Postoperative Deep Wound Infection Research Articles

Pseudarthrosis After Postoperative Wound Infection in the Lumbar Spine

This retrospective investigation attempts to define the incidence of fusion success after postoperative infection after a posterior lumbar fusion, as well as which risk factors may adversely affect arthrodesis after successful debridement. At an average follow-up of 37 months, 18 of 29 patients (62.1%) had a successful arthrodesis. Eighty-seven percent of patients whose fusion excluded the sacrum had a solid arthrodesis, compared with only 36% of those fusions including the sacrum. The fusion rate in female patients was 33.3%, compared with 82.4% in male patients. The rate of fusion with allograft bone was 17.2 versus 83.3% with autograft bone. Female sex, the use of allograft bone, and extension of the fusion mass to the sacrum significantly increase the incidence of nonunion after a postoperative deep spinal wound infection.

Condylar plate fixation of subtrochanteric femoral fractures

We describe our experiences in 40 consecutive patients with subtrochanteric fractures treated with an AO 95° condylar blade plate. Three patients died early due to multiple injuries. One patient developed a delayed union which ultimately resulted in repeated plate fractures due to fatigue. All other fractures healed despite deep postoperative wound infection in three cases. Based on our favourable results, we consider the condylar blade plate fixation of subtrochanteric fractures to be an excellent method, especially if an image intensifier and/or fracture table are not available.

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Prevention of Deep Periprosthetic Joint Infection*†

Although the prevalence of postoperative deep wound infection after total joint arthroplasty has decreased over the past few decades, it remains a feared consequence for both surgeons and patients107. Moynihan stated that “every operation in surgery is an experiment in bacteriology.”80 This statement provides remarkable insight into the seemingly variable and unpredictable nature of infection. Often, the specific mechanism and timing of bacterial delivery in a given wound is unknown, and it is usually extremely difficult to prove the exact cause of the infection in an individual situation. Despite improved outcomes of treatment for established deep periprosthetic infection, prevention remains a meaningful objective. The estimated cost of treatment67 of an infection at the site of a total hip or total knee arthroplasty exceeds $50,000. A thorough appreciation of and respect for the innumerable factors that may contribute to an infection is essential in the development of an over-all approach to prevention. The concept of an interdependent relationship among the triad of bacteria, host, and wound is helpful when considering prevention Fig. 1. Infection depends on the number and virulence of the bacteria introduced into a wound, the host's ability to eliminate these bacteria, and the status or viability of the wound environment. Within this triad, multiple variables can contribute to the deposition of bacteria into the wound, many conditions may impair the patient's ability to eliminate bacteria, and numerous vagaries of the wound milieu can facilitate the infectious process (Table I). Every variable may be influenced by the other variables within the triad. For example, the effect of a foreign body on the absolute number of bacteria required to facilitate the infectious process is well known29. Venn diagram demonstrating the dependent nature of bacteria, host factors, and wound environment on the development of …

Determinants of the occurrence of and survival from prosthetic valve endocarditis: Experience of the Veterans Affairs Cooperative Study on Valvular Heart Disease

For the determination of the risk factors associated with the development of and death caused by prosthetic valve endocarditis, data were reviewed from 66 patients who were prospectively entered into the Veterans Affairs Cooperative Study on Valvular Heart Disease and in whom prosthetic valve endocarditis subsequently developed. Data were recorded at 13 medical centers between October 1977 and September 1982 in patients randomized to receive a mechanical valve (Björk-Shiley spherical disc, n = 510 patients) or a bioprosthetic valve (Hancock porcine heterograft, n = 522 patients). The average rate of prosthetic valve endocarditis development was 0.8% per year over an average follow-up period of 7.7 years. Of the 66 patients in whom prosthetic valve endocarditis developed (5.8%), 15 cases occurred within 2 months of operation (early) and 51 occurred after operation (late). The most significant preoperative predictor of prosthetic valve endocarditis was active endocarditis at the time of operation (7.4% versus 0.9%) (p = 0.001). Early prosthetic valve endocarditis occurred more frequently in patients who underwent operation for multivalvular disease (p = 0.023). Significantly related perioperative variables were coma, prolonged mechanical ventilation, deep postoperative wound infection, postoperative jaundice, ventricular tachycardia, ventricular fibrillation, and replacement of more than one valve (p < 0.05). Multivariate predictors were hypoxia (p = 0.001), preoperative endocarditis (p = 0.003), preoperative valve lesion (p = 0.020), and resident surgeon (p = 0.05). Significant preoperative variables predictive of late prosthetic valve endocarditis were mitral stenosis and mixed mitral stenosis-regurgitation. The only multivariate predictor of late prosthetic valve endocarditis was superficial wound infection (p = 0.004). Of deaths attributable to prosthetic valve endocarditis, 41% occurred in patients treated with antibiotics alone, 48% occurred in patients treated with surgical intervention and antibiotics, and death resulted in both patients who received no treatment. No difference was found in the risk of early or late postoperative prosthetic valve endocarditis developing in patients receiving the mechanical valve versus those receiving the bioprosthetic valve. (J THORAC CARDIOVASC SURG 1994;108;207-14)

Determinants of the occurrence of and survival from prosthetic valve endocarditis

Abstract For the determination of the risk factors associated with the development of and death caused by prosthetic valve endocarditis, data were reviewed from 66 patients who were prospectively entered into the Veterans Affairs Cooperative Study on Valvular Heart Disease and in whom prosthetic valve endocarditis subsequently developed. Data were recorded at 13 medical centers between October 1977 and September 1982 in patients randomized to receive a mechanical valve (Bjork-Shiley spherical disc, n = 510 patients) or a bioprosthetic valve (Hancock porcine heterograft, n = 522 patients). The average rate of prosthetic valve endocarditis development was 0.8% per year over an average follow-up period of 7.7 years. Of the 66 patients in whom prosthetic valve endocarditis developed (5.8%), 15 cases occurred within 2 months of operation (early) and 51 occurred after operation (late). The most significant preoperative predictor of prosthetic valve endocarditis was active endocarditis at the time of operation (7.4% versus 0.9%) ( p = 0.001). Early prosthetic valve endocarditis occurred more frequently in patients who underwent operation for multivalvular disease ( p = 0.023). Significantly related perioperative variables were coma, prolonged mechanical ventilation, deep postoperative wound infection, postoperative jaundice, ventricular tachycardia, ventricular fibrillation, and replacement of more than one valve ( p p = 0.001), preoperative endocarditis ( p = 0.003), preoperative valve lesion ( p = 0.020), and resident surgeon ( p = 0.05). Significant preoperative variables predictive of late prosthetic valve endocarditis were mitral stenosis and mixed mitral stenosis-regurgitation. The only multivariate predictor of late prosthetic valve endocarditis was superficial wound infection ( p = 0.004). Of deaths attributable to prosthetic valve endocarditis, 41% occurred in patients treated with antibiotics alone, 48% occurred in patients treated with surgical intervention and antibiotics, and death resulted in both patients who received no treatment. No difference was found in the risk of early or late postoperative prosthetic valve endocarditis developing in patients receiving the mechanical valve versus those receiving the bioprosthetic valve. (J THORAC CARDIOVASC SURG 1994;108;207-14)

Total Hip Arthroplasty Sepsis: Prevention and Diagnosis

Postoperative deep wound infection following total hip arthroplasty remains a serious and all too frequent complication. Although diagnostic capabilities have improved with the evolution of new imaging and immunologic techniques, the devastating consequences for patients with an early diagnosis cannot yet be aborted. Thus, further emphasis must be placed on prevention of this complication. Although major referral centers have managed to achieve exceptionally low incidences of postoperative sepsis with the prophylactic administration of antimicrobial agents and discipline within the operating room, these advances have not translated into a similar reduction of the national experience. Thus, further investigation and the development of additional techniques must be sought.

Changes in C-reactive protein and erythrocyte sedimentation rate after hip fractures

Serial measurements of C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) were performed during the week after operation in 140 patients with hip fractures. There was no selection, and patients with minor or major complications before or after operation were included. In uncomplicated cases, the ESR was variably raised during the first week, whereas the CRP showed a distinct pattern with a rapid increase on the second day; it then decreased by the 7th day. In cases with early postoperative bronchopneumonia and deep wound infection, the CRP was high, but minor infections did not influence the usual levels. Complications had no effect on the ESR during the 1st week.

Intra-operative antibiotic prophylaxis in neurosurgery. A prospective, randomized, controlled study on cefotiam

In this prospective, randomized and controlled study the effect of cefotiam for the prevention of wound infections following trepanations was investigated. The main interest was centered on the rate of post-operative bone flap infections requiring operative revision. Administration of cefotiam was randomized for patients undergoing major craniotomies. The antibiotic was administered intravenously in a single dose of 2 g with induction of anaesthesia. Only clean or clean contaminated cases were included. Excluded were contaminated cases, operations with a transnasal-transsphenoidal approach, shunt-operations and patients with any other preoperative infection or antibiotic therapy. Outpatients were excluded due to difficulties in obtaining sufficient clinical information. From originally 918 consecutive patients operated on 711 fulfilled the entry criteria. With regard to age, sex, diagnosis and the site of te trepanation, control patients (n = 355) and cefotiam treated patients (n = 356) were shown to be comparable. In the various subgroups formed for different primary diagnoses, concomitant steroidal therapy and concomitant severe internal medical diseases cefotiam treated patients and controls were comparable as well. A highly significant difference for bone flap infection could be shown with 0.3% in the cefotiam group versus 5.1% in the control group (p less than 0.001). The overall rate of post-operative deep wound infections including meningitis and abscesses was also significantly (p less than 0.005) different with 3.1% in the cefotiam versus 9.0% in the control group. Thus it was concluded that a single dose of cefotiam significantly reduces post-operative deep wound infection.

Cefamandole versus cefonicid prophylaxis in cardiovascular surgery: A prospective study

We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) ( p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infec0tion, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group ( p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.

Deep postoperative wound infection after carpal tunnel release

Between January 1976 and December 1985, 3620 carpal tunnel releases were done at the Mayo Clinic. A deep postoperative infection developed in 17 (0.47%) patients. These 17 were compared control group of 102 patients to identify possible risk factors. Statistically significant risk factors included intraoperative instillation of steroid solution into the carpal canal, flexor tendon synovectomy, prolonged operative time, and use of a surgical drain. Infection incidence was 0.87% in males and 0.25% in females (statistically significant). Seven (41%) of the 17 patients had a suboptimal result at final follow-up.

Incidence of wound infection in patients undergoing craniotomy: influence of type of shaving.

How the method of shaving affects the incidence of deep postoperative wound infections was examined in 475 patients. It is shown that the rate of infection is not lower after wet shaving than after dry shaving. The overall infection rate was 4.2%, 2.9% in patients who had been shaved wet versus 5.5% in patients shaved dry. The difference is, however, not significant on the 5% level. With respect to dry shaving, the infection rate was not affected by whether the hair was removed with electric clippers alone (2.8%) or whether a disposable razor was also used for additional hair removal in the area of skin incision (3.2%).

Total Replacement of the Hip Joint by Low Friction Arthroplasty

SUMMARY 1. This study of early results and complications relates to the first 700 low friction arthroplasty procedures performed at The New York Orthopedic Hospital. 2. The results are encouraging in regard to the quality of the arthroplasty and are quite comparable to the results in series reported by others. 3. The incidence of early deep postoperative wound infection was low (less than 1 per cent), and no late infection was observed. The factor that might have favorably influenced the rate of infection in this series was the routine prophylactic use of antibiotics during operation. 4. The most serious complication was thromboembolism, which continues to be a problem with this major surgical procedure 5. We conclude that despite early gratifying results with this procedure, this operation must be reserved only for patients with severe pain and functional disability. 6. Excellent results can be achieved by careful selection of patients and strict adherence to aseptic technique.