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Cost-Effective Prophylaxis of Surgical Infections

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Summary

There are few formal pharmacoeconomic studies of antibacterial prophylaxis in surgery. An important reason for this is that such prophylaxis is difficult to study, because extremely large patient samples are needed to demonstrate differences or equalities with reasonable statistical power. When the cost effectiveness of various regimens is evaluated, indirect methods must often be used. Clearly, the ideal prophylactic regimen, both clinically and economically, is one that is easy to administer, has a low acquisition cost, can be given as a single dose and provides maximal protection against postoperative infections.

However, if and when such a regimen is identified, its universal acceptance and use might have negative ecological consequences (e.g. the selection of resistant organisms in the hospital environment). Thus, the search for the ideal prophylactic regimen must be a continuous process.

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References

  1. Davey P, Malek M, Thomas P. Measuring the cost-effectiveness of antibiotic prophylaxis in surgery. Am J Surg 1992; 164 Suppl. 4A: 39S–43S

    Article  PubMed  CAS  Google Scholar 

  2. Davey PG. Cost-effectiveness of antibiotic prophylaxis of wound infections. J Chemother 1994; 6 Suppl. 2: 29–33

    Google Scholar 

  3. Davey PG, Parker SE, Crombie IK, et al. The cost effectiveness of amoxicillin/clavulanic acid as antibacterial prophylaxis in abdominal and gynaecological surgery. PharmacoEconomics 1995; 7: 347–356

    Article  PubMed  CAS  Google Scholar 

  4. Lynch W, Davey PG, Malek M, et al. Cost-effectiveness of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis. J Hosp Infect 1992; 21: 179–191

    Article  PubMed  CAS  Google Scholar 

  5. Davey P, Lynch B, Malek M, et al. Antimicrobial practice: cost-effectiveness of single dose cefotaxime plus metronidazole compared with three doses each of cefuroxime plus metronidazole for the prevention of wound infection after colorectal surgery. J Antimicrob Chemother 1992; 30: 855–864

    Article  PubMed  CAS  Google Scholar 

  6. Davey PG, Parker SE, Malek MM. Pharmacoeconomics of antimicrobial prophylaxis. J Antimicrob Chemother 1993; 31 Suppl. B: 107–108

    Article  PubMed  Google Scholar 

  7. Wise R, Donovan IA, Ambrose S, et al. The penetration of cefoxitin into peritoneal fluid. J Antimicrob Chemother 1981; 8: 453–457

    Article  PubMed  CAS  Google Scholar 

  8. Manek N, Wise R, Donovan IA. Intraperitoneal penetration of ticarcillin/clavulanic acid (Timentin). J Antimicrob Chemother 1987; 19: 363–366

    Article  PubMed  CAS  Google Scholar 

  9. Voesten GJM, Degenere JE, Dukstra PK, et al. Optimizing antimicrobial prophylaxis in reconstructive vascular surgery. Vasa 1993; 22: 342–346

    PubMed  CAS  Google Scholar 

  10. Wong-Beringer A. Corelli RL. Schrock TR, et al. Influence of timing of antibiotic administration on tissue concentrations during surgery. Am J Surg 1995; 169: 379–381

    Article  PubMed  CAS  Google Scholar 

  11. Sanderson PJ. Antimicrobial prophylaxis in surgery: microbiological factors. J Antimicrob Chemother 1993; 31 Suppl. B: 1–9

    Article  PubMed  Google Scholar 

  12. Ridgway EJ. Wilson AP, Kelsey MC. Preoperative screening cultures in the identification of staphylococci causing wound and valvular infections in cardiac surgery. J Hosp Infect 1990; 15: 55–63

    Article  PubMed  CAS  Google Scholar 

  13. Starr MB. Lally JM. Antimicrobial prophylaxis for ophthalmic surgery. Surv Ophthalmol 1995; 39: 485–501

    Article  PubMed  CAS  Google Scholar 

  14. Allen HP. Mangiaracine AB. Bacterial endophthalmitis after cataract extraction: II. Incidence in 36 000 consecutive operations with special reference to preoperative topical antibiotics. Arch Ophthalmol 1974; 91: 3–7

    Article  PubMed  CAS  Google Scholar 

  15. Kattan HM, Flynn HW, Pflugfelder SC. et al. Nosocomial endophthalmitis. Ophthalmology 1991; 98: 227–238

    PubMed  CAS  Google Scholar 

  16. Mindermann T, Zimmerli W, Gratzl O. Randomized placebo-controlled trial of single-dose antibiotic prophylaxis with fusidic acid in neurosurgery. Acta Neurochir 1993; 121: 9–11

    Article  CAS  Google Scholar 

  17. Savitz MH. Malis LI. Prophylactic clindamycin for neurosurgical patients. NY State J Med 1976: 76: 64–67

    CAS  Google Scholar 

  18. Geraghty J, Feely M. Antibiotic prophylaxis in neurosurgery: a randomized controlled trial. J Neurosurg 1984; 60: 724–726

    Article  PubMed  CAS  Google Scholar 

  19. Shapiro M, Wald U, Simchen E, et al. Randomized clinical trial of intraoperative antimicrobial prophylaxis of infection after neurosurgical procedures. J Hosp Infect 1986; 8: 283–295

    Article  PubMed  CAS  Google Scholar 

  20. Young RF, Lawner PM. Perioperative antibiotic prophylaxis for prevention of postoperative neurosurgical infections: a randomized clinical trial. J Neurosurg 1987; 66: 701–705

    Article  PubMed  CAS  Google Scholar 

  21. Blomstedt GC. Kytta J. Results of a randomized trial of vancomycin prophylaxis in craniotomy. J Neurosurg 1988; 69: 216–220

    Article  PubMed  CAS  Google Scholar 

  22. Blum J, Schatz M. Voth D. Antibiotic single-dose prophylaxis of shunt infections. Neurosurg Rev 1989; 12: 239–244

    Article  PubMed  CAS  Google Scholar 

  23. Kontny U, Hofling b. Guthjar P, et al. CSF shunt infections in children. Infection 1993; 21: 89–92

    Article  PubMed  CAS  Google Scholar 

  24. Haines SJ. Walters BC. Antibiotic prophylaxis for cerebrospinal fluid shunts: a meta-analysis. Neurosurgery 1994: 34: 87–92

    Article  PubMed  CAS  Google Scholar 

  25. Lungles JM. LeBlanc JC. Drake J. et al. Efficacv of antimicrobial prophylaxis in placement of cerebrospinal shunts. Clin Infect Dis 1993; 17: 98–103

    Article  Google Scholar 

  26. Blair EA. Johnson JT, Wagner RL, et al. Cost analysis of antibiotic prophylaxis in clean head and neck surgery. Arch Otolaryngol Head Neck Surg 1995; 121: 269–271

    Article  PubMed  CAS  Google Scholar 

  27. Mustafa E, Tahsin A. Cefotaxime prophylaxis in major non-contaminated head and neck surgery: one-day vs. seven-day therapy. J Laryngol Otol 1993: 107: 30–32

    Article  PubMed  CAS  Google Scholar 

  28. Piatt R. Zucker JR. Zaleznik DF. et al. Perioperative antibiotic prophylaxis and wound infection following breast surgery. J Antimicrob Chemother 1993; 31 Suppl. B: 43–48

    Article  Google Scholar 

  29. Winslet MC. Obeid ML. A national audit of antimicrobial prophylaxis in vascular surgery. Eur J Vase Surg 1993; 7: 638–641

    Article  CAS  Google Scholar 

  30. Edwards Jr WH. Kaiser AB. Tapper S. et al. Cefamandole versus cefazolin in vascular surgical wound infection prophylaxis: cost-effectiveness and risk factors. J Vase Surg 1993; 18: 470–475

    Article  Google Scholar 

  31. Geroulanos S. Soteriou M. Jemec M. et al. Cost-saving single-shot prophylaxis in cardiovascular surgery. S Afr J Surg 1989: Suppl: 7–10

    Google Scholar 

  32. Galbraith U. Schilling J. von Segesser LK. et al. Antibiotic prophylaxis in cardiovascular surgery: a prospective randomized comparative trial of one day cefazolin versus single dose cefuroxime. Drugs Exp Clin Res 1993; 19: 229–234

    PubMed  CAS  Google Scholar 

  33. Hall JC. Christiansen K. Carter MJ, et al. Antibiotic prophylaxis in cardiac operations. Ann Thorac Surg 1993; 56: 916–922

    Article  PubMed  CAS  Google Scholar 

  34. Doebbeling BN, Pfaller MA. Kuhns KR, et al. Cardiovascular surgery prophylaxis: a randomized controlled comparison of cefazolin and cefuroxime. J Thorac Cardiovase Surg 1990; 99: 981–989

    CAS  Google Scholar 

  35. Romanelli VA, How ie MB. Myerow itz PD, et al. Intraoperative and postoperative effects of vancomycin administration in cardiac surgery patients: a prospective double-blind, randomized trial. Crit Care Med 1993: 21: 1124–1131

    Article  PubMed  CAS  Google Scholar 

  36. Townsend TR. Reiz BA, Bilker WB. et al. J Thorac Cardiovase Surg 1993; 106: 664–670

    CAS  Google Scholar 

  37. Wellens F. Pirlet M, Larbuisson RL. et al. Prophylaxis in cardiac surgery: a controlled comparison between cefazolin and cefuroxime. Eur J Cardiothorac Surg 1995; 9: 325–329

    Article  PubMed  CAS  Google Scholar 

  38. Curtis JJ, Boley TM. Walls JT. et al. Randomized, prospective comparison of first- and second-generation cephalosporins as infection prophylaxis for cardiac surgery. Am J Surg 1993; 166: 734–737

    Article  PubMed  CAS  Google Scholar 

  39. Baraka A, Taha S, Bijani A, et al. Administration of vancomycin during cardiopulmonary bypass. Anaesthesia 1992; 47: 1086–1087

    Article  PubMed  CAS  Google Scholar 

  40. Wertzel H, Swoboda L, Joos-Würtemberger A, et al. Perioperative antibiotic prophylaxis in general thoracic surgery. Thorac Cardiovase Surg 1992; 40: 326–329

    Article  CAS  Google Scholar 

  41. Cant PJ, Smyth S, Smart DO. Antibiotic prophylaxis is indicated for chest stab wounds requiring closed tube thoracotomy. Br J Surg 1993; 80: 464–466

    Article  PubMed  CAS  Google Scholar 

  42. Ratto GB. Fantino G, Tassara E, et al. Long-term antimicrobial prophylaxis in lung cancer surgery: correlation between microbiological findings and empyema development. Lung Cancer 1994; II: 345–352

    Article  Google Scholar 

  43. Bernard A. Pi I let M. Goudet P. et al. A prospective randomized double-blind trial of flash cefuroxime versus forty-eight-hour cefuroxime. J Thorac Cardiovase Surg 1994; 107: 896–900

    CAS  Google Scholar 

  44. Bates T, Roberts JV. Smith K. et al. A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery. Postgrad Med J 1992; 68: 811–816

    Article  PubMed  CAS  Google Scholar 

  45. Kow L, Toouili J, Brookman J, et al. Comparison of cefotaxime plus metronidazole versus cefoxitin for prevention of wound infection after abdominal surgery. World J Surg 1995: 19: 680–686

    Article  PubMed  CAS  Google Scholar 

  46. Paladino JA. Rainsein MA, Serrianne DJ. el al. Ampicillin-sulbactam versus cefoxitin for prophylaxis in high-risk patients undergoing abdominal surgery. Pharmacotherapy 1994; 14: 734–739

    PubMed  CAS  Google Scholar 

  47. Hall JC Hall JL. Christenson K. A comparison of the roles of cefamandole and ceftriaxone in abdominal surgery. Arch Surg 1991; 126. 512–516

    Article  PubMed  CAS  Google Scholar 

  48. McArdle CS, Morran CG. Anderson JR, et al. Oral ciprofloxacin prophylaxis in gastrointestinal surgery. J Hosp Infect 1995; 30: 211–216

    Article  PubMed  CAS  Google Scholar 

  49. Salam IMA. Abu Galala KH. El Ashaal Yl, et al. A randomized prospective study of cefoxitin versus piperacillin in appendicectomy. J Hosp Infect 1994; 26: 133–136

    Article  PubMed  CAS  Google Scholar 

  50. El Mufti M. Rakas F, Glessa A, et al. A single prophylactic antibiotic for emergencv appendiceetomv? Chemotherapy 1989; 35: 383–388

    Article  Google Scholar 

  51. Matkainen M. Hiltunen KM. Parenteral single dose ceftriaxone with tinidazole versus aminoglycosides with tinidazole in colorectal surgery: a prospective single-blind randomized multicentre study. Int J Colored Dis 1993: 8: 148–150

    Article  Google Scholar 

  52. Fingerhut A. Hay JM, French Association for Surgical Research. Single-dose ceftriaxone, ornidazole, and povidone-iodine enema in elective left colectomy. Arch Surg 1993; 128: 228–232

    Article  PubMed  CAS  Google Scholar 

  53. Arnaud JP, Bcllisant E, Boissel P, et al. Single-dose amoxicillin-clavulanic acid vs. cefotetan for prophylaxis in elective colorectal surgery: a multicentre, prospective, randomized study. J Hosp Infect 1992; 22 Suppl. A: 23–32

    Article  PubMed  Google Scholar 

  54. Kwok SPY, Lau WY, Leung KL, et al. Amoxicillin and clavulanic acid versus cefotaxime and metronidazole as antibiotic prophylaxis in elective colorectal resectional surgery. Chemother 1993; 39: 135–139

    Article  CAS  Google Scholar 

  55. McArdle CS, Morran CG, Pettit L, et al. Value of oral antibiotic prophylaxis in colorectal surgery. Br J Surg 1995; 82: 1046–1048

    Article  PubMed  CAS  Google Scholar 

  56. Garcia-Rodriguez JA, Puig-La Calle J, Amau C, et al. Antibiotic prophylaxis with cefotaxime in gastroduodenal and biliary surgery. Am J Surg 1989; 158: 428–434

    Article  PubMed  CAS  Google Scholar 

  57. Katz S, Glicksman A, Levy Y, et al. Cefuroxime prophylaxis in biliary surgery: single versus triple dose. Isr J Med Sci 1993; 29: 673–676

    PubMed  CAS  Google Scholar 

  58. Meijer WS, Schmitz PIM, Jeekel J. Meta-analysis of randomized controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. Br J Surg 1990; 77: 283–290

    Article  PubMed  CAS  Google Scholar 

  59. Ranabaldo CJ, Karran SE, Bailey IS, et al. Antimicrobial prophylaxis in clean surgery: hernia repair. J Antimicrob Chemother 1993; 31 Suppl. B: 5–41

    Google Scholar 

  60. Davey PG, Duncan ID, Edward D, et al. Cost-benefit analysis of cephradine and mezlocillin prophylaxis for abdominal and vaginal hysterectomy. Br J Obstet Gynaecol 1988; 95: 1170–1177

    Article  PubMed  CAS  Google Scholar 

  61. van der Linden MCGJ, van Erp EJM, Ruijs GJHM, et al. A prospective randomized study comparing amoxycillin/clavulanate with cefuroxime plus metronidazole for perioperative prophylaxis in gynaecological surgery. Eur J Obstet Gynaecol Reprod Biol 1993; 50: 141–145

    Article  Google Scholar 

  62. Cartafia J, Cortes J, Yarnoz MC, et al. Antibiotic prophylaxis in Wertheim-Meigs surgery: a single dose versus three doses. Eur J Gynaecol Oncol 1994; 15: 14–18

    Google Scholar 

  63. Mayer HO, Petru E, Haas J, et al. Perioperative antibiotic prophylaxis in patients undergoing radical surgery for gynaecologic cancer: single dose versus multiple dose administration. Eur J Gynaecol Oncol 1993; 14: 177–181

    PubMed  CAS  Google Scholar 

  64. Dhar KK, Dhall GI, Ayyagari A. Tinidazole prophylaxis in elective abdominal hysterectomy. Int J Gynecol Obstet 1993; 42: 121–125

    Article  CAS  Google Scholar 

  65. Hemsell DL, Johnson ER, Hemsell PG, et al. Cefazolin is inferior to cefotetan as single-dose prophylaxis for women undergoing elective total abdominal hysterectomy. Clin Infect Dis 1995; 20: 677–684

    Article  PubMed  CAS  Google Scholar 

  66. Carlson C, Duff P. Antibiotic prophylaxis of cesarean delivery: is an extended-spectrum agent necessary? Obstet Gynecol 1990; 76: 343–346

    PubMed  CAS  Google Scholar 

  67. Matkaris M, Markentes K, Stayannis K, et al. Reduction of hospital cost and administration of prophylactic anti-biotherapy in gynecological surgery. Isr J Med Sci 1991; 27: 134–136

    PubMed  CAS  Google Scholar 

  68. del Rio G, Dalet F, Chechile G. Antimicrobial prophylaxis in urologic surgery: does it give some benefit? Eur Urol 1993; 24: 305–312

    PubMed  Google Scholar 

  69. Hargreave TB, Botto H, Rikken GHJM, et al. European collaborative study of antibiotic prophylaxis for transurethral resection of the prostate. Eur Urol 1993; 23: 437–443

    PubMed  CAS  Google Scholar 

  70. Slavis SA, Miller JB, Golji H, et al. Comparison of single-dose antibiotic prophylaxis in uncomplicated transurethral resection of the prostate. J Urol 1992; 147: 1303–1306

    PubMed  CAS  Google Scholar 

  71. Viitanen J, Talja M, Jussila E, et al. Randomized controlled study of chemoprophylaxis in transurethral prostatectomy. J Urol 1993; 150: 1715–1717

    PubMed  CAS  Google Scholar 

  72. Klimberg IW, Childs SJ, Madore RJ, et al. A multicenter comparison of oral lomefloxacin versus parenteral cefotaxime as prophylactic agents in transurethral surgery. Am J Med 1992; 92 Suppl. 4A: 121S–125S

    Article  PubMed  CAS  Google Scholar 

  73. Brown N. An audit of prophylactic antibiotic prescribing patterns in orthopaedic practice. R Coll Surg Edinb 1994; 39: 55–59

    CAS  Google Scholar 

  74. Ritter MA, Barzilauskas CD, Faris PM, et al. Vancomycin prophylaxis and elective total joint arthroplasty. Orthopedics 1989; 12: 1333–1336

    PubMed  CAS  Google Scholar 

  75. Bodoky A, Ner TU, Heberer M, et al. Antibiotic prophylaxis with two doses of cephalosporins in patients managed with internal fixation for a fracture of the hip. J Bone Joint Surg 1993; 75: 61–65

    PubMed  CAS  Google Scholar 

  76. Paiment GD, Renaud E, Dagenais G, et al. Double-blind randomized prospective study of the efficacy of antibiotic prophylaxis for open reduction and internal fixation of closed ankle fractures. J Orthop Trauma 1994; 8: 64–66

    Article  Google Scholar 

  77. Janknegt R, Wijnands WJA, Stobberingh E. Antimicrobial prophylaxis in bowel surgery in the Netherlands. Eur J Clin Microbiol Infect Dis 1994; 13: 596–600

    Article  PubMed  CAS  Google Scholar 

  78. Hedelin H, Bergman B, Frimodt-Moller C, et al. Antibiotic prophylaxis in urological procedures in Scandinavia. Nord Medicin 1995; 110: 9–11, 25

    CAS  Google Scholar 

  79. Martin C, French Study Group on Antimicrobial Prophylaxis in Surgery, French Society of Anesthesia and Intensive Care. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. Infect Control Hosp Epidemiol 1994; 15: 463–471

    Article  PubMed  CAS  Google Scholar 

  80. Committee on Antimicrobial Agents, Canadian Infectious Diseases Society, Wadell TK, et al. Antimicrobial prophylaxis in surgery. Can Med Assoc J 1994; 151: 925–931

    Google Scholar 

  81. Page CP, Bohnen JMA, Fletcher JR, et al. Antimicrobial prophylaxis for surgical wounds. Arch Surg 1993; 128: 79–88

    Article  PubMed  CAS  Google Scholar 

  82. Nichols RL. Surgical antibiotic prophylaxis. Med Clin North Am 1995; 79: 509–523

    PubMed  CAS  Google Scholar 

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  1. Department of Infectious Diseases, University of Lund, Lund University Hospital, S-221 85, Lund, Sweden

    S. Ragnar Norrby

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Ragnar Norrby, S. Cost-Effective Prophylaxis of Surgical Infections. Pharmacoeconomics 10, 129–140 (1996). https://doi.org/10.2165/00019053-199610020-00005

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