-operative stay of at least 3 days were studied, involving 3112 patients. Each patient was observed for 7 days, starting from the day before surgery. Antibiotics were administered to 71·9% of all patients; 21·9% received therapeutic antibiotics and 52·9% prophylactic antibiotics; 2·9% received both. Of the 1285 patients undergoing a surgical procedure with no indication for antimicrobial prophylaxis, 50·7% nevertheless received prophylaxis; 92·8% of patients with a generally recognized indication for prophylaxis received antibiotic prophylaxis. Less than one fifth (17·1 %) of all prophylactic courses were stopped on the day of the intervention whilst 26·3% were continued up to the fifth post-operative day or beyond. The most frequently prescribed drugs for this indication included first and second generation cephalosporins and nitroimidazoles. The number of different generic drugs utilized per hospital ranged from 1 to 18 (mean: 7·7).

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“…The antibiotic dose is not usually repeated during the operation, even though most drugs in the cephalosporin class would be at very low levels at the time the operative site is at greatest risk of infection. Additionally, antibiotics prescribed for prophylaxis are often continued long beyond the perioperative period (11). When these drugs are given intravenously, they increase the risk of phlebitis.…”

mentioning

confidence: 99%

Comparison of ceforanide and cephalothin prophylaxis for vaginal hysterectomies

Jacobson¹,

Hebertson²,

Kasworm³

1982

Antimicrob Agents Chemother

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We compared the safety and efficacy of a six-dose regimen of cephalothin with a two-dose regimen of ceforanide for the prevention of infection after elective vaginal hysterectomy. A total of 150 patients were randomly assigned to either regimen. The overall incidence of documented pelvic infection was 5.3% and did not differ significantly between the prophylaxis groups when stratified by type of surgery. No serious adverse reactions were encountered in either group, but phlebitis was significantly more common in patients receiving cephalothin. We conclude that a two-dose regimen of ceforanide given intramuscularly is as effective as, and possibly better tolerated than, a six-dose regimen of cephalothin.

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Use of Antimicrobial Drugs in General Hospitals. II. Analysis of Patterns of Use

Cited by 69 publications

References 8 publications

Comparative prophylactic efficacies of ciprofloxacin, ofloxacin, cefazolin, and vancomycin in experimental model of staphylococcal wound infection

Comparative prophylactic efficacies of ciprofloxacin, ofloxacin, cefazolin, and vancomycin in experimental model of staphylococcal wound infection

National study on the utilization of prophylactic antibiotics in surgery, Belgium, 1986

Comparison of ceforanide and cephalothin prophylaxis for vaginal hysterectomies

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