Increased incidence of postoperative infections during prophylaxis with cephalothin compared to doxycycline in intestinal surgery

<p>Abstract</p> <p>Background</p> <p>The antibiotics used for prophylaxis during surgery may influence the rate of surgical site infections. Tetracyclines are attractive having a long half-life and few side effects when used in a single dose regimen. We studied the rate of surgical site infections during changing regimens of antibiotic prophylaxis in medium and major size surgery.</p> <p>Methods</p> <p>Prospective registration of surgical site infection following intestinal resections and hysterectomies was performed. Possible confounding procedure and patient related factors were registered. The study included 1541 procedures and 1489 controls. The registration included time periods when the regimen was changed from doxycycline to cephalothin and back again.</p> <p>Results</p> <p>The SSI in the colorectal department increased from 19% to 30% (p = 0.002) when doxycycline was substituted with cephalothin and decreased to 17% when we changed back to doxycycline (p = 0.005). In the gynaecology department the surgical site infection rate did not increase significantly. Subgroup analysis showed major changes in infections in rectal resections from 20% to 35% (p = 0.02) and back to 12% (p = 0.003).</p> <p>Conclusion</p> <p>Doxycycline combined with metronidazole, is an attractive candidate for antibiotic prophylaxis in medium and major size intestinal surgery.</p

Organization and training at national level of antimicrobial stewardship and infection control activities in Europe: an ESCMID cross-sectional survey

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking

Brasagem da zircônia metalizada com titânio à liga Ti-6Al-4V Brazing of metalized zirconia with titanium to Ti-6Al-4V alloy

Zircônia tetragonal estabilizada com ítria foi mecanicamente metalizada com titânio e a condição de molhamento avaliada com as ligas convencionais Ag-28Cu e Au-18Ni. Estas dissolveram o revestimento de titânio para uma completa distribuição deste metal ativo na superfície cerâmica, gerando uma liga ativa in situ e possibilitando adequadas ligações químicas ao metal base na temperatura de união. Os melhores resultados de molhamento foram selecionados para brasagem indireta em forno de alto-vácuo nas juntas ZrO2/Ti-6Al-4V. Testes de detecção de vazamento de gás hélio foram realizados na interface de união das juntas; amostras removidas na seção transversal de juntas estanques foram examinadas por técnicas de análise microestrutural. Formou-se uma camada escura adjacente à cerâmica metalizada, responsável pelo molhamento ocasionado pela liga Ag-28Cu. Entretanto, o uso da liga Au-18Ni resultou em precipitação de intermetálicos e microtrincamento interfacial. Perfis de microdureza através da interface resultante até onde a zircônia mostrou típico escurecimento não indicaram alternância significativa entre medições consecutivas; os resultados dos ensaios de resistência mecânica à flexão-3p foram considerados satisfatórios.<br>Yttria tetragonal zirconia polycrystal was mechanically metallized with titanium and the wetting behavior on the ceramic surface was analyzed using the conventional fillers Ag-28Cu and Au-18Ni. These alloys had dissolved the active metal coating, which acts to zirconia reduction on its surface and promoting suitable chemical bonding to the metallic member. Better wetting results were selected for indirect brazing in a high-vacuum furnace for ZrO2/Ti-6Al-4V simple butt joints. Helium gas leak detection was made at the joints interface; samples were removed from the tight joints cross-section and examined by microstructural analysis techniques and EDX analysis. There was formation of a dark reaction layer close to the metalized ceramic surface, which was responsible for its good wetting behavior using the filler Ag-28Cu. However, the Au-18Ni filler alloy caused an excessive presence of intermetallics and interfacial microcracking. Microhardness profiles were made across the joints interface to where zirconia undergone typical darkening and there was no significant variation between consecutive measurements; performance of brazed joints was considered satisfactory by three-point flexure testing