Occurrence Of Surgical Site Infection Research Articles

Correlation of surgical site infection with empirical antibiotic therapy in children with perforated appendicitis

Surgical site infection (SSI) is one of the possible complications after the surgery of perforated appendicitis (PA) in children. This problem could occur due to the use of inappropriate empirical antibiotics. Evaluating the correlation between empirical antibiotics and surgical site infection could benefit patient care. This was an observational analytic study. We included patients aged less than 18 years old who were diagnosed with PA and treated at Dr. Soetomo General Hospital, Surabaya, from March to July 2020. The patients were given cefuroxime and metronidazole as empirical antibiotics. Appendix tissue and pus samples were taken during the surgery and submitted for microbiology tests. Patients were observed for 30 days post-surgery to examine the occurrence of SSI. Data were taken from the medical records and the correlations with the incidence of SSI were analyzed with Pearson or Spearman correlation tests. Thirty patients were included in this study. Four patients developed superficial incisional SSI and two patients developed organ SSI. No significant relationship between empirical antibiotic therapy with the incidence of SSI was found (p = 0.129). Further analysis also found no significant relationship between sex (p = 0.680), age (p = 0.713), nutritional status (p = 0.645), culture result (p = 0.384), or surgery waiting time (p = 0.13) with the incidence of SSI. However, we found a significant relationship between surgery duration and the incidence of SSI (p = 0.004). Patients with surgery duration > 120 minutes had a 19-fold risk of developing SSI (OR = 19). There was no correlation between the empirical antibiotic type and the incidence of SSI. On the other hand, surgery duration was significantly related to the incidence of SSI.

Comparison between the prophylactic effects of amoxicillin 24 and 48 hours pre-operatively on surgical site infections in Japanese patients with impacted mandibular third molars: A prospective cohort study

IntroductionAccording to the guidelines, the dosage for mandibular wisdom tooth extraction (MWTE) varies within the administration period. There is a 24-fold difference between the minimum and maximum doses. If an appropriate antimicrobial can be administered without increasing incidence of surgical site infection (SSI), it may lead to a global action plan on antimicrobial resistance (AMR). Therefore, we prospectively surveyed incidence of SSI post-operatively and use of oral antibiotics (OA) for MWTE. MethodsSubjects were patients who underwent MWTE in our dental outpatient clinic from May 2019 to April 2020. Two groups were formed depending on type of administration period they received: 24 h and 48 h after surgery. The following information was collected: (1) patient factors (age, gender, body mass index, presence/absence of preoperative medication, diagnosis, impacted wisdom tooth status; (2) surgical factors (operative time, presence/absence of closure, presence/absence of hemostat, doctor career, type and frequency of painkiller); (3) relationship between administration period of OA and SSI occurrence; and (4) details of SSI. ResultsThree hundred forty subjects were analyzed, all of which used amoxicillin. There were 106 cases in 24 h group and 234 cases in 48 h group. The total incidence of SSI was 1.1% (4/340 cases), with 0.9% (1/106 cases) in 24 h group and 1.3% (3/234 cases) in 48 h group; there was no difference between the two groups. ConclusionOur study suggests that amoxicillin (250 mg/dose every 8 h x 3 doses beginning 1 h before surgery) might be sufficient in preventing SSI in Japanese dental patients without SSI risk factors.

Prevalence and Factors Associated With Surgical Site Infections in the University Clinics of Traumatology and Urology of the National University Hospital Centre Hubert Koutoukou Maga in Cotonou.

Objectives: Study the prevalence and factors associated with the occurrence of surgical site infections in University Clinics of Trauma-Orthopedics, Reconstructive Surgery and Urology in a developing country.Methods: This was a retrospective descriptive and analytical study of 384 people operated on during the period of 2019. Logistic regression was used to study the factors associated with surgical site infections. The associations between the dependent variable and the other variables were assessed by the odds ratio (OR) followed by their 95% confidence interval.Results: The prevalence of surgical site infections was 7.81% CI 95% = (5.12–10.51). The factors linked to the surgical site infections in the studied population were the patient's admission method [OR = 2.74; 95% CI = (1.08–6.95)] and the length of the postoperative stay [OR = 8.75; 95% CI = (2.83–26.98)]. The interview and direct observation identified health care system dysfunctions, medical errors, patient monitoring and financial unavailability as factors that could favor the onset of surgical site infections.Conclusion: Interventions should be focused on the factors identified for the effective management of operated patients.

Relevance of Antibiotic Prophylaxis in Non-Mesh Inguinal Hernia Repair in Remote and Poor Medical Settings in Sub-Saharan Africa

Background: Because of the poor local medical conditions, and because the surgical site infection (SSI) rate after hernia repair in sub-Saharan Africa is higher than in developed countries, deployed surgeons within Role 2 usually perform non-mesh inguinal herniorrhaphy. Regarding antimicrobial prophylaxis, the latter currently is not recommended in non-mesh inguinal hernia repairs. Our study aimed at assessing the relevance of antibiotic prophylaxis in non-mesh inguinal hernia repair within a Role 2 surgical structure deployed in sub-Saharan Africa. Methods: From January 1 to December 31, 2019, we conducted a non-randomized prospective study in a French Role 2 military surgical structure deployed to Abidjan, Republic of Côte d'Ivoire. We included all patients presenting with uncomplicated inguinal hernia. All subjects underwent open herniorrhaphy through a groin incision. The primary endpoint was the occurrence of an SSI. Results: We recorded 120 open hernia repairs. Antimicrobial prophylaxis was administered in 70 interventions (60%). An SSI was reported in 13 cases (11%). Multivariable logistic regression analysis of SSI occurrence, according to the administration of intra-operative antimicrobial prophylaxis, showed a 0.219 odds ratio with a 95% confidence interval of 0.05-0.84 and p = 0.028. This finding was in favor of its significant protective effect on the risk of SSI after open non-mesh inguinal hernia repair, taking into account the American Society of Anesthesiologists score, Body Mass Index, and recurrence status. Conclusion: Administration of intra-operative antimicrobial prophylaxis in open non-mesh inguinal hernia repair in remote and poor medical settings, for example during deployment conditions as in our study, was associated with a reduction of the SSI rate.

Intraoperative subcutaneous culture as a predictor of surgical site infection in open gynecological surgery.

PurposeTo analyze the relationship between intraoperative cultures and the development of surgical site infection (SSI) in women undergoing laparotomy for gynecological surgery.MethodsProspective observational cohort study. Over a six-year period, women who underwent elective laparotomy at our hospital were included. Patients’ demographics, underlying co-morbidities, surgical variables, type and etiology of postoperative surgical site infections were collected. Skin and subcutaneous samples were taken just prior to skin closure and processed for microbiological analysis. Univariate and multivariate analyses (logistic regression model) were conducted to explore the association of the studied variables with SSIs.Results284 patients were included in our study, of which 20 (7%) developed surgical site infection, including 11 (55%) superficial and nine (45%) organ-space. At univariate analysis, length of surgery, colon resection, transfusion and positive intraoperative culture were associated with surgical site infection occurrence. Skin and subcutaneous cultures were positive in 25 (8.8%) and 20 (7%) patients, respectively. SSI occurred in 35% of women with positive subcutaneous culture and in 20% of those with positive skin cultures. Using multivariate analysis, the only independent factor associated with surgical site infection was a positive subcutaneous culture (OR 10.4; 95% CI 3.5–30.4; P<0.001).ConclusionIntraoperative subcutaneous cultures before skin closure may help early prediction of surgical site infection in open gynecological procedures.

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery.

Surgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score-matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery. The authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group). In a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368-1.111; p = 0.114). Using a one-to-one propensity score-matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243-0.972; p = 0.041). There were no systemic complications related to the use of vancomycin. The current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

Urgency of surgery as an indicator for the occurrence of surgical site infections: data from over 100,000 surgical procedures

The risk for surgical site infections (SSIs) is influenced by patient- and procedure-related factors. Urgent surgery represents a challenge in operative medicine and is frequently linked to a variety of complications, including SSIs. We aimed to investigate whether urgency was significantly associated with SSI occurrence, and determine whether collection of this variable provided useful information for SSI surveillance. We performed a retrospective data analysis of caesarean sections (C-sections) and colon surgeries conducted between 2017 and 2019 within the German national SSI surveillance network. A multivariable logistic regression model was utilized to determine the influence of urgency on SSI occurrence. For this purpose, data on procedures and SSIs were associated with available department- and patient-related parameters. A total of 115,648 procedures were included in the analysis: 78,288 C-sections and 37,360 colon surgeries. For C-sections, the SSI rate per 100 procedures was 0.98 (95% confidence interval: 0.85-1.11) for urgent and 0.46 (0.40-0.53) for elective procedures (P<0.001). For open colon surgeries, SSI rates were 9.66 (8.89-10.49) for urgent and 8.60 (8.13-9.11) for elective procedures (P<0.001). For laparoscopic colon surgeries, SSI rates did not differ significantly. Multivariable analysis revealed that urgency significantly increased the likelihood of SSI occurrence only for C-sections. Urgency significantly increased the SSI risk of C-sections, but not colon surgeries. Hence, collection of this variable is useful for SSI surveillance of C-sections, but may be dispensable for other procedures. Future analyses on the matter should therefore focus on other procedure types.

Clinical Significance of Intraoperative Bile Culture in Surgery Including Bile Duct Resection

It is widely accepted that intraoperative bacterial infection may potentially result in a worse postoperative outcomes. The purpose of this study is to analyze the microbiology of intraoperative bile smear culture test and the correlation between the results of culture and postoperative outcomes in bile duct resection operation. Methods: The data was prospectively collected from 235 patients who underwent bile duct resection at Samsung Medical Center for one year from October 2018 to September 2019. The diseases included in the data are periampullary cancer, gallbladder cancer, hilar cholangiocarcionoma, and intrahepatic cholangiocarcinoma. Intraoperative bile smear test was performed in operation, and the included operation was pancreaticoduodenectomy and liver resection surgery with bile duct resection. Specimens were obtained from culture swab of bile drained during bile duct resection. Results: Of the 235 patients, microorganism was isolated in 141 patients (60%). The predominant microorganisms grown from the intraoperative bile cultures were Enterococcus faecalis (38 cultures, 27.0%), Enterococcus faecium (32 cultures, 22.7%), Klebsiella pneumoniae and Enterobacter cloacae (28 cultures, 19.9%). In postoperative complication, the positive results of intraoperative bile cultures was related with Clavien-Dindo Classification≥Ⅲ (OR3.117, 95%CI:1.498-6.485, p=0.002). Also, it was a risk factors for occurrence of surgical site infection (OR3.266, 95%CI:1.237-8.621, p=0.013) and intra-abdominal abscess (OR1.145, 95%CI:1.057-1.240, p=0.003). In addition, the incidence of postoperative pancreatic fistula was increased in patients with microorganisms grown in bile (OR1.974, 95%CI:1.098-3.549, p=0.022). Conclusions: Smear positivity of intraoperative bile fluid is associated with occurrence of major complication. It was risk factor for surgical site infection and intra-abdominal abscess.

Evaluation of post-surgical site infection wounds in a tertiary care hospital of Central India

Introduction: Surgical site infections (SSIs) are one of the commonest hospital-acquired infections globally. Materials and Methods: A total of 2083 cases were included in the study; surgical sites were graded in accordance to the set of clinical criteria recommended by the CDC’s NNIS system. We graded the wounds on the basis of culture positive with respect to age and sex, pre-operative hospitalization, duration of surgery, duration of drain, hemoglobin levels, random blood sugar, and smoking. Results: The total males and females included were 1561 and 522, respectively. The age group of 40–50 years was the highest operated group, whereas the 12–21 age group was with least surgeries. The numbers of SSI were higher in subjects with longer pre-operative hospital stay. The occurrence of SSIs was higher in surgeries with longer duration. Patients with drain of longer duration had higher number of SSIs when compared with subjects with no drain in wounds. The hemoglobin pattern suggested that anemic subjects were more susceptible to SSIs when compared with non-anemic subjects. Diabetic patients were more prone to SSI when compared with non-diabetic subjects. Smokers were more prone to SSIs when compared with non-smokers. Conclusion: The study established a relationship between SSI and various factors, which would help clinicians in handling cases of post-operative SSIs.

Usefulness of a multidisciplinary surgical site infection team in colorectal surgery.

Background : Surgical site infection (SSI) is an adverse event that places a major burden on patients and staff. In this study, we examined the occurrence of SSI and the characteristics of patients referred to the SSI team after colorectal surgery. Methods : In total, 955 patients underwent colorectal surgery at our hospital from 2014 to 2019. Of these 955 patients, 516 received therapeutic support by the SSI team from 2017 to 2019. All patients were evaluated using an SSI surveillance sheet, and we checked for reports of SSI once a month. Each attending physician performed SSI prophylaxis (use of new instruments before wound irrigation and closure). Results : SSI occurred in 80 (8.4%) patients. The incidence of SSI and the incidence of surface SSI were higher in the patients who did not receive intervention by the SSI team than in the patients who did. Organ / space SSI occurred in 18 patients. Among patients with surface SSI, Enterococcus was the most commonly detected bacteria. Among the 18 patients with organ / space SSI, 5 developed anastomotic leakage and 4 developed intra-abdominal abscesses. Conclusions : An SSI team for prevention and treatment of infection may contribute to reduction of SSI. J. Med. Invest. 68 : 256-259, August, 2021.

894. Patient and Surgery Characteristics on Wound Complication and Surgical Site Infection in Sarcoma Patients undergoing Hemipelvectomy

BackgroundHemipelvectomy is associated with a significant risk of wound complications, including infections, bleeding and injuries to nearby neurovascular structures as well as the gastrointestinal and genitourinary tract. This study aimed to determine the patient characteristics and approach to treatment that could affect the occurrence of surgical site infection or wound complications in sarcoma patients undergone hemipelvectomy.MethodsWe conducted a retrospective analysis of 33 adult patients who underwent hemipelvectomy at Moffitt Cancer Center, Tampa, FL, from 2008 to 2016. We used Chi-square (Exact Fisher) test to investigate the association between wound complication and categorical variables. We used a T-test to evaluate the difference in numerical variables for outcomes.ResultsOut of 33 patients, 12 (36.4%) patients experienced wound complications after hemipelvectomy (Table 1). The average age of patients with wound complications was 63.3 3 (57.1±15.4) years old, significantly higher than that of patients without wound complications (p=0.004). Without adjustment, the use of computer navigation had a lower wound complication rate (p=0.027). Patients with wound complications had longer hospital length of stay (14.8 vs. 7.0 days, p=0.016). Among patients with surgical site infection (Table 2), there were no patients’ characteristics or surgical characteristics associated with this outcome. Five (15%) patients developed surgical site infection and they had longer hospital stay (19.4 vs. 8.1 days, p=0.001). The organisms identified from wound cultures include methicillin-resistant Staphylococcus aureus, viridans Streptococcus, Peptostreptococcus asaccharolyticus, Enterobacter cloacae, Pseudomonas aeruginosa, Candida albicans. The organisms in late infections (more than 6 months since surgery), included above organisms plus Stenotrophomonas maltophilia and Achromobacter xylosidans. ConclusionOlder patients undergoing hemipelvectomy are at an increased risk of developing wound complications with a prolonged hospital stay. Initial antimicrobial therapy for suspected surgical site infection should include a broad-spectrum coverage to include skin and gastrointestinal flora.Disclosures All Authors: No reported disclosures

Contamination of Gloved Hands by Multidrug Resistant Bacteria ‎During Small Animal Surgery Wet-labs and its Potential Implication for ‎Occurrence of Surgical Site Infections

This study was carried out to evaluate the level of asepsis at various stages of the surgical procedures during the undergraduate students’ wet-lab sessions. Skin and/or wound swabs were collected from different wet lab groups, sessions and stages. The swabs were processed for bacteriological isolation using standard microbiological procedures. A total of 62 isolates of bacteria belonging to 8 genera: Staphylococcus (n=38), Streptococcus (n=1), Corynebacterium n=4), Escherichia (n=7), Proteus (n=8), Klebsiella (n=2), Serratia (n=1) and Acinetobacter (1), were isolated. The most commonly isolated species of bacteria were Staphylococcus equorum (n=31) and Proteus spp. (n=7), which were detected in swabs from ungloved and gloved hands of surgeon and his assistant, patient’s surgical sites and surgical site infections. All the isolates (Gram-positive and negative) were resistant to at least one antibiotic with resistance to the β-lactam antibiotics: ampicillin (89.3% and 100% and amoxicillin (75% and 100%) most observed. The bacteria were more susceptible to doxycycline (75%) and imipenem (87.5%) respectively. Majority of the isolates (83.3%, n=30) were multidrug resistant, presenting in one of 24 different multidrug resistance patterns. The detection of these bacteria from the normally aseptic surgical procedure indicates a break in asepsis. Similarly, the danger of spreading multidrug resistant bacteria to the surgical wounds may result in wound infection, dehiscence, delayed healing and increased cost of post-surgical management. It is recommended that adherence to stringent pre-surgical and intra-surgical asepsis should be observed.

Spectrum of surgical site infections at a tertiary care hospital in Hyderabad

Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, readmission, length of hospital stay and significant morbidity and mortality. The present study was aimed to determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram at our tertiary care hospital.This study was conducted for a period of one year (January to December 2019). The SSI occurrence, the organisms isolated, antibiotic sensitivity pattern as well as outcome of the treatment is evaluated. In overall surgeries conducted in a year at our institute, we found 15 cases from various department were clinically diagnosed of having SSIs, including 11 male and 4 females with the mean age of 43.7 years. Out of the total 15 samples processed, 9 (60%) yielded bacterial growth including and . Most of these are organisms isolated were not multidrug resistant. Management of SSIs remains a significant concern for surgeons and physicians in a health care facility, which carries a load with high morbidity and mortality. Due to the proper hospital infection control management we report the occurrence of low SSI in our hospital with the absence of multidrug resistance. We emphasis the importance of hospital infection control monitoring with proper precautions during surgeries to reduce the load of SSI and better outcome of the treatment.

POSSIBILITIES OF FORECASTING SURGICAL SITE INFECTION AFTER HIP AND KNEE REPLACEMENT

1707 Total Hip and Knee Arthroplasty had been retrospectively analyzed for the research. All patients’ data (non-complicated post- Hip and Knee Arthroplasty (1st group - 1579 patients) and post- Hip and Knee Arthroplasty with surgical site infection in 12 months (2nd group - 128 patients)) had been used as an educational matrix for a mathematic forecast and as a construction of a prevention algorithm for septic complications in primary THA and TKA. The study had shown 14 significant criteria which can influence the occurrence of surgical site infection in THA and TKA. 12-month testing period of the software in prospective research (467 cases) had shown a significant decrease rate of surgical site infection in comparison to retrospective research (decrease of 7.5% in the prospective cases and 4.1% - in retrospective).

Risk factors for surgical site infection after emergency abdominal surgery: a multicenter cross-sectional study in China

Objective: Surgical site infection (SSI) is the most common infectious complication after emergency abdominal surgery (EAS). To a large extent, most SSI can be prevented, but there are few relevant studies in China. This study mainly investigated the current situation of SSI occurrence after EAS in China, and further explored risk factors for SSI occurrence. Methods: Multi-center cross-sectional study was conducted. Clinical data of patients undergoing EAS in 33 hospitals across China between May 1, 2019 and June 7, 2019 were prospectively collected, including perioperative data and microbial culture results from infected incisions. The primary outcome was the incidence of SSI after EAS, while the secondary outcomes were postoperative hospital stay, ICU occupancy rate, length of ICU stay, hospitalization cost, and mortality within postoperative 30 days. Univariate and multivariate logistic regression models were used to analyze the risk factors of SSI after EAS. Results: A total of 660 EAS patients aged (47.9±18.3) years were enrolled in this study, including 56.5% of males (373/660). Forty-nine (7.4%) patients developed postoperative SSI. The main pathogen of SSI was Escherichia coli [culture positive rate was 32.7% (16/49)]. As compared to patients without SSI, those with SSI were more likely to be older (median 56 years vs. 46 years, U=19 973.5, P<0.001), male [71.4% (35/49) vs. 56.1% (343/611), χ(2)=4.334, P=0.037] and diabetes [14.3% (7/49) vs. 5.1% (31/611), χ(2)=5.498, P=0.015]; with-lower preoperative hemoglobin (median: 122.0 g/L vs. 143.5 g/L, U=11 471.5, P=0.006) and albumin (median: 35.5 g/L vs. 40.8 g/L, U=9452.0, P<0.001), with higher blood glucose (median: 6.9 mmol/L vs. 6.0 mmol/L, U=17 754.5, P<0.001); with intestinal obstruction [32.7% (16/49) vs. 9.2% (56/611), χ(2)=25.749, P<0.001], with ASA score 3-4 [42.9% (21/49) vs. 13.9% (85/611), χ(2)=25.563, P<0.001] and with high surgical risk [49.0% (24/49) vs. 7.0% (43/611), χ(2)=105.301, P<0.001]. The main operative procedure resulting in SSI was laparotomy [81.6%(40/49) vs. 35.7%(218/611), χ(2)=40.232, P<0.001]. Patients with SSI experienced significantly longer operation time (median: 150 minutes vs. 75 minutes, U=25 183.5, P<0.001). In terms of clinical outcome, higher ICU occupancy rate [51.0% (25/49) vs. 19.5% (119/611), χ(2)=26.461, P<0.001], more hospitalization costs (median: 44 000 yuan vs. 15 000 yuan, U=24 660.0, P<0.001), longer postoperative hospital stay (median: 10 days vs. 5 days, U=23 100.0, P<0.001) and longer ICU occupancy time (median: 0 days vs. 0 days, U=19 541.5, P<0.001) were found in the SSI group. Multivariate logistic regression analysis showed that the elderly (OR=3.253, 95% CI: 1.178-8.985, P=0.023), colorectal surgery (OR=9.156, 95% CI: 3.655-22.937, P<0.001) and longer operation time (OR=15.912, 95% CI:6.858-36.916, P<0.001) were independent risk factors of SSI, while the laparoscopic surgery (OR=0.288, 95% CI: 0.119-0.694, P=0.006) was an independent protective factor for SSI. Conclusions: For patients undergoing EAS, attention should be paid to middle-aged and elderly patients and those of colorectal surgery. Laparoscopic surgery should be adopted when feasible and the operation time should be minimized, so as to reduce the incidence of SSI and to reduce the burden on patients and medical institutions.

COMPARISON BETWEEN LAPARATOMY AND LAPARASCOPY COLORECTAL CANCER FOR LENGTH OF HOSPITAL, SURGICAL SITE INFECTION AND INTRAPERITONEUM ADHESION

Colorectal cancer (CRC) is the development of cancer from the colon or rectum. There are two kinds of surgery which are laparotomy and laparoscopy. This course of action had a significant effect on the length of stay, surgical site infection, and intraperitoneal adhesion. The purpose of this study is to find out the comparison between laparotomy and colorectal cancer laparoscopy with the length of stay, surgical site infection and intraperitoneal adhesion. The researcher used a cross sectional design. The sample for this study was taken from the medical record data of colorectal cancer patients in Dr. Kariadi Semarang from 2013 to 2018. The data were collected using purposive sampling technique. There were 57 samples that included inclusion and exclusion criteria with 28 details of laparoscopy and 29 samples of laparotomy. Numeric-scale data were tested for normality of data by Kolmogorov-Smirnov and found abnormal data using the Mann Whitney test. Nominal scale data were processed using the non-parametric Chi-Square test and it significant if p&lt;0.05. There is a difference in length of stay and frequency of occurrence of surgical site infections and intraperitoneal adhesion between laparotomy and laparoscopy.

Perioperative antimicrobial prophylaxis in adult patients: The first multicenter clinical practice audit with intervention in Greek surgical departments.

To audit clinical practice and implement an intervention to promote appropriate use of perioperative antimicrobial prophylaxis (PAP). Prospective multicenter before-and-after study. This study was conducted in 7 surgical departments of 3 major Greek hospitals. Active PAP surveillance in adults undergoing elective surgical procedures was performed before and after implementation of a multimodal intervention. The surveillance monitored use of appropriate antimicrobial agent according to international and local guidelines, appropriate timing and duration of PAP, overall compliance with all 3 parameters and the occurrence of surgical site infections (SSIs). The intervention included education, audit, and feedback. Overall, 1,447 patients were included: 768 before and 679 after intervention. Overall compliance increased from 28.2% to 43.9% (P = .001). Use of antimicrobial agents compliant to international guidelines increased from 89.6% to 96.3% (P = .001). In 4 of 7 departments, compliance with appropriate timing was already >90%; an increase from 44.3% to 73% (P = .001) and from 20.4% to 60% (P = .001), respectively, was achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P = .001) was observed in 1 department. All but one department achieved a shorter PAP duration, and most achieved duration of ~2 days. SSIs significantly decreased from 6.9% to 4% (P = .026). After the intervention, it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times more likely to administer an antimicrobial for the appropriate duration and 5.3 times more likely to administer an overall appropriate PAP. An intervention based on education, audit, and feedback can significantly contribute to improvement of appropriate PAP administration; further improvement in duration is needed.

Controle glicêmico e suas evidências para prevenção de infecção de sítio cirúrgico em cirurgias de coluna

Objetivo: Analisar as evidências disponíveis na literatura sobre o controle glicêmico como medida de prevenção para a infecção de sítio cirúrgico (ISC) em cirurgias de coluna. Métodos: Revisão integrativa desenvolvida com a seleção de artigos primários nas bases de dados Medical Literature Analysis and Retrieval System on-line (MEDLINE), Biblioteca Virtual em Saúde (BVS) e no Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) utilizando-se os descritores: Glycemic control, wound infection, spine, spine surgery, surgical site infection e hemoglobinaA1c. Resultados: Os resultados evidenciaram a hiperglicemia como fator de risco independente para ISC em pacientes submetidos a cirurgia de coluna. O nível de hemoglobina glicada foi associado à infecção de ISC sendo que o risco se torna maior à medida em que há aumento do nível de hemoglobina glicada. O Diabetes Mellitus foi apontado como preditor independente significativo para ISC. Considerações finais: A hiperglicemia perioperatória, independentemente da condição de Diabetes Mellitus, está relacionada a ocorrência de ISC. Observou-se a falta de parâmetros quanto o nível glicêmico ideal o que aponta a necessidade de novos estudos capazes de nortear essa lacuna.

An excuse to misuse? Evaluating the use of prophylactic antibiotics in elective skin graft surgery: a systematic review and meta-analysis

Introduction: Plastic surgeons may opt to administer prophylactic perioperative antibiotics in elective skin graft surgeries to curtail the risk of surgical site infections (SSI). However, the use of antibiotics brings the risk of adverse events or antibiotic resistance and evidence comparing the risk versus benefit is still lacking. Thus, there are no specific guidelines regarding the use of antibiotics prophylaxis in skin graft surgery and the potential for misuse of antibiotics is high. Methodology: A systematic literature search was conducted to retrieve all articles comparing the use versus nonuse of “prophylactic antibiotics” in “skin graft surgery” on March 29, 2020. All comparative study designs were considered for inclusion. The primary outcome was occurrence of SSI. A meta-analysis using the Mantel-Haenszel method with random effect model was used to pool the effect estimates from included studies. Result: A total of 1403 articles were identified, of which, 6 were included in the meta-analysis. The 6 articles included were all comparative studies (5 RCTs and 1 cohort study) and reported the outcomes of 391 patients and 404 grafts. A total of 202 patients received prophylactic antibiotics and 202 patients did not receive antibiotics. All 6 studies were included in the meta-analysis. The overall pooled effect estimates comparing treatment groups showed no significant difference for outcomes in terms of SSI (odds ratio: 0.43; 95% confidence interval: 0.18, 1.02; I 2 0%; P=0.06). Conclusion: Incidence of SSI in elective skin graft surgery is relatively low. Our data shows there is limited utility in the use of prophylactic antibiotics to prevent clinically significant SSI in patients undergoing elective skin graft surgery. However, there are still only a small number of studies conducted on the topic to date, and more work is required before definitive conclusions can be used.

Increase in Surgical Site Infections Caused by Gram-Negative Pathogens in Warmer Weathers Data From More Than 2 Million Surgeries

Background: Various studies have linked periods of warmer temperatures to an increased occurrence of surgical site infections (SSIs) and healthcare-associated infections in general. In an observational study, we sought to determine the pathogens for which this association was especially strong. Method: Patient- and procedure-related data of the SSI-module of the German nosocomial infection surveillance system were linked with monthly aggregated meteorological data from the German Meteorological Service for a period from 2000 to 2016. Due to high correlation with other meteorological parameters, analyses were executed focusing on the outside ambient temperature. Temperature was regarded as both a continuous variable and a categorical variable with different temperature intervals (5°C steps ranging from &lt;5°C to ≥20°C). Through multivariable logistic regression analysis, adjusted odds ratios (OR) with 95% confidence intervals were calculated for SSI rates relating to temperature. SSIs were stratified by pathogen and depth of infiltration. Result: Altogether, 2,004,793 procedures, conducted in 1,455 German surgical departments and resulting in 32,118 SSIs, were included. A general association of warmer mean temperatures in the month of surgery with an increased SSI-risk was observed, particularly for SSIs caused by gram-negative pathogens. Stratification by pathogen revealed that the association was especially prominent for Acinetobacter spp, Pseudomonas aeruginosa, and certain Enterobacteriaceae. Per additional 1°C, we observed a 6% increase in the risk for SSIs caused by Acinetobacter spp (OR, 1.06; 95% CI, 1.04–1.09), and a 4% increase in the risk for SSIs caused by Enterobacter spp (OR, 1.04; 95% CI, 1.03–1.05). Among gram-positive pathogens, temperature-association was strongest for Staphylococcus aureus. Superficial SSIs showed a higher temperature-association than deeper SSIs. The risk for superficial SSIs with Acinetobacter spp significantly increased &gt;10-fold after surgeries conducted in months with a mean temperature of ≥20°C in reference to &lt;5°C. For Pseudomonas aeruginosa, we observed a &gt;2-fold statistically significant increase in the risk for superficial SSIs, when comparing the same temperature categories (≥20°C vs &lt;5°C). Conclusions: Our study demonstrated that higher temperatures were associated with increased SSI-rates caused by gram-negative bacteria. As a consequence, future SSI-prevention measures should place a higher emphasis on the parameter season as part of a more tailormade, personalized approach at infection prevention. For instance, it may be conceivable to seasonally adjust decolonizing regimes and certain prophylaxes. Underlying shifts in microbiome composition due to meteorological factors should be considered in further analyses. Given the expected rise of global temperatures until the end of the century, the topic gains relevance from multiple perspectives.Funding: NoneDisclosures: None