Cause Of Postoperative Infection Research Articles

Analysis of postoperative complications of orbital fracture.

To analyze the types and causes of complications following orbital fracture reconstruction and enhance clinicians' capacity to manage or prevent such complications. We conducted a retrospective case series analysis, retrospectively collecting and analyzing clinical data of patients with orbital fractures who received surgical treatment at the Affiliated Eye Hospital of Nanchang University from May 2012 to May 2022. Descriptive statistics were employed to document common postoperative complications, and we recorded complications persisting after a minimum 6-month follow-up period. Among the 227 patients who underwent orbital fracture surgery, they were followed up for 6 to 36 months, and complications occurred in 15 cases, resulting in an incidence rate of 6.61%. These complications included implant material infections and rejections (4 cases), persistent diplopia (3 cases), intraorbital hematomas (2 cases), epiphora (2 cases), lower eyelid eversion or retraction (2 cases), and skin scars (2 cases). The primary cause of postoperative infection was chronic inflammation in the paranasal sinuses or closed cavities within the fracture area. Postoperative complications in orbital fractures were associated with various factors, including the timing of surgery, surgical approach, repair materials, surgical skills, and auxiliary techniques. Standardizing surgical techniques and implementing precise auxiliary technologies may reduce the incidence of complications and enhance the operation's success rate.

Intracellular bactericidal activity and action mechanism of MDP1 antimicrobial peptide against VRSA and MRSA in human endothelial cells.

Staphylococcus aureus is a prominent cause of postoperative infections, often persisting within host cells, leading to chronic infections. Conventional antibiotics struggle to eliminate intracellular S. aureus due to poor cell penetration. Antimicrobial peptides are a new hope for tackling intracellular bacteria. Accordingly, this study examines the antimicrobial peptide MDP1, derived from melittin, for its efficacy against intracellular S. aureus. In this study, the physiochemical properties (Prediction of three-dimensional structure, circular dichroism and helical wheel projection analysis) were investigated. Extracellular antibacterial activity and cytotoxicity of MDP1 were also assessed. The mechanism of interaction of MDP1 with S. aureus was evaluated by molecular dynamic simulation, atomic force and confocal microscopy. Bacterial internalization into an endothelial cell model was confirmed through culture and transmission electron microscopy. The effect of the peptide on intracellular bacteria was investigated by culture and epi-fluorescence microscopy. 3D structural prediction proved the conformation of MDP1 as an α-helix peptide. Helical-wheel projection analysis indicated the proper orientation of hydrophobic amino acid residues for membrane interaction. CD spectroscopy of MDP1 showed that MDP1 in SDS 10 and 30 mM adopted 87 and 91% helical conformation. Atomic force and confocal microscopy assessments as well as molecular dynamics studies revealed the peptide-bacterial membrane interaction. MDP1, at the concentration of 0.32 μg mL-1, demonstrated a fold reduction of 21.7 ± 1.8, 1.7 ± 0.2, and 7.3 ± 0.8 in intracellular bacterial load for ATCC, VRSA, and MRSA, respectively. Molecular dynamics results demonstrate a preferential interaction of MDP1 with POPG/POPE membranes, primarily driven by electrostatic forces and hydrogen bonding. In POPC systems, two out of four MDP1 interacted effectively, while all four MDP1 engaged with POPG/POPE membranes. Gathering all data together, MDP1 is efficacious in the reduction of intracellular VRSA and MRSA proved by culture and epi-fluorescent microscopy although further studies should be performed to increase the intracellular activity of MDP1.

Postoperative mediastinitis after cardiac surgery caused by Mycoplasma hominis: a case report

BackgroundMycoplasma hominis is a human commensal bacterium of the urogenital tract, and extragenital infection caused by M. hominis has rarely been reported. The identification of M. hominis is challenging, and surgeons are generally not aware that this bacteria can cause postoperative infection. Here, we report a rare case of postoperative mediastinitis caused by M. hominis after cardiac surgery in an immunocompetent patient.Case presentationA 54-year-old man presented with pain and purulent discharge from the wound after aortic valve replacement and patent foramen ovale closure. However, Gram staining and culture of bacteria from the purulent discharge was negative, and empiric sulbactam/ampicillin therapy was not effective. This patient developed mediastinitis and rupture of a pseudoaneurysm of the ascending aorta caused by mediastinitis, and re-operation was performed. Then, postoperative mediastinitis caused by M. hominis or Ureaplasma species was suspected and bacterial cultures targeting these pathogens were performed. M. hominis was identified from abscess and tissue obtained from the surgical site and urine. A final diagnosis of postoperative mediastinitis caused by M. hominis was determined. The patient was initially treated with levofloxacin and then with minocycline for 3 weeks. The patient’s clinical condition improved; the patient was transferred to another hospital.ConclusionThe role of M. hominis as a cause of postoperative infection might be underestimated in cardiac surgery. M. hominis should be considered when culture-negative purulent discharge is observed or there is no response to standard empiric treatment of postoperative infections.

Risk Factors for Infectious Complications after Surgical Treatment of Spinal Metastases in Patients with Breast and Kidney Cancer

Relevance. In patients with the most common malignant new growth such as breast, kidney and lung cancer the rate of spinal metastases amounts to 70%. Increasing number of surgical procedures results in growing frequency of postoperative complications including surgical site infection (SSI) which do not only deteriorate the quality of patient’s life but change the timelines for renewal of therapy for the primary disease. Study design — case control study. Purpose of the study — to identify key risk factors as well as impact of tumor therapy on development of infectious complications in patients with breast and kidney cancer after surgical management of metastatic spine lesion. Materials and Methods. The authors collected and compiled the data on 2023 oncological patients who underwent specialized neuroorthopaedic treatment in the period from 2000 until 2017 due to tumor spine lesions. Inclusion criteria: malignant breast and kidney tumors with spine metastases, continued systemic tumor therapy, decompression and stabilization spine surgery irrespective of used implants. Patients that corresponded to inclusion criteria were divided into two groups. The first (main) group included patients (n = 22) with infectious complications after surgery. The second (control) group (n = 23) was formed by propensity score matching. Results. The analysis of obtained data resulted in identification of severe significant factors (р0.05): diabetes mellitus, postoperative liquorrhea, certain classes by ASA (3, 4) and ECOG (2, 3, 4) scales, volume of blood loss, time of surgery and type of tumor therapy. However, the three latter have the highest statistical significance (р0.01): surgical factors (blood loss volume and time of procedure) and type of tumor therapy. Conclusion. Postoperative SSI remains a common severe complication after surgeries due to metastatic spine lesions. The causes of postoperative infection after tumor resection are compromised immune status of the patient; long time of procedure with heavy blood loss and adjuvant tumor therapy.

COMPUTATIONAL FLUID DYNAMICS SIMULATION OF FLOW OF EXHALED PARTICLES FROM POWERED-AIR PURIFYING RESPIRATORS.

In surgical settings, infectious particulate wound contamination is a recognized cause of post-operative infections. Powered air-purifying respirators (PAPRs) are widely used by healthcare workers personal protection against infectious aerosols. Healthcare infection preventionists have expressed concern about the possibility that infectious particles expelled from PAPR exhalation channels could lead to healthcare associated infections, especially in operative settings where sterile procedural technique is emphasized. This study used computational fluid dynamics (CFD) modeling to simulate and visualize the distribution of particles exhaled by the PAPR wearer. In CFD simulations, the outward release of the exhaled particles, i.e., ratio of exhaled particle concentration outside the PAPR to that of inside the PAPR, was determined. This study also evaluated the effect of particle sizes, supplied air flow rates, and breathing work rates on outward leakage. This simulation study for the headform and loose-fitting PAPR system included the following four main steps: (1) preprocessing (establishing a geometrical model of a headform wearing a loose-fitting PAPR by capturing a 3D image), (2) defining a mathematical model for the headform and PAPR system, and (3) running a total 24 simulations with four particle sizes, three breathing workloads and two supplied-air flow rates (4×3×2=24) applied on the digital model of the headform and PAPR system, and (4) post-processing the simulation results to visually display the distribution of exhaled particles inside the PAPR and determine the particle concentration of outside the PAPR compared with the concentration inside. We assume that there was no ambient particle, and only exhaled particles existed. The results showed that the ratio of the exhaled particle concentration outside to inside the PAPR were influenced by exhaled particle sizes, breathing workloads, and supplied-air flow rates. We found that outward concentration leakage from PAPR wearers was approximately 9% with a particle size of 0.1 and 1 μm at the light breathing and 205 L/min supplied-air flow rates, which is similar to the respiratory physiology of a health care worker in operative settings, The range of the ratio of exhaled particle concentration leaking outside the PAPR to the exhaled particle concentration inside the PAPR is from 7.6% to 49. We found that supplied air flow rates and work rates have significant impact on outward leakage, the outward concentration leakage increased as particle size decreased, breathing workload increased, and supplied-air flow rate decreased. The results of our simulation study should help provide a foundation for future clinical studies.

Medical Tourism and Postoperative Infections: A Systematic Literature Review of Causative Organisms and Empiric Treatment.

Medical tourism has become increasingly globalized as individuals travel abroad to receive medical care. Cosmetic patients in particular are more likely to seek surgery abroad to defray costs. Unfortunately, not all procedures performed abroad adhere to strict hygienic regulations, and bacterial flora vary. As a result, it is not uncommon for consumers to return home with difficult-to-treat postoperative infections. A systematic literature review of PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was performed to assess the microbiology patterns and medical management of patients with postoperative infections after undergoing elective surgery abroad. Forty-two cases of postoperative infections were reported among patients who underwent elective surgery abroad. Most cases were reported from the Dominican Republic, and the most common elective procedures were abdominoplasty, mastopexy, and liposuction. Rapidly growing mycobacteria such as Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae were among the most common causes of postoperative infection, with M. abscessus involving 74 percent of cases. Most cases were treated with surgical débridement and a combination of antibiotics. Clarithromycin, amikacin, and moxifloxacin were the most common drugs used for long-term treatment. When encountering a patient with a history of medical tourism and treatment-refractory infection, rapidly growing mycobacteria must be considered. To increase the likelihood of yielding a diagnostic organism, multiple acid-fast bacilli cultures from fluid and débridement content should be performed. There has been reported success in treating rapidly growing mycobacterial infections with a combination of antibiotics including clarithromycin, amikacin, and moxifloxacin.

Postoperative Infection Related with the Total Elbow Arthroplasty (Kudo's Prosthesis) in Rheumatoid Arthritis.

Total Elbow Arthroplasty (TEA) for the rheumatoid arthritis (RA) has been popularized since 1980s. The outcomes of TEA using any type of implant design for RA has been satisfactory. On the other hand, many orthopedicians experience several postoperative complications. Among them, postoperative infection has still being the most troublesome and difficult to treat. This study is to clarify the causes of postoperative infection of TEA using Kudo's prosthesis for RA and discuss how to manage and prevent infection. 421 TEAs were performed for 405 cases with RA at the authors' institute during the period between 1982 and 2007. They were followed up for 1~25 years (Av. 12.3 years). The authors examined pain, the range of motion, roentgenograms and complications postoperatively. We were able to start treatment within 4 weeks after occurrence of infection. For surgical management of infected TEAs, debridement of the synovium and removal of the prosthesis with loosening were performed for all cases. In addition, all cases have been regularly and strictly followed-up with the elbow protector to prevent recurrence of infection since 2008. There were 98 TEAs with the postoperative complications (23.3%). Eight out of 98 TEAs were infected (1.9%). Five of eight infected TEAs were primarily at the surgical scar site infection (SSSI) (60%), unknown causes in two, hematogenous course in 1. It's obvious that surgical scar site infection (SSSI) was the leading cause of postoperative infection in this study. Thus, the authors made the elbow proctor to avoid injuries of the skin around surgical scar site (SSS). Since 2008, all of the TEAs and revised TEAs have been applied with this protector. The authors reported 8 infected TEAs: 5 cases were revised, 2 with the brace, 1 had above the elbow amputated. The regular and meticulous follow up and application of the elbow protector were useful to prevent infection of post-TEAs using Kudo's prosthesis in RA. Since 2008, there have been no infection of post TEAs and revised TEAs.

Preoperative chronic sinusitis as significant cause of postoperative infection and implant loss after sinus augmentation from a lateral approach

Among intra/postoperative complications of sinus augmentation from a lateral approach, postoperative infection and implant loss are particularly important because they have irreversible consequences. The purpose of this study was to determine the causes of postoperative infection and implant loss after a lateral approach and to determine the appropriate prophylaxis and therapy. In total, 109 patients (121 sinuses, 252 implants) were included in this study. The correlation between postoperative infection and implant loss and clinical variables was assessed using logistic regression analyses. Postoperative infection and implant loss occurred in 8/121 sinuses (6.6%). Infection had the strongest correlation to preoperative chronic sinusitis (p=0.007), followed by timing of implant insertion. Implant loss had the strongest correlation to preoperative chronic sinusitis (p=0.007), followed by sex, diabetes, postoperative use of dentures, and intraoperative perforation of the sinus membrane. Preoperative chronic sinusitis could be a significant cause of postoperative infection and implant loss when using sinus augmentation from a lateral approach. For appropriate prophylaxis and therapy, it is necessary to diagnose the presence of chronic sinusitis that should be treated with proper methods prior to sinus augmentation.

Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality.The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study.Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI.Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

An audit on the documentation of the interpretation of chest radiographs following thoracic surgery

s / International Journal of Surgery 11 (2013) 589e685 614 ABSTRACTS Conclusions: Whilst discharge documentation has improved, significant deviation from local guidelines remains and is principally due to use of antiplatelet therapy after mitral repair. 0941: AN AUDIT ON THE DOCUMENTATION OF THE INTERPRETATION OF CHEST RADIOGRAPHS FOLLOWING THORACIC SURGERY Daron Nazari , Kapil Sugand , Martin Yates , Ian Hunt . 1 St George's University of London, London, UK; 2 Imperial College London, London, UK. Aims: All patients undergoing thoracic surgery at our institution undergo post-operative and post-drain removal chest radiographs (CXR). General Medical Council (GMC) Good Medical Practice guidelines state that the interpretation of all investigations should be documented by the requesting physician. The aim of this audit was to assess compliance with GMC standards. Methods: A prospective audit was carried out of all patients who underwent thoracic surgery between 1st November and 7th December 2012. Quality of documentation within the patient record was assessed by a single investigator for both the post-operative and the post-drain removal CXR's. For each CXR, basic demographics (date, patient details and physician identification) and the presence or absence of post-operative pulmonary complications were assessed. Results: During the period of study 63 patients underwent thoracic surgery. 49(78%) patients had documentation of post-operative and 46(73%) post-drain removal CXRs. However, more detailed clinical information was included in only 9(14%) and 12(19%) of records respectively. Conclusions: There is a suboptimal level of documentation of routine CXRs post-thoracic surgery. Improvement, therefore, is crucial in recording the presence or absence of radiographic post-operative complications in patient records. A pro forma for CXR documentation has been introduced and re-audit is currently in progress. 0982: THE EUROSCORE II IS A BETTER PREDICTOR OF MORTALITY THAN LOGISTIC EUROSCORE FOR PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION Ashok Kar, Daniel Moffat, Simon Kennon, Anne Malecki, Wael Awad. London Chest Hospital, London, UK. Objectives: Patient selection for transcatheter aortic valve implantation (TAVI) is critical because of proven efficacy for conventional aortic valve surgery (AVR). Currently available risk scoring systems are known to be inadequate; logistic Euroscore (LES) over predicts mortality for AVR. This study compared predictive ability of the new EuroSCORE II (ES2) with LES in patients undergoing TAVI. Methods: All patients undergoing TAVI (January 2009 September 2012) were identified from our registers. LES and ES2 scores were calculated and predicted mortalities for the 2 scoring systems compared with that observed. Results: 124 patients underwent TAVI: 3 cases were excluded due to insufficient data. Mean age of patients (n1⁄4121) was 81.9 years (75 e 91). Mean predicted LES was 21.6 12.6 compared to 7.7 6.2 for ES2; paired student t-test showed ES2 to be significantly lower (p 60kg. This may contribute to longer hospital admissions and more patients being discharged in AF. Other cardiac units should be encouraged to audit local practice and initiate change to guidelines. 1225: PRE-OPERATIVE TOPICAL ANTISEPTICS AND POST-OPERATIVE INFECTION RATES IN CARDIOTHORACIC SURGERY: META-ANALYSES OF PROSPECTIVE STUDIES Sudeep Das De. University of Cambridge, Cambridge, UK. Aim: To investigate the role of routine pre-operative topical antiseptic agents in cardiothoracic surgery. Background: Staphylococcus aureus is a major cause of post-operative infection after open-heart surgery, with the patient's endogenous flora as the principal source. However the routine use of pre-operative topical antiseptics in all cardiothoracic patients has not been established. In a meta-analysis, we quantitatively assessed the associations reported in prospective studies of routine use of preoperative topical antiseptics. Methods and Results: Studies were identified by computer-assisted searches of the published literature and scanning of relevant reference lists. The following was abstracted: size and type of cohort, mean age, mean duration of follow-up, and the relative risk ratio of developing a post-operative infection when using topical antiseptic agents. There were 5 studies reporting the use of pre-operative chlorhexidine and 4 studies on topical mupirocin. The combined relative risk ratio of developing a postoperative infection when using topical chlorhexidine versus the control armwas 0.47 (CI 0.39-0.63, p<0.05). The combined relative risk ratio when using topical mupirocin of developing an infection was 0.43 (CI 0.32-0.72, p<0.05). Conclusion: Published prospective studies provide good evidence to support the routine use of preoperative topical antiseptic agents.

Bacteriological Evaluation of the Cardiac Surgery Environment Accompanying Hospital Relocation

Airborne bacteria in the environment are thought to be a cause of postoperative infection. With the relocation of our hospital, the operating room we had used for 35 years was replaced, changing the surgical environment for cardiac operation completely. We conducted this study to evaluate the bacteriological change in the surgical environment between the new and old operating rooms. Airborne contaminants in the operating rooms were collected on blood agar plates, and samples of intraoperative salvaged blood from cardiac surgery were drawn from salvaged bags produced by Cell Saver 5 (Haemonetics, Braintree, MA, USA) in both the old (group O) and the new operating rooms (group N). These samples were cultured and evaluated bacteriologically. We collected nine samples of airborne contaminants from both group O and group N. The mean number of isolated bacteria colonies was 5.0 +/- 1.2 in group O, and 2.0 +/- 0.94 in group N (P < 0.001). Bacterial growth was detected in 85% of the salvaged blood samples from group O (n = 20) versus 60% from group N (n = 15) (P = 0.09). The mean bacteria count was 1.9 +/- 2.7 colony-forming units (cfu)/ml in group O versus 0.4 +/- 0.5 cfu/ml in group N (P = 0.032). Hospital relocation resulted in an improved operating room environment with less bacterial contamination of intraoperative salvaged blood.

Methicillin-Resistant Staphylococcus aureus Infections in Vascular Surgery: Increasing Prevalence

Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism that causes substantial infection-related morbidity and mortality in hospitalized patients. For example, MRSA infection of prosthetic vascular grafts can be limb- and life-threatening in surgical patients. We investigated the incidence of MRSA infection in vascular surgical patients who developed postoperative infectious complications. Prospective data (including procedure, nature of complication, and outcome) were collected on all vascular surgery patients (n = 772) over a two-year period from January, 2000, to December, 2001. The study cohort included all patients who developed postoperative complications (n = 119, 15.4%), including infection, unplanned or prolonged intubation, metabolic abnormalities, and myocardial ischemia. Bacteriologic data of all clinical cultures were reviewed and infection-related outcomes were examined. Hospital-acquired infection occurred in 79 (66.4%) of 119 patients who developed postoperative complications. Review of microbiology data (total, 197 bacterial isolates) confirmed that gram-positive organisms were the leading cause of infections, with 120 gram-positive isolates (60.9%). Of the gram-positive isolates, S. aureus was the most common pathogen, isolated in 73 (60.8%) cultures. The single most prevalent organism was MRSA, identified in 42 of 73 (57.5%) of cultures. The site of MRSA infection was confirmed to be the surgical site (54.8%), sputum (17.0%), blood (14.3%), urine (9.5%), peritoneal fluid (2.4%), or catheter insertion site (2.4%). Only four patients had prior MRSA infection or colonization. Prosthetic vascular grafts were placed in 51 (42.9%) of the 119 vascular patients, and 26 patients (51.6%) acquired MRSA infection. Graft removal was required in three patients due to infection (MRSA infection in two patients, Pseudomonas aeruginosa in one patient). Forty percent of patients with MRSA infection required an amputation as their surgical procedure. No patient died of MRSA bacteremia during the study period. Mean hospital length of stay (LOS) was longer in patients with MRSA infection (29.6 d vs. 22.7 days, range 2-174 days, p < 0.05) compared to the total study cohort of vascular patients with postoperative infections. Methicillin-resistant S. aureus has emerged as the leading cause of postoperative infection in vascular surgery patients, and is associated with substantial morbidity, increased hospital LOS, and higher incidences of amputation and graft removal. Greater emphasis on preoperative screening protocols for MRSA colonization is warranted, in conjunction with aggressive infection control measures, alteration of preoperative prophylactic antimicrobial use in MRSA-colonized patients, and meticulous postoperative surveillance for MRSA infection. Furthermore, antimicrobial treatment of postoperative infectious complications in vascular surgery patients should include empiric coverage for MRSA in institutions where MRSA is endemic.

Study of developed resistance due to antibiotic treatment of coagulase-negative Staphylococci.

Coagulase-negative Staphylococci (CoNS) are a major cause of postoperative infections. These infections are often associated with foreign material implants and/or a compromised immune system in the patient. Multiresistant strains are increasingly common in the hospital environment and there is concern that the infections will become difficult or impossible to treat. This report is based on a study of 75 patients, with postoperative infections caused by CoNS after thoracic surgery. All patients were treated with surgical revision and antibiotic therapy. One or more bacterial cultures were made in each case, and the resistance pattern of the CoNS found was determined. The goal of the study was to evaluate possible relationships between antibiotic therapy and the appearance of resistance to antibiotics in CoNS found. To describe this relationship, three models were constructed and analyzed by multiple logistic regression. The results indicate an increased resistance to beta-lactam antibiotics and clindamycin after the use of cephalosporins. Also, the use of vancomycin or vancomycin in combination with rifampicin or fusidic acid increases the risk for development of resistance to beta-lactam antibiotics, ciprofloxacin, fusidic acid, clindamycin, netilmycin, and rifampicin. The hypothesis that a combination of antibiotics will curtail the development of resistance was not supported in this study.

No Routine Role for Mupirocin Before Surgery

Staphylococcus aureus is a common cause of postoperative infections, especially among the 25% to 30% of the population who carry this organism in their

The Effects of Ketorolac on T Cell Subsets in Patients Undergoing a Gastrectomy

Background: Perioperative procedures like surgery, anesthesia, pain control etc. induce immunosuppression and this immunosuppression can be the cause of postoperative infection or micrometastasis. PGE2 is the major cytokine related to immunosuppression especially in tissue trauma. NSAIDs blocked the cyclo-oxygenase pathway and then reduced PGE2 production. Therefore, we studied immunologic changes during a gastrectomy, and the effects of ketorolac administration. We used T cell subsets as immunologic indicator. Methods: Forty patients scheduled for a gastrectomy due to stomach cancer were randomly allocated to the control group or the ketorolac group. The ketorolac group received 60 mg ketorolac before anesthesia and then 30 mg 6 hours later. Blood sampling was done before anesthesia, 2 hours and 24 hours after anesthesia. T cell subsets were studied by a monoclonal antibody technique. We also observed postoperative demerol consumption, side effects, infection, and discharge date. A Student's t-test, MannWhitney Rank Sum Test, and Chi-square were used for between groups comparisons, and a repeated measured ANOVA and then multiple comparison by the Tukey or Dunnett test for within-group comparison. Results: T4 was decreased to 89.3%, 81% at 2 hours, and 24 hours in the control group but increased to 128.4%, 104.6% in the ketorolac group. T8 was not different between or within-groups. The T4/T8 ratio was decreased to 83.5%, 84.9% at 2 hours, and 24 hours in the control group but increased to 117.7%, 107.2% in the ketorolac group. 24 hour demerol consumption was higher in the control group than in the ketorolac group. Duration of infection and hospitalization were prolonged in the control group by 1 and 2 days each. Conclusions: Ketorolac increased the T4/T8 ratio and reduced demerol consumption, infection, and hosipitalization. Therefore ketorolac could help reverse immunosuppression during the perioperative period especially in immunocompromised patients. (Korean J Anesthesiol 2001; 40: 201∼209) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Lessons learned from studies on immune-nutrition inpostoperative patients

Current opinion supports the use of perioperative TPN in patients with gastrointestinal disease only if they are severely malnourished (1-3). There is, however, a substantial body of data suggesting that one major cause of postoperative infection is the decrease in immune response due to surgical trauma, anaesthesia, perioperative care and the disease itself irrespective of the nutritional status of the patients. There is also experimental and clinical evidence that some nutritional substrates have important immune-enhancing effects, and that nutrition via the enteral route is more beneficial in modulating metabolic response to the surgical trauma than intravenous nutrition. The purpose of this paper is to briefly review the main metabolic effects of certain immune-enhancing substrates in human beings, to report on randomized clinical trials in surgical patients, and to speculate on the preliminary conclusions of these clinical investigations.

Translocation of microbial organisms to pelvic lymph nodes as a possible cause of postoperative infection in gynecologic oncology patients

Translocation of microbial organisms to pelvic lymph nodes as a possible cause of postoperative infection in gynecologic oncology patients

Neutrophil function and cardiopulmonary bypass in humans. The effects of glucose and non-glucose containing bypass pump priming fluids

Defective polymorphonuclear neutrophil function during cardiopulmonary bypass (CPB) has been implicated as a cause of postoperative infection following open-heart surgery. Neutrophil function is known to be impaired in poorly controlled diabetics with elevations of blood glucose concentrations of the order which occur frequently during CPB when glucose containing priming fluids are used. Neutrophil function, as measured by bactericidal assay, and neutrophil and whole blood luminol dependent chemiluminescence, was studied in two groups of 1 2 patients undergoing coronary artery bypass graft surgery. Patients received either a glucose or non-glucose containing bypass pump-priming fluid. Postoperatively neutrophil luminol-dependent chemiluminescence was significantly increased in both groups (glucose prime groups p &lt; 0.01, non-glucose prime group p &lt; 0.01). Whole blood chemiluminescence was increased significantly intra and postoperatively in the glucose prime group ( p &lt; 0.02, p &lt; 0.02 respectively) but the increase was not significant in the non-glucose prime group. Bactericidal activity remained unchanged during and after surgery in both groups (mean bactericidal index intraoperatively 96.4 glucose group, 96.2 non-glucose group; postoperatively 99.7 glucose group, 99.7 non-glucose group). These data suggest that glucose containing bypass priming fluids do not modulate significantly the function of circulating neutrophils after CPB. Neutrophil function was not decreased after surgery, and other factors may be responsible for the reported higher incidence of bacterial infection after CPB.

Airborne contamination and postoperative infection after total hip replacement

The results of 163 hip replacements at the Uppsala University Hospital are presented. Deep infection occurred in ten cases and was caused by Staphylococcus aureus in four early or intermediate infections and by anaerobes in four late infections. The remaining two infections (both of which were late) were probably associated with Staphylococcus albus--in one case possibly also with alpha streptococci. Two superficial infections not affecting the operative result were caused by Staphylococcus aureus and betahaemolytic streptococci. The results of environmental analyses of staphylococci and the total number of bacteria in the air during 77 operations did not indicate that airborne infection is a major cause of postoperative infections--there was no difference between the number of bacteria found in the air during operations after which infection occurred and uninfected operations, and the use of special zonal ventilation with high rates of air exchange in the operating area had no effect on the infection frequency.