Premedication

PurposeEndoscopic lithotripsy has become widely adopted worldwide and is considered the gold standard for managing upper urinary tract lithiasis. One of its possible complications is post-operative infection. We aimed to review available literature about the role of preoperative antibiotic prophylaxis and its indications.MethodsWe performed a systematic search of the literature including "ureteroscopy", "PNL", "retrograde intrarenal surgery", "antibiotic prophylaxis" and "sepsis" as keywords. Out of 760 relevant studies only 13 met our inclusion criteria: at least 10 adult patients (≥ 18 years old) diagnosed with kidney or ureteral stones; antibiotic prophylaxis described and reported; post-operative sepsis, UTI or SIRS assessed.ConclusionsAntibiotic prophylaxis strategies for stone surgery show different degrees of effectiveness depending on both the approach and the patient's condition. Today's evidence suggests that while routine antibiotic prophylaxis might not be necessary for all patients with sterile urine undergoing ureterorenoscopy and lithotripsy vs. percutaneous nephrolithotripsy, for those patients with positive preoperative urine cultures it is beneficial reducing the risk of postoperative infective complications.

BackgroundThe question of whether antibiotic prophylaxis should be administered routinely for dental implant surgery is unresolved. Despite the lack of conclusive supportive evidence, antibiotics are often administered to reduce the risk of infection, which could lead to early implant failure. Increasing antibiotic resistance is a major concern and it is therefore important to reduce the overall use of antibiotics, including in dentistry. The aim of the present systematic review and meta-analysis was to evaluate the efficacy of preoperative antibiotics in preventing early implant failure, in overall healthy patients undergoing dental implant surgery.MethodsAn electronic search was undertaken of PubMed (Medline), Web of Science and the Cochrane Library up to October 1st, 2023, to identify randomized clinical trials (RCTs). All RCTs comparing antibiotic prophylaxis with no antibiotics/placebo in overall healthy patients receiving dental implants were included. The primary outcome was patients with early implant failure. Risk of bias was assessed, data were extracted, a meta-analysis was done, and GRADE certainty-of-evidence ratings were determined. The risk ratio (RR), the risk difference (RD) and 95% confidence intervals (CI) were estimated.ResultsAfter removal of duplicates, 1086 abstracts were screened, and 17 articles were reviewed in full text. Seven RCTs with moderate or low risk of bias and with a total of 1859 patients and 3014 implants were included in the meta-analysis. With reference to early implant failure at patient level, the meta-analysis failed to disclose any statistically significant difference (RR: 0.66, 95% CI: 0.30-1.47) between antibiotic prophylaxis and a placebo. The risk difference was -0.007 (95% CI: -0.035-0.020) leading to a number needed to treat (NNT) of 143.ConclusionAntibiotic prophylaxis for dental implant surgery does not seem to have any substantial effect on early implant failure ( ). The results do not support routine antibiotic prophylaxis for dental implant surgery.

ImportancePerioperative antibiotic prophylaxis (PAP) reduces the incidence of surgical site infections (SSIs). Guidelines recommend 24 hours or less of PAP for cystectomy with urinary diversion; however, evidence specifying optimal PAP duration for this surgery is lacking, and prolonged administration of PAP is common practice.ObjectiveTo establish noninferiority of 24-hour PAP vs extended-duration PAP in preventing SSIs within 90 days after cystectomy with urinary diversion.Design, setting, and participantsThis single-center, noninferiority randomized clinical trial was performed from April 18, 2018, to August 18, 2022, in patients aged older than 18 years undergoing elective open cystectomy with urinary diversion. Exclusion criteria were contraindications to administered drugs and inability to follow study procedures.InterventionPAP administered for 24 hours (24-hour PAP group) vs PAP until all catheters and stents were removed (extended PAP group).Main outcome and measuresThe primary end point was the rate of SSI, and the secondary end points included all-cause mortality, both within 90 days after surgery. Noninferiority of the 24-hour PAP treatment was assessed by comparing the 90% CI (corresponding to a significance level of α = .05) with the predefined noninferiority margin of 10%.ResultsA total of 95 patients were randomly assigned to the 24-hour PAP group (median [IQR] age, 69.3 [63.1-76.8] years; 66 males [69.5%]) and 98 to the extended PAP group (median [IQR] age, 69.5 [60.8-75.5] years; 68 males [69.4%]). Patients in the 24-hour PAP group received PAP for a median of 1 day (IQR, 1-1 day), and patients in the extended PAP group received PAP for a median of 8 days (IQR, 7-10 days). No significant differences in SSIs occurring within 90 days were found (24-hour PAP group, 8 patients [8.4%]; extended PAP group, 12 patients [12.2%]; P = .53). The risk difference for 90-day cumulative SSI incidence was -3.8% (90% CI, -11.1% to 3.4%), establishing noninferiority of 24-hour PAP vs extended PAP to prevent SSI. Mortality was not significantly different between groups.Conclusions and relevanceThe findings of this randomized clinical trial demonstrate noninferiority of 24-hour PAP vs extended-duration PAP in preventing SSIs within 90 days after cystectomy with urinary diversion and may contribute to antibiotic stewardship efforts in urology.Trial registrationClinicalTrials.gov Identifier: NCT03305627.

Surgical antimicrobial prophylaxis involves the administration of antimicrobials to reduce the risk of a surgical site infection and represents a significant proportion of all antimicrobial use in cats and dogs. This evidence-based, European Network for Optimization of Veterinary Antimicrobial Therapy guideline provides recommendations for both peri- and post-operative surgical antimicrobial prophylaxis for a wide range of soft tissue and orthopaedic procedures performed in dogs and cats. A multidisciplinary panel developed the recommendations while adhering to the Grading of Recommendations Assessment, Development and Evaluation framework. The opinions of veterinary practitioners were incorporated to ensure applicability. Ten strong recommendations against, three conditional recommendations against and five conditional recommendations for the use of surgical antimicrobial prophylaxis were drafted by the panel. Strong recommendations against surgical antimicrobial prophylaxis were often informed by low- to very low-certainty evidence that treatment has no beneficial effect. However, the anticipated harmful effects of antimicrobial use are well established and offer an important counterbalance to unsubstantiated use. Conditional recommendations were made when there was a probable balance of effects in one direction, although appreciable uncertainty was present. The European Network for Optimization of Veterinary Antimicrobial Therapy guidelines initiative encourages national or regional guideline makers to use the evidence presented in this document and the supporting systematic review to draft national or local guidance documents that support rational surgical antimicrobial prophylaxis.