Surgical Wound Infection Research Articles

INCIDENCE OF SURGICAL SITE INFECTION/ WOUND GAPING IN SUTURED VS STAPLED CLOSURE OF ABDOMINAL INCISION: A COMPARATIVE STUDY

Background Surgical wound is any wound inicted during surgical process and infection of surgical wound is a relevant complication with an incidence of 1% to 3%. Many factors are responsible for the occurrence of surgical site infections, like age, presence of comorbidities, type of procedure, wound closure method, level of contamination etc. Surgical Site Infection or SSI is associated with a signicant economic burden in terms of extended length of stay and increased costs of treatment. Objectives- To determine whether the incidence of surgical site infections differed after wound closure with non-absorbable suture material vs skin stapler, in elective abdominal surgeries. Methods- A comparative study to determine the incidence of surgical site infections after elective abdominal surgery was conducted in a tertiary care setup for a duration of one year. The study population was divided by random computer method in two arms, consisting of 30 patients each. In one arm the abdominal wound after elective surgery was closed with non-absorbable sutures while in the other with skin staplers. Outcomes were noted in terms of Surgical site infection, i.e, presence of wound gape, burst abdomen, closure duration, duration of hospital stay and interventions like secondary suturing, daily cleaning and dressing (CnD) Results- A total of 60 patients who underwent elective abdominal surgeries were divided into two arms of 30 patients each. Wound closure in one group done by non-absorbable suture material while in the other group with skin stapler. The groups were comparable in demographics, ASA (American society of Anaesthesiologist) grading and CDC (Centre for disease control) class of surgical wound. In our study, Surgical site infections were detected in 33.3 % (10 patients) in the sutured arm of closure of abdominal incision, while SSI were detected in 26.6 % (8 patients) of stapled arm of closure of abdominal incision. No signicant difference encountered in the incidence of SSI in sutured and stapled closure of abdominal wound. 76.7% (23 patients) underwent wound closure within 10 minutes in the stapled arm, while only 20 % (6 patients) in the sutured arm had surgical time duration of wound closure less than 10 minutes (p value < 0.001), the wound closure duration in the stapled arm was signicantly less compared to the sutured arm. Conclusions- There was no signicant difference in the incidence of surgical site infections in both the groups, but the surgical time duration of wound closure was signicantly lower in the stapled group.

Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study.

Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro-Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD=14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P< 0.001), and interns responsible for changing dressings (P= 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre- and postoperative antibiotic use. Gram-positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection-associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.

A160 A SARCOMATOID CARCINOMA OF THE COMMON BILE DUCT PRESENTING AS PAINLESS JAUNDICE AND EXTRAHEPATIC BILIARY OBSTRUCTION

Abstract Background Sarcomatoid carcinomas are extremely rare tumors made of epithelial and mesenchymal elements. They have been found in various organs, but presence in the common bile duct (CBD) has only been reported a handful of times. Insight regarding the clinical history, histopathology, treatment, and prognosis is limited. The majority of CBD sarcomatoid carcinomas have occurred in elderly women, including this case. Surgical resection is the mainstay of treatment and the roles for chemotherapy and radiation therapy are undetermined. Prognosis is variable, but generally poor. Purpose Additional information regarding sarcomatoid carcinomas of the CBD will aid in establishing a timely diagnosis and may alter treatment options and prognosis. We aim to add to the limited literature surrounding this rare CBD neoplasm. Method A 71-year-old female presented with painless jaundice, decreased appetite, and weight loss. Initial investigations showed an alkaline phosphatase (ALP) of 3075 U/L, aspartate transaminase (AST) of 507 U/L, alanine aminotransferase (ALT) of 298 U/L, total bilirubin of 325.5 µmol/L, and direct bilirubin of 254.1 µmol/L. Initial computed tomography (CT) scan done showed marked intra- and extrahepatic biliary ductal dilation with appropriate tapering and the presence of a distal CBD hyperdensity. Tissue biopsy obtained by endoscopic retrograde cholangiopancreatography (ERCP) was suspicious for a malignant peripheral nerve sheath tumor. The differential also included synovial sarcoma and sarcomatoid mesothelioma. Result(s) After multidisciplinary discussion involving hepatobiliary surgery, medical oncology, and radiation oncology, pancreaticoduodenectomy was performed; there was no role for neoadjuvant/adjuvant chemotherapy/radiation therapy. Final pathology revealed a well circumscribed mass with a narrow attachment to the posterior CBD, measuring 5.6 x 3.2 x 2.8 cm. Immunohistochemistry showed mixed differentiation with sarcomatoid, squamous, and glandular components, consistent with a sarcomatoid carcinoma. H3K27me3 expression was lost in neoplastic cells. Immunostaining showed strong expression of vimentin and weak expression of CD34, calretinin, CK5 and EMA. Post-operative course was complicated by pancreaticojejunal leak, surgical wound infection, myocardial injury, and esophageal stricturing. 14-weeks post-pancreaticoduodenectomy the patient was found to have C.difficile infection and a perforated viscus, exact location of which was not visible on imaging. Emergent laparotomy revealed a gastroduodenal leak and diffuse small bowel ischemia. The patient passed away shortly after emergent surgery. Conclusion(s) This case illustrates a rare presentation of sarcomatoid carcinoma within the CBD and highlights some of the diagnostic challenges, limited management strategies, complications, and potential poor prognosis of the disease. Further research is required to guide diagnosis and management, and ultimately improve patient outcomes. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Metabolic Bone Disorders Are Predictors for 2-year Adverse Outcomes in Patients Undergoing 2-3 Level Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy or Myelopathy.

Retrospective cohort study utilizing the New York statewide planning and research cooperative system. To investigate postoperative complications of patients with metabolic bone disorders (MBDs) who undergo 2-3 levels of anterior cervical discectomy and fusion (ACDF). MBDs and cervical degenerative pathologies, including cervical radiculopathy (CR) and cervical myelopathy (CM), are prevalent in the aging population. Complications with ACDF procedures can lead to increased hospitalization times, more expensive overhead, and worse patient outcomes. Patients with CM/CR who underwent an ACDF of 2-3 vertebrae from 2009 to 2011 with a minimum 2-year follow-up were identified. Patients diagnosed with 1 or more MBD at baseline were compared with a control cohort without any MBD diagnosis. Cohorts were compared for demographics, hospital-related parameters, and 2-year medical, surgical, and overall complications. Binary multivariate logistic regression was used to identify independent predictors. A total of 22,276 patients were identified (MBD: 214; no-MBD: 22,062). Among MBD patients, the majority had vitamin D deficiency (n = 194, 90.7%). MBD patients were older (53.0 vs 49.7 y, P < 0.001), and with higher Deyo index (1.0 vs 0.5, P < 0.001). MBD patients had higher rates of medical complications, including anemia (6.1% vs 2.3%), pneumonia (4.7% vs 2.1%), hematoma (3.3% vs 0.7%), infection (2.8% vs 0.9%), and sepsis (3.7% vs 0.9%), as well as overall medical complications (23.8% vs 9.6%) (all, P ≤0.033). MBD patients also experienced higher surgical complications, including implant-related (5.7% vs 1.9%), wound infection (4.2% vs 1.2%), and wound disruption (0.9% vs 0.2%), and overall surgical complications (9.8% vs 3.2%) (all, P ≤0.039). Regression analysis revealed that a baseline diagnosis of MBD was independently associated with an increased risk of 2-year surgical complications (odds ratio = 2.10, P < 0.001) and medical complications (odds ratio = 1.84, P = 0.001). MBD as a comorbidity was associated with an increased risk of 2-year postoperative complications after 2-3 level ACDF for CR or CM.

ASUHAN KEBIDANAN KOMPREHENSIF PADA NY.P UMUR 39 TAHUN G5P3A1 DENGAN RESIKO TINGGI UMUR DAN GRANDE MULTIPARA DI PUSKESMAS BUMIAYU KABUPATEN BREBES

Maternal mortality is a global health problem. The highest maternal mortality rate in central Java is Brebes regency. The Bumiayu health center contributes to the maternal mortality rate in Brebes district with 3 deaths in 2021. The purpose of this study was to be able to carry out Comprehensive Midwifery Care in Mrs.P aged 39 years G5P3A1 with Resti Age and Grande Multipara in Bumiayu health center with Varney and SOAP's seven-step midwifery management. The research method used is qualitative descriptive research with a case study approach. The case study conducted in the form of comprehensive widwifery care that examines woman during pregnancy, maternity, newborns, puerperium to Family Planning with seven-step languish management Varney and SOAP. The results of comprehensive widwifery care in Mrs.P, namely in pregnancy, preeclampsia was found Labor giving birth of casarean section and the newborns was normal. In the neonate found jaundice and then proper management was carried out so that the problem was resolved. During the Puerperium period, signs of Surgical Wound Infection were found and then collaborated with dr. Sp.OG so that the problem is resolved by Mom using KB MOW. Based on this care, it was concluded that the care provided had been carried out in accordance with midewifery service standards and the problems found can be resolved.&#x0D;

A meta-analysis of the effect of different body mass index on surgical wound infection after colorectal surgery.

We conducted a meta-analysis to assess the effect of different body mass index on surgical wound infection after colorectal surgery. A systematic literature search up to November 2022 was performed and 2349 related studies were evaluated. The chosen studies comprised 15 595 colorectal surgery subjects participated in the selected studies' baseline trials; 4390 of them were obese according to the selected body mass index cut-off used to measure obesity in the selected studies, while 11 205 were nonobese. Odds ratio (OR) with 95% confidence intervals (CIs) were calculated to assess the effect of different body mass index on wound infection after colorectal surgery by the dichotomous methods with a random or fixed effect model. The body mass index ≥30 kg/m2 resulted in significantly higher surgical wound infection after colorectal surgery (OR, 1.76; 95% CI, 1.46-2.11, P < .001) compared with the body mass index <30 kg/m2 . The body mass index ≥25 kg/m2 resulted in significantly higher surgical wound infection after colorectal surgery (OR, 1.64; 95% CI, 1.40-1.92, P < .001) compared with the body mass index <25 kg/m2 . The subjects with higher body mass index had a significantly higher surgical wound infection after colorectal surgery compared with the subjects with normal body mass index.

Effect of the implementation of an enhanced recovery after surgery protocol (ERAS) in patients undergoing an elective cesarean section.

To demonstrate that the application of an enhanced recovery after surgery (ERAS) protocol in elective cesarean sections is associated with reduced hospital stay without increasing maternal complications. This retrospective, comparative study included patients who underwent an elective cesarean section. The patients were divided into groups: group 1, women who received elements of standardized care according to ERAS guidelines, and group 2, women who did not receive this care. The study included 295 patients, 139 in group 1 (ERAS) and 156 in group 2. The demographic characteristics were similar. Hospital stay and postoperative pain at 24 and 48 hours were lower in patients in group 1; these differences were statistically significant (p < 0.001). The overall complication rate, head pain, surgical wound infection, urinary retention, and readmission were similar in both groups. The application of an ERAS protocol can reduce hospital stay and postoperative pain without increasing the postoperative complication rate in patients who undergo an elective cesarean section. In developing countries, the application of this protocol could help in optimizing available health system resources.

Implementation of Orthogeriatrics in Portugal.

Orthogeriatrics is the subspecialty of geriatrics that is dedicated to the care of elderly patients with fragility fractures. The Orthogeriatrics Unit of the Vila Nova de Gaia Hospital Centre was the first unit created in Portugal in October 2015, in a co-management model. Patients older than 65 years and with femur fractures were admitted to the unit after surgery. The department was run by internists with differentiation in geriatrics, and multidisciplinary support from orthopaedics, physiatrists, physiotherapists, nutritionists, and social workers, as well as rehabilitation nursing. A comprehensive multidisciplinary assessment was performed upon admission, including comprehensive geriatric assessment as well as postoperative monitoring of complications, investigation of fall mechanisms, functional rehabilitation, and outpatient orientation. Analysed variables included demographics, comorbidities, prior level of functionality, delay of orthopaedic surgery, complications, time of hospitalization, functional prognosis, and destination after discharge. Follow-up was maintained to assess short- and medium-term mortality. Kaplan-Meier curves and Cox regression were used for the statistical analysis of mortality. In four years of activity with 444 admissions, the typical patients were women (80.7%), with an average age of 84 years, coming from home (92%) after an accidental fall resulting in a proximal femur fracture. About half (54%) were previously autonomous, but with a high index of comorbidities (mean Charlson Index of 4.85), the most relevant of which were arterial hypertension (71%), malnutrition (46%), heart failure (35%), hyperlipidaemia (34%), osteoporosis (32%), and dementia (16%). During hospitalization, most patients had medical complications (86.3%), the most frequent ones beinganaemia (45%), infections (35%), namely, urinary, respiratory, and surgical wound infections, acute heart failure (15%), and acute kidney injury (11%). Prevalent geriatric syndromes were also identified and corrected through protocols for delirium, urinary incontinence, pressure ulcers, and constipation. The mean length of stay was 12.49 days. At discharge, 75% presented a modified Rankin Scale score lower than 3 and 73% of patients were able to return home, with a low referral rate to long-term care facilities (5.9%). The in-hospital mortality rate was 2.65%. It was possible to maintain follow-up protocol after discharge in 343 patients, and the mortality at 12 months was 19.23% and at three years, it was 25.52%, with a risk of death almost doubled for patients discharged with a high degree of dependence (modified Rankin Scale score ≥ 3; OR: 2.19; p < 0.001). We demonstrated reduced in-hospital mortality despite an elderly, frail population, with multiple previous comorbidities and a high number of inpatient intercurrences evidencing the importance of a good in-hospital co-management between internal medicine and orthopaedics, demonstrating the benefit of orthogeriatric units in patients with fragility fractures of the femur.

Pectoral Fascial Plane Versus Paravertebral Blocks for Minimally Invasive Mitral Valve Surgery Analgesia

This study examined the postoperative analgesic efficacy of single-injection pectoral fascial plane (PECS) II blocks compared to paravertebral blocks for elective robotic mitral valve surgery. A single-center retrospective study that reported patient and procedural characteristics, postoperative pain scores, and postoperative opioid use for patients undergoing robotic mitral valve surgery. This investigation was performed at a large quaternary referral center. Adult patients (age ≥18) admitted to the authors' hospital from January 1, 2016, to August 14, 2020, for elective robotic mitral valve repair who received either a paravertebral or PECS II block for postoperative analgesia. Patients received an ultrasound-guided, unilateral paravertebral or PECS II nerve block. One hundred twenty-three patients received a PECS II block, and 190 patients received a paravertebral block during the study period. The primary outcome measures were average postoperative pain scores and cumulative opioid use. Secondary outcomes included hospital and intensive care unit lengths of stay, need for reoperation, need for antiemetics, surgical wound infection, and atrial fibrillation incidence. Patients receiving the PECS II block required significantly fewer opioids in the immediate postoperative period than the paravertebral block group, and had comparable postoperative pain scores. No increase in adverse outcomes was noted for either group. The PECS II block is a safe and highly effective option for regional analgesia for robotic mitral valve surgery, with demonstrated efficacy comparable to the paravertebral block.

Management of Surgical Site Infections in Spine Surgery: A Current Concept Review

Background: Surgical sites infections (SSIs) in spine surgeries represent one of the commonest hospital-acquired infections. SSIs refers to infection of surgical wound within 30 days of surgery or one year of implant usage. SSIs portend a huge disease burden with devastating consequences to the patient and the hospital facility with attendant physical and psychological trauma to the patient and it is associated with increase rate of morbidity and mortality. Objective: The aim of this review is to identify factors that predispose a spine patient to SSIs and to highlight the current preventive and management concepts. Methods: We carried out a comprehensive review of literatures, using key words such as surgical site infections, spine surgery, predisposing factors, prevention, diagnosis, treatment, outcomes on search engines of Google Scholar, Scopus and PUBMED. Eligible articles for the review included full length published articles in English which we have access to contents. Results: Twenty-five full length articles were found eligible for the review. In spite of improvement in spine care and surgery, SSIs continue be a source of great concern to the patients, surgeons and healthcare system of any nation. Gram positive organisms are more common than gram negative organisms. The risk factors for SSIs include patient- and surgeon - related factors. Albeit, there is no universally accepted protocol for the prevention and treatment of SSIs in spine surgery. The incidence of SSIs is on the increase worldwide with associated high risk of morbidity, overall decrease in the quality of life and sometimes mortality. The economic burdens of the management of SSI is huge and stressful for every nation. Treating SSIs after spine surgery is daunting as the choice between removing the implants for proper bacteria clearance and the risk of causing spinal instability is a hard nut to crack. Conclusions: Despite the improved surgical technique, protocol on asepsis and role of prophylactic antibiotics in clean spine surgeries, there are still substantial increase in the rate of SSIs. Therefore, prevention is more profitable than the hope of proper treatment.

A meta-analysis examined the effect of topical nursing application of antimicrobial as a prophylaxis for the stoppage of surgical wound infection in colorectal surgery.

To assess the impact of topical antimicrobial (TA) as a prophylaxis for the stoppage of surgical wound infection (SWI) in colorectal surgery (CS), we lead a meta-analysis. 9160 participants with CS were enrolled in the chosen studies; 4719 of them used TA, while 4441 served as controls. To assess the effectiveness of TA application in lowering SWIs following CS, odds ratios (OR) with 95% confidence intervals (CIs) were computed with a dichotomous technique with a fixed- or random-effect model. Significantly lower SWIs post CS for TA as whole (OR, 0.50; 95% CI, 0.38-0.64; P< .001), gentamicin collagen sponge and beads (OR, 0.52; 95% CI, 0.32-0.86; P= .01), triclosan impregnated fascial suture (OR, 0.57; 95% CI, 0.38-0.84; P= .005), antibiotic powder, ointment, lavage, or injection for the abdominal wound (OR, 0.35; 95% CI, 0.21-0.59; P< .001), and ionised silver dressing on the closed abdominal wound (OR, 0.45; 95% CI, 0.27-0.77; P= .003) compared to control. Significantly lower SWIs post CS for TA as a whole, gentamicin collagen sponge and beads, triclosan impregnated fascial sutures, antibiotic powder, ointment, lavage, or injection for the abdominal wound, and ionised silver dressing on the closed abdominal wound compared with control. The low sample size of 8 out of the 39 included studies in this meta-analysis calls for precaution when analysing the outcomes.

Accurate molecular dynamics modeling of Pseudomonas aeruginosa outer membrane interaction with signaling molecules.

Pseudomonas aeruginosa is an opportunistic pathogen responsible for lungs, urinary tract, and surgical wound infections. This gram-negative bacterium releases outer membrane vesicles (OMV) derived from the cell's outer membrane (OM), serving diverse functions in bacterial survival, including nutrient acquisition, signaling, antibiotic resistance, delivery vehicle, and host-immune response modulation. This work aims to develop an accurate in silico model of P. aeruginosa outer membrane using all-atom molecular dynamics (MD) to understand OMV biogenesis formation based on the prediction of the bilayer-couple model. This model predicts the intercalation of a signaling molecule name Pseudomonas Quinolone Signal (PQS) to the OM as the main driver for the vesicle formation. In this study, the asymmetric model OM is composed of PA14 Lipid A in the outer leaflet and a mixture of POPE and POPG phospholipids in the inner leaflet. Due to the use of periodic boundary conditions in MD simulations, the compositional asymmetry imposes a fixed ratio of lipid numbers between the two leaflets, which needs to be set with caution. It has been shown that many widely used methods of defining this ratio lack control over the stress state of the membrane. As a result, the generated membrane could have a non-zero per leaflet tension. We investigate the role of the initial stress state on the intercalation of PQS to the OM. Free energy calculation shows that the favorable position of PQS within the membrane would shift significantly by variation of per leaflet tension, which could have important implications on the bilayer-couple model of OMV biogenesis. In addition, we model various PQS analogs to probe the role of different functional groups of PQS on the spontaneous intercalation of this signaling molecule to the membrane.

SG-APSIC1175: Reusing of single-use devices management

Objectives: Single-use devices are supposed to be used only once, but under some conditions those devices need to be reused. Therefore, we conducted the “Reuse of Single-Use Devices Management” project in our hospital. We evaluated single-use devices that are reused for the following factors: (1) reuse of the single-use device with the same patient; (2) a manufacturer stop production order; (3) lack of devices in inventory; and (4) device value &gt;5,000 Thai baht (US $150). Every unit in the hospital is able to handle and monitor the reuse of single-use devices systematically for patient safety. We performed a quality surveillance project to monitor and prevent patient infection and injury from worn-out reused single-use devices, and we collected data related to the cost of reusing single-use devices. Methods: In a working group that studied single-use devices, responsibilities and roles were assigned and the purposes and scope of work were established. We reviewed the reuse of single-use devices policy. We created a request form for the reuse of single-use devices and a quality record form for use in units that reused single-use devices. We analyzed outcomes, monitored data, and audited the completion of these forms on these units. We assured the completion of single-use device registration. We measured the rate of reuse of single-use devices. We monitored the incidence of surgical wound infections related to reuse of a single-use device. Results: Both of these forms were implemented at 100%, and the number of surgical wound infections was zero. Conclusions: The project focused on single-use device registration and the rate of devices ready to use. The uptake of new procedures was 100%, and the expected number of surgical wound infections in patients was zero.

The effectiveness of Barbagli technique compared to Kulkarni technique for urethral strictures: a systematic review and meta-analysis

Introduction: Urethroplasty is one of the management of urethral stricture. Various studies reported that urethroplasty procedures have a higher long-term success rate than urethrotomy for treating urethral stricture. We aim to compare the efficacy and safety of urethroplasty using the Barbagli and Kulkarni approaches. Materials and Methods: This systematic review and meta-analysis were performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We systematically searched for relevant articles through several databases. The outcomes evaluated in this study were success rate, mean operative time, and complication rate. Outcomes with dichotomous data were analyzed using odds ratio (OR). Continuous data will be analyzed using mean difference (MD) and standard deviation (SD). Statistical analysis using RevMan 5.4 for Windows. Results: Three studies were evaluated involving 272 urethral stricture patients. Urethroplasty procedure using the Barbagli technique had a success rate that was not significantly different from that of the Kulkarni technique (OR 0.55, 95% CI 0.28-1.08, p = 0.08). The Barbagli technique had a significantly longer duration of operation (MD 10.34, 95% CI 3.83-16.85, p = 0.002). The incidence of surgical wound infection was not significantly different in both groups (OR 2.13, 95% CI 0.46-9.83, p = 0.33). There was no significant difference in overall complication rates between patients undergoing urethroplasty using the Barbagli and Kulkarni technique (OR 1.52, 95% CI 0.42-5.55, p = 0.52). Conclusion: This SRMA found that the success rate in the Barbagli technique urethroplasty procedure was not significantly different from the Kulkarni technique. However, the operation duration was significantly longer in the Barbagli technique. Complication rates were minimal in both groups.

Surgical Site Wound Infection Following Caesarian Section at Ad-din Women’s Medical College and Hospital, Dhaka: Rates and Microbiological Profile

Background: Surgical site infection (SSI) occurs within 30 days of post-surgical procedure involving skin, subcutaneous tissue, soft tissue or any other parts of anatomy. According to the CDC. SSI is a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the occurrence, the risk factors for infection following caesarean section (C/S) and to analyze its microbiological pattern. Method: This prospective hospital-based study was conducted at the OBG Dept. of Ad-din Women's Medical College and Hospital. Dhaka, from 6 months period (January to June 2021). Total 5199 caesarean sections were performed at the OBG, AWMCH among women who developed surgical site infections (SSI) within 30 days of CS performed. Suspected SSIs were confirmed clinically by the surgeon, attested, by bacteriological culture. Results: Of 5199 caesarean deliveries, 136 cases developed SSI (2.6%). The highest incidence of SSI was documented among women aged 20-30 years (63.2%), of who 54.4% were multiparous. The majority women were originally from rural areas (5 1.5%) women, 76.5% of women which were due to not attending for an antenatal care (ANC) checkup. Of them 90 cases (66.2%) belonged to middle class family. The incidence of infection was higher in obese women (47.8%) having BM1 &gt; 30. and 33% in those with a BMI of 25-29.9. Of all associated comorbidities Premature Rupture of Membranes (PROM) were 25%, Gestational Diabetes Mellitus (GDM) in 14.7%, anemia in 14.7% and Gestational hypertension (GHTN) in 1 1%. Majority emergency caesarean deliveries 77.9% cases. Of total 52.2% cases had prolonged operation. On bacteriological culture growth. 26% which were S. aureus, followed by 25% P. Aeruginosa, 12.5% S. Epidermis's and 1 1.5% E. coli. However, 60 cases (44.1%) revealed as Multi-drug Resistant (MDR). Conclusion : Surgical site infection in patients of caesarean delivery may be reduced by maintaining a normal BMI, ensuring proper and regular ANC to identify and treat comorbidities, limiting the preoperative hospital stay, improving surgeon's operative skill and technique and to reduce the operating duration and also informing the patients about the risk of SSI associated with elective C/S. The Journal of Ad-din Women's Medical College; Vol. 11 (1), Jan 2023; p 26-32

Management of acute surgical wounds in Saudi Arabia: nursing staff knowledge and practice.

Nursing staff play a crucial role in postoperative wound care and management; it is therefore imperative that their knowledge is kept up to date to avoid complications. The overarching objective of this study was to assess the knowledge and practice of nursing staff regarding various aspects of the management of acute surgical wounds. We conducted a cross-sectional study to assess nurses' clinical knowledge and practices in the management of acute wounds in four large hospitals in Saudi Arabia. The eligible participants included nurses who were working in the medical or surgical departments and those who were employed by the Ministry of Health. We administered a study questionnaire and conducted descriptive analysis to report frequencies and proportions of knowledge and practice aspects. A total of 360 nurses responded to the survey, giving a response rate of 70%. A total of 221 nurses completed all survey questions. Of the participants, 56.56% were ≥30 years old, 95.48% were female, and 50.02% had >6 years' working experience. With regards to nurses' knowledge: 71.9% of the participants had updated their knowledge about wound care in the past two years; 54.3% perceived their knowledge of the availability of wound products as good; 74.66% correctly reported the classic signs of inflammation; 66.97% correctly identified general signs of wound infection; 84.62% of the sample considered surgical site infection as one complication of surgical wound infection. Only 61.09% of the nurses reported following wound care guidelines, 48.42% considered wound appearance as a highly important factor that influences nurses' choice of surgical dressing products, and 41.63% considered hospital policies and practices as important in making evidence-based decisions in wound management. This study found that nurses' knowledge about the management of wounds was generally good; however, there were gaps in the practical component which need to be filled to avoid wound complications.

Bacterial Pathogens Isolated from Surgical Wound and Their Antimicrobial Resistance Pattern in A Government Hospital in Anambra, Nigeria

Surgical wound infections are among the most common healthcare-associated infections as complications associated with them can have a significant long-term effect on the morbidity, mortality, and quality of life for patients. Knowledge on local pathogens and sensitivity to antimicrobial agents are crucial for successful treatment and management of surgical wound infection. This study evaluates the bacterial pathogens present in infected surgical wounds and their antimicrobial susceptibility profile. A total of 200 wound swabs from 112 males and 88 female patients of ages from 10 – 70 years with surgical wound infection were collected using clean, sterile swabs and analyzed using standard microbiological methods. Antibiotic disk diffusion method was used to determine the antibiotic resistance profile. Result showed that 142(71%) wound specimens were culture positive while 58(29%) showed no growth on culture media. Majority of the culture positive wounds (90.1%) showed single bacterial growth while the remaining (9.9%) revealed poly-microbial growth. The isolates were found to belong to both Gram-positive 53(37.3%) and Gram-negative 89(62.7%) bacteria. The most predominant isolate from the infected surgical wound was Gram-positive Staphylococcus aureus 53 (37.3%), followed by Gram-negative Pseudomonas aeruginosa 45(31.7%), Escherichia coli 32 (22.5%) and Klebsiella pneumoniae 12 (8.5%). The result of their antibiotic sensitivity test showed that majority of the wound isolates were highly resistant to ampicillin 126(88.7 %), followed by erythromycin 114(80.3%), gentamicin 109(76.7%) and trimetoprim-sulphametoxazole 103(72.5%). The overall findings on antimicrobial profile revealed high level of antimicrobial resistance from microorganisms isolated from surgical wound infections to commonly prescribed antibiotics. Therefore, there is a need for adequate intervention to control the spread of antimicrobial resistance.

Assessment of late postoperative complication in the emergency department

Nowadays, due to the shortening of the hospital stay, it is quite common for surgical patients to develop surgical complications which will declare themselves after having been discharged. Usually, the first point of contact to receive medical treatment will be the Emergency Department. Post-operative complications can be divided into early-onset, the ones which occur in the first 4 weeks, and late-onset for the ones developing more than 4 weeks after surgery. Early-onset complications are the most common, and usually they tend to appear in the immediate postoperative period. These include seromas, surgical wound infections, eviscerations, ileus, anastomotic leak, and medical complications such as pneumonia and thromboembolism. Later-onset complications are more specific to the type of procedure performed. Classic examples are jaundice due to stricture of the bile duct stenosis after hepatobiliary surgery or afferent loop syndrome secondary to gastric surgery. An early diagnosis of any complications reduce their negative impact and helps in their treatment. For these reasons, the Emergency physician must have a high index of diagnostic suspicion. Computed Tomography (CT) scan with intravenous contrast is almost always the best modality to reach a diagnosis. An early surgical consultation is always advisable.

The Delivery of Grand Multiparas in a Semi-Rural Setting: A Cross-Sectional Descriptive Study at the Ayos Locality of Cameroon

Introduction: Grand multiparity is a known risk factor for maternal and fetal complications. Materials and Methods: We carried out a cross-sectional descriptive study on the delivery of grand multiparas at the maternity of the regional hospital annex of Ayos, a semi-rural locality in the Center region of Cameroon. The study covered the period from January 2012 through December 2020, and the objective was to assess the frequency, the determinants and the outcome of delivery in grand multiparas. Results: We recorded 1384 deliveries and enrolled 137 cases of delivery of grand multiparas. This gives a frequency of grand multipara delivery of 9.89%. The mean age of the women was 34.96 ± 4.45 years. Married parturients accounted for 65% of the cases and 16.8% were HIV positive. Delivery occurred at term in 89.9%. In 35.8%, no antenatal consultation was done. The use of the partograph during labor was reported in 11.7%. Per vaginal delivery was noted in 88.3%, emergency cesarean in 10.2% and elective cesarean in 1.5%. The most frequent maternal complications included post-partum hemorrhage (19.9%), genital tract tears (12.4%), endometritis (9.5%) and surgical wound infection (8.7%). No maternal death was recorded. The mean birth weight of the newborns was 3336.8 ± 550 g. Fetal complications were mostly represented by neonatal infection (20.1%), perinatal death (7.9%) and neonatal asphyxia (9.5%). Conclusion: The frequency of grand multiparous delivery in the semi-rural locality of Ayos, Cameroon, was 9.89%. The mean age of parturients was 38.96 years and the proportion of vaginal delivery was 88.3%.

Burkholderia cepacia complex (BCC) causing bacteremia in patients suffering from B-cell acute lymphocytic leukemia: A case report

Background: Burkholderia cepacia complex consists of 24 species of microorganisms that include B. cepacia, B. multivorans, B. cenocepacia, B. vietnamiensis, B. ambifaria, and many more. It is a ubiquitous microorganism found in the soil and aquatic milieu. The most common infections caused by these isolates include bacteremia, pneumonia, genital tract infections, and surgical wound infections. Their potential to cause nosocomial outbreaks in wards of immunocompromised patients is well known. Case Description: In this case report, we describe two cases of community-acquired B. vietnamese bacteremia in patients suffering from B-cell acute lymphocytic leukemia and their antibiotic sensitivity pattern to guide the treatment of these individuals. Conclusion: The identification of rare opportunistic pathogens like Burkholderia vietnamese and adequate treatment in the pandemic-ridden era is the need of the hour due to a rise in immunocompromised conditions owing to the rigorous use of antimicrobials and steroids.