INFECTION AFTER RETINAL DETACHMENT SURGERY
|
|
- Adrian Foster
- 5 years ago
- Views:
Transcription
1 Australian and New Zealand Journal of Ophthalmology 1986; 14: INFECTION AFTER RETINAL DETACHMENT SURGERY OSMOND BRUCE HADDEN FRACO Auckland Hospifal. Auckland, New Zealand Abstract: In 250 consecutive retinal detachment operations performed by the author, there were 14 cases (5 6%) of infection of the scleral buckle The commonest infecting organism was Staphylococcus aureus The surgery in these infected cases took longer than average, and utilized more than the usual amount of silicone sponge, a higher proportion were reoperations After an average follow-up of 22 months, only six of the 14 had vision of 6/36 or better and of these, two had persisting inferior traction detachments On the basis of this study and others, the preferred management of infected scleral buckles is to remove the sponge as soon as the diagnosis is made The risk of redetachment is a lesser evil than the sequelae of prolonged inflammation which include traction retinal detachment, massive perirebnal proliferabon, and premacular fibrosis Key words Retinal detachment - infection after surgery, scleral buckle infections, silicone sponge infections The purpose of this paper is to describe the frequency, nature, and management of infection after retinal detachment surgery. A previous paper by the author described the postoperative complications in 135 consecutive retinal detachment operations. ' In the course of the past four years, during which the series has expanded to 250 cases, infection has remained a recurring problem. This paper compares the infected with the noninfected cases, in an attempt to identify significant differences, the recognition of which may reduce the rate of this potentially avoidable complication. METHODS The records of 250 consecutive retinal detachment operations performed by the author between January 1976 and January 1984 were analysed. The 14 cases which developed postoperative infection were recalled and reexa- mined if the records were incomplete or if the follow-up period was less than six months. The follow-up time ranged from six months to eight years, with a mean of 22 months. Comparisons with the 236 non-infected cases were made of surgical time, amount of sponge used, rate of reoperation, rate of successful reattachment, and visual outcome. The results of this and previously published series were used to formulate a plan to reduce the incidence of infection and to improve the management of established infection. RESULTS Prevalence Fourteen of the 250 cases (5.6%) became infected. Folio W-up Follow-up time ranged from six months to 93 months, with a mean of 22 months. Reprint requesfs: Dr 0. B. Hadden, Eye Department, Auckland Hospital, Auckland, I. New Zealand. INFECTION AFTER RETINAL DETACHMENT SURGERY 69
2 TABLE 1 Comparisons Between Infected and Non-infected Cases Feature Number (Yo) of cases Statistical Infected Non-infected significance (14 cases) (236 cases) Attached Vision 6/36 or 7 (50%) 201 (85%) p<0.001 better 6 (43%) 170 (72%) p=0.02 Encircling sponge 4 (28%) 38 (16%) * Reoperations 4 (28%) 35 (15%) * Duration of surgery 140 min 125 min t *Numbers insufficient for analysis.?not statistically significant. min =minutes. Time of Presentation Nine of the 14 infections became apparent within the first week after surgery. The longest interval between surgery and manifest infection was eight weeks. Retinal Reattachment Only seven of the 14 had attached retinas when last seen. Three of those seven had poor vision due to premacular fibrosis. Visual Acuity Only six of the 14 had vision of 6/36 or better. Those six included the four with attached retinas without premacular fibrosis, and two with persisting inferior traction detachments, but with the maculas attached. Of the other five patients with poor vision, two had traction detachments involving the macula and three had massive periretinal proliferaton (MPP). Comparison with Non-in fected Cases Table 1 gives comparisons between the infected and non-infected cases. Sponge Removal All 14 cases had the sponge removed at intervals varying from the first postoperative day to 10 weeks after the diagnosis of infection. The two cases in which the sponge was removed the day after the diagnosis of infection both did well, with vision of 6/18 and 6/24 respectively. The three cases in which the sponge was removed later than eight weeks after the diagnosis of infection had poor vision. Two had attached retinas but premacular fibrosis, and one had traction detachment. Of the other nine in whom the sponge was removed between two and six weeks after the diagnosis of infection, three had good results and six had poor results. Three of the six had MPP, one had premacular fibrosis, and two had traction retinal detachment. Redetachment in relation to sponge removal Seven cases had detached retinas when last seen. In two, the detachment was present before the sponge was removed. In one of those, there was a localized balloon detachment first seen two days after surgery; six days later a subretinal abscess was visible under the balloon detachment. In the other case, a peripheral traction detachment developed during a prolonged period of inflammation, before the sponge was finally removed eight weeks after infection was diagnosed. In the other five cases with detachment, the retina detached at periods ranging from five days to eight weeks after removal of the sponge. No sponge was removed sooner than three weeks after the initial retinal surgery. Numbers were insufficient to correlate the chance of detachment with time when the sponge was removed. However, premacular fibrosis was significantly related to the length of time between manifestation of infection and removal of the sponge. In the three cases in which premacular fibrosis occurred, the times between manifest infection and removal of the sponge were four, nine and 10 weeks respectively; it did not occur in the seven cases in which the sponge was removed within three weeks of the infection becoming manifest. Because of the small numbers, the significance of this timing could not be statistically validated. Infecting Organism Staphylococcus aureus was the culprit in eight cases, staphylococcus epidermidis in two cases, beta-haemolytic Streptococcus in one, and Pseudomonas in one case. The records were missing in two cases. Of the 10 cases infected with Staphylococcus (aureus or epidermidis), 70 AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY
3 TABLE 2 Sensitivities of Infecting Staphylococcal Species Antibiotic Number Number Number tested sensitive resistant Methicillin Erythromycin Tetracycline Penicillin Ampicillin Gentamicin eight of the 10 were tested against methicillin and seven were sensitive; six were tested against erythromycin and all were sensitive; three were tested against both tetracycline and gentamicin, and all were sensitive; six were tested against penicillin and only two were sensitive; three were tested against ampicillin and none were sensitive. These results are summarized in Table 2. DISCUSSION The frequency of infection of silicone sponges has been reported as ranging from 0.1Vo2 to 24.4%. Hilton and Wallyn4 listed the infection rates published by five other authors, those rates having a mean of 3.3%. Thus the infection rate of 5.6% in the present series is above average. The extremely high frequency of 24.4%, reported by Russo and Ruiz, relates to inclusion of patients in whom sponges were removed up to four years after surgery, because of mechanical problems such as discomfort, mild inflammation, and subconjunctival haemorrhage, and in which organisms were cultured from the removed sponges. If those chronic cases were excluded, their frequency would reduce to 7.1%, which is still moderately high. The use of silicone sponges, as designed by Lincoff et al,s is often criticized because of the higher frequency of infection as compared with solid silicone materials. All cases in the present series utilized silicone sponges, the only solid silicone being an encircling band (strap), which was never used without a local sponge. Hilton and Wall~n,~ in 600 consecutive cases, had seven infections in the 385 cases in which sponge was used, but no infections in the 215 cases in which only solid silicone was used. In 14 infected cases, INFECTION AFTER RETINAL DETACHMENT SURGERY Russo and Ruiz removed the sponges but retained the solid silicone bands, and all healed well. However, silicone sponges are easy to use, create high localized buckles, and do not damage the underlying sclera. Even in infected cases, the underlying sclera usually remains healthy. This series demonstrates the following points. 1. The more sililcone sponge that is used, the higher the chance of infection. Russo and Ruiz and Hahn et ai6 found likewise. 2. Reoperations are more likely to become infected. Ulrich and Burton found likewise. 3. The commonest infecting species is the staphylococcus.2-6therefore the most useful prophylactic antibiotics are methicillin, erythromycin, tetracycline and the aminoglycosides (neomycin, gentamicin, tobramycin). 4. The sponge should be removed as soon as infection is diagnosed, to reduce the chance of premacular fibrosis. Premacular fibrosis has not been mentioned in the literature as a problem associated with sponge infection. In this series it accounted for very poor vision in three cases with attached retinas. It is a recognised cause of poor vision after uncomplicated detachment surgery, but occurs also in vitreous inflammatory disease. * Thus it was not unexpected that the three cases in which it occurred had had the sponge in situ for four to nine weeks after infection had become manifest, although this time-fibrosis relationship could not be statistically validated. Nevertheless it seems reasonable to advise early removal of infected sponges. Early removal of infected sponges may also reduce the chance of massive periretinal proliferation (MPP). Ulrich and Burton removed only 54% of their infected sponges inside three months. Thirteen of the 37 (35%) developed MPP before the sponge was removed. In the present series all the sponges were removed inside 10 weeks, and only three of 14 (21%) developed MPP. Earlier removal does increase the chance of redetachment, but lessening the risk of 71
4 premacular fibrosis and MPP justifies the risk. Schwarz and Pruett9 removed buckles from 152 eyes for various reasons. When buckles were removed inside six months, 39% redetached; when removed between six and 12 months, 21.4% redetached; and when removed later than one year, 5.8% redetached. The overall detachment rate was 14.5%, but when only infected cases were analysed the detachment rate was 28% after sponge removal. The value of preoperative and intraoperative antibiotics has been established. Two rabbit experiments are relevant. Buettner et al sutured sponges to the scleras of rabbits. Half the sponges had been squeeze-soaked in a solution of neomycin, and the other half were soaked in neomycin without squeezing. There was a significantly higher neomycin level in the squeezesoaked sponges when they were later removed from the sclera. Doft et a19 immersed sponges in suspensions of Staphylococcus aureus and then sutured them to the sclera of rabbits. Twentyfour hours later the sponges were removed, and colony counts performed. Bacterial growth was eliminated by preoperative subconjunctival gentamicin. Bacterial growth was reduced but not eliminated by preoperative gentamicin eyedrops, by preoperative systemic gentamicin, and by postoperative systemic gentamicin. Postoperative subconjunctival steroids did not increase the bacterial growth. Hahn et a16 studied a series of 900 consecutive operations in New York and 1000 consecutive operations in Bonn, done during the same period. Both used preoperative local antibiotics and both soaked and squeezed their sponges in antibiotic solutions. The New York patients had no postoperative antibiotics, whereas the Bonn patients had systemic penicillin for five days and antibiotic eyedrops for five weeks. The Bonn patients had a conjunctival smear on the morning of surgery, and if bacteria were present, surgery was delayed. Between the two groups there was no significant difference in the rates of infection, which were 3.4% in the New York patients and 2.7% in the Bonn patients. This large study concluded that the rate of infection was reduced neither by using postoperative prophylactic antibiotics nor by requiring a sterile conjunctiva preoperatively. Ulrich and Burton had 37 cases of infection, 31 of which had had a routine preoperative conjunctival swab. In only five of the 31 cases was the infecting organism the same as the preoperative organism. Those cases in which there had been a positive preoperative swab had a higher chance of infection, but excluding them would have reduced the infection rate by only 0.4%. Thus preoperative conjunctival swabs are worthless. They were not done in the present series. Infected cases had a longer than average operating time in this series. Hilton and Wallyn suggested that a shorter operating time was associated with a reduced frequency of infection. However, operating time is probably not an independent factor, as the more significant factors of increased amounts of silicone sponge and reoperations are both automatically associated with a longer operation time. CONCLUSION Data accumulated from this and previous studies suggest that the following are reasonable guidelines for reducing the incidence of infection and for improving its management. 1. Use preoperative antibiotic drops which are effective against staphylococci, such as methicillin or an aminoglycoside. 2. Squeeze-soak the sponge in a solution of neomycin (or one of the newer aminoglycosides, gentamicin or tobramycin). 3. Use a minimum amount of sponge and, where convenient, use solid silicone rather than sponge. Encircle with bands (straps), not with sponges. 4. Flood the scleral bed with neomycin, or another aminoglycoside, during surgery. 5. Avoid the need for reoperation. 6. When infecton is diagnosed, remove the sponge promptly to minimize the chance of premacular fibrosis and MPP. Other reasonable but untested precautions include: (i) using a limbal incision to ensure a thick continuous covering of the sponge by conjunctiva and Tenon s capsule; (ii) thorough 72 AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY
5 preparation of the eyelid margins, including trimming of the lashes and covering the lid margins with a sticky sterile plastic drape. ACKNOWLEDGEMENTS I am indebted to the ophthalmologists who allowed me to operate on their patients, and who provided much of the follow-up information. I thank Mrs Wendy Smith for typing the manuscript. References 1. Hadden OB. Lessons from one hundred and thirty-five consecutive retinal detachment operations. Trans Ophthalmol SOC NZ. 1981; 33: Buettner H, Goldstein BG, Anhalt JP. Infection prophylaxis with silastic sponge explants in retinal detachment surgery. Ophthalmol 1981; 2: Russo CE, Ruiz RS. Silicone sponge rejection: early and late complications in retinal detachment surgery. Arch Ophthalmol 1971; 85: Hilton OF, Wallyn RH. The removal of scleral buckles. Arch Ophthalmol 1978; 96: Lincoff H, Boras I, McLean JM. Modifications to the Custodis procedure for retinal detachment. Arch Ophthalmol 1965; 73: Hahn YS, Lincoff BS, Lincoff H, Kreissig I. Infection after sponge implantation for scleral buckling. Am J Ophthalmol 1979; 87; Ulrich RA, Burton TC. Infections following scleral buckling procedures. Arch Ophthalmol 1974; 92: Gass JDM. Stereoscopic atlas of macular diseases. 2nd ed. St Louis: Molsby, 1977: Schwarz PL, Pruett RC. Factors influencing retinal redetachment after removal of buckling elements. Arch Ophthalmol 1977; 95: Doft BH, Lipkowitz MD, Kowalski BS, Taylor F. An experimental model to assess factors associated with scleral buckle infection. Retina 1983; 3: One of the most interesting treatments for essential blepharospasm with and without oromandisular dystonia is subcutaneous injection of purified botulinum toxin. Although this procedure, originally developed by Dr Alan Scott, is of short term benefit, lasting about 3-4 months, it takes only a few minutes to perform, requires no anaesthesia, and appears to be perfectly safe. While the long term effects of repeated botulinum injections are unknown, this treatment may represent the optimum form of therapy currently available for patients with essential blepharospasm and Meige s Syndrome. p th Edition. Walsh & Hoyt s Clinical Neuro-Ophthalmology, INTtC rlon A1 I1 K KI I INAL UI I \( tl\ll N I \UKOLKY 73
Breast Reconstruction in the U.S.
The State of Antibiotic Use in Implant Based Breast Reconstruction Robert D. Foster, MD Professor of Surgery Division of Plastic and Reconstructive Surgery UCSF Breast Reconstruction in the U.S. Each year
More informationAntimicrobial Prophylaxis in the Surgical Patient. M. J. Osgood
Antimicrobial Prophylaxis in the Surgical Patient M. J. Osgood Outline Definitions surgical site infection (SSI) Risk factors Wound classification Microbiology of SSIs Strategies for prevention of SSIs
More informationF1 IN THE NAME OF GOD
F1 IN THE NAME OF GOD Slide 1 F1 FEIKO.IR.SOFT; 2011/07/06 Lid Laceration Conjunctival Hemorrhage a) No therapy is necessary b) Usually resolve in 7-12 days. Subconjunctival Hemorrhage Corneal Abrasion
More informationREVIEW OF OPHTHALMOLOGY SECTION OF WHO MODEL LIST OF ESSENTIAL MEDICINES. Sight Savers International and The Vision 2020 Technology Group
REVIEW OF OPHTHALMOLOGY SECTION OF WHO MODEL LIST OF ESSENTIAL MEDICINES Anti infective agent Medicine suggested for inclusion Ciprofloxacin: 0.3 % eye drops Application submitted by Sight Savers International
More informationMANAGEMENT OF TOTAL JOINT ARTHROPLASTY INFECTIONS
MANAGEMENT OF TOTAL JOINT ARTHROPLASTY INFECTIONS Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine TOTAL JOINT ARTHROPLASTIES In 2009: 1 million THA and TKA By 2030,
More informationSource: Portland State University Population Research Center (
Methicillin Resistant Staphylococcus aureus (MRSA) Surveillance Report 2010 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Health Authority Updated:
More informationRole of Moxifloxacin in Bacterial Keratitis
Original Article Role of Moxifloxacin in Bacterial Keratitis Aamna Jabran, Aurengzeb Sheikh, Syed Ali Haider, Zia-ud-din Shaikh Pak J Ophthalmol 29, Vol. 25 No. 2.................................................................................
More informationAntimicrobial Selection and Therapy for Equine Musculoskeletal Trauma
Antimicrobial Selection and Therapy for Equine Musculoskeletal Trauma Lucio Petrizzi DVM DECVS Università degli Studi di Teramo Surgical site infections (SSI) Microbial contamination unavoidable Infection
More informationScleral buckle infections: microbiological spectrum and antimicrobial susceptibility
Chhablani et al. Journal of Ophthalmic Inflammation and Infection 2013, 3:67 BRIEF REPORT Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility Open Access Jay Chhablani
More informationEPAR type II variation for Metacam
23 June 2011 EMA/674662/2011 International Non-proprietary Name: Meloxicam Procedure No. EMEA/V/C/033/II/084 EU/2/97/004/026, 33-34 Scope: Type II Addition of indication for cats Page 1/6 Table of contents
More informationOphthalmology Research: An International Journal 2(6): , 2014, Article no. OR SCIENCEDOMAIN international
Ophthalmology Research: An International Journal 2(6): 378-383, 2014, Article no. OR.2014.6.012 SCIENCEDOMAIN international www.sciencedomain.org The Etiology and Antibiogram of Bacterial Causes of Conjunctivitis
More informationPathogens and Antibiotic Sensitivities in Post- Phacoemulsification Endophthalmitis, Kaiser Permanente, California,
Pathogens and Antibiotic Sensitivities in Post- Phacoemulsification Endophthalmitis, Kaiser Permanente, California, 2007-2012 Geraldine R. Slean, MD, MS 1 ; Neal H. Shorstein, MD 2 ; Liyan Liu, MD, MS
More informationThe Effect of Perioperative Use of Prophylactic Antibiotics on Surgical Wound Infection
THE IRAQI POSTGRADUATE MEDICAL JOURNAL PROPHYLACTIC ANTIBIOTICS ON SURGICAL WOUND INFECTION The Effect of Perioperative Use of Prophylactic Antibiotics on Surgical Wound Infection Ahmed Hamid Jasim*, Nabeel
More informationLab Exercise: Antibiotics- Evaluation using Kirby Bauer method.
Lab Exercise: Antibiotics- Evaluation using Kirby Bauer method. OBJECTIVES 1. Compare the antimicrobial capabilities of different antibiotics. 2. Compare effectiveness of with different types of bacteria.
More informationOptimal Duration for the Use of 0.5% Levofloxacin Eye Drops Before Vitreoretinal Surgery
original clinical study Optimal Duration for the Use of.5% Levofloxacin Eye Drops Before Vitreoretinal Surgery Xiaoxin Li, MD,* Xiaoling Liang, MD, Luosheng Tang, MD, Junjun Zhang, MD, Lijun Shen, MD,
More informationamoxycillin/clavulanate vs placebo in the prevention of infection after animal
Archives of Emergency Medicine, 1989, 6, 251-256 A comparative double blind study of amoxycillin/clavulanate vs placebo in the prevention of infection after animal bites P. H. BRAKENBURY & C. MUWANGA Accident
More informationAntibiotic-resistant Staphylococcus aureus in dermatology and burn wards
J. clin. Path., 1977, 30, 40-44 Antibiotic-resistant Staphylococcus aureus in dermatology and burn wards G. A. J. AYLIFFE, WENDA GREEN, R. LIVINGSTON, AND E. J. L. LOWBURY From the Hospital Infection Research
More informationAntimicrobial Stewardship Strategy: Antibiograms
Antimicrobial Stewardship Strategy: Antibiograms A summary of the cumulative susceptibility of bacterial isolates to formulary antibiotics in a given institution or region. Its main functions are to guide
More information2017 SURVEILLANCE OF SURGICAL SITES INFECTIONS FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY
Canadian Nosocomial Infection Surveillance Program 2017 SURVEILLANCE OF SURGICAL SITES INFECTIONS FOLLOWING TOTAL HIP AND KNEE ARTHROPLASTY FINAL Working Group: E. Henderson, M. John, I. Davis, S. Dunford,
More informationStudy of Bacteriological Profile of Corneal Ulcers in Patients Attending VIMS, Ballari, India
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 5 Number 7 (2016) pp. 200-205 Journal homepage: http://www.ijcmas.com Original Research Article http://dx.doi.org/10.20546/ijcmas.2016.507.020
More informationSymptoms of cellulitis (n=396) %
Cellulitis and lymphoedema Vaughan Keeley May 2012 What is cellulitis? - also called erysipelas, acute inflammatory episodes etc. - bacterial infection of skin + subcutaneous tissues - more common in people
More informationAntimicrobial prophylaxis. Bs Lưu Hồ Thanh Lâm Bv Nhi Đồng 2
Antimicrobial prophylaxis Bs Lưu Hồ Thanh Lâm Bv Nhi Đồng 2 Definition The United States Centers for Disease Control and Prevention (CDC) has developed criteria that define surgical site infection (SSI)
More informationPost-operative surgical wound infection
Med. J. Malaysia Vol. 45 No. 4 December 1990 Post-operative surgical wound infection Yasmin Abu Hanifah, MBBS, MSc. (London) Lecturer Department of Medical Microbiology, Faculty of Medicine, University
More informationTreatment of Surgical Site Infection Meeting Quality Statement 6. Prof Peter Wilson University College London Hospitals
Treatment of Surgical Site Infection Meeting Quality Statement 6 Prof Peter Wilson University College London Hospitals TEG Quality Standard 6 Treatment and effective antibiotic prescribing: People with
More informationCLINICAL MASTITIS PERCEPTIONS OF KANSAS DAIRY PRODUCERS. J.R. Roberson 1
Dairy Day 2003 CLINICAL MASTITIS PERCEPTIONS OF KANSAS DAIRY PRODUCERS J.R. Roberson 1 Summary Mastitis is considered the most costly disease in the U.S. dairy industry. Treatment of clinical mastitis
More informationReducing Infections in Surgical Practice. Fred A Sweet, MD Rockford Spine Center Illinois, USA
Reducing Infections in Surgical Practice Fred A Sweet, MD Rockford Spine Center Illinois, USA Introduction: How bacteria get in The Host The Surgeon The Procedure The STAFF Skin PREP Prophylactic Antibiotics
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER. GENTAMICIN VISION 3 mg/g eye ointment Gentamicin
PACKAGE LEAFLET: INFORMATION FOR THE USER GENTAMICIN VISION 3 mg/g eye ointment Gentamicin Read all of this leaflet carefully before you start using this medicine. - Keep this leaflet. You may need to
More informationProspective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora
European Journal of Ophthalmology / Vol. 17 no. 5, 2007 / pp. 689-695 Prospective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora C.N.
More informationSurgical Site Infections (SSIs)
Surgical Site Infections (SSIs) Postoperative infections presenting at any level Incisional superficial (skin, subcutaneous tissue) Incisional deep (fascial plane and muscles) Organ/space related (anatomic
More informationThe Role of Topical Antibiotic Prophylaxis to Prevent Endophthalmitis after Intravitreal Injection
The Role of Topical Antibiotic Prophylaxis to Prevent Endophthalmitis after Intravitreal Injection Philip Storey, MD, MPH, 1 Michael Dollin, MD, 1 John Pitcher, MD, 1 Sahitya Reddy, BA, 2 Joseph Vojtko,
More informationAll India Ophthalmological Society members survey results: Cataract surgery antibiotic prophylaxis current practice pattern 2017
Original Article All India Ophthalmological Society members survey results: Cataract antibiotic prophylaxis current practice pattern 2017 Prafulla Kumar Maharana, Jay K Chhablani 1, Tara Prasad Das 1,
More informationSURGICAL ANTIBIOTIC PROPHYLAXIS GUIDELINES WITHIN ORTHOPAEDIC SURGERY FOR ADULT PATIENTS
SURGICAL ANTIBIOTIC PROPHYLAXIS GUIDELINES WITHIN ORTHOPAEDIC SURGERY FOR ADULT PATIENTS Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if
More informationPerioperative Care of Swine
Swine are widely used in protocols that involve anesthesia and invasive surgical procedures. In order to ensure proper recovery of animals, preoperative, intraoperative and postoperative techniques specific
More informationThe CARI Guidelines Caring for Australians with Renal Impairment. 8. Prophylactic antibiotics for insertion of peritoneal dialysis catheter
8. Prophylactic antibiotics for insertion of peritoneal dialysis catheter Date written: February 2003 Final submission: May 2004 Guidelines (Include recommendations based on level I or II evidence) Antibiotic
More informationAn Evidence Based Approach to Antibiotic Prophylaxis in Oral Surgery
An Evidence Based Approach to Antibiotic Prophylaxis in Oral Surgery Nicholas Makhoul DMD. MD. FRCD(C). Dip ABOMS. FACS. Director, Division of Oral and Maxillofacial Surgery Assistant Professor McGill
More informationGynaecological Surgery in Adults Surgical Antibiotic Prophylaxis
Gynaecological Surgery in Adults Surgical Antibiotic Prophylaxis Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date
More informationREDUCTION IN THE BACTERIAL LOAD
Session 267 PresentaGon 2300 REDUCTION IN THE BACTERIAL LOAD ON THE SKIN IN A CLINICAL SETTING David W. Stroman Co-authors: K. Mintun, A. Epstein, C. Brimer, C. Patel, J. Branch, K. Najafi The Skin Microbiome
More informationAntimicrobial Susceptibility Patterns
Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH Outline Methodology Overall KNH data Surgery department
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Bennett-Guerrero E, Pappas TN, Koltun WA, et al. Gentamicin
More informationAntibiotic Prophylaxis Update
Antibiotic Prophylaxis Update Choosing Surgical Antimicrobial Prophylaxis Peri-Procedural Administration Surgical Prophylaxis and AMS at Epworth HealthCare Mr Glenn Valoppi Dr Trisha Peel Dr Joseph Doyle
More informationFelipe N. Gutierrez MD, MPH Chief, Infectious Diseases Phoenix VA Healthcare
Felipe N. Gutierrez MD, MPH Chief, Infectious Diseases Phoenix VA Healthcare 100% of all wounds will yield growth If you get a negative culture you something is wrong! Pseudomonas while ubiquitous does
More informationTreatment of septic peritonitis
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Treatment of septic peritonitis Author : Andrew Linklater Categories : Companion animal, Vets Date : November 2, 2016 Septic
More informationCataract Surgery in the Dog
Introduction Cataract Surgery in the Dog A cataract is any abnormal cloudiness in the lens of the eye. This may vary from a small area requiring no treatment through to total cataract and blindness. The
More informationIntra-Abdominal Infections. Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018
Intra-Abdominal Infections Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018 Select guidelines Mazuski JE, et al. The Surgical Infection
More informationStanding Orders for the Treatment of Outpatient Peritonitis
Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.
More informationThe Battle of Resistance: Treating Infections in the Age of Resistance
The Age of Modern Medicine The Battle of Resistance: Treating Infections in the Age of Resistance Mark T. Dunbar, O.D., F.A.A.O. Bascom Palmer Eye Institute University of Miami, Miller School of Med Miami,
More information3 Infection Prevention Solutions
3 Infection Prevention Solutions 3M DuraPrep Surgical Solution Nothing is faster, easier or more effective. We can all make a difference. Fast Not only did 3M design an applicator that is fast to activate
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Adnexal pain, in farm animals, ocular squamous cell carcinoma and, 431 432 Age, as factor in OSCC, 518 Akinesia, in eye examination in
More informationHelp with moving disc diffusion methods from BSAC to EUCAST. Media BSAC EUCAST
Help with moving disc diffusion methods from BSAC to EUCAST This document sets out the main differences between the BSAC and EUCAST disc diffusion methods with specific emphasis on preparation prior to
More informationNeurosurgery Antibiotic Prophylaxis Guideline
Neurosurgery Antibiotic Prophylaxis Guideline Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date (when this version
More informationPatient Preparation. Surgical Team
January 2019 www.nursingcenter.com Surgical Site Infection Prevention Surgical site infections (SSIs) are one of the most common and costly healthcare-associated infections in the United States (Smith
More informationAntibiotic Prophylaxis in Spinal Surgery Antibiotic Guidelines. Contents
Antibiotic Prophylaxis in Spinal Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: DCSS & Tertiary Medicine Unique
More informationAustralian College of Veterinary Scientists. Fellowship Examination. Small Animal Surgery Paper 1
Australian College of Veterinary Scientists Fellowship Examination June 2011 Small Animal Surgery Paper 1 Perusal time: Twenty (20) minutes Time allowed: Three (3) hours after perusal Answer your choice
More informationMethicillin-Resistant Staphylococcus aureus and Methicillin-Resistant Coagulase-Negative Staphylococci From Conjunctivas of Preoperative Patients
CLINICAL INVESTIGATIONS Methicillin-Resistant Staphylococcus aureus and Methicillin-Resistant Coagulase-Negative Staphylococci From Conjunctivas of Preoperative s Tsuyoshi Kato* and Seiji Hayasaka *Division
More informationStanding Orders for the Treatment of Outpatient Peritonitis
Standing Orders for the Treatment of Outpatient Peritonitis 1. Definition of Peritonitis: a. Cloudy effluent. b. WBC > 100 cells/mm3 with >50% polymorphonuclear (PMN) cells with minimum 2 hour dwell. c.
More informationIntravitreal vancomycin and gentamicin concentrations in patients with postoperative endophthalmitis
Br J Ophthalmol 2001;85:1289 1293 1289 The Rotterdam Eye Hospital I M Gan W H Beekhuis J C van Meurs Leiden University Medical Center, Department of Infectious Diseases J T van Dissel Leiden University
More informationGENERAL NOTES: 2016 site of infection type of organism location of the patient
GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered
More informationPocket Guide to Diagnosis & Treatment of Cardiovascular Implantable Electronic Device (CIED) Infections
Pocket Guide to Diagsis & Treatment of Cardiovascular Implantable Electronic Device (CIED) Infections Draft Version : November 208 DEFINITION Pocket infection, if all 4 criteria are fulfilled: Investigation/sign
More informationMastitis and On-Farm Milk Cultures - A Field Study - Part 1
Mastitis and On-Farm Milk Cultures - A Field Study - Part 1 This two-part article discusses the results of a research project undertaken by Dr. Tim Olchowy, Senior Lecturer in Livestock Medicine, School
More informationBacteriology of Surgical Site Infections and Antibiotic Susceptibility Pattern of the Isolates at a Tertiary Care Hospital in Karachi
Abstract Bacteriology of Surgical Site Infections and Antibiotic Susceptibility Pattern of the Isolates at a Tertiary Care Hospital in Karachi Abid Mahmood ( Department of Pathology, PNS Shifa, Karachi.
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #407: Appropriate Treatment of Methicillin-Susceptible Staphylococcus Aureus (MSSA) Bacteremia National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES:
More informationPediatric Surgical Approach To Childhood Abscess: A Study From An Outpatient Facility
ISPUB.COM The Internet Journal of Surgery Volume 6 Number 2 Pediatric Surgical Approach To Childhood Abscess: A Study From An Outpatient Facility N Eray, H Bahar, M Torun, S Celayir Citation N Eray, H
More informationResponsible use of antibiotics
Responsible use of antibiotics Uga Dumpis MD, PhD Department of Infectious Diseases and Infection Control Pauls Stradiņs Clinical University Hospital Challenges in the hospitals Antibiotics are still effective
More informationVOTS Meeting Nov Puerto Rico. Billie Beckwith-Cohen, DVM, MBA Comparative Ocular Pathology Fellow UW-Madison School of Veterinary Medicine
VOTS Meeting Nov. 2013 Puerto Rico Billie Beckwith-Cohen, DVM, MBA Comparative Ocular Pathology Fellow UW-Madison School of Veterinary Medicine What is COPLOW? Founded in 1983 by Dr. Richard R. Dubielzig
More informationOBSTETRICS & GYNAECOLOGY. Penicillin G 5 million units IV ; followed by 2.5 million units 4hourly upto delivery
OBSTETRICS & GYNAECOLOGY A.OBSTETRICS Infection/Condition/likely organism Intrapartum Group B Streptococcal (GBS) infection; positive mothers Suggested treatment Preferred Penicillin G 5 million units
More informationWalter M. Guterbock, DVM, MS Veterinary Medicine Teaching and Research Center University of California, Davis
Walter M. Guterbock, DVM, MS Veterinary Medicine Teaching and Research Center University of California, Davis 1993 WESTERN LARGE HERD MANAGEMENT CONFERENCE V LAS VEGAS NEVADA 27 Alternatives To Antibiotic
More informationInteractive session: adapting to antibiogram. Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe
Interactive session: adapting to antibiogram Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe Case 1 63 y old woman Dx: urosepsis? After 2 d: intermediate result: Gram-negative bacilli Empiric antibiotic
More informationProphylactic antibiotic timing and dosage. Dr. Sanjeev Singh AIMS, Kochi
Prophylactic antibiotic timing and dosage Dr. Sanjeev Singh AIMS, Kochi Meaning - Webster Medical Definition of prophylaxis plural pro phy lax es \-ˈlak-ˌsēz\play : measures designed to preserve health
More informationCUMULATIVE ANTIBIOGRAM
BC Children s Hospital and BC Women s Hospital & Health Centre CUMULATIVE ANTIBIOGRAM 2017 Division of Medical Microbiology Department of Pathology and Laboratory Medicine Page 1 of 5 GRAM-POSITIVE BACTERIA
More informationSUMMARY OF PRODUCT CHARACTERISTICS. Cephacare flavour 50 mg tablets for cats and dogs. Excipients: For a full list of excipients, see section 6.1.
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Cephacare flavour 50 mg tablets for cats and dogs 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each tablet contains: Active
More informationThe Infected Implant in Orthopaedic Reconstruction: An Update on the Clinical and Molecular Approaches to Prevention and Diagnosis
The Infected Implant in Orthopaedic Reconstruction: An Update on the Clinical and Molecular Approaches to Prevention and Diagnosis (Organized by the Musculoskeletal Tumor Society (MSTS) and ORS) Organizers:
More informationTHIS PATIENT GROUP DIRECTION HAS BEEN APPROVED on behalf of NHS Fife by:
Patient Group Direction for Named Community Pharmacists to Supply CHLORAMPHENICOL EYE DROPS 0.5% To patients aged 1 year and older Under the Minor Ailments Service. Number 114 Issued October 2016 Issue
More informationDREXEL UNIVERSITY COLLEGE OF MEDICINE ANIMAL CARE AND USE COMMITTEE POLICY FOR PREOPERATIVE AND POSTOPERATIVE CARE FOR NON-RODENT MAMMALS
DREXEL UNIVERSITY COLLEGE OF MEDICINE ANIMAL CARE AND USE COMMITTEE POLICY FOR PREOPERATIVE AND POSTOPERATIVE CARE FOR NON-RODENT MAMMALS OBJECTIVE: This policy is to ensure that appropriate provisions
More informationLOWER EYELID RECONSTRUCTIVE SURGERY AFTER SEBACEOUS GLAND ADENOMA RESECTION IN A GERMAN SHEPHERD DOG: A CASE REPORT
Indo-Am. J. Agric. & Vet. Sci., 2014 ISSN Rambabu 2321 9602 Kalaka www.iajavs.com et al., 2014 Vol. 2, No. 3, September 2014 2014 Meghana Publications. All Rights Reserved Case Report LOWER EYELID RECONSTRUCTIVE
More informationCADTH. Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal. Canadian Agency for Drugs and Technologies in Health
Canadian Agency for Drugs and Technologies in Health Agence canadienne des médicaments et des technologies de la santé Rapid Response Report: Peer-Reviewed Summary with Critical Appraisal CADTH Intracameral
More informationImpact of a Standardized Protocol to Address Outbreak of Methicillin-resistant
Impact of a Standardized Protocol to Address Outbreak of Methicillin-resistant Staphylococcus Aureus Skin Infections at a large, urban County Jail System Earl J. Goldstein, MD* Gladys Hradecky, RN* Gary
More informationFluoroquinolone and fortified antibiotics for treating bacterial corneal ulcers
378 Centre for Eye Research Australia, The University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia N Gangopadhyay M Daniell L Weih H R Taylor Correspondence to: Dr Mark Daniell
More informationGive the Right Antibiotics in Trauma Mitchell J Daley, PharmD, BCPS
Give the Right Antibiotics in Trauma Mitchell J Daley, PharmD, BCPS Clinical Pharmacy Specialist, Critical Care Dell Seton Medical Center at the University of Texas and Seton Healthcare Family Clinical
More informationBacterial Resistance. The Battle of the Bugs: Treating Infections in the Age of Resistance. How Resistance Develops. The Age of Modern Medicine
The Age of Modern Medicine The Battle of the Bugs: Treating Infections in the Age of Resistance Mark T. Dunbar, O.D., F.A.A.O. Bascom Palmer Eye Institute University of Miami, Miller School of Med Miami,
More informationSUMMARY OF PRODUCT CHARACTERISTICS
SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE VETERINARY MEDICINAL PRODUCT Amfipen LA 100 mg/ml suspension for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Active substance: Each ml contains:
More informationMRSA CROSS INFECTION RISK: IS YOUR PRACTICE CLEAN ENOUGH?
Vet Times The website for the veterinary profession https://www.vettimes.co.uk MRSA CROSS INFECTION RISK: IS YOUR PRACTICE CLEAN ENOUGH? Author : CATHERINE F LE BARS Categories : Vets Date : February 25,
More informationDiabetic Foot Infection. Dr David Orr Consultant Microbiologist Lancashire Teaching Hospitals
Diabetic Foot Infection Dr David Orr Consultant Microbiologist Lancashire Teaching Hospitals History of previous amputation [odds ratio (OR)=19.9, P=.01], Peripheral vascular disease (OR=5.5, P=.007)
More informationBacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota
Bacterial Resistance of Respiratory Pathogens John C. Rotschafer, Pharm.D. University of Minnesota Antibiotic Misuse ~150 million courses of antibiotic prescribed by office based prescribers Estimated
More informationConcise Antibiogram Toolkit Background
Background This toolkit is designed to guide nursing homes in creating their own antibiograms, an important tool for guiding empiric antimicrobial therapy. Information about antibiograms and instructions
More informationThis is the use of antibiotics before, during and after a diagnostic, therapeutic or surgical procedure to prevent infectious complications.
Antibiotic prophylaxis in surgery CSu2 Policy Antimicrobial prophylaxis is used to reduce the incidence of post operative wound infection; patients undergoing procedures associated with high infection
More informationAntibiotic prophylaxis guideline for colorectal, hepatobiliary and vascular surgery for adult patients.
Antibiotic prophylaxis guideline for colorectal, hepatobiliary and vascular surgery for adult patients. Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience,
More informationBACTERIOLOGY OF THE HEALTHY CONJUNCTIVA*
Brit. J. Ophthal. (1954), 38, 719. BACTERIOLOGY OF THE HEALTHY CONJUNCTIVA* BY C. H. SMITH Department of Pathology, Institute of Ophthalmology, University of London THE normal bacterial flora of the mucous
More informationNebcin0 in the treatment of experimental
Brit. J. Ophthal. (15) 5, 5 Nebcin in the treatment of experimental Pseudomonas keratitis RUBENS BELFORT, JR., GLBERT SMOLN, MASAO OKUMOTO, and HONG BOK KM From the Francis. Proctor Foundation for Research
More informationCellulitis. Assoc Prof Mark Thomas. Conference for General Practice Auckland Saturday 28 July 2018
Cellulitis Assoc Prof Mark Thomas Conference for General Practice Auckland Saturday 28 July 2018 Summary Cellulitis Usual treatment flucloxacillin for 5 days Frequent recurrences consider penicillin 250mg
More informationUse And Misuse Of Antibiotics In Neurosurgery
Use And Misuse Of Antibiotics In Neurosurgery CSF infection in the United States after neurosurgery from 1992 to 2003 0.86% to 2.32% * *National Nosocomial Infections Surveillance System: National Nosocomial
More informationSTUDY OF SURGICAL SITE INFECTIONS AMONGST ORTHOPAEDIC PATIENTS IN A TERTIARY CARE HOSPITAL
Page283 IJPBS Volume 5 Issue 2 APR-JUN 2015 283-287 Research Article Pharmaceutical Sciences STUDY OF SURGICAL SITE INFECTIONS AMONGST ORTHOPAEDIC PATIENTS IN A TERTIARY CARE HOSPITAL Chitralekha Saikumar,
More informationBreastfeeding Challenges - Mastitis & Breast Abscess -
CLINICAL PRACTICE GUIDELINE Breastfeeding Challenges - Mastitis & Breast Abscess - SCOPE (Area): Maternity Unit, Emergency Department, Paediatrics SCOPE (Staff): Medical, Midwifery & Nursing DESIRED OUTCOME/OBJECTIVE
More informationn Am I B I A U n IVE RS ITV OF SCIEnCE AnD TECH n 0 LOGY
n Am I B I A U n IVE RS ITV OF SCIEnCE AnD TECH n 0 LOGY FACULTY OF HEALTH AND APPLIED SCIENCES DEPARTMENT OF HEALTH SCIENCES QUALIFICATION: BACHELOR OF BIOMEDICAL SCIENCES QUALIFICATION CODE: SOBBMS LEVEL:
More informationDECISION AND SECTION 43 STATEMENT TO THE VETERINARY COUNCIL BY THE COMPLAINTS ASSESSMENT COMMITTEE: CAC Dr A. (Section 39 referral/complaint)
DECISION AND SECTION 43 STATEMENT TO THE VETERINARY COUNCIL BY THE COMPLAINTS ASSESSMENT COMMITTEE: CAC15-07 Dr A (Section 39 referral/complaint) Dr A B Dr C Veterinarian Clinic where Dr A works Former
More informationNorthwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16
Northwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16 These criteria are based on national and local susceptibility data as well as Infectious Disease Society of America
More informationCHAPTER 1 INTRODUCTION
1 CHAPTER 1 INTRODUCTION The Staphylococci are a group of Gram-positive bacteria, 14 species are known to cause human infections but the vast majority of infections are caused by only three of them. They
More informationBurn Infection & Laboratory Diagnosis
Burn Infection & Laboratory Diagnosis Introduction Burns are one the most common forms of trauma. 2 million fires each years 1.2 million people with burn injuries 100000 hospitalization 5000 patients die
More informationManagement of Native Valve
Management of Native Valve Infective Endocarditis 2005 AHA 2015 Baddour LM, et al. Circulation. 2015;132(15):1435-86 2009 ESC 2015 Habib G, et al. Eur Heart J. 2015;36(44):3075-128 ESC 2015: Endocarditis
More informationVolume. December Infection. Notes. length of. cases as 90% 1 week. tonsillitis. First Line. sore throat / daily for 5 days. quinsy >4000.
Volume 8; Number 22 LINCOLNSHIRE GUIDELINES FOR THE TREATMENT OF COMMONLYY OCCURRING INFECTIONS IN PRIMARY CARE: WINTER 2014/15 In this issue of the PACE Bulletin we present an update of our Guidelines
More informationPreventing Surgical Site Infections. Edward L. Goodman, MD September 16, 2013
Preventing Surgical Site Infections Edward L. Goodman, MD September 16, 2013 Outline NHSN Reporting and Definitions Magnitude of the Problem Risk Factors Non Pharmacologic Interventions Pharmacologic Interventions
More information