BACKGROUND: The prosthetic arteriovenous grafts (AVG) being used increasingly to create hemodialysis access are prone to infections that pose potentially life-threatening infectious and bleeding complications, as well as loss of dialysis access. In this study, we identified the bacteriologic agents of infected AVGs by site swab, blood culture, and prosthesis cultures, and to evaluate the role of microbiological findings in the management of the infection. METHODS: We focused on 51 patients with 53 AVGs operated on in our clinic from January 2006 to December 2009. An infected AVG was identified by clinical, ultrasound, and microbiological findings. Sensitivity to antibiotics was determined for all bacterial strains. Isolates were identified by pulsed-field gel electrophoresis (PFGE) of bacterial DNA. In a few cases, positron emission tomography-computed tomography (PET-CT) examination was performed. RESULTS: Strains of Staphylococcus spp., especially S. aureus, were the most frequent cause of infected AVG. All S. aureus strains were sensitive to methicillin. With the exception of a single case, isolates obtained simultaneously from the skin site and the vascular prosthesis were identical genetically. CONCLUSIONS: Our results suggest that bacterial infectious agents detected in site swab, blood, or graft culture confirm a suspicion of AVG infection. A PET-CT examination can provide confirmation. The combination of microbiologic and radionuclide findings can improve the management of the AVG infection, but surgery remains essential.

• MeSH
• Arteriovenous Shunt, Surgical adverse effects   MeSH
• Bacteremia microbiology   MeSH
• Blood Vessel Prosthesis adverse effects   microbiology   statistics & numerical data   MeSH
• Renal Dialysis adverse effects   instrumentation   MeSH
• Prosthesis-Related Infections etiology   microbiology   MeSH
• Humans MeSH
• Prospective Studies MeSH
• Electrophoresis, Gel, Pulsed-Field MeSH
• Staphylococcal Infections etiology   microbiology   MeSH
• Staphylococcus isolation & purification   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: The study objective was to evaluate the impact of a restrictive antibiotic policy, efficacy of inpatient therapeutic and prophylactic antibiotic regimens and susceptibility patterns of infecting bacteria in 2000-2004. SETTING: A 500-bed general hospital in the Czech Republic. METHOD: A retrospective computerized survey of antibiotic prescribing practices over a five-year period 2000-2004, using medical records and laboratory data from the hospital information system (HIS). MAIN OUTCOME MEASURE: Consumption of antibiotics expressed in defined daily doses (DDDs) and Euros per 1,000 bed days. Resistance to antibiotics, average length of hospital stay, rate of inpatients treated with antibiotics, number of nosocomial infections per 1,000 bed days, median length of hospital stay and total mortality. RESULTS: Due to a restrictive antibiotic policy implemented in 2002, the use of several antibiotics in 2003 was significantly reduced but the consumption of several other antibiotics rose in 2003. In comparison with 2001 the cost of antibiotic agents (in Euro per 1,000 inpatient days) fell significantly by 31% in 2003 Euro 969.07 vs. Euro 671.34). The hospital saved about Euro 29,288 after the first year of implementation of the new antibiotic policy. The use of restricted antibiotics increased by 8%; however, the expenditure decreased by 26%. For non-restricted antibiotics, the use and expenditure decreased by 71% and 41%, respectively. Consequently, a net reduction of 55% Euro 804.36 vs. Euro 359.36) was achieved. CONCLUSION: The intervention was effective in reducing the use and cost of antibiotics. The HIS is a helpful tool for observing and evaluating the impacts of the measures taken and can be used for assessment of pharmacotherapy outcomes.

• MeSH
• Anti-Bacterial Agents economics   therapeutic use   MeSH
• Bacterial Infections drug therapy   MeSH
• Drug Resistance, Bacterial * MeSH
• Length of Stay statistics & numerical data   MeSH
• Cross Infection epidemiology   MeSH
• Cost Control MeSH
• Humans MeSH
• Microbial Sensitivity Tests * MeSH
• Hospital Bed Capacity, 500 and over MeSH
• Hospitals, General MeSH
• Hospital Information Systems MeSH
• Retrospective Studies MeSH
• Practice Guidelines as Topic MeSH
• Drug Utilization statistics & numerical data   MeSH
• Cost Savings MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Evaluation Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH

OBJECTIVE: To characterize the pattern of surgical antimicrobial prophylaxis in the Czech Republic. METHOD: Cross sectional survey with a self-administered postal questionnaire. Data collected included use of antimicrobial prophylaxis, surgical site infection rate, pathogens causing surgical site infection and demographics of the institution. Descriptive and multivariate analyses were performed. SETTING: Hospital, surgical departments in the Czech Republic. MAIN OUTCOME MEASURE: Prevalence of surgical antimicrobial use, factors associated with use, the profile of antimicrobial use, timing, route, dosage regimen and duration of initiated prophylaxis. RESULT: The response rate was 55.5%. Surgical antimicrobial prophylaxis was used in 97.5% of departments, and 85% departments justified prophylaxis based on guideline. The timing of the first dosage was within 2 h of operation in 95.0% of departments and 36.7% of all departments administered more than 2 doses of SAP in operations that lasted less than 4 h of all respondents. The three most common prophylactic antimicrobial agent used were cefazolin, co-amoxiclav and cefuroxime amongst the 26 single antimicrobial agents and 16 antimicrobial combinations. Penicillins and enzyme inhibitor was the most frequent class used. Surgical antimicrobial prophylaxis was administered intravenously in 82.5% of all cases. The regimen used varied markedly in dose and duration prescribed. The surgical site infection rate occurred. 1-5% in 71.7% of departments. Most departments identified the causative pathogen at all times. Staphylococcus aureus was the most frequent pathogen of surgical site infection and was detected in 90.8% of all departments. There was significant association between Pseudomonas aeruginosa with cefuroxime use and Bacteriodes fragilis with co amoxiclav use. CONCLUSION: This survey has identified several areas for improvement in surgical antimicrobial prophylaxis in the Czech Republic. Particular areas of concern include route of administration, duration and timing of first dosage of SAP, and the inappropriate use of broad-spectrum antimicrobials.

• MeSH
• Anti-Bacterial Agents administration & dosage   therapeutic use   MeSH
• Antibiotic Prophylaxis * MeSH
• Cefazolin administration & dosage   therapeutic use   MeSH
• Cefuroxime administration & dosage   therapeutic use   MeSH
• Guideline Adherence MeSH
• Surgical Wound Infection prevention & control   MeSH
• Amoxicillin-Potassium Clavulanate Combination administration & dosage   therapeutic use   MeSH
• Humans MeSH
• Hospitals MeSH
• Health Care Surveys MeSH
• Drug Administration Schedule MeSH
• Practice Guidelines as Topic MeSH
• Drug Utilization MeSH
• Drug Administration Routes MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Names of Substances
• Anti-Bacterial Agents MeSH
• Cefazolin MeSH
• Cefuroxime MeSH
• Amoxicillin-Potassium Clavulanate Combination MeSH