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Antibiotics
Special Issues
Antimicrobial Stewardship for Surgical Antibiotic Prophylaxis and Surgical Site Infections
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Antimicrobial Stewardship for Surgical Antibiotic Prophylaxis and Surgical Site Infections

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 1 June 2024 | Viewed by 6573

Special Issue Editors

Dr. Alessandro Pasculli

E-Mail Website
Guest Editor
Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Unit of General Surgery "V. Bonomo", University of Bari "A. Moro", Polyclinic Hospital, Bari, Italy
Interests: general surgery; surgical oncology, emergency surgery, endocrine surgery, minimally-invasive and robotic surgery; surgical training
Dr. Davide Fiore Bavaro

E-Mail Website
Guest Editor
Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Unit of Infectious Diseases, University of Bari "A. Moro", Polyclinic Hospital, Bari, Italy
Interests: clinical microbiology; difficult-to-treat infections; multidrug-resistant infections; implant-associated infection; viral infections; Mycobacterial infection
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In general and specialistic surgery wards, infections from multidrug-resistant microbes are a growing problem. In particular, surgical site infections (SSIs) are far from simple complications, especially for fragile and oncologic patients, and require complex management that implies antimicrobial stewardship strategies and multispeciality care.

The last few decades were characterized by the extensive and irrational use of antibiotics. However, the tendency towards redefinition strategies is now evident, and correct antibiotic prophylaxis and therapy play a crucial role in controlling SSIs.

Antimicrobial stewardship is now helping surgeons to select molecules to fight against specific etiologic agents with the lowest dose required and for the briefest duration, limiting the waste of precious weapons. These strategies require cooperation between pharmacists, nurses, infectious disease specialists, microbiologists, and hygienists in a multidisciplinary team, with a leader and co-leaders, audit and educational programs, case discussions, and the monitoring of efficacy and adverse reactions.

Indeed, the control of emerging microbes in surgery is not only a matter of antimicrobic drugs; it encompasses behavioural rules, hygiene, and nursing. Moreover, the array of rules and protocols from international guidelines and World Health Organization recommendations should always be tailored to the context of facilities, staff, and etiologic agents typical of each hospital and geographic area.

In this issue, the deepening of all these aspects is welcome. The following are suggested topics:

  • emerging microbes in SSIs after abdominal surgery
  • preventing SSIs in oncologic surgery
  • preventing SSIs in the elderly
  • pharmacological and interventional treatment of SSIs
  • the antimicrobial stewardship multidisciplinary team
  • procedural aspects of antimicrobial stewardship
  • adapting international recommendations to local reality

Dr. Alessandro Pasculli
Dr. Davide Fiore Bavaro
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • surgical site infections
  • multidrug-resistant agents
  • multidisciplinary team

Published Papers (3 papers)

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Research

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15 pages, 1843 KiB  
Article
Incidence of Bacteriobilia and the Correlation with Antibioticoprophylaxis in Low-Risk Patients Submitted to Elective Videolaparoscopic Cholecystectomy: A Randomized Clinical Trial
by Marcos Alberto Pagani, Junior, Pedro Meira Dolfini, Beatriz Flávia de Moraes Trazzi, Maria Ines Meira Dolfini, William Saranholi da Silva, Eduardo Federighi Baisi Chagas, Carlos Henrique Bertoni Reis, João Paulo Galletti Pilon, Bruna Trazzi Pagani, Rodrigo Tavore Strasser, Claudemir Gregório Mendes, Fausto Tucunduva Vernaschi, Daniela Vieira Buchaim and Rogerio Leone Buchaim
Antibiotics 2023, 12(10), 1480; https://doi.org/10.3390/antibiotics12101480 - 25 Sep 2023
Viewed by 1301
Abstract
Cholelithiasis has a major impact on global health and affects an average of 20% of the Western population. The main risk factors are females, age over 40 years, obesity and pregnancy. Most of the time it is asymptomatic, but when there are symptoms, [...] Read more.
Cholelithiasis has a major impact on global health and affects an average of 20% of the Western population. The main risk factors are females, age over 40 years, obesity and pregnancy. Most of the time it is asymptomatic, but when there are symptoms, they are generally nonspecific. Bile was considered sterile, but today it is known that it contains a complex bacterial flora, which causes biofilm in the gallbladder and gallstones. Among the main bacteria associated with cholelithiasis are Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, species of Enterococcus spp. and Acinetobacter spp. Antibiotic prophylaxis is used in an attempt to reduce postoperative infections, especially at the surgical site. However, some authors found no relationship between the use of antibiotic prophylaxis and a lower risk of surgical site infection. Thus, the aim of this double-blind randomized clinical trial was to compare the existence or not of bacteriobilia in patients at low anesthetic risk who underwent videolaparoscopic cholecystectomy, and its correlation with the use of prophylactic antibiotics. This study included 40 patients between 18 and 65 years old, diagnosed with cholelithiasis, symptomatic or not, with low anesthetic risk classified by the American Society of Anesthesiology in ASA I or ASA II, without complications or previous manipulation of the bile duct, who underwent elective video cholecystectomy, divided into two groups: Experimental Group A (n = 20), which received 2 g of Cephalotin (first-generation Cephalosporin, Keflin®, ABL antibiotics, Cosmópolis, Brazil) during anesthetic induction, and Control Group B (n = 20), where no antibiotics were administered until bile collection. After the procedure, a bile sample was collected and culture and antibiogram were performed. In the sample, 22 (55%) were classified as ASA I and 18 (45%) as ASA II. It was observed that 81.8% of the patients who had a positive culture did not use antibiotics, against 18.2% of those who used prophylaxis. When comparing patients regarding anesthetic risk, ASA I patients had a positive culture in 9.1% of cases, against 90.9% in patients classified as ASA II. It was concluded that patients with higher anesthetic risk (ASA II) have a higher chance of bacteriobilia and benefit from antibiotic prophylaxis when compared to patients with lower anesthetic risk (ASA I). Full article
(This article belongs to the Special Issue Antimicrobial Stewardship for Surgical Antibiotic Prophylaxis and Surgical Site Infections)
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10 pages, 260 KiB  
Article
Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals
by Kovy Arteaga-Livias, Vicky Panduro-Correa, Jorge L. Maguiña, Jorge Osada, Ali A. Rabaan, Kiara Lijarza-Ushinahua, Joshuan J. Barboza, Walter Gomez-Gonzales and Alfonso J. Rodriguez-Morales
Antibiotics 2023, 12(5), 808; https://doi.org/10.3390/antibiotics12050808 - 25 Apr 2023
Cited by 2 | Viewed by 2217
Abstract
Introduction: Surgical site infections (SSI) can be as high in gynecology and obstetrics surgeries compared to other areas. Antimicrobial prophylaxis is an effective tool in the prevention of SSIs; however, it is often not adequately administered, so this study aimed to understand the [...] Read more.
Introduction: Surgical site infections (SSI) can be as high in gynecology and obstetrics surgeries compared to other areas. Antimicrobial prophylaxis is an effective tool in the prevention of SSIs; however, it is often not adequately administered, so this study aimed to understand the compliance and factors associated with the use of the clinical practice guidelines for antibiotic prophylaxis in gynecological surgeries in two hospitals in the city of Huanuco, Peru. Methods: An analytical cross-sectional study of all gynecologic surgeries performed during 2019 was performed. Compliance was determined based on the antibiotic chosen, dose, administration time, redosing, and prophylaxis duration. Age, hospital of origin, presence of comorbidities, surgery performed, as well as its duration, types of surgery, and anesthesia were considered as related factors. Results: We collected 529 medical records of patients undergoing gynecological surgery with a median age of 33 years. The prophylactic antibiotic was correctly indicated in 55.5% of cases, and the dose was correct in 31.2%. Total compliance with the five variables evaluated was only 3.9%. Cefazolin was the most commonly used antibiotic. Conclusion: Low compliance with the institutional clinical practice guidelines for antibiotic prophylaxis was identified, showing that antimicrobial prophylaxis in the hospitals studied was inadequate. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship for Surgical Antibiotic Prophylaxis and Surgical Site Infections)

Review

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16 pages, 651 KiB  
Review
Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle
by Massimo Sartelli, Federico Coccolini, Francesco M. Labricciosa, AbdelKarim. H. Al Omari, Lovenish Bains, Oussama Baraket, Marco Catarci, Yunfeng Cui, Alberto R. Ferreres, George Gkiokas, Carlos Augusto Gomes, Adrien M. Hodonou, Arda Isik, Andrey Litvin, Varut Lohsiriwat, Vihar Kotecha, Vladimir Khokha, Igor A. Kryvoruchko, Gustavo M. Machain, Donal B. O’Connor, Iyiade Olaoye, Jamal A. K. Al-Omari, Alessandro Pasculli, Patrizio Petrone, Jennifer Rickard, Ibrahima Sall, Robert G. Sawyer, Orlando Téllez-Almenares, Fausto Catena and Walter Siquiniadd Show full author list remove Hide full author list
Antibiotics 2024, 13(1), 100; https://doi.org/10.3390/antibiotics13010100 - 19 Jan 2024
Cited by 2 | Viewed by 2468
Abstract
In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical [...] Read more.
In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean–contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship for Surgical Antibiotic Prophylaxis and Surgical Site Infections)
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