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Cirrhotic patients have an increased susceptibility to infection due to cirrhosis-associated immune-dysfunction. Bacterial infection therefore represents a common event in patients with advanced liver disease causing decompensation of liver cirrhosis and organ failures. Among pharmacological strategies to prevent bacterial infection, antibiotic prophylaxis remains the first-choice, especially in high-risk groups, such as patients with acute upper gastrointestinal bleeding, low ascitic fluid proteins, and prior episodes of spontaneous bacterial peritonitis. Given the growing emergence of multidrug-resistant bacteria, antibiotic prophylaxis has to deal with the evolution of local bacterial epidemiology. To limit the risk of antimicrobial resistance, antibiotic prophylaxis will be stopped after the disappearance of ascites, after the placement of a TIPS and after a liver transplant. Prophylaxis with rifaximin may be applied in case of recurrence of hepatic encephalopathy despite lactulose and before the insertion of a scheduled TIPS. Antibiotic prophylaxis is also the subject of research in the context of alcoholic liver disease and acute on chronic liver failure. This short review offers an overview on the application of antibiotic prophylaxis in cirrhosis, according to the current evidence. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Une antibioprophylaxie vise à s'opposer à la prolifération bactérienne afin de réduire le risque d'infection chez un patient. L'émergence des bactéries multirésistantes pouvant aboutir à des impasses thérapeutiques amène la communauté médicale internationale à proposer régulièrement des programmes d'optimisation de l'utilisation des antibiotiques. Le GPIP a mis à jour les recommandations de bonne pratique en antibioprophylaxie chirurgicale de l'enfant, en collaboration avec la SFAR (Société française d'anesthésie réanimation), et l'antibioprophylaxie médicale courte. Ces recommandations proposent un cadre général issu de l'analyse de données nationales et internationales, voire le plus souvent d'avis d'experts, et entendent servir de support à la mise en place de protocoles locaux d'antibioprophylaxie propres à chaque équipe. Antibiotic prophylaxis aims to counteract bacterial proliferation in order to reduce the risk of infection in a patient. The emergence of multi-resistant bacteria, which can lead to therapeutic impasses, has prompted the international medical community to regularly propose programs to optimize the use of antibiotics. In collaboration with the SFAR (Société Française d'Anesthésie Réanimation), the GPIP has updated its recommendations for good practice in surgical antibiotic prophylaxis in children, and for short antibiotic prophylaxis in medicine. These recommendations provide a general framework based on the analysis of national and international data, and more often than not on expert opinion, and are intended to support the implementation of local antibiotic prophylaxis protocols specific to each team. [ABSTRACT FROM AUTHOR]

Objectif : Identifier les antibiotiques utilisés et évaluer notre pratique en médecine humanitaire. Patients et Méthode : Etude prospective de 30 jours. La saisie et l’analyse des données ont été faites par Windows 8, Epi info 3.5.3 fr et le khi² pour le test statistique. Résultats : Soixante-trois (63) patients répondaient aux critères. L’âge moyen était de 33,3 ± 18, 5 ans. Les femmes rurales prédominaient. Les urgences représentaient 65,1% des cas. L’indication de l'antibioprophylaxie était Gynéco-obstétricale dans 63, 5% suivie de la chirurgie viscérale dans 20,6%, de l’urologie dans 11,1% et de la traumatologie dans 4,8%. Les patients étaient ASA I dans 69,8%. La classe d’Altémeier était II dans 81%. Une antibioprophylaxie a été faite dans 88,9%. Les β lactamines en monothérapie ont été les plus utilisées dans 84,1% suivies de l’association β lactamine-imidazole dans 9,5%, de l’association β lactamine-aminoside dans 1,6% et les quinolones dans 1,6%. Le délai entre l’administration de l’antibiotique et l’induction anesthésique était de : 6 ± 2,4 minutes. L’antibiotique a été administré entre 25 et 40 minutes avant l’incision chirurgicale. Une complication infectieuse a été observée dans 11, 1%. L’évolution était favorable dans 98,4%.Conclusion : Même en situation de crise sanitaire, l’utilisation de l’antibiotique au bloc opératoire doit répondre à des critères dont l’écologie microbienne et le site opératoire sont déterminants.

En fréquence et en gravité, l'implantation de stimulateurs cardiaques et de défibrillateurs est de loin l'activité cardiologique la plus risquée sur le plan infectieux. Le nombre d'implantations de dispositifs cardiaques implantables ne cesse d'augmenter avec près de 2 millions de poses par an au niveau mondial. Le profil des patients implantés se révèle parfois à haut risque infectieux. Plusieurs mesures permettent de réduire le risque d'infection de matériel. Le bénéfice de l'antibioprophylaxie systématique est bien démontré à condition de respecter ses modalités de prescription, en particulier concernant le choix de molécule et les délais d'administration avant l'intervention. Malgré les précautions prises lors de l'intervention chirurgicale (asepsie, antibiothérapie prophylactique...), le taux d'infections péri-opératoires est évalué à près de 2 %. Il s'agit d'une complication associée à une morbi-mortalité élevée et un coût important pour le système de santé. Les Staphylococcus aureus (SA) et epidermidis (SE) sont les agents pathogènes les plus souvent impliqués. La prévention est essentielle car le traitement d'une infection sur dispositif cardiaque endocavitaire est toujours difficile, du fait des résistances aux antibiotiques et surtout de la nécessité quasi systématique d'explanter tout le matériel. Le pace maker sans sonde et le défibrillateur sous cutané semblent être des alternatives à ces dispositifs cardiaques endocavitaires, avec certaines limites. Récemment, un consensus sur la prévention, le diagnostic et le traitement des infections de dispositifs cardiaques endocavitaires implantables a été proposé par un groupe d'experts. The implantation of pacemakers and defibrillators carries the highest risk of infection in interventional electrophysiology. The use of implantable cardiac devices is continually increasing with almost 2 million devices implanted worldwide each year. The recipients' profile may also be associated with an increased risk of infection. Several measures can be implemented to reduce the risk of device-related infection. Systematic antibiotic prophylaxis has proven to be beneficial provided that prescription modalities are respected, especially with respect to the selection of the appropriate molecule and timing of administration prior to the procedure. Despite all the precautions taken during surgery (asepsis, prophylactic antibiotic therapy....) the estimated rate of peri-procedural infection is around 2%. Device related infections are associated with a high rate of morbidity and mortality as well as substantial healthcare costs. Staphylococcus aureus (SA) and epidermidis (SE) are the pathogenic agents involved in most cases. Prevention is crucial given the difficulties in treating such infections because of the near-systematic need to remove the device and antibiotic resistance. Leadless pacemakers and subcutaneous defibrillators are potential alternatives to implantable endocardial devices, albeit with certain limitations. A group of experts has recently issued consensus paper on the prevention, diagnosis and treatment of infections associated with endocardial implantable cardiac devices. [ABSTRACT FROM AUTHOR]

L'émergence de bactéries multirésistantes aboutissant à des impasses thérapeutiques fait de la bonne gestion des antibiotiques une priorité internationale de santé publique. L'utilisation des antibiotiques dans un but de prévention (antibioprophylaxie) doit donc être raisonnée et guidée par les preuves. Les mesures d'antibioprophylaxie doivent toujours s'accompagner de mesure de prévention des infections (vaccination quand cela est indiqué, respect strict des règles d'hygiène). Il existe deux grandes catégories d'antibioprophylaxie : l'antibioprophylaxie chirurgicale et l'antibioprophylaxie médicale. La première a montré son efficacité pour la prévention des infections de sites opératoires dans des situations bien définies. Elle repose sur le principe d'obtention d'une concentration d'antibiotique suffisante au site d'incision pour éviter que les bactéries présentes pénètrent dans le site opératoire et y prolifèrent. Le choix de l'antibiothérapie varie en fonction des sites opératoires et du type de chirurgie. L'antibioprophylaxie chirurgicale ne concerne pas la chirurgie de site infecté et doit être limitée dans le temps avec, le plus souvent, une seule injection périopératoire et toujours d'une durée maximale de 48 heures. L'antibiothérapie médicale peut être indiquée dans certaines situations très bien définies comme certaines situations d'immunodépression (asplénie, déficit de l'immunité cellulaire sévère), la postexposition à des infections invasives (méningococcémie, coqueluche, infection invasive à streptocoque du groupe A, morsure) ou à des situations à risques (certains gestes invasifs chez des patients porteurs de cardiopathies à risques). L'indication de l'antibioprophylaxie urinaire est de plus en plus restreinte au vu de la balance bénéfice/risque et doit toujours être discutée avec un spécialiste. [ABSTRACT FROM AUTHOR]

En chirurgie plastique, les recommandations sur l'antibioprophylaxie sont imprécises et incomplètes, du fait d'une quasi-absence d'étude de haut niveau de preuve sur le sujet. L'objectif principal est de proposer des recommandations nationales détaillées consensuelles concernant l'antibioprophylaxie en chirurgie plastique. Une analyse multicentrique des pratiques au sein de trois Centres Hospitaliers et Universitaires, comparée à une analyse interdisciplinaire des recommandations de la Société Française d'Anesthésie et de Réanimation et de la littérature scientifique a été proposée pour discussion et validation à un groupe de travail composé de chirurgiens plasticiens membres du chapitre de plastique générale de la Société française de Chirurgie plastique reconstructrice et esthétique, d'infectiologues et d'anesthésistes afin de définir des protocoles d'antibioprophylaxie préopératoire clairs et précis. Une antibioprophylaxie par céfazoline (ou clindamycine ± gentamicine en cas d'allergie), est recommandée pour les interventions de chirurgie générale avec lambeau ou prothèse, la chirurgie mammaire avec ou sans prothèse, la lipostructure, les dermolipectomies de membres, les chirurgies abdominales et les rhinoplasties/septorhinoplasties. Aucune antibioprophylaxie n'est recommandée lors des autres interventions de chirurgie plastique, hors lambeau ou implant, ou de la face, hors rhinoplastie. Nous avons établi un protocole détaillé qui constitue une première étape vers l'actualisation des recommandations concernant l'antibioprophylaxie en chirurgie plastique. Celui-ci pourra être évalué en situation clinique afin de permettre sa possible validation. In plastic surgery, guidelines about antibiotic prophylaxis are inaccurate and incomplete, due to result the absence of high-level studies on this subject. The main aim is to establish national common recommendations for plastic surgery antibiotic prophylaxis. A working group will discuss and validate a multi-center analysis of practices in three University Hospital Centers compared to an interdisciplinary analysis of recommendations to the French Society of Anaesthesia and Intensive Care Medicine and scientific literature. This working group is composed of plastic surgeon members of the French Society of Aesthetic Reconstructive Plastic Surgery, infectious disease physicians, and anaesthesiologists to define clear and precise antibiotic prophylaxis recommendations. Antibiotic prophylaxis with cefazoline (or clindamycine ± gentamicine in case of allergy), has been recommended for general surgery with flap or implants, for breast surgery, lipofilling, and rhinoplasty. In other plastic surgery, no antibiotic prophylaxis has been recommended. We established common recommendations for plastic surgery antibiotic prophylaxis that is the first step to update these recommendations. Now, they can be evaluated in clinical situation to validate them. [ABSTRACT FROM AUTHOR]

Résumé: L'antibioprophylaxie (ATBP) est l'une des mesures spécifiques de prévention des infections du site opératoire dont l'impact a été quantifié dans les interventions chirurgicales. Matériels et méthodes : Il s'agit d'une étude rétrospective en per-protocole multidisciplinaire, qui a été réalisée au bloc opératoire et ensuite aux services de chirurgie pour 315 patients opérés pour une chirurgie programmée. Le recueil des données était réalisé sur une période de six semaines, soit du 5 juin au 17 juillet 2017. La conformité des prescriptions a été évaluée par confrontation au référentiel de la Société française d'anesthésie et de réanimation 2017(*). Résultats : Parmi les 270 dossiers inclus, 235 dossiers comportent une administration d'ATBP. Le taux de conformité globale était de 53,3 %. La conformité de chacun des 6 critères majeurs était de 90 % pour l'indication ; 57,1 % pour le moment d'administration ; 97,6 % pour les réadministrations ; 87,2 % pour le choix de l'antibiotique ; 91 % pour la dose de la première administration et 81,6 % pour la durée de l'ATBP. La conformité globale était variable selon le service, moindre en chirurgie urologique. Conclusion : Une stratégie globale intégrant organisation, éducation et restriction, pourrait permettre une réelle amélioration des taux de conformité des pratiques d'ATBP. La réalisation d'audits successifs devrait s'inscrire dans une démarche régulière, afin d'évaluer l'impact des actions entreprises. Antibiotic prophylaxis (ATBP) is one of the specific measures for the prevention of surgical site infections, whose impact has been quantified in surgery. Material and methods : It is a retrospective multidisciplinary and perprotocol study, performed in the operating room and surgical departments for 315 patients operated for an elective surgery. Data were collected during a six-week period, from June 5 to July 17, 2017. Compliance was assessed by comparing the guidelines of the French society of anesthesia and intensive care 2017. Results : Among the 270 cases included, 235 cases involve ATBP administration. The overall compliance rate was 53.3%. The compliance with each of the 6 major criteria was 90% for the indication; 57.1% for the administration schedule; 97.6% for repeating the administration; 87.2% for the choice of antibiotic; 91% for the dose of the first administration and 81.6% for the duration of ATBP. The overall compliance was variable depending on the department; less compliance was reported in the urological surgery. Conclusion : A global strategy including organization, education and restriction, could lead to a real improvement in the rate of compliance with ATBP practices. Successive audits should be carried out regularly in order to evaluate the impact of the undertaken actions. [ABSTRACT FROM AUTHOR]

Objectif : Identifier les antibiotiques utilisés et évaluer notre pratique en médecine humanitaire. Patients et Méthode : Etude prospective de 30 jours. La saisie et l'analyse des données ont été faites par Windows 8, Epi info 3.5.3 fr et le khi² pour le test statistique. Résultats : Soixante-trois (63) patients répondaient aux critères. L'âge moyen était de 33,3 ± 18, 5 ans. Les femmes rurales prédominaient. Les urgences représentaient 65,1% des cas. L'indication de l'antibioprophylaxie était Gynéco-obstétricale dans 63, 5% suivie de la chirurgie viscérale dans 20,6%, de l'urologie dans 11,1% et de la traumatologie dans 4,8%. Les patients étaient ASA I dans 69,8%. La classe d'Altémeier était II dans 81%. Une antibioprophylaxie a été faite dans 88,9%. Les β lactamines en monothérapie ont été les plus utilisées dans 84,1% suivies de l'association β lactamine-imidazole dans 9,5%, de l'association β lactamine-aminoside dans 1,6% et les quinolones dans 1,6%. Le délai entre l'administration de l'antibiotique et l'induction anesthésique était de : 6 ± 2,4 minutes. L'antibiotique a été administré entre 25 et 40 minutes avant l'incision chirurgicale. Une complication infectieuse a été observée dans 11, 1%. L'évolution était favorable dans 98,4%.Conclusion : Même en situation de crise sanitaire, l'utilisation de l'antibiotique au bloc opératoire doit répondre à des critères dont l'écologie microbienne et le site opératoire sont déterminants.

L'antibioprophylaxie (ATBP) est l'une des mesures spécifiques de prévention des infections du site opératoire dont l'impact a été quantifié dans les interventions chirurgicales propres et propres contaminées. L'objectif de notre étude est d'évaluer la conformité des pratiques d'ATBP et le respect des prescripteurs des protocoles adoptés au sein de notre établissement. Notre travail est une étude observationnelle rétrospective, de type Audit Clinique , évaluant les pratiques d'ATBP dans notre établissement durant le mois de mars 2015. Le critère de jugement principal était la conformité globale des pratiques observées aux 5 critères majeurs définis par la haute autorité française de santé (HAS). Nous avons adopté le référentiel de la société française d'anesthésie réanimation parue en 2010. Nous avons inclus 150 patients opérés des services de chirurgie générale, d'orthopédie et d'urologie. Le taux de conformité globale était de 33,3%. La conformité de chacun des 5 critères majeurs définis par la HAS était de 74% pour l'indication; 84% pour le délai injection-incision; 60% pour le choix de l'ATB; 89,3% pour la dose de 1ère injection et 72% pour la durée de l'ATBP. La conformité était variable selon le service, meilleure en urologie ; en cas de chirurgie programmée et quand le prescripteur est un réanimateur. Une stratégie globale intégrant organisation, éducation et restriction, pourrait permettre une réelle amélioration des taux de conformité des pratiques d'ATBP. La réalisation d'audits successifs devrait s'inscrire dans une démarche régulière, afin d'évaluer l'impact des actions entreprises.

Most hospitals use protocols for surgical antibioprophylaxis (ABP). Despite SFB's 2009 recommendations promoting ABP in burn patients and stating the molecules to be used, wide variations exist within hospitals and among French hospitals, in cases of skin grafting and use of dermal substitutes. We contacted surgeons in 12 French Burn Centres (BCs) via email and questioned them about ABP in cases of skin grafting (thin and total) as well as in the use of dermal substitutes, in acute and sequelae settings. Eight BCs answered. In the acute phase, 3 BCs (37.5%) always use ABP in skin grafts, 2 (25%) use ABP on suspicion of wound infection and 3 (37.5%) never use ABP. When installing skin substitute, 5 BCs (62.5%) use ABP, one (12.5%) does so if the wound is suspected of being infected and 2 (25%) never use ABP. For sequelae, 5 BCs (62.5%) use ABP whatever the surgery, while 3 (37.5%) never use it. Infection onset after skin graft or use of dermal substitute is frequent. Our study shows wide variations in the use of ABP in these surgeries. A multi-centre evaluation of the implementation of SFB's 2009 recommendations and their role in preventing postoperative infections after skin grafting and skin substitute use, both in acute and sequelae phases, could help harmonize practices in BCs. [ABSTRACT FROM AUTHOR]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intravitreal injection (IVI) of a drug allows for immediate intraocular concentrations of active ingredients higher than those obtained by intravenous injection while reducing the risk of systemic side effects. Today, IVI's play a central role in the treatment of many vitreoretinal diseases. With the aging of the population and the advent of vascular endothelial growth factor (VEGF) antagonists, their indications have increased exponentially, creating structural, organizational and economic difficulties. IVI is now one of the most widely performed medical procedures in industrialized countries, and its indications are expected to expand further in the near future with the development of new molecules. Although the overall safety of this practice is proven, an IVI exposes the patient to a 0.05 % risk of endophthalmitis, the consequences of which are often dramatic. This article details the current recommendations, in particular regarding asepsis and antisepsis, and proposes a typical sequence for performing an IVI., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Un homme de 64 ans est hospitalisé pour un premier épisode de DHBA du membre inférieur gauche. L'examen clinique d'entrée révèle un érythème de la face interne de la cuisse et du creux inguinal gauche sans adénopathies, associé à une hyperthermie à 39°C. Le risque de récidive des DHBA non nécrosantes des membres inférieurs est de l'ordre de 10 à 30 % [1] mais il n'y a pas de donnée concernant la fréquence et les facteurs de récidive dans la localisation pénienne. Les recommandations américaines préconisent une antibioprophylaxie par pénicilline V ou érythromycine pendant 4 à 52 semaines ou par benzathine pénicilline G intramusculaire toutes les 2 à 4 semaines chez les patients ayant 3 à 4 épisodes de dermohypodermites par an malgré la prise en charge des facteurs prédisposant et le traitement des portes d'entrée potentielles [7]. [Extracted from the article]

The obese parturient is a high risk patient by the combination of obesity and pregnancy physiological changes. Regional anesthesia is recommended to avoid general anaesthesia. Epidural analgesia is a medical indication for vaginal delivery and spinal combined spinal and epidural anaesthesia is recommended for caesarean section. Antibiotic prophylaxis for cesarean section should use dosages correlated with BMI, some even recommending combination therapy. Thromboprophylaxis may be indicated even if vaginal delivery and will be correlated with BMI. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Il s'agira de déterminer l'incidence et les facteurs associés à l'infection post opératoire dans les chirurgies gynécologiques et obstétricales propres et propres contaminées. METHODES: étude de cohorte prospective axée sur la surveillance de l'infection post opératoire chez les patientes opérées d'une chirurgie gynécologique ou obstétricale propre ou propre contaminée au Service de Gynécologie B de l'Hôpital Général de Yaoundé, après une antibioprophylaxie avec la cefazoline. La période d'étude de 18 mois s'est étalée de janvier 2012 à juin 2013. La surveillance des patientes opérées se poursuivait sur les 30 premiers jours post opératoires. RESULTATS: au total 211 patientes opérées d'une chirurgie gynécologique ou obstétricale propre ou propre contaminée ont été enrôlées dans cette étude. La moyenne d'âge des patientes était de 35,4 ,10 ans; les chirurgies propres contaminées représentaient 76,3% et les chirurgies propres 23,7%. Nous avons observé au total 06 (2,8%) cas d'infection post opératoire, dont 03 (1,4%) cas d'infection du site opératoire, 02 (0,95%) cas d'infection urinaire et 01(0,47%) cas d'infection pulmonaire. Les variables significativement associées à l'infection post opératoire étaient la durée de la chirurgie (durée moyenne: 126, 89min vs 82, 50 min; p= 0,04) et le diabète (OR. 40,8; IC à 95%. 2,2-749,2; p=0,000. CONCLUSION: notre taux d'infection post opératoire global de 2,8% et d'infection du site opératoire de 1,4% vient renforcer les données de la littérature sur l'efficacité de l'antibioprophylaxie dans les chirurgies gynécologiques et obstétricales propres et propres contaminées en milieu africain. Cependant le respect des principes d'asepsie péri opératoire et une sélection précise de la classe de chirurgie devraient être de règle dans notre contexte.

Objective: To identify procedures to reduce maternal morbidity during cesarean., Material and Methods: The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane and EMBASE databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations., Results: Of the 27 questions, there was agreement between the working group and the external reviewers on 26. The level of evidence of the literature was insufficient to provide a recommendation on 15 questions. Preventing hypothermia is recommended to increase maternal satisfaction and comfort (weak recommendation) and to reduce neonatal hypothermia (strong recommendation). The quality of the evidence of the literature did not allow to recommend the skin disinfectant to be used nor the relevance of a preoperative vaginal disinfection nor the choice between the use or nonuse of an indwelling bladder catheterization (if micturition takes place 1 hour before the cesarean section). The Misgav-Ladach technique or its analogues should be considered rather than the Pfannenstiel technique to reduce maternal morbidity (weak recommendation) bladder flap before uterine incision should not be performed routinely (weak recommendation), but a blunt (weak recommendation) and cephalad-caudad extension of uterine incision (weak recommendation) should be considered to reduce maternal morbidity. Antibiotic prophylaxis is recommended to reduce maternal infectious morbidity (strong recommendation) without recommendation on its type or the timing of administration (before incision or after cord clamping). The administration of carbetocin after cord clamping does not significantly decrease the incidence of blood loss>1000 ml, anemia, or blood transfusion compared with the administration of oxytocin. Thus, it is not recommended to use carbetocin rather than oxytocin in cesarean. It is recommended that systematic manual removal of the placenta not to be performed (weak recommendation). An antiemetic should be administered after cord clamping in women having a planned cesarean under locoregional anaesthesia to reduce intraoperative and postoperative nausea and vomiting (strong recommendation) with no recommendation regarding choice of use one or two antiemetics. The level of evidence of the literature was insufficient to provide any recommendation concerning single or double-layer closure of the uterine incision, or the uterine exteriorization. Closing the peritoneum (visceral or parietal) should not be considered (weak recommendation). The quality of the evidence of the literature was not sufficient to provide recommendation on systematic subcutaneous closure, including in obese or overweight patients, or the use of subcuticular suture in obese or overweight patients. The use of subcuticular suture in comparison with skin closure by staples was not considered as a recommendation due to the absence of a consensus in the external review rounds., Conclusion: In case of cesarean, preventing hypothermia, administering antiemetic and antibiotic prophylaxis after cord clamping are the only strong recommendations. The Misgav-Ladach technique, the way of performing uterine incision (no systematic bladder flap, blunt cephalad-caudad extension), not performing routine manual removal of the placenta nor closure of the peritoneum are weak recommendations and may reduce maternal morbidity., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The main aim of this study was to assess dentists' compliance with current guidelines of antibiotic prophylaxis of Infective Endocarditis (IE) in France. Methods: A national survey was carried out, using a questionnaire developed in collaboration with the Association for the Study and Prevention of Infective Endocarditis (AEPEI). An electronic survey of 136 questions was sent out from September to October 2012 to the 12,000 practitioners who were members of the French Union for Oral Health (UFSBD). Results: 906 practitioners answered the questionnaire and 530 fully completed it. 94% of dentists declared managing patients at risk of IE; however, only 57% properly identified the publication date of the current guidelines promoted by the National Agency for Medicinal and Health Product Safety (ANSM) in 2011. This study highlighted a lack of knowledge of the respondents about the currently recommended management of patients at risk of EI, whether for the assessment of the risk of IE, its prevention or the follow-up of patients with predisposing cardiac conditions. Practitioners were not aware of their lack of knowledge: 59% declared that they had a good or a very good knowledge of these guidelines, but only 13% correctly assessed the risk of developing IE, 3% really knew the allowed or contraindicated procedures in patients at risk of IE, and only 22% had an appropriate drug prescription plan. In addition, there was a lack of the practitioners' compliance with the current guidelines. Only 41% declared having modified their practice according to these guidelines and only 16% had adapted their frequencies. Two major reasons for this lack of compliance were identified by this survey: the low level of scientific evidence to support these guidelines, and a huge evolution in the pathogenesis of IE. Finally, three-quarters of the respondents still wrongly prescribed an antibiotic prophylaxis to patients with moderate risk of EI. Nevertheless, comparing these results with those of two similar previous surveys in 1991 and 2001, the implementation of guidelines has globally improved in 20 years. Conclusions: The compliance with the guidelines on management of patients at risk of IE could be improved. The apparent stability of the incidence of oral streptococci IE in France since the reduction of the antibiotic prophylaxis indications in 2002 could reflect more the lack of the practitioners' compliance than a real efficacy of the current prevention strategies. [ABSTRACT FROM AUTHOR]

Résumé: L’antibioprophylaxie en chirurgie carcinologique ORL diminue l’incidence des infections du site opératoire (ISO). Toutefois, dans certaines chirurgies à risque, réalisées sur des terrains favorisants, avec persistance d’un ensemencement salivaire postopératoire, la question du choix entre antibioprophylaxie et antibiothérapie curative se pose. Nous avons mené une démarche pluridisciplinaire visant à un consensus local en adéquation avec les bonnes pratiques. Pour cela, une revue systématique de la littérature selon les recommandations PRISMA a été réalisée pour répondre aux questions des indications respectives de l’antibioprophylaxie et de l’antibiothérapie curative, de la durée optimale de l’antibioprophylaxie et de la nature de l’antibioprophylaxie en chirurgie carcinologique ORL. À l’issue de ce travail, il apparaît que les patients bénéficiant d’une procédure carcinologique ORL de classe Altemeier 2 à 3 doivent bénéficier d’une antibioprophylaxie peropératoire restreinte aux 24 premières heures postopératoires. Il n’a pas été démontré de bénéfice à sa prolongation au-delà de ces 24heures. Les associations de molécules à privilégier sont « amoxicilline+acide clavulanique » et « clindamycine+gentamicine ». Toutefois, le niveau de preuve concernant les chirurgies les plus délabrantes à haut risque d’ISO apparaît inférieur à celui concernant les chirurgies carcinologiques cantonnées au pharynx ou au larynx, rendant souhaitable la réalisation de nouvelles études randomisées de forte puissance chez ces patients. Il convient enfin de rappeler que l’antibioprophylaxie doit s’intégrer dans un ensemble de mesures préventives des ISO comportant une prise en charge générale du patient, des mesures d’hygiène peropératoires et une surveillance postopératoire attentive des signes d’ISO. [ABSTRACT FROM AUTHOR]

Abstract: Each year in France 6000 to 9000 patients are splenectomised or spleen embolized. As spleen has immunological functions, it contributes to protect against infections. Thus, hypo or asplenia increase the risk of infection, especially the risk of Overwhelming Post-Splenectomy Infection (OPSI). OPSI is a medical emergency, characterized by aspecific symptoms, which may rapidly progress to fulminant infection and death in 50% of cases within 48h. Encapsulated bacteria as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis are most of the time responsible of these infections in asplenic patients. To prevent OPSI, several measures are essential and must begin before a scheduled surgery or just after an urgent splenectomy. Patients must carry a card. The first proposed prevention measure is to enhance partial surgery when it''s possible. Then, the two other measures, antibiotic prophylaxis and vaccination, shall be implemented whatever is the indication of surgery. Postoperative antibiotic prophylaxis by phenoxymethyl-penicillin is prescribed for two years minimum and lifelong prophylaxis should be offered to high risk of pneumococcal infection patients. Pneumococcal, H. influenzae type b and meningococcal vaccination should be administered 2 to 6 weeks before scheduled splenectomy and 2 weeks after urgent surgery. Yearly, patients must receive Influenza vaccination. As an interindividual variation exists in vaccinal response, measurement of serotype-specific antibodies can be used, if available, to individualized risk patients and to organize revaccination. Finally, to prevent OPSI, patient and next-of-kin must be educated about prevention measures and infectious risk to optimize patient''s compliance. [Copyright &y& Elsevier]

Abstract: Introduction: Information technologies appear to be interesting tools to assess and improve professional practices. In that setting, the management of surgical antibiotic prophylaxis represents an appropriate clinical area for using and evaluating such a tool. Despite the existence of guidelines in one hand and the demonstrated interest for a strict application of recommendations in the other hand, some irregularities in the management of surgical antibiotic prophylaxis remain in France in 2010. Objectives: Since we have had computer systems in our department for several years, we performed an evaluation of practice to assess the impact of both the computer-based help and the updating of knowledge in physicians as tools to improve the application of guidelines for surgical antibiotic prophylaxis. Study design: Clinical audits. Methods: Three clinical audits have therefore been performed before an implementation of computer-based help for clinical decisions and a clinical update for physicians, immediately after, and two years after this combined procedure (2322, 2678 and 2863 patients, respectively). Results: There was an enhancement of clinical practices and compliance to guidelines secondary to the beginning of computer-based prescription (55 to 81%, P <0.05). However, a weaning effect was observed with longer intervals between clinical update and surgical procedure, in association with increased omissions of antibiotic prophylaxis. Conclusion: Computer-based help for clinical decision and prescription seems to be a useful tool for surgical antibiotic prophylaxis but it should be accompanied by direct regular educational measures to update protocols and databases. [Copyright &y& Elsevier]

Objectives: The main objective was to evaluate the surgical antibiotic prophylaxis's compliance rate. The secondary objectives were to evaluate the tools designed to help the surgical antibiotic prophylaxis's prescription, and evaluate the surgical site infection rate., Methods: This retrospective study was done in a university hospital on a random selection of 125 pediatric patients having undergone a surgery (cardiac, general, neurological, ENT, orthopedic or plastic). Compliance to the current recommendations has been assessed., Results: Out of the 125 studied patients (2 exclusions), the indication was compliant at 87% (107/123). The perioperative document included an intention to use antibiotic prophylaxis in 24% of cases (29/123). The compliance for the presence of the standard order set for antibiotic prophylaxis was only 15% (19/123). The compliance for the preoperative administration varied: antibiotic choice (94%, 63/67), dose (91%, 61/67), route (99%, 66/67), timing (30%, 20/67). The compliances for intra- and postoperative administrations were respectively 75% (57/76) and 89% (68/76). The surgical site infection rate was 4% (5/123)., Conclusions: The use of a standard order set for antibiotic prophylaxis and the timing of the preoperative administration were sub-optimal. A better dissemination and use of the administrative tools and the implementation of a coordination system with the members of anesthesia services would improve these important aspects of the surgical antibiotic prophylaxis. The establishment of a digital perioperative document is planned., (Copyright © 2022 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Abstract: Objective: To describe the knowledge of paediatricians regarding the practice of antimicrobial prophylaxis for caesarean section in reference to the Consensus Conference of the French Society of Anesthesia and Intensive Care (SFAR) and assess the feasibility of a change in attitude (injection of the antibiotic prior to incision) among paediatricians Perinatal Health Network of Auvergne (RSPA) working in maternity. Study design: Cross sectional study by survey. Methods: First questionnaire was sent to 46 RSPA paediatricians working in maternity. Almost one-third of paediatricians who returned the questionnaire said they were not concerned. A second questionnaire was developed with two paediatricians of the CHU and sent to the same 46 paediatricians. The statistical part involved percentages. Results: Response rates were respectively 61% and 67%. For the first questionnaire, only 25% of the paediatricians knew the antibiotic and the time for injection. For the second questionnaire, 87% were in favour of an administration before incision and 42% thought it will not affect the care of the newborn. For 35% of respondents, it could lead to a change in the duration of antibiotic therapy in cases of perinatal infection and for 13% only a delay in the implementation of antibiotic therapy in children. Conclusion: The RSPA paediatricians did not know the practices of antibiotic prophylaxis for caesarean section. However, they did not appear opposed to an administration before cord clamping as it would not delay the implementation of any antibiotics in the newborn. [Copyright &y& Elsevier]

Abstract: Method: In 2007, a questionnaire covering all items of a Ministry of Health circular was sent to healthcare institutions in the French Poitou-Charentes region to assess the good antibiotic use policy. Results: A comparison with the Nosocomial Infection Committee 2006 activity report concerning measures included in the ICATB (antibiotic use) indicator revealed widespread implementation of surveillance and of protocols for first-line antibiotics and surgical antibiotic prophylaxis (88% of all healthcare institutions). The assessment of protocol monitoring and of professional practice was to be implemented. Antibiotic therapy training sessions were deficient because of a shortage of expert physicians (50% of healthcare institutions), and mirrored by a lack of treatment re-evaluation at 48 or 72hours (58% of healthcare institutions). However, nominative prescription use was widespread (90% of healthcare institutions). Securing drugs circuit with online drug prescriptions, computerized patient file, sharing data with other services (microbiology laboratory, pharmacy) were difficult to integrate to hospital information systems. Pharmaceutical-economic indicators used to monitor antibiotic consumption were rarely given to units using antibiotics. The average ICATB indicator in 2006 ranged between 6 and 8/20. Comments: Antibiotic therapy training sessions and evaluation of professional practices must be improved. Computerizing the drug circuit should improve interdisciplinary practices. [Copyright &y& Elsevier]

Summary: Vesicoureteric reflux (VUR) is found in about 30 % of children with pyelonephritis (PN). It has been identified as a risk factor for the development of urinary tract infections, renal scars, hypertension and chronic renal failure but this risk is considerably smaller than previously assumed. Currently the therapeutic option was to use an antibiotic prophylaxis in order to keep the urinary tract sterile in order to prevent pyelonephritis and new renal scars. The review of the available data has shown that the antibiotic prophylaxis therapy is subject to discussion. The aim of this study was to evaluate the follow up of children with low-grade reflux before and after stopping the urinary antibiotic prophylaxis as soon as they became toilet-trained. Methods: Fifty-eight children with low-grade reflux (grade I, II, III) were enrolled in this study. The follow up ranged from October 2002 till February 2007. The children who have not attained bladder control received antibiotic prophylaxis. This treatment was stopped as soon as they became toilet-trained. The presence of urinary tract infection (UTI) was considered in case of unexplained fever and urinalysis and urine culture were performed. Results: VUR, mainly grade II, was discovered at a median age of 16 months. The prophylaxis was stopped at a median age of 40 months. The follow up after stopping the antibacterial prophylaxis was 27 months. Under treatment 2 pyelonephritis occurred, without treatment 2 pyelonephritis and 3 cystitis were diagnosed. At the end of the follow up, the grade of reflux decreased in half of the cases and disappeared in 3 cases. Conclusion: By stopping the urinary antibiotic prophylaxis in children with mild/moderate grade VUR when they became toilet-trained, there is no increase of the incidence of UTI, pyelonephritis. This study does not support the role for urinary antibiotic prophylaxis in preventing the recurrence of pyelonephritis. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this systematic review was to assess the effect of preoperative rather than after umbilical cord clamping antimicrobial prophylaxis for caesarean delivery on maternal and neonatal infectious postoperative morbidity. Study design: Meta-analysis. Methods: Three electronic databases (Pubmed, Cochrane Central Register of Randomized Controlled Trials and Embase) were searched without language restriction and retrieved 201 potentially relevant trials. Five randomized controlled trials (n =1108) studying the timing of antimicrobial prophylaxis for caesarean section were included. The quality of included trials was assessed on the modified Oxford validity scale. Results: Preoperative administration of antibiotics (n =456) rather than after cord clamping (n =563) provides a significant reduction in the incidence of endometritis (Odds Ratio (OR) 0.59 [95% Confidence Interval (CI) 0.35–0.98]) and of total maternal infectious morbidity (OR 0.51 [95% CI 0.32–0.82]). This benefit was not observed regarding the incidence of wound infection (Peto OR 0.58 [95% CI 0.29–1.16]), neonatal infection (Peto OR 1.06 [95% CI 0.57–1.96]), neonatal sepsis workup (OR 1.02 [95% CI 0.67–1.54]), neonatal documented sepsis (Peto OR 0.93 [95% CI 0.43–2.02]) or neonatal intensive care unit admission (OR 0.97 [95% CI 0.61–1.56]). No significant heterogeneity was observed between the included studies. Conclusion: This meta-analysis provides strong evidence that the preoperative rather than after cord clamping administration of antimicrobial prophylaxis for caesarean delivery provides a reduction in the incidence of endometritis and maternal total infectious morbidity without affecting the incidence of wound infection and neonatal infectious morbidity. [Copyright &y& Elsevier]

Abstract: Purpose: Antibiotic prophylaxis for infective endocarditis is still debated because of unproven efficacy and risk of side effects. French recommendations for infective endocarditis prophylaxis were revised in 2002 and its indications were restricted. Current knowledge and key points: Several arguments plead against prophylaxis: the absence of scientific evidence of its efficacy, the very high number of antibiotic doses required to prevent a very small number of endocarditis, the possible failure of prophylaxis even if correctly administered and a lack of compliance with current recommendations. High-risk patients for whom dental extraction is required should receive prophylaxis. For moderate-risk patients, prophylaxis is optional and should be discussed for each case individually. Future prospects and projects: Although prophylaxis is discussed, one should focus on prevention measures, such as dental hygiene and education of physicians, dentists and patients. [Copyright &y& Elsevier]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The rationale having led to the profound change in the guidelines on the prevention of endocarditis is presented. The current trend to abandoning systematic antibiotic prophylaxis in patients at risk for infective endocarditis is in fact based upon a sound scientific background. Systematic antibiotic prophylaxis remains necessary, however, in the category of patients at very high risk. [Copyright &y& Elsevier]

Abstract: Objective: The aim of the study was to estimate the prescription and administration of antibioprophylaxis for hip and knee replacement in Aquitaine (SouthWestern France). Methods: In 2003, “Social Security” medical experts performed a descriptive and retrospective study on a sample of scheduled surgical operations in all the Aquitaine public and private hospitals. Antibioprophylaxis, protocols, and practice were assessed by studying the patients'' medical files. The analysis was made on adjusted numbers to take into account the size of every institution. Results: In 51 hospitals, 58.8% of antibioprophylaxis protocols followed French guidelines. The sample corresponded to an adjusted number of 9,651 patients. Antibiopropylaxis was prescribed for 99.3% of patients, the course of antibioprophylaxis followed guidelines for 77.4% of the patients, the choice of the molecule and the dosage in 85.4% of the cases. Interval between antibiotic injection and surgical section was the main criterion of nonconformity (56.3%); it was under30 minutes for 43.7% of cephalosporin injections. In the post-operative period, administration complied with the medical prescription for 76.4% of the patients and dosage was adapted for 60.0% of the patients. According to the studied variables, 3 to 23.5% of data was missing in the medical files. Conclusion: If the quality of care and practice must be improved, it is mandatory to implement written and confirmed antibioprophylaxis protocols, to better document medical files, to insure an improved coordination among professionals before, during, and after surgery. [Copyright &y& Elsevier]

Abstract: Infections due to bacteria, virus or parasites are frequent during pregnancy and can have severe consequences. Moreover, the vaginal carriage of commensal bacteria or dramatic changes in the equilibrium of the vaginal flora can induce complications and cause fetal contaminations. With the help of the guidelines set up by the French Agency of Accreditation and Evaluation in Health (Anaes), the authors detail the microbiological exams and screening which take part in the management of different situations at risk. [Copyright &y& Elsevier]

Abstract: Objective. – In 2003, asplenia had involved 250000 patients in France. These patients are at risk of severe infection, mostly with capsulated bacteria as pneumococci, meningococci and Haemophilus. The higher mortality and morbidity due to infection in asplenic patient led in June 2003 a French expert committee to propose preventive management based on vaccination and antibioprophylaxis. Study design. – Update article. Data synthesis. – For vaccination, two vaccines against pneumococci are available. The first one, the antipolysaccharide (Pneumo 23®) is recommended for adults. It is effective for the majority of the serotypes even if its efficacy can be variable. The second one a conjugated pneumococcal vaccine (Prenevar®) is used for children under two years because it has higher activity on antibiotic resistant strains therefore increasing antibiotic prophylaxis efficiency. When splenectomy is required, vaccination against pneumococci, Haemophilus (b type) and C meningococci must be performed at least 15 days before surgery, in order to get better immune stimulation. In case of emergency, vaccines have to be administrated within 30 days after surgery. Antibioprophylaxis is based on cefazolin injection before splenectomy and by postoperative intravenous amoxicillin administration. As soon as oral intake is allowed, antibioprophylaxis is continued for at least two years in adults and five years in children. Both antibiotic and vaccination have been reported to reduce pneumococcus infections. [Copyright &y& Elsevier]