Purpose: The primary aim was to determine the risk of infection after knee arthroscopy and to evaluate the risk factors for surgical site infection (SSI).
Methods: The PubMed/Medline, Embase and Cochrane Library databases were systematically searched, as were the reference lists of previous systematic reviews and meta-analysis manual studies. A random-effects model was used to calculate the estimated pooled odds ratio (OR).
Results: A total of 38,321 potential articles met the initial inclusion criteria. After a review of the titles, abstracts and full texts, the remaining 41 articles were included in the final analysis. We identified 9,089,578 patients who underwent knee arthroscopy in 41 articles. High-quality (class I) evidence showed that autografts (cruciate ligament reconstruction) (OR, 2.66% CI, 1.84-3.86) or high procedure complexity (OR, 2.02;95% CI, 1.69-2.43) had a higher risk of infection, while medium-quality (class II or class III) evidence showed that obesity (BMI ≥ 30 kg/m2) (OR, 1.27; 95% CI, 1.08-1.49) or male (OR, 1.52; 95% CI, 1.32-1.75) or diabetes (OR, 1.71; 95% CI, 1.36-2.14) or tobacco use (OR, 1.65; 95% CI, 1.38-1.97) or preoperative steroid use (OR, 3.41; 95% CI, 2.10-5.54) had a higher risk of infection. The meta-analysis showed that there was no association between age or antibiotic prophylaxis and infection incidence.
Conclusions: The meta-analysis showed that significant risk factors for infection after knee arthroscopy included obesity, male sex, diabetes, tobacco use, high procedure complexity, graft type, and preoperative steroid use.
Level of evidence: Level IV, systematic review of Level III and Level IV studies.
{"title":"Risk factors for infection in patients undergoing knee arthroscopy: A Systematic Review and Meta-analysis.","authors":"Yuanhu Lei, Yuhuan Zeng, Zhengyu Li, Zhihong Xiao, Guojun Tang, Yi Liu, Changming Xiao, Mingjiang Luo, Huyong Yan, Hao Chen, Xiaoxu Wang","doi":"10.1016/j.jhin.2024.06.013","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.06.013","url":null,"abstract":"<p><strong>Purpose: </strong>The primary aim was to determine the risk of infection after knee arthroscopy and to evaluate the risk factors for surgical site infection (SSI).</p><p><strong>Methods: </strong>The PubMed/Medline, Embase and Cochrane Library databases were systematically searched, as were the reference lists of previous systematic reviews and meta-analysis manual studies. A random-effects model was used to calculate the estimated pooled odds ratio (OR).</p><p><strong>Results: </strong>A total of 38,321 potential articles met the initial inclusion criteria. After a review of the titles, abstracts and full texts, the remaining 41 articles were included in the final analysis. We identified 9,089,578 patients who underwent knee arthroscopy in 41 articles. High-quality (class I) evidence showed that autografts (cruciate ligament reconstruction) (OR, 2.66% CI, 1.84-3.86) or high procedure complexity (OR, 2.02;95% CI, 1.69-2.43) had a higher risk of infection, while medium-quality (class II or class III) evidence showed that obesity (BMI ≥ 30 kg/m<sup>2</sup>) (OR, 1.27; 95% CI, 1.08-1.49) or male (OR, 1.52; 95% CI, 1.32-1.75) or diabetes (OR, 1.71; 95% CI, 1.36-2.14) or tobacco use (OR, 1.65; 95% CI, 1.38-1.97) or preoperative steroid use (OR, 3.41; 95% CI, 2.10-5.54) had a higher risk of infection. The meta-analysis showed that there was no association between age or antibiotic prophylaxis and infection incidence.</p><p><strong>Conclusions: </strong>The meta-analysis showed that significant risk factors for infection after knee arthroscopy included obesity, male sex, diabetes, tobacco use, high procedure complexity, graft type, and preoperative steroid use.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level III and Level IV studies.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-09DOI: 10.1016/j.jhin.2024.06.010
Background
Chlorhexidine gluconate (CHG) and povidone-iodine (PI) are commonly used to prevent prosthetic joint infection (PJI) during total joint replacement; however, their effective concentrations and impact on biofilms are not well defined.
Aim
To determine: (1) the in-vitro minimum inhibitory concentration of CHG and PI against model PJI-causing organisms and clinical isolates; (2) their impact on biofilm formation; (3) whether there is a synergistic benefit to combining the two solutions; and (4) whether adding the antibiotic vancomycin impacts antiseptic activity.
Methods
We measured in-vitro growth and biofilm formation of Staphylococcus epidermidis, meticillin-sensitive and meticillin-resistant Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Candida albicans, as well as recent clinical isolates, in the presence of increasing concentrations of CHG and/or PI. Checkerboard assays were used to measure potential synergy of the solutions together and with vancomycin.
Findings
CHG and PI inhibited growth and biofilm formation of all model organisms tested at concentrations of 0.0004% and 0.33% or lower, respectively; highly dilute concentrations paradoxically increased biofilm formation. The solutions did not synergize with one another and acted independently of vancomycin.
Conclusion
CHG and PI are effective at lower concentrations than typically used, establishing baselines to support further clinical trials aimed at optimizing wound disinfection. There is no synergistic advantage to using both in combination. Vancomycin is effective at inhibiting the growth of S. epidermidis and S. aureus; however, it stimulates P. aeruginosa biofilm production, suggesting in the rare case of P. aeruginosa PJI, it could exacerbate infection.
背景:葡萄糖酸氯己定(CHG)和聚维酮碘(PI)常用于预防全关节置换术中的假体关节感染(PJI);然而,它们的有效浓度及其对生物膜的影响尚未明确。目的:确定:(1) CHG 和 PI 对模型 PJI 致病菌和临床分离菌的体外最小抑制浓度;(2) 它们对生物膜形成的影响;(3) 将两种溶液结合使用是否有协同作用;(4) 加入抗生素万古霉素是否会影响杀菌活性:我们测量了表皮葡萄球菌、对甲氧西林敏感和耐甲氧西林金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌和白色念珠菌以及最近的临床分离物在浓度不断增加的 CHG 和/或 PI 存在下的体外生长和生物膜形成情况。采用棋盘试验来衡量这两种溶液与万古霉素的潜在协同作用:结果:CHG 和 PI 在浓度分别为 0.0004% 和 0.33% 或更低时,可抑制所有受试模式生物的生长和生物膜的形成;高浓度稀释液反而会增加生物膜的形成。这两种溶液不会相互增效,其作用独立于万古霉素:结论:CHG 和 PI 在较低浓度时比通常使用的浓度更有效,这为进一步临床试验优化伤口消毒提供了基础。两者联合使用没有协同优势。万古霉素能有效抑制表皮葡萄球菌和金黄色葡萄球菌的生长;但它会刺激铜绿假单胞菌生物膜的生成,这表明在铜绿假单胞菌PJI的罕见病例中,万古霉素可能会加重感染。
{"title":"The effects of chlorhexidine, povidone-iodine and vancomycin on growth and biofilms of pathogens that cause prosthetic joint infections: an in-vitro model","authors":"","doi":"10.1016/j.jhin.2024.06.010","DOIUrl":"10.1016/j.jhin.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><p>Chlorhexidine gluconate (CHG) and povidone-iodine (PI) are commonly used to prevent prosthetic joint infection (PJI) during total joint replacement; however, their effective concentrations and impact on biofilms are not well defined.</p></div><div><h3>Aim</h3><p>To determine: (1) the in-vitro minimum inhibitory concentration of CHG and PI against model PJI-causing organisms and clinical isolates; (2) their impact on biofilm formation; (3) whether there is a synergistic benefit to combining the two solutions; and (4) whether adding the antibiotic vancomycin impacts antiseptic activity.</p></div><div><h3>Methods</h3><p>We measured in-vitro growth and biofilm formation of <em>Staphylococcus epidermidis</em>, meticillin-sensitive and meticillin-resistant <em>Staphylococcus aureus</em>, <em>Escherichia coli</em>, <em>Pseudomonas aeruginosa</em> and <em>Candida albicans</em>, as well as recent clinical isolates, in the presence of increasing concentrations of CHG and/or PI. Checkerboard assays were used to measure potential synergy of the solutions together and with vancomycin.</p></div><div><h3>Findings</h3><p>CHG and PI inhibited growth and biofilm formation of all model organisms tested at concentrations of 0.0004% and 0.33% or lower, respectively; highly dilute concentrations paradoxically increased biofilm formation. The solutions did not synergize with one another and acted independently of vancomycin.</p></div><div><h3>Conclusion</h3><p>CHG and PI are effective at lower concentrations than typically used, establishing baselines to support further clinical trials aimed at optimizing wound disinfection. There is no synergistic advantage to using both in combination. Vancomycin is effective at inhibiting the growth of <em>S. epidermidis</em> and <em>S. aureus</em>; however, it stimulates <em>P. aeruginosa</em> biofilm production, suggesting in the rare case of <em>P. aeruginosa</em> PJI, it could exacerbate infection.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0195670124002305/pdfft?md5=5542356cda3ead233d61b918b3165481&pid=1-s2.0-S0195670124002305-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141592117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1016/j.jhin.2024.06.006
Background
Florence Nightingale was the first person to recognize the link between the built environment and patient ill-health. More than 160 years later, the threat of the end of the antibiotic era looms large. The antimicrobial resistance action plan focuses on antimicrobial stewardship and developing new therapeutic agents. The risk from the built environment has been ignored, with wastewater systems identified as major sources of antimicrobial resistance within healthcare facilities. England is undertaking the largest healthcare construction programme globally. These facilities will be operating when antimicrobial resistance is predicted to be at its fiercest. Water-free patient care is a strategy for limiting dispersal of antimicrobial resistance, and preventing patient infections that need further evaluation in new hospitals.
Methods
A narrative review was undertaken using the terms: waterless/water-free units; waterless/water-free care; sink reduction; sink removal; and washing without water. PubMed, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2000 to February 2024 for reviews and original articles. Unit type, geographical location, reasons for a waterless/water-free approach, and outcomes were recorded.
Findings
Seven papers were identified. Four involved adult intensive care units (ICUs), one involved a care of the elderly setting, and two involved neonatal ICUs. In five papers, the aim of intervention was to reduce Gram-negative infections/colonizations. One paper was a systematic review of ‘washing without water’ which reviewed cost-effectiveness and patient experience. All of the five papers focusing on Gram-negative bacilli reported a reduction in infections or colonizations post intervention.
Conclusion
More studies are highlighting the risks from water and wastewater to patient safety, and the value of water-free strategies in reducing infection rates.
{"title":"Water-free patient care: a narrative review of the literature and discussion of the pressing need for a way forward","authors":"","doi":"10.1016/j.jhin.2024.06.006","DOIUrl":"10.1016/j.jhin.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><p>Florence Nightingale was the first person to recognize the link between the built environment and patient ill-health. More than 160 years later, the threat of the end of the antibiotic era looms large. The antimicrobial resistance action plan focuses on antimicrobial stewardship and developing new therapeutic agents. The risk from the built environment has been ignored, with wastewater systems identified as major sources of antimicrobial resistance within healthcare facilities. England is undertaking the largest healthcare construction programme globally. These facilities will be operating when antimicrobial resistance is predicted to be at its fiercest. Water-free patient care is a strategy for limiting dispersal of antimicrobial resistance, and preventing patient infections that need further evaluation in new hospitals.</p></div><div><h3>Methods</h3><p>A narrative review was undertaken using the terms: waterless/water-free units; waterless/water-free care; sink reduction; sink removal; and washing without water. PubMed, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects were searched from January 2000 to February 2024 for reviews and original articles. Unit type, geographical location, reasons for a waterless/water-free approach, and outcomes were recorded.</p></div><div><h3>Findings</h3><p>Seven papers were identified. Four involved adult intensive care units (ICUs), one involved a care of the elderly setting, and two involved neonatal ICUs. In five papers, the aim of intervention was to reduce Gram-negative infections/colonizations. One paper was a systematic review of ‘washing without water’ which reviewed cost-effectiveness and patient experience. All of the five papers focusing on Gram-negative bacilli reported a reduction in infections or colonizations post intervention.</p></div><div><h3>Conclusion</h3><p>More studies are highlighting the risks from water and wastewater to patient safety, and the value of water-free strategies in reducing infection rates.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1016/j.jhin.2024.06.007
Background
For Clostridioides difficile infections (CDIs) in Germany no longitudinal multi-centre studies with standardized protocols for diagnosing CDI are available. Recent evaluations of general surveillance databases in Germany indicate a downward trend in CDI rates. We aimed to describe the actual burden and trends of CDI in German university hospitals from 2016 to 2020.
Methods
Our study was a prospective multi-centre study covering six German university hospitals. We report the data in total, stratified by year, by medical specialty as well as by CDI severity. Multi-variable regression analyses were performed to assess risk factors for severe CDI.
Results
We registered 3780 CDI cases among 1,436,352 patients. The median length of stay (LOS) of CDI cases was 20 days (interquartile range 11–37) compared with a general LOS of 4.2 days. In-hospital all-cause mortality in CDI patients was 11.7% (N = 444/3780), while mortality attributed to CDI was 0.4% (N = 16/3761). CDI recurrence rate was comparatively low at 7.2%. The incidence density of severe healthcare-associated healthcare onset (HAHO)-CDI showed a significant decrease from 2.25/10,000 patient days (pd) in 2016 to 1.49/10,000 pd in 2020 (trend calculation P=0.032).
Conclusions
Compared with a European point-prevalence study in 2013/2014, where overall CDI incidence density was 11.2 cases/10,000 pd in Germany (EUCLID), we see in our study halved overall CDI rates of 5.6 cases/10,000 pd in 2020. Our study shows current data on the distribution of CDI cases in German university hospitals and thus provides international comparative data on the key indicators of CDI.
{"title":"Occurrence and trends of Clostridioides difficile infections in hospitalized patients: a prospective multi-centre cohort study in six German university hospitals, 2016–2020","authors":"","doi":"10.1016/j.jhin.2024.06.007","DOIUrl":"10.1016/j.jhin.2024.06.007","url":null,"abstract":"<div><h3>Background</h3><p>For <em>Clostridioides difficile</em> infections (CDIs) in Germany no longitudinal multi-centre studies with standardized protocols for diagnosing CDI are available. Recent evaluations of general surveillance databases in Germany indicate a downward trend in CDI rates. We aimed to describe the actual burden and trends of CDI in German university hospitals from 2016 to 2020.</p></div><div><h3>Methods</h3><p>Our study was a prospective multi-centre study covering six German university hospitals. We report the data in total, stratified by year, by medical specialty as well as by CDI severity. Multi-variable regression analyses were performed to assess risk factors for severe CDI.</p></div><div><h3>Results</h3><p>We registered 3780 CDI cases among 1,436,352 patients. The median length of stay (LOS) of CDI cases was 20 days (interquartile range 11–37) compared with a general LOS of 4.2 days. In-hospital all-cause mortality in CDI patients was 11.7% (<em>N</em> = 444/3780), while mortality attributed to CDI was 0.4% (<em>N</em> = 16/3761). CDI recurrence rate was comparatively low at 7.2%. The incidence density of severe healthcare-associated healthcare onset (HAHO)-CDI showed a significant decrease from 2.25/10,000 patient days (pd) in 2016 to 1.49/10,000 pd in 2020 (trend calculation <em>P</em>=0.032).</p></div><div><h3>Conclusions</h3><p>Compared with a European point-prevalence study in 2013/2014, where overall CDI incidence density was 11.2 cases/10,000 pd in Germany (EUCLID), we see in our study halved overall CDI rates of 5.6 cases/10,000 pd in 2020. Our study shows current data on the distribution of CDI cases in German university hospitals and thus provides international comparative data on the key indicators of CDI.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0195670124002275/pdfft?md5=de1f5822d824f14961de89954e71014e&pid=1-s2.0-S0195670124002275-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-03DOI: 10.1016/j.jhin.2024.06.005
Luke B Snell, Desiree Prossomariti, Adela Alcolea-Medina, Mingaile Sasson, Michael Dibbens, Noor Al-Yaakoubi, Gul Humayun, Themoula Charalampous, Christopher Alder, Daniel Ward, Alfredo Maldonado-Barrueco, Obaro Abadioru, Rahul Batra, Gaia Nebbia, Jonathan A Otter, Jonathan D Edgeworth, Simon D Goldenberg
Background: Hospital drains and water interfaces are implicated in nosocomial transmission of pathogens. Metagenomics can assess the microbial composition and presence of antimicrobial resistance genes in drains ('the drainome') but studies applying these methods longitudinally and to assess infection control interventions are lacking.
Aim: Apply long-read metagenomics coupled with microbiological measurements to investigate the drainome and assess the effects of a peracetic acid-containing decontamination product.
Methods: 12-week study in three phases: a baseline phase, an intervention phase of enhanced decontamination with peracetic acid, and a post-intervention phase. Five hospital sink drains on an intensive care unit were sampled twice weekly. Each sample had 1) measurement of total viable count (TVC), 2) metagenomic analyses including i) taxonomic classification of bacteria and fungi ii) antibiotic resistance gene detection iii) plasmid identification, and 3) immunochromatographic detection of antimicrobial residues.
Findings: Overall TVCs remain unchanged in the intervention phase (+386 CFU/mL, SE 705, p=0.59). There was a small but significant increase in the microbial diversity in the intervention phase (-0.07 in Simpson's index, SE 0.03, p=0.007), which was not sustained post-intervention (-0.05, SE 0.03, p=0.08). The intervention was associated with increased relative abundance of the Pseudomonas genus (18.3% to 40.5% [+22.2%], SE 5.7%, p<0.001). Extended spectrum beta-lactamases were found in all samples, with NDM-carbapenemase found in 3 drains in 6 samples. Antimicrobial residues were detected in a large proportion of samples (31/115, 27%), suggesting use of sinks for non-handwashing activities.
Conclusions: Metagenomics and other measurements can measure the composition of the drainome and assess the effectiveness of decontamination interventions.
{"title":"The drainome: longitudinal metagenomic characterisation of wastewater from hospital ward sinks to characterize the microbiome and resistome and assess the effects of decontamination interventions.","authors":"Luke B Snell, Desiree Prossomariti, Adela Alcolea-Medina, Mingaile Sasson, Michael Dibbens, Noor Al-Yaakoubi, Gul Humayun, Themoula Charalampous, Christopher Alder, Daniel Ward, Alfredo Maldonado-Barrueco, Obaro Abadioru, Rahul Batra, Gaia Nebbia, Jonathan A Otter, Jonathan D Edgeworth, Simon D Goldenberg","doi":"10.1016/j.jhin.2024.06.005","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.06.005","url":null,"abstract":"<p><strong>Background: </strong>Hospital drains and water interfaces are implicated in nosocomial transmission of pathogens. Metagenomics can assess the microbial composition and presence of antimicrobial resistance genes in drains ('the drainome') but studies applying these methods longitudinally and to assess infection control interventions are lacking.</p><p><strong>Aim: </strong>Apply long-read metagenomics coupled with microbiological measurements to investigate the drainome and assess the effects of a peracetic acid-containing decontamination product.</p><p><strong>Methods: </strong>12-week study in three phases: a baseline phase, an intervention phase of enhanced decontamination with peracetic acid, and a post-intervention phase. Five hospital sink drains on an intensive care unit were sampled twice weekly. Each sample had 1) measurement of total viable count (TVC), 2) metagenomic analyses including i) taxonomic classification of bacteria and fungi ii) antibiotic resistance gene detection iii) plasmid identification, and 3) immunochromatographic detection of antimicrobial residues.</p><p><strong>Findings: </strong>Overall TVCs remain unchanged in the intervention phase (+386 CFU/mL, SE 705, p=0.59). There was a small but significant increase in the microbial diversity in the intervention phase (-0.07 in Simpson's index, SE 0.03, p=0.007), which was not sustained post-intervention (-0.05, SE 0.03, p=0.08). The intervention was associated with increased relative abundance of the Pseudomonas genus (18.3% to 40.5% [+22.2%], SE 5.7%, p<0.001). Extended spectrum beta-lactamases were found in all samples, with NDM-carbapenemase found in 3 drains in 6 samples. Antimicrobial residues were detected in a large proportion of samples (31/115, 27%), suggesting use of sinks for non-handwashing activities.</p><p><strong>Conclusions: </strong>Metagenomics and other measurements can measure the composition of the drainome and assess the effectiveness of decontamination interventions.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.1016/j.jhin.2024.06.004
Introduction
Surgical site infections (SSIs) are significant postoperative risks; antibiotic prophylaxis is crucial due to the presence of anaerobic bacteria. This study investigated the efficacy and safety of a novel nitroimidazole, morinidazole, in SSI reduction in class III wounds, as there is currently a lack of evidence in the existing literature.
Methods
A multi-centre randomized clinical trial was conducted from December 2020 to October 2022 in the general surgery departments of 12 tertiary hospitals in China, including 459 patients in two treatment groups using morinidazole plus ceftriaxone or ceftriaxone alone. Efficacy and safety were evaluated including SSI incidence, adverse events, and compliance. Statistical analysis employed SAS 9.4 software. Data analysis was performed from February to May 2023.
Results
A total of 440 participants (median (interquartile range, IQR) age, 63.0 (54.0, 70.0) years; 282 males (64.09%); 437 patients were of Han race (99.32%) and were randomized. The experimental group exhibited a significantly lower SSI rate compared with the control group (31 (14.49%) vs 52 (23.01%); risk difference, 1.76%, 95% confidence interval (CI) 1.08–2.88%; P=0.0224). The superficial incisional site infections revealed a marked reduction in the experimental group (12 (5.61%) vs 31 (13.37%); risk difference, 2.68%; 95% CI 1.34–5.36%; P=0.0042). Non-surgical site infections, severe postoperative complications, and total adverse events showed no statistically significant differences between the groups (P>0.05).
Conclusion
The significant decrease in SSI rates and superficial incisional infections demonstrates morinidazole to be a valuable prophylactic antibiotic. Our findings provide valuable insights for clinical practice, where this new-generation nitroimidazole can play a crucial role in SSI prevention.
导言:手术部位感染是术后的重大风险,由于厌氧菌的存在,抗生素预防至关重要。由于现有文献中缺乏相关证据,本研究调查了新型硝基咪唑--吗啉咪唑在减少Ⅲ类伤口 SSI 方面的有效性和安全性:2020年12月至2022年10月,在中国12家三级医院的普外科开展了一项多中心随机临床试验。459例患者分两组治疗,分别使用吗替麦考酚酯加头孢曲松或单用头孢曲松。对疗效和安全性进行了评估,包括 SSI 发生率、不良反应和依从性。统计分析采用 SAS 9.4 软件。数据分析时间为 2023 年 2 月至 5 月:共有 440 名参与者(中位数[IQR]年龄为 63.0 [54.0, 70.0]岁;282 名男性[64.09%];437 名患者为汉族[99.32%])接受了随机治疗。实验组的 SSI 感染率明显低于对照组(31 [14.49%] vs 52 [23.01%];风险差异,1.76%,95%CI,1.08% to 2.88%;P=0.0224)。实验组表皮切口部位感染明显减少(12 [5.61%] vs 31 [13.37%];风险差异,2.68%;95%CI,1.34%~5.36%;P=0.0042)。非手术部位感染、术后严重并发症和总不良事件在组间无统计学差异(P>0.05):结论:SSI 发生率和表皮切口感染率的明显降低表明,吗啉达唑是一种有价值的预防性抗生素。我们的研究结果为临床实践提供了宝贵的启示,新一代硝基咪唑在预防 SSI 方面可以发挥重要作用。
{"title":"Assessing morinidazole for surgical site infection in class III wounds prevention: a multi-centre, randomized, single-blind, parallel-controlled study","authors":"","doi":"10.1016/j.jhin.2024.06.004","DOIUrl":"10.1016/j.jhin.2024.06.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Surgical site infections (SSIs) are significant postoperative risks; antibiotic prophylaxis is crucial due to the presence of anaerobic bacteria. This study investigated the efficacy and safety of a novel nitroimidazole, morinidazole, in SSI reduction in class III wounds, as there is currently a lack of evidence in the existing literature.</p></div><div><h3>Methods</h3><p>A multi-centre randomized clinical trial was conducted from December 2020 to October 2022 in the general surgery departments of 12 tertiary hospitals in China, including 459 patients in two treatment groups using morinidazole plus ceftriaxone or ceftriaxone alone. Efficacy and safety were evaluated including SSI incidence, adverse events, and compliance. Statistical analysis employed SAS 9.4 software. Data analysis was performed from February to May 2023.</p></div><div><h3>Results</h3><p>A total of 440 participants (median (interquartile range, IQR) age, 63.0 (54.0, 70.0) years; 282 males (64.09%); 437 patients were of Han race (99.32%) and were randomized. The experimental group exhibited a significantly lower SSI rate compared with the control group (31 (14.49%) vs 52 (23.01%); risk difference, 1.76%, 95% confidence interval (CI) 1.08–2.88%; <em>P</em>=0.0224). The superficial incisional site infections revealed a marked reduction in the experimental group (12 (5.61%) vs 31 (13.37%); risk difference, 2.68%; 95% CI 1.34–5.36%; <em>P</em>=0.0042). Non-surgical site infections, severe postoperative complications, and total adverse events showed no statistically significant differences between the groups (<em>P</em>>0.05).</p></div><div><h3>Conclusion</h3><p>The significant decrease in SSI rates and superficial incisional infections demonstrates morinidazole to be a valuable prophylactic antibiotic. Our findings provide valuable insights for clinical practice, where this new-generation nitroimidazole can play a crucial role in SSI prevention.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jhin.2024.02.004
H. Hagiya , Y. Fujita , T. Kiguchi , T. Higashionna
{"title":"Another factor with an adverse effect on hand hygiene compliance","authors":"H. Hagiya , Y. Fujita , T. Kiguchi , T. Higashionna","doi":"10.1016/j.jhin.2024.02.004","DOIUrl":"10.1016/j.jhin.2024.02.004","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jhin.2023.10.026
H. Barnsley , S. McFall , R. White , S. Suleman , B. Pichon , M. Patel
This paper aims to describe the investigation and control of an outbreak of USA300 ST8 Panton–Valentine leucocidin (PVL)-positive meticillin-resistant Staphylococcus aureus (MRSA), confirmed by whole genome sequencing (WGS), within a maternity and neonatal setting in the UK. The identification of two linked PVL-MRSA cases led to an outbreak investigation. A lookback exercise conducted using the infection control surveillance database, typing of saved MRSA isolates, enhanced patient screening, and staff screening were used to identify further cases. Environmental screening was also performed. Genetic relatedness between isolates was assessed by WGS. During the outbreak, 18 cases were identified between 11th July 2021 and 22nd December 2022: 10 cases were infections and eight cases were colonizations. A healthcare worker (HCW) tested positive for colonization with the same strain, and environmental swabbing identified contaminated information technology equipment in the hospital. The outbreak was brought to an end by exclusion of the colonized HCW from work, and infection prevention and control measures. Since the end of the outbreak, cases of PVL-MRSA with similar molecular profiles have been found in the community. It is likely that the HCW played a role in the transmission of PVL-MRSA. Their exclusion from work and decolonization were key to preventing further cases. WGS was valuable in identifying and linking cases. The identification of community cases of PVL-MRSA with similar molecular profiles confirms transmission of the organism outside of healthcare settings.
{"title":"Emergence and control of an outbreak of PVL-positive MRSA in a UK-based maternity setting","authors":"H. Barnsley , S. McFall , R. White , S. Suleman , B. Pichon , M. Patel","doi":"10.1016/j.jhin.2023.10.026","DOIUrl":"10.1016/j.jhin.2023.10.026","url":null,"abstract":"<div><p>This paper aims to describe the investigation and control of an outbreak of USA300 ST8 Panton–Valentine leucocidin (PVL)-positive meticillin-resistant <em>Staphylococcus aureus</em> (MRSA), confirmed by whole genome sequencing (WGS), within a maternity and neonatal setting in the UK. The identification of two linked PVL-MRSA cases led to an outbreak investigation. A lookback exercise conducted using the infection control surveillance database, typing of saved MRSA isolates, enhanced patient screening, and staff screening were used to identify further cases. Environmental screening was also performed. Genetic relatedness between isolates was assessed by WGS. During the outbreak, 18 cases were identified between 11<sup>th</sup> July 2021 and 22<sup>nd</sup> December 2022: 10 cases were infections and eight cases were colonizations. A healthcare worker (HCW) tested positive for colonization with the same strain, and environmental swabbing identified contaminated information technology equipment in the hospital. The outbreak was brought to an end by exclusion of the colonized HCW from work, and infection prevention and control measures. Since the end of the outbreak, cases of PVL-MRSA with similar molecular profiles have been found in the community. It is likely that the HCW played a role in the transmission of PVL-MRSA. Their exclusion from work and decolonization were key to preventing further cases. WGS was valuable in identifying and linking cases. The identification of community cases of PVL-MRSA with similar molecular profiles confirms transmission of the organism outside of healthcare settings.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139022499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jhin.2024.02.031
J. Broom , A. Broom
{"title":"Qualitative research methods: powerful tools for understanding practice and informing change","authors":"J. Broom , A. Broom","doi":"10.1016/j.jhin.2024.02.031","DOIUrl":"10.1016/j.jhin.2024.02.031","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.jhin.2024.03.016
S. Mizuno, M. Kasai
{"title":"Inhibition of bacterial growth on sinks of a paediatric intensive care unit using a 222-nm far ultraviolet irradiation device (Care222)","authors":"S. Mizuno, M. Kasai","doi":"10.1016/j.jhin.2024.03.016","DOIUrl":"10.1016/j.jhin.2024.03.016","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}