Antibiotic prophylaxis in vascular surgery.

Annals of Surgery (Impact Factor: 6.33). 10/1978; 188(3):283-9.
Source: PubMed

ABSTRACT Preoperative and intraoperative antibiotic prophylaxis of infection in peripheral vascular surgery has been widely used although controlled studies have been lacking. A randomized, a prospective, double-blind study of cefazolin versus placebo during 565 arterial reconstructive operations was performed at this hospital from February 1976 through August 1977. Among the 462 patients undergoing surgery of the abdominal aorta and lower extremity vasculature, there was a highly significant difference in the infection rates: 6.8% for placebo recipients versus 0.9% for cefazolin recipients (p less than .001). Of the 18 infections, four involved vascular grafts and all four graft infections occurred in the placebo group. Over 8% of abdominal wounds of patients receiving placebo became infected versus 1.2% of cefazolin patients (p less than .05). Groin wounds were infected infrequently, 1.1% for placebo patients versus none for cefazolin patients. No infections occurred among 103 brachiocephalic procedures. Skin antisepsis was analyzed retrospectively. Infection rates were significantly higher (p less than .01) following hexachlorophene-ethanol versus a povidone-iodine skin preparation. Adverse effects of cefazolin were carefully monitored: no rash, phlebitis, or emergence of resistant strains was observed. A breif perioperative course of cefazolin and povidone-iodine skin antisepsis are recommended in vascular reconstructive surgery of the abdominal aorta and lower extremity vasculature.

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    ABSTRACT: Surgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis.Methods/design: In this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5 surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three years.
    Trials. 05/2014; 15(1):188.
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    ABSTRACT: Synthetic vascular graft infection (SVGI) remains associated with high morbidity-mortality rates. Newly developed polyester vascular prostheses (PVP) functionalised with cyclodextrin (PVP-CD) allowed sustained-drug-eluting of several antibiotics. This study aimed to evaluate the efficacy of PVP-CD loaded with antibiotics against bacteria that are commonly responsible for SVGI in current practice. Samples of PVP-CD loaded with antibiotics and uncoated-PVP were tested in-vitro for their ability to limit bacterial adhesion and prevent bacterial proliferation over time. Their anti-infectious properties were further evaluated in-vivo in a mouse model of SVGI. Both Gram-positive (Staphylococcus aureus, Staphylococcus epidermidis, MRSA) and Gram-negative (Escherichia coli, En. cloacae and Pseudomonas aeruginosa) bacteria were tested. PVP-CD loaded with rifampin showed significant bacterial adhesion reduction and growth inhibition against Gram-positive bacteria. Similar results were obtained against Gram-negative bacteria with PVP-CD loaded with ciprofloxacin. In the mouse model, Gram-positive and Gram-negative bacterial proliferations were significantly prevented by PVP-CD loaded with rifampin or with ciprofloxacin respectively. A decrease in macroscopic infections correlated with the bacterial proliferation rates depicted on the samples (Spearman's rho = 0.61; P < 0.0001). We have demonstrated the efficacy of PVP-CD loaded with appropriate antibiotics both in-vitro and in-vivo against six of the most common bacteria involved in human SVGI.
    The Journal of infection 10/2013; · 4.13 Impact Factor


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