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    • Vascular interventional radiology VIR laboratories perform

    2024-03-04

    Vascular interventional radiology (VIR) laboratories perform a myriad of procedures ranging from simple tunneled peripherally inserted central catheter lines to complex transjugular intrahepatic portosystemic shunt placements. Infections are a common complication in the VIR environment; thus, the practice of administering prophylactic Malonic acid (Pr-Abx) was adopted by SIR over 25 years ago (Sutcliffe et al., 2015). Smith, Lankster, and McInnis (2007) acknowledge that infections remain a common complication of IR procedures and stress the importance of appropriate timing of the prophylactic antibiotic to ensure effectiveness of the medication. The VIR at a large academic medical center in the southeastern United States established a goal to administer Pr-Abx within 1 hr of the procedure start time; however, compliance rates consistently fell below 60%.
    Materials and methods The VIR medical team consists of seven full-time interventional radiologists, three full-time physician assistants, five full-time IR fellows, and rotating radiology residents. Imaging devices and techniques such as fluoroscopy, ultrasound, and computed tomography are used to provide treatments for such things as malignant tumors, peripheral arterial, venous, urologic, and hepatobiliary disease (UAB School of Medicine, 2015).
    Results The compliance data for the project are provided in Figure 4, Figure 5, Figure 6 as well as in Table 2, Table 3, Table 4. Compliance rates are provided for both IR procedures completed on inpatients and outpatients. Findings show that the overall compliance rate for the five common procedures during the preintervention time frame ranged from 39% to 55%. The overall compliance rate for the postintervention period ranged from 92% to 97%. The compliance rate for outpatients during the preintervention time frame ranged from 37% to 53%, whereas the postintervention compliance rate ranged from 90% to 100%. The compliance rates for inpatients showed similar results. The preintervention compliance rate ranged from 44% to 57%, whereas the postintervention compliance rate ranged from 94% to 100%.
    Discussion
    Conclusion
    Necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) cause significant morbidity and mortality among infants born premature in neonatal intensive care units (NICUs). Among infants born <32 weeks of gestational age, 7% develop NEC, in whom case fatality is ~30%., LOS occurs in up to one-third of infants <32 weeks of gestational age, with most infants born preterm experiencing the greatest risk. High postnatal empiric antibiotic use is an epidemiologic correlate of both NEC and LOS. Cotten et al studied a national cohort of 5693 infants of extremely low birth weight and found that infants receiving prolonged initial antibiotic therapy had an increased risk for developing NEC or death. Subsequently, Kuppala et al studied 365 infants born premature in Cincinnati, Ohio, and reported that prolonged initial empiric antibiotics were associated with increased risk for NEC, LOS, or death. In a cohort of 328 infants born premature in Saudi Arabia, Abdel Ghany and Ali also reported that each treatment day with empiric antibiotics was associated with an increased risk of death and the combined outcome of NEC or death. Greenwood et al examined the impact of high antibiotic use on the microbiome and found that infants receiving early antibiotics experienced a surge in Enterobacteriaceae as well as greater risk of NEC, sepsis, or death. However, infant antibiotic exposure may begin prenatally as a result of maternal exposure to antibiotics, and this prenatal exposure could potentially influence neonatal disease. Bizzarro et al noted an increase in ampicillin-resistant infections in mothers exposed to ampicillin. Similarly, Didier et al found that maternal exposure led to an increase in amoxicillin-resistant organisms. However, the effects of maternal antibiotic exposure before delivery on neonatal outcomes have not been well defined. With this concern in mind, we analyzed an extant cohort of infants born preterm to test the hypothesis that infant antibiotic exposure prenatally is associated with increased incidence of NEC, LOS, or death.