Overall Rate Of Surgical Site Infection Research Articles

Comparative study of preoperative prophylactic antibiotic versus no antibiotic in patients undergoing elective laparoscopic cholecystectomy

Introduction: Laparoscopic cholecystectomy stands as one of the most commonly performed surgical procedures worldwide, primarily indicated for symptomatic cholelithiasis and associated gallbladder diseases. Despite its minimally invasive nature, concerns persist regarding the risk of postoperative infections, which can significantly impact patient outcomes and healthcare costs. Antibiotic prophylaxis has long been considered a standard practice to mitigate this risk, yet the optimal approach remains a subject of debate. Objective: This research was aimed to elucidate the comparative effectiveness of preoperative prophylactic antibiotic versus no antibiotics in patients undergoing elective laparoscopic cholecystectomy. Methodology: We conducted a prospective comparative study at Birat Medical College Teaching Hospital from 27 November 2023 to 27 February 2024. A total of 200 patients undergoing elective laparoscopic cholecystectomy were enrolled consecutively and assigned to the no antibiotic prophylaxis group and single dose preoperative antibiotic prophylaxis group (SD) on a roll basis. The SD group received a preoperative injection of ceftriaxone (third generation of cephalosporin) (1gm) 30 minutes before the surgical procedure. Data were collected and analyzed using SPSS version 23. Results: The overall rate of SSI was 4% in our study. Five out of 100 patients who received prophylactic and 3 out of 100 patients who did not receive antibiotics developed surgical site infection(SSI). However, the difference was not statistically significant. Conclusion: Our study comparing preoperative prophylactic antibiotics versus no antibiotics in elective laparoscopic cholecystectomy patients reveals no significant association between antibiotic use and outcomes such as surgical site infections and fever.

Assessment of Knowledge, Attitude and Practice of Pharmacovigil Comparative study of preoperative prophylactic antibiotic versus no antibiotic in patients undergoing elective laparoscopic cholecystectomy ance among Healthcare Professionals: A Cross-sectio

Introduction: Laparoscopic cholecystectomy stands as one of the most commonly performed surgical procedures worldwide, primarily indicated for symptomatic cholelithiasis and associated gallbladder diseases. Despite its minimally invasive nature, concerns persist regarding the risk of postoperative infections, which can significantly impact patient outcomes and healthcare costs. Antibiotic prophylaxis has long been considered a standard practice to mitigate this risk, yet the optimal approach remains a subject of debate. Objective: This research was aimed to elucidate the comparative effectiveness of preoperative prophylactic antibiotic versus no antibiotics in patients undergoing elective laparoscopic cholecystectomy. Methodology: We conducted a prospective comparative study at xxxxxxxxxxxx from 27 November 2023 to 27 February 2024. A total of 200 patients undergoing elective laparoscopic cholecystectomy were enrolled consecutively and assigned to the no antibiotic prophylaxis group and single dose preoperative antibiotic prophylaxis group (SD) on a roll basis. The SD group received a preoperative injection of ceftriaxone (third generation of cephalosporin) (1gm) 30 minutes before the surgical procedure. Data were collected and analyzed using SPSS version 23. Results: The overall rate of SSI was 4% in our study. Five out of 100 patients who received prophylactic and 3 out of 100 patients who did not receive antibiotics developed surgical site infection(SSI). However, the difference was not statistically significant. Reviewer recommendation: Few lines of important characteristic of disease profile (like % stented GSD, of empyema, complicated GSD etc) which has high risk of SSI should have been mentioned in results for better interpretation of results in abstract is recommended) Conclusion: Our study comparing preoperative prophylactic antibiotics versus no antibiotics in elective laparoscopic cholecystectomy patients reveals no significant association between antibiotic use and outcomes such as surgical site infections and fever.

Benefits of cyanoacrylate mesh closure following exploratory laparotomy in horses.

Skin closure of laparotomy incisions using topical 2-octyl cyanoacrylate (2-OCA) mesh provides a secure bactericidal barrier in humans, which may reduce therisk of postoperative incisional complications. However,the benefits ofusingthismeshhave not been objectively assessed in horses. From 2009 to 2020, three methods of skin closure were used following laparotomy for acute colic, including metallic staples (MS), suture (ST) and cyanoacrylate mesh (DP). The closure method was not randomised. Owners were contacted 3 months or more afterthesurgerytorecordanypostoperative complicationsthatoccurred. For each method of closure, the rates of surgical site infection (SSI) and herniation were recorded, as well as surgical time and treatment costs, including those for incisional complications. Chi-square testing and logistic regression modelling were used to assess differences between the groups. A total of 110 horses were recruited (45 in the DP group, 49 in the MS group and 16 in the ST group) The overall rate of SSI was 15.5%, with rates of 8.9%, 18.4% and 25% for the DP, MS and ST groups, respectively (p = 0.23). In addition, incisional hernias developed in 21.8% of cases, with 8.9%, 34.7% and 18.8% of horses in the DP, MS and ST groups, respectively, being affected (p = 0.009). The median total treatment cost did not differ significantly between groups (p = 0.47). This was a retrospective study with non-randomised choice of closure method. No significant differences in the rate of SSI or overall cost wwere demonstrated between treatment groups. However, MS was associated with a higher rate of hernia formation than DP or ST. Despite increased capital cost, 2-OCA proved to be a safe skin closure method in horses and was no more expensive than DP or ST by the time visits to remove sutures/staples and treat infections were factored in.

Surgical Site Infection in Obstetric and Gynecological Surgeries: A Prospective Observational Study.

Introduction An infection at an incisional site that develops within 30 days after surgery, or within a year if a prosthetic is implanted, is referred to as a surgical site infection (SSI). They are mainly caused by exogenous and/or endogenous microbes that penetrate the surgical site during surgery (primary infection) or after the procedure (secondary infection). The prevention of SSI should be the ultimate goal of the surgery team and hospital administration. Methodology The prospective observational study of SSI consisted of 920 patients who were admitted and underwent surgery between April 2021 and September 2022. After a complete examination, a detailed proforma for the collection of data pertaining to patients in this study was prepared, and patients were included as per the inclusion and exclusion criteria. Results The study demonstrated significant results in terms of the association of body mass index (BMI), hemoglobin, and blood sugar level with the SSI status (p<0.05) and nonsignificant results in terms of emergency/elective surgery, type of surgery, and type of incision (p>0.05). Conclusion The overall rate of SSI was 9.2% in the present study. The major reasons involved are inadequate infrastructure facilities, different antibiotics policies, and non-uniform pre-, intra-, and post-operative measures that add woes and result in an increased incidence of SSI. In the present study that was undertaken at a teaching and tertiary care center, the SSI incidence is comparatively lower, but with the implementation of correct knowledge and technique, the rate can further be reduced to a large extent.

Comparison of surgical site infection in post-op patients for whom wound closure is done using staplers and sutures

Background: Surgical site infection (SSI) is a common healthcare-associated infection with a complication rate of up to 10%-20% of surgeries. After a surgical procedure, skin closure is crucial in preventing infection at the surgical site. The purpose of this study is to compare skin closure using sutures versus staplers in elective orthopaedic surgery cases that are followed for 4 weeks for post-operative surgical site infection. Materials and Methods: This is a prospective study of 30 patients who underwent elective orthopaedic procedures between October 2021 to November 2021 with a follow up duration of 4 weeks. Our primary outcome was any surgical site infection and wound gaping within 4 weeks of surgery. 30 patients were divided into two groups of 15 each. In group A wound closure was done using staplers and in group, B sutures (ethylon) were used. There was no statistical difference of risk factors between two groups in terms of age, gender and operative time. Results: The patients were divided into 2 groups of 15. In group A, there were 6 surgical site infections and in group B, there were 3 cases of surgical site infection identified. The overall rate of SSI was lower in group B (SUTURES). Conclusion: By this study it can be concluded that sutures can be used for wound closure instead of staplers in elective orthopaedic surgical procedures as the rate of surgical site infections (SSIs) were less in patients whose wound closure were done using sutures.

Double blind randomized controlled trial for subjects undergoing surgery receiving surgical antimicrobial prophylaxis at tertiary hospital: the clinical pharmacist's interventions.

A surgical site infection (SSI) has significant clinical, humanistic and economic consequences. Surgical antimicrobials prophylaxis (SAP) is a reliable standard to prevent SSIs. The objective was to test that the clinical pharmacist's interventions may facilitate the implementation of SAP protocol and subsequent reduction of SSIs. This was double blinded randomized controlled interventional hospital-based-study at Khartoum State-Sudan. A total of 226 subjects underwent general surgeries at four surgical units. Subjects were randomized to interventions and controls in a (1:1) ratio where patient, assessors and physician were blinded. The surgical team has received structured educational and behavioral SAP protocol mini courses by way of directed lecturers, workshops, seminars and awareness campaigns delivered by the clinical pharmacist. The clinical pharmacist provided SAP protocol to the interventions group. The outcome measure was the primary reduction in SSIs. There were (51.8%, 117/226) females, (61/113 interventions versus 56/113 controls), and (48.2%, 109/226) males (52 interventions and 57 controls). The overall rate of SSIs was assessed during 14 days post-operatively and was documented in (35.4%, 80/226). The difference in adherence to locally developed SAP protocol regarding the recommended antimicrobial was significant (P <0.001) between the interventions group (78, 69%) and the controls group (59, 52.2%). The clinical pharmacist's implementation of the SAP protocol revealed significant differences in SSIs with reduction in SSIs from 42.5% to 25.7% versus the controls group from 57.5% to 44.2% respectively, P = 0.001 between the interventions group and the controls group respectively. The clinical pharmacist's interventions were very effective in sustainable adherence to SAP protocol and subsequent reduction in SSIs within the interventions group.

Effect of negative pressure wound therapy in exploratory laparotomies with coexisting ostomy

Background:&#x0D; Surgical site infection (SSI) is one of the most common healthcare-associated infections. The use of negative pressure wound therapy (NPWT) has shown to decrease the overall rate of SSI, wound dehiscence, and length of hospital stay in surgical conditions. This study aims to determine the impact of NPWT applied on closed surgical incisions on patients with coexisting ostomy undergoing exploratory laparotomy.&#x0D; &#x0D; Methods:&#x0D; A retrospective study on patients who underwent exploratory laparotomies from 2017 to 2019 was conducted. NPWT was compared to standard post-operative surgical wound dressing. A sub-analysis of patients with ostomies was performed.&#x0D; &#x0D; Results:&#x0D; A total of 286 patients who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received standard dressing. The NPWT group had a higher percentage of patients with an ostomy (37.3% vs 20.4%, P=.016), of which 25.5% were colostomies (vs 12.3%) and 11.8% were ileostomies (vs 8.1%) with P=.002. No significant difference in the overall rate of SSI (7.8% vs 5.5%, P= .517), wound dehiscence (7.8% vs 2.1 %, P=.057), and seroma formation (3.9% vs 2.1%, P=.612) were observed. The mean length of ICU stay (3.5 vs 7.0, P=.051) and unplanned reoperation (5.9% vs 16.6%, P=.051) were lower in the NPWT group compared to the control group. Sub analysis of patients with stoma found no significant difference in SSI.&#x0D; &#x0D; Conclusions:&#x0D; In our study, the use of NPWT on closed surgical incision wound was not associated with the reduction of SSI in patients with ostomies. Large studies are needed to ascertain significant benefits in patients with ostomies.&#x0D; &#x0D; Keywords: negative pressure wound therapy, surgical site infection, ostomy, exploratory laparotomy

A Randomized Controlled Trial Comparing Chlorhexidine in Water and Povidone Iodine for Surgical Site Preparation in Abdominal Surgery

Background: Surgical site infection (SSI) is the common complication after abdominal surgery. Proper use of antiseptic can decrease SSI. According to previous studies, chlorhexidine in alcohol is superior to povidone iodine when using as skin preparation before abdominal surgery. Due to alcohol is flammable substance, there are many reports shown usage of chlorhexidine in alcohol for skin preparation can cause skin burn. Our study will compare whether chlorhexidine in water superior to povidone iodine as effective antiseptic agent for skin preparation before abdominal surgery. Objective: The aim of the present study is to compare SSI rate between using chlorhexidine in water and povidone iodine in patient undergoing abdominal surgery. Materials and Methods: Patients undergoing abdominal surgery by single surgeon (WS) between 1 July 2017 to 30 June 2018 in Ramathibodi Hospital were randomized to use skin preparation with chlorhexidine in water or povidone iodine. The inclusion criteria were elective clean-contaminated abdominal surgery, patient&rsquo;s age between 18 to 75 years, and patients who signed consent form. Exclusion criteria were history of allergic to antiseptic agents, previous skin infection at surgical site, refused to participate in study and cannot follow-up. The primary outcome was SSI rate within 30 days after surgery. Results: A total of 87 subjects (38 in the chlorhexidine in water group and 49 in the povidone iodine group) were enrolled. There are 19 males (50%) and 19 females (50%) in chlorhexidine in water group while there are 19 males (38.8%) and 30 females (61.2%) in povidone iodine group. The overall rate of SSI was 10.5% in chlorhexidine in water group and 16.3% in povidone iodine group (p-value=0.463). Conclusion: Preoperative skin preparation with chlorhexidine in water tend to had lower SSI rate compared to povidone iodine, even without statistically significant. Future study with larger sample size may reveal any difference. Keywords: Surgical site infection; Povidone iodine; Chlorhexidine in water

Deep infection after hip hemiarthroplasty: risk factors for infection and outcome of treatments.

AimsDeep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited.MethodsPatients who underwent a hemiarthroplasty between March 2007 and August 2018 were reviewed. Multivariable binary logistic regression was performed to identify and adjust for risk factors for SSI, and to identify factors predicting a successful DAIR at one year.ResultsA total of 3,966 patients were identified. The overall rate of SSI was 1.7% (51 patients (1.3%) with deep SSI, and 18 (0.45%) with superficial SSI). In all, 50 patients underwent revision surgery for infection (43 with DAIR, and seven with excision arthroplasty). After adjustment for other variables, only concurrent urinary tract infection (odds ratio (OR) 2.78, 95% confidence interval (CI) 1.57 to 4.92; p < 0.001) and increasing delay to theatre for treatment of the fracture (OR 1.31 per day, 95% CI 1.12 to 1.52; p < 0.001) were predictors of developing a SSI, while a cemented arthroplasty was protective (OR 0.54, 95% CI 0.31 to 0.96; p = 0.031). In all, nine patients (20.9%) were alive at one year with a functioning hemiarthroplasty following DAIR, 20 (46.5%) required multiple surgical debridements after an initial DAIR, and 18 were converted to an excision arthroplasty due to persistent infection, with six were alive at one year. The culture of any gram-negative organism reduced success rates to 12.5% (no cases were successful with methicillin-resistant Staphylococcus aureus or Pseudomonas infection). Favourable organisms included Citrobacter and Proteus (100% cure rate). The all-cause mortality at one year after deep SSI was 55.87% versus 24.9% without deep infection.ConclusionDeep infection remains a devastating complication regardless of the treatment strategy employed. Success rates of DAIR are poor compared to total hip arthroplasty, and should be reserved for favourable organisms in patients able to tolerate multiple surgical procedures.Cite this article: Bone Jt Open 2021;2(11):958–965.

A Randomized Controlled Trial of Negative Pressure Wound Therapy to Reduce Colorectal Surgical Site Infection

Background: The rate of surgical site infection (SSI) in clean-contaminated wounds resulting from elective colorectal procedures ranges from 15 to 30%. Within the region considered in the study, the SSI rate is 20% despite the adoption of preventative measures. Objective: The objective of this study was to determine the effectiveness of prophylactic negative pressure wound therapy (NPWT) in reducing superficial SSIs in clean-contaminated wounds resulting from elective colorectal surgery to below 10%. Design: An unblinded randomized controlled trial was conducted. Settings: The study was conducted at two Canadian tertiary academic hospitals. Patients and Methods: Patients undergoing elective, non-emergent, clean-contaminated colorectal resection by both laparoscopic and open procedures were included. Participants were randomized to either standard surgical dressing (SSD) or NPWT over a closed incision. Main Outcome Measures: Incidence of superficial SSI on postoperative day 30. Results: The study closed early due to lack of accrual. From the planned group of 398 patients, 126 were randomly assigned to SSD (n = 61) or NPWT (n = 61). The analysis included 55 patients from the SSD group and 47 from the NPWT group. The mean age for the groups was 64.9 years (SSD) and 65.1 years (NPWT) with males comprising 52.7% (n = 29) and 44.7% (n = 21) of the populations, respectively. The results showed a clinically important but statistically non-significant difference between the two groups. The overall rate of SSI in the as-treated analysis was 14.7%, while it was slightly lower at 13.5% in the intent-to-treat (ITT) analysis. In both cases, there was a trend toward higher rates of SSI in the SSD, with the ITT analysis showing somewhat larger differences; however, in both the logistic regression models, the trends were non-significant. Conclusion: We present a randomized controlled trial of prophylactic NPWT following elective colorectal resection. The results indicated a clinically important reduction in the superficial SSI rate compared with standard surgical dressing. A more extensive randomized study is needed to clarify the effectiveness of NPWT to reduce wound infections in this patient population. Limitations: Neither patients nor clinicians were blinded to the treatment. The lack of recruitment introduced a type two statistical error, which led to a non-significant difference between the cases and controls. Conflict of Interest: None.

Do Preoperative Nasal Antiseptic Swabs Reduce the Rate of Surgical Site Infections After Adult Thoracolumbar Spine Surgery?

Surgical site infection (SSI) remains a major complication after adult spinal surgery. We investigated whether adding preoperative nasal decontamination by antiseptic swab (skin and nasal antiseptic povidone-iodine, SNA-PI) to our antimicrobial protocol reduces the SSI rate among our patients undergoing thoracolumbar spinal surgery.We retrospectively reviewed all adult thoracolumbar spinal surgeries performed between June 2015 and May 2017 at a single hospital. Patients were divided into those who received nasal decontamination (SNA-PI+) and those who did not (SNA-PI-). SSI rates and responsible pathogens were compared between the cohorts.A total of 1,555 surgeries with nasal decontamination (SNA-PI+) and 1,423 surgeries without (SNA-PI-) were included. The SSI rate in the SNA-PI+ group was 13 of 1,555 (0.8%) versus 10 of 1,423 (0.7%) for SNA-PI- group (P = 0.68). The infection rate was the highest among posterior instrumented fusions in the SNA-PI+ group (1.4%). Methicillin-sensitive Staphylococcus aureus was responsible for 70% of infections in the SNA-PI- group and 38% in the SNA-PI+ group (P = 0.13).Routine nasal antiseptic swab before spine surgery did not affect the overall rate of SSI in thoracolumbar spinal surgeries. The incidence of methicillin-sensitive S aureus was lower in patients who received nasal decontamination (5/1,555, 0.3%) compared with those who did not (7/1,423, 0.5%); however, this result was not statistically significant (P = 0.57).

Systematic Review of Risk Factors Predicting Surgical Site Infection Following Pancreatic and Liver Resections

Introduction: The risk factors for surgical site infection (SSI) after HPB surgery are poorly reported. This review aimed to identify the risk factor profile for SSI after pancreas and liver resection. Method: The PUBMED, MEDLINE, EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. Results: Seventeen studies including 52,416 patients made the final analysis, of which 39,748 patients underwent pancreatic resection and 12,668 patients liver resection. The overall rate of SSI after pancreatic and liver resection were 25% and 10% respectively (p< 0.001). 32% of pancreaticoduodenectomies (PD) developed SSI vs 28% after distal pancreatectomy (p< 0.001). The rate of incisional SSI in the pancreatic group was 8.8% and organ space SSI 16%. Biliary resection during liver surgery was a risk factor for SSI (25% vs 16%, p=0.004). After liver resection, the incisional SSI rate was 7.6% and organ space SSI rate was 10%. Pancreas specific SSI risk factors were male sex, pre-operative biliary drainage and chemotherapy. Liver specific SSI risk factors were smoking, open resections, significant blood loss and peri-operative blood transfusion. Conclusions: The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection. PD has increased risk of SSI compared to DP. Similarly, biliary resections during liver surgery increase the rates of SSI.

Surgical Antibiotic Prophylaxis: Incidence and Risk of Surgical Site Infection

Introduction: This prospective cross sectional study assessed surgical antibiotic prophylaxis (SAP) practice, the incidence of surgical site infection (SSI) and its associated risks in Universiti Kebangsaan Malaysia Medical Centre. Methods: Patients for elective colorectal, hepatobiliary, upper gastrointestinal, breast and endocrine surgery, who received SAP were included and followed up until day-30 postoperatively. Types of antibiotic, preoperative–dose timing, intraoperative re-dosing and its duration were recorded. The incidence of SSI was calculated and its associated risks expressed in odds ratio. Results: Out of 166 patients recruited, 121 (72.89%) patients received SAP preoperatively, and 91 (75.21%) of them were prescribed the appropriate antibiotic as per our institutional guideline. Three patients who continued to receive therapeutic antibiotic postoperatively were excluded from statistical analysis. Eleven (9.10%) patients received SAP beyond the preoperative–dose timing of 60 minutes (p=0.001), which was an independent risk factor for SSI (adjusted OR 4.527, 95% CI; 1.058-19.367, p=0.042). The risk of SSI also remained in patients who continued to receive SAP beyond 24 hours (OR 4.667, 95% CI; 1.527-14.259, p=0.007). The overall rate of SSI was 17.18%. Conclusion: We found that the choice of antibiotic prescribed for SAP was in accordance to institutional guideline and the relatively high SSI incidence was similar to a recent local report. Although the number of patients receiving preoperative dose-timing of &gt; 60 minutes was low, it was nonetheless an independent risk factor for SSI. The postoperative continuation of SAP for more than 24 hours showed no benefit in reducing SSI.

Impact of oral antibiotic prophylaxis on surgical site infection after rectal surgery: results of randomized trial.

To evaluate the impact of oral antibiotic prophylaxis on surgical site infection (SSI) rate after rectal surgery. It was a single-center 1:1 randomized controlled open parallel trial (registration number NCT03436719). The patients undergoing rectal resection for benign and malignant tumors were assigned randomly to two groups: the oral plus intravenous (IV) antibiotic prophylaxis (AP) and the IV antibiotic prophylaxis only. The primary endpoint was the overall rate of SSI. Between November 2017 and December 2018, 116 (male-55, the mean age-64 years) patients were enrolled into the trial. Of them, 57 had oral erythromycin 500 mg + metronidazole 500 mg a day before surgery and 1,000 mg of cephalosporin IV 30-90 min before operation. In the other group, 59 patients had the same IV antibiotics only. The incidence of SSIs was 22% (13/59) and 3.5% (2/57) correspondingly (р = 0.002). The statistically significant difference was detected for superficial SSI 0 (0%) vs. 5 (8.5%) (p = 0.03) and organ/space SSI 2 (3.5%) vs. 9 (15.3%) (p = 0.03), respectively. A multivariate analysis of risk factors of SSI identified two independent ones: bacterial contamination of the pelvic cavity ≥ 105 CFU at the end of surgery OR 17.9, 95% CI 2.1-150.0 (p = 0.008) and oral antimicrobial prophylaxis OR 0.2, 95% CI 0.03-0.8 (p = 0.02). Oral-parenteral AP significantly reduced the risk of SSI following elective rectal surgery. Bacterial contamination of the pelvic cavity ≥ 105 CFU at the end of surgery and oral antimicrobial prophylaxis were independent risk factors of SSI.

Meta-Analysis and Meta-Regression of Risk Factors for Surgical Site Infections in Hepatic and Pancreatic Resection.

The risk factors for surgical site infection (SSI) after HPB surgery are poorly defined. This meta-analysis aimed to quantify the SSI rates and risk factors for SSI after pancreas and liver resection. The PUBMED, MEDLINE and EMBASE databases were systematically searched using the PRISMA framework. The primary outcome measure was pooled SSI rates. The secondary outcome measure was risk factor profile determination for SSI. The overall rate of SSI after pancreatic and liver resection was 25.1 and 10.4%, respectively (p < 0.001). 32% of pancreaticoduodenectomies developed SSI vs 23% after distal pancreatectomy (p < 0.001). The rate of incisional SSI in the pancreatic group was 9% and organ/space SSI 16.5%. Biliary resection during liver surgery was a risk factor for SSI (25.0 vs 15.7%, p = 0.002). After liver resection, the incisional SSI rate was 7.6% and the organ space SSI rate was 10.2%. Pancreas-specific SSI risk factors were pre-operative biliary drainage (p < 0.001), chemotherapy (p < 0.001) and radiotherapy (p = 0.007). Liver-specific SSI risk factors were smoking (p = 0.046), low albumin (p < 0.001) and significant blood loss (p < 0.001). The rate of organ/space SSI in patients with POPF was 47.7% and in patients without POPF 7.3% (p < 0.001). Organ/space SSI rate was 43% in patients with bile leak and 10% in those without (p < 0.001). The risk factors for SSI following pancreatic and liver resections are distinct from each other, with higher SSI rates after pancreatic resection. Pancreaticoduodenectomy has increased risk of SSI compared to distal pancreatectomy. Similarly, biliary resections during liver surgery increase the rates of SSI.

Caracterização das infecções de sítio cirúrgico em um hospital público de ensino na cidade de Cascavel, Paraná

Introduction: Surgical Site Infection (SSI) is one of the major Health Care-Related Infections (HAI) and a persistent problem in the hospital setting. Objective: To characterize SSI in a public teaching hospital located in the city of Cascavel-PR. Method: cross-sectional retrospective study of documentary source and quantitative approach. The SSIs notified from May 2017 to May 2018 were analyzed. The variables of interest were tabulated and submitted to descriptive statistical analysis. Results: there were 5,169 surgical procedures in the period, with 196 (100%) cases of SSI. Of these, there was a predominance in young adults aged between 21 and 40 years (39.3%). The specialty of Gynecology / Obstetrics (30.1%) and General Surgery (29.1%) presented the highest rates of SSI, most frequently in Potentially Contaminated surgeries (53.1%); with superficial incisional SSI (59.7%); and with clinical confirmation criteria (79.1%). Regarding the microorganisms isolated in the cultures, Pseudomonas aeruginosa (16.7%) and Enterococcus spp (16.7%) stood out. Conclusions: It is noted that there is a need to review SSI prevention measures, especially due to the proportion of clean surgeries that developed the adverse event. However, considering the values reported in the literature, the overall rate of SSI was discrete.

Olanexidine gluconate versus povidone-iodine for preventing surgical-site infection in orthopaedic surgery: A retrospective study

BackgroundOlanexidine gluconate (OLG) is a newly developed skin antiseptic, which is effective against a broad range of bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. The purpose of this study was to evaluate the bactericidal efficacy and safety of OLG in orthopaedic surgery. MethodsThis retrospective study included a total of 1103 patients who underwent clean orthopaedic surgery. They were divided into two groups: 556 patients who were treated with OLG (OLG group), and 547 patients who were treated with povidone-iodine (PVP-I) (PVP-I group). The efficacy and the safety outcomes were measured as the rate of surgical-site infection (SSI) within 30 days after surgery and the rate of adverse skin reaction, respectively. ResultsThere was no significant difference between the OLG group and PVP-I group (1.80% vs. 2.38%; p = 0.50) based on the overall rate of SSI. Also, there was no significant difference in both superficial incisional infections (1.08% vs. 2.01%; p = 0.21) and deep incisional infections (0.72% vs. 0.37%; p = 0.35). The overall rate of adverse skin reaction was significantly higher in the OLG group than in the PVP-I group (2.16% vs. 0.73%; p = 0.047). ConclusionsThis retrospective study demonstrated that OLG has an efficacy similar to PVP-I in preventing SSI in clean orthopaedic surgery. However, adverse skin reactions at the application site of OLG requires more attention.

Evidence-based wound classification for vulvar surgery: Implications for risk adjustment

ObjectivesThe correct wound classification for vulvar procedures (VP) is ambiguous according to current definitions, and infection rates are poorly described. We aimed to analyze rates of surgical site infection (SSI) in women who underwent VP to correctly categorize wound classification. MethodsPatients who underwent VP for dysplasia or carcinoma were collected from the National Surgical Quality Improvement Program database (NSQIP). SSI rates of vulvar cases were compared to patients who underwent abdominal hysterectomy via laparotomy, stratified by the National Academy of Sciences wound classification. Descriptive analyses and trend tests of categorical variables were performed. ResultsBetween 2008 and 2016, 2116 and 31,506 patients underwent a VP or TAH, respectively. Among VP, 1345 (63.6%), 364 (17.2%), and 407 (19.2%) women underwent simple vulvectomy, radical vulvectomy, or radical vulvectomy with lymphadenectomy, respectively. The overall rate of SSI for VP was higher than that observed for TAH (5.6% vs. 3.8%; p < 0.0001). While patients undergoing TAH displayed a corresponding increase in the rate of SSI with wound type (type I: 3.4%; type II: 3.8%, type III: 6.8%; type IV 10.6%; p < 0.001), no such correlation was observed for simple VP (type I: 3.3%, type II: 3.0%; type III: 3.2%; type IV: 0%; p = 0.40). On the other hand, a non-significant correlation was observed for radical VP (type I: 4.0%, type II: 10.1%; type III: 14.3%; type IV: 20.0%; p = 0.08). The overall rate of SSI in patients undergoing any radical VP was similar to patients undergoing hysterectomy with a type IV wound (10.1% vs 10.6%, p = 0.87). ConclusionPatients undergoing VP are at high risk of infection. Simple vulvectomy should be classified as a type II and radical vulvectomy as a type III wound. These recommendations are important for proper risk adjustment.

IMPACT OF ORAL ANTIBIOTIC PROPHYLAXIS ON SURGICAL SITE INFECTION AFTER RECTAL SURGERY: RANDOMIZED CONTROLLED TRIAL

AIM: to evaluate the efficacy of preoperative oral antibiotics in reduction of surgical site infection (SSI) in rectal surgery. METHODS: patients undergoing rectal resection were assigned randomly to 2 groups: control (standard preoperative care and intravenous injection of 3d generation cephalosporin) and oral antibiotics group (the above was complemented by three-knit oral metronidazole 500 mg and erythromycin 500 mg after beginning of mechanical bowel cleansing at 5.00, 8.00 and 10.00 p.m.). The primary endpoint was the overall rate of SSI. RESULTS: between November 2017 and October 2018, 104 patients (48 in the oral antibiotics group and 56 in control group) were enrolled for this study. The incidence of SSIs was 19.6% (11/56) in control group and 4.1% (2/48) in the oral antibiotics group(р=0.01). Both groups had no statistically significant differences in intensity of SSIs and rate of anastomotic leakage. CONCLUSION: preoperative oral antibiotic significantly reduced the risk of SSIs following rectal surgery. The study needs to be continued for evaluation of preoperative oral antibiotics impact to intensity of SSIs and rate of anastomotic leakage.

Surgical Site Infection in Endometriosis Surgery Is a Rare Complication: Results of a Single Center's Prospective Surveillance of Eight Hundred Ninety-Six Procedures.

Background: There are no studies reporting the rate of surgical site infection (SSI) after surgery for endometriosis, although this information is valuable when discussing the most appropriate treatment strategy with the patient. Methods: We conducted a prospective cohort study in a university hospital and regional reference center for endometriosis. We sought to measure the rate of SSI after endometriosis surgery using prospective SSI post-discharge surveillance data and the hospital information system via an ad hoc algorithm using both diagnosis and procedure code classifications. Results: Among 896 consecutive endometriosis surgical procedures, we identified 365 procedures with involvement of the gastrointestinal tract, defined as the deep invasive procedure (DIP) group, 107 procedures with involvement of an ovary, and 424 other procedures. Twelve SSI (all organ/space infections) were observed, all in the DIP group, corresponding to an overall SSI incidence of 1.3% 95% confidence interval (CI) 0.7-2.3, and an SSI incidence in the DIP group of 2.8%, 95% CI 1.5-4.9. The median delay between the procedure and the SSI was 6.5 days (range, 3-23). At least one micro-organism was found in 10 patients (four Escherichia coli, four Enterobacter cloacae, three Enteroccus faecalis, two Bacteroides fragilis, one Pseudomonas aeruginosa, one Candida albicans). Conclusion: A low overall rate of SSI after surgery for endometriosis was observed. Nevertheless, procedures with involvement of the intestinal tract were at risk of SSI.