Surgical infections最新文献

Background: Sepsis remains a leading cause of mortality in critically ill patients, particularly those with intra-abdominal infections, which account for up to two-thirds of surgical sepsis cases. Despite extensive research, treatment has been limited to infectious source control, antibiotics, and supportive care. Excessive immune activation, particularly from splenic cytokine production, drives systemic inflammation and organ failure in sepsis. Emerging evidence suggests oral sodium bicarbonate (NaHCO₃) may induce a splenic anti-inflammatory phenotype. The present study postulated that direct topical splenic application of NaHCO₃ during source control laparotomy may attenuate splenic proinflammatory signaling and improve survival in rats with feculent peritonitis. Methods: Male Sprague-Dawley rats underwent cecal ligation and incision (CLI) to induce sepsis. Two hours post-CLI, animals underwent peritoneal washout with either physiologic saline (0.5 mL/g, PS, control), 0.1 mEq/mL NaHCO₃ (bicarbonate peritoneal washout group), PS washout plus topical splenic NaHCO₃ application (1 mEq/mL, 1 µL/g), or PS washout with osmolality-matched 5.8% hypertonic saline (HTS) topical splenic application (osmolality control, 1 µL/g). Survival was monitored for 10 days. Results: Peritoneal NaHCO₃ washout prolonged survival (median 13.5 vs. 9.0 h, p = 0.01); however, all animals died within 36 h. In contrast, topical splenic NaHCO₃ resulted in 60% survival at 10 days, an effect not replicated with HTS. Splenic NaHCO₃ application inhibited the Caspase-1/NLRP3/IL-1β axis, neutrophil extracellular traps and promoted an anti-inflammatory M2 phenotype. Conclusion: Topical splenic NaHCO₃ application was associated with improved survival in severe intra-abdominal sepsis by modulating splenic immune function. This novel tactic holds translational potential as a targeted immunomodulatory adjunct during surgical source control.

Background: This study sought to determine key risk factors for post-operative pulmonary infections (PPIs) in traumatic intra-cranial hematoma (TICH) patients and to develop a nomogram for evaluating infection risk. Methods: A retrospective analysis was performed on TICH patients at a single-center hospital between October 2014 and September 2023. Key risk factors for PPI were identified using multi-variable logistic regression analysis, which were subsequently incorporated into a nomogram. Internal validation of the model was performed to assess its reliability and accuracy. Results: This study included 252 TICH patients, identifying significant risk factors for PPI such as age ≥60 years (odds ratio [OR]: 3.45, 95% confidence interval [CI]: 1.89-6.78, p < 0.001), smoking history (OR: 2.95, 95% CI: 1.56-5.24, p < 0.001), Glasgow Coma Scale [GCS] score <8 (OR: 4.10, 95% CI: 2.22-8.35, p < 0.001), mechanical ventilation for more than 3 days (OR: 6.25, 95% CI: 3.35-11.75, p < 0.001), and chest injury (OR: 4.75, 95% CI: 2.49-9.16, p < 0.001). A predictive nomogram based on these factors demonstrated good discriminative power upon internal validation. Conclusion: Age, smoking history, GCS score, duration of mechanical ventilation, and chest injury are independent risk factors for PPI in TICH patients. The developed nomogram is a valuable tool for clinicians in predicting infection risk and guiding post-operative management.

Background: This study aimed to evaluate the infection-related complication rates associated with the use of Esmarch exsanguination compared with gravitational exsanguination in patients undergoing surgery for acute hand and forearm infections. Patients and Methods: A retrospective cohort study was conducted from December 2020 to March 2024 at a level 1 trauma center. Adult patients with acute hand or forearm infections who underwent irrigation and debridement (I&D) within 21 days of symptom onset were included. Patients with systemic infection at admission were excluded. The incidence of infection-related complications, including repeat I&D, hematological spread of infection, and 30-day readmission, was compared between those who underwent Esmarch exsanguination and those who did not, using Fisher exact test. Results: The study included 80 patients, 33 in the Esmarch group and 47 in the non-Esmarch group. The overall complication rate was 15.2% in the Esmarch group compared with 8.5% in the non-Esmarch group. Repeat I&D was required in 12.1% of Esmarch patients versus 6.4% of non-Esmarch patients. Hematological spread occurred in one patient in each group, and readmissions were 9.1% in the Esmarch group compared with 2.1% in the non-Esmarch group. There was no statistically significant difference in the rates of infectious complications between the Esmarch and non-Esmarch groups. Conclusions: This study challenges the longstanding avoidance of Esmarch exsanguination in the context of acute hand infections, suggesting that its use does not significantly increase the risk of infection-related complications. These findings suggest that surgeons may consider the use of Esmarch exsanguination in hand surgery without a significant increase in infection-related risks, potentially improving surgical visualization and outcomes. Further studies are needed to confirm these results.

Background: Surgery ward caregivers are responsible for educating patients about the pre-operative shower (POS), assisting with the shower as necessary, and evaluating skin cleanliness before transport to the operating theater to mitigate the risk of surgical site infections. Aim: To describe the knowledge, attitudes, and declared practices of surgery ward caregivers concerning the POS. Methods: A multi-center prospective survey was performed on a random sample of nurses and nurse assistants from five French surgical facilities. Caregivers were asked about their training regarding POS, their ward protocol, knowledge of current French guidelines, attitudes, self-reported practices, and challenges pertaining to the POS. Results: All selected caregivers agreed to participate. Of the 72 respondents, 39% declared having received POS-related initial training, whereas 49% indicated the presence of a POS protocol within their ward. Both nurses and nurse assistants reported a lack of clear delineation in their tasks regarding the POS. Knowledge of the existing POS guidelines was found suboptimal, with superfluous precautions wrongly deemed mandatory. With regard to personal practices, caregivers highlighted the need to tailor communication to the patient's age, dependence, and body size. The predominant declared method for assessing skin cleanliness was verification of POS completion, occasionally supplemented by visual inspection of the incision site. Skin cleanliness assessment was poorly organized and perceived as intrusive by caregivers, especially for surgical procedures involving genital areas, with the patient's gender markedly impacting this perception. Discussion: This survey corroborates substantial deficiencies in POS process training, implementation, and caregiver perceptions.

Background: Surgical site infections (SSIs) constitute major yet preventable complications. Antimicrobial stewardship programs (ASPs) are evidence-based interventions recommended to reduce SSI incidence, yet their implementation and impact in India remain poorly characterized. This study aimed to assess current ASP implementation and SSI surveillance practices in Indian hospitals to identify gaps and inform future interventions. Methods: A prospective cross-sectional survey of five geographically diverse Indian academic medical centers was conducted between 2017 and 2021, assessing existing ASPs, surgical volume, SSI incidence and surveillance protocols, prevalence of multi-drug-resistant organisms (MDRO), and microbiology laboratory capability. Data were collected using REDCap® and analyzed for inter-center variations. Results: Three of five (60%) centers completed the survey. All reported SSI surveillance, with heterogenous monitoring frequency (i.e., daily to monthly). Two had formal patient safety and infection prevention committees; none had an ASP committee. Only one provided formalized education on pre-operative patient preparation or ASP principles. All had an accessible microbiology laboratory, but only one had pharmacy informatics to track antimicrobial agent utilization. Across hospitals, the mean (range) MDRO prevalence was as follows: methicillin-resistant Staphylococcus aureus 3.9% (1.5%-11.5%); extended-spectrum beta-lactamase producers 32.7% (15.1%-57.4%); and carbapenem-resistance 16.0% (3.7%-30.0%). Conclusions: ASP implementation and SSI surveillance practices vary widely across Indian academic hospitals, with key gaps in committee oversight, clinician education, informatics infrastructure, and subspeciality-based data. High MDRO rates highlight the urgent need for standardized, scalable stewardship frameworks tailored to the Indian healthcare context. Multiple opportunities exist to address these gaps and combat antimicrobial agent resistance at a national level, but a lack of infrastructure poses barriers.

Aim: A cryptoglandular anorectal abscess is a collection of purulent material around the anus, often leading to the development of an anal fistula after drainage. Although Escherichia coli and Bacteroides fragilis have been considered key bacteria in these conditions, recent evidence suggests the need to revisit this assumption. This work aimed to analyze the presence and role of bacteria in the development of anal fistulas following anorectal abscesses. Patients and Methods: A search was conducted using MEDLINE via PubMed, EMBASE, Cochrane Library, and Google Scholar. Articles reporting the microbiology of cryptoglandular anorectal abscesses and the resulting anal fistulas in human beings were included. The main outcome was to evaluate the presence of bacteria in cultures of anorectal abscesses or in patients who developed anal fistulas. Additional goals included identifying patient characteristics and assessing clinical outcomes on the basis of the isolated bacteria. Results: In total, 22 articles on anorectal abscesses and seven on anal fistulas met the inclusion criteria. Men were the most prevalent in both cases. Escherichia coli and the Bacteroides genus were the most isolated microorganisms in abscesses and fistulas, though inconsistently in the latter. Bilophila wadsworthia was newly isolated in abscesses, and Rothia sp. was notable in fistulas using new molecular techniques. Conclusions: Escherichia coli and Bacteroides sp. are involved in anorectal abscesses and anal fistula formation. Recently, using new technology non-well-known bacteria had been isolated involved in this clinical problem.

Background: Hospital-acquired infections (HAIs) are important risk factors for mortality in trauma patients and are increasingly under scrutiny as markers of healthcare quality. We sought to define the effect of trauma on the prevalence, diagnosis, microbiology, and outcomes of ventilator-associated pneumonia (VAP). Patients and Methods: We performed retrospective national case-control and single-center cohort studies. Injured and non-injured patients from a representative cohort of inpatient hospital visits in the United States from 2010 to 2014 were case-matched, and the prevalence and outcomes of patients with VAP were compared. Patients with a diagnosis of VAP at our institution from 2002 to 2015 were then identified. We compared the effect of trauma on the prevalence, demographics, microbiologic testing, and recovered microorganisms of patients. Results: Overall, 1.7 million trauma visits were identified in the 2010-2014 National Inpatient Sample. In total, 94% of these visits were case-matched with non-injured controls. Trauma visits had a three-fold increased prevalence of a diagnosis of VAP. Cases of VAP (n = 635) were then extracted from our institutional database. We found an increased prevalence of VAP in injured inpatients. Microbiologic cultures were more frequently assessed in injured patients. Injury was associated with an increased frequency of gram-positive VAP and a decreased frequency of gram-negative pneumonia. Discussion: Injured inpatients are three-fold more likely to receive a diagnosis of VAP as compared with uninjured inpatient controls and are more likely to have a microbiologic diagnosis.

Background: Post-operative urinary tract infections (UTIs) are a notable complication of radical prostatectomy, contributing to prolonged hospital stays, increased healthcare costs, and diminished patient quality of life. Despite international guideline recommendations of European Association of Urology and the French Society of Anesthesia and Intensive Care Medicine regarding the use of pre-operative urine cultures and antibiotic prophylaxis (AP) before radical prostatectomy, the role of pre-operative urine cultures in mitigating UTI risk remains uncertain. Methods: This multi-center prospective cohort study analyzed data from six French urology departments. Patients who underwent radical prostatectomy between January 2019 and June 2023, with variable inclusion periods across centers, were included if pre-operative urine cultures were performed. Patients were stratified into subgroups based on the occurrence of post-operative UTIs. Uni-variable and multi-variable logistic regressions, as well as receiver-operating characteristic (ROC) curve analysis, were used. Results: A total of 467 patients were analyzed, among whom post-operative UTIs developed in 30 patients. Among peri-operative factors, only the ASA (American Society of Anesthesiologists) score (p = 0.014) and the duration of post-operative catheterization (p = 0.001) were significantly associated with UTI occurrence in uni-variable analyses. Multi-variable logistic regression confirmed both factors as independent predictors of post-operative infections, with a model area under the ROC curve for catheterization duration of 0.789. A seven-day threshold for catheterization duration was identified as the optimal cutoff for predicting infection risk. Notably, neither pre-operative urine bacterial cultures nor AP reduced the incidence of post-operative UTIs. Conclusion: This study demonstrates that pre-operative urine cultures and prophylactic antibiotic agents do not mitigate UTI risk following radical prostatectomy, underscoring the need for optimized infection prevention tactics. The findings challenge the clinical utility of routine pre-operative urine cultures and highlight the critical roles of ASA score and post-operative catheterization duration in predicting infections.