Surgical infections最新文献

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.

Background: Vancomycin for intra-abdominal infections (IAI) should be reserved for healthcare-acquired infections, history of multiple interventions, or methicillin-resistant Staphylococcus aureus (MRSA). The MRSA incidence is low; however, fear of missing MRSA leads to overutilization. Methods: This single-center retrospective cohort study evaluated the cost and risks of empiric vancomycin for IAI. The primary objective was to determine the incidence of MRSA-positive culture and surveillance testing. Secondary outcomes included acute kidney injury (AKI) incidence, progression to dialysis, direct costs of vancomycin overutilization, length of stay, and 30-day mortality. Results: A total of 1,045 patients with IAI were identified and 491 (47%) received at least one dose of vancomycin. Thirty patients (2.9%) grew MRSA. Of those who grew MRSA, 21 (70%) were MRSA positive on the surveillance multi-drug resistance (MDR) culture or by polymerase chain reaction during hospitalization. There were no deaths within the MRSA group. AKI developed in 351 (33.6%) patients during their hospitalization, with 49.6% occurring within 48 hours of vancomycin administration. Of the 65 patients (6.9%) who required dialysis, 27 patients (42%) received vancomycin. The cost of unnecessary doses equated to $21,655 and $188,643.84 for vancomycin levels. Conclusion: Given the low MRSA culture incidence, it is reasonable to avoid vancomycin as empiric treatment for those being admitted for IAI alone to reduce the risk of AKI and reduce healthcare costs. Vancomycin should be limited mainly to those with a positive MRSA culture with consideration of vancomycin in those at highest MRSA risk such as a history of MRSA or known MRSA colonization.

Background: Wound complications in gynecologic oncology, especially among patients with overweight and obesity, can significantly impact post-operative recovery and delay the initiation of adjuvant treatment. Although staples are commonly used for vertical incisions, sutures may offer clinical advantages; however, direct comparative data remain limited. This study aimed to compare post-operative wound complication rates between staples and non-absorbable sutures in patients with gynecologic cancer with a body mass index ≥25 kg/m² and undergoing a vertical incision surgical procedure. Patients and Methods: A retrospective review was conducted at a gynecologic oncology center between January 2022 and September 2023. Patients who underwent midline laparotomy with either staples or 3-0 non-absorbable monofilament sutures for skin closure were included. Patients with prior chemotherapy, benign pathology, or age <18 were excluded. Wound complications-including seroma, hematoma, dehiscence (superficial and fascial), and infection-were recorded within eight weeks postoperatively. Results: Of 72 patients, 29 received staples and 43 received sutures. Wound complications occurred in 41% of the staple group and 21% of the suture group (p = 0.061). Fascial dehiscence was observed in four cases (two in each group). Although rates of dehiscence and infection were higher with staples, differences were not statistically significant. Hospital stay was significantly longer in the staple group (p = 0.045). Conclusion: Although not statistically significant, suture closure was associated with fewer wound complications and a shorter hospital stay, suggesting potential advantages in wound healing. These findings may inform future recommendations, and further prospective studies are warranted.

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.