Early Postoperative Infection Research Articles

#2106 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at months 1 and 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI < 1.4 g/kg·d, n = 110). Occurrence of hospitalization and postoperative infections within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 1 post-transplant were 1.58 ± 0.22 g/kg·d in Group 1 and 1.02 ± 0.31 g/kg·d in Group 2, respectively (P < 0.05), this huge difference in DPI between the two groups continued to month 3. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of hospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein may reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

#2736 Higher daily protein intake can reduce the risk of infections in kidney transplant recipients during the early post-transplant period

Abstract Background and Aims Kidney transplantation (KT) is considered the most effective treatment for end-stage renal disease (ESRD), and it significantly contributes to enhancing the quality of life and extending the survival of patients with ESRD. After kidney transplantation, the early and heavy use of immunosuppressants and glucocorticoids can affect the recipients' immune status to varying degrees, increasing the risk of postoperative infections caused by a wide range of pathogens. Thus, the prevention and management of infectious diseases are major factors contributing to improved outcomes in kidney transplantation. Protein-energy wasting (PEW) is commonly observed in uremic patients, and it may persist even after they have undergone kidney transplantation (KT). And PEW is a significant factor in the progression of chronic kidney disease (CKD). Providing appropriate dietary guidance and intervention is essential for enhancing the immune status of recipients, promoting a positive nitrogen balance in the body, minimizing infections, and safeguarding graft function. This study aimed to investigate the relationship between daily protein intake (DPI) and postoperative infections at 3 months post-transplant, which may establish a foundation for the early postoperative protein intake regimen, reducing the incidence of postoperative infections, and improving the early prognosis of kidney transplantation. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at month 3 post-transplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease, namely high intake group (Group 1, with DPI ≥ 1.4 g/kg·d, n = 66) and low intake group (Group 2, with DPI < 1.4 g/kg·d, n = 110). Occurrence of postoperative infections events within 3 months were recorded. Multiple logistic regression was utilized to analyze the association between DPI and early postoperative infections at 3 months post-transplant. Results Mean DPI levels at month 3 post-transplant were 1.75 ± 0.56 g/kg·d in Group 1 and 0.98 ± 0.24 g/kg·d in Group 2, respectively. There was no significant difference in age, gender, pre-transplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. There was a statistically significant difference in the percentage of hospitalization for infections between the two groups during the postoperative period of 3 months (P = 0.027). Pneumonia was the most common reason of rehospitalization after transplantation, followed by urinary tract infection. The results of multiple logistic regression analysis showed that higher DPI in the early post-transplant period was a protective factor for infection after kidney transplantation. Conclusion In the early post-transplant period, consuming higher levels of dietary protein can reduce the risk of infections and complications, and help preserve the function of the transplanted kidney.

The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part I: Lung Transplantation

These highlights focus on the research in lung transplantation (LTX) that has been published in the year 2022 and includes the assessment and optimization of candidates for LTX, donor optimization, the use of organs from donation after circulatory death (DCD), and outcomes when using marginal or novel donors, recipient factors affecting LTX, including age, disease, the use of extracorporeal life support (ECLS), and special situations, such as COVID-19, pediatric LTX, and retransplantation. The remainder of the article focuses on the perioperative management of LTX, including the perioperative risk factors for acute renal failure (AKI), and the incidence and management of phrenic nerve injury, delirium, and pain and the postoperative management of hyperammonemia, early postoperative infections, and the use of donor-derived cell-free deoxynucleic acid (DNA) to detect rejection.

Anatomic shoulder arthroplasty in patients 40 years or younger

BackgroundGlenohumeral arthritis in adults less than 40 years old represents a challenging clinical scenario to manage. While patients older than 55 have had reproducible success with current shoulder arthroplasty techniques, young patients have historically had less successful outcomes, possibly due to higher physical demands and more complex pathologies. Despite these concerns, anatomic total shoulder arthroplasty (TSA) remains the treatment of choice for young, active patients with severe glenohumeral arthritis and intact rotator cuff. We hypothesize that TSA provides significant relief in pain and functional outcomes in patients less than 40 years old. MethodsWe performed a single-institution retrospective analysis of consecutive patients aged 40 years and younger who underwent TSA between 2007 and 2022. Demographic data included age, sex, body mass index, Charlson comorbidity index, and preoperative diagnosis. Outcome measures included the Single-Assessment Numerical Evaluation (SANE) score, final range of motion, complications, and revision rate. Statistically significant differences between variables were evaluated using a 2-sample t-test at an α level of P < .05. ResultsTwenty-six TSAs were performed in 23 patients with an average final follow-up of 2 years after the procedure. The average age was 33.4 ± 5.3 years with a range of 19-39 years. The most common preoperative diagnosis was osteoarthritis (46%), followed by rheumatoid arthritis (27%) and osteonecrosis/avascular necrosis (19%). The most common glenoid morphology was type B (15) of which 14 were B2 glenoid, followed by type A (11). The SANE score, mean active forward elevation, abduction, external rotation, and internal rotation all improved significantly (P < .05) by the final follow-up. On average, patients in all groups were able to achieve minimal clinically important difference in SANE score after 1 year. There was 1 complication reported of an early postoperative infection treated with irrigation and débridement, and no revision surgeries were performed during the follow-up period. Discussion/ConclusionTSA significantly improved functional outcome measures in patients less than 40 years old with a low rate of complications and revisions in short-term outcomes. As the frequency of TSA continues to increase in adults less than 40 years old, additional studies recording long-term functional outcomes and implant survivorship in this population can be explored.

Lower Rates of Reoperation Following Partial or Complete Revision Arthroplasty Compared to Debridement, Antibiotics, and Implant Retention for Early Postoperative and Acute Hematogenous Periprosthetic Hip Infection

BackgroundThis study aimed to: 1) compare treatment outcomes between debridement, antibiotics, and implant retention (DAIR) and partial or complete revision arthroplasty (RA) for early postoperative and acute hematogenous total hip arthroplasty periprosthetic joint infection (PJI) and 2) identify factors associated with treatment outcome. MethodsThe study consisted of a retrospective cohort of patients who underwent surgery for PJI between 2004 and 2021. There were 76 patients (74.5%) who underwent DAIR and 26 patients (25.5%) who underwent RA. Treatment success was defined as treatment eradication at a minimum of a 2-year follow up. Bivariate regression analysis was used to assess the effect of different factors on treatment outcomes. Kaplan-Meier survivorship was performed to compare survivorship between cohorts. ResultsAt a mean follow-up of 8.2 years (range, 2.2 to 16.4), significantly more DAIR failed treatment (DAIR, 50 [65.8%]; 10 [38.5%]; P = .015). The 8-year Kaplan-Meier survivorship was 35.1% [95% confidence interval (CI), 24.3 to 45.9] for patients treated with DAIR and 61.5% [95% CI, 42.9 to 80.1] for those treated with RA (log rank = 0.039). Bivariate regression analysis showed performing a RA was associated with a higher likelihood of treatment success (odds ratio 4.499, 95% CI 1.600 to 12.647, P = .004), whereas a higher body mass index was associated with treatment failure (odds ratio 0.934, 95% CI 0.878 to 0.994, P = .032). ConclusionsTo reduce the rate of recalcitrant infection following early postoperative or acute hematogenous total hip arthroplasty PJI, RA may be of benefit over DAIR. This is especially relevant in the early postoperative period, when components can be readily exchanged.

Complications after total wrist arthroplasty.

We reviewed the incidence and management of complications after total wrist arthroplasty, as reported in the literature, with so-called fourth-generation implants and other recent designs. While early intraoperative and postoperative complications, including fractures, tendon lacerations, infection, nerve compression, tendonitis, stiffness and chronic regional pain syndrome, had an acceptable incidence, late complications, such as periprosthetic osteolysis and implant loosening, occurred more frequently. Implant survival at 10 years was in the range of 70%-80% in most publications. Several of the implants have been modified or withdrawn. Instability and dislocation were frequent after a pyrocarbon spacer. Failed arthroplasties can be salvaged by revision arthroplasty or total wrist arthrodesis. Revision arthroplasty has a lower survival rate than primary arthroplasty and does not clearly offer important significant advantages over total wrist arthrodesis in terms of patient-reported outcome measures. Further development of prosthetic design, new materials and more knowledge on patient-related risk factors are needed.

Early postoperative COVID infection is associated with significantly increased risk of venous thromboembolism after metabolic and bariatric surgery

BackgroundPatients who undergo metabolic and bariatric surgery (MBS) are at risk for thromboembolism. Patients are susceptible to coronavirus throughout the perioperative period, which also has a well-known association with thrombotic complications. ObjectivesTo identify and define the association between venous thromboembolism (VTE) and postoperative coronavirus diagnosis in bariatric surgery patients. SettingUnited States. MethodsWe conducted a retrospective cohort study using the MBS Accreditation and Quality Improvement Program (MBSAQIP) 2021 database to analyze the incidence of VTE within 30 days of surgery. VTE was a composite variable defined as either postoperative pulmonary embolism or postoperative venous thrombus requiring treatment. Cohorts were stratified by whether the patient was diagnosed with postoperative coronavirus. We created a multivariable logistic regression model to determine the adjusted odds of postoperative VTE based on various factors. Additionally, we conducted subset analyses of sleeve gastrectomy and Roux-en-Y bypass cases, the 2 most frequent bariatric operations in the United States. ResultsPatients diagnosed with postoperative coronavirus were significantly more likely to develop postoperative VTE (1.1% versus .3%, P < .001). In our logistic regression model, the adjusted odds of postoperative VTE for patients with postoperative coronavirus was 3.55 (95% CI: 2.15–5.87, P < .001). For patients who underwent Roux-en-Y bypass, the adjusted odds was even greater at 5.69 (95% CI: 2.76–11.70, P < .001). ConclusionsEarly postoperative coronavirus infection after MBS is associated with higher odds of postoperative VTE. This persisted on subset analyses of the 2 most common procedures and appeared particularly important for Roux-en-Y bypass. COVID infection after MBS may warrant prolonged VTE prophylaxis.

Impact of enhanced recovery after surgery protocols on surgical site wound infection rates in urological procedures.

This meta-analysis assesses the impact of Enhanced Recovery After Surgery (ERAS) protocols on surgical site wound infections (SSWIs) in urological procedures. Analysing data from 10 studies, our focus was on SSWI rates on the third and seventh postoperative days. The results reveal a significant reduction in SSWI rates for patients managed under ERAS protocols compared with traditional care. Notably, Figure 4 demonstrates a substantial decrease in SSWI on the third day (I2 = 93%; random: standardized mean difference [SMD]: -6.25, 95% confidence interval [CI]: -7.42 to -5.05, p < 0.01), and Figure 5 mirrors this trend on the seventh day (I2 = 95%; random: SMD: -4.72, 95% CI: -6.28 to -3.16, p < 0.01). These findings underscore the effectiveness of ERAS protocols in minimizing early postoperative wound infections, emphasizing their importance for broader implementation in urological surgeries.

Treatment experience with continuous local antibiotic perfusion for periprosthetic joint infection

BackgroundAntibiotic concentrations 100–1000 times higher than the minimum inhibitory concentration are necessary for eradicating biofilms in periprosthetic joint infections (PJI). Achieving this with intravenous antibiotics is challenging, but continuous local antibiotic perfusion (CLAP) can increase the local concentration of antibiotics. Although there are several reports on CLAP therapy in the fracture-related infection, there are only few reports on its application in PJI. Here, we report our experience with CLAP therapy for PJI. MethodsEight patients with PJI (two males and six females, with mean age of 73.5 years [±11.6]) were treated at our department, and their clinical characteristics were analyzed. The parameters considered were the classification of PJI, surgical procedure, duration of CLAP, duration of transvenous antibiotic administration, time of CRP-negative status, whether the infection resolved or recurred, and whether there were complications due to CLAP. ResultsInitial surgery included total knee arthroplasty in five cases, unicompartmental knee arthroplasty in one case, and total hip arthroplasty in two cases. There were four cases of early postoperative infection, two of acute delayed infection, and two of chronic delayed infection. The surgical procedures performed were two-stage revision for two patients, and debridement, antibiotics, and implant retention (DAIR) for the other six. The mean durations of CLAP and transvenous antibiotic administration were 8.5 (±2.4) and 22.4 days (±13.7), respectively, and the mean time to CRP-negative status was 23.3 days (±10.7). All eight patients successfully resolved without additional irrigation or debridement, and no recurrence was observed at the last follow-up after discontinuation of oral antibiotics. No systemic side effects of gentamicin or other complications associated with CLAP were observed. ConclusionAll patients achieved infection resolution with the combined use of CLAP. This suggests that CLAP is a useful treatment option for PJI.

Abstract 13879: Characterizing Post-Cardiac Surgery Infection Risk: A Statewide Experience

Introduction: Patients undergoing cardiac surgery are at risk for developing early (in-hospital or within 30-days) and late (up to 180 days after surgery) postoperative infections. Current national database infection metrics are limited in scope and duration of follow-up. Aim: Evaluate rates and types of early and late postoperative infections and mortality. Methods: Medicare claims from 8335 Michigan fee-for-service beneficiaries undergoing isolated coronary artery bypass grafting (CABG) (n=4162), isolated surgical aortic valve replacement (SAVR) (n=618), CABG + SAVR (n=627), or transcatheter aortic valve replacement (TAVR) (n= 2946) between 2017-2020 at 33 Michigan hospitals were linked to The Society of Thoracic Surgeons data. Nine infection types were tracked within 180 days following surgery. The relationship between infections and 180-day and 365-day mortality was evaluated. Results: The average age was 74.2 ± 9.1 years, 36.5% were female, 5.0% were Black and 1.4% were Hispanic. The in-hospital infection rate was 8.9%, while 17.8% within 180 days after surgery. Infection rates varied by hospital (9.1%-33.9%), year (2017 vs 2020: 20.1% vs 16.0%), and procedure type (CABG: 18.2%, SAVR: 14.9%, CABG+SAVR: 19.6%, TAVR: 17.4%). Most common infections were urinary tract infection (8.7%), pneumonia (7.0%) and sepsis (5.2%). The overall mortality rate was 5.9% at 180-days (and varied by infection type, Table ) and 9.0% at 365 days. Patients with an infection had higher associated 180-day mortality compared to those with no infection (17.7% vs 3.4%, p&lt;0.001). Among infection types, sepsis was associated with the highest 180-day mortality rate. Conclusions: Nearly 20% of Medicare beneficiaries develop an infection within 180 days after cardiac surgery, with rates varying by 24% across hospitals and contributing to higher 180-day mortality. Future efforts should identify determinants of postoperative infections, especially given their impact on mortality.

WTP8.4 Head and Neck Surgical Site Infections: A Quality Improvement Project

Abstract Aim Audit incidence of Surgical Site Infection (SSI) and early post-operative infection in open head and neck surgery in a tertiary centre and identify opportunities for improvement. Method We performed two 6-month audit cycles of rates of post-operative infection in elective open head and neck surgery against national rates. Cycle 1 was from August 2021-January 2022, and Cycle 2 from March-September 2022. Between cycles we introduced a flow-chart antibiotics prophylaxis protocol as an improvement measure and presented findings at a local meeting. Results 172 open head and neck operations were performed in Cycle 1. 7 patients developed SSIs. 169 open head and neck operations were performed in Cycle 2. 6 patients developed SSIs. Cycle 1 included 14 diabetic patients, of whom 7 received prophylactic antibiotics. Cycle 2 included 19 diabetic patients, of whom 16 received prophylactic antibiotics. In Cycle 1, 2 diabetic patients developed early post-operative infections, one of which was an SSI, compared with 0 in Cycle 2. SSI was more likely in patients who had surgical drains placed (8 out of 94 patients with drains, p = 0.008498*) and prophylactic antibiotic practice in this group was inconsistent in both cycles. Conclusion Our tertiary centre had comparable rates of SSI to national standards. We identified low rates of prophylactic antibiotic prescription for patients with diabetes and introduced a prophylaxis protocol which, despite not reaching statistical significance, appears to have improved rates of infection in diabetic patients. Additional changes should be introduced to reduce rates of infection in patients with surgical drains.

T-cell lymphopenia is associated with an increased infecting risk in children after cardiopulmonary bypass.

children who undergo CPB operations are at an elevated risk of infection due to immunosuppression. This study aims to investigate the association between lymphopenia following CPB and early postoperative infection in children. A retrospective analysis including 41 children under 2 years old underwent CPB. Among them, 9 subjects had an early postoperative infection, and 32 subjects were period-matched without infection. Inflammatory cytokines, serum CRP and PCT values were measured in plasma, additionally, circulating total leucocyte and lymphocyte subpopulations were counted. Infected subjects exhibited significantly higher levels of inflammatory cytokines, including IL-6, IL-8, IL-10, IL-1β and TNF-α, than non-infected subjects after CPB. Additionally, lower absolute number of lymphocyte and their subpopulations CD3+ T cells, CD4+ T-helper cells and CD8+cytotoxic T-cells, were observed in infected subjects. The impairment of T-cells Immune was found to be associated with higher levels of inflammatory cytokines IL-10. The ROC demonstrated that the absolute number of CD3+ T-cells <1934/ul, CD4+ T helper cells <1203/ul and CD8+cytotoxic T-cells <327/ul were associated with early postoperative infection. Higher levels of inflammatory cytokines resulted in T-cells lymphopenia after CPB, which significantly increasing the risk of postoperative infection in infants and young children. Infection complications after cardiopulmonary bypass (CPB) in pediatric CHD patients are serious issues, identifing the infection from after CPB remains a challenging. CPB can release numerous inflammatory cytokines associated with T cells lymphopenia, which increases the risk of postoperative infection after surgery. Monitoring T cells lymphopenia maybe more beneficial to predict early postoperative infection than C-reactive protein and procalcitonin.

Circular external fixation for revision of failed tibia internal fixation.

The management of failed tibial fracture fixation remains a challenge for orthopaedic surgeons. This study investigate the utility and outcomes of circular external fixation in the management of failed internal fixation of tibial fractures. Retrospective review of a prospectively collected database of a complex limb reconstruction unit at a major trauma centre was done during December 2022. Patients with failed internal fixation of tibial fracture who underwent revision surgery with circular external fixation frame were included. 20 patients with a mean age of 47.8 ± 16.5years (range: 15-69) were included. Fourteen (70.0%) patients had failed plate and screws fixations, and the remaining six (30.0%) failed intramedullary nail fixation. The most common indication for revision surgery was development of early postoperative surgical site infection (5 patients; 25.0%). The mean duration of frame treatment was 199.5 ± 80.1days (range = 49-364), while the mean follow-up duration following frame removal was 3.2 ± 1.8years (range = 2-8). The overall union rate in this series was 100%; and all infected cases had complete resolution from infection. The total number of complications was 11, however, only two complications required surgical intervention. The most common complications reported were pin site infection (6; 30.0%) and limb length discrepancy of 2cm (2; 10.0%). Circular external fixation is a reliable surgical option in the treatment of failed internal fixation of tibia fractures. This technique can provide limb salvage in complex infected and noninfected cases with a high union rate and minimal major complications.

Validity of C-Reactive Protein as a Surrogate Marker for Infectious Complications After Surgery for Colorectal Cancer

Abstract Background: This study aimed to establish a threshold of C-reactive protein (CRP) level for early detection of post-operative infectious complications after surgery for colorectal cancer. Patients and Methods: In this single-center, retrospective analysis, we studied the data of 178 patients who underwent surgery for colorectal cancer between January 2018 and February 2022. Elective surgery with curative intent was performed, and serum CRP levels were measured on five consecutive days after surgery. Receiver operating characteristic curves were utilized to assess the cutoff point of the CRP level with maximum predictive value, Results: A total of 59 cases of early post-operative complications, including pneumonia, wound infection, intra-abdominal infection, and anastomotic leakage were evaluated. During the monitoring period, patients with complications had higher CRP level than those without complications. The cutoff points on the five post-operative days were estimated to be 6.50, 10.83, 11.44, 6.67, and 5.71 mg/dL, respectively, and they were correlated to the occurrence of infectious complications. Higher CRP levels were associated with greater blood loss during surgery (p = 0.003) and increased length of hospital stay (p < 0.001) than did lower CRP levels. Conclusions: C-reactive protein monitoring in the early post-operative period is a cost-effective test that can be easily performed to predict the occurrence of infectious complications. It may be helpful in improving surgical outcomes, shortening the length of hospital stay and appropriate antibiotic administration.

Dental Implant Survival after Postoperative Infection

Aim: Dental implant failure might be brought on by an early postoperative infection. The purpose of this study was to assess the prevalence of acute postoperative infection in survived and failed implants and the associated factors. Methods: This cohort cross-sectional study held in the Oral surgery department of Altamash Institute of Dental Medicine, Karachi for two-years duration from January 2021 to December 2022 and evaluate early postoperative infection after dental implant surgery. The location of the implant, the patients' ages and genders, smoking, postoperative antibiotic therapy, bone augmentation and the time of infection development or diagnosis were among the study variables. The study's results showed which implants failed and which survived. Two groups of patients; those who survived implants included in Group A and those who had failed implants were included in group B. Results: Out of 190 patients, 12 (6.3%) patients, including 8 men and 4 women, experienced a postoperative infection after implant insertion. In group A of implant survival, 5 implants (41.7%) acquired post-operative infection while 7 implants (58.3%) in the failed group experience infections. The significant variations among the both groups were noted in terms of the smoker patients, the timing of diagnosis, patients who got bone transplant and fresh socket versus delayed implant placement. Relating to the variables, the Kaplan-Meier analysis revealed that when infection developed 4 days after surgical procedure in subjects not given antibiotic treatment postoperatively, the probability of implant failure increased by 1.1 times (hazard ratio). If the infection developed after six days in people who smoked and after nine days in people who do not smoked and were given antibiotics postoperatively, the likelihood of failure rose. Conclusion: In light of the study's findings, it appears that smoking, early infection, implants placement in newly created sockets, and implants placement in conjunction with bone substitutes may all enhance the failure ratio of dental implants following acute infection. Keywords: antibiotic, implant, infection, and bone

Ballistic diaphyseal forearm fractures result in high incidence of neurovascular injury and compartment syndrome but have low rates of early infection: A single level I trauma center experience

IntroductionBallistic injuries to the upper extremity represent a small subset of injuries, and there is little data to provide guidance on management and outcomes. The purpose of this study is to assess the incidence of neurovascular injuries, compartment syndrome, and early postoperative infection, as well as patient and injury factors predictive of neurovascular injury following ballistic fractures of the forearm. Patients and methodsA retrospective review of operatively treated ballistic forearm fractures at a single level I trauma center between 2010 and 2022 was performed. Thirty-three patients with 36 forearm fractures were identified. Only diaphyseal injuries in patients greater than 18 years old were included. Medical and radiographic records were reviewed to identify pre-injury patient-specific factors, including age, sex, smoking status, and history of diabetes. Injury characteristics, including the type of firearm used, forearm fracture location, and any associated neurologic or vascular injury, as well as compartment syndrome, were collected and analyzed. Short-term outcomes such as post-operative infection and recovery of neurologic function were also collected and analyzed. ResultsThe median age was 27 years (range: 18–62), with a majority of male patients (78.8%, n = 26). 4 patients (12.1%) sustained high-energy injuries. 4 patients (12.1%) were found to have compartment syndrome pre-operatively or intra-operatively. 11 patients (33.3%) had nerve palsies postoperatively with 8 patients (24.2%) continuing to have nerve palsies at their final follow-up (mean follow-up= 149.9 +/- 187.2 days). The median length of stay was 4 days. There were no patients with infection at follow-up. ConclusionBallistic forearm fractures are complex injuries and can result in severe complications such as neurovascular injury and compartment syndrome. As such, a comprehensive evaluation and appropriate management of ballistic forearm fractures are essential to minimize the risk of severe complications and optimize patient outcomes. In our experience, when treated operatively, these injuries have a low rate of infection.

Efficacy of Antibiotic Cement in Preserving Endoplants After Infection With Plate Exposure.

Background: To study the feasibility and efficacy of antibiotic cement in preserving endoplants after infection in patients with early tibial plateau fracture on plate exposure. Patients and Methods: A retrospective analysis of 23 patients treated for post-operative infection with plate exposure after tibial plateau fracture between 2017 and 2021. They were divided into the observation group (10 patients) and the control group (13 patients). Total operation time, length of hospitalization, hospitalization cost, the number of surgeries, white blood cell (WBC) count, neutrophil (NEUT) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the post-operative evaluation index, and complications were observed during the follow-up period. Results: All patients were followed up for 6 to 12 months; wound healing was observed in both groups. The total operation time for patients in the control group was longer compared with the observation group. However, the length of hospitalization, hospitalization cost, and number of surgeries in the observation group were less compared with the control group. No difference in WBC, NEUT, ESR, and CRP levels was observed one day after surgery. Furthermore, WBC, NEUT, ESR, and CRP levels were higher in patients in the control group compared with the observation group 72 hours after surgery. There were no differences in the post-operative evaluation index and complications in both groups. Conclusions: The antibiotic cement coating used for treating early post-operative infection in patients with tibial plateau fracture could effectively control infection while retaining endoplant, thereby promoting wound healing. It could also reduce pain and the medical burden on patients.

Association of Preoperative Glycated Hemoglobin and Early Postoperative Infections After Elective Craniotomy: A Retrospective Cohort Study

The prognostic value of preoperative glycated hemoglobin (HbA1c) testing is controversial. The available evidence on the role of preoperative HbA1c in predicting postoperative complications after different surgical procedures has been conflicting. The primary aim of our retrospective observational cohort study was to assess the association between preoperative HbA1c and postoperative infections after elective craniotomy. We extracted and analyzed data from an internal hospital database on 4564 patients who underwent neurosurgical intervention from January 2017 to May 2022. The primary outcome measure of the present study was infections established in the first week after surgery using the Centers for Disease Control and Prevention criteria. The records were stratified by the HbA1c values and intervention types. For patients who had undergone brain tumor removal with a preoperative HbA1c ≥6.5%, the odds of early postoperative infections were increased (odds ratio, 2.08; 95% confidence interval, 1.16-3.72; P= 0.01). We found no association between HbA1c and early postoperative infections for patients who had undergone elective cerebrovascular intervention, cranioplasty, or a minimally invasive procedure. After adjusting for age and gender, the threshold for significant infection risk for neuro-oncological patients increased with an HbA1c ≥7.5% (adjusted odds ratio, 2.97; 95% confidence interval, 1.37-6.45; P= 0.0058). For patients undergoing elective intracranial surgery for brain tumor removal, a preoperative HbA1c ≥7.5% is associated with a higher infection rate within the first postoperative week. Future prospective studies are required to assess the prognostic value of this association for clinical decision-making.

Application value of combined detection of serum IL-6, SDF-1 and CD64 in the diagnosis of early postoperative infection after limb fractures

ABSTRACT Objective. To explore the application value of combined detection of serum interleukin-6 (IL-6), stromal cell-derived factor-1 (SDF-1) and neutrophils CD64 (CD64) in the diagnosis of early postoperative infection after limb fractures. Methods. 419 patients with limb fractures un erwent surgical treatment in our hospital were selected as study subjects, and they were divided into infection group (n = 104) and non-infection group (n = 315) according to postoperative pathological results of puncture to detect the levels of serum IL-6, SDF-1 and CD64 in the two groups on the 1st, 3rd, 5th and 7th day after surgery, and to analyze the clinical diagnostic efficacy of single and combined detection of the three indexes in early postoperative infection after limb fractures by ROC curve. Results. The levels of serum IL-6, SDF-1 and CD64 in infection group were overtly higher than those in non-infection group at different time after surgery (P < 0.05), and the AUC value, specificity and sensitivity of combined detection were higher than those of single diagnosis. In this study, 14 patients in infection group underwent reoperation, 22 patients received conservative treatment in the later period, 6 patients had postoperative muscular dystrophy, and the remaining patients had a good prognosis. Conclusion. Serum IL-6, SDF-1 and CD64 are closely related to the occurrence of early postoperative infection after limb fractures, and their combination is helpful to improve diagnostic accuracy of early postoperative infection and provide effective reference value for the treatment of postoperative infection in orthopedics.

Dare to DAIR: Is Rifampin Always Necessary?

The treatment of early post-operative staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics, and retention of the implant (DAIR) is becoming increasingly common. This approach has many advantages, primarily more rapid mobilization and return to normal activities compared to a one- or two-stage revision [1]. A recent prospective multicenter observational study conducted at 27 hospitals in Australia and New Zealand found that DAIR was as successful as one or two-stage revisions, especially in patients with acute infections [2]. However, there is still considerable confusion as to the best antibiotics and duration of therapy. Some guidelines have adopted rifampin combination therapy as the cornerstone antibiotic treatment for staphylococcal PJI treated with DAIR, based on experimental animal models, one randomized trial, and several cohort studies [3,4]. However, rifampin combination therapy is associated with significant side effects and drug–drug interactions. A common justification for adding rifampin is a prospective randomized trial of early MSSA PJI conducted by Zimmerli and published in 1998 [5]. This was a prospective, randomized, double-blind trial that showed 100% success with combination therapy compared to 58% in the non-rifampin arm. Only 33 patients were included in this trial and only 24 completed the study. Of the 18 patients in the rifampin arm, there were 5 hip replacements, 3 knee replacements and 10 internal fixation devices. In the placebo arm, there were 3 hip replacements, 4 knee replacements and 8 internal fixation devices. This study was certainly a remarkable accomplishment; however, arguably, it should not be considered the definitive word on how to treat PJI with DAIR and drive clinical practice for decades. Unfortunately, it seems that this has been the case given the recommendations of current guidelines.