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AIM: This study aimed to evaluate adherence to an antibiotic prophylaxis protocol and its impact on incidence of surgical site infection (SSI). MATERIALS AND METHOD: A prospective observational cohort study was conducted at a teaching hospital in São Paulo, Brazil, from September to November 2015. The population were adults who underwent surgery with surgical antibiotic prophylaxis. The main outcomes measured were incidence of SSI at 30-days postoperatively, protocol adherence and surgical wound complications. STROBE guidelines were followed. RESULTS: Among the 527 participants recruited, a 30-day follow-up was completed by 78.7 % (n = 415). Within this cohort, 57.6 % were females aged over 60 years (36.4 %). The incidence of SSI stood at 9.4 % (n = 39), with dehiscence being the most prevalent complication at 64.1 % (n = 25), followed by increased exudate at 51.3 % (n = 20). Notably, full adherence to the antibiotic prophylaxis protocol was low at 1.7 % (n = 7). The study observed a 60 % increased risk of SSI for every protocol mistake made. Alarmingly, 17.8 % (n = 74) of participants received antibiotic treatment exceeding the stipulated protocol duration. The overall mortality rate stood at 13.5 % (n = 56), with 1 % (n = 4) of these deaths attributed to SSI. CONCLUSION: There is a pressing global necessity to enhance antibiotic management, as underscored by this study's revelation of low adherence to the antibiotic prophylaxis protocol. This lack of adherence correlated with a notable incidence of SSI and subsequent wound complications. Nearly 20 % of participants received prolonged antibiotic treatment. Adhering strictly to the protocol could substantially impact SSI-related outcomes and enhance global antibiotic management.

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Antibiotic prophylaxis in patients with cirrhosis and acute variceal bleeding is part of the standard of care according to most clinical guidelines. However, with recent evidence arguing against antibiotic prophylaxis, the role of this intervention has become less clear.

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Introducción: La endocarditis infecciosa es una enfermedad con riesgo de mortalidad que se puede originar por un tratamiento odontológico. Por ello, los cirujanos dentistas deben tener conocimientos básicos sobre la prevención de endocarditis infecciosa. Objetivo: Determinar el nivel de conocimientos sobre la profilaxis antibiótica de endocarditis infecciosa previa a procedimientos odontológicos en estudiantes de pregrado y posgrado de estomatología. Métodos: Se diseñó un estudio descriptivo y transversal cuya muestra estuvo formada por 74 estudiantes de pregrado y 234 de posgrado de la carrera de Estomatología de la Universidad Científica del Sur en el año 2019. Se empleó un cuestionario previo validado en el Perú, conformado por 20 preguntas de opción múltiple y dividido en 4 dimensiones (epidemiología, etiopatogenia, indicación y farmacología de la profilaxis antibiótica de endocarditis infecciosa). Los resultados se categorizaron en nivel de conocimiento bajo, regular y alto. Resultados: El 73,1 % de los estudiantes presentó un nivel de conocimiento global bajo, mientras que el 23,7 % presentó un nivel regular y el 3,2 %; un nivel alto. La calificación promedio fue 8,71 ± 2,78 [IC95 % 8,40 a 9,10]. Los estudiantes de pregrado tuvieron un puntaje de 8,64 ± 2,72 [IC95 % 8,01 a 9,26] y los de posgrado; 8,74 ± 2,80 [IC95 % 8,38 a 9,10]. Conclusión: El nivel de conocimiento sobre profilaxis antibiótica para la prevención de endocarditis infecciosa previa a procedimientos odontológicos es bajo en pregrado y posgrado.

Introduction: Infective endocarditis is a potentially life-threatening disease that can be caused by dental treatment. Therefore, dental surgeons should have basic knowledge about the prevention of infective endocarditis. Objective: To determine the level of knowledge of antibiotic prophylaxis of infective endocarditis prior to dental procedures in undergraduate and postgraduate students of stomatology at the Universidad Cientifica del Sur, Lima - Peru. Method: A descriptive and cross-sectional study was designed with a sample of 74 undergraduate and 234 graduate students of the Universidad Cientifica del Sur Stomatology career in 2019. A questionnaire previously validated in Peru was used, consisting of 20 multiple-choice questions, and divided into 4 dimensions (epidemiology, etiopathogenesis, indication, and pharmacology of antibiotic prophylaxis of infective endocarditis). The results were categorized into low, regular, and high levels of knowledge. Results: 73.1% of the students presented a low level of global knowledge, while 23.7% presented a regular level, and 3.2% a high level. The average score was 8.71 ± 2.78 [95% CI 8.40 to 9.10]. Undergraduate students had a score of 8.64 ± 2.72 [95% CI 8.01 to 9.26] and graduate students; 8.74 ± 2.80 [95% CI 8.38 to 9.10]. Conclusion: The level of knowledge of antibiotic prophylaxis for the prevention of infective endocarditis prior to dental procedures was predominantly low in undergraduate and postgraduate students.

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BACKGROUND: Surgical site infections (SSI) are the most frequent early complications of hand surgeries. However, the indications still remain uncertain for antibiotic prophylaxis in elective clean soft tissue surgeries of the hand and upper limb. Therefore, a systematic review of the literature and a meta-analysis was conducted to investigate the impact of antibiotic prophylaxis on the prevention of SSI in these types of surgeries. METHODS: An electronic search was performed in the following databases: MEDLINE/Pubmed, PMC/Pubmed, Web of Science/Clarivate Analytics, Embase/Elsevier, Scopus/Elsevier, BVS/Lilacs, and the Cochrane Library, with no restrictions regarding publication language or date. The primary outcome of interest was the occurrence of SSI following elective clean soft tissue surgeries of the hand and upper limb according to the administration of preoperative antibiotic prophylaxis and no antibiotic prophylaxis. Surgeries involving simultaneous bone procedures or orthopedic implants were excluded. Study selection and data extraction were conducted independently by two reviewers. RoB 2.0 and ROBINS-I are Cochrane risk-of-bias tool for randomized trials and non-randomized studies of interventions. The magnitude of the intervention effect was estimated using the relative risk (RR). The meta-analysis was performed with the Review Manager and R software tools, using the Mantel-Haenszel random-effects model and a 95% confidence interval (CI). Results with p ≤ 0.05 were considered statistically significant. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The initial search yielded 1175 titles, from which 12 articles met the inclusion criteria for the systematic review, and 10 were included in the subsequent meta-analysis. The majority of these studies were nonrandomized intervention trials, exhibiting a moderate risk of bias. According to our review, preoperative antibiotic prophylaxis did not have a statistically significant impact on the incidence of SSI (RR = 1.13, 95% CI 0.91-1.40, p = 0.28). The overall quality of evidence for this outcome was rated as low. Moderate statistical heterogeneity was observed (I2 = 44%), and the prespecified sensitivity analysis highlighted the consistency of the results. CONCLUSIONS: While these results were consistent with the findings from individual studies included in this review, it is important to note that, given the threshold of p ≤ 0.05 for statistical significance, no definitive conclusions can be drawn from the quantitative analysis of the data obtained. LEVEL OF EVIDENCE: Level 2. TRIAL REGISTRATION: CRD42023417786.

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Even though there are guidelines for the management of snakebite envenoming (SBE), the use of antibiotics in this pathology remains controversial. The aim of this study is to provide a narrative review of the literature and recommendations based on the best available evidence regarding antibiotic use in SBE. We performed a narrative review of relevant literature regarding SBE and antibiotic use as prophylaxis or treatment. A total of 26 articles were included. There is wide use of antibiotics in SBE; nevertheless, infection was not necessarily documented. The antibiotics used varied according to the study, from beta lactams to lincosamide and nitroimidazoles, and from monotherapy to combined antimicrobials. The most common recommendations were to manage skin and soft tissue infections and avoid infectious complications, but these suggestions are not necessarily based on bacteriological findings. Prophylactic use of antibiotics in SBE is discouraged in most studies. Antibiotic prescription in SBE should be based on the susceptibility of microorganisms isolated from the affected tissue or identified in snakes' oral cavities. Antibiotics should be reserved only for patients with a demonstrated infection, or those at a high risk of developing an infection, i.e., presenting severe local envenoming, local signs of infection, or those with incorrect manipulation of wounds. Prospective studies are needed to correlate microbiological findings at the wound site and the response to antibiotic use.

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ABSTRACT A 69-year-old female was referred with sudden unilateral painless decreased vision that began 2 days after uncomplicated cataract surgery in the left eye. Visual acuity was hand motion and biomicroscopy showed a mild anterior chamber reaction, no hypopyon, and an intraocular lens that had been placed within the capsular bag. A dilated fundus examination revealed optic disk edema, widespread deep and superficial intraretinal hemorrhages, retinal ischemia, and macular edema. A cardiological evaluation was normal and thrombophilia tests were negative. After surgery, prophylactic vancomycin (1mg/0.1ml) had been injected intracamerally. The patient was diagnosed with hemorrhagic occlusive retinal vasculitis likely secondary to vancomycin hypersensitivity. Recognition of this entity is important to ensure early treatment and the use of intracameral vancomycin in the fellow eye should be avoided after cataract surgery.

RESUMO Esse caso se refere a uma paciente de 69 anos, sexo feminino, com relato de baixa acuidade visual súbita e indolor no olho esquerdo, de início 2 dias após cirurgia de catarata sem complicações. A acuidade visual era de movimento de mãos e a biomicroscopia mostrou reação de câmara anterior moderada, sem hipópio, e lente intraocular posicionada dentro do saco capsular. A fundoscopia evidenciou edema de disco óptico, hemorragias difusas intrarretinianas superficiais e profundas, isquemia retiniana e edema macular. A avaliação cardiológica foi normal e os testes para trombofilia foram negativos. Ao final da cirurgia foi injetado antibioticoprofilaxia com vancomicina (1mg/0,1ml) na câmara anterior. A paciente foi diagnosticada com vasculite hemorrágica oclusiva da retina secundária à hipersensibilidade a vancomicina. O reconhecimento dessa entidade é importante para o tratamento precoce e para evitar o uso de vancomicina intracameral em caso de cirurgia de catarata no olho contralateral.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the prevalence of early neonatal sepsis in pregnant women with a positive culture for group B beta-hemolytic Streptococcus in a middle-income city in Southeastern Brazil. METHODS: A retrospective cohort study was conducted, involving singleton low- and high-risk pregnancies in whom group B beta-hemolytic Streptococcus cultures were evaluated between 35 and 37 weeks of gestation using vaginal and anal swabs. A specific medium (Todd-Hewitt) was used for culturing. The pregnant women were divided into two groups based on positive (n==201) and negative (n==420) cultures for group B beta-hemolytic Streptococcus. RESULTS: The maternal colonization rate by group B beta-hemolytic Streptococcus was 32.3%. The prevalence of early neonatal sepsis was 1.0% (2/201) among patients with a positive group B beta-hemolytic Streptococcus culture and 1.9% (8/420) among patients with a negative culture. Among the patients who underwent adequate prophylaxis, crystalline penicillin G was used in 51.9% (54/104), followed by cefazolin in 43.3% (45/104), ampicillin in 3.8% (4/104), and clindamycin in 1.0% (1/104). A model that included prematurity (p==0.001) proved to be an independent risk predictor of early neonatal sepsis [χ2 (1)==15.0, odds ratio: 16.9, 95% confidence interval: 4.7-61.6, p<0.001, Nagelkerke R2==0.157]. CONCLUSION: The prevalence of a positive culture for group B beta-hemolytic Streptococcus was high. However, the prevalence of early neonatal sepsis was low in pregnant women with both positive and negative group B beta-hemolytic Streptococcus cultures and in pregnant women with a positive culture who underwent both adequate and inadequate antibiotic prophylaxis. Prematurity proved to be an independent predictor of early neonatal sepsis, considering the entire study population.

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Abstract Objectives: to assess the prevalence and epidemiological factors associated with group B Streptococcus (GBS) colonization in pregnant women in Porto Velho City, Rondônia. Methods: GBS was identified and isolated by genotypic and microbiological methods from rectovaginal samples of pregnant women between 35 and 37 weeks of gestation. Epidemiological data were collected using questionnaires and their correlation with colonization was assessed. The antimicrobial susceptibility profile was determined by disk diffusion method. Results: a total of 22.5% (102/453) pregnant women were colonized with GBS. A higher level of colonization was observed at the vaginal tract (17.6%), compared to the rectal area. We did not find any sociodemographic or obstetric factors associated with an increased risk of GBS colonization. All strains were susceptible to antibiotics penicillin, ampicillin, cefazolin, and ceftriaxone. In contrast, the rates of resistance to tetracycline (74.1%), erythromycin (14.1%), and clindamycin (3.5%) were observed. Conclusion: the prevalence of GBS as well as the absence of predictors of colonization demonstrated the need for universal screening for GBS in all pregnant women in the region. In addition, we showed that the first-line antibiotics recommended for prophylaxis are still good options for the prevention of neonatal GBS disease in the region.

Resumo Objetivos: avaliar a prevalência e os fatores epidemiológicos associados à colonização por Streptococcus do grupo B (GBS) em gestantes na cidade de Porto Velho, Rondônia. Métodos: GBS foi identificado e isolado por métodos genotípicos e microbiológicos a partir de amostras retovaginais de grávidas com 35-37 semanas de gestação. Os dados epidemiológicos foram coletados através de questionários e sua correlação com a presença de colonização foi avaliada. O perfil de susceptibilidade antimicrobiana foi determinado pelo método de disco-difusão. Resultado: um total de 22.5% (102/453) gestantes foram colonizadas por GBS. Um nível mais alto de colonização foi observado no sítio vaginal (17.6%) em comparação ao sítio retal. Não encontramos nenhum fator sociodemográfico ou obstétrico associado a um risco aumentado de colonização por GBS. Todas as amostras foram suscetíveis aos antibióticos penicilina, ampicilina, cefazolina e ceftriaxona. Em contraste, as taxas de resistência à tetraciclina (74.1%), eritromicina (14.1%) e clindamicina (3.5%) foram observadas. Conclusões: a prevalência de GBS, bem como a ausência de preditores de colonização, demonstraram a necessidade de triagem universal para GBS em todas as gestantes da região. Além disso, mostramos que os antimicrobianos de primeira linha recomendados para profilaxia são boas opções para a prevenção da doença GBS neonatal na região.

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OBJECTIVE: Patients with sickle cell disease (SCD) are at increased risk for invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae. Immunization and antimicrobial prophylaxis may prevent this complication, and landmark clinical trials support discontinuation of antimicrobial prophylaxis at age 5 years. However, antimicrobial prophylaxis continues in some patients indefinitely. The objective of this study was to evaluate the incidence of culture-positive IPD and other infections in the setting of penicillin prophylaxis in the pediatric SCD population. METHODS: This was a single-center, retrospective cohort study of patients with SCD who continued antimicrobial prophylaxis with penicillin, compared with those whose antimicrobial prophylaxis was discontinued. Included patients were aged 5 to 18 years during the study period and had no history of IPD or surgical splenectomy. Patient charts were reviewed for demographics, immunizations, penicillin prescription history, and microbiologic culture data. RESULTS: Antimicrobial prophylaxis continued beyond age 5 years in 65% of patients, a higher percentage of whom had hemoglobin SS or S beta-zero disease. No patients whose antimicrobial prophylaxis was discontinued experienced IPD; 1 patient who continued antimicrobial prophylaxis died of S pneumoniae sepsis. Rates of other infections were comparable between groups (21% in prophylaxis versus 18% in no prophylaxis). CONCLUSIONS: These results support appropriate de-prescribing of antimicrobial prophylaxis in patients with SCD who are not at high risk for IPD. Further multicenter studies are needed to evaluate consequences of antimicrobial prophylaxis with alternative agents on antibiotic resistance, examine provider rationale for continuation of antimicrobial prophylaxis, and assess quality of life effects (e.g., medication adherence, adverse drug reactions) of antimicrobial prophylaxis.

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This study aims to characterize the impact of the implementation of an antimicrobial stewardship program (AMS) on the optimal selection of surgical antibiotic prophylaxis in adult patients. This is a retrospective quasi-experimental study that compared the selection and duration of antibiotics for all surgical prophylaxis prescriptions over six months, both before (pre-AMS) and after a five-year intervention of AMS (post-AMS). In addition, data related to the consumption of antibiotics, adverse drug reactions, and surgical site infections throughout the years of the intervention were analyzed. The rate of appropriate selection of antibiotic prophylaxis in surgical procedures improved to 80% during the post-AMS period. The percentage of optimal duration increased from 69.1% (N = 1598) in the pre-AMS period to 78.0% (N = 841) in the post-AMS period (p < 0.001). The consumption of ceftriaxone significantly decreased, while the use of cefazolin increased more than nine times. No severe adverse reactions or increases in surgical site infections were detected after the intervention. The implementation of an AMS in the surgical ward demonstrated a trend towards a positive overall impact on the selection and duration of prophylactic antibiotics for surgery, with positive results also observed in other variables associated with the prescription of these antibiotics.