Postoperative Antibiotic Therapy Research Articles

Should an appendicectomy be performed in the presence of a macroscopically healthy appendix, during laparoscopic exploration?

Introduction: In contrast to the conventional laparotomy approach, the decision to perform an appendicectomy or not in the presence of a macroscopically normal appendix remains contentious during laparoscopic procedures. Our objective is to assess the rate of appendix conservation and conduct a literature review on the management of a macroscopically normal appendix intraoperatively. Materials and Methods: This was a descriptive, prospective, evaluative study involving 337 patients undergoing laparoscopic surgery for non-traumatic acute abdominal emergencies. Results: Of the 337 patients operated on, 190 were females (56.4%), with a mean age of 38 years ± 15 years (range 15 to 82 years). In 7 patients (2.1%), the appendix appeared macroscopically normal intraoperatively, despite preoperative diagnosis favoring acute appendicitis. These 7 patients (6 females and 1 male) all underwent thorough clinical examination and preoperative ultrasound, although CT scans were performed in only 3 patients. Among these 7 patients, 2 had ovarian cyst torsions, 2 had ruptured hemorrhagic ovarian cysts, 1 case was diagnosed as retrocaecal internal hernia, and in 2 patients, no etiology was identified. The appendix was preserved in all 7 cases. All patients received postoperative antibiotic therapy. No postoperative complications or surgical reinterventions were recorded. Conclusion: Our study demonstrates that a macroscopically normal appendix can be left in situ without postoperative complications or need for surgical reintervention.

Severe cholecystitis during the COVID-19 pandemic : Influence of the COVID-19 pandemic on the frequency of surgery and outcome for elective and emergency cholecystectomy: a monocentric retrospective cohort analysis

With the outbreak of the COVID-19 pandemic medical care focused on management of the infectious event. Elective interventions were cancelled and the general advice was to stay at home. How this impacted urgent and elective cholecystectomies is the subject of this work. Urgent and elective cholecystectomy patients during the first year of the pandemic were compared with those of the previous year. The primary endpoint was the frequency of surgery. Furthermore, the American Society of Anesthesiologists (ASA) score, symptom duration until presentation as well as until surgery, preoperative inflammatory parameters, imaging, positive Murphy's sign, type and duration of surgery, intraoperative drain placement, intraoperative and histological severity, need for and duration of postoperative antibiotic therapy, intensive care stay, length of stay and occurrence of postoperative complications were recorded. During the pandemic patients were sicker (ASA2.13 vs. 2.31; p = 0.039), the operating time was prolonged (64.4 min vs. 74.9 min; p = 0.001) and patients were more likely to have concomitant peritonitis (15.4% vs. 29.1%: p = 0.007). Furthermore, there was atrend in the presence of leukocytosis, apositive Murphy's sign, intraoperative drain placement, intraoperative severity of inflammation, duration of postoperative antibiotic therapy and complication rate. During the COVID-19 pandemic cholecystitis presented with more pronounced inflammation, the surgical conditions were more difficult and postoperative recovery was prolonged.

Postoperative prophylactic antibiotic therapy after pancreaticoduodenectomy in bile duct-stented patients reduces postoperative major complications

BackgroundPancreaticoduodenectomy can entail a high complication rate, especially in patients who underwent preoperative bile duct drainage through bile duct stenting. Pancreaticoduodenectomy bile duct stenting patients frequently receive prophylactic antibiotic therapy in the postoperative period. However, the exact value and the benefit of prophylactic antibiotic therapy in pancreaticoduodenectomy bile duct stenting patients remains under-investigated and thus unclear. MethodWe conducted a retrospective single-center study of pancreaticoduodenectomy bile duct stenting patients between January 2007 and December 2022. Demographic, clinical, laboratory, and pathology data of 370 patients were collected, and intraoperative swab cultures of the bile were obtained from all patients upon transection of the common bile duct. The groups to be investigated were formed on the basis of postoperative antibiotic prophylaxis. Postoperative complications and antibiotic resistance analysis were recorded. ResultsPostoperative antibiotic prophylaxis in stented patients after pancreaticoduodenectomy significantly reduced major complications (odds ratio: 0.547 [95% confidence interval 0.327–0.915]; P = .02) such as reoperation (P = .041) and readmission to the intensive care unit (P = .037). Patients with Enterococcus faecalis (odds ratio: 1.699 [95% confidence interval 0.978–2.950];P = .048), Enterococcus faecium (odds ratio: 1.808 [95% confidence interval 1.001–3.264]; P = .050), or Citrobacter (odds ratio: 2.211 [95% confidence interval 1.087–4.497]; P = .029) in their bile had a higher probability of developing wound infections. Appropriate antibiotic prophylaxis, according to the bile duct microbiome, significantly reduced the risk of wound infection (odds ratio: 2.239 [95% confidence interval 1.167–4.298]; P = .015). ConclusionPostoperative antibiotic prophylaxis in pancreaticoduodenectomy bile duct stenting patients significantly reduced major complications such as intensive care stay and reoperation. Targeted antibiotic treatment according to the biliary microbiome reduced the incidence of wound infections.

COVID-free surgical pathways for treating patients with acute calculous cholecystitis: a retrospective comparative study.

During the Sars-Cov-2 crisis, some of the resources committed to emergency surgery services were transiently reallocated to the care of patients with severe COVID-19, preserving immediate treatment of mostly non-deferrable conditions. Moreover, the fear of contracting infections or hindering the treatment of critical COVID-19 patients has caused many individuals to defer seeking emergency care. This situation has then possibly modified the standard of care of some common surgical conditions and the relative outcomes. Our aims was to highlight any difference in surgical outcomes in patients treated for acute cholecystitis before and during the COVID-19 outbreak. This is a retrospective study on a prospectively collected database that included all consecutive patients treated for acute cholecystitis from March 2019 to February 2021 at the Lugano Regional Hospital, a COVID-free hospital for general surgery patients. Patients were divided into pre-and post-COVID-19 outbreak groups. We collected thorough clinical characteristics and intra-and postoperative outcomes. We included 124 patients, of which 60 and 64 were operated on before and after the COVID-19 outbreak respectively. The two groups resulted similar in terms of patients' clinical characteristics (age, gender, body mass index, ASA score, and comorbidities). Patients in the post-outbreak period were admitted to the hospital 0.7 days later than patients in the pre-outbreak period (3.8 ± 6.0 days vs. 3.1 ± 4.1 days, p = 0.453). Operative time, recovery room time, complications, and reoperations resulted similar between groups. More patients in the post-outbreak period received postoperative antibiotic therapy (63.3% vs. 37.5%, p = 0.004) and for a longer time (6.9 ± 5.1 days vs. 4.5 ± 3.9 days, p = 0.020). No significant histopathological difference was found in operatory specimens. Despite more frequent antibiotic therapy that suggests eventually worse inflammatory local status, our results showed similar outcomes for patients treated for acute cholecystitis before and during the COVID-19 pandemic. The local COVID management, reallocating resources, and keeping COVID-free hospitals was key to offering patients a high standard of treatment.

Intramedullary Positive Tissue Culture Increases the Risk of Reinfection Following One-Stage Septic Revision Total Knee Arthroplasty

BackgroundIntraoperative acquisition of representative tissue samples is essential during revision arthroplasty of the infected total knee arthroplasty (TKA). While the number of intraoperative tissue samples needed to identify the organism is well described in the literature, there is still a paucity of evidence regarding the location of positive intraoperative samples and their correlation to postoperative outcomes. MethodsThere were forty-two patients who had septic failure following one-stage revision TKA for periprosthetic joint infection who were identified between January 2009 and December 2017. They were matched to a control group of patients who had successful one-stage revision TKA without septic failure. The location of positive intraoperative tissue samples was categorized as: 1) soft tissue; 2) interface between bone and prosthesis; and 3) intramedullary (IM). Chi-square, Student’s t-, and Wilcoxon Mann-Whitney U-tests were used as appropriate. Univariate and multivariate logistic regression analyses were performed to evaluate predictors of septic failure. ResultsWeight > 100 kilograms (P = .033), higher Charlson Comorbidity Index (P < .001), and positive IM cultures (P < .001) were associated with a higher risk of reinfection after one-stage revision TKA. A positive IM sample carried a nearly five-fold increase in odds of reinfection (odds ratio 4.86, 95% confidence interval 1.85 to 12.78, P = .001). ConclusionsA positive IM culture sample is significantly associated with septic failure after one-stage exchange for periprosthetic joint infection of the knee. Patients who had positive IM cultures may benefit from longer postoperative antibiotic therapy for the treatment of one-stage exchange arthroplasty to minimize the risk of reinfection.

Accuracy of the GeneXpert® MRSA/SA SSTI test to diagnose methicillin-resistant Staphylococcus spp. infection in bone fixation and fusion and management of infected non-unions

IntroductionThe GeneXpert® MRSA/SA SSTI (Methicillin Resistant Staphylococcus aureus/S. aureus skin and soft tissue infection) PCR test allows early detection of methicillin resistance in staphylococci. This test was developed for skin infections and has been evaluated for prosthetic joint infections but, to our knowledge, has not been evaluated for hardware infections outside of arthroplasties. Furthermore, we conducted a retrospective study in patients with non-prosthetic osteosynthesis hardware aiming: (1) to identify the diagnostic values of the PCR test compared to conventional cultures and the resulting rate of appropriate antibiotic therapy; (2) to identify the rate of false negative (FN) results; (3) to identify and compare the rates of failure of infectious treatment (FN versus others); (4) to search for risk factors for FN of the PCR test. HypothesisThe PCR test allowed early and appropriate targeting of antibiotic therapy. Material and methodsThe results of PCR tests and conventional cultures for osteoarticular infections of non-prosthetic hardware over four years (2012–2016) were compared to identify the diagnostic values of using the results of conventional culture as a reference and the rate of appropriate antibiotic therapies. Infectious management failures between the results of the FN group and the others were compared, and variables associated with a FN of the PCR test were identified. ResultsThe analysis of 419 PCR tests allowed us to establish a sensitivity of 42.86%, a specificity of 96.82%, a positive predictive value of 60% and a negative predictive value of 93.83%. Using the results of the PCR test for the targeting of postoperative antibiotic therapy, it was suitable for staphylococcal coverage in 90.94% (381/419). The rates of patients for whom infectious treatment failed were not significantly different between the FN group and the other patients (20.8% versus 17.7%, respectively; Hazard Ratio=1.12 (95%CI 0.47-2.69, p=0.79)). A skin opening during the initial trauma (p=0.005) and a polymicrobial infection were significantly associated with a risk of FN from the PCR test (p<0.001). ConclusionThe PCR test makes it possible to reduce the duration of empirical broad-spectrum antibiotic therapy during the treatment of an infection of osteosynthesis hardware but causes a lack of antibiotic coverage in 9.06% of cases. Level of evidenceIII; diagnostic case control study.

Recurrence - Related Factors of Medication Related Osteonecrosis of the Jaw (MRONJ) ; a Retrospective study

Duration of administration of related medications, presence of bacterial infections in necrotic areas, and methods of treatment have been suggested as factors related to the recurrence of MRONJ. The purpose of this study was to investigate recurrence risk factors in patients who had undergone surgical treatment. The recurrence rate was statistically significant when the teeth affected by alveolar bone necrosis were removed together. When comparing patients who received post-operative antibiotic treatment, recurrence was significantly reduced. Comprehensive surgical approaches, including the extraction of adjacent teeth during surgery, and appropriate post-operative antibiotic therapy can be effective strategies for reducing the recurrence rate of MRONJ.

The role of intraoperative swab during appendectomy in patients with uncomplicated and complicated appendicitis

IntroductionBacteria play an important role not only in pathogenesis of appendicitis but also in the postoperative course of patients. However, the usefulness of an intraoperative swab during appendectomy is controversial. The primary aim of this study was to investigate the impact of intraoperative swab during appendectomy on the postoperative outcome in patients with uncomplicated and complicated appendicitis.MethodsA retrospective analysis was conducted on a consecutive series of 1570 adult patients who underwent appendectomy for acute appendicitis at the University Hospital Erlangen between 2010 and 2020. Data regarding the intraoperative swab were collected and analyzed for the entire cohort as well as for patients with uncomplicated and complicated appendicitis.ResultsAn intraoperative swab was taken in 29% of the cohort. The bacterial isolation rate in the obtained intraoperative swabs was 51%, with a significantly higher rate observed in patients with complicated appendicitis compared to those with uncomplicated appendicitis (79% vs. 35%, p < 0.001). The presence of a positive swab was significantly associated with worse postoperative outcomes, including higher morbidity, increased need for re-surgery, and longer hospital stay, when compared to patients without a swab or with a negative swab. A positive swab was an independent risk factor for postoperative morbidity (OR 9.9 (95% CI 1.2–81.9), p = 0.034) and the need for adjustment of postoperative antibiotic therapy (OR 8.8 (95% CI 1.1–72.5), p = 0.043). However, a positive swab resulted in postoperative antibiotic therapy adjustment in only 8% of the patients with bacterial isolation in the swab.ConclusionThe analysis of swab samples obtained during appendectomy for acute appendicitis can help identify patients at a higher risk of a worse postoperative outcome. However, the frequency of antibiotic regime changes based on the swab analysis is low.

Prophylactic antibiotics in septoplasty with intranasal septal splints: A comparative analysis.

Postoperative antibiotic therapy is a common practice following septoplasty with intra-septal splints placement (ISS), even though there is a lack of evidence to support it. We sought to investigate the role of antibiotic therapy in septal surgeries with the placement of ISS. A retrospective comparative study was conducted using the electronic charts of adult patients who underwent septoplasty with the placement of ISS with or without turbinate reduction. Nasal cultures were taken routinely during surgery as part of the department's protocol for monitoring infectious diseases. The ISS were also routinely examined for the presence of bacteria after their removal on the eighth day following surgery. A large otolaryngology department in a tertiary medical center. Adult patients who underwent septoplasty in our institution. We analyzed all post-operative infections to search for risk factors in the cohort. Post-operative infection rates following septoplasty with ISS were low at 6%, which is consistent with previously published rates. Infection rates were significantly higher in patients who were not treated with antibiotics (OR = 8.2, 95%CI: 1.63-41.1; p = .01, φ = 0.04). Diabetes was associated with an increased risk of postoperative infection regardless of prophylactic antibiotic therapy (OR = 5.2, 95%CI: 1.15-23.5; p = .032, φ = .04). The detection of Klebsiella pneumonia before surgery was associated with an increased rate of postoperative infection (OR = 16.6, 95%CI: 3.02-91.54; p = .001, φ = 0.12). Patients undergoing septoplasty with the placement of ISS are at increased risk of gram-negative bacterial colonisation, and development of postoperative nasal infection. A single preoperative dose of IV antibiotic therapy should be considered a potential prophylactic option for septoplasty with ISS.

Factors Influencing Prevalence of Surgical Site Infections among Mothers Undergoing Ceaserean Section in Iganga Hospital, Uganda

Caesarean Section as a mode of delivery is the most commonly done surgical procedure in maternity departments all over the world. Surgical site infection complicates about one-third to two-thirds of caesarean sections in low-income countries which is about 9 times higher compared with the high-resource countries. Surgical Site Infection is associated with increased maternal morbidity, prolonged hospital stay and increased medical costs. The development of post-caesarean surgical site infection is hung on a complex interplay of many factors not limited to wound class, immune status, maternal age, hypertensive disorders, ASA classification, number of vaginal examinations, the virulence of the microorganisms, maternal weight, surgical techniques and premature rupture of membrane. The study employed a descriptive cross-sectional and quantitative approach to study the factors influencing the prevalence of surgical site infections among mothers undergoing caesarean section in Iganga Hospital. A sample size of 288 participants were enrolled using a random sampling technique and close-ended questionnaires were employed to obtain the data from participants. Data analysis was done using SPSS version 20 and statistical significance was set at a P-value less than 0.05 at 95% confidence interval. A total of 288 post-caesarean mothers were studied from October – November 2021 in Iganga Hospital. The majority of the participants were married 255(88.8%) and had a secondary level of education 142(49.3%). The mean age of the participants were 25.6 years with 21 as the modal age. The prevalence of surgical site infection among post-caesarean mothers at Iganga Hospital was 20.5% (59 out of 288) and the factors which were statistically influencing the SSI included early rupture of membranes of more than 18 hours (aOR 23.715 95% C.I 5.976-94.117, P 0000) and postoperative haemoglobin (aOR 15.109 95% C.I 3.494-65.333, P 0.000) There’s a high burden of SSI among post-caesarean mothers in Iganga Hospital. Earlyrupture of membranes more than 18 hours and post-operative haemoglobin less than 11g/dl are key contributory factors. Aggressive prophylactic and post-operative antibiotic therapy should be considered in mothers with early rupture of membranes and post-operative anaemia. Keywords: Caesarean Section, Maternal morbidity, Surgical Site Infection, Post-caesarean mothers, Vagina examination. IN

Transcutaneous compression suture with iodine gauze for wound closure in revision surgery for therapy-resistant periprosthetic shoulder infections

To successfully treat a periprosthetic infection, successful bacteria eradication and successful wound closure are mandatory. Despite adequate surgical débridement in the deep, persistence of wound drainage and subsequent persistence of periprosthetic infection may occur, especially in patients with compromised soft tissue conditions. This study presents a transcutaneous compression suture technique with iodine gauze that was used in patients with persistent wound secretion in therapy-resistant periprosthetic shoulder infections in order to achieve successful infection control and wound healing. All patients with persistent periprosthetic or implant-associated shoulder joint infections despite correct previous surgical and antibiotic therapy attempts were included in the study. In all patients, in addition to repeat deep surgical débridement, a transcutaneous "iodine-gauze-compression-suture" was performed with postoperative antibiotic therapy. The primary endpoint was infection control; the secondary endpoint was wound healing rate; and the third endpoint was complication rate after index surgery. Ten consecutive patients with a mean age of 74 (±7.6) years and a mean follow-up of 14 (±2) months were included. All ten patients showed infection control and successful wound healing, with no need for further revision surgery. In 8 out of 10 patients, the wound healing was fast and completely uncomplicated. Two out of 10 patients showed delayed wound healing with fibrin coatings for 3 and 4 weeks, respectively. No additional intervention was necessary in both patients. Transcutaneous iodine gauze compression sutures were used to achieve successful infection control without additional revision surgery in 10 out of 10 patients who previously underwent surgery with failed infection control. This wound closure technique is a reliable adjunctive therapy method in the treatment of implant-associated infections of the shoulder in patients with fragile wound conditions.

Initial antibiotic therapy for postoperative moderate or severe diabetic foot infections: Broad versus narrow spectrum, empirical versus targeted.

To retrospectively evaluate clinical and microbiological outcomes after combined surgical and medical therapy for diabetic foot infections (DFIs), stratifying between the empirical versus the targeted nature, and between an empirical broad versus a narrow-spectrum, antibiotic therapy. We retrospectively assessed the rate of ultimate therapeutic failures for each of three types of initial postoperative antibiotic therapy: adequate empirical therapy; culture-guided therapy; and empirical inadequate therapy with a switch to targeted treatment based on available microbiological results. We included data from 332 patients who underwent 716 DFI episodes of surgical debridement, including partial amputations. Clinical failure occurred in 40 of 194 (20.6%) episodes where adequate empirical therapy was given, in 77 of 291 (26.5%) episodes using culture-guided (and correct) therapy from the start, and in 73 of 231 (31.6%) episodes with switching from empirical inadequate therapy to culture-targeted therapy. Equally, a broad-spectrum antibiotic choice could not alter this failure risk. Group comparisons, Kaplan-Meier curves and Cox regression analyses failed to show either statistical superiority or inferiority of any of the initial antibiotic strategies. In this study, the microbiological adequacy of the initial antibiotic regimen after (surgical) debridement for DFI did not alter therapeutic outcomes. We recommend that clinicians follow the stewardship approach of avoiding antibiotic de-escalation and start with a narrow-spectrum regimen based on the local epidemiology.

Surgical Duration Is Independently Associated with an Increased Risk of Surgical Site Infection and May Not Be Mitigated by Prolonged Antibiotics: A Secondary Analysis of the PARITY Trial of Infection After Lower-Extremity Endoprosthetic Reconstruction for Bone Tumors.

Infection after tumor resection and endoprosthetic reconstruction is a potentially limb-threatening complication. The duration of surgery has been shown to be a risk factor for infection, but the ability of an extended duration of postoperative prophylactic antibiotics to potentially minimize that risk has not been specifically studied. The objective of this study was to determine whether extended postoperative antibiotic therapy protects against surgical site infection (SSI) in the setting of prolonged surgical duration in patients undergoing endoprosthetic reconstruction after tumor resection. This study was a planned secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial data set. Patients in the PARITY trial were randomized to receive 24 hours or 5 days of postoperative prophylactic antibiotics. The current study assessed the risk of SSI in those cohorts on the basis of surgical duration. A multivariable regression model was used to examine the adjusted effects of the duration of surgery on SSI, after controlling for other significant risk factors and potential confounders. All 604 patients who had been included in the final data analysis in the PARITY trial were also included in this secondary analysis. Those who sustained an SSI had a greater mean duration of surgery (6.2 hours) compared with those who did not sustain an SSI (4.9 hours, p < 0.0001). There was no specific time point at which the risk of infection significantly increased. Extended postoperative prophylactic antibiotic therapy did not appear to mitigate the risk of SSI even in patients with prolonged surgical duration. Increased surgical duration was an independent risk factor for SSI in orthopaedic patients undergoing endoprosthetic reconstruction after tumor resection. However, surgical duration is multifactorial and is influenced by several variables. For example, there may be protective features of flap coverage that increase surgical duration while paradoxically decreasing the risk of SSI. Extended postoperative antibiotic therapy did not mitigate the risk of infection in this cohort, and other risk mitigation strategies will need to be considered in future studies. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Risk Analysis of Restrictive Factors for Fast-Track Knee Arthroplasty-A Retrospective Study of 1,224 Patients.

With the implementation of a fast-track principle as an interdisciplinary and multimodal concept, an accelerated convalescence and reduction of postoperative complications and a reduction of hospital stay can be achieved. This has been shown not only to increase patient satisfaction but in reduction of hospital cost as well. However, the concept cannot be successfully implemented in all patients. Patients who require an extended length of stay (LOS) after surgery can profit from optimizations of postoperative care and rehabilitation as well. Therefore, early identification of such patients is desirable. This case control study aimed to identify patient characteristics and patient-independent factors that may affect fast-track programs and lead to extended length of stay in knee arthroplasty. From October 2007 to May 2013, 1224 patients were treated at the University Hospital Halle (Saale) with a total knee arthroplasty (TKA). A maximum stay of seven days was defined as the target of the "fast-track arthroplasty" concept. There were 164 patients (13%) that did not reach this timeframe and were assigned to the case group (n=164). Each case group patient was compared to a patient with an inpatient stay of seven days or less who was operated on the same day and by the same surgeon. These patients formed the control group (n=164). In addition to causes for extended LOS, metadata (age, sex, body mass index [BMI]), chronic nicotine and alcohol abuse, American Society of Anesthesiology (ASA) score, blood transfusion necessity, and comorbidities were determined. The statistical analysis included two sample t-tests, a chi-square test, and logistic regression analyses. Additionally, 95% confidence intervals were calculated (p<0.05). Gender distribution in both groups showed no differences (case group: 40.2% male, 59.8% female vs. control group: 32.3% male, 67.7% female). The ø age in the case group was 69.6 ± 8.7 years, significantly higher than that of the control group with 66.5 ± 9.4 years (p=0.002). Another difference between the groups was seen in the need for red blood cell transfusion (case group 51.2%, control group 39.6%, p=0.03). The need for postoperative antibiotic therapy was associated with a 3.741-fold risk of prolonged hospital stay. ASA score and BMI were identical in both groups. For the patients with positive nicotine abuse, the regression analysis showed a 2.465-fold risk of prolonged length of stay. Alcohol abuse did not appear to play a role in length of stay in our patient cohort. For pre-existing conditions, patients from the case group were more likely to have a cardiac burden than those from the control group (p=0.03). The most common causes of prolonged LOS were elevated CRP followed by effusion and delayed wound healing. The study shows that especially patient age, the presence of cardiac secondary diseases, nicotine consumption, and patient-independent factors like blood loss could have a negative influence on convalescence. Despite constant cost reductions in the healthcare system, the concept of "fast track arthroplasty" should always be adapted to the specifics of each individual patient in view of increasing patient age or critically questioned already preoperatively.

Species Characteristics of Causative Agents of Acute Appendicitis in Children and Determination of Their Susceptibility to Antibiotics

In pediatric surgery, acute appendicitis is considered one of the most common problems requiring surgical intervention. Among the causes of this disease, microorganisms are of primary importance. The specificity of postoperative treatment depends both on the degree of virulence of the pathogen and on the microbial load that caused the inflammatory process. The increase in the use of antimicrobial agents is of great concern because of the emergence of antibiotic-resistant bacteria. Therefore, the issue of rational postoperative antibiotic therapy remains relevant, as excessive, often unjustified use and incorrect dosage of drugs have become the cause of many medical problems. The aim of the research was to determine the species structure and analyze antibiotic resistance of microorganisms in biomaterial obtained from children after appendectomy for acute appendicitis. Methods. We studied biomaterial obtained from 74 patients aged 2—18 years who were treated at the MNCE Ternopil Regional Children Clinical Hospital TRC in the period from September 2021 to March 2022. After appendectomy, the samples were placed in a transport medium for further laboratory research, which involved staining smears according to the Gram method, sowing microorganisms on nutrient media such as blood agar, salt agar, sugar broth and serum agar, and Endo medium for enterobacteria as well as for anaerobic pathogens — thioglycolic medium and Kitta-Tarozzi medium, and identifying by morphological, tinctorial, cultural and biochemical properties. The sensitivity of selected pathogenic microorganisms to antibiotics was determined using the Kirby-Bauer method. Statistical processing of digital data was carried out using Excel software (Microsoft, USA) and the Statistica 10.0 program. Results. 74 children aged from 2 to 18 years were involved in the study. E. coli (28.4% of all examined), S. aureus (21.6%), and P. aeruginosa (14.9%) were found during the laboratory study of biomaterial. E. faecalis, Klebsiella spp., S. epidermidis, and S. viridans occurred much less often (from 9.4% to 4.5%). The study of antibiotic resistance showed that the isolated microorganisms differed significantly in their sensitivity both to different groups of antimicrobial agents and to generations of drugs within the same group. Ceftriaxone was the most effective inhibitor of all detected microorganisms. E. coli, S. aureus, P. aeruginosa, and S. epidermidis showed 100% sensitivity to it, and the others — within 75—50%. Bacteria Klebsiella spp. and S. epidermidis were sensitive to amikacin, strains of E. coli — 90.5%, P. aeruginosa and S. aureus — 81.8% and 81.2%, respectively. Amoxiclav and ampisulbin had weak inhibitory activity, except for 100% of Klebsiella spp. and 75% of E. faecalis, which were inhibited only by amoxiclav. However, almost all studied microorganisms were partially sensitive to azithromycin. The activity of this antibiotic ranged from 100—81.8% (S. epidermidis, S. aureus) to 36.4% (P. aeruginosa). Conclusions. The most common causative agents of acute appendicitis among children are the following microorganisms: E. coli, S. aureus, P. aeruginosa, and sporadically — S. saprophiticus, Micrococus spp., S. viridans, and Candida spp. Among the antibiotics used for the treatment of postoperative complications in various forms of appendicitis, the most effective were ceftriaxone — cephalosporins of the III generation — 100—66.7%, amikacin — aminoglycosides — 100—57.1%, and furagin — nitrofuran derivatives — 100—60%. The studied microorganisms were the least sensitive to penicillins and antibiotics of the II generation of the fluoroquinolone group. Resistance of microorganisms to certain antibiotics was also found, in particular: P. aeruginosa and E. faecalis — to cefuroxime and cefazolin; E. coli and S. aureus — to tobramycin, S. epidermidis — to ofloxacin and amoxiclav.

Residual osteomyelitis at the resection margin after conservative surgery is not associated with the recurrence of diabetic foot infection and may successfully be treated without postoperative antibiotic therapy.

We hypothesize that microbiology- and pathology-confirmed positive bone margins after the resection of diabetes-related foot osteomyelitis are associated with worse outcomes. We conducted a prospective study consisting of a cohort of 93 patients with diabetes-related foot osteomyelitis (histopathology confirmed) who underwent bone resection and where an additional bone biopsy was taken at the resection margin. The primary outcome was the recurrence of the infection. Pathology-confirmed positive margins were detected in 62 cases (66.7%), microbiology-confirmed positive margins were detected in 75 cases (80.6%) and recurrence was detected in 19 patients (20.4%). Chi-squared test failed to show the presence of an association between the recurrence of the infection with pathology-confirmed positive margins (p = 0.82), with microbiology-confirmed positive margins, (p = 0.34) and with the use of postoperative antibiotics (p = 0.70). Healing in patients with pathology-confirmed positive margins was achieved in a median of 12 weeks (95% CI 9.2-18) and those with pathology-confirmed negative margins in 14.9 weeks (95% CI 10.2-21.9), Log-rank test, p = 0.74. Thirty-four patients out of 61 available for follow-up (55.7%) with pathology-confirmed positive margins were treated without postoperative antibiotics. In that group, Chi-squared test failed to show the presence of an association between the recurrence of the infection with the use of postoperative antibiotics (p = 0.47). A positive margin was neither associated with the recurrence of the infection nor with the time to healing. More than half of patients with pathology-confirmed positive margins were treated without postoperative antibiotics and this approach was not associated with the recurrence of the infection.

Dental Implant Survival after Postoperative Infection

Aim: Dental implant failure might be brought on by an early postoperative infection. The purpose of this study was to assess the prevalence of acute postoperative infection in survived and failed implants and the associated factors. Methods: This cohort cross-sectional study held in the Oral surgery department of Altamash Institute of Dental Medicine, Karachi for two-years duration from January 2021 to December 2022 and evaluate early postoperative infection after dental implant surgery. The location of the implant, the patients' ages and genders, smoking, postoperative antibiotic therapy, bone augmentation and the time of infection development or diagnosis were among the study variables. The study's results showed which implants failed and which survived. Two groups of patients; those who survived implants included in Group A and those who had failed implants were included in group B. Results: Out of 190 patients, 12 (6.3%) patients, including 8 men and 4 women, experienced a postoperative infection after implant insertion. In group A of implant survival, 5 implants (41.7%) acquired post-operative infection while 7 implants (58.3%) in the failed group experience infections. The significant variations among the both groups were noted in terms of the smoker patients, the timing of diagnosis, patients who got bone transplant and fresh socket versus delayed implant placement. Relating to the variables, the Kaplan-Meier analysis revealed that when infection developed 4 days after surgical procedure in subjects not given antibiotic treatment postoperatively, the probability of implant failure increased by 1.1 times (hazard ratio). If the infection developed after six days in people who smoked and after nine days in people who do not smoked and were given antibiotics postoperatively, the likelihood of failure rose. Conclusion: In light of the study's findings, it appears that smoking, early infection, implants placement in newly created sockets, and implants placement in conjunction with bone substitutes may all enhance the failure ratio of dental implants following acute infection. Keywords: antibiotic, implant, infection, and bone

Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction.

The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27-83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m2 (20.8-45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12-98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4-42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations.

Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Joint Infections: A Consecutive Series.

Periprosthetic joint infections (PJI) represent a devastating consequence following total joint arthroplasty (TJA). In this study, the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure (DAIR) to improve the possibilities of retaining an acutely infected TJA. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads in a setting of acute (<4 weeks from symptoms onset) PJI with pathogen identification. The combination of three different surgical techniques (tumor-like synovectomy, argon beam/acetic acid application and chlorhexidine gluconate brushing) aims to remove the bacterial biofilm from the implant without explanting the original hardware. In total, 62 patients met the acute infection criteria (<4 weeks of symptoms); there were 57 males and five females. The patients' average age at the time of treatment was 71 years (62-77) and the average BMI was 37 kg/m2. The micro-organism, always identified through synovial fluid analysis (culture, multiplex PCR or Next Generation Sequencing), was an aerobic Gram + in 76% (S. Coag-Neg 41%; S. aureus 16%), Gram-in 10% (E. coli 4%) and anaerobic Gram + in 4%. The DAPRI treatment was performed at an average of 3 days from symptoms onset (1-7 days). All patients underwent a 12-week course of post-operative antibiotic therapy (6 weeks I.V. and 6 weeks oral). All patients were available at the 2-year minimum FU (24-84 months). A total of 48 (77.5%) patients were infection-free at the final FU, while 14 patients underwent 2-stage revision for PJI recurrence. In total, four patients (6.4%) had a prolonged drainage from the wound after placement of the calcium sulphate beads. This study suggests that the DAPRI technique could represent a valid alternative to the classic DAIR procedure. The current authors do not recommend this procedure outside of the main inclusive criteria (acute scenario micro-organism identification).

Cutibacterium positive cultures in total joint arthroplasty: a comparison of the hip, knee, and shoulder.

Cutibacterium spp. (formerly Propionibacterium) is a slow growing, Gram-positive, anaerobic bacteria and is an emerging clinical entity in prosthetic joint infection (PJI). This study compares the presentation, surgical management, and post-operative antibiotic therapy of patients with positive intraoperative cultures during revision total joint arthroplasty (TJA) of the hip, knee, and shoulder. This was a retrospective cohort study of patients from 2014 to 2020 of 57 revision TJAs (27 total hip arthroplasty (THA), 17 total shoulder arthroplasty (TSA), and 13 total knee arthroplasty (TKA)) with intraoperative cultures positive for Cutibacterium at a tertiary academic centre. Patient demographics, pre-operative labs, radiographs, and aspirate results were collected. Intraoperative data was reviewed. Post-operative antibiotic therapy and repeat infections were recorded. Data was compared with univariate analyses. There was no significant difference in pre-operative lab values between the cohorts. All cohorts had >58% radiographic lucency. Revision TSA patients had significantly fewer pre-operative aspirates. Six patients undergoing revision THA, three TKA and one TSA had a repeat infection requiring further surgery. Four in the THA cohort and one in the TKA cohort with repeat infections did not receive prolonged antibiotic therapy. Cutibacterium is an infectious agent that can present in an indolent fashion after TJA. It commonly causes progressive radiographic lucency. The workup and post-operative management differs in the hip, knee, and shoulder, which is likely due to existing literature guiding physician practice. In all joints, Cutibacterium is a virulent pathogen that can cause repeat infections requiring surgical treatment.