Surgical infections最新文献

Background: This study investigated the clinical characteristics and risk factors for cytomegalovirus (CMV) gastrointestinal (GI) disease in patients with trauma using covariate matching. Patients and Methods: This study included immunocompetent patients with trauma who had received a diagnosis of CMV GI disease between 2017 and 2022, confirmed by symptoms and quantitative real-time polymerase chain reaction. Patients were matched 3:1 on the basis of age, gender, mechanism of injury, Injury Severity Score, and Trauma and Injury Severity Score. Matched cases were compared using χ² or Fisher exact test and the Mann-Whitney U test. Significant variables identified during uni-variable analysis were entered into logistic regression. Results: A total of 23 patients received a diagnosis of CMV GI disease. After matching, 22 CMV-positive and 62 CMV-negative patients were analyzed. CMV-positive patients frequently underwent hollow viscus (HV) organ surgery (p = 0.028) and pre-peritoneal pelvic packing (PPP) (p = 0.012). The disease-positive group also exhibited a greater demand for mechanical ventilation, stress-dose steroids, renal replacement therapy (RRT) (all p < 0.001), and a greater blood product requirement within 24 h (p = 0.007). Logistic regression identified HV organ surgery (OR: 6.65, 95% confidence interval [CI]: 1.34-32.89, p = 0.020), PPP (OR: 12.58, 95% CI: 1.14-139.15, p = 0.039), stress-steroid use (OR: 8.31, 95% CI: 1.15-47.40, p = 0.017), and RRT (OR: 15.72, 95% CI: 3.02-81.81, p = 0.001) as risk factors for the disease. Conclusions: This study identified HV organ surgery, PPP, steroid usage, and RRT as significant risk factors for CMV GI disease in patients with trauma.

Background: Actinomycosis is a chronic inflammatory condition caused by Actinomyces israelii or other Actinomycetes species, with primary abdominopelvic involvement being the most important form of the disease, especially when there is splanchnic infiltration. In cases of colonic involvement, the disease is often misdiagnosed as a neoplasm by imaging studies, and surgery is undertaken. Case Presentation: We report the case of a 48-year-old male living in a rural area in whom a computed tomography (CT) scan showed a large, irregular abdominopelvic mass infiltrating the urinary bladder, the left ureter, and the sigmoid colon with luminal obstruction. He was referred with the presumptive diagnosis of abdominal sarcoma for surgical evaluation and treatment. He underwent a Hartmann's procedure with resection of the sigmoid colon and formation of an end colostomy. Multiple tissue samples were taken from the mass for histopathological examination. The correct diagnosis was made after pathological examination by detection of actinomycetes colonies. Penicillin-based therapy was commenced and continued for six months, when a CT revealed complete resolution of the pre-operative findings without any evidence of a mass. Conclusion: Although rare, actinomycosis should be considered in the differential diagnosis of colonic neoplastic lesions. Proper long-term antibiotic treatment is necessary for complete eradication of the infection and resolution of tissue alterations.

Background: There is no consensus on the optimal strategy for surgical site infection (SSI) prevention in anorectal surgery. Pre-operative antibiotic agents and enema are commonly used, but their effectiveness in SSI prevention has not been studied. The objective of this study was to determine the combined effect of antibiotic agents and enema on SSI rates in anorectal surgery for benign disease. Methods: A retrospective study was conducted between July 2015 and June 2024 in an academic institution on adult patients who underwent either elective excisional hemorrhoidectomy, lateral internal sphincterotomy (LIS), or simple fistulotomy. Patients were categorized into four groups on the basis of the pre-operative prophylactic strategy utilized: neither antibiotic agents nor enema, enema only, antibiotic agents only, or both antibiotic agents and enema. The primary outcome measured was the effect of pre-operative prophylactic strategy on reducing SSI rates, analyzed within the overall cohort and stratified by procedure performed. Other outcomes measured were factors associated with SSI development. Results: During the study period, 555 patients met the inclusion criteria. Of these, 136 (24.5%) patients received neither antibiotic agents nor enema, 65 (11.7%) received enema only, 217 (39.1%) received antibiotic agents only, and 137 (24.7%) received both antibiotic agents and enema. No significant differences were observed between the four groups with regard to age, gender, associated comorbidities, or smoking status. SSI occurred in 40 (7.2%) patients within the cohort; of these 3 (7.5%) patients required incision and drainage, and the remaining 37 (92.5%) patients were managed with antibiotic therapy. There was no difference in the SSI rate on the basis of the pre-operative prophylactic strategy utilized. Similarly, no difference was observed among the four groups when stratified by the procedure performed. Conclusion: Pre-operative antibiotic agents and enema, whether administered individually or in combination, showed no substantial effect on SSI rate.

Background: Enterocutaneous (EC) fistulae are a significant complication of abdominal surgery. The surgical takedown of EC fistulae carries a high risk of complications, including sepsis, recurrence, and mortality. Identifying biomarkers to detect complications early may improve outcomes. C-reactive protein (CRP), a marker of inflammation and tissue injury, has shown promise in predicting anastomotic leaks in colorectal surgery. This study evaluates the utility of post-operative CRP declination curves in detecting leaks after EC fistula takedown. Methods: This retrospective case series analyzed adult patients undergoing EC fistula takedown performed by a single surgeon at our institution over the past three years. Inclusion required documented EC fistulae, failure of nonoperative management, and at least three post-operative high-sensitivity CRP measurements. C-reactive protein, white blood cell (WBC), and temperature trends were analyzed alongside secondary outcomes: fistula recurrence, hospital stay, and complications. Results: Seven of 15 eligible cases met the inclusion criteria. C-reactive protein levels peaked immediately post-operatively and on average declined in patients without leaks, stabilizing by the second post-operative week. In patients with leaks, CRP levels deviated from this pattern, remaining elevated until managed. While WBC counts and temperatures showed variable trends, CRP demonstrated more consistent correlations with post-operative recovery and complications. Conclusion: High-sensitivity CRP may serve as a useful adjunct for early detection of post-operative leaks following EC fistula takedown. Preliminary findings support further prospective studies to validate CRP declination curves as a diagnostic tool, potentially improving monitoring and patient outcomes in this high-risk population.

Introduction: Given concerns for antibiotic resistance, broader spectrum antibiotic agents such as ertapenem are being used for pre-operative prophylaxis. We hypothesize that pre-operative ertapenem prior to laparotomies and colectomies is superior at decreasing surgical site infections (SSIs) compared with other widely used antibiotic agents. Methods: Medline, Embase, the Cochrane Library, and Web of Science were queried for studies until February 02, 2025. Studies were excluded if they did not evaluate ertapenem as a pre-operative antibiotic prophylaxis in patients undergoing laparotomy or colectomy, the outcome was not SSIs, or it represented a review of prior publications. Three reviewers independently extracted relevant articles, and two performed risk-of-bias analyses. Results: Of 6,389 abstracts identified, 9 studies remained after full-text review. Seven of the included studies were observational (78%), and two (22%) were randomized controlled trials (RCTs). The median number of patients enrolled was 499 (inter-quartile range 253, 5192). Study populations included colorectal surgery (n = 8) and trauma patients undergoing laparotomy (n = 1). Ertapenem was compared with single-agent second-generation cephalosporins such as cefotetan, cefuroxime, and cefoxitin and to a single-agent penicillin with or without a combined β-lactamase inhibitor (i.e., ampicillin-sulbactam). In total, five (56%) studies showed that ertapenem was superior in preventing SSIs, decreasing SSI rates by as much as 59% (adjusted odds ratio = 0.41 [0.28-0.61]; p < 0.001). Conclusion: Approximately half of the studies (56%) demonstrated that ertapenem was superior to other commonly used antibiotic prophylaxis regimens in decreasing SSI after laparotomies and colectomies. However, most studies were observational. Therefore, RCTs, especially in trauma, are needed.

Purpose: Fournier's gangrene (FG) is a rapidly progressive, life-threatening necrotizing fasciitis with mortality rates ranging from 20% to 50%. Despite advances in management, reliable and readily accessible prognostic markers for early mortality risk stratification remain limited. This study aimed to assess the prognostic utility of red cell distribution width (RDW) and RDW-derived indices in predicting in-hospital mortality in patients undergoing surgical treatment for scrotal FG. Materials and Methods: A retrospective cohort analysis was conducted on patients treated surgically for scrotal FG between January 2012 and January 2025. Preoperative laboratory parameters, including RDW, albumin, neutrophil, lymphocyte, and platelet counts, were collected. Derived indices-RDW-to-albumin ratio (RAR), RDW-to-lymphocyte ratio (RLR), and RDW-to-platelet ratio (RPR)-were calculated. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) analyses were performed to evaluate the diagnostic performance of these indices. Results: Of the 62 patients included, 17.7% died during hospitalization. Although stand-alone RDW levels were not substantially associated with mortality, the RAR exhibited excellent predictive accuracy (area under the curve = 0.955). RLR, RPR, and neutrophil-to-lymphocyte ratio (NLR) also showed substantial prognostic value. Non-survivors had markedly lower serum albumin and hemoglobin concentrations and higher creatinine and NLR values. Post-operative intensive care unit admission and bowel diversion were strongly associated with mortality. Conclusion: RDW-derived indices, particularly RAR, appear to be robust, easily obtainable biomarkers for early mortality risk prediction in scrotal FG. Their integration into clinical evaluation algorithms may enhance prognostic precision and guide timely interventions. Further multi-center prospective studies are warranted to confirm these findings and support their routine use in clinical practice.

Purpose: Transperineal prostate biopsy has been widely recommended because of its low post-operative complications. We aim to evaluate the clinical value of routine urine culture in non-febrile patients on transperineal prostate biopsy, particularly in terms of infection-related complications and cancer detection rates. Materials and Methods: A retrospective analysis was conducted on patients who met the following inclusion criteria: (a) no fever, and (b) no antimicrobials in the 7-day period prior to transperineal prostate biopsy. Patients were categorized based on urine culture results: negative urine culture group, urine culture contamination group, and positive urine culture group. Results: Infectious complications were more common in the positive urine culture group (11.8%, p < 0.05) than the others. There were no sepsis or death events. In multi-variable logistic regression analysis, patients in the positive urine culture group had 6.54 times higher the odds of developing infection-related complications compared to those in the negative group (95% confidence interval [CI]: 1.805-23.731, p = 0.004). The cancer detection rate was higher in the negative urine culture group than the positive group (49% vs. 33.8%, p < 0.05). Patients in the negative urine culture group had 2.12 times higher the odds of cancer detection rate than patients in the positive group (95% CI: 1.175-3.83, p = 0.013). Conclusion: Urine culture prior to prostate biopsy remains clinically relevant. Furthermore, for patients with positive urine culture, who are non-febrile and have not received antibiotic treatment or prophylaxis, it would be meaningful to explore whether attempted antibiotic therapy could improve prostate cancer detection rates or avoid unnecessary prostate biopsies.

Background and Objectives: Colon surgical site infections (SSIs) impose clinical and financial burden. To guide reimbursement, the Centers for Medicare and Medicaid Services utilize the National Healthcare Safety Network's Complex 30-Day SSI Model for Colon Procedures, which is used to compare the observed number of SSIs to the expected number of SSIs for all colon surgeries, regardless of underlying etiology. This study assessed the predictive accuracy of the Complex 30-day SSI Model for inpatients undergoing emergent colon operations for trauma. Patients and Methods: The Trauma Quality Program Participant Use File was used to identify all patients who underwent emergent colon surgery because of trauma between 2017 and 2021 (excluding 2020). The predicted probability of colon SSI was calculated using the NSHN Complex 30-day Model using the following variables: diabetes mellitus, gender, age, body mass index, closure technique, American Society of Anesthesiology Score, and oncology hospital status. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC) was calculated to evaluate the model's predictive accuracy. Results: In total, 292,688 patients were included. Among all patients, an SSI occurred in 0.33% (n = 1,097). For patients with complete data, the rate of SSI was 0.34%. The ROC curve for complete case analysis showed an AUC of 0.523 (95% confidence interval 0.506-0.541). Conclusion: The predictive accuracy of the NSHN Complex 30-Day SSI Model after colon injury is poor. The current model may not adequately capture the complexities and risk associated with trauma. An improved model is needed for more accurate risk assessment to improve patient care and accuracy of hospital reimbursement.

Background: The main complications of hepatic hydatid disease are infection and rupture into the biliary tree or into the peritoneal cavity. Fungal infections within the biliary tract and the liver are very rare, whereas cases of hepatic echinococcal cysts infected by fungi have not been previously reported. Case Presentation: We report on a 63-year-old male patient with a 3-day history of dull, non-radiating pain in the right hypochondrium, low-grade fever, and malaise. His past medical history included a Roux-en-Y hepatico-jejunostomy and gastro-enteroanastomosis for locally extended adenocarcinoma of the intra-pancreatic common bile duct. Laboratory analyses showed elevated WBC and C-reactive protein levels. The computed tomography scan showed an infected hydatid cyst grade CE5 according to Gharbi's and WHO classifications. Catheterization was performed, and cultures revealed Candida glabrata. Anidulafungin was initiated with a loading dose of 200 mg, followed by a daily dose of 100 mg. After 23 days, cultures of the draining fluid showed no fungi or other bacteria. Two days later the catheter was removed, the patient was discharged, and at the time of follow-up at 1 and 2 months, remained well. Conclusion: Fungal infections should be considered in patients with an infected echinococcal cyst of the liver. Understanding of the etiology and epidemiology, along with early and rapid detection of C. glabrata, is necessary for prompt treatment.

Background: Preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing revision arthroplasty is crucial, so we evaluated whether serum ferritin and hepcidin contribute to this diagnosis. Patients and methods: Patients who underwent revision hip or knee arthroplasty were prospectively divided into those who experienced PJI or not, based on the 2013 International Consensus Meeting Criteria. The serum levels of ferritin and hepcidin, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were compared between the groups. The diagnostic values of the tested biomarkers and their combinations were compared based on the area under the receiver operating characteristic (ROC) curve using the z-test. Results: Of the 88 included patients, 44 were diagnosed with PJI. Serum ferritin in PJI patients was higher than that in non-PJI patients (p = 0.048), whereas there was no significant difference in serum hepcidin between the groups. The area under the ROC curve was 0.830 for CRP, 0.824 for ESR, and 0.643 for ferritin. The combination of serum ferritin with CRP and ESR did not give a higher area under the ROC curve than any pairwise combination. Conclusion: Serum ferritin and hepcidin are of limited value for diagnosing PJI.