Incidence Of SSI Research Articles

320 A Closed Loop Audit of Surgical Site Infection Rate in Elective Colorectal Laparotomies, Pre and Post Introduction of Jubilee Dressing Method

Abstract Introduction Surgical site infections (SSI) are responsible for one third of all inpatient infections and are associated with increased morbidity and extended hospital stay. The colorectal department at Glasgow Royal Infirmary introduced the Jubilee dressing method in August 2019 with the aim of reducing SSI incidence. Method Closed loop audit of all elective colorectal laparotomies at Glasgow Royal Infirmary pre- and post-introduction of Jubilee dressing method (March – July & August – December 2019). Literature reviews informed selection of baseline characteristics relevant to SSI. Analysis by logistic regression of SSI incidence by characteristic and Jubilee dressing use. Results A total of 193 patients were included. There was 52% uptake of Jubilee dressing method in the implementation phase and reduction in total SSI rate from 18.25% to 14.93%. Operation duration and smoking history were the only significant factors at univariate analysis and were put forward to multivariate analysis. Of these, only operation duration made a significant contribution to SSI incidence. Conclusions Jubilee dressing use did not make a significant difference to SSI incidence in this sample. This intervention is likely to have small effect size and there were probable confounding factors. Multifactorial influence in SSI incidence suggests larger datasets are required to isolate independent factors.

Enhanced PeriOperative Care and Health protection programme for the prevention of surgical site infections after elective abdominal surgery (EPO2CH): statistical analysis plan of a randomised controlled multicentre superiority trial

BackgroundSurgical site infections (SSI) are frequent complications after elective abdominal surgery. We designed the Enhanced PeriOperative Care and Health Protection programme (EPO2CH) care bundle, comprising of intraoperative high fractional inspired oxygen; intraoperative goal-directed fluid therapy; active preoperative, intraoperative and postoperative warming; glucose control and treatment of hyperglycaemia (> 10 mmol L− 1) in diabetics as well as non-diabetics; and wound irrigation before closure using an aqueous antiseptic. We hypothesise that EPO2CH added to standard care reduces the incidence of SSI compared to standard care alone for elective abdominal surgery.MethodsThis trial is designed as an open label, pragmatic randomised controlled parallel-group multicentre superiority trial. The primary endpoint is the incidence of SSI, defined by the Centers for Disease Control and prevention, within 30 days after surgery. The incidence of SSI is assessed using the Dutch national complication register and medical chart review. Secondary endpoints include the SSI incidence within 90 days, incidence of anastomotic leakage at 30 and 90 days, the incidence of incisional hernia within 1 year, mortality within 1 year and 5 years, quality of life, health and disability, and cost-effectiveness. Primarily, an intention-to-treat analysis will be performed to estimate the relative risk using a log binomial model. If not feasible, a logistic regression will be used to estimate the odds ratio. A per-protocol analysis will also be performed. Furthermore, the attributive effect of the distinct interventions will be explored.DiscussionThe results of the EPO2CH trial will determine if the EPO2CH bundle is effective to prevent SSI incidence for patients undergoing elective abdominal surgery. Details of the statistical analysis are described in this Statistical Analysis Plan (SAP).Trial registrationRegistration number: Dutch Trial Register Trial NL5572. Registered on March 3, 2016.SAP version: V1.0, January 8, 2020. This SAP has been written based on study protocol V10.

Radiographic spine adipose index: an independent risk factor for deep surgical site infection after posterior instrumented lumbar fusion

BACKGROUND CONTEXTSurgical site infections (SSIs) after spinal fusion surgery increase healthcare costs, morbidity and mortality. Routine measures of obesity fail to consider site specific fat distribution. PURPOSETo assess the association between the spine adipose index and deep surgical site infection and determine a threshold value for spine adipose index that can assist in preoperative risk stratification in patients undergoing posterior instrumented lumbar fusion (PILF). STUDY DESIGN/SETTINGMulticenter retrospective case-control study. PATIENT SAMPLEWe reviewed patients who underwent PILF from January 1, 2010 to December 31, 2018. OUTCOME MEASURESAll patients developing a deep primary incisional or organ-space SSI within 90 days of surgery as per US Center for Disease Control and Prevention criteria were identified. We gathered potential pre-operative and intra-operative deep infection risk factors for each patient. A 1:1 match was performed using the following criteria: gender, age (±3 y), ethnicity, date of surgery (± 1 y), and hospital location of surgery. Spine adipose index was measured on pre-operative mid-sagittal cuts of T2 weighted MRI scans. Each measurement was repeated twice by three authors in a blinded fashion, with each series of measurement separated by a period of at least six weeks. MethodsStepwise binary logistic regression analysis was used to assess the association between SAI and the development of deep SSI. Separate logistic regression models were used for body mass index (BMI) and direct measures of subcutaneous fat thickness. Receiver Operating Characteristic analysis was used to determine the optimal value for SAI, and subsequent risk ratios were calculated using the identified threshold. Intra- and inter-observer reliabilities were assessed using intra-class coefficients. ResultsForty-two patients were included in final analysis, with twenty-one cases and twenty-one matched controls. The spine adipose index was significantly greater in patients developing deep SSI (p=.029), and this relationship was maintained after adjusting for confounders (p=.046). Risk of developing deep SSI following PILF surgery was increased 2.0-fold when the spine adipose index was ≥0.51. The spine adipose index had excellent (ICC >0.9; p<.001) inter- and intra-observer reliabilities. ConclusionThe spine adipose index is a novel radiographic measure and an independent risk factor for developing deep SSI, with 0.51 being the ideal threshold value for pre-operative risk stratification in patients undergoing PILF surgery.

Risk factors associated with surgical site infections after thoracic or lumbar surgery: a 6-year single centre prospective cohort study

BackgroundSurgical site infection (SSI) is a risk in every operation. Infections negatively impact patient morbidity and mortality and increase financial demands. The aim of this study was to analyse SSI and its risk factors in patients after thoracic or lumbar spine surgery.MethodsA six-year single-centre prospective observational cohort study monitored the incidence of SSI in 274 patients who received planned thoracic or lumbar spinal surgery for degenerative disease, trauma, or tumour. They were monitored for up to 30 days postoperatively and again after 1 year. All patients received short antibiotic prophylaxis and stayed in the eight-bed neurointensive care unit (NICU) during the immediate postoperative period. Risk factors for SSI were sought using multivariate logistic regression analysis.ResultsWe recorded 22 incidences of SSI (8.03%; superficial 5.84%, deep 1.82%, and organ 0.36%). Comparing patients with and without SSI, there were no differences in age (p=0.374), gender (p=0.545), body mass index (p=0.878), spine diagnosis (p=0.745), number of vertebrae (p=0.786), spine localization (p=0.808), implant use (p=0.428), American Society of Anesthesiologists (ASA) Score (p=0.752), urine catheterization (p=0.423), drainage (p=0.498), corticosteroid use (p=0.409), transfusion (p=0.262), ulcer prophylaxis (p=0.409) and diabetes mellitus (p=0.811). The SSI group had longer NICU stays (p=0.043) and more non-infectious hospital wound complications (p<0.001). SSI risk factors according to our multivariate logistic regression analysis were hospital wound complications (OR 20.40, 95% CI 7.32–56.85, p<0.001) and warm season (OR 2.92, 95% CI 1.03–8.27, p=0.044).ConclusionsContrary to the prevailing literature, our study did not identify corticosteroids, diabetes mellitus, or transfusions as risk factors for the development of SSI. Only wound complications and warm seasons were significantly associated with SSI development according to our multivariate regression analysis.

Ileal Pouch Excision can Be Performed With Similar Outcomes in Obese Patients Compared to Nonobese Counterparts: An Assessment From American College of Surgeons National Surgical Quality Improvement Program.

Failed pouches may tend to be managed with only a loop ileostomy in obese patients due to some safety concerns. The effect of obesity on ileal pouch excision outcomes is poorly studied. In our study, we aimed to assess the short-term outcomes after ileal pouch excision in obese patients compared to their nonobese counterparts. The patients who underwent pouch excision between 2005 and 2017 were included using ACS-NSQIP participant user files. The operative outcomes were compared between obese (BMI ≥30kg/m2) and nonobese (BMI<30kg/m2) groups. There were 507 pouch excision patients included of which eighty (15.7%) of them were obese. Physical status of the obese patients tended to be worse (ASA>3, 56.3 vs 42.9%, P = .027). There were more patients who had diabetes mellitus (DM) and hypertension (HT) in the obese group (26.3% vs. 11.2%, P = .015; 11.3 vs. 4.4%, P < .001, respectively). Operative time was similar between 2 groups (mean ± SD, 275 ± 111 vs. 252±111minutes, P = .084). Deep incisional SSI was more commonly observed in the obese group (7.5 vs 2.8%, P = .038). In multivariate analysis, only deep incisional SSI was found to be independently associated with obesity (OR: 2.79, 95% CI: 1.02-7.67). Obese patients were readmitted more frequently than nonobese counterparts (28.3 vs 16%, P = .035). The length of hospital stay was comparable [median (IQR), 7 (4-13.5) vs. 7 (5-11)days, P = .942]. Ileal pouch excision can be performed in obese patients with largely similar outcomes compared to their nonobese counterparts although obesity is associated with a higher rate of deep space infection.

A study to evaluate the effects of various abdominal closure techniques on midline laparotomy wounds in a tertiary care hospital in West Bengal

Background: Post-operative complications of wound repair after laparotomy pose a major threat to life as well as to the health economy of a developing nation. Among many other factors, the length of suture used during wound closure has been studied for long. A prospective randomized control study comprising of 104 patients was conducted in the department of surgery of Bankura Sammilani medical college for comparing the incidence of SSI, wound dehiscence and incisional hernia after using short stitch and long stitch for repairing midline laparotomy wounds.Methods: Out of 104 patients enrolled in the study, 51 patients were randomly allocated to short stitch group (suture length: wound length&gt;4:1) and 53 patients were allocated to long stitch group (suture length: wound length=4:1) and both the groups were subsequently followed up for development of the three complications.Results: Data analysis revealed that 11.7 % patients in short stitch group developed SSI whereas 24.5% patients in long stitch group developed SSI. Wound dehiscence occurred in 5.8 % of patients in short stitch group against 15% in long stitch group. 7.8% patients in short stitch group developed incisional hernia against 20.7% patients in long stitch group. In all three situations, p value was significant (&lt;0.05).Conclusions: It is concluded from our study that, the rate of SSI, wound dehiscence and incisional hernia is significantly lower in midline abdominal wounds closed with short stitch length than those closed with long stitch length.

Prospective study of surgical site infections post-open esophageal cancer surgery, and the impact of care bundles

SSIs represent common infection-related morbidity following major surgery. Modern care bundles have been established as prophylactic measures aimed at preventing SSI occurring postoperatively. SSI incidence and data on common culprit pathogens post-esophagectomy for cancer have not been previously reported. Patients (2013-2018) treated with curative intent were studied. SSI was defined as per the Center for Disease Control (CDC) definition. A care bundle pathway following the National Institute for Clinical Excellence (NICE) guidelines for prevention of SSIs was introduced in 2013 and was audited quarterly. Risk factors and associations of SSIs were analyzed, as was the prevalence of isolated pathogens. Multivariable logistic regression examined independently predictive factors of SSIs and oncologic outcomes. Of 343 patients, 34 (9.9%) developed a postoperative SSI, with a median (range) of 8 (6-17). Quarterly audit carried out over 6 years showed no significant annual variance or trend. The most prevalent pathogen cultured was Methicillin-sensitive Staphylococcus aureus (MSSA) in nine patients (32%) followed by Candida albicans (29%), Escherichia coli (14%), and Enterococcus faecium (11%). SSI was significantly associated with pneumonia (P = 0.001), respiratory failure (P = 0.014), atrial fibrillation (P = 0.004), anastomotic leak (P < 0.001), and in-hospital blood transfusions (P = 0.031). SSI did not impact the overall survival (P = 0.951). SSI rates can be maintained at less than 10% using strict care bundles and regular audit. The most common culprit pathogen is gram-positive MSSA representing 32% of cases. These data are novel and may represent a modern benchmark for SSI post-open esophagectomy for cancer. This study highlights the incidence and associations of SSI post-esophageal cancer surgery.

Source and antibiotic susceptibility of gram-negative bacteria causing superficial incisional surgical site infections

BackgroundSurgical site infections (SSIs) are a major public health problem worldwide and the second-most frequently reported type of nosocomial infection. The presence of Gram-negative bacteria (GNB) in the hospital environment is significantly associated with SSIs. As such, this study aimed to explore the rate, antibiotic profile and common sources of bacteria in SSI. MethodsA cross-sectional study was conducted between August 2018 and July 2019 in three surgical centers in Kalar city, Kurdistan region, Iraq. A total of 512 patients, who underwent surgery were followed up with for superficial incisional SSI. Pre-, intra- and postoperative swabs were collected from patients and the surrounding hospital environment and processed for isolation and identification of GNB by microbiological and molecular methods. The isolates were typed by sequencing and tested for antibiotic resistance using the disc-diffusion technique. ResultsSSI developed in 113 (22.07%) of the patients studied. GNB were involved in 48 (9.38%) cases; among these, Klebsiella spp. were the predominant cause 21/48 (43.75%), followed by Escherichia coli 14/48 (29.17%), Pseudomonas aeruginosa 7/48 (14.58%), Enterobacter spp. 3/48 (6.25%) and A. baumannii 2/48 (4.17%). Citrobacter koseri showed the lowest rate of infection 1/48 (2.08%). Sequencing analysis and the antibacterial resistance profile revealed that 25 (74.28%) of the 48 SSI isolates were from the hospital environment, whereas the rest were exogenous, with an undetermined source. The involved GNB were highly resistant to most antibiotics tested. ConclusionSSIs caused by GNB were mostly exogenous or from the hospital environment, not from endogenous sources. All of the bacterial isolates detected from SSI patients were multidrug resistant.

Does povidone-iodine application in surgical procedures help in the prevention of surgical site infections? An updated meta-analysis.

IntroductionSurgical site infections (SSIs) occur after an operative procedure and can range from superficial to deep wound infections. The World Health Organization (WHO) and the Centers for Disease Control (CDC) have proposed guidelines recommending measures to prevent SSIs. Intraoperative measures are largely focused on decontamination of the skin and intraoperative wound irrigation using soap and antiseptics and are simple, efficient, and cost-effective measures to reduce SSIs. Povidone-iodine (PVI) is a topical antiseptic widely used for the reduction of SSIs.AimA meta-analysis was conducted to determine the efficacy of preoperative or intraoperative use of PVI from randomized controlled trials (RCTs).Material and methodsA systematic literature review was conducted using MEDLINE and Central databases for RCTs that involved PVI application versus saline or no treatment control groups across various surgical categories. The primary outcome was SSI or post-operative wound infections. A random-effects model was used to calculate the pooled risk ratio and subgroup analyses were performed.ResultsA total of 59 RCTs were included in the meta-analysis with information from 20,497 patients. A reduction in overall SSI incidence was found (RR = 0.70, 0.60–0.80, p = 0.0002, I2 = 44%). Subgroup analyses showed that the comparator treatment and type of procedure did not modify the effect of PVI on SSI incidence. However, inconsistent results on SSI incidence were obtained when the data were stratified by PVI application method and surgery category.ConclusionsThe results of the meta-analysis provide support for the preoperative or intraoperative use of PVI in decreasing the incidence of SSI.

SURGICAL SITE INFECTION AFTER CESAREAN SECTION IN UKRAINE: RESULTS A MULTICENTER STUDY

The aim: To obtain the first national estimates of the current prevalence rate of SSI after CSEC and antimicrobial resistance of causing pathogens in Ukraine. Materials and methods: We performed a retrospective multhicentre cogort study based surveillance data was conducted from May 2017 to December 2019. The study population consisted of all women who had a cesarean section in 11 regional women hospitals of Ukraine. Definitions of SSI after cesarean section were used from the CDC/ NHSN. Results: A total of 2 326 CSEC operations and 14.7% SSI were identified within 30 days of the operation. Of these, 44.4% were superficial incisional SSI, 28.9% were deep incisional SSI, and 26.6% were organ/space SSI, 25.7% of which were classed as endometritis. Of all cases 70.5% of infections were detected post discharge. The most commonly identifed pathogen were Staphylococcus aureus (23.5%), Escherichiacoli (20%), Coagulase-negative staphylococci (8.1%), Enterococcus spp. (7.7%), Pseudomonasaeruginosa (7.7%), Enterobacter spp. (6.4%), and Streptococcus spp. (5.6%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 18.3% and of methicillin-resistance in S. aureus(MRSA) 13.9%. Resistance to third-generation cephalosporins was observed in 15.2% E.coli and 7.9% Klebsiellapneumoniae isolates. Carbapenem resistance was identified in 7.3% of P.aeruginosa isolates. Conclusions: The results of this study revealed high rates of SSI after CSEC and most causing pathogens were associated with resistant to antibiotic stranis. This knowledge is essential to develop targeted strategies to surveillance and reduce the incidence of postoperative infections.

904. Surgical Site Infection After Bariatric Surgery: a Small Risk that Defines Life and Death of Patients

BackgroundSurgical site infection (SSI) in bariatric surgery can lead to devastating outcomes such as peritonitis, sepsis, septic shock and organ space infection. The objective of our study is to answer four questions: a) What is the SSI risk after bariatric surgery? b) What are the risk factors for SSI after bariatric surgery? c) What are the main outcomes to SSI in bariatric surgery? d) What are the main bacteria responsible for SSI in bariatric surgery?MethodsA retrospective cohort study assessed 8,672 patients undergoing bariatric surgery between 2014/Jan and 2018/Dec from two hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. Outcome: SSI, hospital death and total length of hospital stay. 20 preoperative and operative variables were evaluated by univariate and multivariate analysis (logistic regression).Results77 SSI were diagnosed (risk = 0.9% [C.I.95% = 0.7%;1.1%]). Mortality rate in patients, without infection was only 0.03% (3/8,589) while hospital death of infected patients was 4% (3/77; RR = 112; p< 0.001). Hospital length of stay in non-infected patients (days): mean = 2, std.dev.= 0.9; hospital stay in infected patients: mean = 7, std. dev. = 15.6 (p< 0.001). Two main factors associated with SSI after bariatric surgery were identified by logistic regression: duration of procedure (hours), OR = 1.4;p=0.001, and laparoscopy procedure, OR = 0.3;p=0.020. From 77 SSIs, in 28 (36%) we identified 34 etiologic agents. The majority of SSI (59%) was caused by species of Streptococcus (32%), Klebsiella (15%), and Enterobacter (12%).ConclusionSSI is rare after bariatric surgery, however, when it happens, it’s a disaster for the patient. The incidence of SSI can be reduced significantly when laparoscopy procedure is used and the surgeon is able to perform a rapid surgery.Disclosures All Authors: No reported disclosures

Nationwide trends of surgical site infections rates after primary shoulder arthroplasty

BackgroundSurgical site infections (SSI) are relatively uncommon, but can be debilitating complications following shoulder arthroplasty. Infections can result in further complications including sepsis and revision surgery. MethodsThe National Surgical Quality Improvement Program database was queried for all total and reverse total shoulder arthroplasty cases (Current Procedural Terminology code 23472) between 2012 and 2015 yielding 8438 total cases. The outcome of interest was 30-day SSI incidence, defined as a superficial and/or deep wound infection. The infection incidence for each year was calculated. ResultsThe total number of primary shoulder arthroplasties increased from 2012 to 2015 (1191 to 3227; 271% increase). Over the 4-year study period, the incidence of SSIs following TSA was 0.40%. A downward trend in SSI rates was observed over time. An inverse relationship between SSI rates and year of surgery (R2−0.17) was observed; however, this was not statistically significant (P> .05). Infection rates in 2015 decreased by 48% when compared to 2012 (0.31 vs. 0.50%, P> .05). A larger decrease in SSI rate (76%) was noted between 2015 and 2013 (0.31 vs. 0.69%, P> .05). ConclusionSSI rates following shoulder arthroplasty declined from 2012 to 2015 by 48%. There was an inverse relationship between SSI rate and year of surgery, with the lowest infection rate found to be in the most recent year studied. It is hoped that continued measures will further promulgate these downward trends of these devastating complications. Level of EvidenceLevel IV; Retrospective Case Series

Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study

IntroductionSurgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and...

POSTOPERATIVE SURGICAL SITE INFECTION AND PROFILE OF MICROORGANISM IN ELECTIVE LAPAROTOMIES

Laparotomy is one of the most common surgical procedures done by a surgeon. It is performed both as elective and an emergency procedure. Laparotomy procedures are prone to post-operative complications such as pain, fever, wound infection, wound dehiscence, incisional hernia, etc. The rate of these complications depends on preoperative antibiotic prophylaxis, skin antisepsis, control of contamination and surgical skills. SSI is the most common health-care-associated infection and is a cause of one-third of post-operative deaths. A prudent antibiotic prophylaxis and post-operative antibiotic management should be done. For successful management knowledge is necessary regarding the possible pathogens and their antibiotic resistance patterns. The aim of the study is to find out the incidence of SSI in elective laparotomies and to find out the type of pathogenic organism causing wound infection. This prospective observational study was conducted on 180 patients who had undergone elective laparotomy after taking an informed consent.Asterile swab for culture and sensitivity was taken Pre-operatively from incision site and sent to laboratory for assessment with normal culture technique. Repeat swabs for culture and sensitivity was done for patients with post-operative wound infection. Patients were followed up for 1 month. Out of 180 cases incidence of the SSI was seen in 17 cases of elective laparotomy (9.4%). Out of 17 SSI swab specimens 2 (11.8%) were Gram positive involving CONS pathogen, 13 (64.7%) were Gram negative involving E. coli, K.pneumoniae and Pseudomonas (41.2%, 29.4%, 5.9%) while no growth was observed in 11.8% specimens. SSIs were unaffected by demographic or operative variables. Surgical site infections were instrumental in prolonging the duration of hospital stay. Tigecycline and colistin were found to be 100 % sensitive for all the pathogens.

Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study

PurposesSurgical site infection (SSI) after colorectal surgery is a frequent complication associated with the increase in morbidity, medical expenses, and mortality. To date, there is no nationwide large-scale database of SSI after colorectal surgery in China. The aim of this study was to determine the incidence of SSI after colorectal surgery in China and to further evaluate the related risk factors.MethodsTwo multicenter, prospective, cross-sectional studies covering 55 hospitals in China and enrolling adult patients undergoing colorectal surgery were conducted from May 1 to June 30 of 2018 and the same time of 2019. The demographic and perioperative characteristics were collected, and the main outcome was SSI within postoperative 30 days. Multivariable logistic regressions were conducted to predict risk factors of SSI after colorectal surgery.ResultsIn total, 1046 patients were enrolled and SSI occurred in 74 patients (7.1%). In the multivariate analysis with adjustments, significant factors associated with SSI were the prior diagnosis of hypertension (OR, 1.903; 95% confidence interval [CI], 1.088–3.327, P = 0.025), national nosocomial infection surveillance risk index score of 2 or 3 (OR, 3.840; 95% CI, 1.926–7.658, P < 0.001), laparoscopic or robotic surgery (OR, 0.363; 95% CI, 0.200–0.659, P < 0.001), and adhesive incise drapes (OR, 0.400; 95% CI, 0.187–0.855, P = 0.018). In addition, SSI group had remarkably increased length of postoperative stays (median, 15.0 d versus 9.0d, P < 0.001), medical expenses (median, 74,620 yuan versus 57,827 yuan, P < 0.001), and the mortality (4.1% versus 0.3%, P = 0.006), compared with those of non-SSI group.ConclusionThis study provides the newest data of SSI after colorectal surgery in China and finds some predictors of SSI. The data presented in our study can be a tool to develop optimal preventive measures and improve surgical quality in China.

Evaluating the role of methicillin-resistant Staphylococcus aureus (MRSA)-specific antibiotic prophylaxis for neurosurgical patients

ObjectiveSurgical site infection (SSI) in neurosurgical patients increases morbidity. Despite the rise of methicillin-resistant Staphylococcus aureus (MRSA) colonization, there is little consensus regarding antibiotic prophylaxis for SSI in MRSA-colonized neurosurgical patients. Our objective was to examine the incidence of SSI in MRSA-colonized neurosurgical patients and interrogate whether MRSA-specific antibiotic prophylaxis reduces SSIs. MethodsWe performed a retrospective analysis of adult patients undergoing neurosurgical procedures between 2013 and 2018. The primary outcome was SSI in patients with MRSA colonization receiving MRSA-specific antibiotics. Secondary outcomes included predictors of SSI, including whether broad use of MRSA-specific antibiotics affects SSI rate. ResultsOf 9739 procedures, 376 had SSI (3.9 %). Seven hundred forty-four procedures (7.6 %) were performed on patients screened preoperatively for MRSA, including 54 procedures on MRSA-colonized patients. MRSA-colonized patients were more likely than MRSA-non-colonized patients to receive MRSA-specific antibiotics (35.2 % vs. 17.8 %, p = 0.002) for prophylaxis. Nevertheless, MRSA-colonized patients had higher SSI rates compared to MRSA-non-colonized patients (22.2 % vs. 6.4 %, p = 0.00002). MRSA-colonization led to 3.49 greater odds (95 % CI 1.52–7.65, p = 0.002) of SSI relative to MRSA-non-colonization. MRSA-colonized patients receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had lower SSI rates, but this difference was not statistically significant (15.8 % vs. 25.7 %, p = 0.40). In the non-screened population, those receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had significantly higher SSI rates (6.9 % vs. 3.0 %, p = 0.00001). The use of MRSA-specific antibiotic prophylaxis in the non-screened population increased the odds of SSI (OR 1.90, 95 % CI 1.45−2.46, p = 0.0001). ConclusionMRSA-colonized neurosurgical patients had a higher SSI rate compared to MRSA-non-colonized patients. While MRSA-specific antibiotics may benefit those with MRSA colonization, the difference in SSI rate between MRSA-colonized patients receiving MRSA-specific antibiotics vs. non-specific antibiotics requires further investigation. The broader use of MRSA-specific antibiotics may paradoxically confer an increased risk of SSI in a non-screened neurosurgical population.

Efficacy of short term versus long term antibiotic therapy in preventing deep wound infections in elective orthopaedic surgeries

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Comparison of the efficacy of short term (up to 48 hours) versus long term (five days) antibiotic therapy in preventing deep wound infections in elective orthopaedic surgeries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two hundred patients of all ages and both sexes were divided into two groups of 100 patients. One group received long term antibiotic treatment consisting of 2 days intra-venous cefoperazone sulbactam 1.5 gm twice daily and intra-venous amikacin 500 mg twice daily followed by 3 days of oral amoxicillin clavulunate 625 mg thrice daily. Other group received short term antibiotic of 2 days intra-venous cefoperazone sulbactam 1.5 gm twice daily and intra-venous amikacin 500 mg twice daily. Comparison of SSI was done with age, sex, BMI, pre-operative haemoglobin, TLC, duration of surgery in both the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In group I and group II respectively, average duration of surgery in procedures involving implants was 65.02±27.41 and 59.47±20.27 minutes and non implant related procedures was 53.66±23.97 and 53.74±22.40 minutes. Overall incidence of SSI in Group I and Group II was 14% and 10% respectively. Mean infection in the present study was 12%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;It was concluded that in clean orthopaedic elective surgeries short term antibiotics regimen is as effective as long term antibiotics regimen. Continuing antibiotics for more than two days is associated with drug related complications like allergic reactions and gastrointestinal upset, adverse interactions in other drugs, development of resistant organisms and it adds to overall cost of treatment.&lt;/p&gt;

The Optimal Course Duration for Antibiotic Prophylaxis in the Prevention of Surgical Site Infection in Major Lower Limb Amputations: A Randomised Controlled Trial

Background: Major LLA remains a common operation in the United Kingdom with ⁓5000 procedures performed yearly. Amputations are described as ‘clean surgery’ and SSIs in this patient cohort have been previously under-reported. The true incidence lies between 13-35% and is associated with patient mortality, morbidity and implications on health economics. Previous work done in this thesis has demonstrated lack of consensus in clinical practice regarding perioperative antibiotic prophylaxis, and lack of high-quality studies to formulate and sustain a common practice across the UK. Methods: A single centre RCT was designed to which a total of 161 patients were recruited and randomised to receive either a 5-day or a 24-hour prophylactic antibiotic course. Within the groups further allocation to skin preparation (alcoholic chlorhexidine Vs. alcoholic povidone iodine) was performed by stratification. Results: A total of 152 patients were included in the final analysis. Groups were well matched for comorbidities and demographics. The use of a 5-day course was associated with a statistically significant lower incidence of SSI(n=9, 11.8%) when compared to the 24-hour group (n=30, 39.5%) (P<0.001) and lower incidence of IWH(n=17, 22.4% Vs. n=44, 57.9% respectively) (P<0.001). The level of amputation was the only other statistically significant independent factor associated with an increase in SSI incidence (P=0.018, P=0.005, and P<0.001 respectively). Choice of skin preparation between alcoholic chlorhexidine and povidone iodine had no effect on the incidence of SSI / IWH. The presence of SSI statistically significantly increased the post-operative length of hospital stay (from median 14 to 28 days, P=0.0125) Conclusions: This is a Level 1 study which demonstrated that the use of a 5-day over a 24- hour antibiotic course can significantly reduce incidence and risk of SSI/IWH development. It has also highlighted another independent factor, the level of amputation. The presence of SSI is associated with prolonged hospital stay, something which has significant implications on patient morbidity as well as incurring significant costs on healthcare resources. Trial Registration: The protocol was registered online as EudraCT Number: 2012- 003146-32 Funding Statement: Internal University funding only (Hull York Medical School, UK) Declaration of Interests: None Ethics Approval Statement: All necessary national and local ethics board approvals were obtained.

Antimicrobial prophylaxis is considered sufficient to preserve an acceptable surgical site infection rate in clean orthopaedic and neurosurgeries in dogs

BackgroundSurgical site infections (SSI) are associated with increased morbidity and mortality. To lower the incidence of SSI, antimicrobial prophylaxis is given 30–60 min before certain types of surgeries in both human and veterinary patients. However, due to the increasing concern of antimicrobial resistance, the benefit of antimicrobial prophylaxis in clean orthopaedic and neurosurgeries warrants investigation. The aims of this retrospective cross-sectional study were to review the rate of SSI and evaluate the compliance with antimicrobial guidelines in dogs at a veterinary teaching hospital in 2012–2016. In addition, possible risk factors for SSI were assessed.ResultsNearly all dogs (377/406; 92.9%) received antimicrobial prophylaxis. Twenty-nine dogs (7.1%) did not receive any antimicrobials and only four (1.1%) received postoperative antimicrobials. The compliance with in-house and national protocols was excellent regarding the choice of prophylactic antimicrobial (cefazolin), but there was room for improvement in the timing of prophylaxis administration. Follow-up data was available for 89.4% (363/406) of the dogs. Mean follow-up time was 464 days (range: 3–2600 days). The overall SSI rate was 6.3%: in orthopaedic surgeries it was 6.7%, and in neurosurgeries it was 4.2%. The lowest SSI rates (0%) were seen in extracapsular repair of cranial cruciate ligament rupture, ulnar ostectomy, femoral head and neck excision, arthrotomy and coxofemoral luxation repair. The highest SSI rate (25.0%) was seen in arthrodesis. Omission of antimicrobials did not increase the risk for SSI (P = 0.56; OR 1.7; CI95% 0.4–5.0). Several risk factors for SSI were identified, including methicillin-resistant Staphylococcus pseudintermedius carriage (P = 0.02; OR 9.0; CI95% 1.4–57.9) and higher body temperature (P = 0.03; OR 1.69; CI95% 1.0–2.7; mean difference + 0.4 °C compared to dogs without SSI).ConclusionsAntimicrobial prophylaxis without postoperative antimicrobials is sufficient to maintain the overall rate of SSI at a level similar to published data in canine clean orthopedic and neurosurgeries.

Impact of postoperative remote infection on length of stay and medical costs in hospitals in Japan.

To analyze the impact of postoperative remote infections (PRIs) on medical expenditure. The subjects of this retrospective study were 338 patients who had undergone gastroenterological surgery at one of the 20 Japanese institutions within the Japan Society for Surgical Infection (JSSI) and mainly authorized as educational institutions. The patients were allocated to 169 pairs of those with a PRI (PRI (+) group) matched with those without a PRI (PRI (-) group). PRIs included pneumonia, urinary tract infection (UTI), catheter-associated blood stream infection (CA-BSI), and antibiotic-associated enteritis. SSI developed in 74 of the 338 patients (22 without PRI and 52 with PRI). The SSI incidence was significantly higher in the PRI (+) group (p < 0.001). The difference in the median postoperative length of hospital stay was 15days, indicating a significant prolongation in the PRI (+) group (p < 0.001). The PRI (+) group also had a higher rate of inter-hospital transfer (p < 0.01) and mortality (p < 0.001). Similarly, the difference in median postoperative medical fees was $6832.3, representing a significant increase in the PRI (+) group (p < 0.001). The postoperative length of hospital stay is longer and the postoperative medical expenditure is higher for patients with a PRI than for those without a PRI.