Incidence Of Surgical Site Infection In Patients Research Articles

Analysis of the incidence of surgical site infections after open reposition of long bone fractures and closed fracture settings in a 7-year follow-up in an orthopedic and trauma ward in southern Poland.

Surgical Site Infection (SSI) is the most common clinical form of Healthcare-Associated Infections (HAI) in orthopedic and trauma wards. A retrospective study was conducted at the Department of Orthopedics and Trauma Surgery in Tarnów in 2012-2018. 3 155 patients treated for bone fractures were analyzed, including 1961 Open Reduction of Fracture (FX) and 1 194 Closed Reduction of Fracture with Internal Fixation (CR) surgeries. The study was conducted in accordance with the methodology recommended by the Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). The aim of the study was to assess the incidence of SSI in patients undergoing the FX and CR procedures. 28 SSIs were identified in the examined ward; 16 SSI cases related to the FX procedure and 12 cases related to CR. The incidence for FX was 0.8% and for CR 1%. In patients with diagnosed SSI, the stay in the ward was longer (p <0.001) than in patients without SSI. In FX operations, the standardized risk index (SIR) did not exceed the value of one. Staphylococcus aureus was the most common organism isolated from materials from patients with SSI. In the examined period, the median age of women was higher than that of men, which may indicate a higher incidence of fractures in women. Patients with diagnosed SSI had a longer stay in the ward than patients without SSI. The incidence of SSI in FX and CR has been reduced compared to previous studies in the same ward.

Bacteriological Profile of Patients with Intra-Abdominal Sepsis and Superficial Surgical Site Infection Following Emergency Abdominal Surgery—Is It Concordant?

The rates of surgical site infections (SSI) continue to be reported with great variability, even for the same operation, from different geographical areas. Hence, a hospital-based surveillance of SSI can help in designing effective preventive strategies. This study was done to assess the risk factors, characteristics, and incidence of SSI in patients undergoing emergency gastrointestinal surgery. The study was a case series analysis, enrolling all consecutive patients undergoing emergency gastrointestinal surgery. The patients were examined daily for SSI using ASEPSIS score and during the post-operative period up to 30 days. For patients with SSI, wound swab was taken for culture and sensitivity. Patient and operative characteristics were analyzed for identifying risk factors, and the bacteriological profile and sensitivity pattern of intra-abdominal specimens were analyzed and compared with microbiological profile of SSI. A total of 100 patients were studied. The incidence of SSI was 33%. Age (44.33 ± 18.277 vs. 39.43 ± 16.158; p 0.015) and pre-operative blood transfusion (61.1 vs. 38.9; p 0.012) were found to be significant risk factors for SSI. On multivariate analysis, blood transfusion (p 0.027) and the duration of operation (p 0.005) were found to be independent risk factors. In cases where the isolated organisms were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumoniae, concordance was noted between the intra-abdominal pathogens and the organisms isolated from the SSI. Risk factors for SSI in patients undergoing emergency abdominal surgeries include increasing age, pre-operative blood transfusion, prolonged operating time, intra-operative blood loss, and operative procedures involving bowel resection. Concordance exists between intra-abdominal and SSI pathogens.

The effectiveness of local application of vancomycin powder in the prevention of surgical site infections in spine surgery: a meta-analysis

To perform a meta-analysis of studies examining the effectiveness of the local application of vancomycin powder for the prophylaxis of surgical site infections (SSIs) in spine surgery. Retrospective cohort studies and prospective randomized clinical trials were searched for in the Pubmed, EMBASE, Cochrane Library and eLibrary databases published from 2008 to December 2018. For the resulting variables, the odds ratio and 95% confidence interval were calculated using random and fixed effects models. Estimation of the degree of heterogeneity is estimated using the coefficient I2. Statistically significant differences were considered differences p<0.05. The meta-analysis included 28 clinical studies that included the results of the local application of vancomycin powder in 17,469 patients after performing various spinal surgical interventions. Two publications had a prospective, randomized, controlled study design. Topical application of vancomycin powder reduces the incidence of SSIs after spine surgery (p<0.0001). The use of vancomycin powder reduces the incidence of SSIs in patients operated on with stabilizing implants (p=0.004). On the other hand, the topical application of vancomycin powder did not affect the prevalence of SSIs in respondents who were operated on without the use of stabilizing implants (p=0.12) or due to deformities of the spine (p=0.06). Topical application of vancomycin powder is highly effective in preventing the development of SSIs in patients after spinal surgical interventions.

Nylon Skin Sutures Carry a Lower Risk of Post-Operative Infection than Metal Staples in Open Posterior Spine Surgery: A Retrospective Case-Control Study of 270 Patients.

Background: Controversy still exists regarding the optimal method for post-operative skin closure in orthopedic surgery. In total knee replacement, closure with metal staples is faster but carries a higher surgical site infection (SSI) risk. Other studies have found differing results in foot and ankle and hip surgery. Very little evidence exists on this subject after spine surgery. The aim of this study was to determine whether closure of the skin incision in open posterior spine surgery carries a different rate of post-operative SSI when using nylon sutures compared with metal staples. Methods: Up to 2006, virtually all skin incisions at our spine surgery unit were closed with metal staples and from 2006 onward with nylon sutures. This was a retrospective historical control study comparing the incidence of SSIs in patients operated on before (n = 127; staples) and after (n = 143; sutures) the transition date. Results: The staples group had an overall 11.8% combined deep and superficial infection rate whereas the nylon suture group had a 4.2% rate (p = 0.017). The two groups also differed in the type of antibiotic prophylaxis used, likelihood of incisional discharge, and the number of days the vacuum drains remained. Conclusions: In our departmental setting, closure of the skin incision with nylon sutures after open posterior spine surgery carried a significantly lower risk of post-operative SSI compared with metal staples. The generalizability of our findings is unclear, but they warrant further investigation.

Incidence study of surgical site infections in a large University Hospital in Rome, first results

Abstract Background Surgical Site Infections (SSI) represent about a quarter of healthcare associated infections (HAI), increase the risk of mortality and hospital stay and extend healthcare costs. The aim of this work is to evaluate the incidence of SSI in patients undergoing surgical procedures of Hospital Units in the Fondazione Policlinico A. Gemelli IRCCS (FPG). Methods This descriptive observational monocentric study has a 30-months duration: the first phase was conducted between July 2018 and March 2019. Patients undergoing abdominal surgery procedures were enrolled. Active infection surveillance was performed, according to the ECDC, during the hospital stay and the surgical outpatient visits. We also performed a post-discharge surveillance (PDS) at 30 days (or 90 days if an implant has been inserted), through a telephone interview, made by a medical doctor resident in Public Health. Results During the first phase were enrolled 431 procedures in 2 Hospital Units, about emergency and hepatobiliary surgery. There were 53 cases of surgical site infection (SSI) highlighted in these procedures. Therefore, SSI’s were reported in 12.09% of the procedures. In particular, in 6.28% of cases, SSIs were diagnosed during the hospital stay. The results of this study showed statistically significant differences (p &amp;lt; 0.005) in incidence rate of emergency (10,70%) and hepatobiliary tract (13,17%) procedures. The average hospital stay was significant higher (p &amp;lt; 0.001) in patients who developed an SSI (17.27 days) than in patients without SSI (4.89 days). Conclusions These preliminary results show that the incidence rate of SSI for gastrointestinal procedures is similar to other European Countries (9.6%). The Hospital Health Management of FPG take care to the surveillance of hospital infections and monitor the correct application of the procedures, in line with the standards defined by Joint Commission International for guarantee high level in patients’ care. Key messages Performing a survey to measure the incidence of surgical site infections for surgery procedures is very important to define it and to improve surveillance systems of hospital infections in FPG. Active surveillance of surgical site infections may allow to enhance appropriate preventive measures.

Effect of Triclosan-Coated Suture on Surgical Site Infection of Abdominal Fascial Closures.

Background: Surgical site infections (SSIs) are a serious problem after abdominal surgery. This study aimed to compare closure of fascia with triclosan-coated monofilament polydioxanone (PDS) or standard PDS in decreasing the incidence of SSIs in patients who underwent abdominal surgery. Methods: In this randomized study, a total of 890 consecutive patients undergoing laparotomy for any gastrointestinal pathology were allocated to closure of the fascia with triclosan-coated PDS (treatment group; TG) or standard PDS (control group; CG). Patients were assessed every day during the hospital stay for SSIs and at the first, second, and fourth week after discharge. The surgical site was assessed in terms of superficial, deep incisional, or organ/site SSI. Results: The main important finding was that SSIs were reduced as much as 24% by using triclosan-coated PDS. Surgical site infections occurred in 200 patients (22.4%), with 105 being early (in the first week) and 95 occurring late. Eighty five of the SSIs (19.1%) were noted in patients in the TG, whereas 115 of them (25.8%) were in the CG (p = 0.016). The infections were superficial in 126 patients, deep incisional in 48 patients, and organ/site in 26 patients. Most of patients (n = 651) had clean-contaminated sites. In subgroup analysis, SSI rates with triclosan-coated PDS were lower in clean, clean-contaminated, and contaminated incisions (0 in the TG versus 24.2% in the CG; p = 0.009; 13.6% in the TG versus 24.3% in the CG, p = 0.001; and 16.6% in the TG versus 27.8% in the CG; p < 0.0001, respectively). Conclusions: Closure of the fascia with triclosan-coated PDS decreased SSI rates as much as 24%. Also, SSIs were decreased significantly at clean, clean-contaminated, and contaminated sites. Therefore, triclosan-coated PDS might be recommended for fascial closure as a means of decreasing SSIs.

Perioperative Catheter Use as a Risk Factor for Surgical Site Infection After Cervical Surgery: An Analysis of 39,893 Patients.

Retrospective cohort study. To demonstrate the relationship between perioperative use of catheters and the incidence of surgical site infection (SSI) after cervical spine surgery, after adjusting for patient's age, severity of comorbidity, surgical approach, and use of instrumentation. Although the association between SSI and the use of arterial catheters (ACs) or central venous catheters (CVCs) is established in cardiac surgery, the relation in the cervical spine was not well elucidated. A private insurance database was analyzed. The incidence of SSI within 1 month postoperatively and the crude odds ratio (cOR) and 95% confidence interval (95% CI) were calculated based on the use of catheters. Subsequently, logistic regression analysis was performed to identify independent factors for SSI. Independent variables of the regression analysis included Charlson comorbidity index with the score of age, the use of CVC, the use of AC, surgical approach (anterior or posterior), and instrumentation (fusion or decompression alone). A total of 39,893 patients received cervical surgery between 2007 and 2015. Of these, 1.6% patients experienced an SSI. The incidence of SSI in patients treated with and without AC was 3.2% and 1.3%, respectively (cOR 2.44, 95% CI: 2.05-2.99, P < 0.001). Likewise, incidence of SSI in patients with and without CVC was 5.8% and 1.5%, respectively (cOR 2.61, 95% CI: 2.97-5.55, P < 0.001). Multivariate logistic regression analysis demonstrated that the adjusted OR was 1.66 in CVC use (95% CI: 1.08-2.46, P = 0.016), whereas the AC use was not significant variable (P = 0.086). The use of CVC can be a potential risk factor for SSI regardless of age, severity of comorbidity, surgical approach, or presence of instrumentation. Although the essential benefits of catheters are undisputed, our data can bring up the surgeon's attention to appropriate management of the CVC. 3.

Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy?

There are currently no established recommendations for the use of perioperative antibiotics (PAs) to prevent surgical site infections (SSIs) for direct microlaryngoscopy (DML). This study examined the incidence of SSI in patients undergoing DML with and without PAs. Retrospective, multi-institutional chart review. A retrospective, multi-institutional chart review was performed at four tertiary referral academic medical centers. Patients undergoing DML from 2010 to 2017 were identified using Current Procedural Terminology codes. Medical records of patients undergoing DML with biopsy, microsurgery, laser ablation, or vocal fold injection who had adequate follow-up were reviewed. Procedures with significant cartilage destruction, concurrent open surgery, or esophageal surgery were excluded. Data recorded included age, gender, pacemaker history, American Society of Anesthesiologists class, wound class, indication for surgery, use of laser, complications, emergency room visits, hospitalizations, pain, fever, and postoperative steroid and antibiotic prescriptions. Presence or absence of SSIs was evaluated by a fellowship-trained laryngologist. There were 834 patients who met inclusion criteria. Of those, 698 did not receive PAs and 136 received PAs. The median age of patients was 54 years of age in the PA group and 57.5 years of age in the non-PA group, and all cases were recorded as wound class II. Overall, 58% of surgeries involved use of carbon dioxide or potassium-titanyl-phosphate laser. Only one SSI was reported on follow-up in a patient who did receive PAs. SSIs are exceedingly rare following DML. PA use is not indicated for routine DML. 4 Laryngoscope, 128:2838-2843, 2018.

Local vancomycin powder administration is not the Holy Grail, only on the half way there

Surgical-site infections (SSIs) is a typical sort of hospital acquired infections (HAIs) which leads to a substantial worse prognosis and high national health expenditure. In the latest issue of Neurosurgery, Arka’s prospective observational cohort study with 355 patients (1) showed that vancomycin local use could reduce the incidence of SSIs in patients with craniotomy (0.49% vs. 6%, P=0.002). The study is timely and with great importance due to SSIs after craniotomy may result in significant consequences such as paresis, hydrocephalus and blood stream infections (2). Despite the encouraging results, more concerns with the topical use of vancomycin merit discussion.

Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience.

Surgical site infection (SSI) is the most common complication of colorectal surgery, resulting in significant burden in terms of morbidity and length of hospital stay. The aims of this study were to establish the incidence of SSI in patients undergoing colorectal surgeries and to identify potentially modifiable risk factors to reduce overall SSI rates. This retrospective study analyzed patients who underwent colorectal resection at our Department. Patients were identified using a prospective SSI database. Univariate and multivariate analyses were used to identify risk factors. A total of 687 patients were enrolled in the study and the overall SSI rate was 19.9% (137 patients). Superficial incisional surgical site infections (SSSIs) developed in 52 (7.6%) patients, deep incisional surgical site infections (DSSIs) developed in 15 (2.2%), and organ/space infections (OSIs) developed in 70 (10.1%). Univariate and multivariate analyses confirmed that age, diabetes, emergency surgery, and a high infection risk index are risk factors for SSI. There are some modifiable and non-modifiable risk factors for SSI. IRI and age are non-modifiable, whereas the timing of surgery and diabetes can be modulated by trying to defer some emergency procedures to elective ones and normalizing the glycemia of diabetic patients.

A laparoscopic approach is associated with a decreased incidence of SSI in patients undergoing palliative surgery for malignant bowel obstruction

BackgroundSeveral authors have reported on the utility of a laparoscopic approach for the palliation of malignant bowel obstruction (MBO); however, the advantages of laparoscopic surgery for MBO have not yet been confirmed. MethodsWe retrospectively reviewed the medical records of patients who underwent palliative surgery for MBO between 2007 and 2015. Laparoscopic procedures have been performed when technically possible since 2014. Successful palliation was defined as the ability to tolerate solid food (TSF) for at least 2 weeks. ResultsTwenty-two patients underwent laparoscopic palliative surgery, and 171 patients underwent conventional open palliative surgery to relieve the symptoms of MBO. Laparoscopic palliative surgery was performed for patients with MBO due to colorectal cancer (n = 12), uterine cancer (n = 3), and other types of cancers (including gastric, prostate, and renal cancer). The following laparoscopic procedures were performed: stoma placement (n = 18), palliative resection (n = 3) and bypass (n = 2). The median operative time was 100 min and the median operative blood loss was 9 ml. The laparoscopic palliative operation allowed 91% (20/22) of the patients to consume a solid diet for more than 2 weeks, and be discharged from hospital. There were no significant differences between laparoscopic surgery and open surgery with regard to the ability to TSF or the postoperative mortality rate. The postoperative morbidity (Clavien-Dindo Grade ≥ II) rates in the laparoscopic and open surgery groups were 14% and 32%, respectively. Laparoscopic surgery led to a significantly lower rate of postoperative surgical site infection (SSI) in comparison to open surgery (4.5% vs 32%; P = 0.0053). ConclusionA laparoscopic approach in palliative surgery for MBO was safe and feasible, and was associated with a lower incidence of SSIs. By minimizing the postoperative morbidity rate, the laparoscopic approach may provide significant benefits to patients with MBO who have a limited life expectancy.

Controversies in Reduction Mammoplasty: Being A "Clean" Operation, Does It Mandate Antibiotic Prophylaxis?

Considered a clean operation, breast surgery has surgical site infection (SSI) rates ranging from 4% to 18%, higher than the reference value for clean surgery (<3.4%). The aim of this study was to measure the incidence of SSI in patients undergoing reduction mammoplasty with and without antibiotic prophylaxis, comparing the results and defining the value of antibiotic prophylaxis. The study was randomized, double-blinded, and interventional. Two groups were formed randomly, with 75 patients in each. Group 1 received prophylactic antibiotic (cefazolin 2 g 30 min before surgery with repetition at 1 g every 3 h during surgery), and Group 2 (control) did not have antibiotic prophylaxis. Patients were followed until the 30th post-operative day for identification of SSI. There were 13 cases of SSI, 3 in Group 1 (4.1%) and 10 in Group 2 (13.9%) (p = 0.039). Their secretion cultures were positive for Staphylococcus aureus. There were more cases of SSI in patients having greater resections (n = 9), but the difference was not significant (p = 0.051). Infection was significantly more common in the group that did not receive prophylaxis.

Influence of Peri-Operative Hypothermia on Surgical Site Infection in Prolonged Gastroenterological Surgery

There have been several recent studies on the correlation between intra-operative hypothermia and the occurrence of surgical site infection (SSI). Differences in the depth and timing of hypothermia and the surgical procedure may have led to conflicting results. Patients undergoing gastroenterologic surgery with a duration of >3 h were analyzed. Hypothermia was defined as a core temperature <36°C and was classified as mild (35.5-35.9°C), moderate (35.0-35.4°C), or severe (<35.0°C). Hypothermia also was classified as early-nadir (<36°C within two h of anesthesia induction) and late-nadir (after that time). Risk factors for SSIs were analyzed according to these classifications. Among 1,409 patients, 528 (37.5%) had hypothermia, which was classified as mild in 358, moderate in 137, and severe in 33. Early-nadir and late-nadir hypothermia was found in 23.7% and 13.8%, respectively. There was no significant difference in the incidence of SSIs between patients with and without hypothermia (relative risk 1.00; 95% confidence interval [CI] 0.80-1.25; p = 0.997). However, there was a significantly greater incidence of SSIs in patients with severe hypothermia (33.3%) than in those with normothermia (19.2%; p = 0.045) or mild hypothermia (17.0%; p = 0.021). The incidence of SSIs also was significantly greater in patients with late-nadir than in those with early-nadir hypothermia (23.7% vs. 16.5%; p = 0.041). The incidence of organ/space SSIs was significantly greater in patients with late-nadir hypothermia (19.6%) than in patients with normothermia (12.7%; p = 0.012). In multivariable analysis, neither severe hypothermia (odds ratio 1.24; 95% CI 0.56-2.77] nor late-nadir hypothermia (OR 0.71; 95% CI 0.46-1.01) was an independent risk factor for SSIs. Severe and late-nadir hypothermia were associated with a greater incidence of SSIs and organ/space SSIs. However, neither of these patterns was identified as an independent risk factor for SSIs, possibly because of the small number of patients.

Does Transumbilical Incision Influence Surgical Site Infection Rates of the Laparoscopic Sigmoidectomy and Anterior Resection?

Laparoscopic surgery is widespread and is safe and effective for the management of patients with colorectal cancer. However, surgical site infection (SSI) remains an unresolved complication. The present study investigated the comparative effect of supraumbilical incision versus transumbilical incision (TU) on the incidence of SSI in patients undergoing laparoscopic surgery for colon cancer. Medical records from patients with colorectal cancer who underwent laparoscopic sigmoid and rectosigmoid colon surgeries with either supraumbilical incision (n = 150) or TU (n = 150) were retrospectively reviewed. There was no difference in demographics, comorbidities, or operative variables between the two groups. The transumbilical group and the supraumbilical group were comparable with regards to overall SSI (6.0% vs 4.0%; P = 0.4062), superficial SSI (6.0% vs 3.3%; P = 0.2704), and deep SSI (0% vs 0.7%; P = 0.2385). SSI developed after laparoscopic sigmoid and rectosigmoid colon cancer surgery in 15 (5.0%) of the 300 patients. Of these superficial SSI, all wounds were in the left lower quadrant incision, and the transumbilical port sites did not become infected. Univariate analysis failed to identify any risk factors for SSI. Avoidance of the umbilicus offers no benefit with regard to SSI compared with TU.

The Impact of Anesthetic Management on Surgical Site Infections in Patients Undergoing Total Knee or Total Hip Arthroplasty.

Surgical site infection (SSI) is one of the most challenging and costly complications associated with total joint arthroplasty. Our primary aim in this case-controlled trial was to compare the risk of SSI within a year of surgery for patients undergoing primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) and revision TKA or THA under general anesthesia versus neuraxial anesthesia. Our secondary aim was to determine which patient, anesthetic, and surgical variables influence the risk of SSI. We hypothesized that patients who undergo neuraxial anesthesia may have a lesser risk of SSI compared with those who had a general anesthetic. We conducted a retrospective, case-control study of patients undergoing primary or revision TKA and THA between January 1, 1998, and December 31, 2008, who subsequently were diagnosed with an SSI. The cases were matched 1:2 with controls based on type of joint replacement (TKA versus THA), type of procedure (primary, bilateral, revision), sex, date of surgery (within 1 year), ASA physical status (I and II versus III, IV, and V), and operative time (<3 vs >3 hours). During the 11-year period, 202 SSIs were identified. Of the infections identified, 115 (57%) occurred within the first 30 days and 87 (43%) occurred between 31 and 365 days. From both univariate and multivariable analyses, no significant association was found between the use of central neuraxial anesthesia and the postoperative infection (univariate odds ratio [OR] = 0.92; 95% confidence interval [CI], 0.63-1.34; P = 0.651; multivariable OR = 1.10; 95% CI, 0.72-1.69; P = 0.664). The use of peripheral nerve block also was not found to influence the risk of postoperative infection (univariate OR = 1.41; 95% CI, 0.84-2.37; P = 0.193; multivariable OR = 1.35; 95% CI, 0.75-2.44; P = 0.312). The factors that were found to be associated with postoperative infection in multivariable analysis included current smoking (OR = 5.10; 95% CI, 2.30-11.33) and higher body mass index (BMI) (OR = 2.68; 95% CI, 1.42-5.06 for BMI ≥ 35 kg/m compared with those with BMI < 25 kg/m). Recent studies using large databases have concluded that the use of neuraxial compared with general anesthesia is associated with a decreased incidence of SSI in patients undergoing total joint arthroplasty. In this retrospective, case-controlled study, we found no difference in the incidence of SSI in patients undergoing total joint arthroplasty under general versus neuraxial anesthesia. We also concluded that the use of peripheral nerve blocks does not influence the incidence of SSI. Increasing BMI and current smoking were found to significantly increase the incidence of SSI in patients undergoing lower extremity total joint arthroplasty.

Risk Factors of Surgical Site Infection after Acetabular Fracture Surgery.

Surgical site infections (SSI) after acetabular fracture surgery are uncommon but devastating. It is still unknown which risk factors contribute to SSI. The primary objective of this study is to investigate the risk factors of SSI after acetabular fracture surgery. A total of 338 patients who underwent the acetabular fracture surgical procedure were studied retrospectively. Post-operative SSI developed in 16 patients. From the medical record, age, gender, body mass index (BMI), Injury Severity Score (ISS), active smokers, diabetes mellitus, causes of fracture, associated injuries, classification of the acetabular fracture, time from injury to operation, operative approaches, use of the Intra-Aortic Balloon Occlusion (IABO), operative time, surgical blood loss, and days in the intensive care unit (ICU) were extracted. Univariate and multivariable analysis were performed to determine the association between risk factors and infection. There were 10 males and six females in the infected group. According to the univariate analysis, the patients in whom SSI developed were more obese (higher BMI), more severely injured in terms of ISS, and had longer ICU stays. The operative time was longer, and estimated blood loss was larger in the infected group. Associated injuries such as Morel-Lavallée lesion, abdominal trauma, and urinary tract trauma were common in the infected group. Combined approaches and IABO were more commonly applied in the infected group. Multivariate analysis indicated that the operative time, Morel-Lavallée lesion, and abdominal trauma are the independent risk factors for SSI. To reduce the incidence of SSI in patients with acetabular fractures, special attention should be paid to the obese patients, Morel-Lavallée lesion, and concomitant abdominal trauma. Keeping the operative time short also reduces the risk of SSI. It is important to perform surgical intervention immediately after the infection occurs.

Effect of Application of Subcutaneous Suction Drainage with Subcuticular Sutures for Wound Closure on the Incidence of Incisional Surgical Site Infection following Elective General Abdominal Surgery : A Randomized Controlled Trial

Objective:The aim of this trial was to verify whether use of subcutaneous suction drainage with subcuticular sutures for wound closure might decrease the incidence of incisional surgical site infection(SSI)after general abdominal surgery. Summary Background Data:The ideal method for wound closure following general abdominal surgery has not been established yet. Methods:Patients were randomly assigned to receive either subcutaneous drainage with subcuticular sutures (drainage group)or subcutaneous sutures with skin stapling (control group).The primary end point was the incidence of incisional SSI within 30 days after surgery.This trial is registered with UMIN-CTR, number UMI03073. Results:A total of 160 patients were randomly assigned to the drainage group(n=81)or the control group(n= 79).Incisional SSI was observed in 12 patients (14.8%)in the drainage group,and 15 patients (19.2%)in the control group,with no significant difference between the two groups (P=0.459).Subgroup analyses showed that the drainage method significantly reduced the incidence of SSIs in patients with diabetes mellitus (P= 0.048)and/or a subcutaneous fat pad thickness of 2.3 cm (P=0.043). Conclusion :Application of the subcutaneous drainage with subcuticular suture method for wound closure was not associated with any significant decrease in the incidence of incisional SSIs as compared to that of the conventional method. However, the drainage method might be beneficial for reducing the risk of SSIs in patients with diabetes mellitus and/or a subcutaneous fat pad thickness of 2.3 cm. Shinshu Med J 63 : 91―101, 2015 (Received for publication September 30,2014;accepted in revised form December 9,2014)

Wound edge protector for prevention of surgical site infection in laparotomy: an updated systematic review and meta-analysis.

An updated meta-analysis based on randomized controlled trials (RCTs) was conducted to evaluate the efficacy of wound edge protector (WEP) in the prevention of surgical site infection (SSI) in patients undergoing laparotomies. Meta-analysis was conducted using Review Manager 5.2. The pooled risk ratio was estimated with random-effect model. Medline, Embase, the Cochrane library, reference lists and conference proceedings were data sources. Two independent reviewers screened studies for inclusion and data extraction. Eligible trials were RCTs enrolling patients accepting laparotomies to assess the effectiveness of WEP. Eleven RCTs totalling 2344 patients met the inclusion criteria. Six trials (1589 patients) testing the single-ring design WEP did not show a statistically significant reduction in SSI of laparotomy (RR 0.76, 95% CI 0.51-1.12). Pooled analysis of the five trials (755 patients) that tested the effect of dual-ring design WEP on SSI showed a significant reduction (RR 0.29, 95% CI 0.15-0.55). The combined data of the 11 trials favoured the effect of WEP (RR 0.58, 95% CI 0.39-0.87). Analysis adjusted by the degrees of contamination revealed that WEP is effective in reducing the incidence of SSI after laparotomy of contamination incision (RR 0.43, 0.26-0.72) but failed to demonstrate such effect in clean/contaminated and dirty incisions (RR 0.72, 95% CI 0.43-1.21; RR 0.82, 95% CI 0.43-1.55, respectively). Our exploratory meta-analysis suggests that WEP reduces the incidence of SSI in patients receiving laparotomies, especially in the circumstance of dual-ring WEP and in contaminated incisions. In order to fully assess the effectiveness of WEP, large-scale and well-designed RCTs are still needed in the future.

Is postoperative Antimicrobial Prophylaxis Needed for the Management of Surgical Site Infection after Spinal Instrumentation Surgery?

Background: It is widely accepted that postoperative Antimicrobial Prophylaxis (AMP) is effective in reducing the risk of surgical site infections (SSI) following spinal surgery. After publication of the Guideline for Prevention of Surgical Site Infection by the Centers for Disease Control and Prevention in 1999, a large number of studies confirmed the effectiveness of AMP. Due to the possible emergence of AMP resistant bacteria or appearance of side-effects, we have treated and managed patients who underwent spinal surgery without post operative antimicrobial agents since 2003. Purpose: To investigate the incidence of SSI in patients without administration of antibiotics after spinal instrumentation surgery. Subjects: A consecutive 468 patients (230 males and 238 females) were adopted in this study from November 2003 to June 2010. Mean age at the time of operation was 52.1 years. We defined this group as the non-postoperative dose group. There were 121 patients (25.9%) who underwent instrumentation surgery. On the other hand, we defined patients who were administered postoperative multiple doses of AMP between January 2000 and October 2003 as the postoperative dose group. There were 340 cases, consisting of 198 males and 142 females in this group. Average age at the time of operation was 51.3 years. There were 146 patients (42.9%) who underwent spinal instrumentation surgery. Methods: All patients were administered 1 g of cefazolin within 30 minutes of skin incision, and the same dose of antimicrobial agent was added every four hours during surgery in the non-postoperative dose group. We administered AMP before and for 7 days after surgery in the postoperative dose group. Results: The postoperative infection rate was 1.92% (9 cases), of which 7 cases were superficial infections and 2 cases were deep infections in the non-post operative dose group. In the post operative dose group, there were 9 confirmed post operative wound infections in the 340 patients for an overall SSI rate of 2.65%. There was no significant difference between the two groups. The incidence of SSI in patients who underwent spinal instrumentation surgery was 0.83% (one of 121 patients) in the non-postoperative dose group and 2.04% (three of 147 patients) in the postoperative dose group. There was no significant difference between the two groups even with the use of spinal implants. Conclusions: The duration of antimicrobial prophylaxis was not related to the SSI rate at our institution. Postoperative administration of antibiotics appears to be unnecessary for spinal surgery even with spinal implants when perioperative management was achieved for the patient condition and surroundings as recommended in the CDC guidelines.

Surgical Site Infections After Kidney Transplantation—Where Do We Stand Now?

Kidney transplantation (KTx) is a widely accepted method of renal function replacement therapy. Surgical site infections (SSIs), along with urinary tract infections, are among the most common infective complications after KTx. The purpose of this study was to assess the incidence of SSI in patients after KTx, identify risk factors for SSI, and classify patients in which standard antibiotic prophylaxis could be avoided. Between January 2010 and December 2011, 262 KTxs were performed in our center. Deceased donors', recipients' data, and data related to surgical procedures were collected. SSIs were diagnosed in accordance with the guidelines published by the U.S. Centers for Disease Control and Prevention. SSIs were diagnosed in 7.25% (19/262) of patients. Of nineteen SSI patients, two (10.5%) were diagnosed with organ-specific SSIs, which eventually led to graft loss; six (31.5%) developed deep incisional SSIs; and eleven (58%) developed superficial incisional SSIs. Through analysis of this extensive data set, we determined the following risk factors for the development of SSI: kidney from extended criteria donors, a cold ischemia time of more than 30 hr, time of surgical procedure longer than 200 min, confirmed diabetes in the recipients, a recipient body mass index higher than 27 kg/m, and occurrence of delayed graft function. It may be possible to reduce standard antibiotic prophylaxis to a single dose in patients without known risk factors for SSI. Any opportunity to reduce antibiotic use is crucial in preventing the development of multi-drug-resistant pathogens.