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A young woman, known to have glycogen storage disease type 1B (GSD1B) presents with severe periodontitis. GDS1B causes decreased hepatic and renal glucose production and in many cases neutropenia and neutrophil dysfunction leading to recurrent infections. It was decided to treat the patient by extraction of the most affected teeth and retention of the remaining teeth through periodontal treatment, both with antibiotic prophylaxis. After a follow-up period of 1.5 years, during which there was no visible improvement, it was decided to do a full dental extraction and fabricate complete dentures. Due to subsequent bone resorption in both jaws, the dentures were not functional. After consulting the internist and the oral and maxillofacial surgeon, the decision was then made to place dental implants in both the upper and lower jaw for implant-supported prosthetics. After successful treatment and an osseointegration period, the prosthetics were placed. 1 year after placement, there is a stable implantological situation, without pockets or apparent bone loss. The start of SGLT2 medication may have played a significant role in this.

Surgical interventions in the dental practice as well as interventions in the ear, nose and throat area, the skin, the respiratory, gastrointestinal or urogenital tract can lead to transient bacteremia. As a result, an infectious endocarditis (IE) may occur. Overall, this is a rare occurrence, but it is associated with high morbidity and mortality. Individuals with a history of IE, implanted valve prostheses and certain congenital heart defects are at the highest risk for IE. In dental medicine, there is a controversial debate as to whether bacteremia can occur already by chewing or brushing the teeth. Antibiotic prophylaxis for prevention of endocarditis should only be given to those patients who are at the highest risk for IE. This article discusses novelties and Swiss recommendations for antibiotic prophylaxis for highrisk patients for IE in the dental practice. In this context, antibiotic prophylaxis has gained importance for dentists, which is also reflected by the fact that the recommendations on the new endocarditis card are limited solely to dental interventions.

Congenital Heart Disease (CHD) is one of the most common developmental anomalies seen in children and there is an increased risk of developing oral disease and its systemic effects in children with CHD. The present case report highlights the dental management of a 10-year-old boy with CHD and dextrocardia. The diagnosis for the patient included dextrocardia (where the position of the heart is developmentally changed from the left to the right-side), complete atrioventricular septal defect and double outlet right ventricle with pulmonary stenosis. After consultation, diagnosis and treatment planning and upon obtaining consent from the parents and modifying the child’s behaviour, the dental needs of the child were addressed on a visit-by-visit basis. A quadrant approach was adopted to complete the extractions of all retained carious primary teeth, followed by restorative treatment. Oral prophylaxis was performed, followed by topical fluoride application and the patient was then referred to the Department of Orthodontics for treatment of malalignment. This case report focuses on the guidelines followed for antibiotic prophylaxis against Infective Endocarditis (IE) and highlights the importance of maintaining good oral health for this group of patients. The dental management of children with CHD can be complex, as oral health is often neglected by both parents and patients. Cardiovascular problems can significantly impact both the child and the parent, affecting management and financial implications. The dental considerations require early diagnosis of dental problems and prompt treatment to prevent complications and difficulties in implementing treatment due to systemic repercussions. The present case report aimed to improve dental care for children with severe systemic alterations, as there is a lack of scientific literature regarding the dental management of paediatric patients with CHD.

Abstract Background Surgical site infections continue to be a significant challenge following colorectal surgery. These can result in extended hospital stays, hospital readmissions, increased treatment costs, and negative effects on patients’ quality of life. Antibiotic prophylaxis plays a crucial role in preventing infection during surgery, specifically in preventing surgical site infections after colorectal surgery in adult patients. However, the optimal antibiotic regimen is still unclear based on current evidence. Considering the limitations of existing reviews, our goal is to conduct a comprehensive systematic review and network meta-analysis of randomized controlled trials to evaluate the comparative benefits and harms of available antibiotic prophylaxis regimens for preventing surgical site infections following colorectal surgery in adult patients. Methods We will search the Medline, EMBASE, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases to identify relevant randomized controlled trials. We will include trials that (1) enrolled adults who underwent colorectal surgeries and (2) randomized them to any systemic administration of antibiotic (single or combined) prophylaxis before surgery compared to an alternative systemic antibiotic (single or combined antibiotic), placebo, control, or no prophylactic treatment. Pairs of reviewers will independently assess the risk of bias among eligible trials using a modified Cochrane risk of bias instrument for randomized trials. Our outcomes of interest include the rate of surgical site infection within 30 days of surgery, hospital length of stay, 30-day mortality, and treatment-related adverse effects. We will perform a contrast-based network meta-analysis using a frequentist random-effects model assuming a common heterogeneity parameter. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be utilized to assess the certainty of evidence for treatment effects. Discussion By synthesizing evidence from available RCTs, this study will provide valuable insight for clinicians, patients, and health policymakers on the most effective antibiotics for preventing surgical site infection. Systematic review registration PROSPERO CRD42023434544.

Objectives: Doxycycline is commonly prescribed as the primary prophylactic treatment for women undergoing hysterosalpingography (HSG). This study aimed to compare the prophylactic effectiveness and safety of azithromycin and doxycycline in terms of treating infections caused by HSG. Materials and Methods: This double-blind randomized clinical trial enrolled 107 women referred to Amiralmomenin Hospital in Arak, Iran, for HSG. After evaluation based on inclusion and exclusion criteria, the participants were randomly allocated to either the doxycycline or azithromycin group. The primary outcome was the incidence of adverse effects. The patients were also followed up to determine PCR test results for the clearance of chlamydia infection. Results: The cumulative incidence of side effects was 1.85% in the doxycycline group, with adverse effects observed in only one patient. Conversely, no adverse effects were reported in the azithromycin group (P = 0.505). In the doxycycline group, one patient (1.85%) tested positive in the PCR test, while no positive PCR tests were recorded in the azithromycin group. Neither group exhibited cases of fever or required additional treatments. The results of statistical analyses did not reveal any statistically significant differences between the compared groups (P > 0.05). Conclusions: A single dose of azithromycin could be considered interchangeable with a 1-week course of doxycycline as antibiotic prophylaxis in women undergoing HSG, as it provides similar effectiveness and safety.

Introduction: Although debatable, prophylactic antibiotics may be required for patients undergoing cholecystectomy for symptomatic gallstone disease with certain associated risk factors. Our study aimed to perform a non-randomised prospective comparative trial evaluating a single-dose pre-operative antibiotic versus a triple-dose prophylactic post-operative antibiotic in patients with symptomatic uncomplicated cholelithiasis undergoing laparoscopic cholecystectomy. Methodology: This study was a non-randomised prospective comparative study in a single institution. Two hundred patients were enrolled and allocated to two groups. Group A patients were given a single dose of pre-operative prophylactic antibiotic, and Group B patients received a triple dose of prophylactic antibiotic therapy. We also studied the bacteriological profile of bile in all the patients using bile culture and antibiotic sensitivity, and we analysed their association with post-operative surgical site infection (SSI). Results: All the patients were followed up on post-operative days 7 and 30. On post-operative day 7, 2% of patients in Group A and 1% of patients in Group B were found to have SSI, and no statistically significant difference in SSI between the two groups was noted (P = 0.558). On post-operative day 30, no patient was found to have a SSI in either of the two groups. Moreover, post-operative bile culture was obtained in all the cases, and 6% of patients had a positive bile culture. However, none of them developed SSIs on post-operative day 7. Conclusion: A single-dose pre-operative antibiotic is as effective as three perioperative doses in preventing SSI in laparoscopic cholecystectomy for symptomatic, uncomplicated gallstone disease. Our study did not associate port-site SSI with a positive bile culture.

Background: Postoperative wound infection may be due to many causes, of which “microbial contamination” is the factor that is influenced by antibiotic administration. Since the concept of antimicrobial prophylaxis has emerged, several workers have searched for optimal antimicrobial drugs, their routes, and the timing of their administration, with the ultimate goal of achieving zero sepsis. The use of preoperative systemic antibiotics has brought down the incidence of wound infection considerably. Aims and Objectives: The aim is to identify which drug is the best option for single-dose antibiotic prophylaxis to prevent postoperative wound infection. Materials and Methods: This is a prospective study. The study was conducted in the surgical ward of J.A. Group of Hospitals, Gwalior, Madhya Pradesh, India, from May 2020 to April 2022. Patients of all sexes and ages were included in the study. Patients were divided into five groups according to a class of antibiotics. The study consisted of a total of 125 patients admitted to the surgical ward. Statistical Package for the Social Sciences–(10 systems) was applied for the study. P

Abstract Aims To evaluate the effect of antibiotic prophylaxis(AP) in the prognosis of Post-neurosurgical meningitis(PNM) patients. Methods A cohort analysis was performed using the clinical database in Beijing Tiantan Hospital and Capital Medical University. Data were collected on patients with the diagnosis of PNM (n = 3931) during 2012.01 to 2022.04. The microbial distribution, types of AP, and 42 and 90 days survival analysis of AP patients were evaluated using probable statistical methods. Independent risk factors for mortality were established by constructing a logistic regression analysis. Result A total of 1,190 patients were included in this study, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus occupied the highest proportion. Of them, 929 cases received AP, cefuroxime and ceftriaxone are the most frequent used antibiotics. In addition, We found that PNM patients without AP significantly increased the 42 days and 90 days all-cause mortality rates. The use of different levels of AP did not improve patient outcomes, and ICU admission and assisted mechanical ventilation (AMV) were identified as independent mortality risk factors for PNM patient received AP. Conclusions AP plays an important role in the prognosis of PNM patients and has a significant function in improving prognosis. The prevention of PNM with antibiotics prior to neurosurgery should be emphasized in clinical practice, and appropriate selection of antibiotics is necessary to prevent the occurrence of infection and inhibit the emergence of antibiotic-resistant bacteria.

Introduction: Bile is deemed a sterile fluid, with the presence of clinical conditions like cholelithiasis, cholecystitis, previous biliary interventions, biliary strictures, and so on, leading to bile stasis, and increases the chances of bacteriobilia. In this study, we recognize the bacterial spectrum of microorganisms isolated from bile samples, diagnostic parameters, and antibiotic sensitivity patterns. Methods: A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2021 to 2022 to evaluate biliary infections in patients who underwent surgical procedures related to the biliary tract and associated organs. Results: A total of 234 patients’ bile samples were included in our study. The mean age of patients was 48.04 ± 14.74 years, with more patients below the age of 65 years among those with infected bile samples. One hundred and sixty-three (163/234, 69.66%) patients infected by 209 pathogenic microorganisms were recognized. The most common microorganism isolated was Escherichia coli (83/209, 39.71%), followed by Pseudomonas aeruginosa (37/209, 17.7%). Acinetobacter baumannii and Klebsiella pneumoniae isolate owed to more than 90% penicillin, extended-spectrum beta-lactamase, carbapenem, and fluoroquinolone resistance among all isolates. Length of hospital stay, malignant obstruction, and chronic kidney disease were identified as statistically significant risk factors that lead to the isolation of multi-drug-resistant isolates from bile culture. Conclusion: We recognized the spectrum of pathogens causing biliary tract infections at our center along with the antibiotic resistance pattern to guide and facilitate prompt and appropriate treatment by primary health care professionals and family medicine practitioners.

Background. Infectious complications during induction chemotherapy of acute myeloid leukaemia are very common. Prophylactic use of antibiotics however is an ongoing challenge in this situation due to bacterial multi-drug resistance. The aim of this study was to provide a comprehensive overview of the incidence of infectious complications in patients with AML undergoing induction therapy using the "7+3" protocol without routine antibiotic prophylaxis at one clinical site providing specialised haematological care in the Czech Republic, over a period of 15 years. The study also evaluates the aetiological spectrum of causative agents and the development of antibiotic resistance in the context of the use of the various classes of antibiotics. The analysis includes evaluation of the importance of risk factors for infectious complications and their impact on treatment of the underlying disease. The data are compared with published figures for similar cohorts of patients. Patients and Methods. This study presents a retrospective analysis of infectious complications in 242 patients with acute myeloid leukaemia undergoing the first cycle of induction therapy without routine antibiotic prophylaxis in one clinical site in Czech Republic during years 2006-2020. Results. A total of 363 febrile episodes (FE) were recorded. At least 1 FE during the induction was detected in 229 (94.6%) patients. Clinically defined infection was the cause in 96 (26.4%) FEs and blood stream infection in 69 (19.0%) FEs. Both complications occurred simultaneously in 29 (8.0%) FEs. 169 (46.6%) FEs were evaluated as fever of unknown origin (FUO). The achievement of complete remission had a significant effect on the duration of the FE (6 vs. 9 days, P=0.0005) and on the overall survival duration (79.3 vs. 6.5 months, P

Background. The available comparative studies on issues of choosing antibiotic regimen in dental implantation are often observational and describe only visible postoperative signs. More objective assessment of postoperative period and comparison of approaches requires laboratory tests. One of the methods to be used at a dental appointment is to study examination of the biochemical properties of saliva.Objective. To carry out comparative evaluation of single and prolonged regimens of amoxicillin/clavulanate administration after dental implantation indicated by nonspecific immunity in mixed saliva.Methods. A randomized uncontrolled trial of 30 partially edentulous patients was conducted. The clinical phase of the study was performed at the Department of Propaedeutics of Surgical Dentistry, MSUMD; the laboratory phase — at the Pharmacology and Biological Chemistry Departments, MSUMD, in 2021–2022. The study included patients aged 18 to 75 years, anatomically suitable for dental implant placement. Patients with somatic diseases in the decompensation stage were excluded from the study. Patients were randomized into 2 groups. The group 1 was prescribed to take amoxicillin/clavulanate pills (875+125 mg) 30 minutes before surgery. The group 2 was to take amoxicillin/clavulanate (875+125 mg) 30 minutes before surgery and then 1 pill of Amoxicillin/ Clavulanate (500+125 mg) 2 times a day for 7 days after surgery. To evaluate the efficacy of the applied antibiotic therapy, unstimulated mixed saliva was collected from all patients on an empty stomach, 1 ml before surgery and on the third day after surgery. The amount of immunoglobulins of G, M, A classes (mg/l) and б-amylase activity (IU/l) were determined spectrophotometrically in the saliva samples. Statistical processing of laboratory data was performed using Welch's t-test by means of Statistica 10 Pro (StatSoft, USA). Intergroup and intragroup differences were considered significant at p ≤ 0.05.Results. Based on the saliva proteins examined, the most pronounced difference between the patient groups was obtained for IgA. For other studied parameters of saliva, no significant difference between the groups was obtained on the third day after the surgery. However, despite the absence of a statistical difference, a tendency to a stronger increase in the amount of IgA, G, IgM, salivary amylase activity was noted for all indicators; moreover, a high correlation between immunoglobulins of class A, G, immunoglobulins of class G, M, and immunoglobulins of class A, M was revealed.Conclusion. Among patients with the prolonged regimen, the groups did not differ significantly in such saliva parameters as immunoglobulins G and M and salivary б-amylase activity, however, a tendency to a stronger increase of the mentioned immunoglobulins in the saliva of group 1 patients was revealed. The most significant difference was recorded for immunoglobulin A in saliva, the amount of which was significantly lower in the group of prolonged antibiotic administration (p < 0.05).

Objective: to compare pre-operative prophylactic antibiotics with no antibiotics for removing an impacted mandibular third molar tooth to avoid Infection. Study Design: Quasi-experimental study Place and Duration of Study: Ayyub Teaching Hospital Abbottabad, Pakistan from Jan 2018 to June 2018 Methodology: Two hundred four study participants were divided into two groups: those with their third mandibular molar teeth impacted and those without. One Group was given an antibiotic before surgery; the other received a placebo. Both groups were followed after surgery and were observed for the development of post-operative Infection. Results: There were 204 participants in our study whose age group ranged from 17-30 years, (mean age 23.89±2.39 years). Of 204 individuals, 182(89.2%) were treated well, whereas 22 individuals were diagnosed with Infection (10.8%). 18 individuals (17.6%) developed Infection in the Placebo Group, whereas 4(3.9%) patients developed infection in the Antibiotic Group. Conclusion: The frequency of post-operative infections is reduced in individuals with an impacted third mandibular molar tooth who are given antibiotics before surgery.

Abstract Objectives Patients with vascular anomalies (VAs) who receive oral sirolimus may be at high risk of infectious complications. Antibiotic prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMZ) has been advocated. However, there have been few evidence-based analyses on this topic. This study assessed the effect of prophylactic TMP-SMZ on the incidence of infections in VA patients receiving sirolimus monotherapy. Methods A retrospective, multicenter chart review was performed on all VA patients receiving sirolimus treatment from August, 2013 to January, 2021. Results Before January 2017, 112 patients were treated with sirolimus without antibiotic prophylaxis. In the subsequent period, 195 patients were treated with TMP-SMZ for at least 12 months during sirolimus therapy. The percentage of patients with at least one serious infection during the initial 12 months of sirolimus treatment did not differ between the groups (difference, 1.1%; 95% CI − 7.0–8.0%). We observed no difference in the incidence of individual infection or total adverse events between the groups. The rate of sirolimus discontinuation due to adverse events did not differ significantly between groups. Conclusions We demonstrated that prophylactic TMP-SMZ does not decrease the incidence of infection or improve tolerance in VA patients receiving sirolimus monotherapy.

Abstract Introduction Third molar extraction surgery is a common dental procedure, often challenging with increased post-operative complications. The need for antibiotic prophylaxis in these cases remains debated. Objective The aim of this study was to evaluate the effect of antibiotic prophylaxis on the postoperative clinical course of third molar extraction surgeries. Material and method Sixty-three patients were randomly allocated into two groups after extraction of the four third molars. ATB group (N = 33) the patients received 1g of amoxicillin one hour before the surgical procedure, CTR group (N = 30) the patients did not receive antibiotic prophylaxis. Clinical analyses were performed at 3, 7, 14, and 30 days after the surgical procedure. These analyses consisted of assessing oedema, variation in mouth opening, and soft tissue healing. Furthermore, patient-centered analyses were also carried out through the application of the visual analogue scale (VAS) to assess pain, inflammation, bleeding, difficulty opening the mouth, and chewing. Result No influence of antibiotic prophylaxis was observed on the evolution of clinical parameters of healing, oedema, and mouth opening. Patients did not notice differences regarding their comfort during the postoperative period. Conclusion The incidence of complications observed in the present study was low and was not related to infectious processes. The use of prophylactic antibiotic therapy has no beneficial effects on the postoperative clinical course in third molar extraction.

Objective: To assess the risk factors and Surgical Site Infections (SSI) in patients with surgical antibiotic prophylaxis (SAP) within the Indian population. Material and Methods: A prospective cohort study, consisting of 1,362 patients, with the age of 18 and above; admitted for various surgical procedures, and prescribed with SAP were included. In order to determine the significance of categorical data, the chi-square test, and Multiple binary logistic regression via the backward wald method was used to identify the risk factors. Various risk factors and their association to SSI were assessed, with a probability value of ≤0.05 being considered as a significant level. Result: In total, 171 SSI were observed; with an incidence of 12.6% [95% CI=11.1-16.6] among all study patients (1,362). Cefotaxime was the most prescribed SAP in this study. In total 59.6% had gram-positive organisms and 40.4% had gram-negative organisms. Type of surgery, female gender, smoking and alcohol, diabetes with hypertension, microbial growth, American Society of Anesthesiologists (ASA) score (class III), hospital guidelines, and pre-operative hospital stays (>7 days) were the significant risk factors (p-value0.05). Conclusion: This study emphasizes the significant risk factors; such as age, female gender, types of surgery, ASA score, nonadherence to hospital guidelines, monomicrobial and polymicrobial growth and poor compliance to SAP being associated with SSI in surgical patients. These risk factors allow a better understanding related to SSI, which may have therapeutic implications.

To assess whether prophylactic use of Levofloxacin would reduce the number of febrile neutropenia episodes during the induction phase, a single-centre, case-control study was carried out. Data was collected prospectively of patients who received Levofloxacin prophylaxis during the induction chemotherapy from September 2019 till October 2020. The cases were compared with historical controls who did not receive antibiotics prophylaxis. A total of 121 patients were enrolled, among which 61 patients were cases, whereas 60 patients were controls. The patients who received Levofloxacin prophylaxis had lower rate of febrile neutropenia episodes than patients who did not receive any prophylaxis (P 0.01) (odds ratio [OR] :0.23, CI 95percent). No significant difference in induction mortality was seen between the two groups (p 0.14). Levofloxacin prophylaxis reduced the rate of febrile neutropenia episodes among patients, but it did not affect the infection related mortality. Keywords: Antibiotic Prophylaxis, Acute Lymphoblastic Leukaemia, Children.

Even though there are guidelines for the management of snakebite envenoming (SBE), the use of antibiotics in this pathology remains controversial. The aim of this study is to provide a narrative review of the literature and recommendations based on the best available evidence regarding antibiotic use in SBE. We performed a narrative review of relevant literature regarding SBE and antibiotic use as prophylaxis or treatment. A total of 26 articles were included. There is wide use of antibiotics in SBE; nevertheless, infection was not necessarily documented. The antibiotics used varied according to the study, from beta lactams to lincosamide and nitroimidazoles, and from monotherapy to combined antimicrobials. The most common recommendations were to manage skin and soft tissue infections and avoid infectious complications, but these suggestions are not necessarily based on bacteriological findings. Prophylactic use of antibiotics in SBE is discouraged in most studies. Antibiotic prescription in SBE should be based on the susceptibility of microorganisms isolated from the affected tissue or identified in snakes’ oral cavities. Antibiotics should be reserved only for patients with a demonstrated infection, or those at a high risk of developing an infection, i.e., presenting severe local envenoming, local signs of infection, or those with incorrect manipulation of wounds. Prospective studies are needed to correlate microbiological findings at the wound site and the response to antibiotic use.

The autonomous regulation of the composition of breast milk according to the baby’s needs is perhaps the most unique and mysterious mechanism. Under physiological conditions, the first drops of milk are rich in antioxidants that the newborn needs to combat oxygen deprivation. Milk to nourish boys is more nutritious and night milk is rich in melatonin, which can soothe and put the baby to sleep. Unfortunately, the conditions surrounding a pregnant woman and her newborn baby are not always natural. Many external factors are considered in the context of the risk of adverse effects on the health of the mother and the baby. This article discusses the most common factors that distort the microbiota of breast milk: obesity, delivery mode and antibiotic prophylaxis. Caesarean section, which significantly depletes the bacterial diversity of breast milk, is reported to be the most important factor. The associated disruption of microbial colonisation in infancy leads to a high risk of inflammatory bowel disease (including Crohn’s disease and ulcerative colitis), diabetes mellitus, rheumatoid arthritis and celiac disease in children. However, there is another opinion that attributes all the consequences of caesarean section to the necessary preoperative antibiotic prophylaxis in most countries. Maternal obesity also leads to low microbial diversity and impoverishment of breast milk with members of the Bifidobacterium genus, which in turn leads to reduced immunomodulatory potential of breast milk in these women. Often these three factors constitute a vicious circle of problems that interfere with the natural and proper process of forming a healthy microbiome in the newborn and require individualised and professional paediatric care.

Antibiotic prophylaxis is used to prevent infections related to surgery from the administration of antimicrobials before, during and after the procedure. Its practice is mainly recommended in surgeries classified as contaminated or potentially contaminated. Its use should also be considered in clean surgeries in which the occurrence of infections brings serious consequences, such as mastectomy and mammoplasty. Thus, the present study aims to discuss the use of antibiotic prophylaxis in mammoplasty and mastectomy surgeries. This is a narrative literature review, in which the Health Sciences Descriptors (DeCS) “mammoplasty”, “mastectomy” and “antibiotic prophylaxis” were used to search the MedLine and LILACS databases, included in the Virtual Library in Health (BVS). It was observed that the occurrence of infections after mammoplasties or mastectomies can cause damage, such as delay in recovery, in adjuvant therapy, and loss of the reconstructed breast or impaired cosmesis, when applicable, which corroborates the use of antibiotic prophylaxis in these procedures. Patients are screened for methicillin-resistant (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). The main antibiotics used in prophylaxis were cephalosporins (cefazolin, cefadroxil and cefuroxime), isoxazolylpenicillins (flucloxacillin), aminoglycosides (gentamicin) and glycopeptides (vancomycin) in associations. In the studies found, antimicrobial prophylaxis proved to be promising, therefore, the research ratified the importance of using antibiotic prophylaxis in mammoplasty and mastectomy surgeries to prevent infections, also associated with adequate skin preparation practices, with 2% chlorhexidine and 70% isopropyl alcohol.

Chronic rhinosinusitis (CRS) is debilitating condition comprising inflammation of the mucosa of the nasal and paranasal sinuses, requiring conservative and often surgical treatment. Functional endoscopic sinus surgery (FESS) is a CRS treatment during which a microbiological diagnostic procedure may be conducted. Preoperative antibiotic prophylaxis is administrated before FESS. When indicated, the administered empiric antibiotic therapy must cover most common causing microbial agents. The aims of this study were to identify microbial pathogens isolated from sinonasal cavities in patients undergoing endoscopic sinus surgery, to determine bacterial antibiotic susceptibility patterns and compare them with guidelines for treatment and perioperative prophylactic use of antimicrobial agents. A retrospective cohort study on 456 samples collected between 2016 and 2019 was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery and the Department of Microbiology, Parasitology and Hospital Infections in the Clinical University Centre Sestre milordnice, Zagreb. The most common isolated pathogens were Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus, Pseudomonas spp., Fusobacterium spp. and Haemophilus influenzae. According to antibiotic susceptibility patterns, empiric antibiotic treatment with amoxicillin- clavulanic acid was appropriate. Due to high rates of antibiotic resistance of anaerobic bacterial isolates to metronidazole, it cannot be recommended in empirical antibiotic treatment or preoperative surgical antibiotic prophylaxis.

Background: Acute pancreatitis (AP) is an inflammation of the pancreas, a serious emergency with no definitive treatment. It may progress to infected necrosis, non-pancreatitis infection, also death that may occur within the first 1 to 2 weeks. The use of prophylactic antibiotics in AP to prevent complications remains a controversy. The objective of this meta-analysis is to assess the benefit of prophylaxis antibiotics administration to prevent the complication. Method: Trials were identified by searching the medical database. Literature range is within the year 1975 to 2021. Review Manager 5.4.1 was used to analyse data extraction and risk of bias of included studies were elaborated. Risk ratio (RR) was calculated with 95% confidence interval (CI). P 0.05 was considered significant. Results: Twenty trials with a total of 1.287 patients of AP were analysed; 646 patients treated with antibiotic prophylaxis and 641 patients treated with placebo. Prophylaxis antibiotics were found to have significant difference between the two groups. The administration of prophylaxis antibiotics lower the risk of non-pancreatic infections (RR = 0.77; 95% CI: 0.62–0.95; p 0.05) and infected pancreatic necrosis (RR = 0.74; 95% CI: 0.58-0.94; p 0.05). Meanwhile, prophylaxis antibiotics were found to be insignificant to lower the risk of mortality (RR = 0.75; 95% CI: 0.54-1.03; p 0.05). Conclusion: Prophylaxis antibiotics lower the risk of non-pancreatic infections and infected pancreatic necrosis, but did not lower the risk of mortality.

Introduction/Objective. The aim of the present study was to investigate the effects of moxifloxacin and cefixime in preventing postoperative infection following mandibular third molar surgery. Methods. Double-blind study was completed by 157 patients undergoing surgical removal of mandibular third molars. The patients were randomly assigned to the following three groups: moxifloxacin (M), cefixime (C), and placebo (P). Patients in each group were classified into two subgroups: subgroup (a), without previous history of pericoronitis, and subgroup (b), with previous history of pericoronitis. All the patients were evaluated at the postoperative follow-ups on the first, second, and seventh postoperative day. Results. Postoperative infections were registered only in patients with a history of pericoronitis. Antibiotic prophylaxis with cefixime and moxifloxacin reduced the occurrence of postoperative infection. Overall incidence of postoperative infections was 6.4%. All postoperative infections were registered in the placebogroup, where the incidence of postoperative infection was 19.2%. Microbiological tests verified the clinically obtained results. Isolated microflora was resistant to penicillin-derived antibiotics in 50% of the cases. Conclusion. Prophylactic use of antibiotics after third molar surgery should be weighed against potential risks and benefits and could be considered in cases with previous history of pericoronitis, when complicated surgical extraction is performed.

Introduction: Inappropriate antibiotic use in the world leads to an increase in both health care costs and antibiotic resistance. Surgical antibiotic prophylaxis (SAP) is used by most surgeons, especially in the postoperative period. Objective The aim of the study is to determine the approach of ear, nose, and throat (ENT) specialists to surgical antibiotic prophylaxis in routine surgeries, and to raise awareness regarding inappropriate antibiotic use. Methods ENT specialists from all over Turkey participated in the study by filling out a data collecting form. The form consisted of 6 questions and was sent to specialists via email. Routine ENT operations such as adenoidectomy, tonsillectomy, adenotonsillectomy, ventilation tube application, septoplasty, rhinoplasty, septorhinoplasty (noncomplicated), tympanoplasty, and simple mastoidectomy were chosen for the study. Data were analyzed statistically. Results The form results of 110 ENT specialists were evaluated. The rate of participants who used and did not use SAP was 77.3% and 22.7%, respectively. The SAP usage rates of septoplasty, rhinoplasty, and septorhinoplasty operations were 84.7%, 81.2%, and 75.3%, respectively. For tympanoplasty and ventilation tube application operations, the rates were 82.4% and 24.7%, respectively. Finallly, the SAP usage rates of adenoidectomy, tonsillectomy, and adenotonsillectomy were 57.6%, 75.3%, and 72.9%, respectively. Conclusion Otolaryngological surgeries are often classified as clean or clean-contaminated surgeries. In most studies in the literature, it is reported that SAP use is unnecessary in routine otolaryngological surgery. Providing inservice training, regularly updating the prophylaxis guidelines and sharing these guidelines with surgeons may prevent inappropriate SAP use.

ABSTRACT Objective Perioperative deep prosthetic joint infection (PJI) is a serious postoperative complication of total hip arthroplasty (THA). We aimed to compare the efficacy of cefazolin administered within 24 and 48 h of primary THA for PJI prophylaxis. Methods In this retrospective study, 720 patients were divided into two groups depending on whether cefazolin was administered as a single injection of 2 g twice daily within 24 (24-h group) or 48 h of surgery and the following day (48-h group). Sex, age at surgery, body mass index, co-existing diseases, blood test data, and PJI risk factors were evaluated. Results The 24- and 48-h groups included 364 and 356 patients, respectively. Diabetes mellitus was the most common risk factor for PJI in both groups. The corresponding incidence of perioperative deep PJI following primary THA was 0.55% and 0.28% in the 24- and 48-h groups, respectively. There was no significant difference in patient background characteristics between the groups. Conclusions Cefazolin administration within 24 h of primary THA may be appropriate for perioperative deep PJI. Level of Evidence II; Retrospective study.

Objectives. To map the current evidence on surgical antibiotic prophylaxis (SAP) administration and identify knowledge gaps in the literature available in this field. Methods. The PubMed, Cochrane Library, Epistemonikos, and Health Systems Evidence databases were searched from January 2015 to March 2020 for systematic reviews published in English, French, Portuguese, and Spanish. Results. Eighty-three systematic reviews were included, the quality of the reviews was assessed using AMSTAR 2, and data were extracted for all primary outcomes. Perioperative antibiotic administration, the use of first generation cephalosporins, and surgical site infection (SSI) were the most commonly reported for timing of antibiotic administration, drug class, and primary outcome, respectively. Findings showed that, overall, SAP may reduce SSIs compared with a placebo or with no SAP. Results suggested that intraoperative SAP may lower SSI, while postoperative SAP did not show a statistically significant difference. Conclusions. Findings have confirmed the role of SAP in reducing postoperative SSI across various surgeries and do not support the use of antibiotics after surgery to prevent infections. The findings of this scoping review have enhanced the evidence base that can inform decisions regarding the development of global guidelines for the prevention of SSI. However, high-quality systematic reviews and research reflecting diverse populations and settings are needed.

Introduction: In the last decade, the downgrading of indications for antibiotic prophylaxis for infective endocarditis caused an uncertain impact on the incidence of this condition. Since no data is available on the practice of infective endocarditis prophylaxis in Portugal, we aimed to characterize the pattern of antibiotic use for infective endocarditis prophylaxis and the compliance/awareness of scientific guidelines among physician members of the Portuguese Society of Cardiology. Material and Methods: A cross sectional observational study was conducted. An online self-completed questionnaire with 12 items on infective endocarditis prophylaxis was sent to 1330 physicians, specialists and residents, members of the Portuguese Society of Cardiology. In addition, descriptive statistical analysis was performed. Results: Two hundred and fifty-three valid questionnaires were responded. Eighty-seven per cent of respondents were cardiologists (specialists or residents), mostly between 30 and 40 years old (26.7%) and 50 to 80 years old (44.3%). The majority (83.0%) follow the European scientific guidelines. Still, 61.0% had or may have had doubts regarding prophylaxis of infective endocarditis in certain patients. Variable adherence to scientific guidelines was noted. Further scientific evidence was required by 60.6% of respondents. Conclusion: Infective endocarditis prophylaxis was generally guided by European scientific guidelines among physicians of the Portuguese Society of Cardiology. There was, however, an evident discrepancy between the guidelines and real-world perception of the risk of infective endocarditis. This highlights the sensed gap in accessing more robust scientific evidence.

Asthma is a respiratory disease; involving millions of people worldwide. The main cause of asthma is allergy and immune response dysregulation. The effects of azithromycin and doxycycline as asthma-controlling drugs were evaluated in this study. Mice asthma model was produced and asthmatic mice were treated with azithromycin (75 mg/kg, orally) and doxycycline (20 mg/kg, orally). Eosinophils and neutrophils count, interleukin (IL)-4, IL-5, IL-12, IL-13, and total immunoglobulin E (IgE) levels were measured. Histological study and evaluating the genes expression of Muc5ac, Muc5b, IL-33, COX2, MYD88, and TRAF6 were performed. Azithromycin and doxycycline did not affect eosinophil and neutrophil percentage, IL-4, IL-5, IL-12, and total IgE levels, peribronchial and perivascular inflammation, goblet cell hyperplasia, and gene expression of MYD88, TRAF6, and COX2. Treatment with azithromycin significantly decreased IL-13 level, mucus secretion, and gene expression of IL-33, Muc5ac, and Muc5b; compared to the non-treated asthma group. Azithromycin administration controls mucus secretion and inflammation. Azithromycin therapy and not doxycycline might be an effective adjuvant option in asthma with reducing mucus in the airway.

Abstract Background The necessity of antibiotic prophylaxis for postoperative urinary tract infections (UTIs) after transurethral resection of bladder tumours is controversial. This potentially leads to the overuse of antibiotic prophylaxis and rising antimicrobial resistance rates. The objective of this systematic review and meta-analysis is to compare the impact of different antimicrobial prophylaxis schemes versus placebo on the prevention of postoperative UTI and asymptomatic bacteriuria. Methods We designed and registered a study protocol for a systematic review and meta-analysis of randomized controlled trials and non-randomized (e.g. cohort, case-control) studies examining any form of antibiotic prophylaxis in patients with transurethral resection of bladder tumours. Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE (Ovid), EMBASE (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL). Grey literature will be identified through searching conference abstracts. The primary outcome will be postoperative urinary tract infections. The secondary outcome will be asymptomatic bacteriuria. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools (e.g. Risk of Bias 2.0 tool and Newcastle-Ottawa Scale). If feasible, we will conduct random-effects meta-analysis of outcome data. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. study design, publication year, the setting of the study, and antibiotics regimen). We will also search, identify, and discuss potential risk factors for urinary tract infections following transurethral resection of bladder tumours. This may serve as basis for a scoping review. Discussion In times of rising antimicrobial resistance rates, sound evidence on the necessity of antibiotic prophylaxis is essential for implementation into guideline recommendations and for decision-making in clinical practice. Systematic review registration PROSPERO, CRD42019131733

Abstract Background Infective endocarditis is an uncommon but serious infection, where evidence for giving antibiotic prophylaxis before invasive dental procedures is inconclusive. In England, antibiotic prophylaxis was offered routinely to patients at risk of infective endocarditis until March 2008, when new guidelines aimed at reducing unnecessary antibiotic use were issued. We investigated whether changes in infective endocarditis incidence could be detected using electronic health records, assessing the impact of inclusion criteria/statistical model choice on inferences about the timing/type of any change. Methods Using national data from Hospital Episode Statistics covering 1998–2017, we modelled trends in infective endocarditis incidence using three different sets of inclusion criteria plus a range of regression models, identifying the most likely date for a change in trends if evidence for one existed. We also modelled trends in the proportions of different organism groups identified during infection episodes, using secondary diagnosis codes and data from national laboratory records. Lastly, we applied non-parametric local smoothing to visually inspect any changes in trend around the guideline change date. Results Infective endocarditis incidence increased markedly over the study (22.2–41.3 per million population in 1998 to 42.0–67.7 in 2017 depending on inclusion criteria). The most likely dates for a change in incidence trends ranged from September 2001 (uncertainty interval August 2000–May 2003) to May 2015 (March 1999–January 2016), depending on inclusion criteria and statistical model used. For the proportion of infective endocarditis cases associated with streptococci, the most likely change points ranged from October 2008 (March 2006–April 2010) to August 2015 (September 2013–November 2015), with those associated with oral streptococci decreasing in proportion after the change point. Smoothed trends showed no notable changes in trend around the guideline date. Conclusions Infective endocarditis incidence has increased rapidly in England, though we did not detect any change in trends directly following the updated guidelines for antibiotic prophylaxis, either overall or in cases associated with oral streptococci. Estimates of when changes occurred were sensitive to inclusion criteria and statistical model choice, demonstrating the need for caution in interpreting single models when using large datasets. More research is needed to explore the factors behind this increase.

The adequate management of surgical wound infections in neurosurgery is fundamental for reducing the burden of morbidity and mortality in these patients. The suspicion and diagnostic confirmation associated with microbiological isolation are essential to ensure timely treatment and proper management of antibiotics. Therefore, in this review we present, in a synthetic manner, the main points for the prevention and treatment of surgical site infections in neurosurgery, which includes a section on the use of intrathecal/intraventricular antibiotics.

Bloodstream infections (BSI) are life-threatening complications for onco-hematologic patients. Fluoroquinolones prophylaxis (FQP) was recommended for patients with neutropenia. Later, it was correlated with increased resistance rates among this population and its role became debated. While the role of FQ prophylaxis is still being studied, its cost-effectiveness is also unknown. The objective of this study was to evaluate the costs and effects associated with two alternative strategies (FQP vs. no prophylaxis) for patients with hematological malignancies undergoing allogenic stem cell transplant (HSCT). A decision-tree model was built integrating retrospectively collected data from a single transplant center, part of a tertiary teaching hospital in Northern Italy. Probabilities, costs and effects were considered in the assessment of the two alternative strategies. Probabilities of colonization, BSIs, extended-spectrum beta lactamase (ESBL) and Klebsiella pneumoniae carbapenemase (KPC) BSIs and mortality associated with infection, as well as median duration of length of stay (LOS) were calculated based on data collected between 2013 and 2021. The center applied the strategy of FQP between 2013 and 2016, and of no prophylaxis between 2016 and 2021. Data on 326 patients were collected during the considered time period. Overall, the rates of colonization, BSI, KPC/ESBL BSI, and mortality were 6.8% (95% confidence interval (CI) 2.7–13.5), 42% (9.9–81.4) and 20.72 (16.67–25.26), respectively. A mean bed-day cost of 132€ was estimated. Considering no prophylaxis vs. prophylaxis, the difference in costs ranged between additional 33.61 and 80.59€ per patient, whereas the difference in effects ranged between 0.11 and 0.03 life-years (LYs) lost (around 40 and 11 days). Given the small differences in terms of costs and effects between the two strategies, no prophylaxis seems an appropriate choice. Furthermore, this analysis did not consider the broader effect on hospital ecology of multiple doses of FQP, which could provide further support for the strategy of no prophylaxis. Our results suggest that the necessity for FQP in onco-hematologic setting should be determined based on local antibiotic resistance patterns.

The article discusses the unique property of autonomous variability in breast milk composition under the influence of external factors, including endogenous (hormonal) and exogenous (dietary, environmental) factors. The authors presented the analysis of study findings, how the method of delivery and antibiotic prophylaxis affect the bacterial composition of milk and discuss whether there is a difference between two factors. The results of EUROMAPGROUP and HUMAP studies and an approximate estimation of antibiotics volume (in tons) used in food animal production are presented, which demonstrates one of the global problems of our time antibiotic resistance. A modern method for preventing lactational mastitis using the probiotic Lactobacillus fermentum CECT5716, which was recently launched to the Russian pharmaceutical market, is proposed to prevent the child from receiving subtherapeutic antibiotic doses with mother’s milk. The main studies on the breast milk probiotics and the prevention of mastitis and lactostasis in breastfeeding women are presented.

ABSTRACT Objective: To determine whether the topical use of gentamicin reduces periprosthetic joint infection rates in primary total hip arthroplasty (THA). Methods: We retrospectively evaluated two cohorts of patients who underwent primary THA in a university hospital, with a minimum of 1-year postoperative follow-up and full clinical, laboratory, and radiological documentation. Patients who underwent operation in the first 59 months of the study period (263 hips) received only intravenous cefazolin as antibiotic prophylaxis (Cef group), and those who underwent operation in the following 43 months (170 hips) received intravenous cefazolin plus topical gentamicin directly applied on the wound as antibiotic prophylaxis (Cef + Gen group). For the diagnosis of periprosthetic joint infection, we used the criteria of the Centers for Disease Control and Prevention. Data were analyzed using the Fisher exact test, and p values of

Introduction. The outcomes of potential complications of surgical interventions in neurosurgical patients can cause a death. Efficient antibiotic prophylaxis decreases the risks of infection and improves the quality of health care. Purpose. To estimate the appropriateness of prescribing antibiotics in a neurosurgical ward from the perspective of evidence-based medicine. Material and method. A retrospective cohort study has been carried out in a neurosurgical ward of multidisciplinary healthcare setting of Ukraine. Data from 131 in-patient medical cards (MC) of neurosurgical patients has been analyzed. Descriptive statistics methods have been used for data analysis. The relative risk (RR) with the 95% confidence interval (95% CI) has been calculated. Results. We found that among the patients, females prevailed (n = 81 / 61.8%). The patients’ mean age was 49.83 ± 13.90 years. The frequency of antibiotics prescriptions was higher significant in patients, who received surgical procedures in comparison with patients, who did not receive surgical procedures (RR = 1.827; 95% CI: 1,137 – 2.935). Antibiotics were prescribed mostly during the postoperative period. The use of interchangeable antibiotics of the same group has been occurred. The use of antibiotics for prevention in the most cases was of unreasonably long duration. Conclusion. The practice of the use of antibiotics in neurosurgical ward does not correspond to scientifically founded recommendations. It is needed to clearly define the indications for prescribing antibiotics. Duration of antibiotic use should depend on specialization of wards in multidisciplinary healthcare setting. It is expedient to conduct an audit on the use of antibiotics at healthcare settings on a regular basis with involving a specialist in infection control, a clinical pharmacist, and a clinical microbiologist.

Infectious complications in surgery occupy a significant place among the causes of death and increase in the cost of medical care for various pathologies. Antibiotic prophylaxis takes one of the first places in the perioperative period, in addition to surgical treatment and compliance with the rules of asepsis and antiseptics. Laxers is a new drug in the cephalosporin group, consisting of a combination of cefoperazone and sulbactam. It has a wide range of action on gram(-) and anaerobic flora and antistaphylococcal activity, which is not inferior to cefoperazone. Due to sulbactam, it has antimicrobial activity against Pseudomonas aeruginosa and Acinetobacter spp. This article describes the main properties and advantages of Laxers over other cephalosporins in this group as the drug of choice in the treatment of surgical pathologies and alternative antibiotic prophylaxis in the perioperative period in severe patients at risk of contamination of the operating field with hospital flora.

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.

Abstract— Antibiotic resistance is one of the healthcare problems associated with higher medical costs, prolonged hospital stays, and increased mortality rate. Monitoring antibiotic usage purposed to control the incidence of antibiotic resistance. Past research reported that there was an irrational use of surgical prophylaxis in Asia. The objective of this research is to review surgical prophylaxis utilization using DDD method with DDD/100 Bed Days as outcome. The study design used is systematic review. The articles included in this study were cross-sectional study design, in Indonesian or English language, and published between the years 2010-2020. The defined daily dose, antibiotic prophylaxis, surgery were the search term. This study assesses the quality of journals by The Joanna Briggs Institute (JBI) checklist and the journal's reputation. There were eleven articles, five articles had a good quality according to JBI checklist and published at journal indexed Scopus or accredited by National Journal Accreditation (ARJUNA) SINTA 1-3. The most used surgical prophylaxis antibiotic in 6 locations was ceftriaxone. Meanwhile, Cefazolin, the first choice surgical prophylaxis antibiotic recommended by the guideline, only reported being used the most at 2 locations. In Asia, there are irrational surgical prophylaxis antibiotic utilizations. The monitoring of surgical prophylaxis antibiotic use needs to be improved to increase the appropriateness. Keywords: Defined Daily Dose, antibiotic prophylaxis, surgery, Asia Abstrak—Resistensi antibiotik merupakan salah satu masalah kesehatan karena meningkatkan biaya perawatan, memperpanjang lama rawat di rumah sakit, dan meningkatkan angka kematian. Pemantauan penggunaan antibiotik bertujuan untuk mengendalikan kejadian resistensi antibiotik. Penelitian terdahulu melaporkan bahwa masih banyak terjadi pemakaian antibiotik secara irasional di bangsal bedah di Asia. Penelitian ini bertujuan untuk mengkaji pola pemakaian antibiotik di bangsal bedah dalam satuan DDD/100 bed days. Penelitian ini merupakan kajian sistematik. Artikel terpilih dalam penelitian ini adalah artikel penelitian potong lintkang, berbahasa Indonesia atau Inggris, dan dipublikasi antara tahun 2010 sampai 2020. Kata kunci yang dipakai adalah defined daily dose, antibiotic prophylaxis, surgery. Kualitas jurnal dinilai dengan checklist Joanna Briggs Institute (JBI) dan reputasi jurnal. Hasil: Didapatkan sebelas artikel, lima jurnal memiliki kualitas baik menurut checklist JBI dan dipublikasi oleh jurnal terindeks Scopus atau terakreditasi Sinta 1-3. Berdasarkan hasil sintesis, antibiotik golongan sefalosporin merupakan antibiotik yang paling sering dipakai. Seftriakson dilaporkan pada 6 lokasi sebagai antibiotik yang paling sering dipakai sebagai profilaksis pembedahan, sedangkan sefazolin, antibiotik pilihan utama yang direkomendasikan oleh pedoman terapi, hanya dilaporkan paling banyak digunakan di 2 lokasi. Di Asia, penggunaan antibiotik profilaksis di bangsal bedah masih ada yang irasional. Pemantauan penggunaan antibiotik profilaksis di bangsal bedah perlu ditingkatkan. Kata kunci: Defined Daily Dose, antibiotik profilaksis, bangsal bedah, Asia

ABSTRACT Objective: To assess the surgical antibiotic prophylaxis. Methods: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis. Results: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes. Conclusion: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.

Purpose of the study. The aim of this study is to improve the quality of emergency urological care for patients with scrotal and testicular trauma.Patients and methods. The study is a comparison of the results of prospective (according to the algorithm) and retrospective fragments, including a total of 459 patients (414 retrospectively, 45 prospectively). Patients received inpatient urological care for traumatic damage to the scrotum and testicle in D. Pletnyov City Clinical Hospital Department of Health of Moscow, N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology — Branch of the National Medical Radiology Research Centre of the Ministry of Health of the Russian Federation for the period 2008-2018.Results. The article analyzes the clinical effectiveness of the developed algorithm for the choice of therapeutic tactics in different variants of scrotal and testicular injuries. The key differences between the proposed algorithm and the generally accepted tactics are the extension of indications for emergency testicular revision (to operate with hematocele of any volume) and the same type of antibacterial prevention/therapy of infectious posttraumatic orchitis, regardless of the nature of the injury.Conclusion. When using the algorithm, the following clinical advantages were noted: reducing the likelihood of acute post-traumatic orchitis 2.4 times (p = 0,0271); reduced likelihood of postoperative infectious-inflammatory complications is reduced 2.0 times; reducing the likelihood of orchiectomy or hardening of the testicle 1.4 times.

AbstractObjective: We aimed to investigate the incidence and characteristics of acute prostatitis after transrectal prostate biopsy in men whom were given prophylactic ceftibuten combined with gentamicin.Material and Methods: We analyzed the retrospective data from 245 patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy over a 2 year period. Men in which acute prostatitis occured after the procedure were investigated. All patients received 400 mg ceftibuten orally once daily for 5 days, beginning 12 and 2 hours before biopsy; combined with single dose 160 mg gentamicin intramuscularly just before the procedure. All biopsies were performed as outpatient procedures. Results: Of the 245 cases, acute prostatitis developed in 2 (0,8%). Escherichia Coli that was positive for extended spectrum β-lactamase activity was isolated both from blood and urine in 1 case. The bacteria detected in urine and blood cultures were resistant to ciprofloxacin, levofloxacin, gentamicin, cefepime, ceftriaxone and cefuroxime. However, no bacteria was isolated either from blood or urine in the other case. Both patients had acute prostatitis after the first biopsy. Conclusion: Prophylactic ceftibuten combined with single dose gentamicin seems effective in preventing acute bacterial prostatitis after TRUS-guided prostate biopsy. Due to increasing rate of quinolone resistance among the world, alternative prophylaxis regimens including cephalosporins such as ceftibuten should be considered in men undergoing prostate biopsy. Prospective randomized trials with larger series may give more conclusive data.

Abstract Hereditary haemorrhagic telangiectasia (HHT) is a multisystemic vascular dysplasia that leads to nosebleeds, anaemia due to blood loss, and arteriovenous malformations (AVMs) in organs such as the lungs, liver and brain. HHT is estimated to affect 85,000 European citizens, but most health care providers have limited prior HHT exposure or training. Outcome Measures were developed and implemented by the HHT Working Group of the European Reference Network for Rare Vascular Diseases (VASCERN), in order to maximise the number of patients receiving good care. The measures specifically target areas where optimal management reduces morbidity and mortality in HHT patients, and were designed to be robust to emerging new evidence. Thresholds are the percentage of patients in particular settings who have been recommended screening, or provided with written advice. The 5 Outcome Measures cover (1) pulmonary AVM screening; (2) written nosebleed advice, (3) assessment of iron deficiency; (4) antibiotic prophylaxis prior to dental and surgical procedures for patients with pulmonary AVMs, and (5) written advice on pregnancy. They are not a blueprint for detailed HHT management, but are suitable for all clinicians to be aware of and implement. In summary, these 5 Outcome Measures provide metrics to identify healthcare providers of good care, and encourage care improvement by all healthcare providers.