Diagnosis Of Surgical Site Infection Research Articles

Is there a role of calprotectin testing in the diagnosis of surgical site infections after total hip and knee arthroplasty? A preliminary study.

Recent studies have revealed the usefulness of synovial calprotectin (CLP) in diagnosing chronic periprosthetic joint infections (PJIs). However, there is still a lack of evidence to support the use of serum CLP in the diagnosis of early PJIs and surgical site infections (SSIs) after total joint arthroplasties (TJAs). The primary aim of this study is to investigate the standard kinetics of CLP concentrations in the blood during the very early postoperative period after non-complicated total hip arthroplasty (THA) and total knee arthroplasty (TKA). The secondary aim was to perform a preliminary comparison of CLP concentrations between non-infected patients and patients with recognized SSIs. A total of 64 consecutive patients who underwent primary THA and TKA were included in this prospective research. Sixty patients (30 THA and 30 TKA) were scheduled to determine the standard shape of the blood CLP curve and the expected concentrations during the first 5 postoperative days after non-complicated TJAs. In 4 additonal patients, early SSI was confirmed, and they were included in a separate SSI subgroup. Calprotectin demonstrated a linear increase during the first 5 postoperative days. Statistically significant differences in CLP concentrations between non-infected cases and SSIs were not observed. The preoperative median results with interquartile range (Q1-Q3) were 0.52 (0.39-0.64) mg/dL and 0.5 (0.47-0.52) mg/dL (p = 0.77), while post operation they were as follows: on postoperative day 1: 0.88 (0.53-1.3) mg/dL and 0.86 (0.62-1.1) mg/dL (p = 0.84), on postoperative day 3: 1.77 (1.29-2.08) mg/dL and 1.85 (1.70-1.95) mg/dL (p = 0.72), and on postoperative day 5: 2.32 (1.79-2.67) mg/dL and 2.56 (2.25-2.83) mg/dL (p = 0.55), respectively. Serial CLP measurements during the early postoperative period revealed a linear (statistically significant) increase in concentration to postoperative day 5 without an evident point of decrease. A significant difference in median values and the course of curve patterns between the non-complicated and SSI groups was not observed.

Interleukin-6 as a critical inflammatory marker for early diagnosis of surgical site infection after spine surgery.

Early diagnosis of surgical site infections (SSIs) could prevent surgical revision. Inflammatory markers (IMs), such as procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α), seem more accurate in diagnosing SSI than C-reactive protein (CRP) and white blood cell (WBC) count. The aim was to compare the predictive values of CRP, WBC count, PCT, IL-6, and TNF-α in SSI detection. A total of 130 patients undergoing dorsal spondylodesis from 2019 to 2024 were enrolled in a prospective diagnostic study at a maximum care spine center. IMs were measured preoperatively and on the postoperative days (PODs) 1, 2, 3, 5, and 7. Patients with high suspicion of SSI underwent revision surgery. SSI was diagnosed when the microbiological evidence was positive. Patients were divided a posteriori into the non-infection and infection groups. IMs of 118 patients (66.9 ± 13.0years, 61.0% females) were measured. Fifteen of the 118 patients (12.7%) developed an SSI. The groups differed with respect to existing hypertension, number of instrumented segments, region of surgery, CRPPOD1,7, PCTPOD7, and IL-6POD3,5,7. Binary logistic regression for SSI detection including these parameters showed an area under the curve (AUC) of 0.88 (95% CI 0.79-0.98; P < 0.001). The main effect for SSI detection was maintained by IL-6POD7 (odds ratio = 1.13; 95% CI 1.05-1.23; P = 0.001), which itself showed an AUC of 0.86 (95% CI 0.75-0.97). Compared to CRP, WBC count, PCT, and TNF-α, IL-6 seems to be the critical IM for the early detection of an SSI. drks.de: DRKS00033773, date of registration: 29.02.2024, retrospectively registered; Postoperative Markers of Inflammation in Spine Surgery (POMIS) Trial.

Logistic regression model predicts early surgical site infection after spinal fusion: a retrospective cohort study

This study aimed to develop a diagnostic model for predicting early surgical site infection based on postoperative inflammatory markers after spinal fusion surgery. In this retrospective study, we analysed the trends of inflammatory markers between surgical site infection (SSI) group and non-SSI group. The data were randomly divided into training cohort and validation cohort (ratio 7:3). The variables for SSI were analysed using stepwise logistic regression to develop prediction model. To evaluate the model, we analysed its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), as well as the area under curve (AUC) in the validation cohort. Calibration plots and decision curve analysis (DCA) were employed to assess the calibration and clinical usefulness of the model. We observed significant changes in inflammatory markers on the seventh day after surgery. The prediction model included four variables on the seventh day after surgery: body temperature, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil counts. After binary processing of these data, the simplified model achieved an AUC of 0.86 (CI 95%: 0.81-0.92) in the training cohort and 0.9 (CI 95%: 0.82-0.98) in the validation cohort. Calibration plots and DCA demonstrated that the proposed model was effective for the diagnosis of SSI. We developed and validated a prediction model for diagnosing early infection after spinal fusion.

Analysis of risk factor for surgical site infection and other postoperative complications in patients following loop ileostomy reversal.

Introduction:Loop ileostomy reversal (LIR) procedure is associated still with relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. As a result of SSI, it leads to prolonged hospital stay, delay the adjuvant therapy and increase the hospital costs. Aim of the study:The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure.Material and methodsA single-centre retrospective analysis was conducted in a tertiary reference center. Finally, sixty five patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled into the study. Data were collected retrospectively based on the available medical charts. The study group comprised of 23 women (35%) and 42 men (65%) with the mean age 48.914.5 years and the mean body mass index 24.34.9 kg/m2. The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n=42; 64.6%).Results:The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which was important, among others, in during hospitalization after surgery, the need for antibiotic therapy or CRP values. 9 patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI it was over 13 days compared to almost 6 days in the group without SSI (p=0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (p=0.01). The type of intestinal anastomosis had a significant impact on the operative time (p=0.0011) and the time of hospital stay after surgery (p=0.04).Conclusions:Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor of increasing the risk of other postoperative complications and significantly increases the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities, which made patients more likely to develop SSI, CRP increase or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.

O21: ASSIST: Validation of a novel hybrid clinician-patient remote outcome measure for diagnosis of surgical site infection

Abstract Introduction Current remote methods of surgical site infection diagnosis have high specificity but lack sensitivity in diagnosis. This study evaluates the acceptability, reliability and validity of a novel hybrid clinician-patient remote outcome measure (ASSIST) for detecting SSI. Methods Patients completed the Bluebelle wound healing questionnaire (WHQ) at 30 days post-surgery and additionally submitted wound image(s). Images were reviewed two independent clinicians. Internal consistency of the unidimensional scale was assessed. Inter-rater and intra-rater reliability assessments were performed. Sensitivity and specificity for SSI discrimination against face-to-face CDC diagnosis were evaluated and receiver operator characteristic (ROC) curve plotted with calculation of the area under the curve. Results 69 participants were included and no questionnaires contained missing items. The single scale showed strong Internal consistency (α = 0.9). Intra-rater reliability was good with intraclass correlation (ICC) of 0.818 (95% CI, 0.672-0.903, p&amp;lt;0.001). Inter-rater agreement was excellent (ICC 0.915, 95% CI 0.733-0.903, p&amp;lt;0.001). Sensitivity and specificity for SSI diagnosis were excellent at 91.7% and 97.6% respectively. Discrimination for SSI was high with an area under the receiver operating characteristic curve of 0.966 (95%CI 0.913-1.000). Discussion The ASSIST measure is acceptable, reliable, and valid for diagnosis of SSI. Implementation can be safely utilised in both patient-initiated follow-up or at pre-determined time points for safe post discharge surveillance.

Telemedicine for sustainable postoperative follow-up: a prospective pilot study evaluating the hybrid life-cycle assessment approach to carbon footprint analysis.

Surgical site infections (SSI) are the most common healthcare-associated infections; however, access to healthcare services, lack of patient awareness of signs, and inadequate wound surveillance can limit timely diagnosis. Telemedicine as a method for remote postoperative follow-up has been shown to improve healthcare efficiency without compromising clinical outcomes. Furthermore, telemedicine would reduce the carbon footprint of the National Health Service (NHS) through minimising patient travel, a significant contributor of carbon dioxide equivalent (CO2e) emissions. Adopting innovative approaches, such as telemedicine, could aid in the NHS Net-Zero target by 2045. This study aimed to provide a comprehensive analysis of the feasibility and sustainability of telemedicine postoperative follow-up for remote diagnosis of SSI. Patients who underwent a lower limb vascular procedure were reviewed remotely at 30 days following the surgery, with a combined outcome measure (photographs and Bluebelle Wound Healing Questionnaire). A hybrid life-cycle assessment approach to carbon footprint analysis was used. The kilograms of carbon dioxide equivalent (kgCO2e) associated with remote methods were mapped prospectively. A simple outpatient clinic review, i.e., no further investigations or management required, was modelled for comparison. The Department of Environment, Food, and Rural Affairs (DEFRA) conversion factors plus healthcare specific sources were used to ascertain kgCO2e. Patient postcodes were applied to conversion factors based upon mode of travel to calculate kgCO2e for patient travel. Total and median (interquartile range) carbon emissions saved were presented for both patients with and without SSI. Altogether 31 patients (M:F 2.4, ±11.7 years) were included. The median return distance for patient travel was 42.5 (7.2-58.7) km. Median reduction in emissions using remote follow-up was 41.2 (24.5-80.3) kgCO2e per patient (P < 0.001). The carbon offsetting value of remote follow-up is planting one tree for every 6.9 patients. Total carbon footprint of face-to-face follow-up was 2,895.3 kgCO2e, compared with 1,301.3 kgCO2e when using a remote-first approach (P < 0.001). Carbon emissions due to participants without SSI were 700.2 kgCO2e by the clinical method and 28.8 kgCO2e from the remote follow-up. This model shows that the hybrid life-cycle assessment approach is achievable and reproducible. Implementation of an asynchronous digital follow-up model is effective in substantially reducing the carbon footprint of a tertiary vascular surgical centre. Further work is needed to corroborate these findings on a larger scale, quantify the impact of telemedicine on patient's quality of life, and incorporate kgCO2e into the cost analysis of potential SSI monitoring strategies.

Erratum to: Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries.

Erratum to: Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries.

POSTOPERATIVE INFECTIONS OF THE LUMBAR SPINE: PRESENTATION AND MANAGEMENT

: Postoperative infections of the lumbar spine pose significant challenges in clinical management and patient outcomes. Despite advances in surgical techniques and perioperative care, these infections continue to occur, leading to increased morbidity and healthcare costs. Understanding the presentation and management of these infections is crucial for optimizing patient care and outcomes. The objective of the study is to assess the prevalence of spinal surgeries, comorbidities, diagnostic modalities, treatment approaches, and their correlations in managing surgical site infections among patients at Khyber Teaching Hospital. Medical records of 800 patients who underwent lumbar spine surgery at Khyber Teaching Hospital from 2020 to 2022 were retrospectively reviewed. Data regarding patient demographics, surgical details, infection characteristics, microbiological findings, treatment modalities, and outcomes were collected and analyzed. Descriptive statistics were used to summarize the findings, and inferential statistics were employed to explore associations between variables. The study comprised 800 spinal surgery patients at Khyber Teaching Hospital, with a mean age of 58 ± (12.3 SD) years. Laminectomy was the most common procedure (43.75%), followed by discectomy (22.5%). Clinical inspection was predominantly used for SSI diagnosis (95.6%), and post-surgical measures included debridement, antibiotics and cultures. Correlation analysis revealed varying associations between surgeries and post-operative symptoms. The Treatment outcomes showed high-resolution rates, with surgical debridement demonstrating the highest efficacy. This study reveals laminectomy as the most common procedure. As laminectomy was the most common procedure done, that’s why SSI was more common in these procedures. Key diagnostic methods for detecting surgical site infections (SSI) was clinical examination of wound status and pus discharge. The study revealed that patients with early surgical debridement had the best outcome in early resolution of infection and wound healing. Thus, Correlation analysis between surgeries and symptoms guides clinical decisions, with surgical debridement followed by antibiotics showing the highest efficacy in resolving infections. These findings stress the need for tailored patient care strategies to enhance outcomes and reduce complications in spinal surgery.

Surgical Site Infection in the General Surgery Department at the Fousseyni Daou Hospital in Kayes

Objectives: To determine frequency, analyze risk factors, identify responsible germs and antibiotic susceptibility, and assess the cost of infection. Patients and Method: We conducted a prospective study (August 1, 2022 to February 2023) for a period of 6 months. During our series, we received 250 patients who had been operated on and hospitalized in the general surgery department. The diagnosis of surgical site infection was based on criteria set forth by the Atlanta CDC. Data collection was carried out by interviewing, consulting records and anaesthesia sheets. Surgical wound monitoring was done up to the 30th postoperative day. A sample was taken for each infection. The word processor and tables were made on Microsoft Word 2019. Data were captured and analyzed on SPSS software (version 25). Results: We collected a total of 250 patients in our study. 31 developed an infection of the surgical site, a frequency of 12.4%. There were 31 patients, including 23 men and 8 women, with a mean age of 34 years, with a standard deviation of 20.75. The most common type of infection was superficial incision infection with 70.9% followed by deep incision infection with 29.1%. Risk factors for Surgical Site Infection Were: haemoglobin level; the nature of the surgery; ALTEMEIR contamination class 3 and 4; NNISS index 1 and 2; the type of intervention with probability tests P&lt;0.05. The analysis of the 31 samples resulted in 31 positive cultures, i.e. a bacteriological yield of 100%. Echerichia coli was the most isolated germ with 25.8%, followed by Enterobacter cloacae 19.3% and Enterococcus 19.3%. The Treatment was: Carrying out local care based on antiseptics (dakin; Betadine; hydrogen peroxide) and general (adapt to susceptibility testing). The consequence of surgical site infection was the prolongation of the hospital stay by an average of 19 days for infected patients; with an estimated additional cost of 294712 and 0% mortality.

Accuracy of the Wound Healing Questionnaire in the diagnosis of surgical-site infection after abdominal surgery in low- and middle-income countries.

Telemedicine is being adopted for postoperative surveillance but requires evaluation for efficacy. This study tested a telephone Wound Healing Questionnaire (WHQ) to diagnose surgical site infection (SSI) after abdominal surgery in low- and middle-income countries. A multi-centre, international, prospective study was embedded in the FALCON trial; a factorial RCT testing measures to reduce SSI in seven low- and middle-income countries (NCT03700749). It was conducted according to a pre-registered protocol (SWAT126) and reported according to STARD guidelines. The reference test was in-person review by a trained clinician at 30 postoperative days according to US Centres for Disease Control criteria. The index test was telephone administration of an adapted WHQ at 27 to 30 postoperative days by a researcher blinded to the outcome of in-person review. The sum of item response scores generated an overall score between 0 and 29. The primary outcome was the diagnostic accuracy of the WHQ, defined as the proportion of SSI correctly identified by the telephone WHQ, and summarized using the area under the receiving operator characteristic curve (AUROC) and diagnostic test accuracy statistics. Patients were included from three upper-middle income (396 patients, 13 hospitals), three lower-middle income (746 patients, 19 hospitals), and one low-income country (54 patients, 4 hospitals). 90.3% (1088 of 1196) patients were successfully contacted. Those with non-midline incisions (adjusted odds ratio: 0.36, 95% c.i. 0.17 to 0.73, P=0.005) or a confirmed diagnosis of SSI on in-person assessment (odds ratio: 0.42, 95% c.i. 0.20 to 0.92, P=0.006) were harder to reach. The questionnaire correctly discriminated between most patients with and without SSI (AUROC 0.869, 95% c.i. 0.824 to 0.914), which was consistent across subgroups. A representative cut-off score of ≥4 displayed a sensitivity of 0.701 (0.610-0.792), specificity of 0.911 (0.878-0.943), positive predictive value of 0.723 (0.633-0.814) and negative predictive value of 0.901 (0.867-0.935). SSI can be diagnosed using a telephone questionnaire (obviating in-person assessment) in low resource settings.

Efficacy and safety of negative wound pressure in the treatment of surgical complications after radical cystectomy: a retrospective cohort study

Background: Negative pressure wound treatment (NPWT) is a relatively new, but promising method for management of surgical site infection (SSI). The literature data on the use of NPWT for complications in oncology surgery, and after radical cystectomy (RC) in particular, is scarce.&#x0D; Aim: To evaluate the short-term results of NPWT dressings in the management of SSI after RC.&#x0D; Materials and methods: We retrospectively analyzed data from 446 patients who had RC with various uroderivation types in the Department of Oncourology of the N. N. Petrov National Medical Research Center of Oncology from January 2012 to December 2021. A total of 62 cases of SSI emerging up to day 30 after RC were identified with complete data. Thirty six (36) cases of SSI were managed according to standard procedures, and 26 patients with SSI were treated with NPWT (VivanoTec® S 042) at constant negative pressure mode. The physical condition of the patients before RC was assessed according to the American Society of Anesthesiology (ASA) classification, and the severity of the patient's condition at SSI diagnosis within APACHE II scale. The following parameters were also analyzed: body mass index, median number of days in the hospital, number of program wound sanitations (surgical debridement) or frequency of changing NPWT dressings, changes over time in C-reactive protein and leukocyte index of intoxication, and events of clinical interest (intestinal fistulas and lateralization of the median wound margins, hernias).&#x0D; Results: Most cases of post-RC SSIs were identified in men (57/62, 91.93%). The standard management and NPWT study groups were well balanced for age, body mass index, and ASA physical status. The median time from the first surgical debridement of the wound to its closure was significantly shorter in the standard surgical management group: 4 days (0; 8.75) versus 8.5 days (3.25; 12.0) in the NPWT group (p = 0.026). However, this did not negatively affect the length of hospitalization (28.08 ± 12.80 and 30.03 ± 16.27 days, respectively, p = 0.599). The 30-day mortality rates were not significantly different between the groups (p = 0.137). In our series with NPWT dressings, there were no cases of intestinal fistulas in the early and late postoperative periods.&#x0D; Conclusion: Negative pressure wound treatment is a safe and effective method of SSI management. It is not inferior to the generally accepted treatment standard with surgical wound debridement, staged sanitations or dressings. NPWT dressings allow for early primary muscular-fascial closure of the abdominal cavity and does not increase the duration of hospital stay, postoperative death rates and the risk of intestinal fistulas.

Late and Persistent Symptoms Suggestive of Surgical Site Infections After Cesarean Section: Results from a Prospective Cohort Study in Rural Rwanda.

Background: Women in low-resource settings will likely develop late surgical site infections (SSIs), diagnosed after post-operative day (POD) 10. We measured SSI prevalence and predictors of late and persistent SSIs-suggestive symptoms among women who delivered via cesarean section (c-section). Patients and Methods: Women who underwent c-sections at Kirehe District Hospital (KDH) between September 2019 and February 2020 were prospectively enrolled. Data were collected on POD1, POD11, and POD30. Logistic regression identified factors associated with persistent and late SSI symptoms. Results: In total, 808 women were study enrolled. Of these, 646 women physically attended the POD11 clinic visit follow-up, while 671 received the POD30 telephone-based follow-up review. Thirty-three (5.0%) women were diagnosed with an SSI on POD11, and 39 (5.3%) had an SSI diagnosis during POD11 to POD30, giving a cumulative prevalence of 10.3% late SSI rate. Of 671, 400 (59.9%) reported at least one SSI-associated symptom between POD11 and POD30. The reported symptoms included pain (56.6%), fever (19.4%), or incision drainage (16.6%). Of these, 200 women reported still having at least one of these symptoms on POD30. Of the 400 women with late SSI symptoms, 232 (58.0%) did not seek care, and of these, 80 (48.5%), 59 (35.8%), and 15 (8.9%) could not afford transport fare, did not believe symptoms were severe for a medical visit, and were not able to travel, respectively. Lower odds of late SSI-suggestive symptoms were reported among women with health insurance (adjusted odds ratio [aOR], 0.06; p = 0.013), whereas higher late SSI-suggestive symptoms odds were among women with wealthier socioeconomic status (aOR, 2.88; p = 0.004). Conclusions: Women in rural Rwanda are at risk of late and persistent SSI-suggestive symptoms. Financial barriers and the perception that their symptoms were not serious enough for the medical visit need education on early care seeking and interventions to mitigate financial barriers for optimizing perinatal care.

Multiple Sinuses around Umbilical Port Site due to Atypical Mycobacterium after Laparoscopic Cholecystectomy- A Rare Case Report

Uncommon surgical site infection following laparoscopic cholecystectomy characterized by port site tuberculosis caused by atypical mycobacterium or non tubercular mycobacterium. This infection exhibited an atypical pattern spread of infection occurs within subcutaneous plane and leading to the formation of multiple abscesses and sinuses. Comprehensive management approach by surgical intervention by drainage and debridement of the affected area and long- term multidrug anti-tubercular therapy, resulting in complete healing of the sinuses. This case report highlights the importance of considering atypical pathogens in the differential diagnosis of surgical site infection and comprehensive management strategy. Keywords: Atypical Mycobacterium, Tuberculosis, Multiple sinuses, Anterior abdominal wall, Laparoscopic cholecystectomy

Diagnostic value of inflammatory indicators for surgical site infection in patients with breast cancer

BackgroundBreast cancer is the most commonly diagnostic cancer in women worldwide. The main treatment for these patients is surgery. However, there is a high incidence of surgical site infection (SSI) in breast cancer patients. The aim of this study was to identify effective infection-related diagnostic markers for timely diagnosis and treatment of SSI.MethodsThis retrospective study included 263 breast cancer patients who were treated between July 2018 and March 2023 at the Shandong Cancer Hospital and Institute. We analyzed differences between the SSI group and control group and differences before and during infection in the SSI group. Finally, we tested the distribution of pathogenic microorganisms and their susceptibility to antibiotics.ResultsCompared with preoperative inflammatory indicators, white blood cells (WBC), neutrophils (NEU), absolute neutrophil count to the absolute lymphocyte count (NLR), D2 polymers (D-Dimer) and fibrinogen (FIB) were significantly increased, while lymphocytes (LYM), albumin (ALB) and prealbumin (PA) were significantly decreased in the SSI group. Compared with uninfected patients, WBC, NEU, NLR and FIB were significantly increased, ALB and PA were significantly decreased in SSI patients, while LYM and D-Dimer did not differ significantly. The distribution of infection bacteria in SSI patients showed that the proportion of patients with Staphylococcus aureus infection was as high as 70.41%; of those patients, 19.33% had methicillin-resistant Staphylococcus aureus (MRSA) infection. The area under the curves (AUCs) of the receiver operating curves (ROCs) for WBC, NEU, NLR, FIB, ALB and PA were 0.807, 0.811, 0.730, 0.705, 0.663 and 0.796, respectively. The AUCs for other inflammatory indicators were not statistically significant. There was no significant difference in antibiotic resistance for Staphylococcus aureus when compared to that of gram-positive bacteria. The resistance of gram-positive bacteria to ceftriaxone (CRO), cefoxitin (FOX), chloramphenicol (CHL), minocycline (MNO) and tetracycline (TCY) was lower than that of gram-negative bacteria, while the resistance to gentamicin (GEN) was higher.ConclusionThis study demonstrated that WBC, NEU, NLR, FIB and PA have good predictive value for identifying patients at risk of SSI. The cut-off values of inflammatory indicators can be helpful in the prevention and diagnosis of SSI.

Stress-Induced Hyperglycemia is a Risk Factor for Surgical-Site Infections in Nondiabetic Patients with Open Leg Fractures.

Nondiabetic patients with open leg fractures who have elevated blood glucose levels on arrival in the emergency department have an increased risk of surgical-site infections (SSIs). This study evaluates the association between the incidence of SSIs in nondiabetic patients with an open leg fracture and blood glucose levels registered on arrival in the ER. We also analyzed the correlation between patients' days of hospital stay and the incidence of SSIs and the time elapsed between the damage control with external fixation and final fixation and the incidence of SSI. We retrospectively studied nondiabetic patients admitted to our emergency unit from 2017 to 2021 with a diagnosis of open leg fracture consecutively treated. Based on the diagnosis of SSIs, all enrolled patients were divided into two groups based on the developed (group A) or not developed (group B) SSIs within 1 year after surgery. All patients enrolled in the study underwent damage control within 24 hours after admission to the ER. At stabilization of general clinical and local wound conditions, all patients underwent definitive surgery. We enrolled 80 patients. In group A, glycemia on arrival in the ER was on average 148.35 ± 19.59 mg/dl, and in group B, it was 122.61 ± 22.22 mg/dl (p value: 0.0001). In group A, glycemia in the first postoperative day was on average 113.81 ± 21.07 mg/dl, and in group B, it was 99.02 ± 17.60 mg/dl (p value: 0.001). In group A, the average hospitalization was 57.92 ± 42.43 days, and in group B, it was 18.41 ± 14.21 days (p value: 0.01). Through Youden's J, we therefore analyzed the value with the highest sensitivity and specificity which proved to be 132 mg/dl. Our findings show that nondiabetic patients with SIH have a significantly increased risk of SSIs compared to patients without SIH within 1 year after surgery. Patients with open leg fractures with SIH have a significantly higher average hospital stay than patients without SIH. Further studies are needed to confirm 132 mg/dl of blood glucose levels as a value to stratify the risk of SSIs in these patients.

The Prevalence of Multidrug-Resistant Organisms in Patients with Surgical Site Infections in Riyadh, Saudi Arabia: A Cross-sectional Study at a Tertiary Care Hospital

Background: Multidrug-resistant (MDR) infections are a threat in patients undergoing surgery. This study was undertaken to determine the prevalence and possible predictors of MDR infections over a two-year period in patients with surgical site infection (SSI) at a tertiary care hospital in Riyadh, Saudi Arabia. Methods: We conducted a cross-sectional study from April 2016 to April 2018 by reviewing hospital records of patients with a diagnosis of SSI based on a physician report and laboratory findings. The isolation of MDR organisms (MDRO) from SSI was the primary outcome variable as well as other risk factors. Results: SSI was diagnosed in 55 out of 77 patients under study, with MDRO prevalence rate of 44%. Previous antibiotic use and hospitalization in the last 90 days were strongly associated with developing MDRO infection often due to ESBL producing Gram-negative bacterial pathogens. Superficial and deep incisional SSI were more frequent in patients compared to organ/space SSI. History of diabetes mellitus, duration of surgery and bacterial colonization at other body site also increased the likelihood of MDRO. Factors such as trauma, obesity, general anesthesia, and wound types were not found to increase the risk for MDRO. Conclusions: Our study identified recent antibiotic use and hospitalization as major risk factors for MDRO surgical site infections. Other predisposing factors include diabetes mellitus, duration of surgery and bacterial colonization. MDRO isolated include E. coli and Pseudomonas aeruginosa. Bacterial pathogens harboring multiple resistant mechanisms can complicate SSI adversely affecting clinical outcomes following routine surgical procedures.

Annual incidence and assessment of risk factors for early-onset deep surgical site infection following primary total knee arthroplasty in osteoarthritis.

This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site infection (SSI) following primary total knee arthroplasty (TKA) for osteoarthritis, and to identify risk factors that may be associated with infection. This is a retrospective population-based cohort study using prospectively collected patient-level data between 1 January 2013 and 1 March 2020. The diagnosis of deep SSI was defined as per the Centers for Disease Control/National Healthcare Safety Network criteria. The Mann-Kendall Trend test was used to detect monotonic trends in annual rates of early-onset deep SSI over time. Multiple logistic regression was used to analyze the effect of different patient, surgical, and healthcare setting factors on the risk of developing a deep SSI within 90 days from surgery for patients with complete data. We also report 90-day mortality. A total of 39,038 patients underwent primary TKA for osteoarthritis during the study period. Of these, 275 patients developed a deep SSI within 90 days of surgery, representing a cumulative incidence of 0.7%. The annual infection rate did not significantly decrease over the seven-year study period (p = 0.162). Overall, 13,885 (35.5%) cases were excluded from the risk analysis due to missing data. Risk factors associated with early-onset deep SSI included male sex, American Society of Anesthesiologists grade ≥ 3, blood transfusion, acute length of stay, and surgeon volume < 30 TKAs/year. Early-onset deep SSI was not associated with increased 90-day mortality. This study establishes a reliable baseline infection rate for early-onset deep SSI after TKA for osteoarthritis using robust Infection Prevention and Control surveillance data, and identifies several potentially modifiable risk factors.

SUS 2 Telemedicine for diagnosis of Surgical Site Infection (SSI): Feasible, safe and sustainable

Abstract Background In 2019, the NHS contributed to around 25 million tonnes of CO2 equivalent, equating to around 7% of the total UK carbon footprint (CO2e) that year. A significant contributor is CO2e attributable to patient travel, which has almost doubled since 1990. Aim To assess the feasibility and sustainability of telemedicine for diagnosis of SSI. Methods Patients were reviewed remotely at 30 days with a combined outcome measure (photographs and validated questionnaire). If wound complications were identified, face-to-face review or remote management were arranged. The SusQI method of emissions calculations were used with DEFRA conversion factors based on the minimal material and equipment usage and cost in clinic. Patient postcodes were applied to conversion factors based upon mode of travel to calculate kgCO2e for patient travel. Total CO2e per remote review were subtracted from the model clinic emissions for potential savings. Results 25 patients (M:F 1.78, 65.1±11.1 years) were reviewed remotely. The median return distance for patient travel was 26.4 miles (3.4-71.4 miles). The estimated CO2e of clinic was 13.1kgCO2e per patient. Mean emissions per patient travel was 9.7kgCO2e, giving the average simple clinic carbon footprint of 22.8 kgCO2e. Mean carbon footprint of remote follow-up was 0.47kgCO2e per patient, estimating the potential savings at 22.3kgCO2e. Four patients had wound infections, but were diagnosed and managed remotely. Conclusions This model shows that implementation of an asynchronous digital follow-up model is effective in substantially reducing carbon footprint of a tertiary surgical centre.

Análise epidemiológica, prospectiva e descritiva da taxa de infecção em feridas cirúrgicas de urgência em hospital da Amazônia Ocidental

Objective: Evaluate the rate of surgical site infection (SSI) in an Urgency Room for non-elective surgeries of the digestive system, associated organs and abdominal wall. Methods: Epidemiological, prospective and descriptive study carried out in a reference hospital in the Western Amazon, in the city of Porto Velho-Rondônia. Patients were selected for data collection and secretion samples, according to pre-established criteria. Epidemiological data were provided by the hospital coordination. Results: A total of 605 operations were performed over a period of 10 months, 3.30% had a clinical diagnosis of SSI. A greater presence of SSI was identified in men 4.97%, against 1.14% in women, the most affected age group was among patients over 50 years old (4.16%). Conclusion: Possible causes for the SSI rates can be associated with the Urgency Room context itself, which involves high turnover, with precarious infrastructure for the high number of patients.

Central Adjudication Committee and Clinical Site Investigator Agreement on Outcomes in the PARITY Trial: A Secondary Analysis of the PARITY Trial Data.

The detection of a surgical site infection (SSI) in patients with metal implants requires a high degree of clinical acumen. The inherent subjectivity of SSI diagnosis poses a challenge in the design of surgical trials because this subjectivity raises concern for outcome assessment bias. Central Adjudication Committees (CACs) are often utilized to minimize the variability in outcome assessment. Little research has been done to determine the reliability of outcome assessment in trials utilizing a CAC. In the present study, we determined the agreement between the study CAC and the clinical site investigators for the primary and secondary outcome assessments. The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial was a multicenter, blinded, parallel 2-arm, randomized controlled trial that aimed to determine the effect of a 5-day versus 1-day postoperative prophylactic antibiotic regimen on the rate of SSI in patients undergoing surgical excision of tumors in the femur or tibia. The blinded PARITY CAC adjudicated all primary and secondary outcomes identified during the 1-year study follow-up. In the present secondary analysis, the Cohen kappa statistic was utilized to determine the level of agreement. The primary outcome of SSI diagnosis demonstrated a substantial level of agreement between the CAC and the site investigators (0.699; 95% confidence interval [CI], 0.595 to 0.803]). Categorization of the SSI (i.e., superficial, deep, or organ space) showed moderate agreement (0.470; 95% CI, 0.382 to 0.558). Secondary outcomes such as the types of reoperations and the indication for reoperation typically showed substantial to almost perfect agreement, whereas antibiotic-related complications showed fair agreement (0.241; 95% CI, 0.000 to 0.474). Although there was a substantial level of agreement between the PARITY CAC and site investigators on the diagnosis of an SSI, as well as typically at least substantial agreement on the causes and types of reoperations, there was less agreement regarding the type of SSI and the occurrence of an antibiotic-related complication. Therefore, the CAC appears to have provided value when adjudicating the depth of infection and when determining the causality of medical complications associated with antibiotics. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.