Postoperative Infection Research Articles

Longer Preoperative Antibiotic Duration Prior to High-Risk Ureteroscopy Does Not Decrease Infectious Complications.

Introduction: Postoperative infections after ureteroscopy are common and potentially devastating complications. National and international guidelines recommend treatment of symptomatic positive urine cultures prior to operation, but how to manage patients with asymptomatic colonization remains unclear. In clinical practice, there is wide variation in the choice and duration of antibiotics for these patients. To examine how preoperative antibiotic duration impacts postoperative infection rate, we evaluated our institutional practices and outcomes. Materials and Methods: Our prospectively collected database was queried for patients undergoing ureteroscopy between 2015 and 2023. Preoperative urine culture results and antibiotic duration/choice were abstracted. Patients included for study were those with a high risk of urinary colonization defined as those with history of neurological insult, bowel diversion, indwelling suprapubic catheter or foley, or a stent/nephrostomy. Our primary outcome was postoperative infection, defined by urinary tract infection (UTI), pyelonephritis, systemic inflammatory response syndrome (SIRS), or fever within 30 days of operation. Results: A total of 405 patients met our inclusion criteria. Preoperative prophylactic antibiotics were not utilized in 68% of the study cohort, while 11% received less than 3 days or 3-10 days of prophylaxis and the remaining 10% received more than 10 days. The overall rate of UTI or pyelonephritis was 9%, and the SIRS or sepsis rate was 5%. Although receipt of preoperative prophylactic antibiotics of any duration was not predictive of postoperative infectious complications on multivariable analysis, women were associated with a 4.135 (OR: 1.768-9.669, p = 0.001) increased odds of UTI/pyelonephritis compared with men. Conclusions: In high-risk patients, the duration of preoperative antibiotics prior to ureteroscopy did not reduce postoperative infectious complication rates. Women were the only clinical feature associated with increased risk of UTI/pyelonephritis. Further research is needed to identify alternative interventions to prevent postoperative infectious complications.

Leucencephalopathy in Patients with Parkinson's Disease and Deep Brain Stimulation.

Leucencephalopathy (LE) is often detected on magnetic resonance imaging in elderly patients. These white matter lesions may interfere with lead trajectories for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) and are associated with complications after DBS surgery. This study was conducted to assess the incidence of LE in PD patients and to evaluate correlations with complications after DBS surgery. A consecutive cohort of PD patients who underwent DBS surgery in the subthalamic nucleus (STN-DBS) was retrospectively analyzed. The presence and extent of LE were quantified using the Fazekas scale. Postoperative complications were extracted from the medical records. DBS efficacy was calculated using the side-specific motor symptom ratio (Unified Parkinson's Disease Rating Scale, Part III, postoperative stimulation ON/medication off divided by preoperative medication off) at 1-year follow-up. A total of 135 PD patients were included in the study. LE was detected in 35.6% (48/135) of the patients. In 87.7% (57/65), LE was mild, in 10.7% (7/65) moderate, and in 1.6% (1/65) severe. A higher incidence of mild to moderate LE did not correlate with postoperative hemorrhage or postoperative infection. There was no correlation of LE with stimulation efficacy (r = -0.05, P = 0.69) or with surgical index (r = -0.10, P = 0.35). Neither was the presence of mild to moderate LE associated with an increased risk for surgical complications, nor did it negatively impact the long-term improvement in motor function after DBS surgery in PD patients. Therefore, mild to moderate LE should not be considered a contraindication for DBS.

Cardiac output-guided haemodynamic therapy for patients undergoing major gastrointestinal surgery: OPTIMISE II randomised clinical trial

ObjectivesTo evaluate the clinical effectiveness and safety of a perioperative algorithm for cardiac output-guided haemodynamic therapy in patients undergoing major gastrointestinal surgery.DesignMulticentre randomised controlled trial.SettingSurgical services of 55 hospitals worldwide.Participants2498...

Laser interstitial thermal therapy in the management of bottom-of-sulcus dysplasia-related epilepsy.

This study assessed the efficacy and safety of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) versus open surgery (OS) for the treatment of patients with bottom-of-sulcus dysplasia (BOSD)-related epilepsy. Twenty-two patients underwent MRgLITT, while 39 underwent OS. Postoperative seizure-free rates were analyzed using Kaplan-Meier curves. The removal ratio, which represents the extent of damage, was calculated based on preoperative lesion volume and postoperative removal volume. Other outcomes, including adverse events, operative time, and hospital stay, were also compared. Kaplan-Meier curves indicated the seizure-free rates were comparable between the MRgLITT group (90.9%, 26.5 [23.0, 35.1] months) and OS group (89.7%, 25.2 [16.2, 34.6] months) at the final follow-up (p = 0.901, log-rank test). The removal ratio of MRgLITT (1.3 [1.1, 1.7]) was significantly lower (p = 0.007) than that of OS (5.8 [3.6, 8.5]). A comparison of postoperative neurological deficits, infection rates, and fever rates revealed no significant differences between MRgLITT and OS groups. The operative time (hours) of MRgLITT (3.0, [2.1, 4.9]) was significantly shorter (p = 0.007) than that of OS (3.5 [3.0, 4.5]). The hospital stay (days) after MRgLITT (6 [5.0, 7.5]) was significantly shorter (p < 0.001) than that of OS (11.0 [9.0, 13.5]). MRgLITT has advantages over OS, including comparable seizure control and adverse event profiles, along with reduced removal ratios, shorter operative time, and shorter hospital stays.

Hydroxyl Functionalization of a Titanium Implant Drug Carrier Channel Modified by Vacuum Drying-Assisted Laser Texturing to Achieve Delayed Release of CIP-PLGA Microsphere Suspension.

Titanium alloys are commonly used for bone grafting, but in mandibular defect repair, implantation possibly fails due to bacterial infection. The establishment of a long-acting drug delivery system through microspheres and titanium channels can reduce the risk of infection. However, there is insufficient research on the mechanism of microsphere attachment and microsphere-liquid two-phase flow in the hydroxyl-functionalized titanium implantation channel modified by a vacuum-drying-assisted laser texturing. In this paper, poly(lactic-co-glycolic acid) (PLGA) loaded with ciprofloxacin (CIP) was attached to the titanium channel by vacuum drying-assisted laser texturing. Titanium macroscopic flow channels and microscopic texture morphology were designed; three mathematical models of titanium substrate-microsphere-droplet interactions were developed, and the hydroxyl-based surface functionalization mechanism and the effect of laser texture parameters on microsphere adhesion and microsphere-liquid two-phase flow on titanium channels were investigated. The results showed that vacuum drying-assisted laser texture can control the bonding degree of the PLGA hydroxyl group to the titanium channel, which affects the adhesion of microspheres. The laser texture modification can control the flow rate of the microsphere suspension in the titanium channel to achieve a dynamic adjustment of the release effect. The CIP-PLGA microsphere drug delivery system, based on vacuum drying-assisted laser texturing, enables sustained local drug release, providing a potential strategy to suppress inflammation around the implant and reduce the risk of postoperative infection.

Mid-term results of intra-articular calcaneal fractures treated with minimally invasive two-point distractor

Summary Background Displaced intra-articular calcaneal fractures are a complication-ridden injury to treat and there are various treatment techniques to address this injury. The aim of this study was to evaluate the mid-term outcome of a percutaneous two-point distractor technique in patients with displaced intra-articular calcaneal fractures. Methods A retrospective data analysis of patients with intra-articular calcaneal fractures treated in a level 1 trauma center was conducted. The patients were subsequently invited for a follow-up visit to assess the mid-term outcome. The Böhler’s and Gissane’s angles, the American Orthopaedic Foot &amp; Ankle Society hindfoot score, the Maryland foot score and a visual analog scale for pain were measured preoperatively and postoperatively and after at least 6 years to assess the radiological and functional outcome. Results Of the patients 59 completed the study with a mean follow-up of 76 months after surgery. The mean American Orthopedic Foot and Ankle Society hindfoot score at the last follow-up visit was 81, the mean Maryland foot score was 78. There were three cases (5%) of superficial wound complications and secondary arthrodesis of the subtalar joint was performed in five patients (8%). Conclusion The low rates of postoperative infections and secondary arthrodesis in this study underline the good to excellent mid-term functional results for a minimally invasive technique.

Long Term Surgical Outcome of Canal-Tympanoplasty in Patients with Schuknecht Type B Congenital Aural Stenosis.

Congenital aural atresia (CAA) is a complex condition that can present in various forms, including Schuknecht type B stenosis, characterized by a congenitally narrow bony external auditory canal (EAC). This study aims to evaluate the long-term surgical outcomes of canal-tympanoplasty in patients with CAA Schuknecht type B. The study included 21 ears diagnosed with CAA Schuknecht type B that underwent canal-tympanoplasty. The large EAC and tympanic membrane were reconstructed using conchal flap meatoplasty, bony EAC drilling, ossicular reconstruction, and overlay tympanoplasty. Standard pure-tone audiometry was analyzed at various time points post-surgery: 3, 6, 12, and 24-60 months. The incidence of postoperative complications was evaluated. The hearing outcomes of canal-tympanoplasty were satisfactory in this case series. Serviceable hearing was achieved in all patients after 3 months and was sustained for 1 year in 85% of patients. The air-bone gap (ABG) improved from 39.3 ± 15.1 dB preoperatively to 13.7 ± 7.4 dB at 3 months, 16.4 ± 10.5 dB at 6 months, 19.1 ± 11.7 dB at 12 months, and 21.5 ± 16.1 dB at 2-5 years postoperatively. Three patients underwent revision canal-tympanoplasty due to hearing deterioration (14.3%). There were no cases of postoperative infection, facial nerve weakness, vertigo, deterioration of bone conduction thresholds, or complete restenosis of the EAC. Canal-tympanoplasty was a satisfactory surgical intervention for patients with CAA Schuknecht type B. The procedure resulted in significant improvements in hearing outcomes, with serviceable hearing that lasted for several years. The risk of postoperative hearing deterioration and/or revision surgery within 1 year was acceptable.

Retrograde intrarenal surgery with or without ureteral access sheath: a systematic review and meta-analysis of randomized controlled trials.

The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management. To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications. We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively. Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29-0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30-0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99-1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95-1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI -4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI -0.42 to 1.07 days; p=0.40). UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications.

Effect of perioperative blood transfusion on preoperative haemoglobin levels as a risk factor for long-term outcomes in patients undergoing major noncardiac surgery: a prospective multicentre observational study

BackgroundPreoperative anaemia and red blood cell (RBC) transfusions are associated with poorer clinical outcomes. It is unknown whether perioperative RBC transfusions mediate the relationship between preoperative haemoglobin levels and postoperative outcomes. MethodsThis was a prospective observational study among patients aged ≥50 yr undergoing elective major noncardiac surgery from four Swedish hospitals. The co-primary outcomes were 1-yr major adverse cardiovascular and cerebrovascular events (MACCEs) and all-cause mortality. The secondary outcome was a composite of 30-day mortality, MACCEs, acute kidney injury (AKI), pulmonary embolism, anastomotic leak, and postoperative infection. Mediation analyses were conducted with preoperative haemoglobin as the exposure and RBC transfusion as a mediator. ResultsAmong 1060 patients (mean age 70 [SD 9] yr; 472 [45%] women), 171 patients (16.1%) developed 1-yr MACCEs, and 105 patients (9.9%) died within 1 yr. Preoperative haemoglobin levels were significantly associated with both 1-yr MACCEs (b=–0.015, P=0.041) and all-cause mortality (b=–0.028, P<0.001). Volume of RBC transfusion was not directly associated with the outcomes and did not mediate the relationship between preoperative haemoglobin levels and 1-yr MACCEs (b=–0.001, P=0.451) or all-cause mortality (b=–0.002, P=0.293). For the secondary outcome, RBC transfusions had a significant mediating effect between preoperative haemoglobin and the composite 30-day outcome; however, no direct association was observed (b=0.006, P=0.554). ConclusionsPreoperative haemoglobin levels were significantly associated with 1-yr MACCEs and all-cause mortality. This effect was not mediated by perioperative RBC transfusions. Further research is needed to confirm these findings.

A Comparative Analysis of Open Versus Minimally Invasive Pancreatoduodenectomies

ABSTRACTBackground and ObjectivesPancreatoduodenectomy (PD) has been associated with significant morbidity and mortality. To reduce morbidity, minimally invasive pancreatoduodenectomies (MIPD) have become more prevalent. We aimed to compare short‐term survival and complications for open (OPD) versus MIPD and to assess the relationship between operative approach and operative time on outcomes.MethodsPatients undergoing PD between 2017 and 2020 were identified within the National Surgical Quality Improvement Program (NSQIP). The primary outcome was operative time, and the secondary outcomes were death at 30 days, reoperation, readmission, and NSQIP‐identified 30‐day postoperative complications. A multivariable logistic regression was performed.ResultsA total of 14 977 PDs were performed from 2017 to 2020. MIPD increased from less than 8% of pancreatoduodenectomies performed in 2017 to over 10% of PD by 2020. Of the MIPD cohort, 62% were robotic, and 38% were laparoscopic, with robotic surgery becoming most prevalent by the end of the study period. MIPD was associated with significantly longer operative times than OPD (p &lt; 0.01). MIPD was associated with decreased odds of postoperative bleeding and surgical site infection (p &lt; 0.01), but higher odds of death at 30 days.ConclusionsMIPD has been shown to have improved postoperative outcomes compared to OPD but is associated with longer operative times, which can be associated with increased complications.

Intrawound vancomycin powder in primary total knee arthroplasty: Does it reduce early postoperative infection?

BackgroundThe purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA). MethodsFrom October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively. ResultsA total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15). ConclusionsThe overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.

Wide-margin excision of diffuse ankle's tendon sheath giant cell tumor in 24 patients:A mid-term study

Giant cell tumour of tendon sheath (TSGCT) is an uncommon soft tissue tumor, especially in its diffuse subtype (D-TSGCT), which is rare and associated with a high recurrence rate after treatment. This condition significantly affects joint function and quality of life. This retrospective study evaluated the clinical characteristics, surgical outcomes, and long-term follow-up of 24 patients who underwent wide-margin resection for ankle D-TSGCT from 2011 to 2018. The average patient age was 36.5 years, with common symptoms including palpable masses and ankle swelling. All patients received wide-margin resection, with a mean follow-up period of 75.7 months. Tumor recurrence occurred in five patients (21%), with complications included postoperative infections, surgical site pain, ankle instability, and stiffness. There was a significant improvement in the Musculoskeletal Tumor Society (MSTS) scores post-surgery. Additionally, the Foot and Ankle Ability Measure (FAAM) showed improvements in daily living and physical activities, though Ankle Joint Functional Assessment Tool (AJFAT) scores did not demonstrate significant change. These findings indicate that wide-margin resection is an effective treatment for D-TSGCT, preserving ankle function and demonstrating a low recurrence rate, although it may lead to ankle instability requiring careful postoperative monitoring and rehabilitation.

Evaluating the comparative risk of postoperative complications associated with infliximab and vedolizumab for patients with Crohn’s disease

Crohn’s disease is an inflammatory bowel disease that affects millions worldwide. Research indicates that people suffering from Crohn’s disease respond well to monoclonal antibody treatment aimed at characteristic immune cell markers. By targeting immune cell markers, the immune system is subsequently suppressed in a way such that an infection can evolve much quicker. Monoclonal antibody treatment has historically shown to result in increased rates of post-surgical infections in those taking it for Crohn’s disease. Many studies have assessed the increased rates of post-surgical infections following monoclonal antibody treatment for those with Crohn’s disease, but few have compared different treatments. A systematic review of a study that assessed the rates of postoperative infections for those with Crohn’s disease taking infliximab was then compared to the findings of another study which assessed the rates of postoperative infections in those with Crohn’s taking vedolizumab. The patients treated with vedolizumab did not have increased risk of overall postoperative infections or other complications compared with other matched controls. However, those who were treated with infliximab had an increased risk of surgical infections when compared to a control group. Monoclonal antibody treatment for Crohn’s diseases is widespread. It is critical that the side effects of these treatments are readily studied and compared to improve patient outcomes. For this review, infliximab seemed to have a statistically significant increased effect on postoperative infections whereas vedolizumab did not. Further studies with greater sample sizes assessing multiple other side effects of monoclonal antibody immunosuppression are needed.

Recurrent oropharyngeal cancer: Analysis of surgical treatment outcomes

BACKGROUND The main goal of our research is to introduce transoral robotic surgery and laser resection (TLR) as a considerable way of treating patients with recurrent oropharyngeal malignancies. AIM To develop a foundation of minimally invasive transoral surgical technique for patients with oropharyngeal recurrence. METHODS This study prospectively and retrospectively included patients with recurrent tumors from 2003 to 2018. Subjects were allocated into two groups: (1) Group I; underwent TLR; and (2) Group II (control); underwent open surgeries of varying volume. Evaluation was done with intraoperative blood loss, postoperative infection incidence, and quality of life using the scale for patients with head and neck tumors known as the Functional Assessment of Cancer Therapy-Head &amp; Neck Scale. RESULTS One-hundred and forty one patients were included (103 males and 38 females), in 82 cases (85.4%), a recurrent tumor developed earlier than a year after primary tumor therapy; forty-six were in group I and 69 in group II, age ranging from 18 years to 86 years (average: 57.6 years). The first group showed a statistically significant less amount of blood loss and a decreased incidence of infectious complications (P &lt; 0.05). Additionally, there was a significant difference in functional outcomes (quality of life scores) but no significant difference in survival curves. CONCLUSION In properly elected patients, TLR is not just reasonable but tends to be a favorable alternative for recurrent oropharyngeal cancers compared to the outcomes of the open surgery group.

Factors influencing postoperative urinary retention after radical hysterectomy for cervical cancer: development and validation of a predictive model in a prospective cohort study in Southwest China

ObjectivesTo explore influencing factors for postoperative urinary retention (POUR) in cervical cancer patients and construct and validate a POUR prediction model.DesignA prospective cohort study.SettingA large tertiary hospital specialised in child...

Preventive effect of probiotics on infections following colorectal cancer surgery: An umbrella meta-analysis

BACKGROUND Postoperative infections remain a significant source of morbidity among patients undergoing colorectal cancer (CRC) surgery. While probiotics have been proposed as a potential strategy to mitigate the risk of these infections, contemporary meta-analyses have produced conflicting findings. AIM To synthesize the available evidence regarding the prophylactic efficacy of probiotics in preventing infections following CRC surgery. METHODS A comprehensive search of PubMed and Scopus was conducted to identify relevant meta-analyses published up to February 2024. To assess the efficacy of probiotics on outcomes, relative risks (RR) and their corresponding 95%CI were pooled using a random effects model. RESULTS This comprehensive umbrella meta-analysis integrated eleven meta-analyses encompassing 11518 participants who fulfilled the inclusion criteria. Probiotics administration resulted in a statistically significant reduction in the incidence of total infections (RR: 0.40, 95%CI: 0.31-0.51; moderate certainty), surgical site infections (RR: 0.56, 95%CI: 0.49-0.63; high certainty), pneumonia (RR: 0.38, 95%CI: 0.30-0.48; high certainty), urinary tract infections (RR: 0.44, 95%CI: 0.31-0.61; moderate certainty), bacteremia (RR: 0.41, 95%CI: 0.30-0.56; high certainty), and sepsis (RR: 0.35, 95%CI: 0.25-0.44; high certainty). However, probiotics did not significantly affect intra-abdominal, central line, or peritoneal infections. CONCLUSION Probiotics have demonstrated potential in mitigating postoperative infectious complications among patients undergoing CRC surgery.

Effectiveness of subgaleal topical vancomycin powder in reducing infection rates and shunt revisions in pediatric ventriculoperitoneal shunt surgery: a promising prophylactic approach.

This study aims to evaluate the effectiveness of two prophylactic strategies in preventing shunt infections in pediatric patients undergoing ventriculoperitoneal shunt surgery. This retrospective study included pediatric patients who underwent ventriculoperitoneal shunt surgery between 2017 and 2024. Patients were divided into two groups based on the prophylactic method used: Group 1 (VS) where the shunt was washed with vancomycin solution before placement, and Group 2 (TVP) where vancomycin powder was applied to the subgaleal and subcutaneous tissues after shunt placement. Data collected included age, gender, preoperative CRP values, operation length, hospitalization duration, wound site problems, and rates of early (within 3days) and late (within 36months) postoperative infections and shunt revisions. Data from 56 pediatric patients were analyzed. The TVP group had significantly lower rates of early postoperative infections compared to the VS group (3.3% vs. 26.9%, p < 0.05). Late postoperative infections were also lower in the TVP group (3.3% vs. 30.7%, p < 0.05). Shunt revision was required in 26.9% of patients in the VS group, but none in the TVP group (p < 0.05). Wound site problems were a critical factor, with all patients experiencing wound site infections also developing early postoperative infections (p < 0.05). The use of subgaleal topical vancomycin powder is a promising prophylactic method in ventriculoperitoneal shunt surgery, particularly for pediatric patients who are prone to skin problems, as it effectively avoids systemic toxic effects while reducing infection rates and the need for shunt revisions.

Joint Injection or Aspiration before Total Knee Arthroplasty: Does It Increase the Risk of Periprosthetic Joint Infection?

Injections are a common preoperative treatment for patients who eventually undergo total knee arthroplasty (TKA). However, recent studies have shown a relationship between preoperative injections and adverse outcomes following surgery. The purpose of this study was to characterize the type of intra-articular procedure patients receive in the acute period prior to surgery and determine their association with postoperative periprosthetic joint infection (PJI).An observational cohort study was conducted using the Merative MarketScan databases. Patients who underwent primary TKA between April 1, 2019, and July 4, 2021, were included in the study. Patients were grouped according to the type of intra-articular procedure they received within the 90-day period prior to TKA: (i) intra-articular hyaluronic acid (IA-HA), (ii) intra-articular corticosteroid (IA-CS), (iii) aspiration, and (iv) no drug injections or aspirations. The primary outcome was the postoperative 180-day PJI rate.A total of 43,219 patients were included in the study. About 11.8% of patients were found to have received at least one injection or aspiration in the 90 days prior to their TKA. The most common injection performed was IA-CS (78.3%), followed by aspiration (13.0%) and IA-HA (8.7%). No image guidance was performed for 92.3% of injections, with most being administered between 61 and 90 days before surgery (93.6%). Rates of PJI at 180 days were similar between patients with and without injections (OR = 1.11, p = 0.569). Neither drug type nor image guidance had an effect on the overall postoperative PJI rate.Injections performed prior to TKA do not increase the risk of developing postoperative PJI.

Extended sequential intravenous and oral antimicrobial therapy improves cure rate in postoperative intracranial neurosurgical infections: a Spanish multicenter retrospective study

BackgroundPostoperative intracranial neurosurgical infections (PINI) complicate < 5% neurosurgeries. Scarce attention was dedicated to the extension and characteristics of its antimicrobial management considering their high morbidity, not negligible mortality, delayed hospital stay and increased healthcare costs.MethodsWe analyzed retrospectively (2014–2023) 162 PINI from eight Spanish third-level academic hospitals.ResultsElective clean craniotomies after tumor or vascular causes were the leading procedures. Epidural abscess (24.7%), scalp infections (19.8%), postsurgical meningitis (16.7%) and cranioplasty infections (16.7%) were the most frequent PINI. Gram negative bacteria (38.6%) and Staphylococcus spp (28.6%) were the predominant isolates. Overall 85.2% patients underwent pus drainage, mostly by craniotomy (40.3%). Interestingly 34% were already receiving antibiotics for extracranial infections before developing PINI while 16.8% did not receive pre-operative antibiotic prophylaxis. In total 77.2% patients started a combined intravenous (IV) antimicrobial therapy, of which 85.2% switched after 5 days to a second-line IV antibiotic regimen, in 41.3% cases combined, after pus culture results, for a median of 21 days. Overall 61.1% patients continued on oral antimicrobials after hospital discharge, 30.3% as a combined regimen, for a median of 42 days. Complete cure was obtained in 81.5% cases, while 11.1% relapsed, 7.4% failed to cure and 6.8% died after PINI complications. In the multivariate analysis oral antimicrobial therapy after hospital discharge (p = 0.001) was significantly associated with PINI cure with no effect on survival.ConclusionsWe conclude that an extended 6 weeks sequential IV and oral antimicrobial therapy in addition to neurosurgical correction increases PINI cure rate with no effect on survival.Clinical trial numberNot applicable.

New Biocompatible Ti-MOF@hydroxyapatite Composite Boosted with Gentamicin for Postoperative Infection Control.

The standard clinical management of osteomyelitis involves prolonged antibiotic therapy, which frequently necessitates the excision of infected tissues. However, the efficacy of such treatments is increasingly compromised by the rise of antibiotic-resistant pathogens, underscoring an urgent need for innovative approaches. This study introduces a novel composite material designed to offer dual functionality: robust antimicrobial activity and promotion of bone regeneration. The composite integrates biocompatible hydroxyapatite nanoparticles (HA) with a titanium(IV)-metal-organic framework, MIL-125(Ti)-NH2, impregnated with gentamicin (GM). The solvothermally synthesized MIL-125-NH2@HA composite demonstrates high cytocompatibility, as evidenced by assays using osteoblasts (U2-OS) and fibroblasts (L929), alongside an absence of hemolytic activity at concentrations of up to 1000 μg/mL. Importantly, the introduction of GM into the composite significantly amplifies its antibacterial efficacy against Staphylococcus aureus and Pseudomonas aeruginosa. Additionally, nanoindentation assessments reveal enhanced mechanical properties of the MIL-125-NH2@HA composite, indicating the superior elastic performance relative to unmodified HA. The findings of this research are poised to generate significant interest in the development of metal-organic framework (MOF)-based composites for antimicrobial implant applications, presenting a promising avenue for addressing the challenges posed by antibiotic resistance in bone infections.