Incidence Of Soft Tissue Infections Research Articles

The interplay between diabetes Mellitus and soft tissue infections in general surgical patients

BackgroundDiabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited.MethodWe conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analysed.ResultsDuring the study period, 1059 patients were admitted for STIs (88% required surgery). DM was an independent risk factor for LOS. Diabetic patients presented with higher body-mass index (28 vs. 26), larger abscess size (24 vs. 14 cm2) and had a longer length of stay (4.4 days vs. 2.9 days). They also underwent a higher proportion of wide debridement and application of negative pressure wound therapy (42% vs. 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs. 4). Diabetic patients were two times more likely to present with carbuncles (p = 0.02).ConclusionThe incidence of STIs among DM patients represent a significant disease burden, surgeons should consider intensive patient counselling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based upon lifestyle modification and glucose control.

Comparative analysis of surgical approaches in acetabular fractures: Blood loss and procedural efficiency

BackgroundAcetabulum fractures pose significant challenges in orthopedic trauma due to anatomical complexity and the potential for iatrogenic injury to surrounding structures. The study aims to compare the outcomes of two surgical approaches, the ilioinguinal approach (IA) and the modified Stoppa approach (MSA), in managing acetabular fractures. MethodsA retrospective cohort study was conducted on 50 patients with anterior acetabular fractures. Demographic characteristics and perioperative data were collected, and the patients were categorized based on the applied surgical approach, either IA or MSA. Statistical tests were used for data analysis. ResultsThe MSA group showed significantly lower intraoperative blood loss compared to IA (MSA: 404.36 ± 151.94 ml, IA: 650.92 ± 136.33 ml, Δ = 246.56 ml, P < 0.001). The mean procedure duration for MSA was 141.88 ± 27.12 min, compared to 172.24 ± 32.69 min for IA (P = 0.37). The incidence of soft tissue infection (MSA: 8 %, IA: 8 %) and sciatic nerve injury (both 0 %) exhibited no significant differences (P > 0.99). Postoperative assessments, Harris Hip Scores (MSA: 90.08 ± 6.26, IA: 89.29 ± 6.64, P = 0.66) and Modified Merle d’Aubigné Scores (MSA: 14.86 ± 1.37, IA: 15.23 ± 1.16, P = 0.40), showed no substantial variance between groups. ConclusionThe study suggests that the MSA approach demonstrated superiority, particularly due to significantly less intraoperative blood loss. Further comprehensive studies are recommended to validate and generalize these findings.

Assessment of lateral malleolus weber C fractures’ outcomes in patients undergoing syndesmosis-only fixation versus syndesmosis and fibular fixation

Abstract Introduction Ankle fractures were associated with syndesmosis injuries, so it is very important to gain accurate anatomical reduction of the ankle mortise and good fixation of the disrupted syndesmosis. Aim Aim of this study was to assess lateral malleolus Weber C fractures’ outcomes in patients undergoing syndesmosis-only fixation versus syndesmosis and fibular fixation. Subjects and methods The present study was designed as a randomized controlled clinical trial study that included all patients presenting to the emergency room at Suez Canal University hospital after an ankle twisting injury causing lateral malleolus Weber C fracture. Results Patients who had performed syndesmosis-only were found to have significantly higher tibiofibular clear space (AP and mortise views) at 6 months only compared to those who had syndesmosis and fixation. Also, There was no statistically significant difference between syndesmosis-only and syndesmosis with fixation groups in regard to medial clear space, incidence of soft tissue infection, delayed union, Complex regional pain syndrome or all items of OMAS scale. Conclusions There was a significantly stability and nearby functional outcomes with a minimally invasive technique in the group managed by syndesmosis-only fixation and the group managed by syndesmosis and fibular fixation. The results are optimistic regarding the benefits of syndesmosis-only fixtion in patients with lateral malleolus Weber C fractures. However, more confirmatory studies need to be done.

Have Surgery and Implant Modifications Been Associated With Reduction in Soft Tissue Complications in Transfemoral Bone-anchored Prostheses?

The most frequently occurring adverse events in individuals with a transfemoral amputation treated with a bone-anchored prosthesis are soft tissue infections and stoma-related complications. These soft tissue complications are believed to be influenced by surgical technique and implant design, but little is known about the effect of changes to treatment on these events. (1) What is the result of surgical technique and implant modifications on the incidence of soft tissue infections and stoma-related complications in transfemoral bone-anchored prosthesis users, depending on whether they had a conventional stoma and a cobalt-chrome-molybdenum (CoCrMo) osseointegration implant (treatment period 2009 to 2013) or a shallower stoma and titanium osseointegration implant (2015 to 2018)? (2) What is the incidence of serious complications, such as bone or implant infection, aseptic loosening, intramedullary stem breakage, and periprosthetic fracture? Between 2009 and 2013, we performed osseointegration implant surgery using a conventional surgical technique and a CoCrMo implant in 42 individuals who had a lower extremity amputation experiencing socket-related problems that resulted in limited prosthesis use. We considered all individuals treated with two-stage surgery with a standard press-fit transfemoral osseointegration implant as potentially eligible for inclusion. Based on this, 100% (42) were eligible, and 5% (two of 42) were excluded because they did not provide informed consent, leaving 95% (40 of 42) for analysis. Between 2015 and 2018, we treated 79 individuals with similar indications with osseointegration implant surgery, now also treating individuals with dysvascular amputations. We used an adapted surgical technique resulting in a shallower stoma combined with a titanium implant. Using the same eligibility criteria as for the first group, 51% (40 of 79) were eligible; 49% (39 of 79) were excluded because they were treated with transtibial amputation, a patient-specific implant, or single-stage surgery and 1% (one of 79) were lost before the 2-year follow-up interval, leaving 49% (39 of 79) for analysis. The period of 2013 to 2015 was a transitional period and was excluded from analysis in this study to keep groups reasonably comparable and to compare a historical approach with the present approach. Hence, we presented a comparative study of two study groups (defined by surgical technique and implant design) with standardized 2-year follow-up. The risk factors for adverse events were similar between groups, although individuals treated with the shallow stoma surgical technique and titanium implant potentially possessed an increased risk because of the inclusion of individuals with dysvascular amputation and the discontinuation of prolonged postoperative antibiotic prophylaxis. Outcomes studied were soft tissue infections and stoma-related complications (hypergranulation or keloid formation as well as stoma redundant tissue) and bone or implant infection, aseptic loosening, implant stem breakage, periprosthetic fracture, and death. Patients treated with the shallow stoma surgical technique and titanium implant experienced fewer soft tissue infections (13 versus 76 events, absolute risk 0.17 [95% CI 0.09 to 0.30] versus 0.93 [95% CI 0.60 to 1.45]; p < 0.01), which were treated with less invasive measures, and fewer stoma redundant tissue events (0 versus five events, absolute risk 0 versus 0.06 [95% CI 0.03 to 0.14]) than patients treated with the conventional stoma surgical technique and CoCrMo implant. This was contrasted by an increased incidence of surgical site infections occurring between surgical stages 1 and 2, when no stoma was yet created, after the implementation of treatment changes (conventional surgery and CoCrMo implant versus shallow stoma surgery and titanium implant: one versus 11 events, absolute risk 0.01 [95% CI 0.00 to 0.08] versus 0.14 [95% CI 0.08 to 0.25]; p = 0.02). Patients treated with the shallow stoma surgical technique and titanium implant did not experience serious complications, although bone infections occurred (six events in 8% [three of 40] of patients) in the conventional surgery and CoCrMo implant group, all of which were successfully treated with implant retention. Adaptations to surgical technique and newer implant designs, as well as learning curve and experience, have resulted in a reduced incidence and severity of soft tissue infections and stoma redundant tissue, contrasted by an increase in surgical site infections before stoma creation. Serious complications such as deep implant infection were infrequent in this 2-year follow-up period. We believe the benefits of these treatment modifications outweigh the disadvantages and currently advise surgeons to create a shallower stoma with a stable soft tissue envelope, combined with a titanium implant. Level III, therapeutic study.

Neonatal Facial Subcutaneous Abscess: A Case Report

Skin and soft-tissue infections (SSTIs) are a relatively common diagnosis in both the pediatric and adult populations and include abscesses and cellulitis. An abscess is a focal, contained, purulent infection with a clearly defined “cavity” and surrounding inflammation involving the deep subcutaneous tissues. Cellulitis is an infection of the skin, without an organized cavity, presenting with erythema, warmth, induration, and tenderness [1]. There has been a recent rise in the incidence of SSTIs, with up to 95% of this increase attributed to abscesses and cellulitis, with the largest change occurring in the pediatric (&lt;18 years) population [2]. In addition to an overall increase in SSTIs, there has been a concomitant rise in the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) [3]. A 20 days old male full term baby born to a G2P1D1 mother via lower segment cesarean section in view of non progression of labor with birth weight of 2.8 kgs presented in our hospital with subcutaneous abscess diffusly present on the left side of the scalp &amp; face. Informant was father with good reliability. Patient presented with complaints of fever since 2 days and distension of abdomen since 2 days. Swelling over the scalp since birth. All relevant investigations sent &amp; IV antiobiotics like meropenem &amp; vancomycin started. Incision &amp; drainage done by pediatric surgeon &amp; 100 ml pus removed. IV antibiotics given for 14 days. Regular dressing done &amp; patient discharged on day 16 of admission. The gold standard treatment for subcutaneous abscesses remains incision and drainage (I&amp;D). The use of antibiotics for SSTIs after drainage is an area of great debate and variance. As a general guideline, the Infectious Disease Society of America (IDSA) recommends the use of antibiotics after I&amp;D only in the presence of systemic signs of infection. In summary, abscesses are a very common presentation in the pediatric ED. MRSA is the most common isolate of these abscesses, regardless of risk factors. History and physical exam combined with ultrasound should be used to diagnose abscesses. As upper &amp; lower limb skin abscess are more common, we here report facial abscess in neonate which was diffuse &amp; successfully treated.

Skin and soft tissue infections in hospitalized cancer patients: A retrospective study.

Objectives:To assess the clinical and epidemiological characteristics of hospitalized cancer patients with skin and soft-tissue infections (SSTIs).Methods:An observational retrospective study was conducted between March 2016 and December 2020 at the Oncology Department of King Saudi Medical City, Riyadh, Saudi Arabia. Patients with complicated and uncomplicated SSTIs were included.Results:A total of 204 cancer patients with SSTIs were evaluated. The incidence of SSTIs was 1.67% (204/12,203). Breast cancer (39%) was the most common solid tumor in all patients with SSTIs. Exit site infection (n=84, 41.2%) was the most common SSTI in cancer patients, followed by wound infection (n=72, 35.3%), and cellulitis (n=44, 21.5%). The majority of patients received appropriate antimicrobial therapy (n=150, 73.5%).Conclusion:This study has shown a modest incidence of SSTIs in hospitalized cancer patients, with many of the patients received appropriate antimicrobial therapy.

448. Impact of Doxycycline Prophylaxis on Skin and Soft-Tissue Infection Incidence in Naval Special Warfare Trainees

BackgroundSkin and soft-tissue infections (SSTIs) are a common complication of military training. Naval Special Warfare (NSW) training requires prolonged periods of extreme physical exertion and unique environmental exposures, including extended immersion in ocean water. A centerpiece of SEAL training is referred to as “Hell Week” (HW), a colloquial term to reflect the intense physical obstacles and exposure to extreme environmental conditions endured by candidates. Due to such environmental exposures, NSW trainees are at increased risk for SSTI due to uncommon organisms. A prior outbreak of Shewanella SSTI and bacteremia among NSW trainees led to the initiation of prophylactic doxycycline 100 mg daily during and for 7 days after HW to attempt to reduce this risk. The efficacy of this intervention is undetermined.MethodsDoxycycline prophylaxis was initiated in August 2015. We conducted a retrospective analysis of SSTI incidence presenting for medical attention among NSW trainees from April 2013 to November 2018, using case records collected prospectively at the Naval Special Warfare Center. The incidence of SSTI was calculated based on the size of a given class and the number of affected trainees. SSTI cases were then divided and analyzed as occurring during vs. after HW.ResultsThe pre-intervention cohort consisted of 1626 NSW trainees. A total of 76 trainees developed SSTI, with 20 cases during HW and 56 cases in the post-HW period. In the post-intervention cohort, 2022 trainees experienced a total of 81 cases of SSTI during HW and 83 in the post-HW period. 45% of all SSTI cases occurred in the months of June, July, and August. The incidence of cellulitis between the pre- and post-intervention cohorts during HW was 2% and 4%, respectively, and 5% and 6.4% in the post-HW period. There were no hospitalizations for invasive gram-negative infections following the initiation of doxycycline prophylaxis.ConclusionDoxycycline prophylaxis does not appear to reduce the incidence of SSTI but may reduce the incidence of certain severe infections. The choice of antibiotic prophylaxis and dosing may require further investigation. Seasonality of SSTI among NSW trainees is an unexpected finding and may provide valuable information for the prevention of future illness. Disclosures All authors: No reported disclosures.

Staphylococcus aureus colonization and acquisition of skin and soft tissue infection among Royal Marines recruits: a prospective cohort study

ObjectivesSkin and soft tissue infections (SSTIs) are a serious health issue for military personnel. Of particular importance are those caused by methicillin-resistant Staphylococcus aureus and Panton–Valentine leucocidin (PVL)-positive S. aureus (PVL-SA), as they have been associated with outbreaks of SSTIs. A prospective observational study was conducted in Royal Marine (RM) recruits to investigate the prevalence of PVL-SA carriage and any association with SSTIs. MethodsA total of 1012 RM recruits were followed through a 32-week training programme, with nose and throat swabs obtained at weeks 1, 6, 15 and 32. S. aureus isolates were characterized by antibiotic susceptibility testing, spa typing, presence of mecA/C and PVL genes. Retrospective review of the clinical notes for SSTI acquisition was conducted. ResultsS. aureus colonization decreased from Week 1 to Week 32 (41% to 26%, p < 0.0001). Of 1168 S. aureus isolates, three out of 1168 (0.3%) were MRSA and ten out of 1168 (0.9%) PVL-positive (all MSSA) and 169 out of 1168 (14.5%) were resistant to clindamycin. Isolates showed genetic diversity with 238 different spa types associated with 25 multi-locus sequence type (MLST) clonal complexes. SSTIs were seen in 35% (351/989) of recruits with 3 training days lost per recruit. SSTI acquisition rate was reduced amongst persistent carriers (p < 0.0283). ConclusionsNose and throat carriage of MRSA and PVL-SA was low among recruits, despite a high incidence of SSTIs being reported, particularly cellulitis. Carriage strains were predominantly MSSA with a marked diversity of genotypes. Persistent nose and/or throat carriage was not associated with SSTI acquisition. Putative person-to-person transmission within troops was identified based on spa typing requiring further research to confirm and explore potential transmission routes.

Skin and Soft Tissue Infection in People Living With Human Immunodeficiency Virus in a Large, Urban, Public Healthcare System in Houston, Texas, 2009-2014.

Skin and soft tissue infections (SSTIs) disproportionately impact patients with human immunodeficiency virus (HIV). Recent declines in the incidence of SSTIs have been noted in the non-HIV population. We sought to study the epidemiology and microbiology of SSTIs in a population of 8597 patients followed for HIV primary care in a large, urban county system from January 2009 to December 2014. SSTIs were identified from the electronic medical record by use of International Classification of Diseases-9 billing codes. Charts were reviewed to confirm each patient's diagnosis of acute SSTI and abstract culture and susceptibility data. We calculated the yearly SSTI incidences using Poisson regression with clustering by patient. There were 2202 SSTIs identified. Of 503 (22.8%) cultured SSTIs, 332 (66.0%) recovered Staphylococcus aureus as a pathogen, of which 287/332 (86.4%) featured S. aureus as the sole isolated organism. Among the S. aureus isolates that exhibited antibiotic susceptibilities, 231/331 (69.8%) were methicillin resistant, and the proportion did not change by year. The observed incidence of SSTI was 78.0 per 1000 person-years (95% confidence interval 72.9-83.4) and declined from 96.0 infections per 1000 person-years in 2009 to 56.5 infections per 1000 person-years in 2014 (P < .001). Other significant predictors of SSTI incidences in both univariate as well as multivariate analyses included a low CD4 count, high viral load, and not being a Spanish-speaking Hispanic. SSTIs remain a significant problem in the outpatients living with HIV, although rates of SSTIs appear to have declined by approximately 40% between 2009 and 2014.

Profile and outcome of patients presenting with skin and soft-tissue infections to the emergency department

Background: Skin and soft-tissue infections (SSTIs) vary in presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis. Early diagnosis is vital to reduce the complications. Materials and Methods: This prospective, observational, cohort study conducted between April 1, 2018 and June 30, 2018, in the emergency department (ED) of large tertiary care hospital in South India. In this study, all patients >15 years of age with traumatic or nontraumatic SSTI were enrolled consecutively, and SSTI associated with burns were excluded. The 353 patients were interviewed with a prestructured questionnaire and the statistical analysis was performed using SPSS 25.0. This study was aimed to find the incidence of SSTI and the outcome. Results: The cohort consists of… patients with age group between 40 and 65 years, and there was male predominance. Nonnecrotizing SSTI was the most common presentation. The incidence rate was 1.9%. Diabetes mellitus (DM) was the common risk factor n (%). Lower limbs were the most commonly affected site. The most common organism isolated in the blood and pus culture were Staphylococcus epidermidis and mixed flora. A large number (33.9%) of patients required in-patient care and surgical interventions. The mortality rate in our cohort was n (14%). Conclusion: The incidence of SSTI in patients presenting to the ED remains high. DM was the common risk factor, and many required inpatient care, and surgical intervention including amputation. Despite prompt diagnosis and management, mortality rate was still significant.

934. Incidence of Skin and Soft-tissue Infection in People Living With HIV in a Large Urban Public Health Care System in Houston, Texas, 2009–2014

BackgroundSkin and soft-tissue infections (SSTIs) disproportionately impact patients with HIV. Recent declines have been noted in the incidence of SSTIs in the non-HIV population. We set out to study the epidemiology and microbiology of SSTIs in a population of 8,597 patients followed for HIV primary care in a large urban county system from January 1, 2009 to December 31, 2014.MethodsSSTIs were identified from the electronic medical record (EMR) by the use of ICD-9 billing codes. Charts were reviewed to confirm the diagnosis of acute SSTI and abstract culture and susceptibility data. We calculated yearly SSTI incidence using Poisson regression with clustering by patient.Results2202 SSTIs were identified. Of 503 (22.8%) cultured SSTIs, 332 (66.0%) included S. aureus as a pathogen, of which 287/332 (86.4%) featured S. aureus as the sole pathogen. Of S. aureus isolates with susceptibilities, 231/331 (69.8%) were methicillin-resistant, and the proportion did not vary by year (P = NS).The observed incidence of SSTI was 78.0 per 1,000 person-years (95% CI 72.9–83.4) and declined from 96.0 infections per 1,000 person-years in 2009 to 56.5 infections per 1,000 person years in 2014 (P < 0.001). Other significant predictors of SSTI incidence in both univariate as well as multivariate analysis included CD4 count, viral load, and being a Spanish-speaking Hispanic.ConclusionAlthough SSTI rates in a large urban HIV-infected outpatient cohort declined approximately 40% between 2009 and 2014, SSTIs remain a significant problem.Figure 1.SSTI incidence per 1000 person-years, 2009–2014Table 1:Univariate and Multivariate Poisson Regression ResultsFactorUnivariate IRR (95% CI)Multivariate IRR (95% CI)Male gender1.06 (0.92–1.22)–MSM1.09 (0.95–1.25)–Race/ethnicityWhite/Asian/otherRefRefNon-Hispanic African-American0.92 (0.76–1.11)0.86 (0.71–1.04)English-speaking Hispanic0.88 (0.69–1.12)0.88 (0.69–1.12)Spanish-speaking Hispanic0.46¥ (0.36–0.60)0.48¥ (0.37–0.62)CD4 count (cells/µL)100+RefRef50–1001.56* (1.19–2.04)1.23 (0.93–1.62)<502.28¥ (1.80–2.90)1.49* (1.16–1.92)Viral load (copies/mL)<1,000RefRef1,000+2.17¥ (1.91–2.46)1.90¥ (1.66–2.19)Year2009RefRef20100.89 (0.75–1.06)0.92 (0.78–1.10)20110.90 (0.75–1.07)0.96 (0.80–1.15)20120.91 (0.76–1.09)0.99 (0.83–1.19)20130.71¥ (0.58–0.85)0.77* (0.64–0.93)20140.59¥ (0.49–0.71)0.65¥ (0.54–0.79)*P < 0.01. ¥ P < 0.001.Disclosures C. Arias, Merck & Co., Inc.: Grant Investigator, Research support. MeMed: Grant Investigator, Research support. Allergan: Grant Investigator, Research support

Asymptomatic group A Streptococcal throat carriage in Royal Marines recruits and Young Officers

A prospective observational study was conducted in Royal Marines (RM) recruits to investigate throat carriage of group A Streptococcus (GAS) and incidence of soft tissue infections. 1012 RM recruits were followed through a 32-week training programme, with throat swabs being obtained in weeks 1, 6, 15, and 32. Alongside a separate cohort of 46 RM Young Officers (YO) undergoing training were sampled in parallel. Carriage of group A Streptococcus was detected in only 5/1012 (0.49%) recruits at the beginning of training and remained low throughout training. There was no association between GAS carriage and development of soft tissue infection. There was no carriage of GAS in the smaller YO cohort at the start of training, (0/46). At week 6, a surge in GAS carriage was detected in 8/46 (17%) YO, that could be ascribed to a cluster of GAS genotype emm83. Asymptomatic GAS carriage is very infrequent among young adults in England and this should be borne in mind when considering the relevance of a positive throat swab result in symptomatic patients or outbreaks. Despite low prevalence, there is however potential for GAS to rapidly and transiently disseminate among adults during outbreaks.

The effect of financial crisis on the profile of the patients examined at the surgical emergencies of an academic institution in Greece.

Greece is suffering an economic recession of enormous magnitude, but whether its health has deteriorated as a result, has not yet been well established. We aim to present and analyze differences in demographics and clinical distribution of patients examined at the emergency room (ER) in the era of financial crisis. A retrospective data analysis of all patients that were examined to surgical ER, between January 1st 2008 and December 31st 2014, was conducted. We only analyzed and evaluated data for the years 2008, 2011 and 2014. We evaluated the etiology of the examination (main complaint of the patient), the gender, the ethnic origin, the age and the severity of the disease, whenever it was feasible. The diseases that presented differences that were statistically significant were analyzed in terms of medical, social and financial aspects. The number of patients being examined in the ER in 2011 was higher compared with that of 2014 and to 2008 respectively (P<0.05). Throughout the years, there was a decline in vascular emergencies (veins, arteries, AAA; P<0.05). An increased incidence of soft tissue infections (STIs) was also found (P<0.05). Finally, an increased incidence of anal diseases and patients with abdominal pain was also noted (P<0.05). Financial crisis seems to have a multivariable effect on epidemiology and clinical diversity of patients being examined in the ER.

Utility of Prophylactic Antibiotics in Nonoperative Facial Fractures.

Facial fractures are commonly managed nonoperatively. Patients with facial fractures involving sinus cavities commonly receive 7 to 10 days of prophylactic antibiotics, yet no literature exists to support or refute this practice. The aim of this study was to compare the administration and duration of antibiotic prophylaxis on the incidence of soft tissue infection in nonoperative facial fractures. A total number of 289 patients who were admitted to our level I trauma center with nonoperative facial fractures from the beginning of 2012 to the end of 2014 were studied. Patients were categorized into 3 groups: no antibiotic prophylaxis, short-term antibiotic prophylaxis (1-5 days), and long-term antibiotic prophylaxis (>5 days). The primary outcome was the incidence of facial soft tissue infection and Clostridium difficile colitis. Fifty patients received no antibiotic prophylaxis. Sixty-three patients completed a short course of antibiotic prophylaxis and 176 patients received long-term antibiotics. Ampicillin/sulbactam, amoxicillin/clavulanic acid, or a combination of both were used in 216 patients. Twenty-three patients received clindamycin due to penicillin allergy. Short and long courses of antibiotic prophylaxis were administered more commonly in patients with concomitant maxillary and orbital fractures (P <0.0001). No mortality was found in any group. Soft tissue infection was not identified in any patient. C. difficile colitis was identified in 1 patient who had received a long course of antibiotic prophylaxis (P = 0.7246). There was no difference in the outcome of patients receiving short-term, long-term, and no antibiotic prophylaxis. Prospective randomized studies are needed to provide further clinical recommendations.

Emergency general surgery admission proformas: The value of repeated audit to deliver sustained improvements

s / International Journal of Surgery 12 (2014) S13eS117 S95 1097: EMERGENCY GENERAL SURGERY ADMISSION PROFORMAS: THE VALUE OF REPEATED AUDIT TO DELIVER SUSTAINED IMPROVEMENTS Sarah Wheatstone , Brenda Stacey, Kothandaraman Murali. Darent Valley Hospital, Dartford, Kent, UK. Introduction: Clear, accurate and legible medical records are essential elements of good medical practice and prevent medical errors. The assessment and prescription of venous thrombosis (VTE) prophylaxis is a CQUIN target. We reviewed documentation standards before and after introduction of a dedicated emergency general surgery admissions proforma. After further adjustments we twice re-audited improved proformas. Methods: We audited 50 consecutive emergency admission case notes at four different times: April 2011, October 2011, November 2012 and January 2014. Notes were inspected for patient demographics, team contact details, clinical documentation and management plans. Drug charts and handover sheets were also reviewed. Inpatient referrals were excluded. Results: At final audit, significant improvements were found for patient identifying details (71%-100%, p<0.001), VTE risk assessment (2-86%, p<0.001), allergy documentation (87%-100%, p<0.01), and differential diagnosis (87-98%, p<0.05). There were sustained improvements in the recording of admitting doctor, investigations, and prescription of analgesia, anti-emetics and intra-venous fluids. Despite a prompt box, decision to operate and capacity assessment were rarely recorded. Conclusions: A printed proforma can prompt admitting surgeons to capture more information. Re-audit followed by proforma refinement and team education can improve results further. General surgical teams should be engaged in these changes in the documentation process. 1099: SOFTLY SPREADING? THE INCIDENCE OF SOFT TISSUE INFECTIONS IN AN IRISH REGIONAL HOSPITAL David Kennedy , Sarah Phelan, Helen Mohan, Caoimhe Byrne, Niamh Bambury, Ken Mealy. Wexford General Hospital, Co. Wexford, Ireland. Introduction: Soft-tissue infections are a major cause of morbidity and a burden on hospital resources. Internationally, their incidence is rising.1 The main aim of this study was to examine trends in soft-tissue infection at an Irish regional hospital. Methods: A retrospective analysis of a prospectively maintained surgical audit database (based on the Lothian surgical audit system) from January 2000 until December 2012 was performed. Information collected included baseline demographics, number of admissions, length of stay, and rates of surgical intervention. Statistical analysis was performed using Graph Pad Prism 6. Results: In total, therewere 1388 admissions for cellulitis from 2000-2012. Therewas a significant increase in themean number of admissions per year over the study period, with a 53.4% increase from 2000-2003 compared with 2009-2012 (p1⁄40.0286 Mann-Whitney U test). However, the mean length of stay remained unchanged (7.6 days versus 6.5 days, p1⁄4ns). Conclusions: The incidence of soft-tissue infections is rising. This has implications for planning delivery of acute surgical services. Potential approaches include community based care for a suitable subset, and a focus on primary prevention.[1] Lautz TB, Raval MV, Barsness KA. Increasing national burden of hospitalizations for skin and soft tissue infections in children. J Pediatr Surg 2011 Oct; 46(10):1935-41. 1101: IS BILIRUBIN A USEFUL MARKER IN DIAGNOSING APPENDICITIS? Umar Sharif, David Mathews, Ahmed Karim , Michaela Janks, Hannah Boyd-Carson, Tiramula Raju. Heart of England Trust, Birmingham,

Softly spreading? The incidence of soft tissue infections in an Irish regional hospital

Softly spreading? The incidence of soft tissue infections in an Irish regional hospital

Targeting Staphylococcus aureus α-toxin as a novel approach to reduce severity of recurrent skin and soft-tissue infections.

Staphyococcus aureus frequently causes recurrent skin and soft-tissue infection (SSTI). In the pediatric population, elevated serum antibody targeting S. aureus α-toxin is correlated with a reduced incidence of recurrent SSTI. Using a novel model of recurrent SSTI, we demonstrated that expression of α-toxin during primary infection increases the severity of recurrent disease. Antagonism of α-toxin by either a dominant-negative toxin mutant or a small molecule inhibitor of the toxin receptor ADAM10 during primary infection reduces reinfection abscess severity. Early neutralization of α-toxin activity during S. aureus SSTI therefore offers a new therapeutic strategy to mitigate primary and recurrent disease.

Treatment of mandible fractures using resorbable plates with a mean of 3 weeks maxillomandibular fixation: a prospective study

In this study, a 2.5-mm resorbable plating system (Inion CPS, Tampere Finland) was assessed for the fixation of mandibular fractures with 3 weeks of maxillomandibular fixation. Fifty mandibular fractures in 34 patients (32 males, 2 females) with a mean of 20.8 days of maxillomandibular fixation (MMF) were included in this study. The 2.5-mm resorbable plates were adapted along Champy's line of ideal osteosynthesis and secured with four 8 × 2.5 mm monocortical resorbable screws. All patients were followed for a minimum of 6 weeks with an average long-term follow-up of 10 months. The incidence of soft tissue infection, nonunion, malunion, malocclusion, osteomyelitis, nerve injury, and tooth damage was prospectively assessed. Primary bone healing was achieved in 100% of cases. Ten minor complications (20%) were observed: 5 soft tissue infections (10%), 4 plate dehiscences (8%), and 1 malocclusion (2%). No evidence of malunion, nonunion, osteomyelitis, plate fracture, or iatrogenic dental or nerve injury was noted; no readmission or reoperation was necessary. The Inion 2.5-mm resorbable plating system along Champy's line of ideal osteosynthesis plus 3 weeks of MMF is a viable option for the treatment of mandible fractures.

Skin and soft-tissue infection caused by non-tuberculous mycobacteria in Taiwan, 1997–2008

The aim of this study was to investigate the clinical, microbiological, and pathological characteristics and the outcomes of skin and soft-tissue infection (SSTI) caused by non-tuberculous mycobacteria (NTM). Medical records of 50 patients with SSTI caused by NTM identified from 2005 to 2008 and 63 patients previously reported in a medical centre from 1997 to 2004 were reviewed. The annual incidence (per 100,000 outpatients and in-patients) ranged from 0·57 in 2005, 0·38 in 2007, to 1·1 in 2008, with an average of 0·62/100,000. From 1997 to 2008, the average incidence was 1·39/100,000 patients. The average annual incidence of SSTI caused by NTM was 0·62/100,000 outpatients and in-patients during 2005 and 2008. Of the total of 113 patients identified during the 12-year period, patients infected with Mycobacterium fortuitum and M. marinum were younger than those infected with M. avium-intracellulare complex (MAC) (36 and 44 years vs. 55 years, P=0·004 and P=0·056, respectively), and were more likely to have previous invasive procedures than those infected with MAC and M. abscessus (81·8% and 72·0% vs. 27·8% and 54·8%, P=0·007), and less likely to have associated immunosuppression (9·1% and 24% vs. 66·7% and 45·2%, P=0·006). Granuloma was more often observed in immunocompetent patients (60·1% vs. 40%, P=0·019), and in M. marinum-infected specimens (78·3%). There were significant differences in the demographic and clinical features of patients with NTM SSTI, including immunosuppression, trauma experience, and depth of tissue infections.

Community‐Associated Methicillin‐ResistantStaphylococcus aureusand HIV: Intersecting Epidemics

Single-site studies have suggested a link between human immunodeficiency virus (HIV) and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Population-level incidence of HIV-infected patients with CA-MRSA versus community-associated methicillin-susceptible S. aureus (CA-MSSA) infection was assessed in the Cook County Health and Hospitals System (CCHHS), a multi-hospital and ambulatory care center. Rates in zip codes, including those with a high density of individuals with prior incarceration (ie, high-risk zip codes), were calculated. We did a nested case-control analysis of hospitalized HIV-infected patients with S. aureus skin and soft-tissue infections (SSTIs). In CCHHS, the incidence of CA-MRSA SSTIs was 6-fold higher among HIV-infected patients than it was among HIV-negative patients (996 per 100,000 HIV-infected patients vs 157 per 100,000 other patients; P < .001). The incidence of CA-MRSA SSTIs among HIV-infected patients significantly increased from 2000-2003 (period 1) to 2004-2007 (period 2) (from 411 to 1474 cases per 100,000 HIV-infected patients; relative risk [RR], 3.6; P<.001), with cases in period 1 clustering in an area 6.3 km in diameter (P=.035) that overlapped high-risk zip codes. By period 2, CA-MRSA SSTIs among HIV-infected patients were spread throughout Cook County. USA300 was identified as the predominant strain by pulsed-field gel electrophoresis (accounting for 86% of isolates). Among hospitalized HIV-infected patients, the incidence of CA-MRSA increased significantly from period 1 to period 2 (from 190 to 779 cases per 100,000 HIV-infected patients; RR, 4.1; P<.001). Risks for CA-MRSA by multivariate analysis were residence in alternative housing (eg, shelters), residence in high-risk zip codes, younger age, and infection in period 2. HIV-infected patients are at markedly increased risk for CA-MRSA infection. This risk may be amplified by overlapping community networks of high-risk patients that may be targets for prevention efforts.