Cause Of Surgical Site Infections Research Articles

The Impact of an Evidence-Based Bundle on Cesarean Section-Related Surgical Site Infections: A Randomized Clinical Trial

Abstract Objective To compare the effectiveness of an evidence-based bundle in minimizing cesarean section (CS)-related surgical site infections (SSIs) with that of standard routine care. Methods This was a single-center, parallel, and randomized clinical trial conducted at KAHER’s Dr. Prabhakar Kore Charitable Hospital, Belagavi, India, from January 2021 to December 31, 2021. Three hundred twenty women undergoing CS delivery were selected and allocated into two groups (1:1) using simple randomization with fixed allocation. An evidence-based surgical bundle (a combination of more than three perioperative interventions) was used for the intervention group, whereas the control group received routine standard perioperative care. The primary outcome was the incidence of SSI (superficial, deep, and organ or space SSIs) within 6 weeks postpartum in both groups. Categorical and continuous data were analyzed using appropriate statistical tests with a significance threshold set at P < 0.05. Results In this study, 16 and 17 participants each from the control and intervention groups, respectively, were lost to follow-up, resulting in a total of 144 and 143 study participants included in the respective groups. Twenty-eight (19.4%) and 14 (9.8%) women developed SSI in the control and intervention groups, respectively (P = 0.02). Methicillin-resistant Staphylococcus aureus was the most common cause of SSI in both groups (63.6% (7/11) and 100% (3/3) in the control and intervention groups, respectively). Conclusion The use of the evidence-based bundle for CS-related SSI prevention effectively decreased the incidence of SSI by half compared to standard routine practice. Implementing the use of this bundle in routine perioperative care will reduce the cost of CS and improve health outcomes in CS. Trial registration Clinical Trials Registry-India (www.ctri.nic.in). Registration number: CTRI/2020/11/029246.

National variation in prophylactic antibiotic use for elective primary total joint replacement.

Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance. The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital's website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance. The primary choice and dosing of the prophylactic antimicrobial regimens varied widely. The two most used regimens were combined teicoplanin and gentamicin, and cefuroxime followed by two or three doses of cefuroxime eight-hourly, recommended by 24 centres (22.02%) each. The alternative choice and dosing of the prophylactic antimicrobial regimen also varied widely across the 83 centres with data available. Prophylaxis regimens across some centres fail to cover the likeliest causes of surgical site infection (SSI). Five centres (4.59%) recommend co-amoxiclav, which confers no Staphylococcus coverage, while 33 centres (30.28%) recommend cefuroxime, which confers no Enterococcus coverage. Limited adherence to 2018 Philadelphia Consensus Guidance was observed, with 67 centres (61.50%) not including a cephalosporin in their guidance. This analysis of guidance on antimicrobial prophylaxis in primary arthroplasty across 109 hospitals and trusts in the UK has identified widespread variation in primary and alternative antimicrobial regimens currently recommended.

IMPACT OF ACTIVE SURVEILLANCE SCREENING OF MRSA ON SURGICAL SITE INFECTION RATES- A PROSPECTIVE INTERVENTIONAL STUDY

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common cause of surgical site infections. Different methods are employed to reduce nosocomial spread including application of Isolation precautions, admission screening cultures and MRSA decolonization 3,4,5,6,7. Preoperative MRSA screening in patients undergoing cardiac surgeries can reduce the risk of surgical site infections. To evaluate the significance of preoperative MRSA screening on rates of surgical site infections in cardiac surgery patients Material and Methods: This was a prospective interventional study, conducted at the National Institute of Cardiovascular diseases, Karachi from 1st February 2022- 31st July 2022. Preoperative MRSA screening in patients undergoing cardiac surgeries was performed at the Microbiology Laboratory. Patients identified as colonized were isolated and decolonized with chlorhexidine baths prior to surgeries. Surgical site infections (SSIs) rates were recorded by Infection control nurse through active surveillance for the screening period. SSI rates for a prescreening period of 6 months (August 2021- January 2022) was retrieved through electronic medical records for comparison. Results: Total 359 patients were screened from 1st February 2022- 31st July 2022, out of which 20 were colonized with MRSA. None of the patients who screened positive for MRSA developed SSI. 11 SSIs with MRSA were reported from August 2021- January 2022 and 4 SSIs were reported from February 2022-July 2022 (p value < 0.05). Conclusion: It can be concluded that active MRSA screening and subsequent implementation of decolonization policy would decrease the percentage of SSI in cardiac surgery Keywords: MRSA, Screening, Surgical site infection, Surveillance

Prevalence and Antibiotics resistance profile of Staphylococcus aureus isolated from post-operative wounds in secondary health facilities of Ilorin metropolis, Kwara State, Nigeria

Healthcare-associated infections are of different forms, with Surgical Site Infections (SSI) being the second most common type, they continue to be a relatively common postoperative complications and the most frequent reason for re-admission following surgery. Several data from around the world revealed Staphylococcus aureus to be the leading cause of surgical site infection. Therefore, this study aimed to determine the occurrence and drug resistance profile of Staphylococcus aureus and Methicilin Resistant Staphylococcus aureus isolated from post-operative wounds in secondary health facilities within the Ilorin metropolis. With the aid of sterile cotton swabs, a total of hundred and thirty-two (132) wound swab samples were obtained from patients who had been clinically diagnosed with surgical site infection. These samples were processed as per standard microbiological techniques. Staphylococcus aureus was isolated at an occurrence rate of 15.2%. Chi-square analysis showed that there was a significant difference in the number of isolates in relation to both hospitals (GHI and CHO) (p<0.05), the highest occurrence of Staphylococcus aureus (12.6%) was seen in GHI, while an occurrence rate of (24.1%) was recorded at CHO. The antimicrobial susceptibility profile revealed that 8(40%) of the S.aureus isolates were Methicilin Resistant Staphylococcus aureus (MRSA). S.aureus showed 100% susceptibility to Tigecycline and it was 100% resistant to Cefoxitin. Therefore, these findings affirmed that there is significant resistance in Staphylococcus aureus isolated from post-operative wounds in health facilities of the Ilorin metropolis.

Epigenetic Regulation of Leukocyte Inflammatory Mediator Production Dictates Staphylococcus aureus Craniotomy Infection Outcome.

Staphylococcus aureus is a common cause of surgical-site infections, including those arising after craniotomy, which is performed to access the brain for the treatment of tumors, epilepsy, or hemorrhage. Craniotomy infection is characterized by complex spatial and temporal dynamics of leukocyte recruitment and microglial activation. We recently identified unique transcriptional profiles of these immune populations during S. aureus craniotomy infection. Epigenetic processes allow rapid and reversible control over gene transcription; however, little is known about how epigenetic pathways influence immunity to live S. aureus. An epigenetic compound library screen identified bromodomain and extraterminal domain-containing (BET) proteins and histone deacetylases (HDACs) as critical for regulating TNF, IL-6, IL-10, and CCL2 production by primary mouse microglia, macrophages, neutrophils, and granulocytic myeloid-derived suppressor cells in response to live S. aureus. Class I HDACs (c1HDACs) were increased in these cell types in vitro and in vivo during acute disease in a mouse model of S. aureus craniotomy infection. However, substantial reductions in c1HDACs were observed during chronic infection, highlighting temporal regulation and the importance of the tissue microenvironment for dictating c1HDAC expression. Microparticle delivery of HDAC and BET inhibitors in vivo caused widespread decreases in inflammatory mediator production, which significantly increased bacterial burden in the brain, galea, and bone flap. These findings identify histone acetylation as an important mechanism for regulating cytokine and chemokine production across diverse immune cell lineages that is critical for bacterial containment. Accordingly, aberrant epigenetic regulation may be important for promoting S. aureus persistence during craniotomy infection.

The Emerging Paradigm of Antimicrobial Resistance in Surgical Site Infections of the Nilgiris Region

The rise of multidrug-resistant bacterial species in hospitals becomes a global challenge for surgeons who treat healthcare-associated infections. This study aimed to identify the pathogens involved in surgical site infections (SSI) as well as the prevalence of antibiotic resistant bacteria in the Nilgiris region. A hospital-based retrospective study was conducted for three years, at Microbiology Laboratory, the Govt. Medical College Hospital, where the clinical samples were collected, cultured, and identified. Antibiotic susceptibility was assessed using Kirby Bauer’s disc diffusion method. Out of 513 pus samples (from SSI), 242 (47%) have shown positive microbial growth. These isolates were evaluated for antimicrobial resistance using 20 antibiotics belonging to different groups. Staphylococcus aureus was found to be more prominent (69%), followed by Enterococcus species (14.5%) and Streptococcus species (10.3%). Other species like Proteus species, Klebsiella species, Escherichia coli, and Pseudomonas aeruginosa account for less than 2%. These results clearly indicate that Staphylococcus aureus was the leading cause of surgical site infections. Among the antibiotics studied, Staphylococcus aureus was found to be more resistant to Penicillin G (84%) followed by Ampicillin (23%). The high rate of antibiotic resistance highlighted the need for an antibiotic policy that encourages more rational use of antibiotics.

Experimental study on the generation of aerosol particles and microorganisms from surgical staff in an operating room

Surgical site infections (SSIs) will result in longer patient stays and increased hospital costs. Airborne microbe-carrying particles are one of the main causes of SSIs, which mainly originate from the surface release of the surgical team. Therefore, an assessment of the amount of aerosol particles and microorganisms emitted by surgical staff is necessary. This study implemented an experimental chamber test method in a full-size operating room for four garment systems and nine movement combinations. The results presented the emission rates of particles and microorganisms released by the surgical staff as well as microbiome analysis. Larger areas of skin exposure may result in more microbial and particle emissions. The average microbial emission rates were 54.4 and 35.6 CFU/(person•min) when wearing disposable sterile surgical suit and protective clothing suit, respectively. The type and intensity of movement could also significantly affect the number of microorganisms and particles emitted. The quantitative results of microorganisms and particles emitted from surgical staff are expected to contribute to the effective prevention of SSIs.

SG-APSIC1206: Effectiveness of sterilization practice in reprocessing medical devices among different multidisciplinary tertiary-care hospitals in Dhaka City

Objectives: Sterilization failure is one of the main causes of surgical-site infections. We assessed the effectiveness of the sterilization process of surgical instruments to determine the reasons for sterilization failure. Methods: In total, 100 sterilization cycles were observed from February 4, 2022, to September 5, 2022, in hospitals in Dhaka City. We used sterilization quality assurance monitoring tools (ie, biological indicators) for rapid steam and ethylene oxide sterilization methods. Tests were performed using an automatic reading machine, chemical indicator strips, and indicator tape for both steam and ethylene oxide methods. For laboratory testing and data collection, APSIC guidelines were followed. All samples were incubated for 48 hours to cross check the accuracy of the auto-reader result. Results: All ethylene oxide sterilization cycles were 100% successful, as shown by the rapid biological indicator (auto-reader), chemical indicator strips, and indicator tape. However, 22% sterilization failure occurred with steam sterilization, which was confirmed by the auto-reader, chemical indicator strips, and indicator tape. All biological samples showed no growth after 48 hours of incubation, except the sample from steam sterilization, which did show growth after 48 hours of incubation. Conclusions: We detected 22% steam sterilization failure, and serious harm to patients could occur if these surgical instruments were used for surgery. Process recall would not have been not possible if rapid biological indicator tests had not been performed and other chemical monitoring tools had not been used. The regular use of monitoring tools according to guidelines can be a reliable solution to reduce surgical site infections caused by inappropriate sterilization of surgical instruments.

Recent advances in the treatment of biofilms induced surgical site infections.

Recent advances in the treatment of biofilms induced surgical site infections.

Surgical site infections in thyroid and parathyroid surgery in Japan: An analysis of the Japan Nosocomial Infections Surveillance database from 2013 to 2020.

Surgical site infections (SSIs) after thyroid surgery are rare complications, with incidence rates of 0.3%-1.6%. Using a Japanese database, we conducted exploratory analyses on the incidence of SSIs, investigated the incidence of SSIs by the National Nosocomial Infections Surveillance risk index, and identified the causative bacteria of SSIs. SSIs occurred in 50 (0.7%) of 7388 thyroid surgery cases. Risk index-0 patients had the lowest incidence rate of SSIs (0.41%). The incidence of SSIs in risk index-1 patients was 3.05 times the incidence of SSIs in risk index-0 patients. The rate of SSI occurrence for risk index-2 patients was 4.22 times the rate of SSI occurrence for risk index-0 patients. Thirty-one bacterial species were identified as the cause of SSIs in thyroid surgery cases, of which 12 (38.7%) SSIs were caused by Staphylococcus aureus and Staphylococcus epidermidis. Of the nine SSIs caused by Staphylococcus aureus, 55.6% (five cases) were attributed to methicillin-resistant Staphylococcus aureus. Therefore, routine prophylactic antibiotic administration should be avoided, while the target for administration should be narrowed, according to the SSI risk. Administration of prophylactic antibiotics, such as 2 g piperacillin or 1 g cefazolin, is considered appropriate.

Periodontal disease as a primary cause of surgical site infection in fractures of the mandible: is smoking a confounding variable?

Fractures of the mandible are common in contemporary oral and maxillofacial practice. Wound infection is the most common complication after open reduction and internal fixation, and the management of these is complex and costly in terms of morbidity to the patient, and in fiscal terms. Whilst numerous epidemiological studies implicate smoking, alcohol, drug use, and adverse behaviour, as well as fracture complexity and diabetes, as important risk factors, the role of periodontal disease is only occasionally mentioned and not formally investigated. The aim of this study therefore was to assess the presence of periodontal disease and its severity according to the 2018 EFP/AAP periodontitis case classification in patients with fractured mandibles who presented to a single level 1 trauma centre, and to look for a possible association with surgical site infection. A total of 305 patients were assessed retrospectively following open reduction and internal fixation via transoral incisions with load-sharing osteosynthesis. The postoperative infection rate was 22.95%. Multivariate and multiple logistic regression revealed that there was a strong association between periodontal staging and postoperative surgical site infection. Crucially, the study predicts that patients with severe periodontal disease (periodontal stage III and IV) are over seven times more likely to develop a wound infection than disease-negative individuals. This has implications for risk adjustment, prognostication, treatment planning, and postoperative care. Surprisingly in this study, cigarette smoking, an established risk factor in the pathogenesis of periodontal disease, did not achieve statistical significance, potentially conflicting with the established literature.

Nano zinc oxide decorated latex drainage: A promising antibacterial material prevent retrograde infection associated with drainage.

Surgical site infections (SSI) represent a considerable burden for healthcare systems. Studies show retrograde infection of the drainage tube is an important cause of surgical site infection. To this end, Surgeons work in various ways to reduce the incidence of retrograde infections. Fast progress in nanoscience and nanotechnology is revolutionizing the field of medicine to improve the quality of life due to the myriad of applications stemming from their unique properties, including the antibacterial activity against pathogens. Herein, we investigate the antibacterial properties of a novel nanomaterial composed of nano zinc oxide-decorated latex drainages. These materials were produced by the hydrothermal method and characterized through field-emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD), and DLS (Dynamic light scattering techniques). Then inductively coupled plasma mass spectrometry (ICP-MS) measurements showed that nano zinc oxide on the surface of the latex drainages showed a gradient release process. The antimicrobial activity of nano zinc oxide -decorated latex drainage was evaluated against E. coli and Staphylococcus aureus, the main bacteriological agent in the retrograde infection associated with drainage. The results showed that slices and rods nano zinc oxide (SAR-ZnO) drainage tubes had the best antibacterial properties both in vivo and in vitro. In addition, the cell viability assay demonstrated that nano zinc oxide-decorated latex drainages exerted good biocompatibility. Therefore, SAR-ZnO drainage tubes can be a perfect nanomaterial against the retrograde infection associated with drainage.

Drug-Resistant Strains in Surgical Site Infections after Abdominal Surgery: A Prospective Study

Background Surgical site infection (SSI) is a common complication of abdominal surgery associated with substantial discomfort, morbidity, and cost. Objective The aim of this study was to determine the incidence, risk factors, and antimicrobial susceptibility pattern of the associated bacterial causes of SSI in patients after abdominal surgery. Methods A prospective study over a 1-year (Jan 2019–Dec 2019) period was conducted at a tertiary care institution in North India. Postoperative patients of abdominal surgeries with SSI were included in the study. Any exudate from the surgical site was collected aseptically and was processed as per standard operating procedures. Results Of 2,509 patients with abdominal surgeries included in the study, 75 (2.98%, majority, i.e., 50 males) developed SSI. Common risk factors found to be associated with the development of SSI include contaminated surgical sites, obesity, age, immunosuppression, and simultaneous infection at some other sites, with a predominance (89.3%) of gram-negative isolates. Escherichia coli was the most frequently isolated organism (45.3%), followed by Klebsiella spp. (20%), Acinetobacter spp.(10.6%), Pseudomonas spp., and Staphylococcus aureus (8% each). There was a very high (53%) prevalence of extended-spectrum β lactamase production among the E. coli and Klebsiella isolates. Additionally, 58.8% of the E. coli isolates were multidrug-resistant, whereas 73.3% of the Klebsiella isolates were exclusively drug resistant. All the S. aureus isolates were found to be methicillin-resistant. Conclusion Although the SSI rates after abdominal surgery were low, multidrug-resistant gram-negative bacteria were predominant in SSI.

Instrument tables equipped with local unidirectional airflow units reduce bacterial contamination during orthopedic implant surgery in an operating room with a displacement ventilation system

SummaryBackgroundAirborne bacteria present in the operating room may be a cause of surgical site infection, either contaminating the surgical wound directly, or indirectly via e.g. surgical instruments. The aim of this study was to evaluate if instrument and assistant tables equipped with local unidirectional airflow reduce bacterial contamination of the instrument area to ultra clean levels, during orthopedic implant surgery in an operating room with displacement ventilation.MethodsLocal airflow units of instrument and assistant tables were either active or inactive. Colony forming units were sampled intraoperatively from the air above the instruments and from instrument dummies. A minimum of three air samples and two-three samples from instrument dummies were taken during each surgery. Samples were incubated on agar for total aerobic bacterial count. The mean air and instrument contamination during each surgery was calculated and used to analyze the difference in contamination depending on use of local airflow or not. All procedures were performed in the same OR.Results188 air and 124 instrument samples were collected during 48 orthopedic implant procedures. Analysis showed that local unidirectional airflow above the surgical instruments significantly reduced the bacterial count in the air above assistant table (P<0.001) and instrument table (P=0.002), as well as on the instrument dummies from the assistant table (P=0.001).ConclusionsInstrumentation tables equipped with local unidirectional airflow protect the surgical instruments from bacterial contamination during orthopedic implant surgery and may therefore reduce the risk of indirect wound contamination.

The effectiveness of prophylactic antibiotics and betadine skin preparation on cranial cutaneous Cutibacterium acnes – A prospective study

BackgroundCutibacterium acnes, formerly known as Propionibacterium acnes, is increasingly recognized as a cause of surgical site infection and implant failure despite the use of prophylactic antibiotics and antiseptic surgical preparations. The aim of this study was to investigate whether C. acnes persists in the dermal layer of the skin after standard perioperative antibiotics and skin prepping with alcoholic betadine solution in consecutive patients undergoing a craniotomy. MethodsA single centre prospective observational study was performed at Flinders Medical Centre. Adult patients undergoing a cranial neurosurgical intervention between October 2019 to March 2021 were eligible for inclusion. After administration of standard preoperative antibiotics (Cefazolin), three swabs were taken for each patient: one before prepping the skin with alcoholic betadine, one after prepping the skin and a dermal swab once the skin was incised. Results73 patients were included. Cutibacterium acnes cultures were positive in 61 patients of the “pre-prep” group (83.6%), 12 (16.4%) in the “post-prep” group, and 53 (72.6%) were from dermal swabs There was a significant reduction of positive cultures of the skin after surgical preparation was applied (p < 0.00001). There was a non-significant reduction of positive cultures in the dermal swabs after skin preparation (p = 0.068) ConclusionsCutibacterium acnes persists within the dermis of the scalp despite standard prophylactic measures using alcoholic betadine solution and cefazolin.

Isolation and Identification of Microbes from Mobile Phones in Orthopedic Operation Theatre

Background: Post-operative infection in orthopedic surgery is an emerging problem for the orthopedic surgeons and patients. Mobile phones are the most common object brought in theatre by the health professionals and are contaminated by different strains of bacteria which may be the cause of surgical site infection. Objective: To isolate and identify the microbes on the surface of the mobile phones of the hospital staff in orthopedic operation theatre. Methods: Samples were taken from the mobile phones of the health care professionals (Surgeons, assistants, Anesthetists, Staff nurses and paramedical staff) entering the operation theatre of the LIHAS (Lahore Institute of Hand and Arm Surgery). All the samples were taken using the culture swab sticks on both sides of the mobile phones of the health care staff of operation theatre on the same day. Results: The total numbers of mobile phone sampled were 45. 97.3% of the cell phones were contaminated with one or more bacteria and the most common bacteria isolated was Staphylococcus Epidermidis (62.22%) followed by Staphylococcus Aureus (42.2%), Micrococcus (37.77%), Bacillus (33.33%), E.Coli (31.11%), Pseudomonas Aerugonosa (22.22%) and others including Proteus Mirabilis, Enterobacter and Acinetobacter Baumannii (8.88%). Conclusion: It is concluded that the mobile phone can be the major source of contamination in operation theatre, so the use of mobile phone in the theatre should be minimized and should encourage to clean the phone regularly. Key words: Orthopedic operation theatre, contamination, Mobile phones.

Surgical site infections caused by multi-drug resistant organisms: a case–control study in general surgery

Multi-drug resistant organisms (MDR-Os) are emerging as a significant cause of surgical site infections (SSI), but clinical outcomes and risk factors associated to MDR-Os-SSI have been poorly investigated in general surgery. Aims were to investigate risk factors, clinical outcomes and costs of care of multi-drug resistant organisms (MDR-Os-SSI) in general surgery. From January 2018 to December 2019, all the consecutive, unselected patients affected by MDR-O SSI were prospectively evaluated. In the same period, patients with non-MDR-O SSI and without SSI, matched for clinical and surgical data were used as control groups. Risk factors for infection, clinical outcome, and costs of care were compared by univariate and multivariate analysis. Among 3494 patients operated on during the study period, 47 presented an MDR-O SSI. Two control groups of 47 patients with non-MDR-O SSI and without SSI were identified. MDR-Os SSI were caused by poly-microbial etiology, meanly related to Gram negative Enterobacteriales. MDR-Os-SSI were related to major postoperative complications. At univariate analysis, iterative surgery, open abdomen, intensive care, hospital stay, and use of aggressive and expensive therapies were associated to MDR-Os-SSI. At multivariate analysis, only iterative surgery and the need of total parenteral and immune-nutrition were significantly associated to MDR-Os-SSI. The extra-cost of MDR-Os-SSI treatment was 150% in comparison to uncomplicated patients. MDR-Os SSI seems to be associated with major postoperative complications and reoperative surgery, they are demanding in terms of clinical workload and costs of care, they are rare but increasing, and difficult to prevent with current strategies.

Knowledge and Awareness about Wound Infection after Surgery among Population in Saudi Arabia

Background: Surgical site infections (SSI) continue to be one of the most common post-operative consequences following surgery, it is an infection that develops in the incision made during a surgical operation is a significant cause of hospital morbidity, increasing ICU admission rates, hospital readmission, lengthening total hospital stay and tripling death rates. To assess knowledge and awareness about wound infection after surgery among population in Saudi Arabia.&#x0D; Materials and Methods: A cross-sectional study was conduct in Saudi Arabia during July to December 2021, we distributed our questionnaire in Kingdome of Saudi Arabia, the participants involving general population adult living in Saudi (&gt;15). The sample size was 3357 participants. The sample size was estimated using the Qualtrics calculator with a confidence level of 95%. Our inclusion criteria were Age,15 years old and older, residency in Saudi Arabia, Male and female, Saudi and non-Saudi, agree to participate. Analyzes was done by using the “Microsoft Office Excel Software” (2019) for Windows was used to enter data on the computer. The data was then statistically evaluated using the SPSS program, version 23.&#x0D; Results: 63.8% of the participants were females. More than half of the respondents were younger than 25 years old. Most of the respondents (9.1%) had a university degree or higher education. Regards area of residence, 10.1% lived in Riyadh, 14.0% in Medina. The prevalence of SSI was 8.0%. There are 50.2% of respondents have reported that times being admitted to hospital were 5 or less, 53.9% have denied history of undergoing other previous surgeries. Also, 95.5% of respondents denied having a hospital acquired infection besides surgical site infection.&#x0D; Conclusion: SSI is one of the commonest healthcare related infections which have a great impact on patient morbidity and mortality. The causes of SSIs are multi-factorial. The antimicrobial regimen isn’t much more effective than the persuasive strategy in controlling antimicrobial use in the long-term. Moreover, in many settings, there may be inadequate personnel for a restrictive approach and restriction strategies are unable to consider the appropriateness of use of non-restricted antibiotics, which forms the vast majority of antibiotics used in hospital.

Sanguiin H-6 Fractionated from Cloudberry (Rubus chamaemorus) Seeds Can Prevent the Methicillin-Resistant Staphylococcus aureus Biofilm Development during Wound Infection.

Staphylococcus aureus is the most common cause of surgical site infections and its treatment is challenging due to the emergence of multi-drug resistant strains such as methicillin-resistant S. aureus (MRSA). Natural berry-derived compounds have shown antimicrobial potential, e.g., ellagitannins such as sanguiin H-6 and lambertianin C, the main phenolic compounds in Rubus seeds, have shown antimicrobial activity. The aim of this study was to evaluate the effect of sanguiin H-6 and lambertianin C fractionated from cloudberry seeds, on the MRSA growth, and as treatment of a MRSA biofilm development in different growth media in vitro and in vivo by using a murine wound infection model where sanguiin H-6 and lambertianin C were used to prevent the MRSA infection. Sanguiin H-6 and lambertianin C inhibited the in vitro biofilm development and growth of MRSA. Furthermore, sanguiin H-6 showed significant anti-MRSA effect in the in vivo wound model. Our study shows the possible use of sanguiin H-6 as a preventive measure in surgical sites to avoid postoperative infections, whilst lambertianin C showed no anti-MRSA activity.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

IntroductionThis study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication, i.e. postoperative surgical site infection (SSI) in cases with and without mastoid obliteration. Materials and methodsRetrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019. Patient characteristics, peri- and postoperative management and complications were reviewed. The cases were divided into two groups based on whether mastoid obliteration was performed or not. ResultsA total of 336 cholesteatoma operations were performed, of which 248 cases received mastoid obliteration. In total 21 complications were observed, of which SSI was the most common (15/21). No difference in occurrence of any postoperative complication was seen between the obliteration and no-obliteration group (p = 0.798), especially not in the number of SSI (p = 0.520). Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups. In the no-obliteration group a younger age (p = 0.015), as well as primary surgery (p = 0.022) increased the risk for SSI. In the obliteration group the use of bioactive glass (BAG) S53P4 was identified as independent predictor of SSI (p = 0.008, OR 5.940). DiscussionSSI is the most common postoperative complication in cholesteatoma surgery. The causes of SSI are multifactorial, therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.