Surgical infections最新文献

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.

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.

Background: Antibiotics and appendectomy are the mainstays of therapy for acute appendicitis, but wide variation exists in antibiotic choice, duration, and guideline adherence. Despite recommendations favoring narrow-spectrum agents, broad-spectrum antibiotic use remains high. This multi-site quality improvement initiative aimed to implement a standardized care pathway to improve antibiotic stewardship. Methods: A multi-disciplinary task force developed and implemented an evidence-based pathway across six hospitals within a large health system. Data were compared for patients treated 12 months before and after implementation. The primary outcome was empirical broad- versus narrow-spectrum antibiotic use. Secondary outcomes included duration of therapy and balancing measures such as length of stay, 30-day readmission, and cost. Results: Among 1,279 patients with acute appendicitis (619 pre- and 660 post-intervention), empirical narrow-spectrum use increased significantly (14.2%-18.5%, p = 0.04), with corresponding decreases in broad-spectrum use (82.1%-78.2%, p = 0.09). Statistical process control charts revealed special cause variation, including sustained increases in narrow-spectrum prescribing. Clinical outcomes were unchanged: no differences were observed in length of stay (1.5 d [IQR: 0.9-2.8] versus 1.6 d [IQR: 0.9-2.9]; p = 0.62), 30-day readmission (7.9% vs. 7.1%, p = 0.60), infection-related readmission (1.1% vs. 1.6%, p = 0.57), or technical direct cost ($4,700 [IQR: $3,712-$6,680] versus $4,559 [IQR: $3,470-$6,759]; p = 0.183). Conclusion: A standardized care pathway significantly improved antibiotic selection for acute appendicitis without negatively impacting outcomes or costs. This initiative illustrates the feasibility of scalable, evidence-informed interventions to promote stewardship across diverse clinical settings.

Background: A Care Bundle is proposed to prevent surgical site infections (SSIs). This study investigated SSI incidence and risk factors at our hospital, developed an SSI prevention Care Bundle, and tested its efficacy. Methods: A retrospective review of 1,117 patients who underwent spinal surgical procedure under general anesthesia (January 2016-July 2023) was conducted. A total of 764 patients (mean age 69.7 y, 58.0% female) were included. SSI was diagnosed as per U.S. Centers for Disease Control and Prevention's guidelines. Risk factors evaluated included patient factors, operation-related factors, season, and Care Bundle implementation (introduced in April 2019). The Care Bundle included chlorhexidine gluconate bathing, skin disinfection, high-performance air purifier, glove changes, iodine-impregnated drapes, prophylactic antibiotic agents, and pre-operative sponge brushing. Results: SSI incidence was 2.6% (0.7% superficial, 1.9% deep), decreasing from 4.6% pre-Care Bundle to 1.0% post-implementation. Risk factors included smoking (p = 0.003), diabetes mellitus (p = 0.025), instrumentation (p = 0.039), posterior cervical operation (p = 0.049), and warm season (p = 0.024). Logistic regression identified Care Bundle implementation (odds ratio [OR] 0.27, p = 0.013), instrumentation (OR 3.59, p = 0.038), and warm season (OR 3.63, p = 0.025) as independent factors. Conclusion: The Care Bundle effectively reduced SSI. Certain factors such as instrumentation and surgical procedures during warm seasons were associated with greater SSI rates.

Introduction: Enzymatic debridement has emerged as an alternative method to combat biofilms. Bromelain is an enzyme derived from pineapple stems that has been used in several studies as a method of biofilm dissolution (BD). As a result, researchers hypothesized that bromelain could be used to debride contaminated orthopedic implants. Methods: In this study, cortical bone screws were incubated in methicillin-resistant Staphylococcus aureus inoculated broth. Treatment groups were exposed to low-dose bromelain solution, high-dose bromelain solution, or bromelain powder with or without manual scrubbing of the implant. The screws were then stained with crystal violet dye and analyzed using optical density (OD). OD means were compared between each treatment group and their respective control group using analysis of variance. Results: Six screws were used for each group. The average OD of the low-dose bromelain solution group (0.104 ± 0.047) was no different compared with the control group (p = 0.345). The average ODs of the low-dose + scrub bromelain solution (0.068 ± 0.020) and high-dose + scrub solution (0.045 ± 0.014) were significantly different from their respective control group (p = 0.012; p = 0.001). The average ODs of screws in the high-dose (0.056 ± 0.012), powder (0.041 ± 0.010), and powder + scrub (0.032 ± 0.005) groups were also significantly different from their respective control group (p = 0.003; p = 0.001; p < 0.0001). Discussion: On the basis of these outcomes, bromelain is a promising alternative for the debridement of biofilm-contaminated orthopedic implants. Further investigation is required to assess how different concentrations and exposure times may affect the percentage of BD.

Objective: Bacteriophages are promising adjuvant anti-biofilm agents. Yet novel ways to repeatedly administer bacteriophages in vivo are needed. One technique utilizes irrigating wound vacuum systems. However, the proper parameters to use with bacteriophages are poorly defined. Therefore, the objective of this study was to elucidate proper bacteriophage irrigating vacuum parameters. Methods: Individual Pseudomonas aeruginosa and Staphylococcus aureus clinical isolates were allowed to form biofilms in microwell plates and then exposed to repeated irrigations with saline or with bacteriophages over 8 hours. The repeated irrigations corresponded to theoretical different dwell times of the irrigating vacuum system. Residual biofilm mass was compared among groups by staining with crystal violet and measuring optical density. Results: As the number of saline irrigations increased, there was less biofilm burden, and this was substantially less than growth controls (p < 0.05). When compared with saline, bacteriophages substantially reduced biofilms except for the P. aeruginosa bacteriophage at dwell times of 20 minutes. Furthermore, bacteriophages caused no observable colony forming units per milliliter for all dwell times except 20-minute dwell times, and this was statistically significant (p < 0.05) when compared with saline infusions. Conclusions: Frequent irrigation with shorter dwell times facilitates biofilm disruption and reduces bacterial burden. However, if dwell times are too short, bacteriophages may not have sufficient time to hydrolyze biofilm and to infect and kill bacteria. On the basis of our model, we propose a minimum of 1 hour dwell time but appreciate that more translational research is needed to refine these approaches.