Development Of Surgical Site Infection Research Articles

Prevalence of anaerobic bacteria in surgical site infections in Lagos University Teaching Hospital.

Surgical site infection (SSI) is the second most common cause of nosocomial infection, after urinary tract infection. Sequelae of SSI include increased healthcare costs and worse patient outcomes. There is a paucity of research studies on the impact of anaerobic organisms on SSIs in Nigeria. The aim of this study was to determine the role of anaerobic bacteria in SSI encountered at the Lagos University Teaching Hospital (LUTH). A total of 438 patients were consecutively recruited into this study from general surgery, obstetrics and gynaecology and paediatric units of the LUTH from 1 July through 31 December 2019. Two surgical wound specimens were collected from all patients with suspected SSIs. One was for anaerobic culture using Brucella blood agar incubated in an anaerobic jar that secured anaerobiosis using the anaerobic gas pack. The other swab was used for aerobic culture on blood agar incubated on air at 37oC. Identifications and antibiotic sensitivity testing were performed according to standard laboratory procedures. The overall incidence of SSI in the study was 12.3%. The incidence of anaerobic SSI was 1.1%. The distribution of anaerobic infections by medical specialty unit was as follows; general surgery (1.6%), obstetrics and gynaecology (0.8%) and paediatrics (0.9%). Bacteroides species was the only anaerobic isolate. The risk factors associated with the development of SSI by multiple logistic regression analysis were duration of surgery greater than 2 h (OR 1.418; 95% CI 1.834-9.286; P = 0.001) and NNIS risk index 2 and 3 - (OR 2.165; 95% CI 2.366-32.086; P = 0.001). The prevalence of anaerobic SSI was 1.1%. Duration of surgery greater than 2 h and NNIS risk index 2 and 3 were independent predictors of SSI.

Differential diagnosis and treatment of nosocomial spinal infections in patients after open microdiscectomy (brief literature review)

Surgical site infections (SSI) occur in 0.7‒16.1 % of cases and are one of the most frequent nosocomial complications in spinal neurosurgery. The frequency of SSI after open microdiscectomies varies from 1.9 % to 5.5 % depending on several factors and requires clarification. The causative agents of spinal SSI are most often Staphylococcus aureus, S. epidermidis, methicillin-resistant S. aureus, less frequently anaerobic strains, and Mycobacterium tuberculosis.Symptoms of deep SSI caused by the most common Gram-positive and Gram-negative microflora are usually nonspecific and include fever, back pain, and limited movement. Anaerobic spondylodiscitis is characterized by long-lasting back pain, mainly without an increase in temperature, and a high frequency of epidural abscess formation. The most significant factors in the occurrence of SSI are surgical access, type and duration of surgical intervention, the number of levels operated on at once, the duration of hospitalization, the presence of diabetes, and the patient’s high body mass index. However, the importance of each of these and other factors in the development of SSI after surgical interventions for clinically manifest discogenic pathology continues to be studied. In several studies, open microdiscectomies were statistically significantly associated with a higher frequency of SSI formation. Posterior spondylodesis and implants in the spine increase the risk of SSI development. Prevention of SSI should include preoperative, intraoperative, and postoperative stages, compliance with which can contribute to reducing the risk of SSI. Treatment of purulent spondylodiscitis involves antibiotic therapy and long-term dynamic observation. Indications for surgical intervention are the effectiveness of antibiotic therapy, deterioration of neurological symptoms, and violation of the integrity of the vertebrae with the formation of instability. The issue of choosing the optimal access and volume of surgical intervention for postoperative spondylodiscitis is analyzed in many studies and, first of all, is determined by: localization, the nature of structural changes, the presence of accompanying abscesses, the degree of neurological deficit, the presence or absence of vertebral compression fractures and signs of spondylolisthesis.Postoperative SSI worsens patients’ quality of life and disease prognosis in patients with discogenic pathology. A clear understanding of the individual risk factors of SSI, timely diagnosis, and differentiated treatment can prevent the formation of these dangerous complications and minimize their manifestations.

Frequency and Risk Factors of Surgical Site Infection among Sudanese Patients with Oral Squamous Cell Carcinoma.

In Sudan, patients with oral squamous cell carcinoma (OSCC) presented lately in advanced stages. Surgical site infection (SSI) is one of the most common complications of surgical treatment of OSCC which significantly affects the clinical outcomes. The present study aimed to assess the frequency and risk factors of postoperative surgical site infection among OSCC patients underwent surgery at Khartoum Teaching Dental Hospital (KTDH). This is a prospective, analytical, hospital-based study conducted at KTDH during the period from 2022 to 2023. Patients with OSCC were surgically treated and assessed carefully for the development of the SSI. Sixty patients were enrolled in the present study. Twenty-nine (48.3%) patients were above 61 years, with the predominance of males with 42 (70%) patients. The most involved site of OSCC was the lower gingivolabial region in 35 (39.3%) patients. Forty-seven (78%) patients were in advanced stages III and IV. Forty-five (80%) patients had modified radical neck dissection. Blood transfusion was administered in 50 (83.3%) patients. Twenty-six (43.4%) patients developed SSI; 15 (57.7%) patients of them were Toombak dippers. Development of SSI was found to be significantly associated with the tumour site (P value 0.9), clinical stage (P value 0.6), the number of transfused blood units (P value 0.04), and the duration of hospital stay (P value 0.04). In contrast, use of sutures for wound closure was associated with a reduced risk of developing SSI (P value 0.005). Surgical site infection was found in 43.4% of the OSCC patients. It was associated with advanced clinical stage and tumour site. Minimizing the number of blood units transfused intraoperatively, we decrease the duration of hospital stay and the use of sutures for wound closure decreases the risk of SSI significantly.

Impact of Intra-Operative Shock and Resuscitation on Surgical Site Infections After Trauma Laparotomy.

Background: Patients undergoing trauma laparotomy experience high rates of surgical site infection (SSI). Although intra-operative shock is a likely contributor to SSI risk, little is known about the relation between shock, intra-operative restoration of physiologic normalcy, and SSI development. Patients and Methods: A retrospective review of trauma patients who underwent emergent definitive laparotomy was performed. Using shock index and base excess at the beginning and end of laparotomy, patients were classified as normal, persistent shock, resuscitated, or new shock. Univariable and multivariable analyses were performed to identify predictors of organ/space SSI, superficial/deep SSI, and any SSI. Results: Of 1,191 included patients, 600 (50%) were categorized as no shock, 248 (21%) as resuscitated, 109 (9%) as new shock, and 236 (20%) as persistent shock, with incidence of any SSI as 51 (9%), 28 (11%), 26 (24%), and 32 (14%), respectively. These rates were similar in organ/space and superficial/deep SSIs. On multivariable analysis, resuscitated, new shock, and persistent shock were associated with increased odds of organ/space SSI (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.5; p < 0.001) and any SSI (OR, 2.0; 95% CI, 1.4-3.2; p < 0.001), but no increased risk of superficial/deep SSI (OR, 1.4; 95% CI, 0.8-2.6; p = 0.331). Conclusions: Although the trajectory of physiologic status influenced SSI, the presence of shock at any time during trauma laparotomy, regardless of restoration of physiologic normalcy, was associated with increased odds of SSI. Further investigation is warranted to determine the relation between peri-operative shock and SSI in trauma patients.

Use of liposomal bupivacaine in dogs and cats undergoing gastrointestinal surgery is not associated with a higher rate of surgical site infections or multidrug-resistant infections.

To report the rate of surgical site infections (SSIs) after clean-contaminated and dirty gastrointestinal surgery in dogs and cats that did and did not receive incisional infiltration of Nocita and report the bacteria isolated. Client-owned dogs (n = 211) and cats (78). Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and the University of Florida Small Animal Hospital between July 1, 2020, and April 1, 2023, were reviewed for surgical procedures, presence of preoperative septic peritonitis, use of Nocita, perioperative antibiotics administered, postoperative antibiotic use, SSI development postoperatively, and aerobic bacteria isolated. 7 of 124 (5.6%) dogs that received Nocita and 9 of 87 (10.2%) that did not receive Nocita developed an SSI. No dogs presenting with septic peritonitis and given Nocita (n = 5) developed an SSI. Two of 55 (3.6%) cats that received Nocita and 1 of 23 (4%) that did not receive Nocita developed an SSI. Multidrug-resistant (MDR) Escherichia coli was the most common aerobic bacteria isolated from SSIs (n = 3), and MDR bacteria were isolated commonly from both groups (4). Use of Nocita for gastrointestinal surgery in dogs and cats is not associated with higher rates of SSI than published rates of SSI after gastrointestinal surgery. Use of Nocita in dogs with preoperative septic peritonitis is not associated with the development of SSI. MDR bacteria are commonly isolated via culture from both dogs that received Nocita and those that did not.

Prevalence of and risk factors for surgical site infections after pancreaticoduodenectomy: a systematic review and meta-analysis.

Surgical site infections (SSIs) are one of the most common complications after pancreaticoduodenectomy (PD); however, the global prevalence and risk factors for SSIs after PD remain unknown. To investigate the prevalence of and risk factors for SSIs after PD. The PubMed, Embase, Cochrane Library, Web of Science, and Science Direct databases were systematically searched from inception to 1 December 2022. Observational studies reporting adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for SSIs in patients undergoing PD were included. Two independent reviewers in teams performed data extraction, risk of bias assessment, and level of evidence analysis. The pooled results were estimated using a random-effects model. The I 2 statistic and Q χ 2 statistic were used to assess heterogeneity. Funnel plots, Egger's regression test, and the trim-and-fill method were used to determine publication bias. The primary outcomes were identifying risk factors for SSIs after PD. The secondary outcomes were the pooled prevalence rates of SSIs. A total of 98704 patients from 45 studies were included, and 80% of the studies were considered high quality. The estimated pooled prevalence of SSIs was 23% (0.19-0.27, I 2=97%). The prevalence of SSIs was found to be higher in Japan and lower in USA. Preoperative biliary stenting, higher body mass index (BMI), longer operation time, postoperative pancreatic fistula, soft pancreatic texture, perioperative blood transfusion, and cardiac disease were identified as significant risk factors for the development of SSIs after PD. Additionally, broad-spectrum antibiotics were a significant protective factor against SSIs. Subgroup analysis and sensitivity analysis showed that the results were robust. The prevalence of SSIs remains high and varies widely among regions. It is necessary to take effective preventive measures and carry out more prospective studies to further verify these results.

Evaluation of Surgical Site Infection After Elective Surgeries at a Tertiary Care Hospital.

Surgical site infections (SSI) are commonly seen in surgical practice and are the main cause for concern in post-operative patients. There are many risk factors that predispose to the development of SSI. However, the occurrence of SSI in patients undergoing elective class I and class II surgeries, which are considered clean surgeries with minimal contamination, is an important issue bothering the surgeons. SSI are also responsible for increased morbidity due to wound dehiscence, thus prolonging hospital stays and often leading to inconvenience to patients. We hereby present a study to highlight and address this important issue of SSI in our institute. All patients above 12 years of age who underwent elective class I and class II surgeries in the department of general surgery were included in this observational study. After surgery, local examination of the incision or wound site and grading of the SSI were done using the Southampton Wound Grading System (SWGS). Our results showed that 90% of the patients had normal healing, according to SWGS. We found that the incidence of SSI was lower in patients who underwent alternate-day dressing of their wound as compared to daily dressing. Another interesting finding was that the incidence of SSI was lower in patients in whom wound dressing was done with transparent film dressing as compared to povidone-iodine-guaze dressing. We concluded our study by finding that the incidence of SSI after elective class I and class II surgeries in our hospital was quite low, at 10%.

Microbiological spectrum of SSI pathogens in patients with chronic infectious spondylitis requiring revision surgery: results of continuous monocentric 5-year monitoring

Objective. To analyze the results of the continuous monocentric 5-year microbiological monitoring of causative agents of surgical site infection (SSI) in patients who underwent primary surgery for chronic infectious spondylitis and required revision surgery.Material and Methods. The study included patient data from 2018 to 2022. The primary cohort included 569 consecutively operated patients with chronic infectious spondylitis of nonspecific (n1 = 214) and tuberculous (n2 = 355) etiology. The analyzed sample was formed taking into according to inclusion and exclusion criteria. Thus, in 99 patients who required revision surgical interventions due to the development of SSI, a continuous microbiological monitoring of pathogens was performed, including the assessment of drug resistance and the timing of the development of infectious complications. Periodization of the time of SSI development was performed according to the accepted classification of Prinz et al. (2020), the assessment of drug resistance spectrum was performed according to the EUCAST recommendations (2020) and taking into account the approved methodological recommendations.Results. In the general structure of surgical interventions for chronic infectious spondylitis, the share of revision interventions due to the development of SSI was 17.4 %. The highest incidence of complications was noted in the late postoperative period (χ2 = 9.237; p = 0.009). Bacterial detection from the material of vertebral localization was noted in 43 cases (48.3 %), pathogen strains were isolated in urine in 28 (60.8 %), in decubital ulcers in 11 (23.9 %) and in hemoculture in 7 (15.2 %) patients. Culture negative SSI was detected in 10 cases (10.1 %) in the late period. Infectious complications in the setting of chronic non-specific spondylitis were detected more frequently than in spondylitis of tuberculous etiology (χ2 = 21.345; p &lt; 0.001). Gram-positive multidrug-resistant and Gram-negative bacteria with extreme resistance prevailed in the microbiological landscape of late SSI, and Gram-positive strains without drug resistance in that of early and delayed SSI (χ2 = 17.516; p = 0.0032).Conclusion. Drug-resistant Gram-positive bacteria predominate in the structure of SSI with a significantly higher frequency of complication development. Nonspecific etiology of spondylitis is associated with a significantly higher incidence of SSI. In the absence of a positive result of bacteriological examination of the material of vertebral localization, it is advisable to collect blood, decubital ulcer secretion and urine sampling.

Effective Antimicrobial Prophylaxis in Surgery: The Relevance and Role of Pharmacokinetics-Pharmacodynamics.

Appropriate surgical antimicrobial prophylaxis (SAP) is an important measure in preventing surgical site infections (SSIs). Although antimicrobial pharmacokinetics-pharmacodynamics (PKPD) is integral to optimizing antibiotic dosing for the treatment of infections, there is less research on preventing infections postsurgery. Whereas clinical studies of SAP dose, preincision timing, and redosing are informative, it is difficult to isolate their effect on SSI outcomes. Antimicrobial PKPD aims to explain the complex relationship between antibiotic exposure during surgery and the subsequent development of SSI. It accounts for the many factors that influence the PKs and antibiotic concentrations in patients and considers the susceptibilities of bacteria most likely to contaminate the surgical site. This narrative review examines the relevance and role of PKPD in providing effective SAP. The dose-response relationship i.e., association between lower dose and SSI in cefazolin prophylaxis is discussed. A comprehensive review of the evidence for an antibiotic concentration-response (SSI) relationship in SAP is also presented. Finally, PKPD considerations for improving SAP are explored with a focus on cefazolin prophylaxis in adults and outstanding questions regarding its dose, preincision timing, and redosing during surgery.

Risk Factors for Surgical-site Infections After Liver Transplant: Does Perioperative Antibiotic Regimen Matter?

Surgical-site infections (SSIs) are common in liver transplant recipients. The optimal SSI antimicrobial prophylaxis agent and duration are not established. We aimed to explore risk factors for SSIs after transplant, with a particular interest in the impact of perioperative antibiotic regimen on the development of SSIs. Retrospective study of adults undergoing liver transplant across 3 transplant programs between January 1, 2020, and June 01, 2021. Of 557 patients included in the study, 32 (5.7%) were infected or colonized with a multidrug-resistant organism (MDRO) within 1 y before liver transplant. Narrow-spectrum SSI prophylaxis with ceftriaxone or cefazolin alone was administered in 488 of 577 patients (87.6%); the remaining 69 patients (12.4%) received broad-spectrum prophylaxis with vancomycin and aztreonam (n = 40), piperacillin-tazobactam (n = 11), carbapenems (n = 8), ceftriaxone and another antibiotic (n = 7), and others. Patients with pretransplant MDRO were more likely to receive broad-spectrum coverage than those without pretransplant MDROs (28.1% versus 11.4%, P = 0.005). SSIs were identified in 40 patients (7.2%); 25 (62.5%) were organ-space infections, 3 (7.5%) were deep incisional infections, and 12 (30.0%) were superficial incisional infections. The median time from liver transplant to SSIs was 14 d (interquartile range, 10-20.2). MDROs were identified in 12 SSIs (30%). Multivariable analysis revealed no significant association between antimicrobial spectrum and risk of SSIs ( P = 0.5), whereas surgical leak ( P <0.001) and reoperation ( P = 0.017) were independently associated with increased risk of SSIs. SSIs were not significantly associated with composite risk of death or liver allograft failure. The spectrum of antimicrobial prophylaxis did not impact the development of SSIs in liver transplant recipients.

Risk factors for surgical site infection after closed proximal humerus fractures.

Proximal humerus fractures are common in clinical practice, and there are relatively a few studies on postoperative incision infections of such fractures. The purpose of this study was to explore the risk factors for surgical site infection (SSI) after internal fixation in patients with closed proximal humerus fractures. Patients with closed proximal humerus fractures who underwent surgery from January 2016 to January 2022 were retrospectively analysed. Cases with superficial or deep infections within 3 months after surgery were in the infection group and the remaining cases were in the non-infection group. The types of pathogenic bacteria in the infection group were analysed. The potential risk factors for SSI in all patients were recorded: (1) patient-related factors: gender, age, body mass index (BMI), smoking, comorbidities; (2) trauma-related factors: mechanism of injury, Injury Severity Score, visual analogue scale, fracture type, soft tissue condition and combined dislocation; (3) laboratory-related indexes: haemoglobin, albumin; (4) surgery-related factors: time from injury to surgery, American Society of Anesthesiologists anaesthesia classification, surgical time, fixation mode, intraoperative blood loss, suture method, bone graft and postoperative drainage. The risk factors for the occurrence of SSI were analysed using univariate analysis and multivariate logistic regression. The incidence of SSI was 15.7%. The most common bacterium in the infection group was Staphylococcus aureus. High BMI (p = 0.033), smoking (p = 0.030), an increase in mean time from injury to definitive surgery (p = 0.013), and prolonged surgical time (p = 0.044) were independent risk factors for the development of SSI after closed proximal humeral fractures. In patients with closed proximal humerus fractures, weight loss, perioperative smoking cessation, avoidance of delayed surgery, and shorter surgical time may be beneficial in reducing the incidence of SSI.

The Effect of Operative Time on Surgical Site Infection Following Total Shoulder Arthroplasty.

Many factors contribute to the risk of surgical site infection (SSI) following total shoulder arthroplasty (TSA). Operative time is a modifiable factor that may contribute to SSI occurrence following TSA. This study aims to determine the correlation between operative time and SSI following TSA. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a total of 33,987 patient records were queried from 2006 to 2020 and sorted by operative time and the development of an SSI in the 30-day postoperative period. Odds ratio's for developing an SSI were calculated based on operative time. Of the 33,470 patients in this study, 169 patients developed an SSI in the 30-day postoperative period resulting in an overall SSI rate of 0.50%. A positive correlation was identified between operative time and the rate of SSI. An inflection point was identified at 180 minutes of operative time, with a significant increase in the rate of SSI occurrences for operative times over 180 minutes. Increased operative time was shown to be strongly correlated with an increased risk of SSI within 30 days following surgery, with a significant inflection point at 180 minutes. Target operative time for TSA should be under 180 minutes to reduce the risk of SSI.

Effectiveness of A Surgical Wound Care Bundle for Reducing Surgical Site Infection after Emergency Abdominal Surgery

Background: Surgical site infection (SSI) imposes a considerable financial burden to both hospital and patient by increasing the hospital stay, utilization of resources and readmission rates. This study compared the effectiveness of surgical wound care bundle concept with traditional ongoing wound care for reduction of SSI after emergency abdominal surgery. Methods: This cross-sectional analytical study was carried out in Department of Surgery of SSMC, for one-year period after ethical approval. A total of 120 patients who underwent emergency abdominal surgery were included after taking informed written consent and divided into two groups: Group-A (n=60, surgical wound care bundle) and Group-B (n=60, traditional ongoing care). A detailed history and thorough clinical examination were carried out in each patient. Data were collected in separated case-record form and analyzed by SPSS 24. Results: Mean age of Group A and Group B was 44.88±11.2 years and 44.82±13.3 years accordingly (p=0.391) with male majority in both groups (70% in Group-A and 80% in Group-B, p&lt;0.292). Both groups were statistically similar regarding comorbidities, baseline laboratory parameters and pre-operative diagnosis (p&gt;0.05). Group-B patients had higher frequency of SSI development compared to Group-A (43.3% vs. 15%, p=0.001). Besides, patients having traditional ongoing care had longer hospital duration than surgical wound care bundle (10.1±2.7 vs. 6.9±1.9 days, p&lt;0.01). Though not significant, 30-day readmission rate was also higher in Group-B than Group-A (16.7% vs. 5%, p=0.075). Conclusion: Surgical wound care bundle reduce surgical site infections in patients with emergency abdominal surgery. However, further multicenter studies are warranted. Sir Salimullah Med Coll J 2023; 31: 101-106

The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy

Lymph node surgery is commonly performed in the staging and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and, particularly, lymph node dissection (LND) to be plagued by high rates of wound complications, including surgical site infection (SSI) and seroma formation. This study evaluated the incidence of wound complications following lymph node surgery and provided the first published cost estimate of SSI associated with lymph node surgery in the UK. A retrospective cohort study of 169 patients with a histological diagnosis of primary skin malignancy who underwent SLNB or LND of the axilla and/or inguinal region at a single tertiary centre over a 2 year period was conducted. Demographic, patient risk factor, and operation characteristics data were collected and effect on SSI and seroma formation was analysed. Cost-per-infection was estimated using National Health Service (NHS) reference and antibiotic costs. A total of 146 patients underwent SLNB with a SSI rate of 4.1% and a seroma incidence of 12.3%. Twenty-three patients underwent LND with a SSI rate of 39.1% and a seroma incidence of 39.1%. Seroma formation was strongly associated with the development of SSI in both the SLNB (odds ratio (OR) =18.0, p<0.001) and LND (OR = 21.0, p=0.007) group. The median additional cost of care events and treatment of SSI in the SLNB and LND groups was £199.46 and £5187.04, respectively. SSI remains a troublesome and costly event following SLNB and LND. Further research into perioperative care protocols and methods of reducing lymph node surgery morbidity is required and could result in significant cost savings to the NHS.

Risk Factors for Surgical Site Infections Following Fasciotomy in Patients With Acute Compartment Syndrome: A Study on the February 2023 Kahramanmaraş Earthquake.

Surgical site infections (SSIs) developing after fasciotomy are difficult to treat, costly, and an important source of mortality and morbidity. This study aimed to determine the risk factors affecting the development of SSI in patients who underwent fasciotomy with the diagnosis of acute compartment syndrome (ACS) within 72 hours after two consecutive earthquakes of 7.7 and 7.6 magnitude that occurred in Kahramanmaraş on February 6, 2023. A total of 116 patients were retrospectively analyzed. Patients were divided into two groups: those who developed SSI and those who did not. In this study, variables such as basic demographic characteristics, time of fasciotomy, center performing fasciotomy, type of wound closure, affected extremity, concomitant renal failure, hyperbaric oxygen (HBO) therapy, blood creatine kinase (CK) level were examined. Of 116 patients, 58 (50%) had SSI. It was statistically observed that patients who underwent treatment with vacuum-assisted closure (VAC), those who underwent primary closure with the shoelace method, those who went into renal failure, and those whose fasciotomy was performed in an earthquake zone had a higher incidence of SSI (p<0.001). Blood CK level above 17.839 seemed to be a risk factor according to receiver operating characteristic (ROC) analysis (P<0.01). Age (p=0.193), gender (p=0.125), fasciotomy time (p=0.843), lower extremity (p=0.234), upper extremity (p=0.806), and HBO treatment (p=0.56) were not associated with SSI. Infection was found to be a significant risk factor for amputation (p<0.001). The use of VAC as a wound closure technique for SSI after fasciotomy in patients who developed ACSdue to the earthquake, the presence of renal failure in the patients, and performing fasciotomy in the earthquake zone were independent risk factors. A blood CK level above 17.839 was also determined as a risk factor, but the confidence interval was found to be low.

The role of preoperative glycemic control in decreasing surgical site infections in lower extremity fractures

BackgroundPostoperative surgical site infections (SSIs) are an important complication to prevent in surgical treatment. Patients with diabetes mellitus (DM) have a higher risk of SSIs. Preoperative glycemic control is required. For patients with orthopedic trauma, the duration of preoperative glycemic control is limited because delaying operative treatment is difficult. However, whether preoperative glycemic control would decrease the risk of SSIs in diabetic patients with lower extremity fractures is unclear. The first aim of this study was to investigate the rate of SSIs among patients with DM who had undergone preoperative glycemic control, compared with that of patients without DM. As the secondary aim, we sought to demonstrate among patients with DM whether preoperative glycemic control would affect the development of SSIs between patients with controlled DM and patients with poorly controlled DM.MethodsIn this retrospective cohort study, 1510 patients treated surgically for lower extremity fractures were enrolled. Data collected were patient age, sex, body mass index, history of DM, development of SSIs, tobacco use, the presence of an open fracture, the period between the day of injury and the operation, the length of surgery, and blood glucose levels on admission and on the day before surgery.ResultsThe rate of total SSIs was 6.0% among patients with DM and 4.4% among patients without DM (p = 0.31). Multivariate logistic regression revealed a significant association between the development of SSIs and the presence of DM (odds ratio, 1.79; 95% confidence interval 1.01–3.19; p = 0.047). The results of the secondary study revealed that the rate of early SSIs was significantly higher in the poorly controlled DM group than in the controlled DM group (5.9% vs. 1.5%; p = 0.032). However, multivariate logistic regression revealed that control levels of DM were not significantly associated with the development of SSIs.ConclusionsEven though patients with DM had undergone preoperative glycemic control, SSIs were significantly associated with DM, especially when the patients had poorly controlled DM. This finding suggested that continuous glycemic control is important preoperatively and postoperatively to prevent SSIs.

Complication Pattern of Sacral Primary Tumor Resection: A Study on the Risk Factors of Surgical Site Infection and Bowel or Bladder Dysfunction and Their Associations with Length of Hospital Stay.

Retrospective open cohort study. The current study aimed to explore the pattern of complications after primary sacral tumor resection, to investigate the possible effect of several perioperative parameters on the development of complications, and to identify which complications are associated with the length of hospital stay (LOS). Primary sacral tumor (pST) resection is associated with a high complication rate. However, the number of studies on these complications and their effect on LOS is limited. The clinical data of 140 patients with pST surgeries and 106 subsequent patients with local recurrence surgeries in four subgroups (index surgery, local recurrence surgery, malignant, and benign tumor) were prospectively collected and analyzed. The prognostic value of several perioperative factors on the development of surgical site infection (SSI), bowel and bladder dysfunction (BBD), and LOS was investigated using the logistic and linear regression models. The overall complication rates were 61.2% after index surgeries and 50.9% after local recurrence surgeries. The most frequent complications were SSI, vegetative dysfunction, urinary tract infections, and neurological deterioration. Age >55 years, malignant tumors, and red blood cell transfusion had a predictive effect on the development of SSI in the logistic model (p<0.01, R2=0.43). Bilateral S2 or S3 resection commonly caused postoperative BBD (chi-square test=62.5, degrees of freedom=4, p<0.001). In the multiple linear regression model, wound dehiscence, BBD, systemic and urinary tract infection, cerebrospinal fluid leak, and neurologic deterioration were associated with a significantly long LOS (p<0.01, R2=0.62). Surgical resection of pSTs has a high complication rate. Its common complications are SSI and BBD, both of which can have a significant influence on global therapeutic outcome. Malignant tumor diagnosis, old age, and red blood cell transfusion can remarkably increase the risk of SSI. Further, the development of BBD is significantly associated with the number of resected sacral nerve roots. By decreasing perioperative complications, LOS can decrease significantly.

Preoperative and Intraoperative Risk Factors for Surgical Site Infection in Pediatric Cardiac Surgery.

Surgical site infection (SSI) is a major complication of pediatric cardiac surgery. If the risk of developing SSI can be predicted based on the patient's preoperative background, appropriate preoperative management to prevent the development of SSI can be achieved. We retrospectively studied cases for patients younger than 7 years of age among surgeries performed through a median sternotomy at Kagoshima University Hospital from April 2011 to March 2021. SSI was diagnosed according to the Centers for Disease Control and Prevention guidelines and classified into 3 types: superficial incisional SSI (SiSSI), deep incisional SSI (DiSSI) and mediastinitis. Of the 765 consecutive pediatric cardiac surgeries, 597 were included in the analysis based on the exclusion criteria. Of these, 17 (2.8%) developed SSI (3 SiSSI cases, 2 DiSSI cases and 12 mediastinitis cases), with Staphylococcus aureus as the major pathogen. Univariate analysis revealed that low preoperative serum protein ( P = 0.049) and low serum albumin levels ( P = 0.023) were risk factors for the development of SSI. No findings suggested impaired hepatic synthesis, inflammatory disease or protein loss from the kidney or intestinal tract. We concluded that malnutrition caused low serum protein and albumin levels. Low preoperative serum protein and albumin levels are risk factors for SSI development of SSI. Nutritional status should be regularly assessed in children scheduled for cardiac surgery, and interventions, such as nutritional guidance, should be considered if malnutrition is suspected.

Preoperative Hypoalbuminemia and Development of Surgical Site Infection and Anastomotic Leakage in Emergency Colorectal Surgery

Background: Although hypoalbuminemia is a well-known predictor of postoperative complications, including surgical site infection (SSI) and anastomotic leakage (AL) in gastrointestinal surgery patients, which requires necessary interventions before surgery, there is limited opportunity for preoperative optimization and intervention in emergency colorectal surgeries. Objectives: Therefore, this study aimed to assess the relationship between preoperative serum albumin levels and the development of SSI and AL in emergency colorectal surgery patients. Methods: In this cohort study, patients who underwent emergency colorectal surgery during 17 months, were assessed. Albumin level was measured before surgery, and patients were followed for 1 month after surgery to identify the development of SSI and AL. Results: In total, 173 patients were enrolled in the study, but data analysis was performed on 170 patients. They were divided into hypoalbuminemia group (n=98, 57.6%) and non-hypoalbuminemia group (n=72, 42.4%). The mean ages of patients in each group were 57.17±16.19 and 51.61±16.14 years old, respectively (P=0.028). The AL was observed in 4 (2.4 %) patients; 3 patients in the hypoalbuminemia group and one patient in the non-hypoalbuminemia group (P=0.205, relative risk=2.33, 95% CI: 0.42-12.82). The SSI was observed in 13 patients (7.6%) during the 1-month follow-up; 8 patients (5.1%) had superficial SSI and 5 (3.2%) had deep ones. Albumin level was significantly lower in patients with AL (2.9±0.48), compared to those without AL (3.6±0.7 g/dL). Moreover, albumin level was higher in patients with SSI (3.11±0.62), compared to patients without SSI (3.6±0.7 g/dL). The incidence of complications, either AL or SSI, was significantly higher in hypoalbuminemia patients, compared to non-hypoalbuminemia patients (P=0.017, Odds Ratio=4.24, 95% CI: 1.29-13.9). Adjusted OR for age was 3.82 (95% CI: 1.15-12.75, P=0.029); therefore, a 13.5% reduction in OR indicated that age is a confounding factor. Conclusion: Preoperative hypoalbuminemia was significantly associated with post-development of complications in emergency colorectal surgery and older age and lower preoperative albumin levels may serve as valuable indicators for the identification of patients at higher risk of complications.

Impact of Postoperative Antibiotic Prophylaxis on Surgical Site Infections Rates After Mastectomy with Drains but Without Immediate Reconstruction: A Multicenter, Double-Blinded, Randomized Control Superiority Trial.

There is no consensus on the use of postoperative antibiotic prophylaxis (PAP) after mastectomy with indwelling drains. We explored the utility of continued PAP in reducing surgical site infection (SSI) rates after mastectomy without immediate reconstruction and with indwelling drains. A multicenter, two-armed, randomized control superiority trial was conducted in Pakistan. We enrolled all consenting adult patients undergoing mastectomy without immediate reconstruction. All patients received a single preoperative dose of cephalexin within 60min of incision, and postoperatively were randomized to receive either continued PAP using cephalexin (intervention) or a placebo (control) for the duration of indwelling, closed-suction drains. The primary outcome was the development of SSI within 30days and 90days postoperatively. Secondary outcomes included study-drug-associated adverse events. Intention-to-treat analysis was performed using multivariable Cox regression. A total of 369 patients, 180 (48.8%) in the intervention group and 189 (51.2%) in the control group, were included in the final analysis. Overall cumulative SSI rates were 3.5% at 30days and 4.6% at 90days postoperatively. PAP was not associated with SSI reduction at 30 (hazard ratio, HR 1.666 [95% confidence interval CI 0.515-5.385]) or 90 (1.575 [0.558-4.448]) days postoperatively, or with study-drug-associated adverse effects (0.529 [0.196-1.428]). Continuing antibiotic prophylaxis for the duration of indwelling drains after mastectomy without immediate reconstruction offers no additional benefit in terms of SSI reduction. There is a need to update existing guidelines to provide clearer recommendations regarding use of postoperative antibiotic prophylaxis after mastectomy in the setting of indwelling drains.