Pub Date : 2024-06-01Epub Date: 2024-05-06DOI: 10.1089/sur.2024.081
Xinjie Wang
{"title":"<i>Letter to the Editor:</i> Nutritional and Inflammatory Indices and the Risk of Surgical Site Infection After Fragility Hip Fractures: Can Routine Blood Test Point to Patients at Risk?","authors":"Xinjie Wang","doi":"10.1089/sur.2024.081","DOIUrl":"10.1089/sur.2024.081","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864902","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 : 2024-06-01Epub Date: 2024-05-17DOI: 10.1089/sur.2024.010
Colin H Duell, David M O'Sullivan, Anastasia Bilinskaya, Kristin E Linder
Background: Surgical site infections (SSIs) are common healthcare-associated infections, and national guidelines recommend that antimicrobial prophylaxis (AP) be administered 60 min prior to incision. However, there are limited data regarding the "most optimal" time for administration within the 60-min window. Patients and Methods: This was a multicenter, retrospective study of adult (≥18-year-old) patients that underwent an abdominal hysterectomy, colorectal surgery, or craniotomy and received AP within 60 min of incision. Incidence of SSI was compared between patients who received AP 0-30 versus 31-60 min of incision. In addition, a predefined subgroup analysis evaluated incidence of SSI for 15-min intervals within the 60-min timeframe. Results: Of the 277 patients included in the primary analysis, 233 (84.1%) and 44 (15.9%) received AP 0-30 min and 31-60 min prior to incision, respectively. SSIs were documented in 6.0% (14/233) versus 4.5% (2/44) of patients in the primary analysis (p = 0.703). In the secondary analysis, 137 (49.5%), 95 (34.3%), 34 (12.3%), and 11 (4.0%) patients received AP 0-15, 16-30, 31-45, and 46-60 min prior to incision, respectively. There was no difference in incidence of SSIs among the 15-min intervals (4.4% vs. 8.4% vs. 2.9% vs. 9.1%, p = 0.487). Of the 16 patients in this study that incurred a SSI, 5 patients had positive cultures, of which 3 contained bacteria that proved to be resistant to the antibiotic used for AP. Conclusions: The results of our analysis support current national guidelines. Future investigation of different intervals (e.g., AP 15-45 min prior to incision) may be beneficial on the basis of pharmacokinetics of routinely prescribed AP.
背景:手术部位感染(SSI)是常见的医疗相关感染,国家指南建议在切口前 60 分钟使用抗菌药物预防。然而,关于在 60 分钟内用药的 "最佳 "时间的数据却很有限。患者和方法:这是一项多中心回顾性研究,研究对象为接受腹部子宫切除术、结直肠手术或开颅手术并在切口60分钟内接受AP治疗的成年(≥18岁)患者。比较了在切口 0-30 分钟和 31-60 分钟内接受 AP 的患者的 SSI 发生率。此外,一项预定义的亚组分析评估了 60 分钟时间范围内 15 分钟间隔的 SSI 发生率。结果:在纳入主要分析的 277 名患者中,分别有 233 人(84.1%)和 44 人(15.9%)在切口前 0-30 分钟和 31-60 分钟接受了 AP 治疗。在主要分析中,6.0%(14/233)和 4.5%(2/44)的患者发生了 SSI(P = 0.703)。在二次分析中,分别有 137 例(49.5%)、95 例(34.3%)、34 例(12.3%)和 11 例(4.0%)患者在切口前 0-15 分钟、16-30 分钟、31-45 分钟和 46-60 分钟接受了 AP 治疗。15分钟间隔内的SSI发生率没有差异(4.4% vs. 8.4% vs. 2.9% vs. 9.1%,P = 0.487)。在本研究中发生 SSI 的 16 名患者中,有 5 名患者的培养结果呈阳性,其中 3 名患者体内的细菌被证明对 AP 使用的抗生素具有耐药性。结论:我们的分析结果支持当前的国家指导方针。根据常规处方 AP 的药代动力学,未来对不同时间间隔(如切口前 15-45 分钟 AP)的研究可能会有所帮助。
{"title":"Evaluation of Timing of Antimicrobial Surgical Prophylaxis on Rates of Surgical Site Infections.","authors":"Colin H Duell, David M O'Sullivan, Anastasia Bilinskaya, Kristin E Linder","doi":"10.1089/sur.2024.010","DOIUrl":"10.1089/sur.2024.010","url":null,"abstract":"<p><p><b><i>Background:</i></b> Surgical site infections (SSIs) are common healthcare-associated infections, and national guidelines recommend that antimicrobial prophylaxis (AP) be administered 60 min prior to incision. However, there are limited data regarding the \"most optimal\" time for administration within the 60-min window. <b><i>Patients and Methods:</i></b> This was a multicenter, retrospective study of adult (≥18-year-old) patients that underwent an abdominal hysterectomy, colorectal surgery, or craniotomy and received AP within 60 min of incision. Incidence of SSI was compared between patients who received AP 0-30 versus 31-60 min of incision. In addition, a predefined subgroup analysis evaluated incidence of SSI for 15-min intervals within the 60-min timeframe. <b><i>Results:</i></b> Of the 277 patients included in the primary analysis, 233 (84.1%) and 44 (15.9%) received AP 0-30 min and 31-60 min prior to incision, respectively. SSIs were documented in 6.0% (14/233) versus 4.5% (2/44) of patients in the primary analysis (p = 0.703). In the secondary analysis, 137 (49.5%), 95 (34.3%), 34 (12.3%), and 11 (4.0%) patients received AP 0-15, 16-30, 31-45, and 46-60 min prior to incision, respectively. There was no difference in incidence of SSIs among the 15-min intervals (4.4% vs. 8.4% vs. 2.9% vs. 9.1%, p = 0.487). Of the 16 patients in this study that incurred a SSI, 5 patients had positive cultures, of which 3 contained bacteria that proved to be resistant to the antibiotic used for AP. <b><i>Conclusions:</i></b> The results of our analysis support current national guidelines. Future investigation of different intervals (e.g., AP 15-45 min prior to incision) may be beneficial on the basis of pharmacokinetics of routinely prescribed AP.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958430","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 : 2024-06-01Epub Date: 2024-05-03DOI: 10.1089/sur.2023.369
Mana Jameie, Saba Ilkhani, Mina Pashang, Amin Bagheri, Arash Jalali, Khosro Barkhordari, Marjaneh Nosrati, Mohammad Ali Boroumand, Jamshid Bagheri
Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. Patients and Methods: From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. Results: Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. Conclusions: The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.
{"title":"Coronavirus Disease 2019 Pandemic and Reduced Surgical Site Infection After Cardiac Surgery: A Potential Blessing in Disguise.","authors":"Mana Jameie, Saba Ilkhani, Mina Pashang, Amin Bagheri, Arash Jalali, Khosro Barkhordari, Marjaneh Nosrati, Mohammad Ali Boroumand, Jamshid Bagheri","doi":"10.1089/sur.2023.369","DOIUrl":"10.1089/sur.2023.369","url":null,"abstract":"<p><p><b><i>Background:</i></b> The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. <b><i>Patients and Methods:</i></b> From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. <b><i>Results:</i></b> Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. <b><i>Conclusions:</i></b> The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852780","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 : 2024-06-01Epub Date: 2024-05-06DOI: 10.1089/sur.2024.070
Sunnie Yan-Wai Wong, Joseph Derek Forrester
Background:Tsukamurella species were first isolated in 1941. Since then, 48 cases of Tsukamurella bacteremia have been reported, a majority of which were immunosuppressed patients with central venous catheters.A case is described and previous cases of Tsukamurella bacteremia are reviewed. Patients and Methods: A 70-year-old total parenteral nutrition (TPN)-dependent female with recurrent enterocutaneous fistula (ECF), developed leukocytosis one week after a challenging ECF takedown. After starting broad-spectrum antibiotic agents, undergoing percutaneous drainage of intra-abdominal abscess, and subsequent repositioning of the drain, her leukocytosis resolved. Blood and peripherally inserted central catheter (PICC) cultures grew Tsukamurella spp. The patient was discharged to home with 14 days of daily 2 g ceftriaxone, with resolution of bacteremia. Conclusions:Tsukamurella spp. are a rare opportunistic pathogen predominantly affecting immunocompromised patients, with central venous catheters present in most cases. However, there have been few reported cases in immunocompetent individuals with predisposing conditions such as end-stage renal disease and uncontrolled diabetes mellitus.
{"title":"<i>Tsukamurella</i> Bacteremia in a Surgical Patient: Case Report and Review of the Literature.","authors":"Sunnie Yan-Wai Wong, Joseph Derek Forrester","doi":"10.1089/sur.2024.070","DOIUrl":"10.1089/sur.2024.070","url":null,"abstract":"<p><p><b><i>Background:</i></b> <i>Tsukamurella</i> species were first isolated in 1941. Since then, 48 cases of <i>Tsukamurella</i> bacteremia have been reported, a majority of which were immunosuppressed patients with central venous catheters.A case is described and previous cases of <i>Tsukamurella</i> bacteremia are reviewed. <b><i>Patients and Methods:</i></b> A 70-year-old total parenteral nutrition (TPN)-dependent female with recurrent enterocutaneous fistula (ECF), developed leukocytosis one week after a challenging ECF takedown. After starting broad-spectrum antibiotic agents, undergoing percutaneous drainage of intra-abdominal abscess, and subsequent repositioning of the drain, her leukocytosis resolved. Blood and peripherally inserted central catheter (PICC) cultures grew <i>Tsukamurella</i> spp. The patient was discharged to home with 14 days of daily 2 g ceftriaxone, with resolution of bacteremia. <b><i>Conclusions:</i></b> <i>Tsukamurella</i> spp. are a rare opportunistic pathogen predominantly affecting immunocompromised patients, with central venous catheters present in most cases. However, there have been few reported cases in immunocompetent individuals with predisposing conditions such as end-stage renal disease and uncontrolled diabetes mellitus.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865019","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 : 2024-06-01Epub Date: 2024-05-15DOI: 10.1089/sur.2023.356
Jonathan R Warren, McKenna C Noe, Gordon H Stock, Timothy Juelson, William Hotchkiss, Richard M Schwend
Background: No in vitro surgical study has evaluated the time-dependent contamination of surgical suction tips compared with controls. Our purpose was to determine the difference in suction tip bacterial contamination rates between suction-positive and suction-negative tips. Materials and Methods: A matched-pair analysis of the contamination of surgical suction tips over a six-hour period was performed in two clean operating rooms. One suction tip was connected to standard wall suction (suction-positive group), with a matched control tip not connected to wall suction (suction-negative group). At time zero and then at hourly intervals for six hours, the distal 3 cm of suction tips were removed, placed in nutrient broth for 48 hours, then plate cultured. One hundred tips were collected for each time interval. Results: Eighty-two of 700 (11.7%) suction tips had bacterial contamination. Sixty-three (18.0%) of 350 suction-positive tips were contaminated, with 19 (5.4%) of the 350 suction-negative tips contaminated (χ2 = 26.7, p < 0.001). Suction tip contamination was time-dependent with the first significant difference between groups occurring after two hours of continuous suction (χ2 = 4.0, p = 0.04). Contamination rate in the suction-positive group increased significantly after one hour compared with time-zero controls (χ2 = 7.1, p = 0.008). There was no significant difference in frequency of positive cultures over time in the suction-negative group compared with time-zero controls. Conclusions: This is the first controlled laboratory study suggesting a time-dependent increase in positive suction tip cultures. From our data, operating room staff should have an awareness that suction tips represent a potential source of bacterial concentration. We recommend that when not in use, suction tip valves be closed if this feature is available, that hosing be manipulated to cease suction when not needed, that suckers be disconnected from tubing, or that suckers be exchanged at frequent intervals. Doing so may reduce bacterial contamination on the suction tip.
{"title":"Time-Dependent Bacterial Contamination of a Surgical Suction Tip.","authors":"Jonathan R Warren, McKenna C Noe, Gordon H Stock, Timothy Juelson, William Hotchkiss, Richard M Schwend","doi":"10.1089/sur.2023.356","DOIUrl":"10.1089/sur.2023.356","url":null,"abstract":"<p><p><b><i>Background:</i></b> No in vitro surgical study has evaluated the time-dependent contamination of surgical suction tips compared with controls. Our purpose was to determine the difference in suction tip bacterial contamination rates between suction-positive and suction-negative tips. <b><i>Materials and Methods:</i></b> A matched-pair analysis of the contamination of surgical suction tips over a six-hour period was performed in two clean operating rooms. One suction tip was connected to standard wall suction (suction-positive group), with a matched control tip not connected to wall suction (suction-negative group). At time zero and then at hourly intervals for six hours, the distal 3 cm of suction tips were removed, placed in nutrient broth for 48 hours, then plate cultured. One hundred tips were collected for each time interval. <b><i>Results:</i></b> Eighty-two of 700 (11.7%) suction tips had bacterial contamination. Sixty-three (18.0%) of 350 suction-positive tips were contaminated, with 19 (5.4%) of the 350 suction-negative tips contaminated (χ<sup>2</sup> = 26.7, p < 0.001). Suction tip contamination was time-dependent with the first significant difference between groups occurring after two hours of continuous suction (χ<sup>2</sup> = 4.0, p = 0.04). Contamination rate in the suction-positive group increased significantly after one hour compared with time-zero controls (χ<sup>2</sup> = 7.1, p = 0.008). There was no significant difference in frequency of positive cultures over time in the suction-negative group compared with time-zero controls. <b><i>Conclusions:</i></b> This is the first controlled laboratory study suggesting a time-dependent increase in positive suction tip cultures. From our data, operating room staff should have an awareness that suction tips represent a potential source of bacterial concentration. We recommend that when not in use, suction tip valves be closed if this feature is available, that hosing be manipulated to cease suction when not needed, that suckers be disconnected from tubing, or that suckers be exchanged at frequent intervals. Doing so may reduce bacterial contamination on the suction tip.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944875","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: The diagnosis of brain tuberculoma (BT) is sometimes challenging. Herein, we presented a case series to evaluate the combined-diagnostic methods, including acid-fast bacilli (AFB) stain, polymerase chain reaction (PCR), Gene Xpert, and histopathology, of tuberculoma tissue specimens (TTSs). Patients and Methods: A total of 16 patients (11 human immunodeficiency virus [HIV]-positive, 5 HIV-negative) with BT confirmed by combined-diagnostic methods of TTS were included in this study. Clinical data, including clinical symptoms, laboratory tests, neuroimaging features, histopathology, treatment, and prognosis, were assessed in all patients. Results: There were 10 male and 6 female patients (range, 18-73 years). Acid-fast bacilli stain and PCR of TTSs were positive in 11 and 10 patients, respectively. The sensitivity of Gene Xpert of TTSs was (80.0%; 8/10). Nine (56.3%; 9/16) patients were diagnosed with BT by histopathology. After receiving antituberculosis treatment, 12 (75.0%; 12/16) patients improved clinically to a considerable extent. Conclusions: The combined-diagnostic methods of TTS may improve the diagnostic efficiency of BT.
{"title":"Diagnostic Value of Combined-Diagnostic Methods of Brain Tuberculoma Tissue Specimens: A Case Series.","authors":"Bo Liang, Siyuan Yang, Xingang Zhou, Xinghuan Ding, Jianbo Wang, Jingjing Li, Haili Gao, Hongxin Zhao, Enshan Feng","doi":"10.1089/sur.2023.358","DOIUrl":"10.1089/sur.2023.358","url":null,"abstract":"<p><p><b><i>Background:</i></b> The diagnosis of brain tuberculoma (BT) is sometimes challenging. Herein, we presented a case series to evaluate the combined-diagnostic methods, including acid-fast bacilli (AFB) stain, polymerase chain reaction (PCR), Gene Xpert, and histopathology, of tuberculoma tissue specimens (TTSs). <b><i>Patients and Methods:</i></b> A total of 16 patients (11 human immunodeficiency virus [HIV]-positive, 5 HIV-negative) with BT confirmed by combined-diagnostic methods of TTS were included in this study. Clinical data, including clinical symptoms, laboratory tests, neuroimaging features, histopathology, treatment, and prognosis, were assessed in all patients. <b><i>Results:</i></b> There were 10 male and 6 female patients (range, 18-73 years). Acid-fast bacilli stain and PCR of TTSs were positive in 11 and 10 patients, respectively. The sensitivity of Gene Xpert of TTSs was (80.0%; 8/10). Nine (56.3%; 9/16) patients were diagnosed with BT by histopathology. After receiving antituberculosis treatment, 12 (75.0%; 12/16) patients improved clinically to a considerable extent. <b><i>Conclusions:</i></b> The combined-diagnostic methods of TTS may improve the diagnostic efficiency of BT.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865849","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 : 2024-06-01Epub Date: 2024-05-16DOI: 10.1089/sur.2024.040
Negaar Aryan, Areg Grigorian, James Jeng, Catherine Kuza, Allen Kong, Lourdes Swentek, Sigrid Burruss, Jeffry Nahmias
Introduction: Central line-associated blood stream infection (CLABSI) is a hospital-acquired infection (HAI) associated with increased morbidity and mortality among the general patient population. However, few studies have evaluated the incidence, outcomes, and risk factors for CLABSI in trauma patients. This study aimed to identify the rate of positive (+)CLABSI in trauma patients and risk factors associated with (+)CLABSI. Methods: The 2017-2021 Trauma Quality Improvement Program database was queried for trauma patients aged ≥18 years undergoing central-line placement. We compared patients with (+)CLABSI vs. (-)CLABSI patients. Bivariate and multivariable logistic regression analyses were performed. Results: From 175,538 patients undergoing central-line placement, 469 (<0.1%) developed CLABSI. The (+)CLABSI patients had higher rates of cirrhosis (3.9% vs. 2.0%, p = 0.003) and chronic kidney disease (CKD) (4.3% vs. 2.6%, p = 0.02). The (+)CLABSI group had increased injury severity score (median: 25 vs. 13, p < 0.001), length of stay (LOS) (median 33.5 vs. 8 days, p < 0.001), intensive care unit LOS (median 21 vs. 6 days, p < 0.001), and mortality (23.7% vs. 19.6%, p = 0.03). Independent associated risk factors for (+)CLABSI included catheter-associated urinary tract infection (CAUTI) (odds ratio [OR] = 5.52, confidence interval [CI] = 3.81-8.01), ventilator-associated pneumonia (VAP) (OR = 4.43, CI = 3.42-5.75), surgical site infection (SSI) (OR = 3.66, CI = 2.55-5.25), small intestine injury (OR = 1.91, CI = 1.29-2.84), CKD (OR = 2.08, CI = 1.25-3.47), and cirrhosis (OR = 1.81, CI = 1.08-3.02) (all p < 0.05). Conclusion: Although CLABSI occurs in <0.1% of trauma patients with central-lines, it significantly impacts LOS and morbidity/mortality. The strongest associated risk factors for (+)CLABSI included HAIs (CAUTI/VAP/SSI), specific injuries (small intestine), and comorbidities. Providers should be aware of these risk factors with efforts made to prevent CLABSI in these patients.
导言:中心静脉相关性血流感染(CLABSI)是一种医院获得性感染(HAI),与普通患者发病率和死亡率的增加有关。然而,很少有研究对创伤患者 CLABSI 的发生率、结果和风险因素进行评估。本研究旨在确定创伤患者 CLABSI 阳性率以及与 CLABSI 相关的风险因素。方法:查询了 2017-2021 年创伤质量改进计划数据库中年龄≥18 岁接受中心静脉置管的创伤患者。我们比较了(+)CLABSI患者与(-)CLABSI患者。进行了双变量和多变量逻辑回归分析。结果在 175538 名接受中心静脉置管的患者中,469 人(P = 0.003)患有慢性肾病(CKD)(4.3% 对 2.6%,P = 0.02)。(+)CLABSI组的损伤严重程度评分(中位数:25 vs. 13,p < 0.001)、住院时间(LOS)(中位数:33.5 vs. 8天,p < 0.001)、重症监护室住院时间(LOS)(中位数:21 vs. 6天,p < 0.001)和死亡率(23.7% vs. 19.6%,p = 0.03)均有所增加。(+)CLABSI的独立相关风险因素包括导管相关尿路感染(CAUTI)(几率比 [OR] = 5.52,置信区间 [CI] = 3.81-8.01)、呼吸机相关肺炎(VAP)(OR = 4.43, CI = 3.42-5.75)、手术部位感染(SSI)(OR = 3.66, CI = 2.55-5.25)、小肠损伤(OR = 1.91, CI = 1.29-2.84)、CKD(OR = 2.08, CI = 1.25-3.47)和肝硬化(OR = 1.81, CI = 1.08-3.02)(所有 P <0.05)。结论虽然 CLABSI 发生在
{"title":"Incidence, Risk Factors, and Outcomes of Central Line-Associated Bloodstream Infections in Trauma Patients.","authors":"Negaar Aryan, Areg Grigorian, James Jeng, Catherine Kuza, Allen Kong, Lourdes Swentek, Sigrid Burruss, Jeffry Nahmias","doi":"10.1089/sur.2024.040","DOIUrl":"10.1089/sur.2024.040","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Central line-associated blood stream infection (CLABSI) is a hospital-acquired infection (HAI) associated with increased morbidity and mortality among the general patient population. However, few studies have evaluated the incidence, outcomes, and risk factors for CLABSI in trauma patients. This study aimed to identify the rate of positive (+)CLABSI in trauma patients and risk factors associated with (+)CLABSI. <b><i>Methods:</i></b> The 2017-2021 Trauma Quality Improvement Program database was queried for trauma patients aged ≥18 years undergoing central-line placement. We compared patients with (+)CLABSI vs. (-)CLABSI patients. Bivariate and multivariable logistic regression analyses were performed. <b><i>Results:</i></b> From 175,538 patients undergoing central-line placement, 469 (<0.1%) developed CLABSI. The (+)CLABSI patients had higher rates of cirrhosis (3.9% vs. 2.0%, <i>p</i> = 0.003) and chronic kidney disease (CKD) (4.3% vs. 2.6%, <i>p</i> = 0.02). The (+)CLABSI group had increased injury severity score (median: 25 vs. 13, <i>p</i> < 0.001), length of stay (LOS) (median 33.5 vs. 8 days, <i>p</i> < 0.001), intensive care unit LOS (median 21 vs. 6 days, <i>p</i> < 0.001), and mortality (23.7% vs. 19.6%, <i>p</i> = 0.03). Independent associated risk factors for (+)CLABSI included catheter-associated urinary tract infection (CAUTI) (odds ratio [OR] = 5.52, confidence interval [CI] = 3.81-8.01), ventilator-associated pneumonia (VAP) (OR = 4.43, CI = 3.42-5.75), surgical site infection (SSI) (OR = 3.66, CI = 2.55-5.25), small intestine injury (OR = 1.91, CI = 1.29-2.84), CKD (OR = 2.08, CI = 1.25-3.47), and cirrhosis (OR = 1.81, CI = 1.08-3.02) (all <i>p</i> < 0.05). <b><i>Conclusion:</i></b> Although CLABSI occurs in <0.1% of trauma patients with central-lines, it significantly impacts LOS and morbidity/mortality. The strongest associated risk factors for (+)CLABSI included HAIs (CAUTI/VAP/SSI), specific injuries (small intestine), and comorbidities. Providers should be aware of these risk factors with efforts made to prevent CLABSI in these patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944863","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 : 2024-06-01Epub Date: 2024-05-03DOI: 10.1089/sur.2024.026
Hugo J R Bonatti, Anthony Basel
{"title":"<i>Letter to the Editor:</i> Sepsis, Coma, Limb, and Bowel Gangrene and Skin Ulcers: A Case of Twenty-First Century Scurvy.","authors":"Hugo J R Bonatti, Anthony Basel","doi":"10.1089/sur.2024.026","DOIUrl":"10.1089/sur.2024.026","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860114","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 : 2024-06-01Epub Date: 2024-05-17DOI: 10.1089/sur.2024.103
Ying Si, Ke Xiao, Yongmao Huang
{"title":"<i>Letter to the Editor:</i> Isolated Tuberculosis of the Cervical Vertebrae with Abscess Formation.","authors":"Ying Si, Ke Xiao, Yongmao Huang","doi":"10.1089/sur.2024.103","DOIUrl":"10.1089/sur.2024.103","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958472","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}