Surgical infections最新文献

Objectives: Investigate the relationship between incisional negative pressure wound therapy (iNPWT) and the development of superficial surgical site infections (SSIs) and wound dehiscence. Methods: A retrospective chart analysis was performed. Trauma patients between the ages of 18 and 89 years receiving an emergent exploratory laparotomy on admission between January 1, 2015, and March 31, 2022, were included. A multivariable analysis was performed. The primary and secondary outcomes were the development of superficial SSI and wound dehiscence, respectively, on the basis of the type of incision closure. Results: Two hundred forty-seven patients who met our criteria were analyzed. Of these, 135 patients were closed with staples plus iNPWT, and 112 patients were closed with only staples. The multivariable analysis found decreased odds of superficial SSI in patients who received staples plus iNPWT versus staples alone (odds ratio [OR] = 0.28, p = 0.019). The multivariable analysis found decreased odds of wound dehiscence in patients who received staples plus iNPWT versus staples alone (OR = 0.24, p = 0.001). Conclusion: Our study revealed a statistically significant decreased odds of superficial SSI and wound dehiscence in patients who received staples plus iNPWT when compared with staples alone.

Purpose: To highlight the burden of surgical site complications (SSCs) across inpatients who have recently undergone orthopedic surgery by undertaking surgical site infection (SSI) prevalence days. Patients and Methods: Sites from the United Kingdom and Ireland enrolled in a single day's data collection (either March or September 2022) to capture inpatient prevalence of SSIs and other SSCs. Data were collected from patients recovering from primary and revision hip or knee surgery and neck of femur (NOF) fracture surgery. Results: Data were collected on 851 inpatients across the two days, with NOF fracture surgery representing 50% of overall procedures, followed by primary hip (25.4%) and primary knee (12.8%) procedures, with 11.9% of patients in the hospital following revision procedures. The majority of patients documented across both days had at least one risk factor (76% overall). The overall prevalence of SSCs was 8% (n = 68). Revision surgical procedures had significantly higher complication rates than primary surgical procedures in both hips and knees (p < 0.01). The highest observed odds ratios (ORs) for SSCs were in patients who listed immunosuppression (OR = 2.47), previous SSI (OR = 4.59), and smoking (OR = 2.34) among their risk factors. Higher overall lengths of stay were observed in patients with complications. Conclusion: These prevalence days were a successful initiative to help hospital sites understand their own burden, benchmark against national averages, and contribute to a better national understanding of the burden of SSC, both to healthcare systems and, most importantly, patients.

Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a viable alternative to open aortic occlusion for hemorrhage control. It is often performed without maximal barrier precautions, and sterility is not consistently ensured. As REBOA usage increases, a knowledge gap exists in its infectious risks. We sought to characterize the type and incidence of infectious complications in patients undergoing REBOA. Patients and Methods: A retrospective review of all REBOA patients at an urban, American College of Surgeons-verified Level I Trauma Center was conducted from November 2016 to September 2023. The trauma registry was queried for all patients who underwent REBOA placement. Data pertaining to patient demographics and infectious complications were obtained for descriptive analysis. The medical record was then examined for the source of bacteremia and other infectious complications. Patients who did not survive beyond hospital day two were excluded. Results: Seventy patients met the inclusion criteria. The median age was 40.3 years (IQR 29.5), and patients were predominantly male (72.8%). The overall mortality rate was 19.1%. Among all patients, 37% (n = 26) developed pneumonia, 17% (n = 12) had a deep or organ-space surgical site infection (SSI), and 12.8% (n = 9) had a blood stream infection. None were bacteremic within 48 hours of REBOA placement. All blood stream infections could be associated with concurrent infections such as intra-abdominal sepsis, pneumonia, or soft tissue infection. No SSIs were identified at the site of vascular access. Conclusions: Our findings demonstrate a modest rate of infectious complications among patients undergoing REBOA placement, comparable with published historical data, but no evidence to suggest infectious complications directly related to REBOA placement. Although limited by small sample size and single-institution experience, this study serves as one of the first studies to describe the infection rates in patients undergoing REBOA. Further prospective multi-center studies are required to evaluate the true infectious risks associated with REBOA.

Background: Short durations of anti-pseudomonal (Pa) antibiotic (ABX) therapy may seem low-risk; however, emerging data highlight subsequent multi-drug-resistant pathogens in previously treated patients. This study aims to evaluate the safety and efficacy of Pa versus non-pseudomonal (NPa) ABX prophylaxis in liver transplant (LT) recipients undergoing delayed biliary reconstruction (DBR). Methods: This is a single-center, retrospective study of LT recipients following a protocolized change in ABX prophylaxis when undergoing DBR between January 2017 and March 2023. Patients who received piperacillin-tazobactam or cefepime and metronidazole were assigned to the Pa cohort, and those who received ceftriaxone and metronidazole were assigned to the NPa cohort. Surgical site infection (SSI), any bacterial infection, total ABX days, and re-initiation or escalation of ABX therapy were compared between the Pa and NPa cohorts. Results: Forty-eight patients were included in the study, with 27 in the Pa cohort and 21 in the NPa cohort. SSI at 30 days occurred in 10 (37.0%) compared with 4 (19.0%) patients in the Pa and NPa cohorts (p = 0.174), respectively. There were no differences in any bacterial infection, total ABX days, or re-initiation or escalation of ABX therapy. Thirty-day culture results yielded eight (72.7%) Enterococcus faecium species (seven in the Pa cohort) and no Pseudomonas aeruginosa. Conclusions: NPa ABX for peri-operative prophylaxis for patients who undergo DBR in LT was not associated with an increased infectious risk compared with broader-spectrum agents. The combined clinical and microbiological outcomes question the routine need for Pa therapy in this setting.

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 prior to 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 nurses' 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 nurses' 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. As regards 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 surgeries 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.

Objective: We evaluated the early diagnostic value of interleukin-6 (IL-6) for type I and type II necrotizing fasciitis (NF). Methods: A retrospective analysis was conducted of patients with NF between September 2020 and December 2024. They were divided into type I and type II NF. General clinical data, cytokines, and inflammatory markers were compared between the two groups. Threshold cytokine concentrations predictive of type I and type II NF were determined using receiver-operating characteristic (ROC) curve analysis. Results: A total of 106 patients with NF were included in the study, 74 cases (69.8%) were type I NF, whereas 32 cases (30.2%) were type II. The most commonly identified pathogens associated with type II NF included staphylococcus (n = 16). Cytokine and inflammatory marker analysis of type I NF patients compared with type II NF demonstrated elevated plasma IL-6 concentration in type II NF, and IL-6 remained correlated with type II NF on logistic regression after confounder adjustment (p < 0.05). In addition, ROC analysis revealed plasma IL-6 as a strong type II NF predictor. The area under the curve of plasma IL-6 was 0.94 (95% confidence interval: 0.86-1.00, p < 0.05). At the optimal cutoff value of 75.10 pg/mL, the sensitivity and specificity reached 91% and 100%, respectively. Conclusions: Interleukin-6 can be a supplementary diagnostic marker for early differentiation between type I and type II NF. Clinical Trial Registration: KY2022-R142.

Background/Objectives: Surgical site infection (SSI) places a burden on the healthcare system and patients. Literature suggests that vitamin D has indirect antimicrobial effects and an association with a reduction in infections. We aim to evaluate the association between vitamin D deficiency in developing SSIs in adult surgical patients. Methods: Embase, Medline, Clinicaltrials.gov, WHO-ICTRP, Cochrane, Web of Science, CINAHL, Google Scholar, Cochrane Central Register of Controlled Trials, and Citations were searched. Observational studies that evaluated key question were included. The meta-analysis was carried out using bias-adjusted inverse variance heterogeneity methods. A risk of bias assessment was done using the MASTER Scale. The Doi plot and the Luis Furuya-Kanamori index were utilized to visualize and quantify the asymmetry of study effects, respectively, to evaluate publication bias. The GRADE method was utilized for assessing the certainty of evidence. Results: This meta-analysis included 12,737 patients from eight eligible cohort studies. The overall analysis based on vitamin D cut-off levels revealed that vitamin D deficiency (<20 ng/mL) is associated with increased odds of SSI (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 0.80-2.05; I² = 37.2%, p = 0.18). Notably, a cut-off level of <30 ng/mL is linked to even higher odds of SSI (OR: 3.84, 95% CI: 2.13-5.56; I² = 0.0%, p = 0.83). Conclusion: This meta-analysis found a significant association between vitamin D deficiency and an increased risk of SSI. Taken together, these studies suggest that vitamin D deficiency may play a role in SSI development. However, in order to determine if vitamin D supplementation alone will reduce the risk of a post-operative SSI, a prospective clinical trial is necessary.

Introduction: The use of silver (Ag) as an antimicrobial agent has gained attention for its multimodal mechanisms of activity. We have previously demonstrated the efficacy of a 95% titanium dioxide (TiO₂) and 5% polydimethylsiloxane (PDMS) silver carboxylate (AgCar)-eluting chemistry, which has been shown to prevent bacterial adherence, proliferation, and biofilm formation on orthopedic implants and prosthetic liners. This project examines the physical and chemical properties of AgCar on polyether ether ketone (PEEK) implant materials and silicone prosthetic liners, which are prone to bacterial colonization. Methods: PEEK implants were coated with varying concentrations of matrix, AgCar, or both. To determine physical properties, we used water contact angle for hydrophilicity, atomic force microscopy for surface roughness averages, and graphite furnace atomic absorption spectroscopy for Ag elution rate. For durability studies, silicone was coated and examined for compressive, frictional, and wear rate properties. Results: All implants demonstrated hydrophobicity in the presence of the matrix, AgCar, or both; in contrast, uncoated (UNC) PEEK implants were found to be hydrophilic. The 95% 10× matrix exhibited a delayed and extended elution of AgCar into solution compared with other solutions. Implant surface roughness increased as AgCar concentrations increased. Durability studies found no notable differences between UNC and 95% 10× coated implants. Conclusion: Consistent with previous work, the 10× AgCar coating demonstrated the best results for inhibitory behavior on two distinct fronts: mechanically, through roughness and increased hydrophobicity, and chemically, through AgCar elution activity. Furthermore, the 10× coating will likely not impair the durability or elasticity of the implant within the body or silicone prosthetic liners. Thus, the 95% TiO₂:5% PDMS matrix doped with a 10× AgCar concentration is a prime candidate for clinical application consideration.

Introduction: Urinary tract infection (UTI) is an infrequent complication of diagnostic cystoscopy, with an incidence below 5%. Current guidelines are unclear and remain silent regarding the necessity of performing a urine bacterial culture (UBC) before cystoscopy. The objective of this study was to evaluate whether asymptomatic bacteriuria before cystoscopy increases the risk of UTI afterward. In addition, we aimed to identify risk factors in patient characteristics. Patients and Methods: We included all patients who underwent diagnostic cystoscopy at our center between September 2022 and May 2023 and performed a UBC within the preceding 15 days. Patients were excluded if they had received antibiotic treatment or did not provide UBC. Data on the UTI within four weeks post-cystoscopy were collected via telephone interviews. UTIs were defined on the clinical criteria established by the U.S. Centers for Disease Control and Prevention. Results: Six hundred eighteen cystoscopies were analyzed. Twenty-nine cases of UTI were reported, accounting for 4.7% of the procedures. Among these, 24 patients had sterile or polymicrobial UBC, whereas 5 had asymptomatic bacteriuria prior to cystoscopy. There was no significant association between asymptomatic bacteriuria and the occurrence of UTI (OR: 1.385, 95% confidence interval [0.513; 3.739], p = 0.52). In multivariable analysis, age was a protective factor (p = 0.01). There was an increase of UTI when the cystoscopy was performed for a suspected tumor (OR: 4.981, 95% confidence interval [1.122; 22.108], p = 0.035) or for a retention (OR: 7.910, 95% confidence interval [1.329; 47.093], p = 0.023). More UTIs occurred when cystoscopy was performed for suspected tumors (p = 0.035) or urinary retention (p = 0.023). There was a significant correlation between asymptomatic bacteriuria and consultation for urinary symptoms after (p = 0.043). Conclusion: We found no correlation between asymptomatic bacteriuria prior to cystoscopy and the subsequent occurrence of UTI. Routine UBC before cystoscopy appears unnecessary. Eliminating this practice could prevent the rescheduling of cystoscopies, which often leads to diagnostic delays. Moreover, it would contribute to reducing antibiotic consumption and combating antibiotic resistance.