Synthesizing evidence to guide the design and implementation of effective strategies for discontinuing postoperative antibiotic prophylaxis in surgical settings: an umbrella review post-WHO 2018 recommendations

Systematic Reviews, Journal Year: 2025, Volume and Issue: 14(1)

Published: Jan. 8, 2025

Abstract Background Postoperative antibiotic prophylaxis (PAP) involves using antibiotics after surgery to prevent surgical site infections (SSIs). However, studies have shown that PAP offers no additional benefits compared discontinuation incision closure, prompting its de-implementation unnecessary use may contribute resistance. We conducted this review synthesize evidence for guiding the design and implementation of effective strategies discontinuing practice optimizing in settings. Methods This umbrella searched articles from PubMed/MEDLINE Scopus, focusing on reviews human subjects SSIs, published English language 2019 5th July 2024. followed guidelines PRISMA-P PRIOR. The risk bias (methodological quality) was assessed AMSTAR-2. pooled ratio (RR) estimated a fixed-effects model (Mantel–Haenszel method), while I 2 used assess heterogeneity between reviews. registered with PROSPERO (CRD42024566124). Results In our review, we screened 1156 articles, 28 found eligible final analysis, involving over 457 primary studies. About 80,483 patients were involved 9 meta-analysis reviews, which estimate RR. significant continuing beyond 24-h post-surgery immediate discontinuation, RR : 1.07 (95% CI 0.97–1.17, 25%, p -value: 0.22). Strategies such as regularly assessing refining fit specific settings patients’ characteristics, multidisciplinary collaboration, availability resources needed best practices, education training healthcare workers SSI prevention stewardship, patient proper recommended improve practices Conclusions Prolonging did not show protective against SSIs. Our findings support 2018 WHO recommendation following closure clean clean-contaminated procedures. Further research are guide practice.

Language: Английский

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Point Prevalence Survey of Antibiotic Use in Level 1 hospitals in Zambia: Future Prospects for Antimicrobial Stewardship Programs

Infection and Drug Resistance, Journal Year: 2025, Volume and Issue: Volume 18, P. 887 - 902

Published: Feb. 1, 2025

The inappropriate prescribing and use of antibiotics have contributed to the emergence spread antimicrobial resistance (AMR). In Zambia, there is a paucity information on patterns among hospitalized patients in level 1 hospitals. This study investigated antibiotic five hospitals Lusaka, Zambia. cross-sectional utilized World Health Organization (WHO) Point Prevalence Survey (PPS) methodology in-patients admitted before 08:00 a.m. survey day August 2024. Data were analysed using IBM SPSS version 23.0. prevalence inpatients was 59.0%, with ceftriaxone being most prescribed. Antibiotics prescribed mainly for paediatrics male inpatients. found that 53.0% from Access group while 38.2% Watch Access, Watch, Reserve (AWaRe) classification. Adherence national treatment guidelines 36.0%, empirically without evidence culture sensitivity tests. high low adherence findings this demonstrate need establish strengthen stewardship programs laboratory capacity aid clinicians diagnosing, treating, managing across

Language: Английский

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Temporal Patterns and Treatment Associations in Complications Following Hip Arthroplasty

Diagnostics, Journal Year: 2025, Volume and Issue: 15(7), P. 815 - 815

Published: March 23, 2025

Background and Objectives: Hip arthroplasty is commonly performed to enhance mobility quality of life in patients with severe joint degeneration. However, post-surgery complications such as infections, dislocations, mechanical failures remain prevalent vary over time. This study examines the relationship between time intervals occurrence explores associations specific treatment modalities complications. It also investigates temporal patterns infectious inform more effective care. Materials Methods: A retrospective cohort was conducted on hip analyze distribution across medium-term (1-5 years) long-term (≥6 intervals. Treatment modalities, including debridement, lavage, antibiotics, interventions, were analyzed for their association Chi-Square tests used, significance set at p < 0.05. Results: significant found (χ2 = 58.149, df 19, 0.001). Infections medium-term, while dislocation, implant loosening, periprosthetic fractures common long-term. Antibiotics strongly linked 279.000, 0.001), treatments associated dislocations. Conclusions: The confirms that timing plays a critical role occurrence. Specific become different intervals, emphasizing need tailored strategies. infections interventions dislocations should be adjusted based timing. These findings highlight importance time-specific care suggest areas further research strategies risk factors.

Language: Английский

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Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications

JAC-Antimicrobial Resistance, Journal Year: 2023, Volume and Issue: 6(1)

Published: Dec. 28, 2023

Antimicrobial resistance (AMR) is a global public health problem that fuelled by the inappropriate prescribing of antibiotics, especially those from 'watch' and 'reserve' antibiotic lists. The irrational antibiotics particularly prevalent in developing countries, including Zambia. Consequently, there need to better understand patterns across sectors Zambia as basis for future interventions. This study evaluated using WHO indicators alongside 'access, watch reserve' (AWaRe) classification system post-COVID pandemic at faith-based hospital

Language: Английский

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Epidemiological analysis of intra-abdominal infections in Italy from the Italian register of complicated intra-abdominal infections—the IRIS study: a prospective observational nationwide study

World Journal of Emergency Surgery, Journal Year: 2025, Volume and Issue: 20(1)

Published: March 17, 2025

Abstract Background Intra-abdominal infections (IAIs) are common and severe surgical emergencies associated with high morbidity mortality. In recent years, there has been a worldwide increase in antimicrobial resistance intra-abdominal infections, responsible for significant mortality rates. To improve the quality of treatment, it is crucial to understand underlying local epidemiology, clinical implications, proper management resistance, both community- hospital-acquired infections. The IRIS study (Italian Register Complicated InfectionS) aims investigate epidemiology initial complicated IAIs (cIAIs) Italy. Material method This prospective, observational, nationwide (Italy), multicentre study. approved by coordinating centre ethic committee (Local Research Ethics Committee Pisa (Prot n 56478//2019). All consecutively hospitalized patients (older than 16 years age) diagnosis cIAIs undergoing surgery, interventional drainage or conservative treatment have included. Results 4530 included from 23 different Italian hospitals. Community Acquired infection represented 70.9% all cases. Among appendicitis, we found that 98.2% cases were community acquired (CA) 1.8% Healthcare-associated (HA) We observed CA 94.2% HA 5.8% Gastro Duodenal perforation majority colonic diverticulitis (28.3%) followed small bowel occlusion (19%) intestinal ischemia (18%). 27.8% presented septic shock. Microbiological Samples collected 3208 (70.8%) patients. 3041 intrabdominal sample 48.8% resulted positive. major pathogens involved be E.coli (45.6%). During hospital stay, empiric therapy was administered 78.4% Amoxicillin/clavulanate most antibiotic used (in 30.1% 30% occlusion, 30.5% cholecystitis, 51% abdominal wall hernia, 55% perforation) piperacillin/tazobactam (13.3% diverticulitis, 22.6% 24.2% ischemia, 28.6% pancreatitis). Empiric antifungal 2.6% no sign sepsis, 3.1% sepsis 4.1% Azoles 49.2% received therapy. overall rate 5.13% (235/4350). 16.5% required ICU (748/4350). accordance mortality, important highlight 35.7% perforation, 27.6% 25.6% 24.6% gastroduodenal complications ICU. Conclusion Antibiotic stewardship programs correct antimycotic prescription campaigns necessary ulteriorly adequacy drug usage reduce resistances burden. will help improving care cure next generations.

Language: Английский

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Infective endocarditis and litigation for compensation on healthcare-associated infections: an Italian sample analysis

Journal of Forensic and Legal Medicine, Journal Year: 2025, Volume and Issue: 113, P. 102861 - 102861

Published: April 6, 2025

Litigation related to Healthcare-Associated Infections (HAIs) in Italy represent a growing field of interest establishing the medico-legal link between infection and healthcare environment practices for compensation; it is little explored cardiovascular surgery regarding infective endocarditis (IE). We retrospectively analysed civil judgements on Italian region Emilia-Romagna from 2016 July 2024 using Ministry Justice national official database. The search was conducted online database 31, 2024, free word "endocarditis". Two authors independently full-text judgements: , those IE without relevance reason claim were excluded. Main items timeline outcome, with complaint motivation liability ascertainment. In-court confirmation causal reported. Twenty-five judgments retrieved. After screening inclusion, nineteen (11 first instance 8 appeal) included, overall 15 cases endocarditis. Of fifteen cases, median age 60.5 years, 73 % males, time 6 judgement 10 years and, if appealed, 16.5 years. Annual distribution claims linear over time. Eleven (67 %) confirmed as healthcare-associated trial. prevalent improper or delayed diagnosis and/or treatment IE. Valvular resulted 40 %, while more frequent pathogens Staphylococcus aureus (40 epidermidis (30 %). decided favour patient-claimant, an average cost €289.872, plus additional €55.296 case appeal. Only 25 appeal's judge changed decision. In all technical advisors appointed. This sample provides initial insight into litigation compensation endocarditis, highlighting specific characteristics compared HAIs management court. Medico-legal reasoning should be integrated prevention control policies clinical risk strategies.

Language: Английский

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The Role of Clinical Microbiology in Antimicrobial and Diagnostic Stewardship

Published: May 19, 2025

Language: Английский

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Oral Antibiotics Alone versus Oral Antibiotics Combined with Mechanical Bowel Preparation for Elective Colorectal Surgery: A Propensity Score-Matching Re-Analysis of the iCral 2 and 3 Prospective Cohorts

Antibiotics, Journal Year: 2024, Volume and Issue: 13(3), P. 235 - 235

Published: March 3, 2024

The evidence regarding the role of oral antibiotics alone (oA) or combined with mechanical bowel preparation (MoABP) for elective colorectal surgery remains controversial. A prospective database 8359 resections gathered over a 32-month period from 78 Italian surgical units (the iCral 2 and 3 studies), reporting patient-, disease-, procedure-related variables together 60-day adverse events, was re-analyzed to identify subgroup 1013 cases (12.1%) that received either oA MoABP. This dataset analyzed using 1:1 propensity score-matching model including 20 covariates. Two well-balanced groups 243 patients each were obtained: group B (MoABP). primary endpoints anastomotic leakage (AL) site infection (SSI) rates. Group vs. showed significantly higher AL risk [14 (5.8%) 6 (2.5%) events; OR: 3.77; 95%CI: 1.22–11.67; p = 0.021], while no significant difference recorded between two SSIs. These results strongly support use MoABP resections.

Language: Английский

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Documentation for Orthopaedic Surgery: An Audit to Ensure Compliance with the Most Recent Guidelines

Journal of Health and Rehabilitation Research, Journal Year: 2024, Volume and Issue: 4(1), P. 1782 - 1786

Published: March 31, 2024

Background: Consistent and thorough documentation in orthopaedic surgery is critical for ensuring quality patient care protecting the legal interests of surgeons. Adherence to Royal College Surgeons (RCS) guidelines fundamental achieving this. However, studies have identified a persistent deficiency compliance with these across various surgical specialities. Objective: The audit aimed evaluate existing RCS at Dr. Ziauddin Hospital implement tool improve practices. Methods: A closed-loop, two-cycle was conducted. first cycle retrospectively analysed 200 notes from January July 2023, using standardized operation sheet assess guidelines. Identified deficiencies were addressed by introducing an aide-memoir all operating rooms. second prospectively 100 August October 2023 impact intervention. Results: initial revealed 0% rate documenting date, time, type (elective or emergency). Following interventions, showed significant improvements, rates rising 100% date 87% identifying type. Additional parameters such as recording assistant's name incision details also improved, though exact numerical increases not specified. Conclusion: Introducing significantly enhanced This simple, effective facilitated remarkable improvement operative notes, underscoring need regular audits potential integration electronic systems.

Language: Английский

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Antibiotic prophylaxis for preventing surgical site infections after abdominal surgery

International Journal of Health Sciences, Journal Year: 2024, Volume and Issue: 8(S1), P. 705 - 716

Published: May 17, 2024

Surgical site infections (SSIs) pose severe burden in healthcare, specially laparoscopic surgeries. It,s the leading cause of morbidity, mortality, and healthcare costs. The reason to improve this strategy is enhance SAP practices for surgery by evaluating different antibiotics prophylaxis. Conducting a thorough examination on basis vast studies results effective implications rule out surgeries reduce SSI effort safety patient. Our research put great significance customized approaches SAP. In addition SAP,various factors such as kind procedure, patient-specific risks, antimicrobial resistance other preventive measures,such surgical antiseptics glycemic control, RCS also important preventing SSIs. SAP, techniques, postoperative care, stewardship after administration outside operative suite are needed. High-quality diverse populations development standardized protocols warranted optimize patient outcomes. To sum up discussion , chronological review gives esteemed awareness into improving procedures surgery. By amalgamating evidence-based guidelines promoting antibiotic management physicians surgeons can contribute reducing SSIs ameliorate worldwide.

Language: Английский

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