Infection In Surgical Patients Research Articles

Exploring Effective Alternatives to Beta-Lactam Antibiotics for Surgical Prophylaxis: A Comprehensive Investigation

Introduction: The significance of administering preventive antibiotics before a surgical procedure is firmly established,moreover the aim of antibiotic prophylaxis is to limit surgical site infections in surgical patients, based essentially on the use of betalactamines, Individuals with a beta-lactam allergy may experience adverse reactions to antibiotics within this class, such as penicillins and cephalosporins, it leeds to life-threatening symptoms that require immediate medical attention, the aim of our study is to evaluate the surgical antibiotic prophylaxis practices by our staff Material and methods: we carried out a survey using a questionnaire aimed at anesthesia-intensive care staff working in different operating rooms of different types of surgeries. to assess antibiotic prophylaxis practices in the case of allergy to betalactam antibiotics (essentially the alternative antibiotic molecules used). The study lasted 3 months and involved 40 anesthesia-intensive care staff. Once the data had been collected from the questionnaires, they were processed using Excel, then presented in the form of tables and figures, reflecting the results obtained in relation to the aim of the study. Results: the results of antibiotic prophylaxis showed that the use of betalactam antibiotics represented 96% of practices and that the antibiotic molecule chosen as an alternative in case of betalactam allergy was compliant in 84.44% of practices in relation to SFAR 2018 recommendations. Conclusion: Antibiotic prophylaxis practices for patients allergic to betalactamines require major caution in order to limit surgical site infections and reduce hospitalization costs.

Developing an AI-predictive model for predicting the likelihood of post-operative infection in surgical patients

Abstract Introduction Antimicrobial resistance was listed among the top ten global health issues by the World Health Organization in 2019.1 By 2050, it is projected to have caused 10 million deaths, surpassing cancer, diabetes, and road traffic accidents.2 The rise in resistant bacterial strains and reduced availability of novel antibiotics makes tackling antimicrobial resistance even more challenging. Preventing infections is the most effective approach, and Artificial Intelligence (AI) has the potential to help predict the likelihood of a patient experiencing a post-operative infection.3 This can help clinicians identify those who might be at higher risk and implement clinical interventions to potentially reduce this risk, during the pre-operative stage. Aim To develop and internally validate an AI-predictive model for predicting the likelihood of post-operative infection in surgical patients. Methods A secondary care dataset from the Pioneer Research Hub was used to develop the predictive model, which included a range of data such as demographic information, vital signs, microbiological culture results, lab investigations, comorbidities, surgical details, and infection diagnoses. Machine learning techniques and clinician input were used to select predictors, both modifiable (e.g. blood glucose) and non-modifiable (e.g. age). Recursive feature elimination with cross-validation was performed, and the dataset was split into training (80%) and internal validation (20%) sets. Missing data was managed through complete case analysis and multiple imputation. Various supervised machine learning classifier algorithms were trained, and an ensemble model was created. Ethical approval was obtained (20/EM/0183, IRAS 280077). Results Data on 2,716 patients who underwent elective abdominal surgery were included in the model training and validation. The infection incidence in this cohort was 38%. Out of 74 initial predictors, 19 were selected. These predictors included demographic data (gender), comorbidities (diabetes, COPD, cardiac conditions, obesity, anaemia), microbiology data (positive cultures within 90 days before surgery, multi-drug resistance), and laboratory investigations within 90 days before surgery: WBCs, lymphocytes, blood glucose, platelets, haematocrit, mean cell haemoglobin, haemoglobin, total bilirubin, aspartate aminotransferase, alanine transaminase, and C-reactive protein. The gradient boosting classifier performed the best among the supervised machine learning algorithms. The ensemble model showed high performance in training (sensitivity: 85.3%, specificity: 74.6%, AUROC: 88.6%) and internal validation (sensitivity: 96.9%, specificity: 74.1%, AUROC: 85.5%). The PROBAST checklist was used to address bias before predictor selection. Discussion/Conclusion The developed AI-predictive model has the potential to predict the likelihood of an elective abdominal surgery patient experiencing a post-operative infection. Identifying patients at high risk of post-surgical infections can guide clinical decision making and help implement interventions during the pre-operative stage, (i.e. as part of nutritional prehabilitation screening), to reduce infection risk. However, it is important to acknowledge the limitations of this model. One limitation is the presence of missing data in the training dataset, which may introduce biases and affect the accuracy of the model. Additionally, potential inaccuracies in data entry could impact the reliability of the model's predictions. Furthermore, it is crucial to consider any historical biases that might have influenced data collection, as these biases could have adverse effects on the developed model.

Nasal decolonization: What antimicrobials and antiseptics are most effective before surgery and in the ICU

Staphylococcus aureus colonization is a key risk factor for S. aureus infections in surgical patients and in hospitalized patients. Many studies have assessed various decolonization agents, protocols, and settings. This review summarizes key findings about nasal decolonization for 2 different patient populations: patients undergoing surgery and patients hospitalized in intensive care units. We reviewed major studies related to decolonization of patients colonized with S. aureus and who were either undergoing surgical procedures or were hospitalized in intensive care units. We focused on recent studies, particularly randomized controlled trials and robust quasi-experimental trials. We also reviewed select non-randomized trials when more rigorous trials were limited. Mupirocin is the best-studied agent for decolonization. Its use reduces the risk of surgical site infection following orthopedic surgery (strongest data) and cardiac surgery. Mupirocin decolonization also reduces the incidence of S. aureus clinical cultures in the intensive care unit. Povidone-iodine is less well-studied. Current data suggest that it decreases the risk of surgical site infections after orthopedic surgical procedures. In contrast, povidone-iodine is less effective than mupirocin for reducing the incidence of S aureus clinical cultures in the intensive care unit. Both mupirocin and povidone-iodine have important limitations, highlighting the need for future decolonization research.

Plus Sutures for preventing surgical site infection: a systematic review of clinical outcomes with economic and environmental models

BackgroundSurgical site infections (SSIs) represent ~ 20% of all hospital-acquired infections in surgical patients and are associated with prolonged hospital stay, admission to intensive care, and mortality. We conducted a systematic review with economic and environmental models to assess whether triclosan-coated sutures (Plus Sutures) provide benefits over non-coated sutures in the reduction of SSI risk.MethodsSearches were conducted in fifteen databases. A total of 1,991 records were retrieved. Following deduplication and screening by two independent reviewers, 31 randomized controlled trials in adults and children were included in the review.Similarity of the studies was assessed by narrative review and confirmed by quantitative assessment. A fixed effects meta-analysis of SSI incidence model including all groups of patients estimated a risk ratio of 0.71 (95% confidence interval: 0.64 to 0.79) indicating those in the Plus Sutures group had a 29% reduction in the risk of developing an SSI compared with those in the control group (p < 0.001). Safety outcomes were analysed qualitatively.ResultsThe economic model estimated the use of Plus Sutures to result in average cost savings of £13.63 per patient. Plus Sutures remained cost-saving in all subgroup analyses with cost-savings ranging between £11 (clean wounds) and £140 (non-clean wounds).The environmental impact of SSI is substantial, and the model suggests that the introduction of Plus Sutures could result in potential environmental benefits.ConclusionsThe evidence suggests that Plus Sutures are associated with a reduced incidence of SSI across all surgery types alongside cost savings when compared with standard sutures.

Post-extubation use of high-flow nasal oxygenation induces upper airway leak and intrathoracic sepsis after successful Bentall procedure: A case report.

In recent few years, high-flow nasal oxygenation (HFNO) has been widely used for management of acute hypoxemic respiratory failure and during postextubation periods, including after endotracheal intubation general anesthesia (ETGA). However, HFNO generates positive pressure in the injured airway following removal of endotracheal tube may cause airway leaks. This is the first case report of severe airway leak syndrome following postextubation use of HFNO in surgical patients. This case report describes a 75-year-old female with critical aortic stenosis who underwent an emergency Bentall procedure. HFNO (flow rate of 45 L/min) was applied after weaning from mechanical ventilation and removal of the endotracheal tube. At 6 hours after HFNO application, subcutaneous emphysema in the neck bilaterally and face was noted, and the emphysema extended into the supraclavicular regions. The HFNO cannula was removed soon after and the patient was re-intubated with an endotracheal tube the following day due to progressive respiratory insufficiency. Unfortunately, the patient general condition deteriorated, as the subcutaneous air collections progressed into deep tissue infections of the neck, mediastinal abscesses, and left-sided empyema. Patient received surgical interventions repeatedly to drain the mediastinal abscess and empiric antimicrobial therapy was given. The patient passed away about 2 months later due to uncontrollable sepsis. Air leaks in the upper airway can occur during the use of post-extubation HFNO use, and the resulting subcutaneous emphysema can progress to severe intrathoracic infections in surgical patients who have a sternotomy wound. Therefore, HFNO-induced subcutaneous emphysema should be treated more aggressively in open thoracic or sternotomy surgeries to prevent the development of intrathoracic sepsis.

ANTIBIOTIC PROPHYLAXIS USE IN PATIENTS ADMITTED IN GENERAL SURGERY DEPARTMENT AT A TERTIARY CARE TEACHING HOSPITAL IN HARYANA

Objective: In India, due to a lack of adequate information and guidelines for antimicrobial prophylaxis in surgery, there is a need to generate baseline data on the pattern of the use of prophylactic antibiotics. Hence, we planned this study with an objective to study the antimicrobial prophylaxis use in the patients admitted to the general surgery department. Methods: The present study was a prospective observational study conducted in the department of pharmacology in collaboration with the department of surgery with the prior approval of the Institutional Ethical committee. All data were retrieved from the patients’ case records. Using a convenient sampling method, 100 adult patients who underwent surgical procedures in MMIMSR during the study period were taken. Results: A total of 100 patients admitted to the general surgery department of MMIMSR fulfilling the inclusion and exclusion criteria were enrolled. Out of 100 patients, 52 (52%) were male and 48 (48%) were female patients who underwent surgery and the majority of the patients enrolled are between 48 and 58 years (40%) of age. Cholecystectomy (28%) was the most frequent performed surgery type followed by hernial repair (24%) and hemorrhoidectomy (14%) Among all cases, surgical antibiotic prophylaxis was recommended in 93 (93%) patients. The most preferred route of administration of surgical antibiotic prophylaxis was parenteral route 100 (100%) and ceftriaxone was most commonly prophylactically prescribed antibiotic. Conclusion: Surgical site infection is the most common nosocomial infections in surgical patients accounting for prolonged hospital stay, mortality, and increased cost of care. According to the analyzed results of our study and from view of literature, the present study provides us patterns of antibiotic usage in patients admitted in surgery wards.

Prevention of surgical site infections: a personal odyssey

Prevention of surgical site infections: a personal odyssey

The Spectrum of Causative Agents of Complicated Abdominal Infections in Surgical Patients

RELEVANCE Treatment of patients with complicated abdominal infections (AI) is still a difficult task, as evidenced by high mortality rates. THE AIM OF THE STUDY is to analyze the results of microbiological investigations of patients with advanced diffuse peritonitis who were treated in the surgical department of the emergency hospital. MATERIAL AND METHODS In this study, the main pathogens of advanced peritonitis were identified in 69 patients (the average age of patients was 64±17 years). The cause of peritonitis in the absolute majority of cases (94%) was a perforation of the gastrointestinal tract. A study of various types of clinical material was carried out: blood — 143 samples, urine — 125 samples, bronchoalveolar lavage — 119 samples and 130 samples of wound discharge. 260 strains of microorganisms were isolated. RESULTS The predominance of the Enterobacteriacea species (K. pneumoniae and E. coli), non-fermenting bacteria (Acinetobacter spp.) as well as the increasing role of Enterococcus spp. and Staphylococcus spp. (S. aureus and CNS) were found. Multidrug-resistant strains dominated among the identified pathogens. CONCLUSION The obtained data on the structure of pathogens of complicated abdominal infection confirm global trends. In order to develop new treatment methods for complicated AI, one of the possible solutions may be the use of human microbial ecology approaches.

Preliminary Recommendations on the Timing of Lung Surgery after Novel Coronavirus Infection in Patients with Pulmonary Nodules and Lung Cancer

In recent years, the corona virus disease 2019 (COVID-19) pandemic has had a huge impact on the global medical, political and economic fields. Since the beginning of the COVID-19 epidemic, our understanding of the impact of COVID-19 has grown exponentially. Recently, the COVID-19 epidemic has changed rapidly in China, and there has been controversy over how to carry out surgical operations for patients with lung neoplastic lesions. Some studies have shown that lung cancer patients undergoing surgery are more likely to experience respiratory failure and perioperative death after contracting COVID-19 than the general population, however, delays in cancer treatment are also associated with increased mortality among these patients. In particular, the novel coronavirus Omikron variant has a higher transmissibility and may escape the immunity obtained through the previous novel coronavirus infection and vaccination. In order to minimize the risk of novel coronavirus infection in surgical patients, it is necessary to develop new treatment guidelines, expert consensus and preventive measures. However, the current rapid change of the epidemic situation has led to insufficient time and evidence to develop guidelines and consensus. Therefore, thoracic surgeons need to evaluate specific patient populations at higher risk of severe complications before surgery and weigh the benefit of surgical treatment against the risk of novel coronavirus infection. We try to give some recommendations on lung surgery during the current domestic epidemic situation based on the guidelines and consensus of oncology and thoracic surgery organizations in different regions on lung surgery. .

Multidrug-Resistant Enterococcal Infection in Surgical Patients, What Surgeons Need to Know

Enterococci are organisms that can be found in the normal intestinal and skin microbiota and show remarkable ability to acquire antibiotic resistance. This is an enormous challenge for surgeons when faced with surgical site infections caused by multidrug-resistant (MDR) Enterococci. Due to an increase in the prevalence of MDR Enterococcus within the last few decades, there has been a major decrease in therapeutic options, because the majority of E. faecium isolates are now resistant to ampicillin and vancomycin and exhibit high-level resistance to aminoglycosides, traditionally three of the most useful anti-enterococcal antibiotics. There is limited data regarding the magnitude and pattern of multidrug resistance among the enterococcal genus causing surgical site infections in hospitalized patients. The scope of the review is to summarize the most recent findings in the emergence of postoperative MDR Enterococci and discuss recent mechanisms of resistance and the best treatment options available.

Comparative activities of ampicillin and teicoplanin against Enterococcus faecalis isolates

BackgroundEnterococcus faecalis remains one of the most common pathogens causing infection in surgical patients. Our goal was to evaluate the antibiotic resistance of E. faecalis, causing infections in a surgical clinic, against two antibacterial drugs, ampicillin and teicoplanin. One commonly administered in the past for such infections, ampicillin, and another newer, teicoplanin, which demonstrated exceptionally good efficacy.MethodsData from 1882 isolates were retrieved from the microbiology department database during two 5-year periods. Standard biochemical methods were employed for the identification of the isolates. The prevalence of E. faecalis among patients with clinical evidence of infection in a surgical oncology ward was assessed. Confidence interval (CI) as well as standard error (SE) were calculated. Moreover, the annual incidence of E. faecalis infections in this surgical ward was recorded. The susceptibility of E. faecalis to ampicillin and teicoplanin was studied and compared using Fisher’s exact test.Results and conclusionResults showed that the incidence of E. faecalis infections in the surgical clinic was increasing. Ampicillin, in the later year period, was not statistically different from teicoplanin in treating E. faecalis infections. Consequently, ampicillin seems currently to be an effective antibiotic against such infections that could be used as empiric therapy.

A Prospective Study of Surgical Site Infection with its Risk Factors and Their Correlation with the NNIS Risk Index.

Surgical site infection (SSI) is the third most commonly reported nosocomial infection, accounting for 10%-40% of all nosocomial infections and is a major cause of postoperative morbidity. Knowledge of factors related to SSI can help in reducing its incidence and related morbidity, which in many studies is shown to account for 38% of all infections in surgical patients. Lack of extending nosocomial infection surveillance programme and prevention measures in countries like India is viewed as a major challenge for the future. The aims of this work were (1) to study the SSI rate in patients undergoing both elective and emergency abdominal surgery and SSI with CDC, and NNIS risk index; and (2) to assess SSI along with body mass index (BMI), glycaemic status, smoking and duration of pre-operative hospital stay of patients. In total, 300 patients who underwent elective and emergency abdominal surgery were enrolled in the study as per inclusion and exclusion criteria. SSI with CDC's NNIS risk index were analysed considering BMI, glycaemic status, smoking and duration of pre-operative hospital stay of patients. In total, 300 cases of abdominal surgeries (elective and emergency) were analysed, out of which 60 cases were diagnosed to have SSI as per the criteria. This study demonstrated that there is a significant increase in SSI with increasing NNIS score that is, the greater the NNIS score, the greater the risk of SSI. With an increase in age, BMI, glycaemic index and preoperative hospital stay, the risk of SSI increases. Smoking and associated comorbidities also increase the risk of SSI.

Bacteriological Study on Surgical Site Infection in Rangpur Medical College and Hospital

Background: Surgical site infections (SSIs) is a major problem in both developed and developing countries. In developing countries like Bangladesh, infection in surgical patients has been appearing as a serious risk due to insurgence of drug resistance. Surgical site infections (SSIs) contribute significantly to increased health care costs in terms of prolonged hospital stay and lost working days. The problem was largely unexplored in Rangpur Medical College and Hospital, Rangpur.&#x0D; Objective: The aim of the study was to evaluate the bacteriological study on surgical site infections in Rangpur Medical College &amp; Hospital.&#x0D; Methods: This cross-sectional observational study was conducted in the Department of Surgery at Rangpur Medical College Hospital. 72 patients of all ages, sex who developed surgical site infection were included through purposive sampling for observation and clinical follow up and wound swab was microbiologically evaluated.&#x0D; Results: Of the 72 cases, SSI developed 30.6% (22) following elective surgery and 69.4% (50) following emergency surgery. 7 cases were associated with co-morbid conditions like diabetes mellitus (2), malignancy (4) and tuberculosis (1). Most common organisms were Escherichia coli (30 /54) followed by Staphylococcous aureus (14/54), Pseudomonas (07/54) and Klebsiella (03/54).The antibiogram pattern of the organism isolated from wound swab of SSIs were analyzed with commonly used antibiotics. Resistance of Escherichia coli to Amoxycillin, Cotrimoxazole, Doxycycline and Nalidixic acid were 100%, 91.5%, 71.4% and 60.5% respectively. In case of, Staphylococcus aureus 87.5% were resistant to penicillin and Cotrimoxazole. Resistance of Pseudomonas spp. to Ciprofloxacin, Ceftazidime and Gentamicin were 31.2%. 6.3% and 50% respectively. In case of Klebsiella spp, it showed that 100% strains were resistant to Amoxycillin like Esch. coli but all strains were sensitive to both Ceftriaxon and Imipenem.&#x0D; Conclusion: The study emphasizes the need for the evidence-based infection control and antibiotic prescription policies in the hospital.&#x0D; J Rang Med Col. September 2022; Vol. 7, No. 2:12-19

Preoperative triage to detect SARS-CoV-2 infection in surgical patients: lessons learned for resuming surgery.

PurposeTo define the impact of the COVID-19 outbreak on hospital surgical activity and assess the incidence of perioperative COVID-19 within two protocolized screening pathways for elective and non-elective surgery.MethodsWe conducted a prospective cohort study of adults undergoing surgery during the COVID-19 outbreak. The elective pathway included telephone surveys and a quantitative polymerase-chain-reaction test (RT-PCR) only for patients who were asymptomatic and at low risk of infection. Only patients with negative screening underwent surgery. In the non-elective pathway, preoperative screening was performed during the hospital admission.ResultsAmong 835 patients considered for the elective pathway, 725 had negative RT-PCR results and underwent surgery. This reflects an 83% reduction in surgical activity from 2019. Moreover, 596 patients underwent non-elective surgery, representing a 28% reduction. Preoperatively, 39 patients (6.5%) tested positive for SARS-CoV-2 and underwent surgery through the non-elective pathway, vs. none in the elective pathway (p < 0.001). Postoperatively, 1.4% of elective surgery patients and 2.2% of non-elective surgery patients tested positive (p > 0.05). Mortality was higher in non-elective surgery (0.6% vs. 2.9%, p < 0.001) and in patients with COVID-19 (0% vs. 14%, p < 0.001).ConclusionsThe low incidence of COVID-19 in elective surgeries during the outbreak demonstrates the importance and effectiveness of preoperative screening, combining surveys and RT-PCR.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00595-022-02610-8.

Lung ultrasound as a screening tool for SARS-CoV-2 infection in surgical patients.

To evaluate the diagnostic performance of lung ultrasound (LUS) in screening for SARS-CoV-2 infection in patients requiring surgery. Patients underwent a LUS protocol that included a scoring system for screening COVID-19 pneumonia as well as RT-PCR test for SARS-CoV-2. The receiver operator characteristic (ROC) curve was determined for the relationship between LUS score and PCR test results for COVID-19. The optimal threshold for the best discrimination between non-COVID-19 patients and COVID-19 patients was calculated. Among 203 patients enrolled (mean age 48 years; 82 males), 8.3% were COVID-19-positive; 4.9% were diagnosed via the initial RT-PCR test. Of the patients diagnosed with SARS-CoV-2, 64.7% required in-hospital management and 17.6% died. The most common ultrasound findings were B lines (19.7%) and a thickened pleura (19.2%). The AUC of the ROC curve of the relationship of LUS score with a cutoff value >8 versus RT-PCR test for the assessment of SARS-CoV-2 pneumonia was 0.75 (95% CI 0.61-0.89; sensitivity 52.9%; specificity 91%; LR (+) 6.15, LR (-) 0.51). The LUS score in surgical patients is not a useful tool for screening patients with potential COVID-19 infection. LUS score shows a high specificity with a cut-off value of 8.

Postoperative nosocomial COVID-19 infection in surgical patients during pandemic: A prospective observational cohort study.

Background: increased pressure on healthcare systems and possible risk of nosocomial COVID-19 infection during pandemic urged many guidelines to severely restrict the number of operations. The aim of this study was to investigate the risk of COVID-19 infection and its complications in patients undergoing urgent or elective operations.Methods: a prospective observational cohort study was conducted in a tertiary surgical center and all patients with no preoperative history of COVID-19 undergoing elective or emergent surgeries were included in this investigation. chest computed tomography (CT) scan or polymerase chain reaction (PCR) test were performed on patients before and after surgery.Results183 patients who underwent an operation were enrolled in this study. In postoperative follow-up, 12 patients were positive for COVID-19 infection as identified by RT-PCR and non-contrasted chest CT scans. Regrettably, 2 individuals passed with one of these individuals dying as a direct result of COVID-19 infection. All the 12 cases of post-operative COVID-19 patients underwent elective surgeries.Conclusionthe gathered results indicate a need for the re-evaluation of the risks of operation during the COVID-19 pandemic. If operations are performed while observing protective and preventative protocols, the risk of post-operative nosocomial COVID-19 is significantly reduced. Hence, the consequences imposed on patients by the delay or cancellation of operations (most notably in cancer cases) may outweigh the risk of post-operative COVID-19 infections.

Preoperative Surgical Site Hair Removal for Elective Abdominal Surgery: Does It Have Impact on Surgical Site Infection.

Introduction Postoperative surgical site infection (SSI) forms the major burden of nosocomial infections in surgical patients. There is prevalent practice of surgical site hair shaving as a part of preoperative preparation. There is uncertainty regarding the benefit versus harm of shaving for SSIs. Hairs at surgical sites are removed prior to surgery most often by shaving. We performed this study to look for what impact preoperative hair removal by shaving has on postoperative SSI. Methods We performed prospective comparative cohort study in patients undergoing elective abdominal surgeries. We included clean and clean-contaminated surgeries in immunocompetent patients of which half were shaved and other half not shaved prior to surgery. Other confounding factors like skin cleaning, aseptic technique of surgery, antibiotic prophylaxis and treatment, and postoperative wound care were as per care. Patients were assessed for presence and grade of SSI postoperatively on day 7, 14, and 30. Results were analyzed statistically using chi-square and Fischer's exact tests for significance in entire sample as well as in demographic subgroups. Results Overall SSI rate was 11.42%. There was no statistically significant difference in SSI rates between patients who underwent preoperative surgical site hair removal by shaving (232) and who did not have shaving (232) on all the three different assessment timelines in postoperative period, namely, day 7, 14, and 30. Although the absolute number of patients who had SSI was more in those who underwent preoperative surgical site hair removal by shaving, the difference was not statistically significant ( p > 0.05). But on subgroup analysis patients with clean-contaminated surgeries ( p = 0.037) and patients with surgeries lasting for less than 2 hours (Fischer's exact = 0.034) had significantly higher SSI in the shaved group compared with unshaved on day 14. Conclusion As per our results, preoperative shaving did not significantly increase overall SSI except in subgroup of clean-contaminated surgeries and in surgeries of less than 2 hours' duration. So especially in these patients avoiding preoperative surgical site hair shaving may be used as one of the infection control measures.

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Addressing Health Concerns Interrupted by the COVID-19 Pandemic

Hospital Acquired Infections in Surgical Patients: Impact of COVID-19-Related Infection Prevention Measures

BackgroundHospital acquired infections are common, costly, and potentially preventable adverse events. This study aimed to determine the effect of the COVID-19 pandemic-related escalation in infection prevention and control measures on the incidence of hospital acquired infection in surgical patients in a low COVID-19 environment in Australia.MethodThis was a retrospective cohort study in a tertiary institution. All patients undergoing a surgical procedure from 1 April 2020 to 30 June 2020 (COVID-19 pandemic period) were compared to patients pre-pandemic (1 April 2019–30 June 2019). The primary outcome investigated was odds of overall hospital acquired infection. The secondary outcome was patterns of involved microorganisms. Univariable and multivariable logistic regression analysis was performed to assess odds of hospital acquired infection.ResultsThere were 5945 admission episodes included in this study, 224 (6.6%) episodes had hospital acquired infections in 2019 and 179 (7.1%) in 2020. Univariable logistic regression analysis demonstrated no evidence of change in odds of having a hospital acquired infection between cohorts (OR 1.08, 95% CI 0.88–1.33, P = 0.434). The multivariable regression analysis adjusting for potentially confounding co-variables also demonstrated no evidence of change in odds of hospital acquired infection (OR 0.93, 95% CI 0.74–1.16, P = 0.530).ConclusionIncreased infection prevention and control measures did not affect the incidence of hospital acquired infection in surgical patients in our institution, suggesting that there may be a plateau effect with these measures in a system with a pre-existing high baseline of practice.

Nosocomial Infections in Surgical Patients at a Central Academic Hospital in South Africa

Nosocomial infections are infections that develop after 48 hours of admission or within 30 days of discharge from a healthcare facility. The aim of the study was to investigate the rate of occurrence and types of nosocomial infections in patients admitted to the surgical wards. An audit based on records of patients who developed nosocomial infections was conducted. Data extracted included patients’ demography, comorbidities, the organisms cultured, and their resistance patterns. A total of 574 records from 421 patients were found. Seventy percent (69.8%: 294/421) of the patients were males and 66.3% (279/431) were less than 51 years old. Ninety-four (22.3%: 94/421) patients were found to have polymicrobial infections. The records included 62 species of bacteria and 7 candida species. Around 74.7% (429/574) of the cultured organisms were ESKAPE pathogens. The most cultured organism was <i>K. pneumoniae</i> at 18.6% (107/574). Fifty-one percent of the cultured bacteria were resistant to antimicrobials. The overall rate of nosocomial infection was 8.7% with an incidence density of 468.20 per 100 000 patient days. Nosocomial infections were more prevalent in vascular, trauma and neurosurgery patients.