Incidence Of SSIs Research Articles

Surgical site infection and antimicrobial use following caesarean section at QECH in Blantyre, Malawi: a prospective cohort study

BackgroundSurgical site infections (SSIs) are one of the most common healthcare-associated infections and preventable complication of surgical procedure; continue to threaten public health with significant effects on the patients and health care human and financial resources. Therefore, this study aimed to determine the incidence of SSIs, risk factors and common microorganisms associated with SSI and assess the practice of antimicrobial use in women following Caesarean Section (CS) at Queen Elizabeth Central Hospital (QECH).MethodsThis was a hospital-based quantitative prospective study design involving pregnant women who underwent a CS between February, 2023 and July, 2023 at QECH with 30 day-follow-ups. Wound specimens (wound swabs) were collected from all infected CS wounds and processed at QECH main laboratory, and susceptibility testing was conducted using the Kirby-Bauer disk diffusion method with results reported only as susceptible, intermediate, or resistant and the collected data was analyzed using Stata.ResultsThe overall cumulative incidence of SSI recorded at QECH during the study period was 9.61% (20 cases out of 208). Of these, 19 (95%) of them reported superficial SSI following CS. The mean age was 26.1 years with a standard deviation of 6.2. All pregnant women who underwent for CS received antibiotic prophylaxis. This study revealed that 138 (66.35%) patients received both preoperative antibiotics (ceftriaxone) and post-CS antibiotics without knowing the specific bacterial organism isolated. This study revealed that ruptured membrane had twice the incidence of SSIs compared to intact membrane (χ2 = 2.0922), though not statistically significant. The majority of patients with SSIs (n = 12, 60%) were readmitted and 5 (25%) out of 20 with SSIs had antimicrobial resistance following susceptibility testing. Staphylococcus aureus was the most common organism (3, 60%) and other bacterial isolates included were Enterobacteriaceae and Acinetobacter baumanni.ConclusionThe incidence of SSIs and inappropriate antimicrobial use following CS remains a challenge at QECH. Therefore, due to increased number of SSIs following CS with relative emergence of AMR ensure intensive infection prevention and control practices, establishing AMS program and routine surveillance of SSIs at QECH.

1467. Effects Of Oral Antibiotic Prophylaxis For Surgical Site Infections In Colorectal Surgery: Insights From Real World Data

Abstract Background Surgical site infection (SSI) after colorectal surgery is a significant burden on healthcare costs and patient quality of life. Preventive strategies are very important to working on this problem. In a multicenter randomized controlled trial (RCT) published in Annals of Surgery(2016;263:1085-1091), we reported the efficacy of oral antimicrobial prophylaxis in preventing SSI before colorectal surgery. Since the end of the RCT in 2012, we have applied this prophylaxis in our clinical practice and have experienced a large number of cases. Here, we report the incidence of SSIs when this prophylactic measure is applied in real-world clinical practice. Methods We retrospectively evaluated the incidence of SSI in 1192 patients who underwent elective laparoscopic colorectal resection for colorectal tumors between January 2013 and June 2022. We excluded 24 patients who were unable to receive oral prophylaxis. Antimicrobial prophylaxis consisted of oral kanamycin (1 g) and metronidazole (750 mg) twice on the day before surgery and intravenous cefmetazole (1 g) just before and every 3 hours during surgery. The diagnosis of SSI follows the CDC/NHSN definition. Results Our study included 647 males and 545 females, with a mean age of 69.3 years (IQR 63-77) and BMI of 22.6 kg/m2 (IQR 20.2-24.7). The incidence of SSI in all surgical cases was 61/1192 (5.1%; 95% CI 4.0-6.5). The incidence of SSIs in colon surgery was 16/769 (2.1%; 95% CI 1.3-3.4), and in rectal surgery, 45/400 (11.3%; 95% CI 8.5-14.7). The incidence of Clostridioides difficile colitis, which is regarded as a side effect of oral antimicrobial agents, was low at 6/1192 cases (0.5%; 05%CI 0.2-1.1). In our previous RCT, the incidence of SSI was 21/289 (7.26%) in patients treated with oral antibiotics. In a subanalysis of this trial published in the International Journal of Colorectal Disease(2016;31:1775-1784), the incidence of SSI was 9/188 (4.8%) in colon surgery and 13/103 (13%) in rectal surgery. The incidence of SSIs in the present data was similar to or lower than the incidence of SSIs in well-conditioned patients selected in the RCT. Conclusion Our results suggest that preoperative oral antibiotic prophylaxis in colorectal surgery is an effective method to reduce SSIs in a wide variety of patients in real-world clinical practice. Disclosures All Authors: No reported disclosures

INVESTIGATION OF RISK FACTORS AND BACTERIAL PATHOGENS OF SURGICAL SITE INFECTIONS IN A TEACHING HOSPITAL IN HYDERABAD

Background: Surgical site infections are one of the most common healthcare associated infections which results in a delay in patient recovery. These infections being the most common HAI in our area, the present study was conducted to know the incidence of SSIs and to detect the risk factors associated with SSIs. Material and methods: A prospective study on SSIs was conducted over a period of seven months involving 1211 patients. History was taken from these patients regarding the risk factors of SSIs. Pus and wound swabs collected from these patients were subjected to culture. The culture isolates were identified by standard biochemical tests. Antibiotic sensitivity testing was performed using standard protocol. The incidence of SSIs was determined. Results: SSI rate was 6.6 %.The most common risk factors associated with SSIs were age >60 years, diabetes followed by obesity and prolonged duration of surgery. There was no association with smoking, malnutrition, immunosuppression, skin colonization at the time of surgery, presence of skin diseases at the incision site, peripheral vascular disease and anaemia. Majority of isolates were gram negative isolates. Klebsiella and Escherichia coli were the most common isolates. There was maximum sensitivity of isolates to carbapenems and combination drugs. Conclusion: Age>60 years, diabetics, obesity, and prolonged duration of therapy were the major risk factors associated with SSIs. Decreased incidence of SSIs & decreased isolation of exogenous pathogens in SSI, high sensitivity of gram negative bacilli in our study suggests good infection control practices in our hospital area.

Superiority trial comparing intraoperative wound irrigation with aqueous 10% povidone–iodine to saline for the purpose of reducing surgical site infection after elective gastrointestinal surgery: study protocol for a randomised controlled trial

IntroductionSurgical site infection (SSI) is one of the most common complications after gastrointestinal surgery, with a reported incidence of approximately 10%–25%, which is higher than the rates after other types...

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

Impact of an Antibiotic Side-Chain-Based Cross-reactivity Chart Combined With Enhanced Allergy Assessment Processes for Surgical Prophylaxis Antimicrobials in Patients With β-Lactam Allergies.

β-Lactam antibiotics are first-line therapy for perioperative prophylaxis; however, patient-reported allergies often lead to increased prescribing of alternative antibiotics that may increase the incidence of surgical site infections. The R-group side chain of the β-lactam ring is responsible for allergic cross-reactivity and experts recommend the use of β-lactams that are structurally dissimilar. An internally developed, antibiotic side-chain-based cross-reactivity chart was developed and implemented alongside enhanced allergy assessment processes. This single-center, quasi-experimental study analyzed antibiotic prescribing in all adult patients with a documented β-lactam allergy undergoing an inpatient surgical procedure between quartile (Q) 1 (2012)-Q3 (2014) (historical group) and Q3 (2016)-Q3 (2018) (intervention group). Propensity-weighted scoring analyses compared categorical and continuous outcomes. Interrupted time-series analysis further analyzed key outcomes. A total of 1119 and 1089 patients were included in the historical and intervention cohorts, respectively. There was a significant difference in patients receiving a β-lactam alternative antibiotic between cohorts (84.9% vs 15.1%; P < .001). There was a decrease in 30-day readmissions in the intervention cohort (7.9% vs 6.3%; P = .035); however, there was no difference in the incidence of SSIs in patients readmitted (14.8% vs 13%; P = .765). No significant differences were observed in allergic reactions (0.5% vs 0.3%; P = .323), surgical site infections, in-hospital and 30-day mortality, healthcare facility-onset Clostridiodes difficile infection, acute kidney injury, or hospital costs. Implementation of an antibiotic cross-reactivity chart combined with enhanced allergy assessment processes significantly improved the prescribing of β-lactam antibiotics for surgical prophylaxis.

Oral nutritional supplements for preventing surgical site infections: protocol for a systematic review and meta-analysis

BackgroundSurgical site infections (SSIs) are among the most common healthcare-associated infections. Under-nutrition is an important risk factor for SSIs and can lead to delayed wound healing and longer hospital stays. Oral nutritional supplements are prescribed to reduce the risk of infection and improve health status, but data from randomised controlled trials (RCTs) have shown mixed results. Thus, the objective of our planned systematic review is to evaluate oral nutritional supplements on preventing SSIs in adult surgical patientsMethodsRCTs conducted in adult surgical patients who receive oral nutritional support will be included. The primary outcome will be the incidence of SSIs (within 30 days of surgery or within 90 days for joint replacement surgery). Secondary outcomes will be changes in nutritional status, mortality, health-related quality of life and costs. Literature searches will be conducted in several electronic databases (from inception onwards): MEDLINE, Embase, CINAHL and The Cochrane Central Register of Controlled Trials (CENTRAL). Grey literature will be identified through searching clinical trial registers and dissertation databases. Two reviewers will independently screen all citations, full-text articles and abstract data. The study methodological quality (or bias) will be appraised using the Cochrane risk of bias tool. If feasible, we will conduct random effects meta-analysis where appropriate.DiscussionThis systematic review will evaluate the evidence for pre- and post-surgical intervention with oral nutritional supplements in adults. Findings from this planned review may inform subsequent nutritional interventions for hospitalised patients who undergo surgery.Systematic review registrationPROSPERO CRD42020140954

Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p &lt; 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.

Primary Skin Closure after Repair of Hollow Viscus Injuries

Decisions regarding whether to close the skin in trauma patients with hollow viscus injuries (HVIs) are based on surgeon discretion and the perceived risk for an SSI. We hypothesized that leaving the skin open would result in fewer wound complications in patients with HVIs. We performed a retrospective analysis of all adult patients who underwent operative repair of an HVI. The main outcome measure was superficial or deep SSIs. Of 141 patients, 38 (27%) had HVIs. Twenty-six patients developed SSIs, of which 13 (50%) were superficial or deep SSIs. On adjusted analysis, only female gender (P = 0.03) and base deficit were associated (P = 0.001) with wound infections Open wound management was not associated with a decreased incidence of SSIs (P = 0.19) in patients with HVIs. Further research is required to determine optimal strategies for reducing wound complications in patients sustaining HVIs.

The efficacy of intrawound vancomycin powder and povidone-iodine irrigation to prevent surgical site infections in complex instrumented spine surgery

BACKGROUND CONTEXTSurgical site infections (SSIs) are notorious complications in spinal surgery and cause substantial patient morbidity. Intraoperative decontamination of the wound with povidone-iodine irrigation or vancomycin powder has gained attention lately, but the efficacy of either intervention is unclear. PURPOSETo determine the efficacy of intrawound povidone-iodine or vancomycin in reducing the incidence of deep- and superficial SSIs in instrumented spinal surgery. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEA retrospective chart review was performed including all consecutive adult patients undergoing open, posterior, instrumented spinal surgery at any level between January 2012 and August 2017. OUTCOME MEASURESThe presence of SSI was evaluated according to the criteria published by the Centers for Disease Control and Prevention. The SSIs were divided into deep SSIs (below the muscular fascia) and superficial SSIs (above the muscular fascia). METHODSA retrospective cohort without intrawound treatment was compared with two separate, consecutive intervention groups. One intrawound group received 1.3g/L povidone-iodine irrigation and the other received 1-2 grams of intrawound vancomycin powder at the end of surgery. Incidence of SSIs, as well as demographic, surgical and patient-related variables were registered and compared between groups. In patients with SSI, additional microbiological data were collected. RESULTSIn total, 853 patients were included. In the control group (N=257), 25 (9.7%) patients developed a deep and 13 (5.1%) developed a superficial SSI. In the povidone-iodine group (N=217), 21 (9.7%) patients developed a deep and two (0.9%) developed a superficial SSI. Compared with the control group, there was no significant difference in the incidence of deep SSIs (risk ratio [RR]: 1.00, 95% CI 0.57–1.73), although the number of superficial SSIs was reduced significantly (RR 0.18, 95% CI 0.04–0.80). In the vancomycin group (N=379), 19 (5.0%) patients developed a deep and six (1.6%) developed a superficial SSI. Both deep (RR: 0.52, 95% CI 0.29–0.92) and superficial SSIs (RR: 0.31, 95% CI 0.12–0.81) were significantly reduced in the vancomycin group compared with the control group, even when correcting for several risk factors associated with SSIs in a multivariable logistic regression analysis. There were no significant differences in complications between the 3 groups. No gram-negative selection or vancomycin-resistance was seen in the vancomycin group. CONCLUSIONSIntrawound application of vancomycin was associated with a significant reduction in both deep and superficial SSIs in instrumented spinal surgery. A 1.3g/L intrawound povidone-iodine solution did not show a reduction in deep SSIs, although a reduction of superficial SSIs was observed.

Surveillance of surgical site infections after cholecystectomy

Background: The objective of present study is find out various patient factor including demographic data as well as operative data on occurrence of surgical site infection in patients of cholecyctectomy.Methods: A Prospective observational study of 273 patients of cholecystitis undergoing cholecystectomies for Surveillance of surgical site infections was conducted in the Department of General Surgery at the SSG hospital and Medical College Baroda during a period from 1st December 2013 to 30th November 2015. All patients operated for cholecystectomy are included irrespective of technique. Data collected from each patient were: Case start date and time, case end date and time, discharge date &amp; time, case length, postoperative length of stay in hospital, patients characteristics (age, sex, ASA score), operative characteristics like, pathological diagnosis report of specimen, microorganism isolated based on culture report and antibiotic resistance pattern from infected wounds, antibiotic prophylaxis given perioperatively and antibiotics administered to treat SSI`s, intra operative spillage and bleeding, date of infection, urgent/elective procedure.Results: During the period of 24 months total 273 patient were undergone cholecystectomy out of which 12 (4.3%) patients were developed SSI. SSI rate is affected by various factors which are statistically significant are sex of patients, age, type of procedure, ASA score &gt;3.Conclusions: The overall incidence of SSIs in the present study was 4.3%. The rates of SSI were more in patient with higher age, with male sex, emergency procedure and higher ASA score.

SURGICAL SITE INFECTIONS IN PATIENTS AFTER POSTERIOR LUMBAR SPINE FUSION

ABSTRACT Objective: Infectious complications are the most common cause of unsatisfactory results of surgical treatment and prolongation of hospitalization in patients following spinal surgery. The purpose - to assess the microbiological characteristics of SSI in patients after posterior lumbar fusion for degenerative disease, and to determine the relationship between these characteristics and surgical features of SSIs. Methods: A single-center retrospective non-randomized cohort study was performed, 1563 patients aged 37 to 59 years were included in the study. Microbiological characteristics were analyzed, and their interrelations with the surgical features of all cases of SSIs were determined. Results: The incidence of SSIs was 2.67% (41). Monomicrobial SSIs were detected in 46.3% (19) patients, polymicrobial in 36.5% (15) cases, and negative results of inoculation in 17.07% (7) patients. The most frequent pathogens of SSIs in the study group were S. aureus and S. epidermidis - 37.9% (33) and 24.1% (21), respectively. The period of development of symptoms of SSIs in patients after posterior lumbar fusion averaged 25.9±65.3 days. Methicillin-resistant S. aureus and S. epidermidis (MRSA and MRSE) were verified in 24.1% (21) cases. Conclusions: Assessment of microbiological characteristics should be carried out in all diagnosed cases of SSIs in patients after spine surgical interventions, as these are closely linked to the surgical features of the infectious process. Also, the treatment tactics for this group of patients should be determined by a medical team working in conjunction. Level of evidence IV; Descriptive study.

Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection: study protocol for a randomised controlled trial

IntroductionSurgical site infection (SSI) is a serious postoperative complication that increases morbidity and healthcare costs. SSIs tend to increase as the partial pressure of tissue oxygen decreases: previous trials have...

Surgical Antimicrobial Prophylaxis: Challenges in translating evidence to practice.

Surgical-site infections (ssis) are one of the most common healthcare-associated infections, accounting for 31% of all healthcare-associated infections worldwide.1 It is estimated that 2–5% of patients undergoing surgery develop SSIs, with a higher percentage estimated in resource-limited healthcare settings.2 The impact of SSIs on healthcare delivery systems is very severe, resulting in prolonged hospitalisation, complex medical treatments, increased readmissions and outpatient visits as well as increased direct and indirect medical costs.3,4 In addition, these factors result in significant morbidity and mortality.3,4 Previous research indicates that approximately 60–80% of SSIs are preventable through the implementation of evidence-based practices such as surgical antimicrobial prophylaxis (SAP) guidelines.5 The key to preventing SSIs lies in the understanding and careful implementation of SAP guidelines. Choosing the right antibiotic for each case is of particular importance, as the right antibiotic will produce adequate serum and tissue drug levels and exceed the minimal inhibitory concentration for any organisms that are likely to be encountered during the operation. Optimal timing of the antibiotic prophylaxis administration is considered to be 30–60 minutes before the first incision is made, except for certain antibiotics (e.g. vancomycin and ciprofloxacin) which are administered 120 minutes beforehand.6 Bratzler et al. have confirmed that a single dose of an antimicrobial agent is sufficient for most surgical operations.6 Although the principles of antimicrobial prophylaxis in surgery are clearly established and several guidelines have been published, the implementation of these guidelines remains problematic and controversial among surgeons.7 The over-prescription and inappropriate timing and duration of antimicrobials remains a significant issue in the practice of surgical prophylaxis. In addition, the incidence of SSIs has increased and new antimicrobial-resistant bacteria have emerged due to poor adherence to SAP guidelines.8,9 The aforementioned challenges have been widely addressed in many developed countries,10 although very little attention has been given to this issue in developing countries and the Middle Eastern region. In the November 2015 issue of SQUMJ, Telfah et al. published a report on the impact of a multidisciplinary quality improvement project on the adherence to SAP guidelines in the treatment of surgical oncology patients.10 A clinical pharmacist was noted to play a key role in updating the SAP guidelines and providing the surgeons with required prophylaxis education. Telfah et al. concluded that there was significant improvement in the adherence to SAP guidelines following the implementation of the multidisciplinary quality improvement project.10 This approach demonstrates the important role of both clinical pharmacists and surgeons in engaging with and improving adherence to SAP guidelines.7,11 A review of studies evaluating guideline implementation strategies found only modest-to-moderate effects and noted that healthcare organisations’ resources for guideline implementation were usually insufficient to allow much more than the dissemination of educational materials or lunchtime educational meetings, interventions whose effects were usually only short-lived.12 Barlow et al. found that education and audit-based interventions used before the implementation of guidelines resulted in a significant increase in appropriate antibiotic prescriptions after the introduction of a multifaceted education programme.13 Audit feedback systems to improve the quality of care have also been shown to be feasible and effective in hospital settings in low-income countries.14 Consequently, successful guideline implementation programmes need to understand local barriers, incorporate multiple-component interventions and proceed within a framework of continuous quality improvement.12 Although SAP plays an important role in reducing the rate of SSIs, other factors must be taken into consideration. These include attention to basic infection control strategies; the experiences and techniques of the surgeon; the duration of a procedure; hospital and operating room environments; instrument-sterilisation procedures; preoperative preparation techniques (e.g. surgical scrubs, skin antisepsis and appropriate hair removal); perioperative management of patient temperature and glycaemic control; and the underlying medical condition of the patient.6 In conclusion, drafting SAP guidelines without addressing the implementation process will not necessarily decrease SSI rates. To achieve optimal adherence, antibiotic policy-makers should develop evidence-based guidelines in collaboration with surgeons, guarantee an effective distribution of those guidelines, perform periodic audits on adherence to the guidelines and provide feedback from these audits to surgeons and the appropriate authorities. Hospitals also need to establish a SSI surveillance system, formulate a multidisciplinary implementation team and monitor antimicrobial consumption related to surgical procedures. Moreover, education and training on SSI prevention and management, including SAP guidelines, should be integrated in all undergraduate and postgraduate surgical training programmes.

DRUGS system enhancing adherence of Chinese surgeons to antibiotic use guidelines during perioperative period.

ObjectiveIrrational use of antimicrobial agents for preventing postoperative SSIs is a common phenomenon in China, which results in more bacterial resistance, higher hospital infection rates, extra costs of antimicrobial agents. The aim of the study is to evaluate the effect of Drug Rational Usage Guidelines System (DRUGS) on the surgeon's prescription behavior of antimicrobial agents.Methods10 common surgical operations which included 1543 cases (where 778 cases using paper-based guidelines and 765 cases using DRUGS) were selected and their demographic and clinical data were collected. The selected operations include thyroid resection, breast mass resection, myomectomy, etc. The evaluation criteria were antibiotic administrative categories, the time of initial dose, duration of administration, length of stay, the costs of antibiotics, SSIs and drug adverse reactions(ADR).ResultsThe antimicrobial agents were mostly administrated within 0.5 h to 2 h before incision, 656 patients (85.75%) were intervened with DRUGS and 256 (32.90%) with paper-based guidelines according to the protocol. For the clean wounds incision, 547 patients (91.62%) were within 24 h of withdrawal antibiotics with using paper-based guidelines versus 91 (14.79%) with using DRUGS. A total of 19 kinds of antibiotics were used in the 1543 cases. The leading three on the list of frequency were piperacillin and sulbactam sodium, cefathiamidine and cefoperazone. While after the intervention, the list of frequency changed to cefazolin, cefathiamidine, cefoperazone. The average hospital stay was (7.00±4.31)d with paper-based guidelines and (2.54±1.57)d with DRUGS, respectively. The average cost of antibiotics was ¥(3481.36±2584.46) with paper-based guidelines and ¥(1693.39±1478.27) with DRUGS, respectively. However, there were no significant differences in the incidence of SSIs and ADR between two groups.ConclusionIn this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with DRUGS, was associated with an enhanced surgeon adherence to guidelines.

Triclosan-coated sutures reduce wound infections after spinal surgery: a retrospective, nonrandomized, clinical study

Background contextSurgical site infection (SSI) is a serious postoperative complication. The incidence of SSIs is lower in clean orthopedic surgery than in other fields, but it is higher after spinal surgery, reaching 4.15% in high-risk patients. Several studies reported that triclosan-coated polyglactin 910 sutures (Vicryl Plus; Ethicon, Inc., Somerville, NJ, USA) significantly reduced the infection rate in the general surgical, neurosurgical, and thoracic surgical fields. However, there have been no studies on the effects of such coated sutures on the incidence of SSIs in orthopedics. PurposeTo compare the incidence of wound infections after spinal surgery using triclosan-coated suture materials with that of noncoated ones. Study design/settingA retrospective, nonrandomized, and clinical study. Patient sampleFrom May 2010 to April 2012, 405 patients underwent a spinal surgical procedure in the Department of Orthopedic Surgery of two university hospitals. Outcome measuresThe primary outcome was the number of wound infections and dehiscences. MethodsTwo hundred five patients had a conventional wound closure with polyglactin 910 suture (Vicryl) between May 2010 and April 2011 (Time Period 1 [TP1]), and 200 patients underwent wound closure with triclosan-coated polyglactin 910 suture (Vicryl Plus) between May 2011 and April 2012 (TP2). Statistical comparisons of wound infections, dehiscence, and risk factors for poor wound healing or infection were performed. None of the authors has any conflict of interest associated with this study. ResultsThere were two cases of wound dehiscence in TP1 and one in TP2 (p=.509). Using noncoated sutures in TP1, eight patients (3.90%) had wound infections, whereas one patient (0.50%) had wound infections in TP2 (using triclosan-coated sutures); the difference was significant (p=.020). ConclusionsThe use of triclosan-coated polyglactin 910 sutures instead of polyglactin 910 sutures may reduce the number of wound infections after spinal surgery.

Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients

Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilization. Minimally invasive (MI) techniques for posterior/transforaminal lumbar interbody fusion (P/TLIF) were introduced with the goals of smaller wounds, less tissue trauma, reduced blood loss, and quicker postoperative recovery, while maintaining comparable surgical results. Studies with sufficient power to directly compare the incidence of SSI following MI versus open P/TLIF procedures have been lacking. Furthermore, the direct medical cost associated with the treatment of SSI following the P/TLIF procedure is poorly understood and has not been adequately assessed. Thus, the aim in the present study was to determine the incidence of perioperative SSI in patients undergoing MI versus open P/TLIF and the direct hospital cost associated with the diagnosis and management of SSI after P/TLIF as reported in a large administrative database. The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database for 2003 to 2009 to identify patients undergoing 1- or 2-level MI or open P/TLIF for lumbar spondylotic disease, disc degeneration, or spondylolisthesis. The ICD-9-CM procedure codes were used to identify patients undergoing P/TLIF and those experiencing SSI. Infection-related costs were obtained from the total costs incurred by the hospital for SSI-related care provided during inpatient or hospital outpatient encounters. Five thousand one hundred seventy patients undergoing P/TLIF were identified. Demographic profiles, including the Charlson Comorbidity Index, were similar between MI and open cohorts. Overall, 292 patients (5.6%) experienced an SSI with a mean direct cost of $15,817 per SSI. For 1-level MI versus open P/TLIF, the incidence of SSI (38 [4.5%] vs 77 [4.8%], p = 0.77) and the mean SSI-associated cost per P/TLIF ($684 vs $724, p = 0.680) were similar. For 2-level MI versus open P/TLIF, the incidence of SSI (27 [4.6%] vs 150 [7.0%], p = 0.037) and mean SSI-associated cost per P/TLIF ($756 vs $1140, p = 0.030) were both significantly lower among MI-treated patients. In a multivariate model that accounted for differences in demographics and patient severity, open fusion was associated with a strong trend of increased incidence of SSI as compared with MI fusion (OR 1.469, 95% CI 0.959-2.250). In this multihospital study, the MI technique was associated with a decreased incidence of perioperative SSI and a direct cost savings of $38,400 per 100 P/TLIF procedure when used in 2-level fusion. There was no significant difference in the incidence of SSIs between the open and MI cohorts for 1-level fusion procedures. The results of this study provide further evidence of the reduced patient morbidity and health care costs associated with MI P/TLIF.

Elderly and colorectal surgery. Analysis of surgical site infections

Materials and methods From November 2005 to July 2008 we prospectively collected data from patients who underwent colorectal resection. The study group comprised 264 patients, divided in two groups according to age under 70 (group A) or over 70 years (group B). We analyzed comorbidities and ASA score; type of surgical procedure and diagnosis; surgical contamination wound class, incidence of SSIs and their characteristics.