Antibiotic prophylaxis in pacemaker surgery--a prospective study

To evaluate the effect of antibiotic prophylaxis in pacemaker surgery, 100 patients were randomly assigned to a prophylaxis group receiving cloxacillin or to a control group with no antibiotics. Cloxacillin was given intravenously (2 g) 2 hours before operation, followed by 1 g every 6 hours for 2 days and the same dose perorally for 8 more days postoperatively. Adequate plasma concentrations were obtained in all patients. The follow-up time was 1-43 months. The infection rate was 2% (1/50) in the prophylaxis group and 14% (7/50) in the control group (p less than 0.05). The interval from operation to manifest infection was 9-35 days. In the control group the causal microorganism was Staphylococcus aureus in two patients, Staphylococcus epidermidis in two and unknown in three patients. In the only patient with infection in the prophylaxis group, a methicillin-resistant S. epidermidis was isolated. Infection was initially localized to the pacemaker pocket in seven patients, but septicemia developed in one of them and endocarditis in another. In one patient septicemia appeared initially, without local signs of infection. This study suggests that cloxacillin prophylaxis is of value in routine pacemaker surgery.     

Cefuroxime prophylaxis in trochanteric hip fracture operations

In a double-blind-randomized study of antibiotic prophylaxis in trochanteric fractures operated on with a nail and plate, a 24-hour intravenous administration of cefuroxime 0.75 grams thrice daily (Group B) was compared with the previous regimen of cefuroxime for 24 hours plus 6 days of oral cephalexin (Group A). In each group, 56 (Group A) and 65 (Group B) patients could be evaluated. One deep infection occurred in Group B with growth of Staphylococcus aureus, and another 4 patients had discharge and cultures of which 2 showed S. aureus In Group A., 6 patients had signs of an infection, and in 3 patients cultures were taken but were negative. There were no differences between the groups. We concluded that the prophylaxis time need not be longer than 3 days.     

Plasmapheresis for the prophylaxis and treatment of recurrent focal segmental glomerulosclerosis following renal transplant

We evaluated 10 patients with primary focal segmental glomerulosclerosis (FSGS) treated with plasmapheresis (PS) following renal transplantation. Three patients lost their first graft due to FSGS recurrence. In seven patients, PS was indicated as treatment for probable recurrence defined as the onset of proteinuria above 1 g/24 hours. In the remaining three patients, treatment was started in the first week posttransplant as prophylaxis against recurrence. The PS protocol was 17 sessions with the exchange of 2.5 L of plasma for 5% albumin over 10 to 12 weeks. Losartan (25 to 100 mg/d) was given to most patients at the end of PS treatment. The mean follow-up time after PS was 10 months. All patients currently have a functioning graft. A full response to treatment, defined as persistently reduced proteinuria to less than 500 mg/24 hours or the lack of recurrence in prophylactic treatment, was achieved in six patients. Three patients showed a partial decrease in proteinuria (to less than 1 g/24 hours). One patient failed to respond and still has nephrotic range proteinuria. No adverse effects of PS were recorded. A prompt start of PS combined with the use of losartan yields good results in the prophylaxis and treatment of recurrent FSGS following renal transplant in terms of quickly reduced proteinuria. Given the natural course of FSGS, a longer follow-up is needed to estimate the impact of PS on graft survival.     

Cefuroxime prophylaxis in trochanteric hip fracture operations

In a double-blind randomized study of antibiotic prophylaxis in trochanteric fractures operated on with a nail and plate, a 24-hour intravenous administration of cefuroxime 0.75 grams thrice daily (Group B) was compared with the previous regimen of cefuroxime for 24 hours plus 6 days of oral cephalexin (Group A). In each group, 56 (Group A) and 65 (Group B) patients could be evaluated. One deep infection occurred in Group B with growth of Staphylococcus aureus, and another 4 patients had discharge and cultures of which 2 showed S. aureus. In Group A, 6 patients had signs of an infection, and in 3 patients cultures were taken but were negative. There were no differences between the groups. We concluded that the prophylaxis time need not be longer than 3 days.     

Failure of single-dose metronidazole prophylaxis in colorectal surgery. No benefit from high dosage or combination with nalidixic acid

In an open prospective study of postoperative infectious complications, patients undergoing elective colorectal surgery were randomly allocated to one of three groups receiving parenteral single-dose antimicrobial prophylaxis (1 g or 3 g metronidazole or 1 g metronidazole + 3 g nalidixic acid). Because of an unacceptably high rate of surgical infection in all three groups (36%, 29% and 39%, p greater than 0.1) among the first 103 evaluable patients, the study was discontinued. Nalidixic acid--though effective in in vitro tests of bacterial susceptibility--thus was found to be of little or no value as prophylaxis against Gram-negative infection. As the observed infection rate when metronidazole was given at the start of operation was seven-fold that previously found in the same department when 1 g metronidazole was administered 3-4 hours preoperatively (28/103 vs. 2/50, p less than 0.01), the timing of metronidazole prophylaxis was assumed to be potentially important for its ability to protect also against aerobic postoperative infection.     

Antibiotic prophylaxis in cranial base surgery

The role of perioperative antibiotic prophylaxis was investigated in 95 patients undergoing 100 clean-contaminated cranial base surgeries. A variety of antibiotic regimens were employed. Potential risk factors for local infection were analyzed. Seven patients (7%) developed infections at the surgical site (meningitis, intracranial abscess, cellulitis/abscess, and osteomyelitis). Antibiotic prophylaxis for 24 hours or less was associated with a significantly increased risk of infection (p less than 0.04). Prolonged antibiotic prophylaxis (greater than 48 hours) was not more efficacious than prophylaxis for 48 hours. The surgical approach, type of reconstruction, duration of surgery, and use of drains were not significantly correlated with wound infection. The risk of intracranial infection following cranial base surgery is low despite the presence of bacterial contamination intraoperatively. Broad-spectrum coverage of gram-positive and gram-negative organisms for at least 48 hours is recommended. Attention to surgical technique is important in preventing infectious complications.     

Thromboembolic prophylaxis in blunt traumatic intracranial hemorrhage: a retrospective review

There are few data in the literature on venous thromboembolic (VTE) prophylaxis for the traumatic population with intracranial hemorrhage (ICH). We reviewed our institutional experience and compared the incidence of deep vein thrombosis and pulmonary embolism in patients with ICH receiving either early prophylaxis (< 72 hours from admission) or late prophylaxis (> 72 hours from admission), and the respective incidences in progression of intracranial hemorrhage. We identified 124 patients for this study. There were 29 patients (23%) who received early (< 72 hours) pharmacological VTE prophylaxis and 53 patients (43%) received late (> 72 hours) prophylaxis. In the study, 42 patients had intermittent pneumatic compression devices and received no pharmacological VTE prophylaxis. Among those with pharmacological VTE prophylaxis, 10 patients (8%) developed VTE (9 deep vein thrombosis and 1 pulmonary embolism). Three patients with pharmacological VTE prophylaxis developed ICH progression, with one being clinically significant. Our institutional review demonstrated that it seems safe to initiate early pharmacological VTE prophylaxis in blunt head trauma with stable ICH. Nevertheless, further prospective randomized studies are needed to fully elucidate the safety and efficacy in the timing of prophylaxis for blunt head trauma with ICH.     

Systemic and local antibiotic prophylaxis in the prevention of prosthetic vascular graft infection: an experimental study.

AIM: to determine if local, in addition to systemic antibiotic prophylaxis (compared to that provided by systemic prophylaxis alone) provides additional benefit in terms of reducing graft infection. METHODS: gelatin-sealed Dacron grafts were interposed in the infrarenal aorta of 36 mongrels and inoculated with 1 ml of a S. aureus suspension. Group 1 (control group) received no prophylaxis and were inoculated with 1 ml containing 10(9)cfu/ml. Group 2 (n=6) received systemic prophylaxis (1 g cephamandole) and were inoculated with 10(5) cfu/ml (n=3) or 10(7) cfu/ml (n=3). Group 3 received systemic prophylaxis (1 g cephamandole) and were inoculated with 109 cfu/ml. Group 4 received systemic prophylaxis (2 g cephamandole) and were inoculated with 10(9)cfu/ml. In group 5 and 6 grafts were soaked in a rifampicin solution before use and inoculated with 10(9) cfu/ml. Group 5 received no systemic prophylaxis and group 6 received systemic prophylaxis (1 g cephamandole). Grafts were harvested at 2 weeks, and peritonitis, perigraft abscess, anastomotic disruption and graft occlusion recorded. Swabs were taken of the graft, the perigraft tissues and the peritoneal fluid. Graft segments were incubated in broth medium. RESULTS: inoculation with 10(9) cfu/ml ensured graft infection. Systemic or local prophylaxis alone failed to prevent graft infection. Only systemic and local antibiotic prophylaxis provided significant better results than no prophylaxis at all (p<0.01) and local prophylaxis alone (p<0.05). However, total "graft sterility" was not achieved as bacteriologic analysis of the graft segments showed low bacterial counts (<10 bacteria/graft) in 5 of 6 grafts. CONCLUSION: local and systemic prophylaxis provided more protection as demonstrated by the significant decrease in the incidence of "overt" graft infection. Total "graft sterility" cannot be expected in the case of an overwhelming bacterial challenge.     

Low-dose valaciclovir prophylaxis against cytomegalovirus disease in renal transplant recipients

High-dose valaciclovir at up to 8 g/day has been shown to be effective in prophylaxis against cytomegalovirus (CMV) disease in renal transplant recipients. We report our experience with low-dose valaciclovir prophylaxis of up to 3 g/day, adjusted to creatinine clearance. A group of patients at high risk of developing CMV disease who received prophylaxis were selected as the study group. This included all CMV-positive patients who received antilymphocyte therapy (R+, n=20) and all CMV-negative recipients of CMV-positive organs (D+R–, n=15). D+R– patients receiving antilymphocyte therapy were excluded, as most of the patients in the control group had received ganciclovir prophylaxis. A historical control group was used, which consisted of patients who did not receive prophylaxis. Low-dose valaciclovir prophylaxis resulted in a statistically significant decrease (8.5 vs 37%, P=0.004) in CMV disease in the study group at 6 months. On subgroup analysis the decrease was statistically significant only in the R+ group (5 vs 45%, P=0.003), not in the D+R– group (13.3 vs 26.6%, P=0.651). Low-dose valaciclovir prophylaxis seems to be adequate for R+ patients receiving antilymphocyte therapy. The role of low-dose valaciclovir prophylaxis needs to be assessed further in a prospective trial.     

Single-daily-dose treatment of ceftriaxone for biliary tract infections and bacterial counts in bile

To evaluate the effects of ceftriaxone (CTRX) administered once daily, the biliary concentration of CTRX and daily changes in the bacterial count in bile from an indwelling T-tube were measured concomitantly. The effects on prophylaxis of postoperative infections after biliary tract surgery were also examined mainly due to clinical symptoms. The biliary CTRX levels increased rapidly and were sustained as high as 92.5-219 micrograms/ml in all patients even 24 hours after 2 g of CTRX was infused intravenously once daily. Five of 7 patients whose bile samples were positive for bacteria showed high CTRX levels in bile and almost no bacteria present after treatment. CTRX-sensitive bacteria eliminated 1 or 2 hours after the administration in response to the increase of biliary CTRX levels. The changes in bacteria count of bile may be closely related to CTRX antibiotic activity. As an antibiotic prophylaxis, other 18 patients with biliary diseases received intravenous infusion of 2 g of CTRX once daily for 5-7 days (mean 5.9 days). Thus, once-daily dose treatment of CTRX 2 g may have antibiotic effects on biliary infection and postoperative prophylaxis of biliary infections and it is indicated that the prolonged biliary levels of CTRX are essential for its efficacy.     

Temporin A as a prophylactic agent against methicillin sodium-susceptible and methicillin sodium-resistant Staphylococcus epidermidis vascular graft infection

OBJECTIVE: The purpose of this study was to investigate the efficacy of temporin A as a prophylactic agent in a rat model of vascular graft infection from methicillin sodium-susceptible and methicillin sodium-resistant Staphylococcus epidermidis. METHODS: The prospective, randomized, controlled animal study set in a research laboratory in a university hospital used 280 adult male Wistar rats (weight range, 280 to 350 g). Graft infections were established in the back subcutaneous tissue of rats with implantation of 1-cm(2) sterile Dacron grafts followed by topical inoculation with 2 x 10(7) colony-forming units of S epidermidis. The study for each staphylococcal strain included: one control group (no graft contamination), one contaminated group that did not receive any antibiotic prophylaxis, one contaminated group that received temporin A-soaked graft, two contaminated groups that received perioperative intraperitoneal cefazolin (30 mg/kg) or vancomycin hydrochloride prophylaxis (10 mg/kg), and two contaminated groups that received temporin A-soaked graft and perioperative intraperitoneal cefazolin (30 mg/kg) or vancomycin hydrochloride (10 mg/kg) prophylaxis. All grafts were explanted at 7 days after implantation. The main outcome measure was quantification of bacterial contamination. RESULTS: Overall, the perioperative prophylaxis based on soaked grafts was not significantly different to that of parenteral vancomycin hydrochloride. Only the combination between temporin A and vancomycin hydrochloride produced a complete bacterial inhibition for both strains. CONCLUSION: Temporin A showed a similar antibacterial in vitro activity against the two different strains. The in vivo results suggest its potential use in providing prophylaxis to direct graft contamination when used in combination with parenteral vancomycin hydrochloride.     

Pneumonia after cardiac surgery is predictable by tracheal aspirates but cannot be prevented by prolonged antibiotic prophylaxis

BACKGROUND: The purpose of this study was to assess the value of tracheal aspirate as a predictor of pneumonia after coronary artery bypass grafting and to evaluate the efficacy of prolonged perioperative antibiotic prophylaxis. METHODS: Tracheal aspirates of 500 patients undergoing coronary artery bypass grafting were taken immediately after intubation and analyzed for microorganisms by Gram stain and semiquantitative microbiologic cultures. All patients received 2 g ceftriaxone as a single-dose perioperative antibiotic prophylaxis before operation. Results of Gram stains were available before the patients were transferred to the intensive care unit. After the results were known, both groups of patients (positive Gram stain, group 1; negative Gram stain, group 2) were randomly assigned to either conventional antibiotic prophylaxis (A), consisting of ceftriaxone 2 g on postoperative day 1, or prolonged antibiotic prophylaxis (B), with ticarcillin + clavulanic acid 3 x 5.2 g during 72 hours. RESULTS: From 500 patients, 91 had a positive Gram stain whereas 409 had a negative one. The incidence of pneumonia was significantly higher in patients with preoperative positive tracheal aspirates (15.3%) than in patients with a negative one (3.6%; p < 0.01). However, prolonged prophylaxis did not reduce the rate of postoperative pneumonia, which was as high as 13% in untreated positive patients versus 17% in treated positive patients, and 2% in untreated negative patients versus 4% in treated patients. In patients who had pneumonia, there was a high correlation between the microorganisms found in preoperative aspirates and those observed when aspirates were repeated (100% correlation in patients with conventional antibiotic prophylaxis and 87% in those with prolonged prophylaxis). CONCLUSIONS: Early postoperative pneumonia (<7 days) is most likely caused by microorganisms that colonize the respiratory tract before operation. The risk of pulmonary infection after coronary artery bypass grafting can be predicted from the preoperative tracheal aspirates. Prolonged perioperative antibiotic prophylaxis has no efficacy in reducing the incidence of pulmonary infections.     

Routine Use of Low-Molecular-Weight Heparin For Deep Venous Thrombosis Prophylaxis After Foot and Ankle Surgery: A Cost-Effectiveness Analysis

The purpose of the present study was to determine whether certain foot/ankle surgeries would benefit from the routine use of low-molecular-weight heparin (LMWH) as postoperative deep venous thrombosis prophylaxis. We conducted a formal cost-effectiveness analysis using a decision analytic tree to explore the healthcare costs and health outcomes associated with a scenario of no prophylaxis and a scenario of routine LMWH prophylaxis for 4 weeks. The 2 scenarios were compared for 5 procedures: (1) Achilles tendon repair (ATR), (2) total ankle arthroplasty (TAA), (3) hallux valgus surgery (HVS), (4) hindfoot arthrodesis (HA), and (5) ankle fracture surgery (AFS). The outcomes assessed included short- and long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. The costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2015 price base. In the short term, routine prophylaxis was always associated with greater costs compared with no prophylaxis. For ATR, TAA, HA, and AFS, prophylaxis was associated with slightly better health outcomes; however, the gain in QALYs was minimal compared with the cost of prophylaxis (incremental cost-effectiveness ratio well above $50,000/QALY threshold). For HVS, prophylaxis was associated with both worse health outcomes and greater costs. In the long term, routine prophylaxis was always associated with worse health outcomes and either cost more (HA, AFS, HVS) or saved very little (ATR, TAA). We concluded that policies encouraging the routine use of LMWH after foot/ankle surgery are unlikely to be cost-effective. Decisions to perform prophylaxis should be on a case-by-case basis and should emphasize individual patient risk factors.     

A comparison of the roles of cefamandole and ceftriaxone in abdominal surgery

In a prospective, randomized study, we compared the ability of ceftriaxone sodium (serum half-life, 8.0 hours) and cefamandole naftate and sodium carbonate (serum half-life, 0.8 hours) to prevent wound infection in 1238 patients undergoing abdominal surgery. Prophylaxis consisted of single-dose therapy at the time of induction of anesthesia, and treatment regimens contained ceftriaxone sodium, 1 g/d intravenously, or cefamandole naftate and sodium carbonate, 1 g intravenously every 6 hours. Except for low-risk biliary procedures, cephalosporin therapy was accompanied by the administration of metronidazole. No significant difference was noted in the incidence of wound infection, ie, 5.6% for the ceftriaxone group (95% confidence interval, 3.8% to 7.4%) and 6.9% for the cefamandole group (95% confidence interval, 4.9% to 8.9%). Single-dose prophylaxis with 1 g of cefamandole naftate and sodium carbonate was relatively inexpensive and provided a cost savings of 64%. When treatment was required, a 23% cost savings was associated with the use of a once-daily dose of 1 g of ceftriaxone sodium.     

Comparative efficacy of teicoplanin and cefazolin for cardiac operation prophylaxis in 3027 patients. The ESPRIT Group

OBJECTIVE: Cephalosporins, especially cefazolin, are widely used in the prevention of postoperative wound infections after cardiac operations. As more and more Staphylococcus aureus and Staphylococcus epidermidis strains are becoming resistant to cephalosporins and other antibiotics, alternative agents, such as glycopeptides, are often used as prophylaxis. We performed a multicenter double-blind randomized controlled trial comparing teicoplanin, a glycopeptide antibiotic, with cefazolin. METHODS: A total of 3027 adult patients undergoing elective coronary artery bypass grafting, valve operations, or both were randomized to a single dose of teicoplanin (15 mg/kg) or a 2-day course of cefazolin (2 g initial dose, followed by 1 g every 8 hours for 6 more doses). Patients were followed up for a total of 6 months postoperatively. The primary objective was to compare, between groups, the incidence of surgical infections up to 30 days postoperatively. Secondary objectives were incidence of other infections, other complications, and death. RESULTS: A total of 3027 patients were randomized to receive either teicoplanin (n = 1518) or cefazolin (n = 1509). Thirty days postoperatively, there was a trend to more deep sternotomy wound infections in the teicoplanin group (31 vs 18, P =. 087), which became significant by 6 months (36 vs 19, P =.032). One hundred percent of the gram-positive strains infecting patients were susceptible to teicoplanin, whereas 8.3% were resistant to cefazolin. Pneumonia and urinary tract infections were more common in the teicoplanin group. Deep wound infections of the leg were more common in the cefazolin group. CONCLUSIONS: Cefazolin was more effective prophylaxis than teicoplanin against postoperative wound infections after elective cardiac operations. Infection rates were low with either treatment.     

Extended Antibiotic Prophylaxis Confers No Benefit Following Aseptic Revision Total Hip Arthroplasty: A Matched Case-Controlled Study

BackgroundAdministration of perioperative antibiotic prophylaxis is one of the most important practices for prevention of periprosthetic joint infection (PJI) in patients undergoing total hip arthroplasty (THA). It is common to continue perioperative antibiotic prophylaxis for 48 hours or longer in patients undergoing revision arthroplasty, until results of intraoperative culture samples become available. However, the utility of this practice remains unclear. We examined whether extended antibiotic prophylaxis following aseptic revision THA reduces the risk of subsequent PJI.MethodsWe retrospectively reviewed records of patients undergoing aseptic revision THA between January 2000 and December 2015. At our institution, some surgeons administer prophylactic antibiotics to revision patients for only 24 hours while others prefer to extend until intraoperative culture results become available. We matched 209 patients undergoing revision THA who received extended antibiotic prophylaxis (>24 hours) in a 1:1 ratio with 209 patients receiving standard antibiotic prophylaxis (≤24 hours). The matching criteria were age, sex, body mass index, Charlson comorbidity index, and operative time.ResultsThe incidence of subsequent PJI was 4.8% in patients receiving extended antibiotic prophylaxis vs 2.4% in patients receiving standard. After adjusting for all cofounders and using multivariate logistic regression, the administration of extended prophylactic antibiotics did not reduce the incidence of subsequent infection. When stratified by postoperative antibiotic regimens, the 2 groups had similar infection-free implant survival rate (95.2% in extended and 97.6% in standard).ConclusionIt appears that extending perioperative prophylactic antibiotics until intraoperative culture results become available in patients undergoing revision THA for aseptic failures does not provide any additional benefit in terms of reducing the risk of subsequent PJI.     

Antibiotic prophylaxis in high-risk head and neck surgery: one-day vs. five-day therapy

Patients who undergo major contaminated surgery of the head and neck benefit from perioperative antibiotic prophylaxis. This study was developed to determine if 5 days of antibiotic administration would be more effective than 1 day. A multi-institutional prospective randomized double-blind study was designed. Patients who were identified as requiring pedicled flap reconstruction were potential candidates for the study. Later, patients were randomly assigned to receive cefoperazone sodium for either 24 hours or 120 hours. In each case, the drug was administered intravenously, beginning 1 to 2 hours preoperatively and continued for the prescribed period. One hundred nine patients were evaluable. Fifty-three patients were assigned to 1 day of perioperative prophylaxis. Wound infection developed in ten patients (18.9%). Fifty-six patients were assigned to 5 days of perioperative antibiotic prophylaxis. Wound infection developed in 14 (25%) of these patients (P greater than .05). These data suggest that no beneficial effect from administration of antibiotics for longer than 24 hours postoperatively can be achieved in patients who undergo myocutaneous flap reconstruction.     

Pediatric acute graft-versus-host disease prophylaxis and treatment: surveyed real-life approach reveals dissimilarities compared to published recommendations

Pediatric allogeneic hematopoietic cell transplantation (HCT) practices differ from those of adults, particularly the heterogeneity of transplantable nonmalignant diseases and the lower incidence of graft-versus-host disease (GVHD). Several guidelines regarding the management of acute (a) GVHD in adult HCT have been published. We aimed to capture the real-life approaches for pediatric aGVHD prophylaxis/treatment, and data from 75/193 (response rate 39%) EBMT centers (26 countries) were included, representing half (48%) of the pediatric EBMT-HCT activity. Results with ≥75% approval from respondents (74/75) for GVHD prophylaxis after myeloablative HCT for malignancies partially contradict published guidelines: Single-agent cyclosporine A (CsA) was used for matched sibling donor HCT in 47%; blood CsA levels were reported lower; the relapse risk in malignant diseases influenced GVHD prophylaxis with early withdrawal of CsA; distinct longer duration of CsA was employed in nonmalignant diseases. Most centers used additional anti-thymocyte globulin for matched unrelated and mismatched donor HCT, but not for matched siblings. Regarding prophylaxis in nonmyeloablative conditioning (mainly for nonmalignant diseases), responses showed broad heterogeneity. High conformity was found for first-line treatment; however, results regarding steroid-refractory aGVHD indicate an earlier diagnosis in children. Our findings highlight the need for standardized pediatric approaches toward aGVHD prophylaxis/treatment differentiated for malignant and nonmalignant underlying diseases.     

Cutaneous CO2 Laser Resurfacing Infection Rate With and Without Prophylactic Antibiotics

BACKGROUND: Cutaneous laser resurfacing is a well-accepted modality, with excellent clinical outcomes and low morbidity rates, for the treatment of a variety of epidermal and dermal lesions. The use of antibiotic prophylaxis continues to be an area of controversy, with laser practitioners divided in their approach. OBJECTIVE: To identify the rate of postoperative bacterial infection following full-face carbon dioxide (CO2) laser resurfacing with and without antibiotic prophylaxis. METHODS: A retrospective chart review of 133 consecutive patients following full-face CO2 laser resurfacing was performed. The rate, severity, duration, and subsequent treatment of bacterial infections observed in four treatment categories were recorded: (1) no antibiotic prophylaxis; (2) intraoperative single-dose intravenous cephalexin (1 g); (3) postoperative oral azithromycin (1.5 g over 5 days); (4) intraoperative IV cephalexin (1 g) and postoperative oral azithromycin (1.5 g). RESULTS: A significantly higher rate of infection occurred in patients receiving combination intraoperative and/or postoperative antibiotic prophylaxis. The most frequently cultured organisms included Enterobacter and Pseudomonas species. CONCLUSION: The rate of postoperative bacterial infections after full-face CO2 laser resurfacing in this retrospective study was not significantly reduced with the use of prophylactic antibiotics.     

Prophylactic Use of Liposomal Amphotericin B in Preventing Fungal Infections Early After Liver Transplantation: A Retrospective,Single-Center Study

In this study the authors evaluated the efficacy of prophylaxis with liposomal amphotericin B (L-AmB) in the incidence of fungal infections (FI) during the first 3 months after liver transplant (LT). The study was retrospective and accessed a 4-year period from 2008 to 2011. All patients who died in the first 48 hours after LT were excluded. Patients were divided by the risk groups for FI: Group 1, high-risk (at least 1 of the following conditions: urgent LT; serum creatinine >2 mg/dL; early acute kidney injury [AKI] after LT; retransplantation; surgical exploration early post-LT; transfused cellular blood components [>40 U]); and Group 2, low-risk patients. Group 1 patients were further separated into those who received antifungal prophylaxis with L-AmB and those who did not. Prophylaxis with L-AmB consisted of intravenous administration of L-AmB, 100 mg daily for 14 days. Four hundred ninety-two patients underwent LT; 31 died in the first 48 hours after LT. From the remaining 461 patients, 104 presented with high-risk factors for FI (Group 1); of these, 66 patients received antifungal prophylaxis and 38 did not. In this group 8 FI were observed, 5 in patients without antifungal prophylaxis (P = .011). Three more FI were identified in Group 2. By logistic regression analysis, the categorical variable high-risk group was independently related to the occurrence of invasive FI (P = .006). We conclude that prophylaxis with L-AmB after LT was effective in reducing the incidence of FI. No influence on mortality was detected.