Reduction or discontinuation of antibiotic prophylaxis in vascular access surgery, tendon sheath incision and PD catheter placement.
OBJECTIVE
Immune response in dialysis patients is suppressed and these patients are susceptible to bacterial infections. Therefore, minimal use of antibiotics in dialysis patients is recommended to avoid generating drug-resistant bacteria. However, minor surgeries including vascular access surgery, tendon sheath incision and peritoneal dialysis (PD) catheter placement are inevitable in dialysis patients and evidence-based recommendations on the judicious use of antibiotics are not currently available for these procedures. In this study, the optimal antibiotic prophylaxis for minor surgeries was evaluated.


METHODS
This is a retrospective study. In dialysis patients at Kawashima Hospital, a three-step reduction of antibiotic use was performed in 651 cases of arteriovenous fistula (AVF) and tendon sheath incision surgeries from July 2009 through October 2012. Moreover, general surgical guidelines-recommended dose of preoperative antibiotics only were used in 532 cases of arteriovenous graft (AVG) and PD catheter placement from January 2010 through October 2012. The surgical site was observed for 2 weeks after the surgery.


RESULTS
In only one case of AVF surgery, redness of the skin around the stitches was noticed 5 days after the surgery, which was healed with antibiotics taken orally for 3 days. Neither AVG nor PD catheter placement demonstrated any infection at the surgical site during the 2-week observation period.


CONCLUSIONS
Even in dialysis patients, neither pre- nor postoperative antibiotics are necessary for AVF and tendon sheath incision surgeries. AVG and PD catheter placement surgeries require only a small amount of antibiotics preoperatively.
Department of Nephrology, Tokushima University, Tokushima - Japan.
Kojiro
K
Nagai
Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima - Japan.
Kenji
K
Tsuchida
Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima - Japan.
Maki
M
Sasada
Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima - Japan.
Narushi
N
Yokota
Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima - Japan.
Masaaki
M
Nishitani
Department of Urology, Tokushima University, Tokushima - Japan.
Hiro-Omi
HO
Kanayama
Department of Kidney Disease (Dialysis & Transplantation), Kawashima Hospital, Tokushima - Japan.
Jun
J
Minakuchi
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control; D002408:Catheters, Indwelling; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control; D013710:Tendons / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures
D000900:Anti-Bacterial Agents