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Introduction: Endourological surgeries like Percutaneous Nephrolithotripsy (PCNL) and Ureteroscopic Lithotripsy (URSL) is the standard of care for upper urinary tract urolithiasis. Placement of Double J stent (DJ stent) is a routine practice, following these surgical interventions. Though endourological surgeries are less invasive, these are not without complications. Main postoperative complications following these procedures, which hamper daily activities are Urinary Tract Infection (UTI) and Stent Related Symptoms (SRS). There is a lack of literature, about appropriate postoperative antibiotic strategy following uncomplicated endourological surgery for upper urinary tract stone disease in patients, who are on DJ stent. Aim: To evaluate the incidence of UTI and SRS in patients given, a peri-interventional antibiotic prophylaxis only versus a continuous low-dose antibiotic treatment for entire stent indwelling time. Materials and Methods: This was a randomised clinical study conducted in the Department of Urology, SDM Medical College and Hospital, Dharwad, Karnataka, India from january 2020-march 2021. A total of 70 patients following uncomplicated endourological surgery were randomised, to either receive periinterventional antibiotic prophylaxis only (group A=31) or low-dose antibiotic treatment for entire stent indwelling time (group B=39). Randomisation was done to allocate sample into two groups using computer randomisation program. All patients received cefotaxime injection 1 gm at the time of anaesthesia induction as peri intervention prophylaxis. Patients in group B, in addition received nitrofurantoine 100 mg tablet at bedtime for entire stent indwelling time. Patients were evaluated for incidence of UTI and SRSs. Statistical analysis was done using Chi-square and Yates corrected Chi-square for analysis of association between attributes. Independent t-test was used for comparison of two groups with numerical variables. Results: The incidence of UTI was not significantly different between the two groups {group A-4 (12.9%) and group B-6 (15.38%)}. UTI was more common following URSL compared to PCNL {group A 24 (77.42%) and group B 29 (74.36%)}, and more common in those with diabetes mellitus. Similarly the incidence and severity of SRSs was very similar in both the groups {group A 28 (90.32%) and group B 37 (94.87%)}. Conclusion: According to the present study findings, continuous low-dose antibiotic treatment during entire stent indwelling time does not reduce the incidence of UTI and has no effect on SRSs. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of pre-incision intravenous single doses of cefazolin versus cefazolin plus azithromycin as an antibiotic prophylaxis in cesarean delivery (CD). Methods: This was a single-center, double blind, randomized controlled trial conducted in the PGIMER, Chandigarh. 200 women undergoing elective/emergency cesarean section were randomized. Group A received single dose of cefazolin plus placebo while Group B received single dose of cefazolin plus azithromycin. Primary outcome evaluated was occurrence of surgical site infections (SSI); secondary outcomes included incidence of febrile morbidity, UTI, endometritis, neonatal outcome, total cost of antibiotics, and duration of hospital stay in both the study arms. Descriptive statistics and χ2 tests were used for analysis of the data. Result: There was an overall significant reduction in the incidence of SSI (15% vs 3%; P = 0.03), endometritis (8% vs 2%; P = 0.048), and post-operative febrile morbidity (17% vs 3%; P = 0.001) with the addition of azithromycin to cefazolin. Duration of hospital stay was almost two days lesser for the cefazolin plus azithromycin group. Subgroup analysis of patients with SSI showed the age, duration of ruptured membranes, and type of anesthesia as important predictors of infection rate. Study observed statistically significant reduction in requirement of additional post operative antibiotics, phototherapy for neonates, hospital stay and cost of therapy in cefazolin plus azithromycin group (P < 0.05). Conclusion: Tertiary care hospitals in developing countries such as India can opt for the cefazolin plus azithromycin as antimicrobial prophylaxis during CD to maximize the efficacy as well as for decreasing the cost burden of postoperative infections. [ABSTRACT FROM AUTHOR]

Background & objectives: Perioperative antimicrobial prophylaxis constitutes the bulk of antimicrobial consumption in any hospital. This study was conducted at a level 1 Trauma Centre of a tertiary care hospital of India to assess the efficacy of a short (24 h) course of perioperative antibiotic prophylactic regimen in preventing surgical site infections (SSI) in open reduction and internal fixation (ORIF) of closed fractures of limbs and to assess if the same can be implemented as a general policy. Methods: Patients of either sex, aged 18 yr or more, who were scheduled for ORIF and were willing and able to give informed consent, were included in the study. Patients were randomly allocated into two groups. Group 1 (n=100) received 3 doses of 1 g i.v. cefuroxime perioperatively spaced 12 h apart and group 2 (n=97) received the conventional existing regimen [5 days of i.v. antibiotics (cefuroxime 1 g twice daily along with amikacin 15 mg/kg in 2 divided doses), followed by oral cefuroxime, 500 mg twice daily till suture removal]. Results: Of the 197 patients, four patients developed a surgical site infection (three with methicillin resistant Staphylococcus aureus and one Acinetobacter baumanii). Of these, two patients were in group 1 and the remaining two in group 2. These patients were treated with i.v. antibiotics based on the culture and antimicrobial sensitivity reports. The cost of the short course treatment was 150 per patient as compared to 1,900 per patient for conventional regimen. Interpretation & conclusions: There was no significant difference in rates of SSI among the two groups in our study. Cost evaluation revealed that shorter course was less expensive than conventional long course regimen. Implementation of a short course perioperative regimen will go a long way in reducing antimicrobial resistance, cost and adverse reactions to antimicrobials. [ABSTRACT FROM AUTHOR]

Objectives: Surgical site infections (SSIs) contribute significantly to post-surgical morbidity globally. Antimicrobial stewardship programmes (ASPs) are essential to reduce SSI rates and to curb antimicrobial resistance, especially in low-and-middle-income countries. This prospective study aimed to show the reproducibility of ASP implementation and SSI prevention measures in a semi-private institution with high perioperative prophylactic antimicrobial consumption beyond guidelines., Methods: The prevalence of SSIs in clean surgeries was analysed in a government hospital adhering to SSI prevention guidelines including antimicrobial prophylaxis (phase 1; n=335) and in a surgical department unit of a semi-private hospital where the same guidelines were subsequently implemented (phase 2; n=235). SSI rates were compared to check the hypothesis that ASPs and infection control policies are reproducible with similar SSI rates. Moreover, antimicrobial prophylaxis costs were compared between units with and without guideline adherence., Results: Among a total of 570 clean surgeries analysed, SSI rates were similar in both phases (6.0% vs. 5.1%; P=0.659). SSI rates were higher in patients aged >50 years in both phases (P=0.0009 and 0.045), whilst there was no difference in SSI rates between diabetics and non-diabetics (P=0.475 and 0.835). The cost of antimicrobial prophylaxis was lower in the guideline-oriented group (US$0.42 vs US$9 per patient; P=0.0042)., Conclusion: Implementing SSI prevention guidelines, including proper antimicrobial prophylaxis, is feasible and reproducible among different hospital settings, leading to a significant decrease in prophylaxis costs. SSI rates do not differ following the same international standards., (Copyright © 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. All rights reserved.)