Surgical infections最新文献

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.

Introduction: People living with HIV (PLWHIV) have historically faced discrimination and unequal access to healthcare in the United States. This study aims to investigate differences in surgical intervention for common surgical emergencies among this population, specifically cholecystitis and appendicitis. Methods: This study utilized the TriNetX® database to compare the rate of cholecystectomies and appendectomies among PLWHIV with diagnosed cholecystitis or appendicitis, respectively, compared with HIV-negative patients. Inclusion criteria were an indication for surgical intervention, cholecystitis (K81) or appendicitis (K35-37). Cohorts were defined by HIV status, and analysis was stratified by procedure. Cohorts were propensity matched for age, race, leukocyte count, HIV 1 RNA volume, and substance abuse disorders. Outcomes were defined as patients receiving cholecystectomy or appendectomy in two separate analyses. Relative difference (RD) and relative risk (RR) were compared with between HIV+ and HIV- cohorts. Results: The cholecystectomy analysis had 609,127 total patients, with 3,597 per cohort after matching. The appendectomy analysis had 641,395 total patients, with 2,368 per cohort after matching. HIV-positive patients with cholecystitis had a 16.736% risk of undergoing cholecystectomy compared with 23.019% risk in HIV-cholecystitis patients (RD: -6.283% [95% confidence interval (95% CI): -8.122%, -4.444%], p < 0.0001, RR 0.727 [95% CI: 0.662, 0.799]). HIV-positive patients with appendicitis had a 14.147% risk of undergoing appendectomy compared with 17.272% in HIV-appendicitis patients (RD: -3.125%% [95% CI: -5.196%, -1.054%], p < 0.0031, RR 0.819, [95% CI 0.717, 0.935]). Conclusions: This study demonstrates a significant disparity in timely surgical intervention for PLWHIV. Further investigation is needed to elucidate the etiology of demonstrated incongruencies and their clinical relevance.

Background: Systemic corticosteroids are commonly used in critically ill patients. Although steroids may reduce the duration of shock and mechanical ventilation (MV), their use in postoperative surgical patients raises concerns regarding complications such as anastomotic leakage, impaired wound healing, and infection. This study aimed to evaluate the impact of postoperative corticosteroid therapy on clinical outcomes in patients undergoing surgery for gastrointestinal perforation and receiving intensive care. Methods: We conducted a single-center retrospective cohort study of 354 patients treated between January 2013 and March 2023. Postoperative corticosteroid use was identified, and clinical outcomes were compared between treated and untreated patients. To reduce confounding, propensity score matching was performed based on initial and postoperative sequential organ failure assessment scores and the Acute Physiology and Chronic Health Evaluation II score. A generalized linear model and a random forest (RF) regression model were applied to explore associations between steroid-related variables and the duration of MV. Results: Of the 354 patients, 37 (10.5%) received corticosteroids. In the unmatched cohort, the steroid group had higher mortality and complication rates. These differences were not significant after matching. In the matched cohort, the steroid group showed longer MV duration. No steroid-related variable was significantly associated with ventilation duration in regression analysis. Total hydrocortisone-equivalent dose emerged as the strongest predictor of prolonged MV duration in the RF model. Conclusion: Postoperative systemic corticosteroid therapy was independently associated with prolonged MV without adversely affecting mortality or overall morbidity. Although parametric analyses did not confirm a clear dose-response relationship, cumulative steroid dose demonstrated the highest predictive importance for ventilator dependence in machine learning modeling.

Purpose: Occult bacteremia (OB), defined as blood stream micro-organisms confirmed by reverse transcriptase-quantitative polymerase chain reaction that target 16S or 23S ribosomal RNA, has been shown to increase the incidence of post-operative infections during pancreaticoduodenectomy. However, its impact on other surgical procedures remains unclear. This study aimed to evaluate the effect of pre-operative OB on post-operative surgical site infection (SSI) during esophageal cancer surgery. Methods: In this prospective observational study, 56 patients scheduled for esophagectomy were included. Pre-operative blood samples were tested for OB, and fecal samples were analyzed for microbiota. Results: Ten patients (18%) exhibited pre-operative OB. These patients had more frequent SSIs than did those without OB (40% vs. 10.9%, p = 0.044). Other complications or clinical factors did not substantially differ between the OB-positive and OB-negative groups. Fecal samples from OB-positive patients presented a greater prevalence of Atopobium clusters. In addition, the same bacterial species were detected in both the blood and feces of five OB-positive patients, with Collinsella aerofaciens being the most commonly shared species among Atopobium clusters. Conclusions: Pre-operative OB increased the risk of SSI following esophagectomy. These findings emphasize the potential role of the gut microbiota, particularly Collinsella aerofaciens, in OB and subsequent infections.

Background: Since the early 2010s, prophylactic vancomycin powder has been widely adopted in spine surgery, with many surgeons crediting it for low surgical site infection (SSI) rates (1%-2%). However, its efficacy remains debated. Purpose: To compare post-operative SSI and related complications in multi-level posterior lumbar spinal surgery before and after the widespread use of vancomycin powder. Design: Retrospective study using the TriNetX Research Network. Patient Sample: Adult patients undergoing posterior spinal instrumentation (≥3 levels) for lumbar stenosis or spondylolisthesis. Outcome Measures: Primary: Composite rate of post-operative infections (superficial/deep incisional SSI, organ/space SSI, sepsis). Secondary: Incidence of incision and drainage (I&D) for SSIs. Methods: Patients were divided into two cohorts: 2003-2013 (pre-vancomycin era) and 2014-2023 (vancomycin era). Propensity matching was controlled for age, gender, race, and comorbidities. Post-operative infections requiring I&D within 90 days were identified using procedural and diagnostic codes. Results: Of 33,320 patients (mean age: 63.6 y; 43.3% male), 28,649 (86.0%) underwent surgery in 2014-2023 and 4,671 (14.0%) in 2003-2013. After propensity matching (4,668 patients per cohort), the 2014-2023 group had significantly lower odds of requiring I&D (odds ratio [OR] = 0.337) and developing post-operative infections (OR = 0.606). Conclusion: This large-scale, propensity-matched analysis suggests that the likelihood of post-operative infections or requiring I&D following multi-level posterior lumbar spinal instrumentation is approximately 40%-60% lower in the vancomycin era compared with the pre-vancomycin period.

Objective: The treatment of carbapenemase-producing organisms (CPOs) causing bacteremia in patients with intra-abdominal infections remains challenging. The early detection of CPOs from blood specimens is critical for guaranteeing the timely selection of appropriate antibiotics and achieving favorable outcomes. Our aim was to evaluate whether the rapid identification of CPOs can improve clinical outcomes. Patients and Methods: Between January 2019 and January 2024, we conducted a retrospective study of all bacteremia patients admitted to the Intestinal Fistulae and Intra-abdominal Infection Center at Jinling Hospital. A subset of patients underwent screening for CPOs using lateral flow immunoassays (LFIA) method. Results: A total of 163 patients were enrolled, with 96 in the 30-day survivors group and 67 in the 30-day non-survivors group. LFIA was performed in 76 patients, revealing the identification of 64 carbapenemases in four classes: bla Klebsiella pneumoniae carbapenemases (KPC) (45/76, 59.2%), bla NDM (11/76, 14.5%), bla oxacillinase (OXA)-48 (6/76, 7.9%), and bla imipenemase (IMP) (2/45, 2.2%). The most prevalent CPOs cultured were carbapenem-resistant Klebsiella pneumoniae (104/163, 63.8%), followed by carbapenem-resistant Acinetobacter baumannii (36/163, 22.1%), carbapenem-resistant Pseudomonas aeruginosa (32/163, 19.6%), carbapenem-resistant Escherichia coli (19/163, 11.7%), and others (28/163, 17.2%). Univariable analysis revealed that risk factors related to mortality included outbreaks in the intensive care unit or community, sources from the respiratory tract, mechanical ventilation, Pitt score of ≥4, and active therapy before blood culture collection. Multivariable logistic regression analysis indicated that outbreaks in the intensive care unit or community, sources from the respiratory tract, and mechanical ventilation were independent predictors of clinical failure. In addition, LFIA test was associated with decreased 30-day mortality. Conclusions: The LFIA method can rapidly detect the presence of CPOs in patients with bacteremia, thereby improving clinical outcomes. Future multicenter randomized controlled trial (RCT) studies are warranted to investigate the benefits of LFIA detection in bacteremia.

Background: Clostridium sordellii infections are rare and highly lethal. They are most associated with medical abortions and other genitourinary procedures. We report a fatal case of C. sordellii bacteremia from a perforated low rectal cancer with rectovaginal fistula. Case Presentation: A 60-year-old female presented with 10 days of abdominal pain, loose stools, and hematochezia. She developed rapidly progressive septic shock. Imaging identified a perforated rectal mass, pneumovagina, and a large pelvic abscess. She underwent fecal diversion and drainage of the pelvic abscess. Despite this intervention, she had refractory septic shock with multisystem organ failure resulting in death. Blood cultures grew C. sordellii post-mortem. Conclusion: C. sordellii infections are often fatal if not treated immediately. Clinicians must have a high index of suspicion in rectal cancer with associated gynecological involvement.

Background: Surgical site infections (SSIs) following spinal surgery remain a significant concern despite advances in infection control. We report an unexpected outbreak investigation at an institution with historically low infection rates. Methods: During April-June 2012, our spinal surgery department experienced 6 SSIs among 84 procedures (7.1%) compared with our baseline rate of 0.3%. We conducted a comprehensive MECE (Mutually Exclusive and Collectively Exhaustive) analysis, a systematic framework that ensures all potential factors are examined without overlap or omission, investigating all potential bacterial contamination routes: pre-operative, intra-operative, and post-operative factors. Statistical analysis was performed using Fisher exact test. Results: All infections occurred within 8 days post-operatively with skin commensal organisms as causative agents. Patient characteristics were similar between SSI-positive (n = 6) and SSI-negative (n = 78) groups. Environmental investigations revealed no abnormalities. Crucially, all SSI cases involved novice technicians (non-nursing staff responsible for instrument handling) with <6 months experience (100% vs. 10.3%, p < 0.001), all working in a smaller operating room. Conclusions: Traditional risk factor analysis failed to identify the outbreak cause. Only systematic MECE analysis identified a strong association with staff-related factors. Following targeted training interventions, infection rates returned to baseline levels. This investigation demonstrates that even institutions with excellent baseline infection control remain vulnerable to process failures requiring comprehensive systematic investigation beyond conventional risk factors.