Search Results (77)

Background/Objectives: Antibiotic prophylaxis is a key component of infection prevention strategies. This study aimed to evaluate whether the duration of antibiotic prophylaxis influences the incidence of HAIs in patients undergoing elective colorectal surgery. Methods: This prospective cohort study included 278 adult patients who underwent elective colorectal surgery at a single tertiary care center. Patients were categorized into two groups based on the duration of antibiotic prophylaxis: one day or more than one day. Data on demographics, clinical characteristics, perioperative variables, and infection outcomes were collected. Results: The overall incidence of HAIs was 16.9%, with no significant difference between patients receiving one-day versus extended antibiotic prophylaxis. However, traditional multivariate analysis showed that prophylaxis lasting more than one day was independently associated with a significantly lower risk of HAI (RR = 0.30, 95% CI: 0.12–0.75, p = 0.010) and surgical site infections (RR = 0.24, 95% CI: 0.08–0.72, p = 0.011). After adjusting for confounders using propensity score matching, this association was no longer statistically significant. No significant association was found between prophylaxis duration and urinary tract infections. Regarding antibiotic selection, first-generation cephalosporins were the most commonly used agents, accounting for 78.8% of prophylactic prescriptions. This was followed by fluoroquinolones (14.4%) and third-generation cephalosporins (5.0%). All patients received metronidazole, a nitroimidazole-class antimicrobial, in combination with the above agents. Conclusions: One day of prophylactic antibiotics may be sufficient in SSI prevention in patients undergoing elective colorectal surgery. The use of extended antibiotic prophylaxis beyond one day should be considered for high-risk patients at high risk of infection, particularly those requiring ICU care. Full article

Background/Objectives: Antibiotic use is common among hospitalized pediatric patients. However, inappropriate use, including excessive use of Watch antibiotics, can contribute to antimicrobial resistance, adverse events, and increased healthcare costs. Consequently, there is a need to continually assess their usage among this vulnerable population. This was the objective behind this study. Methods: The medical records of all pediatric patients (under 12 years) admitted and treated with antibiotics at a Ghanaian Teaching Hospital between January 2022 and March 2022 were extracted from the hospital’s electronic database. The prevalence and appropriateness of antibiotic use were based on antibiotic choices compared with current guidelines. Influencing factors were also assessed. Results: Of the 410 admitted patients, 319 (77.80%) received at least one antibiotic. The majority (68.65%; n = 219/319) were between 0 and 2 years, and males (54.55%; n = 174/319). Ceftriaxone was the most commonly prescribed antibiotic (20.69%; n = 66/319), and most of the systemic antibiotics used belonged to the WHO Access and Watch groups, including a combination of Access and Watch groups (42.90%; n = 136/319). Neonatal sepsis (24.14%; n = 77/319) and pneumonia (14.42%; n = 46/319) were the most common diagnoses treated with antibiotics. Antibiotic appropriateness was 42.32% (n = 135/319). Multivariate analysis revealed ceftriaxone prescriptions (aOR = 0.12; CI = 0.02–0.95; p-value = 0.044) and surgical prophylaxis (aOR = 0.07; CI = 0.01–0.42; p-value = 0.004) were associated with reduced antibiotic appropriateness, while a pneumonia diagnosis appreciably increased this (aOR = 15.38; CI = 3.30–71.62; p-value < 0.001). Conclusions: There was high and suboptimal usage of antibiotics among hospitalized pediatric patients in this leading hospital. Antibiotic appropriateness was influenced by antibiotic type, diagnosis, and surgical prophylaxis. Targeted interventions, including education, are needed to improve antibiotic utilization in this setting in Ghana and, subsequently, in ambulatory care. Full article

Background/Objectives: Single-dose pre-operative antibiotic prophylaxis for cardiac-device implantation is recommended but extending antibiotic prophylaxis is common. Locally, 50–60% of patients had extended prophylaxis after pacemaker insertion or generator change. Our antimicrobial stewardship programme (ASP) incorporated behavioural change strategies in implementing a multi-pronged intervention bundle to address this and evaluated its effectiveness and safety. Methods: This single-centre, retrospective cohort study included patients aged 21 years old or older, undergoing uncomplicated pacemaker insertion or generator change at Singapore General Hospital (SGH) from October 2022 to March 2025. To improve antibiotic use, ASP interventions incorporating behaviour change strategies were implemented, namely (1) data-driven feedback, (2) targeted education, (3) identification and engagement of ASP champion, and (4) clinical pathway revision. Results: There were 779 patients evaluated; 380 (48.8%) received standard prophylaxis while 399 (51.2%) received extended prophylaxis with oral antibiotics (mean duration, 3.3 ± 0.8 days). Following ASP interventions, the practice of extended prophylaxis declined significantly from 43.8% to 24.0% (p < 0.01). The incidence of surgical site infections was low and similar in both groups (0.8%, p = 1.000); all infections were superficial. There was also significant reduction in the proportion of patients on all antibiotics from 20.7% to 16.3% (p < 0.01). Identification and engagement of ASP champion proved pivotal in changing prescribing behaviour through peer influence and credibility. Conclusions: The bundled ASP interventions, incorporating behavioural change strategies, have effectively and safely reduced the use of extended prophylaxis post-cardiac device implantation. Behavioural change interventions are essential to achieve sustained stewardship success. Full article

Background: The misuse of antibiotics in dental practice significantly contributes to the escalation of antimicrobial resistance. This study aimed to assess the knowledge and attitudes of final-year dental students regarding perioperative antibiotic prophylaxis in oral surgery and to identify potential curricular improvements based on the findings. Methods: A questionnaire was administered to 117 final-year students at Gazi University Faculty of Dentistry in December 2024. The survey presented clinical scenarios related to common oral surgical procedures, evaluating participants’ antibiotic prescribing behaviors. Statistical analyses were performed using descriptive statistics and a One-Sample Chi-Square Test. Results: Students demonstrated a general tendency toward rational antibiotic use in routine clinical scenarios, with statistically significant response patterns favoring the avoidance of unnecessary prescriptions (p < 0.05). However, in complex or borderline cases such as impacted third molar extraction and dental implant placement, response variability was observed. Post hoc analyses revealed no statistically significant differences between closely distributed options, indicating inconsistencies in decision-making in more challenging scenarios. Conclusions: While final-year dental students exhibited a satisfactory level of knowledge regarding appropriate antibiotic use in standard surgical procedures, the variability observed in complex cases underscores the necessity for enhanced educational interventions. Incorporating updated, evidence-based antimicrobial stewardship principles and promoting clinical decision-making through case-based learning are essential to prepare future dental practitioners for responsible antibiotic prescribing, contributing to global efforts to mitigate antimicrobial resistance. Full article

Background: Antimicrobial resistance (AMR) is a public health concern worldwide, particularly in low-to-middle-income countries with few antimicrobial stewardship programs and few laboratories equipped for diagnosis. Methods: As point-prevalence surveys (PPSs) are a well-known tool for assessing antimicrobial use, we adjusted standardized Global-PPS for use in two hospitals in Benin and included an analysis based on the 2021 WHO AWaRe classification. Results: Of the 450 patients enrolled, 148 received antimicrobials (AMs) (overall prevalence 32.9%), most of them orally (54.2%). Both hospitals had a high rate of Access and Watch antibiotics use, and both prescribed mainly metronidazole. In four prescriptions, hospital A used a non-recommended association of antibiotics, such as ceftriaxone + sulbactam and ofloxacin + ornidazole. While hospital A prescribed predominantly amoxicillin + clavulanic acid (19/92; 21%) and ceftriaxone (14/92; 15%), hospital B prescribed ampicillin (24/120; 20%) and cefuroxime (14/120; n = 12%). In hospital B, surgical antimicrobial prophylaxis (SAP) was suboptimal. While there were no single-dose prophylaxis prescriptions, all one-day prophylaxis (SP2) involved ampicillin for cesarean sections. In patients in intensive care units, prolonged prophylaxis (>1 day, SP3) accounted for all postoperative prescriptions. Conclusions: These findings highlight the critical need for implementing antimicrobial stewardship programs, expanding diagnostic laboratory capacity to minimize empirical prescribing, and strengthening medical student training to ensure quality and rational antibiotic use, thereby addressing the growing challenge of resistance in resource-limited settings. Full article

Hospital-acquired infections in operating rooms are contributing factors to the increasing presence of pathogens, with surgical site infections being the most frequent among them. Surgical antimicrobial prophylaxis is administered to minimize the risk of developing surgical site infection. Surgeons are responsible for weighing the benefit of surgical site infection-risk reduction for the individual patient afforded by prophylactic antimicrobial administration against the broader societal risk from such use. The aim of this study was to analyze the data on surgical antimicrobial prophylaxis related to patient status, surgery duration, wound classification and the occurrence of surgical site infection in two operating rooms of the Veterinary Teaching Hospital of Naples from January 2023 to January 2024. Two hundred seventy-seven surgical procedures met the inclusion criteria. For soft tissue clean-contaminated procedures and clean orthopedic surgeries not involving implants, no statistically significant difference was observed between the various antibiotic protocols used and surgical site infection; this finding supports the possibility of avoiding antibiotic use for these procedures. In contrast to previous reports, this study identified a statistically significant association between ASA status and surgical site infection; no correlation was found between surgical duration and the occurrence of infection. Further research on antibiotic use and risk factors associated with surgical site infection will be crucial to strengthen clinical guidelines. Full article

(1) Background: Postoperative antibiotic prophylaxis in dogs undergoing tibial plateau leveling osteotomy (TPLO) is controversial. We evaluated the effect of perioperative antibiotic administration on the incidence of surgical site infection (SSI) and bone healing in dogs that underwent TPLO procedures and compared this protocol with cases that received prolonged postoperative antibiotic treatment. (2) Methods: Two different antibiotic treatment protocols were used. In group A, cefazolin (22 mg/kg IV) was administered preoperatively 30–60 min before skin incision and repeated every 90–120 min intraoperatively. Antimicrobial prophylaxis was extended in the postoperative period with oral cefazolin (22 mg/kg BID) for 10 days after surgery. In group B, dogs only received perioperative treatment, at the same dose used in group A. Dogs were considered to have SSI in cases of incisional drainage, wound dehiscence, positive bacterial culture, or evidence of radiographic signs of infection. (3) Results: In group A, SSI was observed in 3/61 TPLOs (4.9%). In group B, SSI was present in 3/51 TPLOs (5.9%). There was no difference between the two groups. (4) Conclusions: Our results indicate that perioperative antibiotic prophylaxis in TPLO procedures is sufficient to maintain overall low rates of SSI. The incidence of SSI was similarly low compared to the rate observed in dogs that also received postoperative antibiotic treatment. Full article

Background/Objectives: Even with improvements in surgical techniques and the application of appropriate antibiotic prophylaxis, wound infections are still major public health problems in low- and middle-income countries. This study proposes the design of new particulate polymeric matrices based on chitosan (CS) for the controlled release of Metronidazole (MTZ), in order for it to be used for the treatment of Clostridium perfringens infections. Methods: The nanoparticles were prepared via inverse emulsion using tannic acid (TA) and sodium tripolyphosphate (TPP) as cross-linking agents. The ratio of CS to TPP, the concentration of CS solution, and the ratio of CS to TA were varied to optimize the synthesis procedure. Nanoparticles have been characterized based on several points of view in order to correctly correlate their properties with synthesis parameters. Results: The FTIR spectra of the analyzed nanoparticles confirmed both the formation of hydrogen bonds between CS and TA and the ionic cross-linking of CS with TPP. The average diameters of the nanoparticles ranged from 70 to 170 nm, whereas the zeta potential values were around 8 mV. Their swelling degree in a weak basic environment, as well as the drug loading/release capacity was influenced, as expected, by the synthesis parameters. The obtained nanoparticles were tested in vitro to evaluate their behavior in the blood environment, the cytotoxic effect, and the antimicrobial activity of nanoparticles loaded with MTZ against Clostridium perfringens cultures. Conclusions: The in vitro obtained results demonstrate that these non-hemolytic and non-cytotoxic particles can be efficient drug delivery systems for the treatment of Clostridium perfringens in wound infections. Full article

Introduction: Data about compliance with perioperative antimicrobial prophylaxis (PAP) guidelines in the pediatric population are limited. This study aims to evaluate PAP adherence in pediatric surgical subspecialty departments. Methods: A prospective cohort study was conducted from September 2023 to October 2024 at “Aghia Sophia” Children’s Hospital, Athens, Greece. Children <16 years old undergoing surgical procedures in the neurosurgery (NS), orthopedics (OP), and otolaryngology (ORL) departments were included. Data on demographics, surgical characteristics, and PAP practices (timing, agent, duration, and redosing) were collected and compliance with the international guidelines was evaluated. Results: A total of 301 children were included, with a median age (IQR) of 7 (8) years. PAP was received by 249/301 (82.7%) children (100% in the OP and NS, and 48% in the ORL). However, indications for PAP had 50.8% of children: 102/103 (99%) in the NS, 47/98 (47.9%) in the OP, and 4/48 (8.3%) in the ORL. Most children received broad-spectrum or combination of antimicrobials and/or antibiotics for longer duration. Appropriate PAP according to the guidelines was administered in 0% children in NS, 2% in OP, and 2.1% in ORL. Multivariable analysis in the ORL regarding the use of PAP revealed that shorter procedures (≤60 min; OR: 22.9, p = 0.003) and clean wounds (OR: 33.4, p < 0.001) were significantly associated with not using PAP. Conclusions: This study highlights gaps in the PAP guideline adherence in pediatric surgical departments, and the need for educational interventions to improve compliance and reduce antimicrobial use. Based on these findings, we plan to implement an educational intervention in order to optimize PAP practices in the pediatric population. Full article

The growing prevalence of antibiotic-resistant bacteria within the human microbiome has become a pressing global health crisis. While antibiotics have revolutionized medicine by significantly reducing mortality and enabling advanced medical interventions, their misuse and overuse have led to the emergence of resistant bacterial strains. Key resistance mechanisms include genetic mutations, horizontal gene transfer, and biofilm formation, with the human microbiota acting as a reservoir for antibiotic resistance genes (ARGs). Industrialization and environmental factors have exacerbated this issue, contributing to a rise in infections with multidrug-resistant (MDR) bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae. These resistant pathogens compromise the effectiveness of essential treatments like surgical prophylaxis and chemotherapy, increase healthcare costs, and prolong hospital stays. This crisis highlights the need for a global One-Health approach, particularly in regions with weak regulatory frameworks. Innovative strategies, including next-generation sequencing (NGS) technologies, offer promising avenues for mitigating resistance. Addressing this challenge requires coordinated efforts, encompassing research, policymaking, public education, and antibiotic stewardship, to safeguard current antibiotics and foster the development of new therapeutic solutions. An integrated, multidimensional strategy is essential to tackle this escalating problem and ensure the sustainability of effective antimicrobial treatments. Full article

Prosthetic valve endocarditis (PVE) has undergone significant changes over the past five decades and is currently affecting an aging population, with an increasing prevalence in patients with transcatheter valve implants. The introduction of transcatheter aortic valve replacement (TAVR) represents a significant advance in the field of interventional cardiology and cardiac surgery. The incidence of IE after TAVR has remained stable, with rates similar to those reported after surgical aortic valve replacement. This is despite significant refinements in the TAVR procedure, with less invasive handling and its extension to younger and healthier patients. TAVR should be considered as a potential treatment option for patients with PVE, despite some differences. In terms of evolutionary advances, there have been notable and significant developments in the fields of microbiology and imaging diagnostics. The 2023 Duke-International Society for Cardiovascular Infectious Diseases diagnostic criteria for infective endocarditis now incorporate significant advances in molecular biology and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. This has led to a significant enhancement in diagnostic sensitivity for PVE while maintaining the same level of specificity in validation studies. PVE is a deadly disease. A multidisciplinary endocarditis treatment team in a cardiac center is essential to improve outcomes. The availability of novel surgical options allows clinicians to offer an increasing number of patients the opportunity to avoid surgical intervention. Some patients will complete antimicrobial treatment at home. Those with prosthetic valves are eligible for antibiotic prophylaxis before dental procedures. Post-TAVR infective endocarditis (IE) is a subcategory of prosthetic valve endocarditis. This condition presents a particularly complex scenario, characterized by a distinctive clinical and microbiological profile, a high prevalence of IE-related complications, an ambiguous role of cardiac surgery, and a poor prognosis for the majority of patients with TAVR IE. The number of TAVR procedures is set to skyrocket in the coming years, which will undoubtedly lead to a significant rise in the number of people at risk of this life-threatening complication. This review will provide an overview of this rare complication in light of the advent of IE following TAVR. It is crucial to gain a comprehensive understanding of the disease and its associated complications to enhance clinical outcomes. Full article

Prosthetic valve endocarditis (PVE) is the medical term used to describe a focus of infection involving a valvular substitute within the heart. It is a significant concern in the field of cardiology, and the epidemiology of PVE has seen notable developments over the last five decades. The disease currently affects an older demographic and is becoming increasingly prevalent in patients with transcatheter-implanted valves. It is imperative that we urgently address the significant challenges posed by PVE. It is a disease that has a wide range of potential aetiologies, clinical presentations, and courses. In developed countries, Staphylococcus aureus is now the predominant causative organism, resulting in an aggressive form of disease that frequently afflicts vulnerable or elderly populations. However, it is clear that Enterococcus species present a significant challenge in the context of PVE following TAVR procedures, given their elevated prevalence. The 2023 Duke/International Society for Cardiovascular Infectious Diseases infective endocarditis diagnostic criteria now include significant developments in microbiological and image-based techniques for diagnostic purposes, specifically the incorporation of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography. These developments unequivocally enhance the diagnostic sensitivity for PVE, while maintaining the specificity. They do so in accordance with the results of studies conducted specifically for the purpose of validation. The lack of rigorous scientific studies and a shortage of funding and resources for research have led to a significant gap in our understanding. Randomized controlled trials could provide invaluable insight and guidance for clinical practice, but they are missing, which represents a major gap. It is clear that there is an urgent need for more research. PVE is a life-threatening condition that must be handled by a multidisciplinary endocarditis team at a cardiac centre in order to improve outcomes. The emergence of innovative surgical techniques has empowered clinicians to steer more patients away from surgical procedures, despite the presence of clear indications for them. A select group of patients can now complete parenteral or oral antimicrobial treatment at home. Additionally, antibiotic prophylaxis is the best option for individuals with prosthetic valves who are going to have invasive dental procedures. These individuals should be given antibiotics beforehand. Full article

Background/Objectives: Multiple-drug-resistant (MDR) bacteria are pathogens resistant to three or more antibiotic classes, and infection with these bacteria is associated with increased mortality, morbidity, and hospital management costs. Given the rise in antibiotic resistance, selecting appropriate antimicrobial drugs and avoiding the unnecessary use of new antibiotics are crucial. Due to their nosocomial nature, monitoring and preventing MDR infections are essential. Methods: This study enrolled patients who underwent cardiac surgery from January 2020 to May 2022. The patients included were those 18 years or older who tested positive for MDR intestinal colonization before surgery. Excluded were patients who tested positive after surgery, or were younger than 18, pregnant, or lactating. For each positive patient, the National Surgical Quality Improvement Program (NSQIP) score was calculated. The data collected included age, gender, body mass index (BMI), the type of surgery, the intensive care unit (ICU) length of stay, ICU readmission, mortality, and other infections (pneumonia, bacteremia, or surgical site infection) to establish a control group and postoperative outcome measures. Results: No statistically significant differences were found between the groups regarding the ICU length of stay, new ICU admissions, or mortality. Additionally, there were no differences in the infection rates, such as bacteremia, wound infections, and pneumonia. Conclusions: Preoperative rectal colonization by MDR bacteria does not appear to worsen postoperative outcomes for cardiac surgery patients. These findings suggest that patients with a preoperative MDR-positive rectal sample might undergo cardiac surgery without significantly increased risk. Besides the limitations of this study, pre-surgical antibiotic prophylaxis may not need to be adjusted for patients with preoperative MDR positivity. Full article

Background: Antimicrobial resistance (AMR) is a global problem that results in high morbidity and mortality, particularly in low- and middle-income countries. Inappropriate use of antimicrobials is a major driver of AMR. This study aimed to evaluate the rate and quality of antimicrobial prescription and use at the University Teaching Hospital of Kigali (CHUK), a tertiary-referral teaching hospital. Methodology: A point prevalence survey (PPS) of antimicrobial prescription was conducted using the Global PPS tool, including a healthcare-acquired infection (HAI) module. Results: On the day of the PPS, 39.3% (145/369) of inpatients were prescribed at least one antimicrobial. Out of the 259 prescribed antimicrobials, 232 (89.6%) were antibacterials, of which 151 (65.1%) belonged to the watch group of the WHO AWaRe classification. The top three antibiotics prescribed were cefotaxime (87; 37.5%), parenteral metronidazole (31; 13.4%), and meropenem (23; 9.9%). Stop or review dates for the prescribed antimicrobials were documented in 27/259 prescriptions (10.4%). Surgical prophylaxis (SP) was prescribed for longer than one day in 83.3% of 61 patients. Samples for culture were sent for 27.1% (63/232) of all the patients prescribed antibiotics. Conclusion: This PPS demonstrates multiple indicators of the poor use of antimicrobials, including the high prevalence usage of watch antibiotics and prolonged surgical prophylaxis and other poor-quality indicators. Thus, there is an urgent need for intervention to improve antimicrobial stewardship. Full article

Background/Objectives: Few studies have examined the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in acute care hospitals in Kazakhstan. This study aimed to address this gap by conducting a point-prevalence survey (PPS) of HAIs and AMU, as well as evaluating hospital antibiotic consumption via internationally recognized methodologies. Methods: PPS was conducted in four acute care hospitals in Kazakhstan on 11 May 2022, following the methodology of the European Center for Disease Prevention and Control, and included 701 patients. Antibiotic consumption in the same hospitals was assessed via the Global Antimicrobial Resistance and Use Surveillance System methodology. Results: HAIs were observed in 3.8% of patients (27/701), with intensive care unit wards accounting for 48.1% of these cases (13/27). Pseudomonas aeruginosa was the most frequently identified pathogen (5 out of 14 documented cases, 35.7%). Resistance to carbapenems was the most common resistance, followed by resistance to glycopeptides and third-generation cephalosporins. The rate of AMU was 38.2%, with an average of 1.37 antibiotics administered per patient. Surgical prophylaxis lasting more than one day was the most common indication for antimicrobial prescription (44.8%). Ceftriaxone and cefazolin are the most commonly used antibiotics. Conclusions: The results of this study are important for understanding the current situation in Kazakhstan and for informing national antimicrobial stewardship and infection control strategies. Full article