Introduction: Surgical site infections (SSIs) are a substantial healthcare burden in low- and middle- income countries. "Clean Cut" is a checklist-based infection prevention and control (IPC) program intended to improve compliance to peri-operative IPC standards. We aim to study the short-term and long-term impact of its implementation in a tertiary care cancer referral center. Methods: This was a single institute, prospective interventional study. Patients undergoing elective head-neck surgical procedures were included. The "Clean Cut" program consisting of surveillance, audits, and IPC training was implemented for 6 months, after which there was no active oversight. Post-intervention (T2) and 1-year follow-up (T3) data regarding compliance to core IPC practices and SSI rates were compared with baseline (T1). Results: One hundred eighty six patients were included with 50 (26.9%), 86 (46.2%), and 50 (26.9%) patients at T1, T2, and T3, respectively. At baseline, teams complied with a mean of 3.56 of the six critical components of infection control processes which rose to 4.66 (p < 0.001) at T2, but decreased to 4.02 at T3 (p = 0.053). The SSI rate at baseline decreased significantly after Clean Cut implementation [16 (32%) vs. 12 (13.95%), p = 0.012], but returned to baseline levels after 1 year [17 (34%), p = 0.006]. Conclusion: Implementation of the "Clean Cut" program increases compliance to infection control processes and reduces SSI rates in the short term. Without continuing oversight, these rates return to baseline values after 1 year.
{"title":"Long-Term Sustainability of Peri-Operative Infection Control Practices: Implementation of \"Clean Cut,\" a Checklist-Based Quality Improvement Program in India.","authors":"Reshma Ambulkar, Aditya R Kunte, Akanksha Sarangi, Sudhir Nair, Tihitena Negussie, Isabela Lima, Mansi Tara","doi":"10.1089/sur.2023.334","DOIUrl":"10.1089/sur.2023.334","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Surgical site infections (SSIs) are a substantial healthcare burden in low- and middle- income countries. \"Clean Cut\" is a checklist-based infection prevention and control (IPC) program intended to improve compliance to peri-operative IPC standards. We aim to study the short-term and long-term impact of its implementation in a tertiary care cancer referral center. <b><i>Methods:</i></b> This was a single institute, prospective interventional study. Patients undergoing elective head-neck surgical procedures were included. The \"Clean Cut\" program consisting of surveillance, audits, and IPC training was implemented for 6 months, after which there was no active oversight. Post-intervention (T2) and 1-year follow-up (T3) data regarding compliance to core IPC practices and SSI rates were compared with baseline (T1). <b><i>Results:</i></b> One hundred eighty six patients were included with 50 (26.9%), 86 (46.2%), and 50 (26.9%) patients at T1, T2, and T3, respectively. At baseline, teams complied with a mean of 3.56 of the six critical components of infection control processes which rose to 4.66 (p < 0.001) at T2, but decreased to 4.02 at T3 (p = 0.053). The SSI rate at baseline decreased significantly after Clean Cut implementation [16 (32%) vs. 12 (13.95%), p = 0.012], but returned to baseline levels after 1 year [17 (34%), p = 0.006]. <b><i>Conclusion:</i></b> Implementation of the \"Clean Cut\" program increases compliance to infection control processes and reduces SSI rates in the short term. Without continuing oversight, these rates return to baseline values after 1 year.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-07-11DOI: 10.1089/sur.2024.137
Jared M Huston, Philip S Barie, E Patchen Dellinger, Joseph D Forrester, Therese M Duane, Jeffrey M Tessier, Robert G Sawyer, Miguel A Cainzos, Kemal Rasa, Jeffrey G Chipman, Lillian S Kao, Frederic M Pieracci, Kristin P Colling, Daithi S Heffernan, Janice Lester
Background: The Surgical Infection Society (SIS) published evidence-based guidelines for the management of intra-abdominal infection (IAI) in 1992, 2002, 2010, and 2017. Here, we present the most recent guideline update based on a systematic review of current literature. Methods: The writing group, including current and former members of the SIS Therapeutics and Guidelines Committee and other individuals with content or guideline expertise within the SIS, working with a professional librarian, performed a systematic review using PubMed/Medline, the Cochrane Library, Embase, and Web of Science from 2016 until February 2024. Keyword descriptors combined "surgical site infections" or "intra-abdominal infections" in adults limited to randomized controlled trials, systematic reviews, and meta-analyses. Additional relevant publications not in the initial search but identified during literature review were included. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system was utilized to evaluate the evidence. The strength of each recommendation was rated strong (1) or weak (2). The quality of the evidence was rated high (A), moderate (B), or weak (C). The guideline contains new recommendations and updates to recommendations from previous IAI guideline versions. Final recommendations were developed by an iterative process. All writing group members voted to accept or reject each recommendation. Results: This updated evidence-based guideline contains recommendations from the SIS for the treatment of adult patients with IAI. Evidence-based recommendations were developed for antimicrobial agent selection, timing, route of administration, duration, and de-escalation; timing of source control; treatment of specific pathogens; treatment of specific intra-abdominal disease processes; and implementation of hospital-based antimicrobial agent stewardship programs. Summary: This document contains the most up-to-date recommendations from the SIS on the prevention and management of IAI in adult patients.
{"title":"The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update.","authors":"Jared M Huston, Philip S Barie, E Patchen Dellinger, Joseph D Forrester, Therese M Duane, Jeffrey M Tessier, Robert G Sawyer, Miguel A Cainzos, Kemal Rasa, Jeffrey G Chipman, Lillian S Kao, Frederic M Pieracci, Kristin P Colling, Daithi S Heffernan, Janice Lester","doi":"10.1089/sur.2024.137","DOIUrl":"10.1089/sur.2024.137","url":null,"abstract":"<p><p><b><i>Background:</i></b> The Surgical Infection Society (SIS) published evidence-based guidelines for the management of intra-abdominal infection (IAI) in 1992, 2002, 2010, and 2017. Here, we present the most recent guideline update based on a systematic review of current literature. <b><i>Methods:</i></b> The writing group, including current and former members of the SIS Therapeutics and Guidelines Committee and other individuals with content or guideline expertise within the SIS, working with a professional librarian, performed a systematic review using PubMed/Medline, the Cochrane Library, Embase, and Web of Science from 2016 until February 2024. Keyword descriptors combined \"surgical site infections\" or \"intra-abdominal infections\" in adults limited to randomized controlled trials, systematic reviews, and meta-analyses. Additional relevant publications not in the initial search but identified during literature review were included. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system was utilized to evaluate the evidence. The strength of each recommendation was rated strong (1) or weak (2). The quality of the evidence was rated high (A), moderate (B), or weak (C). The guideline contains new recommendations and updates to recommendations from previous IAI guideline versions. Final recommendations were developed by an iterative process. All writing group members voted to accept or reject each recommendation. <b><i>Results:</i></b> This updated evidence-based guideline contains recommendations from the SIS for the treatment of adult patients with IAI. Evidence-based recommendations were developed for antimicrobial agent selection, timing, route of administration, duration, and de-escalation; timing of source control; treatment of specific pathogens; treatment of specific intra-abdominal disease processes; and implementation of hospital-based antimicrobial agent stewardship programs. <b><i>Summary:</i></b> This document contains the most up-to-date recommendations from the SIS on the prevention and management of IAI in adult patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 27-year-old female underwent bilateral mastectomy with left axillary dissection and had immediate breast reconstruction with textured silicone implants and acellular dermal graft (ADG) reinforcement of the inferior quadrants. The patient was maintained on oral antibiotics postoperatively and initially did well. However, she subsequently presented with fever, erythema, and tenderness in the left chest and was admitted for intravenous antibiotic therapy. Despite improvement of her symptoms, she ultimately cultured positive for Staphylococcus aureus and had the tissue expander and the ADG material explanted. These explanted specimens were immediately examined with confocal microscopy using Live/Dead staining under hydrated conditions for the presence of bacterial biofilms. Biofilm bacteria were clearly visualized adherent to both the tissue expander shell and also to the ADG surface. This is the first direct demonstration of viable bacteria in biofilm configuration on the surface of a tissue expander and acellular dermal graft after breast reconstruction.
{"title":"Bacterial Biofilm on Tissue Expander and Acellular Dermal Graft After Breast Reconstruction.","authors":"Avni Kathju, Laura Nistico, Paul Stoodley","doi":"10.1089/sur.2024.156","DOIUrl":"https://doi.org/10.1089/sur.2024.156","url":null,"abstract":"<p><p>A 27-year-old female underwent bilateral mastectomy with left axillary dissection and had immediate breast reconstruction with textured silicone implants and acellular dermal graft (ADG) reinforcement of the inferior quadrants. The patient was maintained on oral antibiotics postoperatively and initially did well. However, she subsequently presented with fever, erythema, and tenderness in the left chest and was admitted for intravenous antibiotic therapy. Despite improvement of her symptoms, she ultimately cultured positive for <i>Staphylococcus aureus</i> and had the tissue expander and the ADG material explanted. These explanted specimens were immediately examined with confocal microscopy using Live/Dead staining under hydrated conditions for the presence of bacterial biofilms. Biofilm bacteria were clearly visualized adherent to both the tissue expander shell and also to the ADG surface. This is the first direct demonstration of viable bacteria in biofilm configuration on the surface of a tissue expander and acellular dermal graft after breast reconstruction.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ozan Baskurt, Benan Baysoy Avinçsal, Furkan Diren, Serdar Kabatas, Hulya Kusoglu, Simay Kara, Nurperi Gazioglu
Background: Pituitary abscess (PA), a rare complication following transsphenoidal (TS) surgery for pituitary adenoma with an incidence of 0.2%, poses a significant risk; carrying potential morbidity, recurrence, and the necessity for reoperation. Timely suspicion, diagnosis, and treatment are imperative. Patients and Methods: We present two cases and provide a literature review on the symptoms, risk factors, diagnosis, treatment, and outcomes associated with secondary PAs following TS surgery for adenoma. Results: We identified 12 articles reporting a total of 45 cases, in addition to our 2 cases. The primary symptoms were headache and visual impairment, with no fever or specific infectious parameters observed. Predominant risk factors identified included cerebrospinal fluid (CSF) leakage and prior radiotherapy (RT). Our first patient, a 45-year-old male, presented 10 weeks after TS surgery with sudden-onset symptoms, whereas our second patient, a 64-year-old female, presented 22 years postoperatively. In the first case, intraoperative CSF leakage, with the patient's history of allergic rhinitis and frequent nasal irrigation possibly contributed to the development of abscess. In the second case, RT was considered a potential risk factor. Severe headache and subclinical signs of infection associated with a cystic lesion of the pituitary gland were common findings. Both patients underwent endoscopic TS drainage and received appropriate antibiotic therapy, resulting in complete recovery without recurrence. Conclusions: When faced with severe headaches in a patient with a history of TS surgery for a pituitary adenoma, coupled with radiological evidence showing a cystic appearance with peripheral enhancement, taking a proactive approach to promptly identify and intervene in secondary PAs is essential for mitigating potential complications and optimizing patient outcomes.
{"title":"Secondary Pituitary Abscess: A Rare Complication of Transsphenoidal Surgery for Pituitary Adenoma - Description of Two New Cases and Review of the Literature.","authors":"Ozan Baskurt, Benan Baysoy Avinçsal, Furkan Diren, Serdar Kabatas, Hulya Kusoglu, Simay Kara, Nurperi Gazioglu","doi":"10.1089/sur.2024.077","DOIUrl":"10.1089/sur.2024.077","url":null,"abstract":"<p><p><b><i>Background:</i></b> Pituitary abscess (PA), a rare complication following transsphenoidal (TS) surgery for pituitary adenoma with an incidence of 0.2%, poses a significant risk; carrying potential morbidity, recurrence, and the necessity for reoperation. Timely suspicion, diagnosis, and treatment are imperative. <b><i>Patients and Methods:</i></b> We present two cases and provide a literature review on the symptoms, risk factors, diagnosis, treatment, and outcomes associated with secondary PAs following TS surgery for adenoma. <b><i>Results:</i></b> We identified 12 articles reporting a total of 45 cases, in addition to our 2 cases. The primary symptoms were headache and visual impairment, with no fever or specific infectious parameters observed. Predominant risk factors identified included cerebrospinal fluid (CSF) leakage and prior radiotherapy (RT). Our first patient, a 45-year-old male, presented 10 weeks after TS surgery with sudden-onset symptoms, whereas our second patient, a 64-year-old female, presented 22 years postoperatively. In the first case, intraoperative CSF leakage, with the patient's history of allergic rhinitis and frequent nasal irrigation possibly contributed to the development of abscess. In the second case, RT was considered a potential risk factor. Severe headache and subclinical signs of infection associated with a cystic lesion of the pituitary gland were common findings. Both patients underwent endoscopic TS drainage and received appropriate antibiotic therapy, resulting in complete recovery without recurrence. <b><i>Conclusions:</i></b> When faced with severe headaches in a patient with a history of TS surgery for a pituitary adenoma, coupled with radiological evidence showing a cystic appearance with peripheral enhancement, taking a proactive approach to promptly identify and intervene in secondary PAs is essential for mitigating potential complications and optimizing patient outcomes.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gamze Sanlıdağ Işbilen, Deniz Akyol, Taşkın Yurtseven, Erkin Ozgiray, Mehmet Sedat Cağlı, Söhret Aydemir, Bilgin Arda, Oğuz Reşat Sipahi
Objectives: Carbapenem-resistant A. baumannii is a common cause of nosocomial meningitis, and it presents a challenge in terms of treatment because of limited therapeutic options. Intravenous tigecycline has been considered a potential salvage therapy against multi-drug-resistant Acinetobacter baumannii. However, its effectiveness is limited by its poor ability to cross the blood-brain barrier. As an alternative treatment option, intrathecal tigecycline has shown promise with its minimal side effects and high concentration in cerebrospinal fluid. Methods: In this report, we present a series of four cases infected with multi-drug-resistant A. baumannii following neurosurgery and treated with intrathecal tigecycline, including antimicrobial therapy. Results: The rate of successful microbiological response was 2 out of 3 cases (66%) in whom microbiological response could be tested anytime during the intrathecal therapy, whereas the 30-day survival rate after treatment completion was ¼ (25%). Conclusion: Although intrathecal tigecycline treatment has shown relative efficacy in achieving microbiological response, its impact on overall survival is still uncertain. Further studies involving larger groups of patients are necessary to evaluate the outcomes of intrathecal tigecycline therapy.
{"title":"Intrathecal Tigecycline in the Treatment of Hospital-Acquired Meningitis: A Review of Four Cases.","authors":"Gamze Sanlıdağ Işbilen, Deniz Akyol, Taşkın Yurtseven, Erkin Ozgiray, Mehmet Sedat Cağlı, Söhret Aydemir, Bilgin Arda, Oğuz Reşat Sipahi","doi":"10.1089/sur.2024.063","DOIUrl":"https://doi.org/10.1089/sur.2024.063","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> Carbapenem-resistant <i>A. baumannii</i> is a common cause of nosocomial meningitis, and it presents a challenge in terms of treatment because of limited therapeutic options. Intravenous tigecycline has been considered a potential salvage therapy against multi-drug-resistant <i>Acinetobacter baumannii</i>. However, its effectiveness is limited by its poor ability to cross the blood-brain barrier. As an alternative treatment option, intrathecal tigecycline has shown promise with its minimal side effects and high concentration in cerebrospinal fluid. <b><i>Methods:</i></b> In this report, we present a series of four cases infected with multi-drug-resistant A. baumannii following neurosurgery and treated with intrathecal tigecycline, including antimicrobial therapy. <b><i>Results:</i></b> The rate of successful microbiological response was 2 out of 3 cases (66%) in whom microbiological response could be tested anytime during the intrathecal therapy, whereas the 30-day survival rate after treatment completion was ¼ (25%). <b><i>Conclusion:</i></b> Although intrathecal tigecycline treatment has shown relative efficacy in achieving microbiological response, its impact on overall survival is still uncertain. Further studies involving larger groups of patients are necessary to evaluate the outcomes of intrathecal tigecycline therapy.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To investigate the predictive value of preoperative peripheral blood inflammatory markers for surgical site infection (SSI) in laparoscopic radical gastrectomy for gastric cancer. Methods: A retrospective analysis was conducted on patients undergoing laparoscopic radical gastrectomy for gastric cancer, categorized into SSI and non-SSI groups based on postoperative SSI occurrences. Patient demographics, surgical details, laboratory results, and SSI incidence data were extracted. Differences in indicators, including neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and platelet-lymphocyte ratio (PLR), were assessed between the two groups. Multivariate logistic regression was utilized to determine the independent association of each indicator with SSI. Receiver operating characteristics (ROC) curve analysis was utilized to evaluate the predictive value of parameters. Results: Of 169 patients, 36 (21.30%) experienced SSI postoperatively. The SSI group exhibited higher preoperative NLR and SII (p < 0.05). After adjusting for variables, preoperative NLR (OR = 1.691, 95% CI: 1.211-2.417, p = 0.003) and SII (OR = 1.001, 95% CI: 1.000-1.002, p = 0.006) were identified as independent risk factors for SSI. Both NLR (AUC = 0.758, 95% CI: 0.666-0.850) and SII (AUC = 0.753, 95% CI: 0.660-0.850) demonstrated favorable diagnostic performance for predicting postoperative SSI. Conclusion: Preoperative NLR and SII significantly associate with postoperative SSI in laparoscopic radical gastrectomy for gastric cancer, making them valuable indicators for early prediction of SSI.
{"title":"Predictive Value of Preoperative Peripheral Blood Inflammatory Markers for Surgical Site Infection in Laparoscopic Radical Gastrectomy for Gastric Cancer.","authors":"Mingqi Huang, Zhe Yuan, Mi Que","doi":"10.1089/sur.2024.009","DOIUrl":"https://doi.org/10.1089/sur.2024.009","url":null,"abstract":"<p><p><b><i>Background:</i></b> To investigate the predictive value of preoperative peripheral blood inflammatory markers for surgical site infection (SSI) in laparoscopic radical gastrectomy for gastric cancer. <b><i>Methods:</i></b> A retrospective analysis was conducted on patients undergoing laparoscopic radical gastrectomy for gastric cancer, categorized into SSI and non-SSI groups based on postoperative SSI occurrences. Patient demographics, surgical details, laboratory results, and SSI incidence data were extracted. Differences in indicators, including neutrophil-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and platelet-lymphocyte ratio (PLR), were assessed between the two groups. Multivariate logistic regression was utilized to determine the independent association of each indicator with SSI. Receiver operating characteristics (ROC) curve analysis was utilized to evaluate the predictive value of parameters. <b><i>Results:</i></b> Of 169 patients, 36 (21.30%) experienced SSI postoperatively. The SSI group exhibited higher preoperative NLR and SII (<i>p</i> < 0.05). After adjusting for variables, preoperative NLR (OR = 1.691, 95% CI: 1.211-2.417, <i>p</i> = 0.003) and SII (OR = 1.001, 95% CI: 1.000-1.002, <i>p</i> = 0.006) were identified as independent risk factors for SSI. Both NLR (AUC = 0.758, 95% CI: 0.666-0.850) and SII (AUC = 0.753, 95% CI: 0.660-0.850) demonstrated favorable diagnostic performance for predicting postoperative SSI. <b><i>Conclusion:</i></b> Preoperative NLR and SII significantly associate with postoperative SSI in laparoscopic radical gastrectomy for gastric cancer, making them valuable indicators for early prediction of SSI.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Wound closure is a critical aspect of medical care, and the choice of closure methods plays a pivotal role in preventing infections. Traditional sutures and staples can introduce foreign material into the wound, increasing the risk of infection. Adhesives offer a potential alternative by providing a physical barrier against microorganisms. Objective: To assess the microbial barrier properties of Exofin High Viscosity Topical Skin Adhesive (HVTSA), a novel adhesive system, against a range of challenge organisms. Methods: This study, conducted by the independent research organization NAMSA (North American Science Associates, LLC), aimed to evaluate the effectiveness of Exofin HVTSA as a microbial barrier. This study was carried out by an independent research organization NAMSA. Challenge organisms, including Staphylococcus aureus, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Escherichia coli, Candida albicans, and Aspergillus brasiliensis, were used to evaluate the adhesive's effectiveness. Inocula of each organism were placed on cured Exofin HVTSA test articles and observed for 14 days. Positive and negative control plates were included to validate the effectiveness of the challenge organisms and assess the absence of contamination. Results: Exofin HVTSA demonstrated effective microbial barrier properties against all challenge organisms, except Pseudomonas aeruginosa. No growth or color change was observed for Staphylococcus aureus, Staphylococcus epidermidis, MRSA, Escherichia coli, Candida albicans, and Aspergillus brasiliensis over the 14-day observation period. Pseudomonas aeruginosa exhibited no growth, but showed a color change in two out of five replicates on day 14. Conclusion: Exofin HVTSA demonstrated effective microbial barrier properties for 14 days against a range of common wound pathogens, suggesting its potential as a safe and effective alternative to traditional wound closure methods. Further research is warranted to investigate its efficacy in clinical settings.
{"title":"An in Vitro Evaluation of the 14-Day Microbial Barrier Property of Exofin High Viscosity Topical Skin Adhesive.","authors":"Chaitanya Dev Pannu","doi":"10.1089/sur.2024.036","DOIUrl":"https://doi.org/10.1089/sur.2024.036","url":null,"abstract":"<p><p><b><i>Background:</i></b> Wound closure is a critical aspect of medical care, and the choice of closure methods plays a pivotal role in preventing infections. Traditional sutures and staples can introduce foreign material into the wound, increasing the risk of infection. Adhesives offer a potential alternative by providing a physical barrier against microorganisms. <b><i>Objective:</i></b> To assess the microbial barrier properties of Exofin High Viscosity Topical Skin Adhesive (HVTSA), a novel adhesive system, against a range of challenge organisms. <b><i>Methods:</i></b> This study, conducted by the independent research organization NAMSA (North American Science Associates, LLC), aimed to evaluate the effectiveness of Exofin HVTSA as a microbial barrier. This study was carried out by an independent research organization NAMSA. Challenge organisms, including <i>Staphylococcus aureus</i>, <i>Staphylococcus epidermidis</i>, methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), <i>Pseudomonas aeruginosa</i>, <i>Escherichia coli</i>, <i>Candida albicans</i>, and <i>Aspergillus brasiliensis</i>, were used to evaluate the adhesive's effectiveness. Inocula of each organism were placed on cured Exofin HVTSA test articles and observed for 14 days. Positive and negative control plates were included to validate the effectiveness of the challenge organisms and assess the absence of contamination. <b><i>Results:</i></b> Exofin HVTSA demonstrated effective microbial barrier properties against all challenge organisms, except <i>Pseudomonas aeruginosa</i>. No growth or color change was observed for <i>Staphylococcus aureus</i>, <i>Staphylococcus epidermidis</i>, MRSA, <i>Escherichia coli</i>, <i>Candida albicans</i>, and <i>Aspergillus brasiliensis</i> over the 14-day observation period. <i>Pseudomonas aeruginosa</i> exhibited no growth, but showed a color change in two out of five replicates on day 14. <b><i>Conclusion:</i></b> Exofin HVTSA demonstrated effective microbial barrier properties for 14 days against a range of common wound pathogens, suggesting its potential as a safe and effective alternative to traditional wound closure methods. Further research is warranted to investigate its efficacy in clinical settings.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Necrotizing soft-tissue infection (NSTI) is a rare and serious disease with high morbidity and mortality. Standard therapeutic concepts have included urgent surgical intervention, broad-spectrum antibiotic treatment, and intensive care. Hyperbaric oxygen therapy (HBOT) is used as adjuvant therapy in some centers, but its benefits remain controversial. Methods: A retrospective analysis was conducted in which 98 patients with a clinical diagnosis of NSTI were treated with standard treatments plus HBOT. The clinical outcomes were wound healing, performance status, hospital length, complication rate, recurrence rate, morbidity (amputation rate), and mortality. Primary or secondary outcomes were compared between the time interval of HBOT and the clinical outcomes. Results: The average times from diagnosis of NSTI to initial HBO treatment and from initial surgery to initial HBO treatment were both significantly longer in dead patients than in surviving patients (P = 0.031; P = 0.020). These two time intervals were both significantly longer in amputated patients than in preserved patients (P = 0.031; P = 0.037). Conclusions: Using combined treatment with early surgical debridement combined with HBOT, it is possible to reduce hospital stay, intensive care unit stay, number of debridements, improve complete wound healing rate, and lower amputation and mortality rates among patients with NSTI. The early onset of HBOT soon after diagnosis, especially during critical conditions, is proved to be associated with higher survival and preservation rates.
{"title":"Is Prompt Hyperbaric Oxygen Adjunctive Therapy Able to Reduce Mortality and Amputation in Management of Necrotizing Soft-Tissue Infection?","authors":"Kuan-Ju Chiang, Yi-Ting Wang, Enoch Kang, Yi-Chun Wu, Ching-Uen Huang, Xin-Yi Lin, Feng-Chou Tsai, Ching-Sung Tsai, Yu-Han Chen, Fu-Yu Wang, Chiehfeng Chen, Wen-Kuan Chiu, Hsian-Jenn Wang, Shun-Cheng Chang","doi":"10.1089/sur.2023.353","DOIUrl":"https://doi.org/10.1089/sur.2023.353","url":null,"abstract":"<p><p><b><i>Background:</i></b> Necrotizing soft-tissue infection (NSTI) is a rare and serious disease with high morbidity and mortality. Standard therapeutic concepts have included urgent surgical intervention, broad-spectrum antibiotic treatment, and intensive care. Hyperbaric oxygen therapy (HBOT) is used as adjuvant therapy in some centers, but its benefits remain controversial. <b><i>Methods:</i></b> A retrospective analysis was conducted in which 98 patients with a clinical diagnosis of NSTI were treated with standard treatments plus HBOT. The clinical outcomes were wound healing, performance status, hospital length, complication rate, recurrence rate, morbidity (amputation rate), and mortality. Primary or secondary outcomes were compared between the time interval of HBOT and the clinical outcomes. <b><i>Results:</i></b> The average times from diagnosis of NSTI to initial HBO treatment and from initial surgery to initial HBO treatment were both significantly longer in dead patients than in surviving patients (P = 0.031; P = 0.020). These two time intervals were both significantly longer in amputated patients than in preserved patients (P = 0.031; P = 0.037). <b><i>Conclusions:</i></b> Using combined treatment with early surgical debridement combined with HBOT, it is possible to reduce hospital stay, intensive care unit stay, number of debridements, improve complete wound healing rate, and lower amputation and mortality rates among patients with NSTI. The early onset of HBOT soon after diagnosis, especially during critical conditions, is proved to be associated with higher survival and preservation rates.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background:Granulicatella adiacens inhabits the oral cavity, urogenital, and gastrointestinal tracts and is a typical commensal of human mucosal surfaces. It rarely causes disease. Identification of these gram-positive cocci can be challenging. Case Report: In a 58-year-old male in an oncology center, we report the first occurrence of bacterial infection caused by G. adiacens. After a precise diagnosis of the infection, the patient received effective treatment. Conclusion: Owing to a lack of sufficient diagnostic tools, G. adiacens may be a more notable pathogen than has been previously identified. Sensitivity testing standards are desperately needed.
背景:Granulicatella adiacens栖息于口腔、泌尿生殖道和胃肠道,是人类粘膜表面的典型共生菌。它很少致病。鉴别这些革兰氏阳性球菌很有难度。病例报告:我们报告了肿瘤中心的一名 58 岁男性首次发生由 G. adiacens 引起的细菌感染。经过精确诊断后,患者接受了有效治疗。结论由于缺乏足够的诊断工具,G. adiacens 可能是一种比以前发现的更值得注意的病原体。灵敏度测试标准亟待制定。
{"title":"<i>Granulicatella adiacens</i> Bacterial Infection After Pancreatectomy Whipple's Procedure.","authors":"Rahul Kumar Banerjee, Manisa Sahu","doi":"10.1089/sur.2024.118","DOIUrl":"https://doi.org/10.1089/sur.2024.118","url":null,"abstract":"<p><p><b><i>Background:</i></b> <i>Granulicatella adiacens</i> inhabits the oral cavity, urogenital, and gastrointestinal tracts and is a typical commensal of human mucosal surfaces. It rarely causes disease. Identification of these gram-positive cocci can be challenging. <b><i>Case Report:</i></b> In a 58-year-old male in an oncology center, we report the first occurrence of bacterial infection caused by <i>G. adiacens</i>. After a precise diagnosis of the infection, the patient received effective treatment. <b><i>Conclusion:</i></b> Owing to a lack of sufficient diagnostic tools, <i>G. adiacens</i> may be a more notable pathogen than has been previously identified. Sensitivity testing standards are desperately needed.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hang-Yu Sun, Yan Ning, Fan-Bin Kong, Xiao-Ying Yao
Background: Puerperal infection is one of the four main causes of maternal mortality. A giant intrauterine mass caused by puerperal infection is a rare form of infection. The delay in treatment may result in the removal of the uterus. Case Presentation: We report a case of a large intrauterine mass resulting from puerperal infection, in which the uterus was salvaged through antibiotic treatment and curettage. The patient was a 27-year-old female, who presented with a large intrauterine mass, accompanied by fever and abdominal pain 35 days after vaginal delivery. The large intrauterine mass was ultimately pathologically confirmed to be necrotic smooth muscle tissue instead of residual pregnancy tissue. Conclusion: In most cases, the intrauterine mass after pregnancy is residual pregnancy tissue. Early identification and management are critical to ensure a good prognosis for patients. Obstetricians and pregnant women should be fully aware of the hazards of puerperal infections.
{"title":"Giant Intrauterine Mass Because of Puerperal Infection: A Case Report.","authors":"Hang-Yu Sun, Yan Ning, Fan-Bin Kong, Xiao-Ying Yao","doi":"10.1089/sur.2024.078","DOIUrl":"https://doi.org/10.1089/sur.2024.078","url":null,"abstract":"<p><p><b><i>Background:</i></b> Puerperal infection is one of the four main causes of maternal mortality. A giant intrauterine mass caused by puerperal infection is a rare form of infection. The delay in treatment may result in the removal of the uterus. <b><i>Case Presentation:</i></b> We report a case of a large intrauterine mass resulting from puerperal infection, in which the uterus was salvaged through antibiotic treatment and curettage. The patient was a 27-year-old female, who presented with a large intrauterine mass, accompanied by fever and abdominal pain 35 days after vaginal delivery. The large intrauterine mass was ultimately pathologically confirmed to be necrotic smooth muscle tissue instead of residual pregnancy tissue. <b><i>Conclusion:</i></b> In most cases, the intrauterine mass after pregnancy is residual pregnancy tissue. Early identification and management are critical to ensure a good prognosis for patients. Obstetricians and pregnant women should be fully aware of the hazards of puerperal infections.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}