Preprocedure Antibiotics Reduce Infection After Cesarean Delivery

Preprocedure Antibiotics Reduce Infection After Cesarean Delivery

Nov 2012

A change in policy to give prophylactic antibiotics before incision instead of after cord clamping significantly reduced the risk of surgical-site infections in women undergoing cesarean delivery at a tertiary care hospital.

More than 31% of infants in the United States are delivered by cesarean section, and the rate of surgical-site infection ranges from 1.46 to 3.82 per 100 cesarean deliveries, depending on patient risk factors. Until recently, usual practice was to wait to administer antibiotics until after umbilical cord clamping to avoid masking neonatal sepsis. Practice guidelines issued in 2011, however, recommend giving antibiotics to all women within an hour before cesarean delivery.

Between 2003 and 2010, Barnes-Jewish Hospital in St. Louis implemented several interventions to reduce the risk of postcesarean infection, including the administration of prophylactic antibiotics before incision instead of after delivery, a ban on artificial nails among surgical staff, and streamlined operating room cleaning and disinfection procedures. Researchers used time series analysis to determine the effects of these interventions (after adjusting for secular trends in patient risk factors) on rates of postcesarean surgical-site infection in the eight-year study period.

Full Article:

American Journal Nursing

An investigation of antibiotic prophylaxis in implant practice in the UK.

Oct 2012

Ireland RS, Palmer NO, Lindenmeyer A, Mills N.

Source

Warwick Dentistry, The University of Warwick, Coventry, CV4 7AL.

Abstract

Background: 

There is increasing evidence of the inappropriate use of antimicrobials in dentistry and this may contribute to the problem of antimicrobial resistance. The research to date with regard to efficacy of antimicrobial prophylaxis in reducing failure of integration and postoperative complications when placing dental implants remains equivocal. The aim of this study was to investigate how dentists in the UK use antimicrobials prophylactically in implant practice.

Method: 

An e-mail link was provided in 2011 to an anonymous online (Smart-Survey) questionnaire using three databases of dentists who, by being on them, had registered an interest in placing dental implants. Absolute frequencies were used to describe the study sample demographics and examine the distribution of responses for all the variables investigated.

Results:

 One hundred and nine completed questionnaires were received. Seventy-two percent (n = 76) routinely prescribed prophylactic antibiotics for all procedures. There was a wide variation in the pre-operative and postoperative prescription regimens with the majority (84%) stating that it was to prevent infection at the site of surgery or to reduce a bacteraemia.

Conclusions: 

Although this was a small study with a low response rate, wide variations in antibiotic prescribing regimens with respect to drug, dose and duration were found. Further research is needed and guidelines developed to prevent antibiotic over prescribing and misuse.

British Dental Journal

Safety and efficacy of prophylactic single antibiotics administration in selective open colorectal surgery

Oct 2012

[Article in Chinese]

Lin GL, Qiu HZ, Xiao Y, Wu B, Niu BZ, Zhou JL, Yu XM, Xuan ZX.

Source

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China. qiuhzpumc@yahoo.com.cn.

Abstract

OBJECTIVE:

To investigate the safety and efficacy of prophylactic single antibiotic administration in selective open colorectal surgery.

METHODS:

Two hundred and seventy-five patients undergoing selective open colorectal surgery in the Peking Union Medical College Hospital from October 2009 to October 2011 were retrospectively reviewed. Prophylatic single antibiotic administration was used by intravenous infusion 30-60 min before incision. No antibiotics would be given after operation if there was no surgical site infection(SSI). According to the incidence of postoperative SSI, unexplained use of antibiotics, anastomotic leakage and distant-site infection, the clinical outcome was assessed to be prophylactic success, prophylactic failure or distant-site infection, respectively.

RESULTS:

There was no intraoperative or postoperative antibiotics related drug anaphylaxis in all the 275 patients. By prophylactic single antibiotic administration, there were prophylactic success in 243 patients(88.4%,243/275), prophylactic failure in 23(8.4%,23/275), distant-site infection in 9(3.3%,9/275). In the 23 patients with failed prophylaxis, there were SSI in 13(4.7%,13/275) patients, postoperative use of broad-spectrum antibiotics for unexplained fever in 2(0.7%,2/275), postoperative anastomotic leakage in 8(3.6%,8/222).

CONCLUSION:

Prophylactic single antibiotic administration in selective open colorectal surgery is safe and effective.

PubMed

Complications of cardiac implants: handling device infections.

2012

Nof E, Epstein LM.

Source

Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Abstract

Managing patients with cardiac implantable electrophysiological devices (CIED) infections can be challenging. The first step should be prevention, which involves patient selection, timing of implantation, and the procedure itself. After implantation, a high degree of suspicion should be applied in order to correctly diagnose patients with infected implanted devices. It is necessary to recognize that patients can present with a wide variety of signs and symptoms. Once diagnosed, the next step is determining if it is a local pocket infection or system infection. In almost every patient, in addition to antibiotics, complete removal of ALL hardware is required. Transvenous lead extraction is now safe and effective, but should only be performed at experienced centres with a practiced extraction team, all possible needed equipment, and cardiothoracic surgical backup. After extraction, the indication for CIED therapy should be re-evaluated to determine re-implantation is warranted. Timing of re-implantation depends on a variety of factors such as type of infection or valvular involvement and should be made in concordance with an infectious disease specialist. This review is aimed at introducing the steps needed to manage patients with infected cardiac devices.

PubMed

Treatment of Mycoplasma contamination in cell cultures with plasmocin.

2012

Uphoff CC, Denkmann SA, Drexler HG.

Source

Department of Human and Animal Cell Lines, Leibniz Institute DSMZ-German Collection of Microorganisms and Cell Cultures, 38124 Braunschweig, Germany.

Abstract

A high percentage of cell lines are chronically infected with various mycoplasma species. The addition of antibiotics that are particularly effective against these contaminants to the culture medium during a limited period of time is a simple, inexpensive, and very practical approach for decontaminating cell cultures. Here, we examined the effectiveness of the new antimycoplasma compound Plasmocin that has been employed routinely to cleanse chronically infected cell lines. In a first round of treatment 45 out of 58 (78%) mycoplasma-positive cell lines could be cured. In a second attempt using back-up cryopreserved original cells, four additional cell lines were cured; thus, the overall cure rate was 84%. Even if the mycoplasma contamination was not eradicated by Plasmocin, the parallel treatment with several other antibiotics (Baytril, BM-Cyclin, Ciprobay, MRA, or MycoZap) led to the cure of all 58 cell lines. The successful decontamination was permanent as mycoplasmas were no longer detected at day +14 posttreatment and at later time points as examined by PCR which is the most sensitive and specific mycoplasma detection method. Collectively, our results highlight certain antibiotics as effective antimycoplasma reagents and support the therapeutic rationale for their use in the eradication of this notorious cell culture contaminant.

PubMed

Drug-induced liver injury: present and future.

Sept 2012

Suk KT, Kim DJ.

Source

Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.

Abstract

Liver injury due to prescription and nonprescription medications is a growing medical, scientific, and public health problem. Worldwide, the estimated annual incidence rate of drug-induced liver injury (DILI) is 13.9-24.0 per 100,000 inhabitants. DILI is one of the leading causes of acute liver failure in the US. In Korea, the annual extrapolated incidence of cases hospitalized at university hospital is 12/100,000 persons/year. Most cases of DILI are the result of idiosyncratic metabolic responses or unexpected reactions to medication. There is marked geographic variation in relevant agents; antibiotics, anticonvulsants, and psychotropic drugs are the most common offending agents in the West, whereas in Asia, 'herbs' and 'health foods or dietary supplements' are more common. Different medical circumstances also cause discrepancy in definition and classification of DILI between West and Asia. In the concern of causality assessment, the application of the Roussel Uclaf Causality Assessment Method (RUCAM) scale frequently undercounts the cases caused by 'herbs' due to a lack of previous information and incompatible time criteria. Therefore, a more objective and reproducible tool that could be used for the diagnosis of DILI caused by 'herbs' is needed in Asia. In addition, a reporting system similar to the Drug-Induced Liver Injury Network (DILIN) in the US should be established as soon as possible in Asia.

PubMed

Antibiotics for clinically diagnosed acute rhinosinusitis in adults.

Oct 2012

Lemiengre MB, van Driel ML, Merenstein D, Young J, De Sutter AI.

Source

Department of General Practice and Primary Health Care, Ghent University, 6K3, De Pintelaan 185, Ghent, Belgium, 9000.

Abstract

BACKGROUND:

In primary care settings, the diagnosis of rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear.

OBJECTIVES:

To assess the effect of antibiotics in adults with clinically diagnosed rhinosinusitis in primary care settings.

SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2012), MEDLINE (January 1950 to February week 4, 2012) and EMBASE (January 1974 to February 2012).

SELECTION CRITERIA:

Randomised controlled trials (RCTs) of antibiotics versus placebo in participants with rhinosinusitis-like signs or symptoms.

DATA COLLECTION AND ANALYSIS:

Two authors independently extracted data and assessed the risk of bias. We contacted trial authors for additional information. We collected information on adverse effects from the trials.

MAIN RESULTS:

We included 10 trials involving 2450 participants. Overall, the risk of bias in these studies was low. Irrespective of the treatment group, 47% of participants were cured after one week and 71% after 14 days. Antibiotics can shorten the time to cure, but only five more participants per 100 will cure faster at any time point between 7 and 14 days if they receive antibiotics instead of placebo (number needed to treat to benefit (NNTB)) 18 (95% confidence interval (CI) 10 to 115, I(2) statistic 0%, eight trials). Purulent secretion resolves faster with antibiotics (odds ratio (OR) 1.58 (95% CI 1.13 to 2.22)), (NNTB 11, 95% CI 6 to 51, I(2) statistic 0%, three trials). However, 27% of the participants who received antibiotics and 15% of those who received placebo experienced adverse events (OR 2.10, 95% CI 1.60 to 2.77) (number needed to treat to harm (NNTH)) 8 (95% CI 6 to 13, I(2) statistic 13%, seven trials). More participants in the placebo group needed to start antibiotic therapy because of an abnormal course of rhinosinusitis (OR 0.49, 95% CI 0.36 to 0.66), NNTH 20 (95% CI 14 to 35, I(2) statistic 0%, eight trials). Only one disease-related complication (brain abscess) occurred in a patient treated with antibiotics.

AUTHORS' CONCLUSIONS:

The potential benefit of antibiotics in the treatment of clinically diagnosed acute rhinosinusitis needs to be seen in the context of a high prevalence of adverse events. Taking into account antibiotic resistance and the very low incidence of serious complications, we conclude that there is no place for antibiotics for the patient with clinically diagnosed, uncomplicated acute rhinosinusitis. This review cannot make recommendations for children, patients with a suppressed immune system and patients with severe disease, as these populations were not included in the available trials

PubMed

Antibiotics for treating human brucellosis.

Oct 2012

Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, Sadeghipour P.

Source

Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, HSC 2C7, Hamilton, Ontario, Canada, L8N 3Z5.

Abstract

BACKGROUND:

Brucellosis is the most common zoonotic infection in the world. Several antibiotics, separately or in combination, have been tried for treatment of human brucellosis. The inconsistencies between different treatment regimens warrants the need for a systematic review to inform clinical practice and future research.

OBJECTIVES:

To evaluate the effects of various antibiotic regimens, monotherapy or in combination with other antibiotics, for treating human brucellosis.

SEARCH METHODS:

We searched the Cochrane Infectious Diseases Group Specialized Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS until May 2012. We browsed the abstract books of several international infectious diseases conferences. We also checked the reference lists of all studies identified

SELECTION CRITERIA:

We included the randomized controlled trials on the pharmaceutical interventions in treatment of acute, chronic, non-complicated, and complicated human brucellosis. The outcomes of interest were relapse, persistence of symptoms at the end of treatment, and adverse drug effects.

DATA COLLECTION AND ANALYSIS:

Two authors independently assessed the studies for inclusion, risk of bias, and extracted relevant data using pre-designed extraction forms. The findings of homogenous studies were pooled using fixed-effect meta-analysis.

MAIN RESULTS:

In total we included 25 studies comparing various antibiotic regimens. Methods of allocation and concealment were inadequately described in half the studies, and only three were blinded. In comparisons of doxycycline plus rifampicin versus doxycycline plus streptomycin we found eight studies with 694 participants. For treatment failure, the doxycycline plus rifampicin regimen was less effective (risk ratio (RR) 1.91, 95% confidence interval (CI) 1.07 to 3.42, seven studies, 567 participants), relapse (RR 2.39, 95% CI 1.17 to 4.86), and minor adverse drug reactions (RR 1.38, 95% CI 0.99 to 1.92). In comparisons of doxycycline plus rifampicin against quinolone (ciprofloxacin or ofloxacin) plus rifampicin we found five studies of 336 participants. The pooled analysis did not demonstrate any significant difference between two regimens in terms of relapse and symptom persistence, but showed a non-significant higher risk of minor adverse reactions in doxycycline plus rifampicin (RR 1.80, 95% CI 0.78 to 4.18). Other comparisons were reported in a few heterogenous studies, and the pooled analyses, where applied, did not show any significant difference.

AUTHORS' CONCLUSIONS:

Doxycycline (six weeks) plus streptomycin (two or three weeks) regimen is more effective regimen than doxycycline plus rifampicin (six weeks) regimen. Since it needs daily intramuscular (IM) injection, access to care and cost are important factors in deciding between two choices. Quinolone plus rifampicin (six weeks) regimen is slightly better tolerated than doxycycline plus rifampicin, and low quality evidence did not show any difference in overall effectiveness.

PubMed

Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation.

Oct 2012

Horsley A, Jones AM.

Source

School of Translational Medicine, University Hospital of South Manchester, Southmoor Road, Manchester, UK, M23 9LT.

Abstract

BACKGROUND:

Chronic pulmonary infection is one of the hallmarks of lung disease in cystic fibrosis. Infections dominated by organisms of the Burkholderia cepacia complex, a group of at least 17 closely-related species of gram-negative bacteria, are particularly difficult to treat. These infections may be associated with a fulminant necrotising pneumonia, and are greatly feared by patients. Burkholderia cepacia bacteria are innately resistant to many common antibiotics and able to acquire resistance against many more. Since strict patient segregation was introduced to cystic fibrosis medical care, the incidence of the more virulent epidemic strains has fallen, and new infections are more likely to be with environmentally-acquired strains which seem to exhibit less virulence. Nonetheless, exacerbations of respiratory symptoms require effective therapy directed against the dominant bacterial species. Although evidence-based guidelines exist for the treatment of respiratory exacerbations involving Pseudomonas aeruginosa, the most common chronic infection in cystic fibrosis, these cannot be directly extended to Burkholderia cepacia complex infections. The aim of this review is to assess the available trial evidence for choice and application of treatments for Burkholderia cepacia complex infections.

OBJECTIVES:

To assess the effectiveness and safety of different antibiotic regimens in people with cystic fibrosis experiencing an exacerbation, who are chronically infected with organisms of the Burkholderia cepacia complex.

SEARCH METHODS:

We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of latest search: 29 November 2011.

SELECTION CRITERIA:

Randomised and quasi-randomised controlled trials of treatments for exacerbations of pulmonary symptoms in cystic fibrosis patients chronically infected with organisms of the Burkholderia cepacia complex.

DATA COLLECTION AND ANALYSIS: No trials were included in this review.

MAIN RESULTS: No trials were included in this review.

AUTHORS' CONCLUSIONS:

Burkholderia cepacia complex infections present a significant challenge for cystic fibrosis clinicians and patients alike. The incidence is likely to increase as the cystic fibrosis population ages and the problem of how to manage and treat these infections becomes more important. There is a lack of trial evidence to guide decision making and no conclusions can be drawn from this review about the optimal antibiotic regimens for cystic fibrosis patients with chronic Burkholderia cepacia complex infections. Clinicians must continue to assess each patient individually, taking into account in vitro antibiotic susceptibility data, previous clinical responses and their own experience. There is a clear need for multi-centre randomised clinical trials to assess the effectiveness of different antibiotic regimens in cystic fibrosis patients infected with organisms of the Burkholderia cepacia complex.

PubMed

Electrical signals guided entrapment and controlled release of antibiotics on titanium surface.

Oct 2012

Shi X, Wu H, Li Y, Wei X, Du Y.

Source

Department of Environmental Science, School of Resource and Environmental Science, Hubei Biomass-Resource Chemistry and Environmental Biotechnology Key Laboratory, Wuhan University, Wuhan 430079, China. shixwwhu@163.com.

Abstract

Electrical signals are used to trigger the entrapment and release of antibiotics on the surface of titanium plate. The entrapment of antibiotics relies on the electrochemically induced pH gradient generated at the titanium surface that allows the gelation of an aminopolysaccharide chitosan and codeposition of vancomycin, a common antibiotic, within chitosan gel. The release of vancomycin is controlled by an anodic signal imposed to the titanium plate that causes a pH decrease and erosion of chitosan gel. We show that the on demand entrapment and release of vancomycin at the surface of titanium plate is fundamentally altered and controlled by voltage. We expect that this rapid, mild and facile electrochemical process forantibiotics loading and release will find applications in controlled drug release from titanium implants.

PubMed

Occurrence of antibiotics as emerging contaminant substances in aquatic environment.

Oct 2012

Milić N, Milanović M, Letić NG, Sekulić MT, Radonić J, Mihajlović I, Miloradov MV.

Source

a Faculty of Medicine, University of Novi Sad, Hajduk Veljkova, 3 , Novi Sad , 21000 , Serbia.

Abstract

The occurrence of pharmaceutical residues in the environment has become a subject of growing concern. Due to the constant input of the emerging contaminants in the surface water via wastewater which leads to the long-term adverse effects on the aquatic and terrestrial organisms, special attention is being paid to their presence in the aquatic environment. Most of the emerging substances, especially pharmaceuticals, could not be completely removed using the wastewater treatment. Pharmaceuticals are usually water soluble and poorly degradable. They can pass through all natural filtrations and then reach the groundwater and, finally, the drinking water. The trace levels of antibiotics could have a negative impact on the environment and public health because of their inherent bioactivity. This article is an overview of the presence of the antibiotic residual concentrations, methods and levels of detection and possible risks to both health and environment.

PubMed

Kidney damage by antibiotics and chemotherapy

Sept 2012

[Article in Italian]

Savoldi S.

Source

S.C. Nefrologia e Dialisi, Ospedale di Cirie', Cirie' (TO) - Italy.

Abstract

Kidney damage caused by antibiotics is a common occurrence. In hospital wards it accounts for approximately 10% of episodes of acute renal failure and 60% of drug-related kidney damage. At greatest risk are elderly patients, especially those with preexisting chronic renal failure or comorbidities, suffering from dehydration, or hospitalized in intensive care units. The kidney's marked susceptibility to this type of damage is due to various factors including the high concentration of the toxic agent and the elevated blood flow in the kidney, and the relatively hypoxic environment. Kidney damage from antibiotics is characterized by different pathogenetic mechanisms and all kidney structures may be affected, resulting in different clinical syndromes. It is therefore of paramount importance to identify those antibiotics which have potential nephrotoxic effects so that their dosage can be based on the patient's renal function and all factors that may potentiate the toxicity can be corrected.

PubMed