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Orthopaedics & Traumatology, Surgery &... Feb 2021When all rules of hygiene have been scrupulously applied, antibiotic prophylaxis (ABP) is the one remaining means of further reducing surgical site infection risk. Its... (Review)
Review
When all rules of hygiene have been scrupulously applied, antibiotic prophylaxis (ABP) is the one remaining means of further reducing surgical site infection risk. Its efficacy in major orthopedic surgical procedures is proven. Guidelines for indications and ABP systemic administration have been long established and are able to address many questions. By extrapolation, the same protocols apply in closed fractures, whereas they are less certain in open fractures, where successive and still incomplete reassessments have been made. There are no specific ABP protocols in implant revision for mechanical or infectious causes or in high-grade open fractures, despite the high associated risk of surgical site infection. All means of prophylaxis need exploring in these contexts: various molecule combinations, and various local applications. Although ideas are by no means lacking, levels of evidence are low or undetermined. Awaiting more objective data, the focus has to be on the quality of implementation. It is easy enough to conceive of ABP in terms of the tissue pharmacokinetics of the antibiotic(s), but real-life implementation is a real organizational challenge. Optimizing practices in clearly defined indications is still the prime objective for surgical ABP.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Orthopedic Procedures; Orthopedics; Surgical Wound Infection; Traumatology
PubMed: 33316449
DOI: 10.1016/j.otsr.2020.102751 -
Heart (British Cardiac Society) Jun 2017The use of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) is controversial. In recent years, guidelines to cardiologists and dentists have... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The use of antibiotic prophylaxis (AP) for prevention of infective endocarditis (IE) is controversial. In recent years, guidelines to cardiologists and dentists have advised restriction of AP to high-risk groups (in Europe and the USA) or against its use at all (in the UK). The objective of this systematic review was to appraise the evidence for use of AP for prevention of bacteraemia or IE in patients undergoing dental procedures.
METHODS
We conducted electronic searches in Medline, Embase, Cochrane Library and ISI Web of Science. We assessed the methodological characteristics of included studies using the Strengthening the Reporting of Observational Studies in Epidemiology criteria for observational studies and the Cochrane Risk of Bias Tool for trials. Two reviewers independently determined the eligibility of studies, assessed the methodology of included studies and extracted the data.
RESULTS
We identified 178 eligible studies, of which 36 were included in the review. This included 10 time-trend studies, 5 observational studies and 21 trials. All trials identified used bacteraemia as an endpoint rather than IE. One time-trend study suggests that total AP restriction may be associated with a rising incidence of IE, while data on the consequences of relative AP restriction are conflicting. Meta-analysis of trials indicates that AP is effective in reducing the incidence of bacteraemia (risk ratio 0.53, 95% CI 0.49 to 0.57, p<0.01), but case-control studies suggest this may not translate to a statistically significant protective effect against IE in patients at low risk of disease.
CONCLUSIONS
The evidence base for the use of AP is limited, heterogeneous and the methodological quality of many studies is poor. Postprocedural bacteraemia is not a good surrogate endpoint for IE. Given the logistical challenges of a randomised trial, high-quality case-control studies would help to evaluate the role of dental procedures in causing IE and the efficacy of AP in its prevention.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Endocarditis; Humans
PubMed: 28213367
DOI: 10.1136/heartjnl-2015-309102 -
Medicina (Kaunas, Lithuania) Dec 2018The use of antibiotic prophylaxis in extraction and implant dentistry is still controversial, with varying opinions regarding their necessity. The overuse of... (Review)
Review
The use of antibiotic prophylaxis in extraction and implant dentistry is still controversial, with varying opinions regarding their necessity. The overuse of antibiotics has led to widespread antimicrobial resistance and the emergence of multi drug resistant strains of bacteria. The main aim of this work was to determine whether there is a genuine need for antibiotic prophylaxis in two common dental procedures; dental implants and tooth extractions. Electronic searches were conducted across databases such as Cochrane Register of Controlled Trials, the UK National Health Service, Centre for reviews, Science Direct, PubMed and the British Dental Journal to identify clinical trials of either dental implants or tooth extractions, whereby the independent variable was systemic prophylactic antibiotics used as part of treatment in order to prevent postoperative complications such as implant failure or infection. Primary outcomes of interest were implant failure, and postoperative infections which include systemic bacteraemia and localised infections. The secondary outcome of interest was adverse events due to antibiotics. The Critical Appraisal Skills Programme tool was used to assess the risk of bias, extract outcomes of interest and to identify studies for inclusion in the meta-analysis. Seven randomised clinical trials (RCTs) were included in the final review comprising = 1368 patients requiring either tooth extraction(s) or dental implant(s). No statistically significant evidence was found to support the routine use of prophylactic antibiotics in reducing the risk of implant failure ( = 0.09, RR 0.43; 95% CI 0.16⁻1.14) or post-operative complications ( = 0.47, RR: 0.74; 95% CI 0.34⁻1.65) under normal conditions. Approximately 33 patients undergoing dental implant surgery need to receive antibiotics in order to prevent one implant failure from occurring. There is little conclusive evidence to suggest the routine use of antibiotic prophylaxis for third molar extractive surgery in healthy young adults. There was no statistical evidence for adverse events experienced for antibiotics vs. placebo. Based on our analysis, even if financially feasible, clinicians must carefully consider the appropriate use of antibiotics in dental implants and extraction procedures due to the risk of allergic reactions and the development of microbial drug resistance.
Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Databases, Factual; Dental Implants; Drug Resistance, Multiple, Bacterial; Endocarditis; Female; Humans; Hypersensitivity; Male; Middle Aged; Randomized Controlled Trials as Topic; Surgical Wound Infection; Tooth Extraction; Young Adult
PubMed: 30513764
DOI: 10.3390/medicina54060095 -
Swiss Medical Weekly Feb 2021The Swiss societies of Infectious Diseases, Pediatric Cardiology and Cardiology and the Pediatric Infectious Disease Group of Switzerland present the current update on...
The Swiss societies of Infectious Diseases, Pediatric Cardiology and Cardiology and the Pediatric Infectious Disease Group of Switzerland present the current update on infective endocarditis prophylaxis in a joint initiative. The major focus of the revised recommendations is a comprehensive prevention campaign for all patients at risk for infective endocarditis. Antibiotic prophylaxis is recommended only for individuals at high risk. Within this high-risk group there is a ranking order, and the conditions are presented accordingly. Antibiotic prophylaxis is no longer recommended for patients with unrepaired ventricular septal defects and patent ductus arteriosus. Recommendations for antibiotic prophylaxis for the prevention of infective endocarditis are categorized in dental and non-dental interventions.
Topics: Antibiotic Prophylaxis; Child; Endocarditis; Endocarditis, Bacterial; Humans; Switzerland
PubMed: 33705562
DOI: 10.4414/smw.2021.20473 -
Journal of the American College of... Sep 2022Antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) is recommended to prevent infective endocarditis (IE) in those at high IE risk, but there are sparse...
BACKGROUND
Antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) is recommended to prevent infective endocarditis (IE) in those at high IE risk, but there are sparse data supporting a link between IDPs and IE or AP efficacy in IE prevention.
OBJECTIVES
The purpose of this study was to investigate any association between IDPs and IE, and the effectiveness of AP in reducing this.
METHODS
We performed a case-crossover analysis and cohort study of the association between IDPs and IE, and AP efficacy, in 7,951,972 U.S. subjects with employer-provided Commercial/Medicare-Supplemental coverage.
RESULTS
Time course studies showed that IE was most likely to occur within 4 weeks of an IDP. For those at high IE risk, case-crossover analysis demonstrated a significant temporal association between IE and IDPs in the preceding 4 weeks (OR: 2.00; 95% CI: 1.59-2.52; P = 0.002). This relationship was strongest for dental extractions (OR: 11.08; 95% CI: 7.34-16.74; P < 0.0001) and oral-surgical procedures (OR: 50.77; 95% CI: 20.79-123.98; P < 0.0001). AP was associated with a significant reduction in IE incidence following IDP (OR: 0.49; 95% CI: 0.29-0.85; P = 0.01). The cohort study confirmed the associations between IE and extractions or oral surgical procedures in those at high IE risk and the effect of AP in reducing these associations (extractions: OR: 0.13; 95% CI: 0.03-0.34; P < 0.0001; oral surgical procedures: OR: 0.09; 95% CI: 0.01-0.35; P = 0.002).
CONCLUSIONS
We demonstrated a significant temporal association between IDPs (particularly extractions and oral-surgical procedures) and subsequent IE in high-IE-risk individuals, and a significant association between AP use and reduced IE incidence following these procedures. These data support the American Heart Association, and other, recommendations that those at high IE risk should receive AP before IDP.
Topics: Aged; Humans; Antibiotic Prophylaxis; Cohort Studies; Dentistry; Endocarditis; Endocarditis, Bacterial; Medicare; United States
PubMed: 35987887
DOI: 10.1016/j.jacc.2022.06.030 -
The New England Journal of Medicine Sep 2023The efficacy of continuous antibiotic prophylaxis in preventing urinary tract infection (UTI) in infants with grade III, IV, or V vesicoureteral reflux is controversial. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The efficacy of continuous antibiotic prophylaxis in preventing urinary tract infection (UTI) in infants with grade III, IV, or V vesicoureteral reflux is controversial.
METHODS
In this investigator-initiated, randomized, open-label trial performed in 39 European centers, we randomly assigned infants 1 to 5 months of age with grade III, IV, or V vesicoureteral reflux and no previous UTIs to receive continuous antibiotic prophylaxis (prophylaxis group) or no treatment (untreated group) for 24 months. The primary outcome was the occurrence of the first UTI during the trial period. Secondary outcomes included new kidney scarring and the estimated glomerular filtration rate (GFR) at 24 months.
RESULTS
A total of 292 participants underwent randomization (146 per group). Approximately 75% of the participants were male; the median age was 3 months, and 235 participants (80.5%) had grade IV or V vesicoureteral reflux. In the intention-to-treat analysis, a first UTI occurred in 31 participants (21.2%) in the prophylaxis group and in 52 participants (35.6%) in the untreated group (hazard ratio, 0.55; 95% confidence interval [CI], 0.35 to 0.86; P = 0.008); the number needed to treat for 2 years to prevent one UTI was 7 children (95% CI, 4 to 29). Among untreated participants, 64.4% had no UTI during the trial. The incidence of new kidney scars and the estimated GFR at 24 months did not differ substantially between the two groups. Pseudomonas species, other non- organisms, and antibiotic resistance were more common in UTI isolates obtained from participants in the prophylaxis group than in isolates obtained from those in the untreated group. Serious adverse events were similar in the two groups.
CONCLUSIONS
In infants with grade III, IV, or V vesicoureteral reflux and no previous UTIs, continuous antibiotic prophylaxis provided a small but significant benefit in preventing a first UTI despite an increased occurrence of non- organisms and antibiotic resistance. (Funded by the Italian Ministry of Health and others; PREDICT ClinicalTrials.gov number, NCT02021006; EudraCT number, 2013-000309-21.).
Topics: Female; Humans; Infant; Male; Antibiotic Prophylaxis; Glomerulonephritis; Intention to Treat Analysis; Vesico-Ureteral Reflux; Anti-Bacterial Agents; Urinary Tract Infections; Drug Resistance, Bacterial
PubMed: 37702442
DOI: 10.1056/NEJMoa2300161 -
Dental and Medical Problems 2019Patients who have suffered a heart attack often require dental treatment. The inflammation of the oral cavity not only reduces the quality of life, but also negatively... (Review)
Review
Patients who have suffered a heart attack often require dental treatment. The inflammation of the oral cavity not only reduces the quality of life, but also negatively affects the course of ischemic heart disease. Dental treatment in patients with a history of myocardial infarction seems complicated, since these patients require special consideration with regard to the timing and form of dental treatment as well as to the precautions required. Patients at risk of cardiac complications that are greater than the benefits of dental treatment should be identified and only the most urgent conditions should be treated. The aim of this study was to present the latest guidelines for dental treatment in patients who have suffered myocardial infarction. We reviewed the available literature explaining when dental treatment can be undertaken, whether antibiotic prophylaxis is required, whether the patient can be anesthetized locally, and how to provide the maximum safety during the visit. The principles of the surgical treatment of patients receiving drugs that affect hemostasis were also reviewed.
Topics: Antibiotic Prophylaxis; Dental Care; Humans; Myocardial Infarction; Myocardial Ischemia; Quality of Life
PubMed: 31577073
DOI: 10.17219/dmp/109232 -
Polski Przeglad Chirurgiczny Nov 2018This paper presentes the current state of konwledge regarding the everlasting problem in surgery- surgical site infections. (Review)
Review
UNLABELLED
This paper presentes the current state of konwledge regarding the everlasting problem in surgery- surgical site infections.
INTRODUCTION
Surgical site infections have accompanied humanity since the dawn of time. Development of medicinie has reduced their percentage, but still they are a huge problem to face with. Surgical site infections cause a significant increase in a cost of hospitalization. This is the main reason why the whole scientific world is looking for prevention of these complications.
MATERIALS AND METHODS
The aim of the paper is to present current views on the etiology and methods of prevention of surgical site infection.
RESULTS
Patients own pathogens are most often responsible for surgical site infections. In hospitalizations over 5-7 days exogenous and hospital flora have the advantage. The most common isolated pathogen is Staphylococcus aureus. The percentage of MRSA-resistant methicillin strains is increasing. Pre-operative antibiotic therapy reduces the frequency of surgical site infection in many surgical procedures. Time of administration, type and dose of antibiotic play an important role in preventing post-operative infections. Pre-operative skin antiseptic is also important. The two most commonly used ingredients are chlorhexidine gluconate and povidone iodine. Recent reports point the chlorhexidine alcohol solution as an agent with a higher degree of efficacy.
CONCLUSIONS
In 2017 Centers for Disease Control and Prevention published the new guidelines for prevention of surgical site infections. This practical tips and tricks should be implemented to every surgical procedure.
Topics: Anti-Infective Agents, Local; Antibiotic Prophylaxis; Humans; Methicillin-Resistant Staphylococcus aureus; Preoperative Care; Staphylococcal Infections; Surgical Wound Infection
PubMed: 31481640
DOI: 10.5604/01.3001.0012.7253 -
International Journal of Environmental... Jun 2023Antibiotics have undoubtedly revolutionized medicine and the health and survival of patients with life-threatening infections, being nonetheless free from potential... (Review)
Review
Antibiotics have undoubtedly revolutionized medicine and the health and survival of patients with life-threatening infections, being nonetheless free from potential adverse effects, and the risk of intestinal dysbiosis, antimicrobial resistance, and the resulting consequences for the patient's health and the public purse. The present study narratively reviewed the epidemiological data on worldwide antibiotic consumption and administration in dental practice, patients' adherence to prescriptions, the antimicrobial resistance phenomenon in dentistry, and the evidence supporting and recommending appropriate antibiotic use in dental care. Eligible systematic reviews and original studies in humans published in the English language from January 2000 to 26 January 2023 were considered. A total of 78 studies, 47 on the epidemiology of antibiotic use and prescription in dentistry, 6 on antibiotic therapy in dentistry, 12 on antibiotic prophylaxis in dentistry, 0 on adherence of dental patients to antibiotic prescription, and 13 on antimicrobial resistance in dentistry, were presently considered. Retrieved evidence revealed that antibiotics are frequently overused and misused in dental practice, dental patients frequently do not adhere to prescriptions, and antimicrobial resistance in dentistry is a still rising phenomenon also secondary to improper oral antiseptics use. The present findings highlighted the need to establish more evidence-based and accurate antibiotic prescriptions to sensitize dentists and dental patients to minimize and rationalize the use of antibiotics only when it is indicated and necessary, improve patients' adherence, and enhance knowledge and awareness of the antimicrobial resistance in dentistry.
Topics: Humans; Anti-Bacterial Agents; Dentists; Antibiotic Prophylaxis; Prescriptions; Dentistry
PubMed: 37297629
DOI: 10.3390/ijerph20116025 -
Minerva Anestesiologica Jan 2015Surgical site infections (SSIs) are a frequent cause of morbidity following surgical procedures. Gram-positive cocci, particularly staphylococci, cause many of these... (Review)
Review
Surgical site infections (SSIs) are a frequent cause of morbidity following surgical procedures. Gram-positive cocci, particularly staphylococci, cause many of these infections, although Gram-negative organisms are also frequently involved. The risk of developing a SSI is associated with a number of factors, including aspects of the operative procedure itself, such as wound classification, and patient-related variables, such as preexisting medical conditions. Antimicrobial prophylaxis (AP) plays an important role in reducing SSIs, especially if patient-related risk factors for SSIs are present. The main components of antimicrobial prophylaxis are: timing, selection of drugs and patients, duration and costs. Compliance with these generally accepted preventive principles may lead to overall decreases in the incidence of these infections. Ideally the administration of the prophylactic agent should start within 30 minutes from the surgical incision. The duration of the AP should not exceed 24 hours for the majority of surgical procedures. The shortest effective period of prophylactic antimicrobial administration is not known and studies have demonstrated that post-surgical antibiotic administration is unnecessary. Furthermore, there were no proven benefits in multiple dose regimens when compared to single-dose regimens. The choice of an appropriate prophylactic antimicrobial agent should be based primarily on efficacy and safety. Broad spectrum antibiotics should be avoided due to the risk of promoting bacterial resistance. Cephalosporins are the most commonly used antibiotics in surgical prophylaxis; specifically, cefazolin or cefuroxime are mainly used in the prophylaxis regimens for cardio-thoracic surgery, vascular surgery, hip or knee arthroplasty surgery, neurosurgical procedures and gynecologic and obstetric procedures. A review of the prophylactic regimens regarding the main surgical procedures is presented.
Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Humans; Surgical Procedures, Operative; Surgical Wound Infection
PubMed: 24561611
DOI: No ID Found