What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

Ruta, David J.; Kadakia, Anish R.; Irwin, Todd A.

doi:10.1007/s11999-014-3733-4

Cited by 15 publications

(28 citation statements)

References 51 publications

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“…Our findings are supported by several recent studies exploring current antimicrobial use practices following minor surgeries and procedures. A recent study used a cross-sectional questionnaire to measure current prolonged prophylaxis practices in outpatient foot surgeries and found that 75% of providers administer systemic oral post-procedure prophylactic antimicrobials, most commonly cephalexin for five to seven days [11]. Recent work on outpatient urology found that rates of prolonged prophylaxis are approximately 22% among community-based urologists – very similar to what we found in this VA population [12].…”

Section: Discussionsupporting

confidence: 75%

“…Notably, the scope of this highly effective metric was limited only to a specific subset of major inpatient surgical procedures; outpatient procedures and some surgical subspecialties, including ENT and urology, were not included. In this large, multi-center, national VA cohort, we determined that implementation of early discontinuation of post-operative antimicrobial prophylaxis was strongly influenced by both surgical subspecialty and facility type; procedures performed within a large, complex hospital system were less likely to receive inappropriate prolonged post-procedural antimicrobial prophylaxis than the same procedures performed in ASCs and low-complexity hospital settings; this is supported by other recent work demonstrating high rates of inappropriate prolonged post-operative antimicrobial use in other outpatient and community settings [11, 12]. There was also a strong influence of surgical subspecialty type on the practice; prolonged prophylaxis was uncommon following orthopedic and general surgeries, which had procedures covered under the inpatient SCIP INF-3, but was frequent following ENT and urology procedures—which did not.…”

Section: Discussionmentioning

confidence: 80%

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Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Branch‐Elliman

Pizer

Dasinger

et al. 2019

Antimicrob Resist Infect Control

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Background Guidelines recommend discontinuation of antimicrobial prophylaxis within 24 h after incision closure in uninfected patients. However, how facility and surgical specialty factors affect the implementation of these evidence-based surgical prophylaxis guidelines in outpatient surgery is unknown. Thus, we sought to measure how facility complexity, including ambulatory surgical center (ASC) status and availability of ancillary services, impact adherence to guidelines for timely discontinuation of antimicrobial prophylaxis after outpatient surgery. A secondary aim was to measure the association between surgical specialty and guideline compliance. Methods A multi-center, national Veterans Health Administration retrospective cohort from 10/1/2015–9/30/2017 including any Veteran undergoing an outpatient surgical procedure in any of five specialties (general surgery, urology, ophthalmology, ENT, orthopedics) was created. The primary outcome was the association between facility complexity and proportion of surgeries not compliant with discontinuation of antimicrobials within 24 h of incision closure. Data were analyzed using logistic regression with adjustments for patient and procedural factors. Results Among 153,097 outpatient surgeries, 7712 (5.0%) received antimicrobial prophylaxis lasting > 24 h after surgery; rates ranged from 0.4% (eye surgeries) to 13.7% (genitourinary surgeries). Cystoscopies and cystoureteroscopy with lithotripsy procedures had the highest rates (16 and 20%), while hernia repair, cataract surgeries, and laparoscopic cholecystectomies had the lowest (0.2–0.3%). In an adjusted logistic regression model, lower complexity ASC and hospital outpatient departments had higher odds of prolonged antimicrobial prophylaxis compared to complex hospitals (OR ASC, 1.3, 95% CI: 1.2–1.5). Patient factors associated with higher odds of noncompliance with antimicrobial discontinuation included younger age, female sex, and white race. Genitourinary and ear/nose/throat surgeries were associated with the highest odds of prolonged antimicrobial prophylaxis. Conclusions Facility complexity appears to play a role in adherence to surgical infection prevention guidelines. Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. Such interventions may be especially useful for genitourinary and ear/nose/throat surgical subspecialties. Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ambulatory surgery centers and hospital outpatient departments in their efforts to improve this facet of patient safety. Electronic supplementary material The online version of this article (10.1186/s13756-019-0503-9) contains supplementary material, which is available to authorized users. ...

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 80%

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Branch‐Elliman

Pizer

Dasinger

et al. 2019

Antimicrob Resist Infect Control

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“…They underlined the necessity of using a suitable cost-effective oral antibiotic that also overcomes resistance mechanism of pathogens. [23] In the present study, it was observed that oral antibiotherapy was not preferred for pre-and postoperative periods in either hospital, which does not comply with literature data.…”

Section: Discussioncontrasting

confidence: 77%

Evaluation of Antibiotic Alternatives Used in Orthopedic Departments of 2 Hospitals According to Rational Use of Antibiotics

Isyar¹

2017

South Clin Ist Euras

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The present study is an analysis of appropriateness of antibiotics use for patients in whom infectious agent was detected. Data from patients in orthopedics and traumatology department of 2 hospitals in the same district were evaluated according to rational antibiotic drug use guidelines and culture antibiogram results. Methods: Data of patients diagnosed with infection between January 1, 2014 and December 31, 2015 in orthopedics and traumatology department of 2 different hospitals were analyzed. Patients diagnosed with malignancy or who were discharged from other departments were excluded. A standard form was used to collect demographic data, culture antibiogram results, details of infectious agent, source of culture material, posology of antibiotic used, duration and appropriateness of use, and length of hospital stay. Costs were estimated based on number of units used and price per unit according to 2014 Ministry of Health price list. Mean price of antibiotics used per patient was calculated and descriptive analyses were also completed. Results: It was determined that appropriate antibiotics for detected infectious agent were not always selected. Though there were effective, less expensive antibiotics that could have been used according to antibiogram results, more expensive antibiotics were often chosen, resulting in greater total cost. Conclusion: Multidisciplinary approach in patient care and use of evidence-based guidelines should be increased. Teams should be formed and led by infectious disease and pharmacology specialists. New strategies should be developed immediately in health economics and new pharmacoeconomic models should be initiated in orthopedics and traumatology departments.

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“…In human medicine, postoperative oral antibiotics are common and the most commonly prescribed antibiotic is cephalexin . Despite their common use, several studies have reported no benefits to postoperative prophylactic antibiotics on the occurrence of SSI in clean orthopedic procedures .…”

Section: Discussionmentioning

confidence: 99%

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

Andrade¹,

Schmiedt²,

Cornell³

et al. 2016

Veterinary Surgery

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Objective: To investigate the frequency, source, and risk factors of intraoperative (IO) surgeon and patient bacterial contamination during clean orthopedic surgeries, and to investigate the relationship between IO contamination and surgical site infection (SSI) in dogs. Study Design: Prospective clinical study. Sample Population: Client-owned dogs undergoing stifle surgery (n ¼ 100). Methods: IO cultures were taken in each case from surgical foot wrap, peri-incisional skin, surgical gloves, and the surgical team's hands. The environment (operating room [OR] lights, computers, scrub sink faucet, anesthesia gurney, and radiology table) was sampled every 5 months. Bacteria were identified and the contamination of each case was categorized. All gloves from the surgical team were collected and tested for perforations using a water infusion test. Cases were followed for at least 8 weeks to determine the presence or absence of SSI. Perioperative variables were evaluated for association with IO contamination and SSI. Results: Bacterial isolates were yielded from 81% of procedures from 1 or more sources; 58% had positive hand cultures, 46% had positive glove cultures, 23% had positive patient skin cultures, and 12% had positive foot wrap cultures. Staphylococcus spp. was the most commonly recovered bacteria. There was no apparent association between IO contamination and SSI. The highest level of environmental contamination was associated with the scrub sink faucet, followed by the radiology table, anesthesia gurney, and OR computers. The IO glove perforation rate was 18%. Conclusion: Clean orthopedic procedures commonly had clinically insignificant bacterial contamination. In our study, bacteria responsible for SSI did not appear to colonize the patient in the OR. In the veterinary literature, surgical site infection (SSI) rates for patients undergoing clean surgical procedures range from 3.6-5.8%. 1-3 Infection occurs despite adherence to well-accepted standards of surgical technique and environmental control designed to maintain a sterile surgical field. 4 Little objective information is available to validate how successfully these techniques control intraoperative contamination of surgical gloves, patient wraps, patient skin, and surgeon skin. In addition, it is not known how bacteria associated with surgical procedures influence complications. Understanding the bacterial ecology of veterinary operating rooms during the intraoperative period is critical in the search for the source of SSI, and allows for the development of evidence-based strategies to control the impact of pathogenic microbes in the surgical environment. In human surgical practice, published intraoperative glove contamination rates range from 14-56%. 5,6 Studies have not reported a clear primary source of contamination. One study reported surgical personnel, followed by the patient, and operating room environment as the most common sources of contamination 7 ; however, another study reported the operating room environment as the major source, followe...

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What are the Patterns of Prophylactic Postoperative Oral Antibiotic Use After Foot and Ankle Surgery?

Cited by 15 publications

References 51 publications

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

Evaluation of Antibiotic Alternatives Used in Orthopedic Departments of 2 Hospitals According to Rational Use of Antibiotics

Survey of Intraoperative Bacterial Contamination in Dogs Undergoing Elective Orthopedic Surgery

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