Antibiotic Prophylaxis in Vascular Surgery

Vanderbilt University, Нашвилл, Michigan, United States
Annals of Surgery (Impact Factor: 8.33). 10/1978; 188(3):283-9. DOI: 10.1097/00000658-197809000-00003
Source: PubMed


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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    • "Antibiotics themselves may cause side effects, such as nephrotoxicity, allergy, and even hemolytic anemia as a result of the production of drug-induced antibodies [12,13]. A rare but important complication of antibiotic use is pseudomembranous enterocolitis, which is induced most commonly by clindamycin, the cephalosporins, and ampicillin [14,15]. "
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    ABSTRACT: To perform a prospective analysis of the clinical outcomes of prophylactic antibiotic treatment before the standard surgical modality of living donor nephrectomy (LDN) without postoperative antibiotic treatment. From November 2005 to June 2010, a total of 470 patients underwent LDN at our medical institution, and 280 of these patients were injected with 1 g cephalosporin 30 minutes before the operation. The group receiving prophylactic antibiotics was compared with a control group composed of 190 patients who received injections of 2 g cephalosporin per day for 5 days after the operation. The presence of fever, incidence of blood transfusion, and period of drainage use were compared between the two groups. There were no significant differences in gender, age, body mass index, incidence of blood transfusion after the operation, fever over 38℃ 3 days after the operation, or period of drain insertion between the single-dose group and the control group. The follow-up was conducted for 1 month after the operation, and 1 case of surgical site infection (SSI) was observed in each group (p=0.783). Of 280 patients in the single-dose group, 1 contracted SSI. In comparison with the control group, which was dosed with prophylactic antibiotics for 5 days after the operation, the single-dose group did not have a significantly different occurrence of SSI. We found that the incidence rate of SSI did not increase, even though prophylactic antibiotics were not used after standard and conventional open surgeries, such as video-assisted minilaparotomy surgery.
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    ABSTRACT: Previous studies have demonstrated that administered antibiotics must be active against major anticipated pathogens and must have reached sufficient concentrations in the tissue or body fluid at risk by the time of bacterial challenge if prophylactic therapy is to be maximally effective in reducing the infection rate of potentially contaminated surgery. The need for continuing antibiotic prophylaxis beyond the day of operation, however, has been uncertain. In a prospective, randomized, double-blind study of 220 patients undergoing elective gastric, biliary or colonic surgery, perioperative administration of cefamandole plus five days of placebo was compared to perioperative plus five days of postoperative antibiotic therapy; no significant difference was found between the groups in the rate of infection of wound (6 and 5%, respectively), peritoneum (2% each) and elsewhere (6% and 5%). In another prospective, randomized, nonblind study of 451 determinant cases of 1,624 patients undergoing emergency laparotomy, cephalothin was instituted preoperatively but after peritoneal contamination had occurred (i.e., abdominal trauma, etc.); continued postoperative antibiotic again failed to reduce further the wound and peritoneal infection rates, as noted on comparing perioperative therapy alone (infection rates 8 and 4%, respectively) with perioperative plus 5-7 days of postoperative treatment (10% and 5%, respectively). Analysis of these data, as well as of the extra expenses incurred by 463 patients because of infection in a previous prophylactic antibiotic study, revealed an average additional expenditure of $2,686.00 for each instance of postoperative infection of the wound and/or peritoneum; whereas savings of $300.00 per patient at risk were obtained whenever appropriate prophylactic antibiotic had been given.
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    ABSTRACT: Most evaluations of antimicrobial prophylaxis have serious defects in design or fail to assess the clinical importance of observed differences. Reports that were published in the last decade and that meet stringent criteria indicate that antimicrobial prophylaxis is justified in few circumstances and nearly always only in very short courses, often just a single dose. These situations include vaginal hysterectomies(cephalosporin or penicillin), total abdominal hysterectomies (cephalosporin), high-risk cesarean sections (cephalosporin), elective colorectal surgery (oral erythromycin-neomycin, kanamycin-metronidazole, or doxycycline), vascular grafts of the abdominal aorta or lower extremity vasculature (cephalosporin), total hip replacement (cephalosporin or penicillinase-resistant penicillin), head and neck cancer surgery (cephalosporin), travelers' diarrhea (doxycycline), prevention of pneumonia due to Pneumocystis carinii in susceptible cancer patients (trimethoprim-sulfamethoxazole), and recurrent urinary tract infections in females (trimethoprim-sulfamethoxazole). Elective high-risk gastric and biliary tract surgery and prosthetic cardiac valve replacementmay also merit prophylaxis, but the information is less conclusive.
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