Surgical infections最新文献

Objective: To evaluate the impact of the Safe Surgery Program on surgical site infection (SSI) rates in spinal procedures and total hip and knee arthroplasties. The analysis compared the pre-implementation (2006-2010) and post-implementation (2010-2022) periods to determine the effect of the program on SSI rate reduction.

Methods: We conducted a nested case-control study including adults (>18 y). Cases were patients with SSI matched 1:1 to controls by procedure type, gender, age, and operation date. Risk factors, antimicrobial agent use, hospital costs, and checklist adherence were analyzed.

Results: A total of 142 patients were included in the analysis (71 cases and 71 matched controls). Most surgical procedures (84.5%) occurred after the implementation of the Safe Surgery Program, with 78.3% adherence to the World Health Organization checklist. In the analysis, blood transfusion was significantly associated with SSI (odds ratio = 2.67; 95% confidence interval: 1.04-6.82; p = 0.040), whereas a longer operative time showed a borderline trend (p = 0.050). SSI rates decreased from 2.0% to 0.7% after program implementation (p = 0.017). Hospital-wide antimicrobial agent consumption increased for cefazolin (+75 defined daily doses per 1,000 patient-days), cefuroxime (+10.6), and vancomycin (+10.2) during the same period, reflecting broader compliance with surgical prophylaxis protocols. Hospital costs were significantly lower among patients without SSI (p = 0.024).

Conclusions: Implementation of the Safe Surgery Program was associated with reduced SSI incidence and hospital costs in complex orthopedic procedures. Blood transfusion remained an important risk factor, highlighting the value of optimization of peri-operative management and adherence to surgical safety practices.

Background: There has been a renewed interest in the use of whole blood (WB) in trauma resuscitation, with studies showing improved mortality rate with WB. However, there is a paucity of studies assessing the impact of WB on infectious complications. The aim of this study was to assess the impact of WB during trauma resuscitation on infectious complications. Methods: A retrospective cohort study utilizing the National Trauma Databank of patients who underwent hemorrhage control laparotomy within one hour was performed. The primary outcome was the impact of receiving WB during trauma resuscitation on surgical infections. Secondary outcome included analysis of a dose-response relation between units of WB and infection. Subgroup analysis was performed on patients undergoing massive transfusion. Multi-variable logistic regression was performed to evaluate outcomes. Results: A total of 2,151 patients received WB compared with 10,641 patients who did not. Receiving WB was not associated with increased odds of infection (odds ratio [OR] = 1.12, 95% confidence interval [95% CI]: 0.94-1.32, p = 0.22). However, each unit of WB received was associated with a 4% increase in odds of infection (OR = 1.04, 95% CI: 1.00-1.08, p = 0.04). In the massive transfusion subgroup, receiving WB was not associated with increased risk of infection. Conclusions: Receiving WB during trauma resuscitation was associated with increased odds of infection in a dose-dependent manner, but not in patients undergoing massive transfusion. Further studies evaluating effects beyond mortality are needed to better evaluate the impact of WB use on trauma patients.

Background: Fungal empyema is uncommon and has worse short-term outcomes than bacterial disease, particularly when a bronchopleural fistula (BPF) sustains contamination. Case: A previously healthy male developed BPF and methicillin-resistant Staphylococcus aureus (MRSA) empyema after right upper lobectomy at age 17, managed by open-window thoracostomy (OWT). An apical residual space persisted and formed a fungus-ball-like nodule. At age 30, he re-presented with fever and nodule growth, with elevated Aspergillus IgG; voriconazole was started. Management: Computed tomography-guided catheter placement and re-OWT exposed air leaks and recurrent MRSA. Staged fistula control with endobronchial Watanabe spigots, n-butyl-2-cyanoacrylate, and cavity-side suturing achieved cessation. Outcome: After irrigation, sterilized cultures, negative-pressure therapy preceded latissimus dorsi flap obliteration. He was discharged on postoperative day 149 without recurrence. Conclusions: A stepwise plan-source control, fistula control, sterilization, and obliteration-can achieve durable cure in mixed Aspergillus-MRSA empyema with BPF after prior OWT.

Introduction: Acute appendicitis remains one of the most common surgical emergencies, yet its pathogenesis is incompletely understood. Although mechanical luminal obstruction has traditionally been considered the initiating factor, emerging evidence suggests that the appendix hosts a unique microbial community that may influence disease onset and severity. Methods: We conducted a narrative review that summarizes current data on the role of microbiota in appendicitis, while focusing on differences between complicated and uncomplicated presentations. Results: High-throughput sequencing studies have identified key taxa associated with inflamed appendices, including Fusobacterium, Prevotella, and oral cavity genera such as Gemella and Parvimonas. On the contrary, protective commensals such as Faecalibacterium prausnitzii and Akkermansia muciniphila appear depleted. Studies suggest that there is significant variation regarding the microbial composition of complicated and uncomplicated cases. We also examine the role of the appendix as a microbial reservoir and the potential health consequences of its removal. Finally, we discuss how microbiome-based approaches may improve treatment, particularly antibiotic agent selection both in operative and non-operative management. Conclusion: Current evidence supports that appendicitis may represent a disease spectrum carrying multiple rather than a single microbial signature that dictates different pathophysiologic processes.

Introduction: Left upper quadrant (LUQ) drain use after trauma splenectomy varies, with minimal existing data to guide practice. We aimed to investigate the association of LUQ drains with organ space surgical site infection (OS-SSI) after splenectomy. We hypothesized that LUQ drains after trauma splenectomy are associated with increased odds of OS-SSI. Patients and Methods: A retrospective study of adult blunt trauma patients who underwent splenectomy from 7/2018 to 6/2024 was performed. We excluded patients who survived <5 days after operation, and those with an intraoperatively identified pancreatic injury. Demographics, surgical details, and drain information were abstracted from the medical record. Inverse probability of treatment weighting (IPTW) was used to balance variables between patients who did and did not receive an LUQ drain after splenectomy. Multivariable logistic regression with IPTW was performed to estimate the association of LUQ drains with OS-SSI. Results: Of 179 patients, 68% (n = 121) were male, the median age was 38 years (interquartile range 28, 55), and 27% (n = 48) received an LUQ drain. Patients with a drain were more likely to be male and overweight. Age, injury severity, use of damage control, and bowel injuries and resections were similar in patients with and without drains. LUQ drains were associated with increased adjusted odds of OS-SSIs (aOR 5.6, 95% confidence interval 1.7-18.3, p ≤ 0.01). Seven patients, all with drains, had a pancreatic fistula (7/48 vs. 0/131). Conclusion: LUQ drains after splenectomy for blunt trauma were associated with increased odds of OS-SSIs. Given the high likelihood of unmeasured confounders and the inability to capture surgeons' complex decision-making in this study, randomized controlled trials are needed to assess the risks and benefits of LUQ drains after splenectomy.

Background: Surgical site infections (SSIs) and complications (SSCs) following open spine surgery result in substantial added healthcare system cost and reduced quality of care. Closed incision negative pressure therapy (ciNPT) is increasingly used as an adjunctive tactic, for postoperative management of high-risk closed incisions. We developed an economic model to evaluate potential savings from SSI and SSC-associated readmission (SSC-AR) reduction against the incremental acquisition cost of the ciNPT system across different patient risk levels. Methods: Patient risk parameters were derived from published predictive models for SSI and SSC-AR risk, using data from the Premier Healthcare Database of open spine surgeries. The economic model incorporated published average costs of SSIs ($18,899) and SSC-ARs ($22,698) within 90 days post-discharge in orthopedic surgery and an estimated ciNPT effectiveness rate ranging from 20% to 80% in spine surgery. Primary measure was estimated economic impact of preventing SSIs or SSC-ARs using ciNPT. Results: Cost savings were observed in populations with SSI/SSC-AR rates ≥15.0 when ciNPT was universally applied. ciNPT was not cost-effective for rates ≤0.5%. For rates between 1.0% and 15.0%, savings were observed depending on specific patient risk levels. Conclusions: Strategic use of ciNPT, guided by patient risk stratification, can provide cost savings for healthcare systems. This model may help surgeons to preoperatively identify spine surgery patients with the highest potential cost benefit from ciNPT.