Surgical infections最新文献

Background: Lactic acidosis can be a sign of poor tissue perfusion but may also be caused by some commonly used drugs, namely metformin and linezolid. Patients and Methods: A 70-year-old overweight female presented to the emergency department with abdominal pain. Although there was concern for biliary sepsis, imaging and lab work were incompatible. Results: Her home medications included linezolid for osteomyelitis and metformin for type II diabetes mellitus. Once these were stopped, the lactate level normalized within 36 h. In addition, she was malnourished and found to be vitamin C and B1 deficient. She made a remarkable recovery after volume, electrolyte, and vitamin supplementation. Conclusions: Although surgeons seek infection and sepsis to explain an elevated lactate, in a patient with multiple co-morbidities, medications, and risk factors such as vitamin deficiencies, a thorough analysis of their history and presentation is vital to uncovering the underlying causes(s) of lactic acidosis.

Purpose: This study aimed to investigate the microbiological profiles of surgical pad cultures in patients undergoing damage control surgery (DCS) for abdominal trauma and to assess their association with clinical outcomes. Patients and Methods: A retrospective observational study was conducted on 122 patients who underwent DCS at a regional trauma center between January 2012 and December 2021. Patients were grouped according to the presence or absence of positive pad culture results. Microbiological data from surgical pad, abdominal, and wound cultures were analyzed. Clinical characteristics and postoperative infectious complications were compared between groups. Multi-variable logistic regression was performed to identify factors associated with infectious complications. Results: Pad cultures were positive in 71 patients (58.2%). The microbial distribution differed between sites: Staphylococcus epidermidis (20.3%) predominated in wound cultures, while Enterococcus faecalis was significantly more prevalent in abdominal cultures (20.0% vs. 4.3%, p = 0.006). Culture-positive patients had significantly higher rates of surgical site infection (42.1% vs. 20.2%, p = 0.018), intra-abdominal abscess (18.4% vs. 8.9%, p = 0.042), and pneumonia (15.2% vs. 7.8%, p = 0.038). In multi-variable analysis, positive pad culture (odds ratio [OR]: 3.49, 95% confidence interval [CI]: 1.52-8.01, p = 0.003) and red blood cell (RBC) transfusion ≥10 units (OR: 4.29, 95% CI: 1.89-9.74, p < 0.001) were independently associated with infectious complications. Culture positivity was not associated with mortality (p = 0.982). Conclusion: Surgical pad cultures obtained during DCS provide independent infection risk stratification beyond clinical and injury parameters. Positive cultures predict infectious complications but not mortality, suggesting specific utility for infection surveillance. Microbiological profiles differ by anatomical site, supporting site-specific antimicrobial approaches. These findings suggest potential utility of routine pad culture collection in DCS patients.

Background: Surgical site infections account for a substantial proportion of hospital-acquired infections, and the proper sterilization of surgical instruments is crucial for their prevention. Hair strands detected in sterile surgical sets are generally considered sufficient grounds for rejection, leading to delays in surgical procedures. The present study evaluates the impact of hair strands on the efficacy of sterilization and the potential for contamination. Patients and Methods: This controlled experimental study was conducted in the sterilization unit of a public hospital in Istanbul between January 15 and February 15, 2023. It was hypothesized that no microbial growth would occur in hair strands or on surgical instruments after sterilization, regardless of the contamination status or sterilization method. The surgical sets obtained for the study were divided into three groups: experiment group 1, to which uncontaminated hair strands were applied (n = 6); experiment group 2, to which hair strands contaminated with one of five bacterial pathogens were applied (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and Enterococcus faecalis; n = 30); and the control group, to which no hair strands were applied (n = 6). The soft tissue surgical instruments in each group were standardized by weight (3-3.5 kg) and sterilized using one of three methods: pressurized steam, ethylene oxide, or hydrogen peroxide. After sterilization, microbiological samples were collected by culturing swabs from the hair strands and surgical instruments under appropriate conditions in tryptic soy broth and various agar media. Results: No microbial growth was observed in any group after sterilization, regardless of the presence or contamination of hair strands or the sterilization method used. The biological indicators also identified no growth after sterilization. Conclusion: The present highlights the effectiveness of proper sterilization techniques, even in the presence of hair strands, and suggests that hair should not be treated as a potential source of contamination in all surgical settings. It should be noted, however, that the present study was conducted under controlled clinical microbiology laboratory conditions and so does not consider the complexity and variability of clinical environments. Surgical units should thus be encouraged to replicate these data or carry out similar studies and revise their practices based on their own results.

Background: Patients with traumatic injuries who develop ventilator-associated pneumonia (VAP) incur a higher risk of developing multi-drug resistance. Shorter duration of antibiotic agents for early VAP at five days may reduce antibiotic agent exposure without worsening patient outcomes. Methods: This retrospective cohort study performed at a Level I Trauma Center included adult (≥16 years old) patients with trauma diagnosed with bronchoalveolar lavage (BAL)-proven early (within four days of intubation) bacterial VAP. Groups were stratified by treatment duration. The primary outcome was the rate of recurrent pneumonia. Secondary outcomes included total antibiotic agent duration, time to recurrent pneumonia, ventilator days, ventilator-free days, intensive care unit and hospital length of stay, re-admission within 30 days, and mortality at discharge and at one year. Results: Of the 73 included patients in the analysis, 38 underwent a shortened course (4-5 d) of systemic antibiotic agents, while 35 patients had a standard course (7-8 d). Patients in the short-duration cohort were significantly older with a lower injury severity score (ISS) and were more likely to be extubated at the time of antibiotic agent discontinuation (61% vs. 37%, p = 0.045). There was no difference in the primary outcome; 10 patients had recurrence in the short-duration cohort, while 7 patients had recurrence in the standard cohort (26% vs. 20%, p = 0.522). There were no significant differences in secondary outcomes. Conclusion: This study suggests that in patients with trauma diagnosed with early VAP on BAL, five days of antibiotic agent therapy can reduce antibiotic agent use with no adverse impact on pneumonia recurrence rates or other salient outcomes.

Background: Patients undergoing plastic and reconstructive procedures with penicillin allergies (PAs) often receive second-line antibiotic agents. Evidence from other surgical specialties suggests this can lead to increased complications and greater morbidity. However, limited research exists in plastic surgery regarding this issue. This systematic review consolidates existing literature on the impact of PAs and alternative antibiotic agent use in plastic surgery, highlighting findings and future research directions. Methods: A systematic search of SCOPUS, PubMed (including MEDLINE), EMBASE, and the Cochrane Library was conducted on January 7, 2025, to identify studies evaluating the effects of PAs or second-line antibiotic agents on plastic surgery outcomes. Studies were included if full-text English articles were available. Five studies, comprising 2,318 patients, met the inclusion criteria. Results: Of the five studies included, two focused on head and neck procedures, one on general plastic surgery, and two on abdominal wall reconstruction. Four studies compared first-line versus second-line antibiotic agents, reporting higher infection and complication rates with second-line agents. No allergic reactions were reported. One study evaluated the implementation of a PA protocol, demonstrating increased first-line antibiotic agent adherence and a reduction in complication rates. Conclusion: Research on the impact of PAs in plastic and reconstructive surgery is limited. However, existing evidence aligns with findings from other surgical fields, suggesting that patients receiving second-line antibiotic agents experience worse outcomes. Further research is needed to optimize prophylactic antibiotic agent selection in patients with PAs undergoing a plastic surgery.

Objective: During sepsis, blood antithrombin (AT) concentrations decrease; administering AT to patients with sepsis-associated intravascular coagulation has been shown to improve their prognosis. Neutrophil extracellular traps (NETs) are closely related to immunothrombosis; however, the relation between AT and NETs remains nebulous. This study examined the effects of AT on NETs of human neutrophils in vitro. Methods: Blood samples were collected from healthy volunteers, and the isolated neutrophils were seeded onto collagen-coated cell culture plates. The cells were then stimulated by lipopolysaccharide (LPS) with platelets. Human serum albumin (hAlb) was used as a control for AT. AT (0.01-10 U/mL) or hAlb was added 30 minutes after LPS and platelet treatment. The timing of AT addition was determined by the results of a single cell NETs assay. NET formation was assessed using enzyme-linked immunosorbent assay and immunostaining. Peptidyl arginine deiminase 4 (PAD4) nuclear transfer was detected by Western blotting. Results: Lipopolysaccharide-induced deoxyribonucleic acid (DNA)-binding neutrophil elastase substantially. NET formation over time was 3%, 15%, 50%, and 70% of the total neutrophils at 30, 60, 100, and 120 minutes after LPS stimulation, respectively. NETs evaluation in addition to AT at 15, 30, or 60 minutes after LPS stimulation showed that AT inhibited NET formation only at 30 minutes. High AT concentrations (i.e., 2-10 U/mL) substantially decreased NET formation and decreased nuclear expression of PAD4. Conclusion: The high concentrations of AT decrease NETs in human neutrophils induced by LPS and platelets via PAD4 pathway.

Purpose: Post-operative fever (POF) is a common infectious complication following ureteroscopy (URS). Early identification of high-risk patients may help reduce morbidity and optimize peri-operative management. This study aimed to evaluate the predictive value of the Stone Management According to Size-Hardness (SMASH) score-a composite index based on stone size and density-for forecasting POF after URS. Patients and Methods: We retrospectively analyzed 143 patients who underwent semi-rigid and flexible URS for unilateral ureteral stones between January 2023 and January 2025. Demographic, radiological, and operative parameters were recorded, including SMASH score, Hounsfield unit (HU), stone size and location, operative time, and hydronephrosis. POF was defined as a body temperature ≥38.3°C with a positive urine culture. Comparative and receiver operating characteristic curve analyses were performed to assess predictors of POF. Results: POF occurred in 17 patients (11.9%). The febrile group had significantly higher SMASH scores (median: 8.08 vs. 5.09, p = 0.001), HU values (720 vs. 626, p = 0.006), and longer operative times (41 vs. 34 min, p = 0.001). Proximal stone location was also more common in the febrile group (p = 0.001). No significant differences were observed in age, gender, comorbidities, or hydronephrosis. Conclusions: Elevated SMASH scores, longer operative time, and proximal stone location were independently associated with POF after URS. The SMASH score may serve as a useful tool for pre-operative risk stratification, allowing for enhanced peri-operative precautions in high-risk patients.

Background: Most systemic analyses of optimum wound closure have not found significant differences in the surgical site infection (SSI) rates between the different methods of skin closure. A recent international survey reported that spine surgeons used continuous sutures, interrupted sutures, and surgical skin staples (SS) frequently for skin closure. We found that SS and running subcuticular stitch using absorbable suture (RSAS) were the two most common methods of skin closure in our spine division, and one surgeon had routinely used SS for skin closure until early 2020, at which time the surgeon switched to RSAS. Our hypothesis was that the infection rate would not be different whether the skin is closed with SS or RSAS. Methods: After IRB approval, a retrospective review of billing and hospital records at a tertiary referral academic medical center was used to identify all open posterior lumbar spine surgeries (OPLS) by a single surgeon in 2018-22 and obtain demographics, clinical history, and surgical characteristics. The inclusion criterion was OPLS closed with the RSAS or SS. Exclusion criteria were oncologic condition and previous infection in the surgical site. Results: There were no significant differences between RSAS and SS groups in the risk factors such as age, BMI, history of diabetes or smoking, number of levels decompressed per case, number of levels fused per instrumented case, and operative time. The incidence of previous surgical procedure in the same site and the percentage of cases with instrumented fusion were both greater in the RSAS group, which should have resulted in greater risk for SSI in the RSAS group. However, the deep SSI rate in the RSAS group (1.4% = 3/216) was less than that in the SS group (5.9% = 6/101), and the difference was statistically significant (p = 0.02). Conclusions: SS skin closure may have a greater risk for deep SSI compared with RSAS skin closure in OPLS.