Lower Infection Rates Research Articles

Comparison of the efficacy of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: meta-analysis of randomized controlled trials.

Preoperative neoadjuvant chemoradiotherapy (nCRT) is considered to be the standard treatment strategy for locally advanced rectal cancer (LARC); however, the risk of adverse events and postoperative recurrence remains significant. This study aimed to evaluate the non-inferiority of neoadjuvant chemotherapy (nCT) compared with nCRT in patients with LARC and to assess the possibility of eliminating radiotherapy on the basis of guaranteed efficacy. We searched the PubMed, Embase, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing the efficacy of nCRT and nCT for LARC. The study protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO). A total of 2706 patients from 7 studies were included in the meta-analysis. There was no significant difference in overall survival (OS) or disease-free survival (DFS) between the nCT and nCRT groups. This study demonstrated a lower rate of infection (OR=0.53, 95% CI=0.34-0.82; P=0.005), anastomotic leak (OR=0.55, 95% CI=0.34-0.87; P=0.01), tumor regression grade (TRG) 0-1 (OR=0.50, 95% CI=0.36-0.69; P < 0.0001), preventive diverting ileostomy (OR=0.41, 95% CI=0.17-1.02; P=0.05) and leukopenia (OR=0.50, 95% CI=0.25-1.01; P=0.05) in the nCT group. However, there was no significant difference in the other toxic events, such as intestinal obstruction, urinary complications, diarrhoea, and surgical or pathological outcomes, such as clinical fistula, sphincter preservation, postoperative mortality (≤ 60 d), R0 resection, ypStage 0-I, positive circumferential resection margin (CRM+) or pathological complete response (pCR) between the two groups. This study indicated that OS and DFS were not lower in the nCT group than in the nCRT group. In addition, the nCT group had fewer complications. Preoperative nCT is expected to become a standard treatment option for most patients with stage II-III LARC. It is worth noting that radiotherapy can not be ignored for some patients who need to ensure the conversion effect of neoadjuvant therapy and strongly request to preserve organ function.

Black-vs-white racial disparities in 30-day outcomes following primary and revisional metabolic and bariatric surgery: a MBSAQIP database analysis.

Previous studies have demonstrated Black-vs-White disparities in postoperative outcomes following primary metabolic and bariatric surgery (MBS). With the rising prevalence of MBS, it is important to examine racial disparities using quality indicators in primary and revisional procedures. This study explores Black-vs-White disparities in postoperative outcomes following primary and revisional MBS. We performed an observational cohort study using the 2015-2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database of adults who underwent primary or revisional Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch, or one-anastomosis gastric bypass. Black and White patients were 1:1 matched using propensity scores across 19 covariates for primary and revisional MBS groups. McNemar's tests were used to compare 11 postoperative outcomes from the MBSAQIP semi-annual report and death, between matched cohorts. We identified 112,495 Black and 434,266 White primary MBS and 10,838 Black and 37,075 White revisional MBS patients. A total of 219,114 primary and 21,314 revisional patients were matched. Following primary MBS, Black patients had higher rates of death (0.1% vs. 0.06%, p < 0.001), all occurrences morbidity (5.6% vs. 4.7%, p < 0.001), serious events (2.2% vs. 1.9%, p < 0.001), and all cause and related reoperations (1.2% vs. 1.1%, p = 0.006; 0.2% vs. 0.1%, p = 0.01), readmissions (4.6% vs. 3.4%, p < 0.001; 2.8% vs. 1.9%, p < 0.001), and interventions (1.4% vs. 1.1%, p < 0.001; 0.8% vs. 0.6%, p < 0.001) compared to White patients. In contrast, there were no significant Black-vs-White disparities in death, morbidity, serious events, reoperations, interventions, and bleeding following revisional MBS. Interestingly, Black patients had higher rates of all cause and related readmissions (7.4% vs. 6.2%, p = 0.005; 4.4% vs. 3.6%, p = 0.01), but lower surgical site infection rates (1.6% vs. 2.1%, p = 0.04). Our findings demonstrate a measurable contrast between racial disparities in postoperative outcomes following primary and revisional MBS. Equity-focused measures in national MBS assessments are needed to elucidate and address these disparities.

Does a gentamicin-coated intramedullary nail prevent postoperative infection in Gustilo type I and II tibial open fractures? A comparative study and retrospective analysis.

Tibial open shaft fractures are very common and susceptible to infection, which can lead to significant morbidity especially infection and non-union. Antibiotic coated nail is one option for fixing open shaft tibial fractures to minimise infection. This study aimed to compare the clinical outcome of Gentamicin-coated tibial nails versus regular unreamed interlocking tibial nails in the treatment of type I and II tibial open fractures. Between 2013 and 2020, in a retrospective study of 124 patients with Gustilo type I and II tibial fractures compared non-antibiotic-coated nails (62 patients) with gentamicin-coated nails (62 patients) over 12 months. This study assessed infection rates, duration of hospital stays, fracture union time, and complications. The antibiotic nail group had significantly lower postoperative infection rates (3.2%) than the regular nail group (17.7%), (χ2 = 4.64, p = 0.031). At the 6-month follow-up, significant differences were observed in ESR (p = 0.031), CRP (p = 0.019), leukocyte count (p = 0.0241), and blood culture (p = 0.018), but not in hemoglobin levels (p = 0.067). The Gentamicin-coated nail group demonstrated better fracture union rates at 6 and 12 months, (p = 0.0267) and lower overall complication rates. A tibial nail coated with Gentamicin is an effective method for preventing infection in type I and II open fracture shafts of the tibia. It allows, shortens hospital stay and healing time, prevents infection, and thus reduces the chance of a second surgery. Level III, a retrospective study. Retrospective analytical study. We hypothesized that Gentamicin-coated nail is effective in preventing infection in Gustilo type I and II open fractures compared to non-antibiotic-coated regular nails.

Management of Systemic Anti-psoriatic Drugs in PsoriasisPatients with ConcurrentParaplegia or Tetraplegia: Insights From a 6-Year Multicenter, Retrospective Observational Study.

Patients with psoriasis (PsO) and permanent spinal cord injuries (SCI) resulting in paraplegia and tetraplegia may experience a higher rate of infections compared to patients with PsO without SCI. It can result in further challenges for therapeutic management with immunosuppressants (biological and non-biological treatments). Thus, weaimed to evaluate the rate of infections in patients with PsO and SCI treated with systemic immunosuppressants. This multicenter, retrospective observational study enrolled patients with PsO and traumatic SCI undergoing systemic immunosuppressive treatments for at least 5years. All patients were evaluated by experienced, board-certified dermatologists and neurologists. Demographic and clinical data were collected. We enrolled 23 patients with SCI (16 with paraplegia and 7 with tetraplegia) treated with methotrexate (MTX) and different biologics (tumor necrosis factor (TNF) inhibitors (i) and interleukin (IL)-17i/IL-23i). Globally, patients with SCI treated with MTX displayed higher rates of infection compared to those treated with biologics. Patients with paraplegia had lower rates of infection compared to patients with tetraplegia during anti-psoriatic therapies (p < 0.05). Those treated with TNFi had greater rates of infection than those treated with IL-17i/IL-23i (p < 0.001). Patients with psoriatic arthritis (PsA) experienced a significant diagnostic delay and clinical monitoring of PsA severity was challenging. In patients with moderate-to-severe PsO and concurrent traumatic SCI, dermatologists should consider using IL-17i/IL-23i as first-line therapy.

Infection rate following mandibular distraction with internal and external devices in infants.

Internal and external devices may be utilized in mandibular distraction osteogenesis (MDO) for the correction of symptomatic micrognathia in infants and children. To compare the rate and severity of infection between internal and external MDO devices. Retrospective cohort study utilizing an institutional database of patients who underwent MDO. Use of internal versus external MDO hardware. Rate of post-operative surgical site infections (minor and major). Patient age, device type, laterality, infection, and treatment were documented. Chi-Square and Fisher Exact Tests were used where appropriate for categorical variables and two-tailed T-tests were used for continuous variables. Significance was set at p<0.05. Between 2010 and 2022, 36 infants (ages 7 days-12 months) underwent bilateral MDO. Thirteen cases utilized internal hardware (n=26 surgical sites) and 23 cases utilized external hardware (n=46 surgical sites). Fifteen patients developed post-operative infections (41.7%), 11 of which were minor infections and 4 were major infections. Seven patients with internal devices (53.8%) and 8 patients with external devices (34.8%) developed an infection (p=0.27). Minor infections occurred in 4 patients with internal hardware (30.8%) and 7 patients with external hardware (30.4%; p=1.00). Major infections occurred in 3 patients with internal hardware (23.1%) and 1 patient with external hardware (4.3%; p=0.25). There were 19 surgical site infections (26.4%), 14 of which were minor infections and 5 of which were major infections. Ten internal devices (38.6%) and 9 external devices (19.6%) were complicated by infection (p=0.08). Minor infections occurred in 6 internal devices (23.1%) and 8 external devices (17.4%; p=0.56). Major infections occurred in 4 internal devices (15.4%) and 1 external device (2.2%; p=0.05). No significant difference was found in overall postoperative infection rate with internal and external MDO. A lower rate of major infection was observed in external devices.

The Efficacy and Safety of Prophylactic Treatment Methods for Cutibacterium Acnes Infection in the Shoulder: A Systematic Review of Level of Evidence I Randomized Controlled Trials.

Cutibacterium acnes (C. acnes), formerly Propionibacterium acnes (P. acnes), is the most common pathogen responsible for postoperative shoulder infections. Prevention of shoulder infection is crucial to improving patient outcomes, prolonging implant longevity, and reducing costs. The purpose of this study is to evaluate the effectiveness of various prophylactic treatments for C. acnes in the shoulder. A systematic review of 15 randomized controlled trials was conducted to evaluate the effectiveness of various skin preparation methods in the reduction of C. acnes for patients undergoing shoulder surgery. Three electronic databases were queried as follows: PubMed, Embase, and the Cochrane Library databases. Data extraction for this study was performed by three independent reviewers, and only level I studies were included. Outcomes were assessed based on the effectiveness of the method used; side effects were also analyzed. Fifteen studies were included in this review. Seven studies utilized a regimen of at-home treatment in the days leading up to culture sampling, while the other eight studies administered treatment just prior to sampling. Seven studies found their respective treatment methods to be statistically significant. No preparation methods applied immediately prior to sampling showed conclusive superiority. The application benzoyl peroxide in the days prior to sampling showed significantly lower rates of colonization when compared to control groups in five separate studies. There remains no consensus on the optimal skin preparation method immediately prior to surgery, however, acne cream applied in the days leading up to surgery has been shown to significantly reduce the bacterial load of C. acnes. While BPO appears to be the superior method of prophylactic treatment, it is also associated with higher rates of complications and skin reactions following treatment; thus, caution is warranted. Further studies should investigate whether this reduction in bacterial load translates to meaningfully lower rates of periprosthetic joint infections.

Neuroendoscopic surgery versus craniotomy for basal ganglia hemorrhage: a systematic review and meta-analysis of randomized controlled trials.

Basal ganglia hemorrhage (BGH) is a prevalent site for intracerebral hemorrhage. Although neuroendoscopy (NE) surgery has emerged as a less invasive alternative to craniotomy (CT), the optimal surgical method remains debatable. This systematic review and meta-analysis aimed to compare the efficacy and safety of NE versus CT in the management of BGH. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted to identify eligible randomized controlled trials (RCTs) comparing NE surgery with CT in BGH patients. Outcomes included mortality, hematoma evacuation rate, good functional outcome (GFO), operative time, infection, pulmonary infection, and postoperative complication. Risk of bias was assessed with Cochrane's ROB-2 tool. Four RCTs were included, comprising 423 patients. NE surgery showed no significant benefit in mortality (p = 0.12) and GFO (p = 0.18). However, NE was associated with a higher hematoma evacuation rate (p = 0.007), shorter operative time (p < 0.00001), and lower rates of infection (p < 0.0001), pulmonary infection (p < 0.0001), and postoperative complications (p < 0.00001). Future research should be designed to assess whether hematoma evacuation using either technique improves outcomes in comparison to optimal medical management in this population.

Fusion MRI/Ultrasound-Guided Transperineal Biopsy: A Game Changer in Prostate Cancer Diagnosis.

Background/Objectives: Multiparametric-Magnetic Resonance Imaging(mp-MRI) presents the ability to detect clinically significant cancer, aiming to avoid biopsy if the results are negative or target an abnormal lesion if a suspected lesion of the prostate is found. Recent guidelines recommend the performance of 12 standard biopsies along with 3 to 5 targeted biopsies in suspected prostate lesions, depending on the size of the prostate lesion. In addition, prostate biopsy can be performed by either the transperineal or the transrectal approach. The aim of this comprehensive review is to highlight the role of both standard and targeted MRI/Ultrasound (US) fusion transperineal biopsy (TPB) in the diagnostic approach of prostate cancer cases, to report its diagnostic efficacy and complication rates and to suggest the promising usage of MRI/US fusion TPB in the future. Methods: A comprehensive review of the existing literature, including systematic reviews, meta-analyses, and clinical guidelines, was conducted to compare the efficacy and safety of transperineal and transrectal approaches in prostate cancer detection. Special emphasis was placed on mp-MRI-guided targeted biopsy and its combination with systematic sampling. Results: Prostate biopsy via the transperineal approach is related to increased detection rates, especially for anterior lesions, and decreased infection risk compared to the transrectal approach, while complication rates (hematuria, hemospermia, etc.) remain similar. Due to lower infection rates via the transperineal route, the performance of prostate biopsy using the transperineal approach is strongly recommended. Finally, transperineal fusion MRI/US biopsy can be valuable for repeat biopsies in patients who had an initial negative biopsy or for the follow-up of patients that undergo active surveillance. Conclusions: MRI/US fusion-guided TPB represents a significant advancement in prostate cancer diagnostics, combining improved precision with reduced infection risks. Although TPB presents higher detection rates for anterior prostatic lesions and lower post-biopsy infection rates, there is no significant difference in cancer detection rates compared to TRB. Targeted training and investment may reduce long-term expenses of TPB by lowering hospitalizations, antibiotic usage, and related costs. Future research should further refine this approach and explore its integration with emerging technologies like artificial intelligence for enhanced lesion targeting and diagnostic accuracy.

Functional outcome of limb sparing surgery of shoulder girdle tumors after free vascularized fibular flap.

Objective: To share the functional outcome of free vascularized fibular flap for shoulder reconstruction using Toronto Extremity Salvage Score (TESS). Study Design: Descriptive Cross-sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2023. Methods: All the patients presented with biopsy proven sarcoma involving proximal humerus were included in this study. Informed consent for data collection was obtained. Patient data regarding demographics, tumor location, extent of lesion, reconstruction and complications was collected from patient records. Six month follow up was done to assess functional recovery of the patient. Toronto Extremity Salvage Score (TESS) was used 6 months post-operatively to assess recovery of the patient using TESS questionnaire. Patient data was analyzed in using an open source software, GNU PSPP version 2.0.0. Results: A total of 11 patients were included in this study. Mean age of the patients was 15±3.5 years. Eight patients (72.7%) were male while 3 (27.3%) were female. Two patients has post-operative bleeding and 1 patient had fracture of fibula. Average TESS score was 61±7.71 years. Eight patients (72.7%) reported a good TESS score while 4 (27.3%) patients scored poor on TESSS Questionnire. Conclusion: Reconstruction of shoulder in sarcoma patients is a complex problem. Both prosthetic and biological reconstructive options present their own set of issues. In our experience, the use of free vascularized fibular flap (FVFF) presents a much better option with lower rate of infection and on average good Toronto Extremity Salvage Score (TESS) Scores.

Iliosacral screw osteosynthesis - state of the art.

Iliosacral screw osteosynthesis is a widely recognized technique for stabilizing unstable posterior pelvic ring injuries, offering notable advantages, including enhanced mechanical stability, minimal invasiveness, reduced blood loss, and lower infection rates. However, the procedure presents technical challenges due to the complex anatomy of the sacrum and the proximity of critical neurovascular structures. While conventional fluoroscopy remains the primary method for intraoperative guidance, precise preoperative planning using multiplanar reconstructions and three-dimensional volume rendering is crucial for ensuring accurate placement of iliosacral or transsacral screws. Particular attention must be given to the preoperative evaluation of both the iliosacral and transsacral corridors, as anatomical variations may restrict the available space for screw insertion. This review aims to highlight the essential aspects of sacroiliac osteosynthesis, with a focus on the critical role of thorough preoperative planning and its impact on achieving successful surgical outcomes.

Partial versus radical cystectomy in localized colorectal cancer: a systematic review and meta-analysis.

Locally advanced colorectal tumors frequently invade adjacent organs, particularly the urinary bladder in the sigmoid colon and upper rectum, complicating multivisceral resections. This study compared postoperative outcomes of partial cystectomy (PC) and total cystectomy (TC) in patients with locally advanced colorectal cancer. A systematic review was conducted in PubMed, Scopus, Central Register of Clinical Trials, and Web of Science for studies published up to November 2024. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with I2 statistics. Statistical analyses were performed in R Software 4.4.1. Nine retrospective studies including 894 patients were analyzed. Among them, 433 (48.43%) underwent PC, and 461 (51.57%) underwent TC. Compared to TC, PC was associated with significantly lower rates of surgical site infection (OR 0.33; 95% CI 0.13-0.80; p = 0.015), shorter operative time (MD - 169.7min; 95% CI - 214.1 to - 125.3; p < 0.01), reduced blood loss (MD - 1005.9ml; 95% CI - 1362.1 to - 649.8; p < 0.01), and shorter hospital stay (MD - 6.6days; 95% CI - 9.4 to - 3.9; p < 0.01). No significant differences were observed between groups in local or distant recurrence, urinary and intestinal leaks, pelvic abscess, ileus, urinary tract infection, or 90-day mortality. Partial cystectomy demonstrated superior postoperative outcomes, including fewer surgical site infections, reduced operative time, less blood loss, and shorter hospitalization. Oncological outcomes and other postoperative complications were comparable between PC and TC, supporting PC as a safe and effective option in selected patients.

Application of minimally invasive debridement for deep second-degree facial burns in the early postburn phase

ObjectiveThis study aimed to evaluate the therapeutic efficacy of minimally invasive dermabrasion for deep second-degree facial burn wounds during the early postburn phase.MethodsA total of 35 patients with deep second-degree facial burns underwent minimally invasive debridement using a hydrosurgery system within 2–4 days post-injury. Subsequently, the wounds were covered with human biological dressings. The wound infection rate, healing time, and overall healing quality following debridement were monitored.ResultIn this cohort of 35 patients, no infections were reported after debridement. The average healing time for these wounds was significantly shorter than that of those treated with standard surgical excision. Clinical observations indicated that minimally invasive dermabrasion was associated with a lower infection rate and reduced healing time. After 6 months, scar assessment using the Vancouver Scar Scale showed that the average score for wounds treated with minimally invasive techniques was lower than those treated with standard surgical excisional technique.ConclusionsThis research indicates that minimally invasive debridement during the early postburn stage can effectively reduce wound infection rates, shorten healing times, and minimize the occurrence of scar hyperplasia and contracture deformities. Therefore, minimally invasive dermabrasion is valuable in treating deep second-degree facial burn wounds.

Indomethacin and Cefazolin for Physical Exam-Indicated Cerclage to Improve Latency: A Protocol Validation Study.

A single-center randomized trial showed improved latency with use of indomethacin and cefazolin (I/C) during and following exam-indicated cerclage (EIC). The same center recently published a pre/post comparison demonstrating similar results. This research aimed to validate the protocol in a different setting. Retrospective cohort study of singleton pregnancies undergoing EIC at a single center between 2013 and 2022. EIC was performed for painless cervical dilation between 16 and 23 weeks' gestation with dilation ≥1 cm. Exposure was defined as receipt of I/C during and following EIC. The primary outcome was latency ≥ 28 days after cerclage placement. Secondary outcomes included latency; gestational age at delivery; delivery ≤ 28 weeks; preterm premature rupture of membranes; intra-amniotic infection (IAI); and median birth weight. Bivariate statistics were used to analyze data; multivariable regression analyses were used to control for confounders (progesterone use, cervical dilation at time of cerclage placement, history of preterm birth, and prolapsing membranes). EIC was placed in 81 pregnancies and 48 (59%) received I/C. Baseline characteristics did not differ between groups, except that prolapsing membranes were significantly less likely in patients receiving I/C (6.2 vs. 21.2%; p = 0.04). Latency ≥ 28 days occurred in 90% of I/C recipients and 82% of the controls (p = 0.32); this difference remained nonsignificant after controlling for confounders (adjusted relative risk: 1.02 [95% confidence interval: 0.85, 1.21]). I/C recipients had lower rates of IAI (4.2 vs. 24.2%, p = 0.007), even after adjustment (adjusted relative risk: 0.18 [95% confidence interval: 0.04, 0.74]). Other secondary outcomes did not differ. Use of I/C at the time of EIC at this center was not associated with increased latency to delivery (albeit in a small cohort) but was associated with lower rates of intra-amniotic infection. Larger-scale validation studies would be helpful to confirm the value of this intervention. · Indomethacin/cefazolin (I/C) increased latency for exam-indicated cerclage in a trial.. · We performed an observational comparison to validate these findings.. · I/C use for exam-indicated cerclages was associated with decreased intra-amniotic infection.. · I/C was not associated with change in latency.. · Larger-scale validation studies needed to confirm the value of intervention..

Comparative systematic analysis of postoperative infection rates between laparoscopic and open appendectomy approaches

Acute appendicitis remains one of the most common surgical emergencies worldwide, requiring prompt intervention to prevent severe complications. This systematic review aimed to compare postoperative infection rates and recovery outcomes between laparoscopic and open appendectomy. A comprehensive search was conducted in databases such as PubMed, Scopus, and Web of Science, focusing on studies published in the last 11 years. Inclusion criteria encompassed clinical trials, cohort studies, and systematic reviews that evaluated postoperative complications, surgical site infections, and recovery metrics. Findings indicate that laparoscopic appendectomy is generally associated with lower rates of surgical site infections, shorter hospital stays, and faster recovery times compared to the open approach, particularly in adult and obese patient populations. However, evidence suggests that in cases of advanced appendicitis, laparoscopic surgery may increase the risk of intra-abdominal abscesses compared to the open method. Additionally, studies involving pediatric populations found no significant differences between the two techniques in terms of infection rates and postoperative complications. The review underscores that while laparoscopic appendectomy offers significant advantages in most scenarios, the choice of surgical technique should be tailored to individual patient profiles, considering factors such as appendicitis severity, comorbidities, and age. These findings highlight the importance of a personalized approach in surgical decision-making to optimize patient outcomes. Further research is recommended to explore long-term outcomes and refine strategies for managing high-risk cases, particularly in children and patients with complex appendicitis presentations.

Effects of Implementing an Enhanced Recovery After Cardiac Surgery Protocol with On-Table Extubation on Patient Outcome and Satisfaction-A Before-After Study.

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with on-table extubation (OTE). This study evaluates the impact of a novel ERAS concept with OTE (RERACS) in elective aortic-valve-replacement and coronary bypass surgery. Methods: In a monocentric study, we compared a prospective RERACS-group (n = 114) to a retrospective control group (n = 119) (TRIAL Registration (DRKS00031402). The RERACS concept contained multiple perioperative treatment measures such as respiratory training, short fasting, and OTE. The control group received standard care. Results: Primary endpoint: postoperative LOS. Secondary measurements: length of postoperative vasoactive drug support, duration of mechanical ventilation, complication rate, and patient satisfaction on the second postoperative day. RERACS patients showed significantly shorter postoperative length of stay (ICU: 40 ± 34 h vs. 56 ± 51 h, p = 0.005; hospital: 9 ± 4 d vs. 11 ± 6 d, p = 0.028), lower nosocomial infection rates (24% vs. 40%), fewer cases of postoperative cognitive dysfunction ((subsyndromal) delirium 40% vs. 57%), reduced nausea and vomiting (14.9% vs. 32.8%), and faster weaning from catecholamines (22 ± 30 h vs. 42 ± 48 h, p < 0.001), as well as high patient satisfaction. Conclusions: Our study indicated that an ERAS concept with OTE is safe and associated with faster and improved recovery, including lower catecholamine requirements, reduced LOS, and high patient satisfaction in low-risk cardiac surgery.

Comparison of outcomes following prepectoral and subpectoral implants for breast reconstruction in patients with breast cancer.

In recent years, different approaches to implant-based breast reconstruction have increasingly become an important option to meet both the treatment and postoperative aesthetic needs of breast cancer patients. This study selected two commonly used techniques for the prepectoral approach: single-incision, gas-inflated endoscopic prepectoral breast reconstruction (SIE-BR) and open prepectoral implant-based breast reconstruction (C-BR), as well as a commonly used technique for the subpectoral approach: open subpectoral implant-based breast reconstruction (SI-BR). By comparing the clinical efficacy and aesthetic outcomes of these three techniques in the treatment of breast cancer patients, this study aims to summarize the advantages of the prepectoral approach. This study screened the clinicopathological data of a total of 136 breast cancer patients from January 2023 to December 2023. Among them, 38 patients underwent SIE-BR, 51 patients underwent C-BR, and 47 patients underwent SI-BR. The patient characteristics, intraoperative and postoperative conditions were analyzed in detail, and satisfaction was assessed using the BREAST-Q questionnaire. The SIE-BR group had the longest surgery time, followed by the SI-BR group, with the C-BR group having the shortest surgery time. The C-BR group had the least blood loss, while the SIE-BR group had the most. The C-BR group also had the lowest drainage volume, and the SIE-BR group had the highest. Patients were categorized into a prepectoral implant-based reconstruction group (PIBR) and a subpectoral implant-based reconstruction group (SIBR). None of the patients experienced implant loss or flap necrosis. The PIBR group had significantly lower rates of wound infection, capsular contracture, and chest muscle pain compared to the SIBR group. The rates of wound dehiscence and implant wrinkling were statistically similar between the two groups. BREAST-Q scores indicated similar satisfaction in terms of breast appearance and sexual life between the groups, but the PIBR group showed significantly better scores inphysical health (chest muscle function preservation) and mental health.Additional advantages of the prepectoral approach, including less postoperative pain, reduced movement-related deformity, and shorter surgery time, have contributed to the steady growth of this technique in recent years. The three implant-based breast reconstruction techniques mentioned above are safe and feasible. Compared to the previously more common subpectoral approach, the prepectoral approach improves patients' postoperative physical and psychological comfort, making it an ideal surgical option.

REVIEW OF PHARMACOLOGICAL INTERVENTIONS FOR THE PREVENTION OF HEALTHCARE-ASSOCIATED INFECTIONS 2025

Healthcare-associated infections (HAIs) are a significant threat to patient safety, contributing to increased morbidity, mortality, and healthcare costs globally. Pharmacological interventions are pivotal in preventing HAIs and addressing antimicrobial resistance. Objective: This narrative review explores key pharmacological strategies for preventing HAIs, including prophylactic antibiotics, antimicrobial stewardship programs (ASPs), infection prevention bundles, and innovative approaches like probiotic cleaning systems. Methods: The review synthesizes recent literature on established and emerging HAI prevention strategies, evaluating their efficacy, challenges, and applicability across diverse healthcare settings. Results: Prophylactic antibiotics are highly effective in reducing surgical site infections when used judiciously, while ASPs optimize antibiotic use and combat resistance. Infection prevention bundles, incorporating evidence-based practices like hand hygiene and catheter care, significantly lower bloodstream infection rates. Innovative approaches, such as probiotic cleaning systems, offer sustainable solutions to reduce environmental contamination. However, challenges remain, including variable adherence to protocols, resource constraints, and the need for scalable solutions in low-resource settings. Conclusion: Pharmacological interventions, when integrated with multidisciplinary approaches, are crucial for reducing HAI rates and improving patient outcomes. Future research should focus on scalable innovations and context-specific strategies to enhance infection prevention globally. Keywords: Healthcare-associated infections, Antimicrobial stewardship, Prophylactic antibiotics, Infection prevention bundles, Multidrug resistance, Patient safety.

A Comparative Study Between Collagen Sheet Dressing and Conventional Paraffin Gauze Dressing to Donor Site in Patients Undergoing Split Skin Grafting

Introduction: Split skin grafting is a common procedure that causes partial thickness injury, typically treated with paraffin-soaked gauze. Re-epithelialization occurs in two weeks, but complications like pain, infection, and delayed healing can arise. This study aimed to compare collagen sheet dressing with conventional gauze dressing in reducing pain, promoting healing, and preventing infection in donor sites. Material and Methods: A prospective comparative study was conducted at a tertiary care hospital from December 2021 to January 2024. Fifty patients undergoing split skin graft surgery were assigned to either Group A (collagen sheet) or Group B (paraffin gauze). Outcomes such as pain, re-epithelialization, and infection were compared using descriptive statistics, chi-square, Fischer’s exact, and Student’s t-tests. P&lt;0.05 was considered significant. Results: The mean age of Group A and Group B was 53.92 and 56.6 years, respectively. Pain scores were significantly lower in the collagen group (P&lt;0.05). Epithelialization on day 10 was higher in the collagen group (85.2±5.09) compared to the conventional group (68.4±8). One patient in the conventional group had an infection, whereas none were observed in the collagen group. Conclusion: Collagen sheet dressing in split skin grafting donor sites results in reduced pain, faster epithelialization, and lower infection rates.

Effectiveness of intra-articular vancomycin in preventing prosthetic joint infections in hip and knee arthroplasty: A systematic review and meta-analysis of RCT's.

This study aimed to evaluate the effectiveness and safety of intra-articular vancomycin powder in reducing prosthetic joint infections (PJIs) in primary hip and knee arthroplasty through a meta-analysis of randomized controlled trials (RCTs). A research in Pubmed, Embase and Cochrane databases was performed to identify randomized clinical trials comparing intra-articular vancomycin use to conventional antibiotic prophylaxis in total hip or knee arthroplasty patients, assessing postoperative infection rates, adverse drug reactions, and venous thrombotic events. Statistical analysis was performed using R (RStudio 2024.04.2), and heterogeneity was assessed with the I2 test. A total of 1485 patients from five randomized clinical trials were included, with 737 receiving intra-articular vancomycin. The infection rate was 0.54% in the intervention group and 1.73% in the control group (RR 0.37; 95% CI 0.02-8.95; p=0.369; I2=49%), showing no statistically significant difference between the groups. Adverse reactions to the glycopeptide were reported in six cases (0.8%) in the intervention group compared to four cases (0.5%) in the control group (RR 1.50; 95% CI 1.50-150; p=0.001; I2=0%). Regarding thrombotic events, there was one case in 647 patients in the intervention group and three cases in 660 patients in the control group (RR 0.45; 95% CI 0.03-7.02; p=0.169; I2=0%). Although no significant difference was found, the intervention group showed a trend toward lower infection rates. Additional RCTs with larger sample sizes are required to confirm these findings. The prospective registration of the meta-analysis was conducted on PROSPERO in July 2024 with the protocol number 565988.

Debridement Technique for Single-Stage Revision Shoulder Arthroplasty.

The incidence of revision shoulder arthroplasty continues to rise, and infection is a common indication for revision surgery. Treatment of periprosthetic joint infection (PJI) in the shoulder remains a controversial topic, with the literature reporting varying methodologies, including the use of debridement and implant retention, single-stage and 2-stage surgeries, antibiotic spacers, and resection arthroplasty20. Single-stage revision has been shown to have a low rate of recurrent infection, making it more favorable because it precludes the morbidity of a 2-stage operation. The present video article describes a meticulous debridement technique as it applies to revision shoulder arthroplasty. The previous deltopectoral incision should be utilized, with extension 1 to 1.5 cm proximally and distally, removing any draining sinuses. First, develop subcutaneous flaps above the muscle layer to better establish normal tissue planes. A large medial subcutaneous flap will allow for identification of the superior border of the pectoralis major. The pectoralis can be traced laterally to its humeral insertion, which is often in confluence with the deltoid insertion. Hohmann retractors can be placed sequentially, working distal to proximal, under the deltoid in order to recreate the subdeltoid space. Next, reestablish the subpectoral space by releasing any scar tissue tethering the pectoralis muscle and conjoined tendon. Dislocate the prosthesis and remove modular components. Restore the subcoracoid space by dissecting between the subscapularis and the conjoined tendon, allowing for axillary nerve identification. Complete a full capsular excision circumferentially around the glenoid, taking care to protect the axillary nerve as it passes from the subcoracoid space under the inferior glenoid to the deltoid muscle. The decision to remove well-fixed components should be made by the surgeon. Any exposed osseous surfaces should undergo debridement to reduce bacterial burden. Reimplantation should focus on obtaining stable bone-implant interfaces to minimize any micromotion that may increase risk of reinfection. Our preference is to irrigate with 9 L of normal saline solution, Irrisept (Irrimax), and Bactisure Wound Lavage (Zimmer Biomet). Multiple cultures should be taken and followed carefully postoperatively to allow tailoring of the antibiotic regimen with infectious disease specialists. Two-stage revision is the most common alternative treatment for shoulder PJI and consists of removal of components, debridement, and delayed component reimplantation; however, it requires at least 1 return to the operating room for definitive treatment. Serum laboratory studies and joint aspiration are not reliable predictors of shoulder PJI because of the high rate of Cutibacterium acnes infections21,22. The incidence of unexpected positive cultures in seemingly aseptic revisions ranges from 11% to 52.2%6-8,23,24. It is prudent for all revision shoulder arthroplasties to be treated as involving a presumed infection, with thorough debridement, because of the high rate of unexpected positive cultures and the greater prevalence of low-virulence organisms in shoulder arthroplasty for PJI. The International Consensus Meeting guidelines for PJI were developed in 2018, and patients with higher Infection Probability Scores are theorized to have higher rates of recurrence19,21. With meticulous debridement, the rate of recurrent infections requiring reoperation is just 5% following 1-stage revision shoulder arthroplasty, averaged across all Infection Probability Scores19. Ensure that an adequate incision is made in order to allow for identification of the deltoid origin on the clavicle and insertion on the humerus.The superior border of the pectoralis major can be traced laterally to the humerus to correctly identify the deltopectoral interval.Subdeltoid dissection is complete when you are able to identify deep deltoid fibers superficially, rotator cuff tendon posteriorly, and humeral bone. Exposure can be improved by abducting and internally rotating the humerus.Capsule excision around the glenoid is complete when the subscapularis can be visualized anteriorly, the fatty tissue of the inferior glenoid space inferiorly, and the rotator cuff tendon (or subdeltoid space if the cuff is absent) posteriorly and superiorly. PJI = periprosthetic joint infectionC. acnes = Cutibacterium acnesUPC = unexpected positive cultureIS score = Infection Probability ScoreDAIR = debridement, antibiotics, and implant retentionCT = computed tomographyWBC = white blood cellCRP = C-reactive proteinESR = erythrocyte sedimentation rateCHG = chlorhexidine gluconateAC = acromioclavicularGT = greater tuberositySGHL = superior glenohumeral ligament.