Postoperative Infection In Patients Research Articles

Nutritional status of patients with gastrointestinal cancers and analysis of factors for postoperative infections.

Patients with gastrointestinal cancer have a higher risk of malnutrition and postoperative infection. To investigate the nutritional status of patients with gastrointestinal cancers and factors for postoperative infections. Based on the nutritional risk status, 294 patients with gastrointestinal tumours were divided into a nutritional risk group and a non-nutritional risk group, and the differences between the two groups were compared. Among the included patients, 128 were at preoperative nutritional risk (43.54%); there were significant differences between the two groups in terms of age (66.25 ± 11.73 vs. 58.36 ± 10.41 years, P < 0.001), percentage of gastric cancers (39.84% vs. 28.92%, P = 0.049), percentage of stage IV tumours (60.16% vs. 45.18%, P = 0.011), total protein (64.90 ± 6.82 vs. 67.21 ± 7.41g/L, P = 0.007), albumin (38.32 ± 4.74 vs. 41.61 ± 5.10g/L, P < 0.001) and haemoglobin (112.72 ± 22.63 vs. 125.11 ± 22.79g/L, P < 0.001). Multivariate logistic regression analysis showed that risk factors for postoperative infections in patients included age ≥ 60 years (odds ratio [OR] = 2.266 95%CI = 1.357-4.134), Nutrition Risk Screening (NRS)-2002 score ≥ 3 (OR = 2.183, 95%CI = 1.218-4.102), alcohol history (OR = 2.505, 95%CI = 1.370-4.683), comorbid diabetes mellitus (OR = 2.110, 95%CI = 1.381-4.023) and surgical time ≥ 6h (OR = 2.446, 95%CI = 1.359-4.758). Patients with gastrointestinal cancers are at high incidence of preoperative nutritional risk, and those with an NRS-2002 score of > 3, history of alcohol consumption and surgical time of > 6h have a higher risk of postoperative infections.

Are Drains Associated With Infection After Operative Fixation of High-Risk Tibial Plateau and Pilon Fractures?

To determine the association between closed suction drainage and postoperative infection in patients with tibial plateau or pilon fractures. Secondarily, this study assessed if intrawound vancomycin powder modified the association of closed surgical drains with infection. Design: Secondary analysis of the Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial (VANCO) trial. 36 academic trauma centers. All patients with high-risk tibia fractures (OTA/AO classification 41B/C or 43B/C) from the VANCO trial were considered. Closed suction drains were placed based on the treating surgeon's discretion. Patients were randomly assigned to received 1-gram intrawound vancomycin powder in the surgical wound at definitive fixation or the standard infection prevention protocol at each center.Outcome Measures and Comparisons: Deep surgical site infection (SSI) within 6 months. Comparisons were made between patients treated with and without drains. Subgroup analysis also examined the effect of drains in patients with and without intrawound vancomycin powder. Of the 978 study patients, 197 (20%) were treated with drains. Deep infection rates did not significantly differ between patients with or without surgical drains (8% versus 8%, p=0.88). However, intrawound vancomycin powder significantly modified the association of surgical drains on deep SSI (interaction p=0.048). Specifically, patients with drains but no vancomycin powder had the highest deep infection rate (13%; 95% CI, 6% to 19%). When vancomycin powder was used in addition to a drain, deep SSI rates were reduced by 10% (95% CI, 2% to 17%, p=0.01). This study suggests that closed suction drains after operative fixation of high-risk tibia fractures may not be associated with deep infection in general. However, a secondary analysis raises the possibility that drains are associated with reduced deep infection rates if topical vancomycin powder is used but associated with increased infection rates if vancomycin powder is not used. Level III.

Association of gut microbiota imbalance with risk of postoperative infections in patients with left ventricular assist device

Abstract Background Infections are the most common complications following left ventricular assist device (LVAD) implantation and associated with adverse events. Gut microbial imbalance may predispose to mucosal colonization with pathogens, resulting in a risk of subsequent serious infections. However, it remains unclear whether gut microbiota imbalance is associated with postoperative infections in patients with LVAD. Purpose The aim of this study was to investigate whether gut microbiota imbalance was associated with postoperative infections in patients with LVAD. Methods We prospectively examined 22 consecutive LVAD patients who were admitted to a university hospital for routine check-ups and had stool cultures taken between March 2022 and December 2023. All patients had no signs of infection. The patients were divided into two groups according to positive (normal bacterial flora and other bacteria including Streptococcus viridans, Klebsiella, or Extended-spectrum β-lactamase Escherichia coli; n = 7) and negative (normal bacterial flora only; n = 15) for stool culture. The primary outcome was serious infection requiring hospitalisation treated with intravenous antimicrobial agents. Results Patients were predominantly male (68%) and the median age was 49 (interquartile range [IQR] 29-58) years. There were no significant differences in age, sex, primary aetiology of heart failure, type of LVAD devices, time on LVAD support, the history of infection, or antibiotics use within six months between the groups. During a median follow-up period of 316 days (IQR 242-559), the primary outcome occurred in seven patients (32%), including four hospitalisation for driveline infections, two pneumoniae and bacterial bloodstream infections, and one lung abscess and bacterial bloodstream infection. Kaplan–Meier analysis showed that the adverse events more frequently occurred in LVAD patients with positive for stool culture (P = 0.010) (Figure). A multivariable Cox regression analysis showed that positive for stool culture was independently associated with an increased subsequent risk of the primary outcome (hazard ratio 6.99, 95% confidence interval 1.17-41.7, P = 0.033), even after adjustments for age, male, body mass index, diabetes, INTERMACS profile, mechanical circulatory support, serum creatinine, serum albumin, and white blood cell count, which are known to be strong determinants of worse clinical outcomes in patients with LVAD. Conclusions In patients with LVAD, gut microbial imbalance was associated with subsequent serious infections. These findings suggest that the screening of stool culture might be useful for early identification of high-risk patients for infectious complication after LVAD implantation.

Effect of Oral Frailty on Postoperative Infection in Patients Undergoing Abdominal Visceral Surgery.

To assess effects of the oral frailty index-8 (OFI-8) on the incidence of postoperative infection. This retrospective study included patients aged ≥ 65 years who underwent elective abdominal visceral surgery under general anaesthesia. Oral frailty was assessed using OFI-8 (total score, 0-11), with higher scores indicating poorer oral health. The primary outcome measure was incidence of postoperative infection. The association between incidence of postoperative infection and OFI-8 score was evaluated using multiple logistic regression analysis adjusted for clinically relevant preoperative and intraoperative covariates. Data of 791 patients (mean age, 74 years; mean OFI-8 score, 3.4) were analysed. The OFI-8 score had a linear association (P for nonlinear effect on postoperative infection = 0.43) with a composite postoperative infection at a rate of 14.2% (95% confidence interval: 11.8-16.7). The adjusted odds ratio of the OFI-8 score for the primary outcome was 1.10 (95% confidence interval: 1.00-1.21), indicating that patients with higher OFI-8 scores tended to have postoperative infections. This study's findings suggest that patients with higher OFI-8 scores were more likely to develop postoperative infection after undergoing elective abdominal visceral surgery.

A novel infrared spectroscopy marker for assessing the postoperative infection risk in patients with upper urinary tract calculus

The aim of this study is to evaluate the ability of infrared wavenumber of calculus to predict postoperative infection in patients with upper urinary tract calculus (UUTC), and to establish a predictive model based on this. From March 2018 to March 2023, 480 UUTC patients from Fujian Provincial Hospital were included in this study. The infrared-wavenumbers related infection score (IR-infection score) was constructed by univariate analysis, multicollinearity screening, and Lasso analysis to predict postoperative infection. Continually, the Delong test was used to compare the predictive power between the IR-infection score and traditional indicators. Afterward, we performed urine metagene sequencing and stone culture to prove the correlation between calculus toxicity and IR-infection score. Finally, logistic regression was used to build a nomogram. IR-infection score composed of four independent wavenumbers could precisely predict postoperative infection (AUCvalidation cohort = 0.707) and sepsis (AUCvalidation cohort = 0.824). IR-infection score had better predictive ability than commonly used clinical indicators. Moreover, metagenomics sequencing and calculus culture confirmed the correlation between IR-infection score and calculus toxicity (all P < 0.05). The nomogram based on the IR-infection score had high predictive power (all AUCs > 0.803). Our study first developed a novel infrared spectroscopy marker and nomogram, which can help urologists better predict postoperative infection in UUTC patients.

Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction in Pakistan

Background: Intraoperative hypothermia, an unintentional drop in core body temperature during surgery, poses a significant risk in implant-based breast reconstruction. This condition can weaken immune function, slow blood flow, and increase the risk of postoperative infections. Objective: To evaluate the impact of intraoperative hypothermia on the incidence of infections in patients undergoing implant-based breast reconstruction in Pakistan. Methods: This retrospective cohort study was conducted at Jinnah Sindh Medical University from January 2023 to November 2023. The study included 195 female breast cancer patients aged 18 and above who underwent implant-based breast reconstruction. Patients with pre-existing infections, concurrent chemotherapy or radiotherapy during the perioperative period, and incomplete medical records were excluded. Detailed patient demographics, surgical specifics, and intraoperative temperature control measures were recorded. Patients were categorized into normothermic (core body temperature ≥ 36°C) and hypothermic (core body temperature &lt;36°C) groups. Infection data post-surgery were collected through clinical assessments, blood tests, and imaging techniques. Data were analyzed using SPSS version 25, with descriptive statistics, chi-square tests for categorical variables, and independent t-tests for continuous variables. A p-value of less than 0.05 was considered statistically significant. Ethical approval was obtained, and informed consent was secured from all participants. Results: The mean age of patients was 45.23±3.45 years in the normothermic group and 46.01±2.89 years in the hypothermic group. The hypothermic group had a slightly higher average BMI (25.1 kg/m²) compared to the normothermic group (24.5 kg/m²). Total infections were observed in 26.3% of the hypothermic group versus 10% in the normothermic group. Superficial infections were reported in 12.6% of hypothermic patients compared to 6% of normothermic patients. Deep infections were more prevalent in the hypothermic group at 13.7%, compared to 4% in the normothermic group. The univariate odds ratio (OR) for intraoperative hypothermia was 3.2 (95% CI: 1.5-6.8) and the multivariate OR was 3.0 (95% CI: 1.3-6.5), both with a p-value of less than 0.01. Conclusion: Intraoperative hypothermia significantly increases the risk of postoperative infections in patients undergoing implant-based breast reconstruction. Effective temperature management strategies, such as preoperative warming and the use of intraoperative warming devices, are crucial to reducing infection rates and improving surgical outcomes

Preoperative Evidence-Based Practice for Prevention of Early Postoperative Infections in Patients Receiving a Liver Transplant.

BACKGROUND This study aimed to evaluate the effectiveness of implementing evidence-based preoperative nursing interventions in reducing postoperative infections and intensive care unit (ICU) length of stay among liver transplant recipients. MATERIAL AND METHODS A controlled study was conducted, comparing postoperative outcomes between an intervention group receiving standardized, evidence-based preoperative care and a control group receiving routine preoperative care. Patients undergoing elective liver transplantation from September 2020 to March 2021 were included and assigned to either the intervention or control group. The intervention group received preoperative interventions based on best available evidence, while the control group received standard preoperative care. The primary outcomes measured were postoperative infection rates and length of ICU stay. RESULTS In the control group the overall Intensive Care Unit (ICU) length of stay was 3 days and the infection rate was 33.30%, while in the intervention group it was 3 days and 13.80% (P<0.05). There was no significant difference in the length of ICU stay between the control and the intervention groups (P>0.05). There was a significant improvement in the awareness, acceptance, and compliance of doctors and nurses. CONCLUSIONS Using the best evidence-based intervention for preoperative nursing of liver transplantation patients can standardize preoperative nursing behavior. Although we did not find significant differences in outcomes before and after the intervention, it is necessary to prevent postoperative infection and improve nursing compliance.

Are More Medically Complex Patients Who Undergo Complex Septorhinoplasty at an Increased Risk for Surgical Site Infection?

BackgroundProphylactic antibiotics are routinely prescribed by surgeons for their patients who undergo septorhinoplasty. However, the literature to support this remains controversial, especially in complex cases, those that require grafts, revision cases, extended surgical time, and an American Society of Anesthesiology (ASA) value greater than or equal to 3. PurposeThe study purpose was to evaluate for a potential association between increased anesthetic complexity and the risk for surgical site infection (SSI) following complex septorhinoplasty. Study DesignRetrospective cohort study of patients who underwent a complex septorhinoplasty between 2005 and 2022 at the Dallas Veterans Affairs Medical Center. Patients were excluded if they did receive a septorhinoplasty, did not follow up, or had insufficient records. Independent VariableAll patients were assigned an ASA value prior to surgery, with an ASA value of 3 serving as this study’s independent variable. Main Outcome VariableThe main outcome variable of interest was the development of a postoperative SSI, defined as findings consistent with cellulitis, purulence, or fistula development necessitating antibiotic treatment. CovariatesThe demographic covariates included patient age and sex. Clinical covariates included diabetes status, history of nasal trauma or surgery, and smoking status. The operative covariates were surgical duration, perioperative antibiotic, intraoperative complication, and type of cartilage graft used. AnalysesChi square analysis and t-tests were used for calculations with p-values < .05 being considered significant. ResultsA total of 182 patients were included in this study, 81 (45%) with an ASA ≤2 and 101 (55%) with an ASA of 3. A patient’s age (P <.01), male sex (P<.01), and a diagnosis of diabetes (P<.01) were associated with an ASA value of 3. In total there were 6 (3.3%) SSIs, with 2 (1%) occurring in those with an ASA of 3. An ASA value of 3 (P = .27, Relative Risk (RR) of .40) was not shown to be associated with an increased risk of SSI. ConclusionsOur results suggest that an ASA of 3 is not significant with regards to postoperative infection in patients who undergo a complex nasal septorhinoplasty and prophylactic postoperative antibiotics are not warranted.

Surveillance of Surgical Site Infections in Post-operative Patients and Bacterial Susceptibility in Tanzania

Surgical site infections (SSI) are infections occurring within 30 days of the post-operative procedure. They are common post-operative morbid complications that may cause death if not treated timely. The common causes of SSI include infectious bacteria, such as Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and some Enterobacteriaceae. This was a cross-sectional study conducted at St. Francis Referral Hospital, Ifakatra, Tanzania over a period of 12 months to investigate the causes of SSI and antimicrobial susceptibility of the causal agents. The study included consenting patients who developed post-operative wound infections during the study period. Identification of infecting micro-organisms and their antimicrobial susceptibility was done at St Francis Referral Hospital Laboratory. Antibiotic susceptibility tests of the isolates were performed by the Kirby–Bauer (K–B 1966) disc diffusion test, and extended spectrum β-lactamase producing Gram-negative species were tested by using the modified double disc synergy test. A total of 130 patients developed post-operative wound infection. Third and fourth decades were the most affected age groups; females were the dominant group with a 1:1.4 male: female ratio. Out of the 130 specimens, 121 isolates were obtained, and nine specimens were negative for culture. P. aeruginosa was the most commonly isolated agent (42.1%), followed by S. aureus (19.8%), while the least were Streptococcus spp. at 0.8%. The isolates showed the highest resistance to ampicillin (91.7%), and least to ciprofloxacin (1.7%). P. aeruginosa was highly resistant to both amoxicillin + clavulanic acid (98%), and to ampicillin (98.0%). Extended spectrum β-lactamase E. coli producers were 68.4%. The bacteria causing SSI require continuous monitoring to obtain data that will support local and national guidelines in the battle against antimicrobial resistance, and improve therapeutic outcomes following surgical interventions.

Effect of perioperative oral care on postoperative infections in patients with cancer: A systematic review and meta-analysis.

This systematic review aimed to assess the effect of non-pharmacologic perioperative oral hygiene care on reduced incidence of postoperative pneumonia (PP), surgical site infection (SSI), and the length of hospital stay in patients with cancer, and to describe the details of oral hygiene care. We searched seven databases. Eligibility criteria were based on perioperative oral hygiene care provided by healthcare professionals to patients aged ≥18 years who were surgically treated under general anesthesia and were evaluated for the incidence of PP and SSI. We reported risk ratios (RR) for dichotomous outcomes for PP and SSI using a fixed-effects model of meta-analysis. The search resulted in 850 articles, among which two were randomized controlled trials (RCTs) and 21 were observational studies. Most studies indicated that dentists and medical care providers performed a combination of oral cleaning, and oral hygiene instructions. In RCTs, perioperative oral hygiene care significantly reduced the incidence of PP (RR, 0.86; p = .60), while in observational studies, perioperative oral hygiene care significantly reduced the incidence of PP (RR, 0.55; p < .001) and SSI (RR, 0.47; p < .001). The length of hospital stay was also significantly reduced (p < .05). However, the effectiveness of nursing intervention was not clear. Perioperative oral hygiene care implemented by healthcare professionals prevented PP and SSI and reduced length of hospital stays for patients after cancer surgery. As daily perioperative oral hygiene care is performed by nurses, it is necessary to research the effects of oral hygiene by nurses in the future.

Is Antibiotic Prophylaxis Needed for the Extraction of Premolars for Orthodontic Purposes?

Introduction Antibiotic prophylaxis for tooth extractions is a common practice in dentistry to prevent postoperative infections. However, the routine use of antibiotics has been questioned due to concerns about bacterial resistance and potential side effects. This study aimed to evaluate the necessity of postoperative antibiotics in patients undergoing orthodontic tooth extraction. Materials and methods This prospective study involved 100 patients requiring orthodontic tooth extraction, divided into two groups. The patients were recruited from Saveetha Dental College and Hospital, Chennai, India, after obtaining approval from the Institutional Human Ethics Committee, Saveetha Dental College (approval number: IHEC/SDC/OMFS-2103/23/293). Group 1 (n = 50) received antibiotics (amoxicillin 500 mg, three times a day for three days) after extraction, while Group 2 (n = 50) did not receive antibiotics. Postoperative infection was assessed on postoperative days (POD) 3and 7.Data analysis was conducted using IBM SPSS Statistics for Windows, version 26.0 (released 2019, IBM Corp., Armonk, NY). Categorical variables were presented as frequencies and percentages, and differences between groups were assessed using chi-square or Fisher's exact tests. A p-value of <0.05 was considered statistically significant. Results The incidence of postoperative infection was recorded in both groups. In group 1 at POD 3 and POD 7, there were two patients and one patientwith infection, respectively. In group 2 at POD 3 and POD 7, there were four patients and two patients with infection, respectively. Conclusion The findings of this study suggest that the routine administration of antibiotics for the non-traumatic extraction of teethin healthy patients might not be necessary. The absence of postoperative infections in patients who did not receive antibiotics indicates that antibiotics may be avoidable in many cases of orthodontic tooth extraction. These results emphasize the importance of reconsidering the widespread use of antibiotics to combat the growing concern of bacterial resistance. Antibiotics should be prescribed judiciously, only for patients with specific medical conditions who are prone to infection. One of the limitations of this study is the limited sample size; hence, studies with larger and heterogeneous groups should be done to validate the same.

The role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma

BackgroundTo investigate the role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma.MethodsWe retrospectively enrolled 1000 patients who underwent laparoscopic nephrectomy from August 2019 to November 2021 in the Peking Union Medical College Hospital. Patients were divided into group without antimicrobial prophylaxis (n = 444) and group with antimicrobial prophylaxis (n = 556). Outcomes including 30-day postoperative infection rate, the increase rate of pre- and post-operative white blood cell counts and hospital stay were analyzed.ResultsThe overall infection rate was 5.0% (28/556) in the group with antimicrobial prophylaxis, which was similar to 4.1% (18/444) in the group without antimicrobial prophylaxis (P = 0.461). The increase rate of pre- and post-operative white blood cell counts was significantly lower (85.5% versus 97.0%) in the group with antimicrobial prophylaxis (P = 0.004). The postoperative hospital stay was 5 (4, 6) days in both groups (P = 0.483). Logistic regression analyses identified the use of antimicrobial prophylaxis had no influence on the occurrence of infection events (odds ratio = 0.797; 95% confidence interval, 0.435–1.460; P = 0.462). Hemoglobin (odds ratio = 0.430; 95% confidence interval, 0.257–0.719; P = 0.001) and partial nephrectomy (odds ratio = 2.292; 95% confidence interval, 1.724–3.046; P < 0.001) influenced the use of antimicrobial prophylaxis independently.ConclusionsThe use of antimicrobial prophylaxis had no impact on postoperative infection in patients receiving laparoscopic nephrectomy for renal cell carcinoma.

Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture

Although recent guidelines recommend against performance of preoperative urine culture before nongenitourinary surgery, many clinicians still order preoperative urine cultures and prescribe antibiotics for treatment of asymptomatic bacteriuria in an effort to reduce infection risk. To assess the association between preoperative urine culture testing and postoperative urinary tract infection (UTI) or surgical site infection (SSI), independent of baseline patient characteristics or type of surgery. This cohort study analyzed surgical procedures performed from January 1, 2017, to December 31, 2019, at any of 112 US Department of Veterans Affairs (VA) medical centers. The cohort comprised VA enrollees who underwent major elective noncardiac, nonurological operations. Machine learning and inverse probability of treatment weighting (IPTW) were used to balance the characteristics between those who did and did not undergo a urine culture. Data analyses were performed between January 2023 and January 2024. Performance of urine culture within 30 days prior to surgery. The 2 main outcomes were UTI and SSI occurring within 30 days after surgery. Weighted logistic regression was used to estimate odds ratios (ORs) for postoperative infection based on treatment status. A total of 250 389 VA enrollees who underwent 288 858 surgical procedures were included, with 88.9% (256 753) of surgical procedures received by males and 48.9% (141 340) received by patients 65 years or older. Baseline characteristics were well balanced among treatment groups after applying IPTW weights. Preoperative urine culture was performed for 10.5% of surgical procedures (30 384 of 288 858). The IPTW analysis found that preoperative urine culture was not associated with SSI (adjusted OR [AOR], 0.99; 95% CI, 0.90-1.10) or postoperative UTI (AOR, 1.18; 95% CI, 0.98-1.40). In analyses limited to orthopedic surgery and neurosurgery as a proxy for prosthetic implants, the adjusted risks for UTI and SSI were also not associated with preoperative urine culture performance. This cohort study found no association between performance of a preoperative urine culture and lower risk of postoperative UTI or SSI. The results support the deimplementation of urine cultures and associated antibiotic treatment prior to surgery, even when using prosthetic implants.

Risk factors analyses associated with postoperative infection in choledochoscopy for intrahepatic bile duct stones (IHDs): a single-center retrospective study in real-world setting.

Choledochoscopy is a highly effective approach for managing intrahepatic bile duct stones (IHDs). However, postoperative infection is a common complication that significantly impacts treatment outcomes. Despite its clinical relevance, the risk factors associated with this procedure remain largely unexplored. This study focused on a consecutive cohort of patients who underwent choledochoscopy for IHDs at our institution between January 2016 and December 2022. The primary objective was to analyze the relationship between various clinical factors and postoperative infection, and to compare the postoperative infection of different choledochoscopic procedures. The study cohort consisted of 126 patients, with 60 individuals (47.6%) experiencing postoperative infection. Notably, preoperative biliary obstruction (odds ratio [OR] 1.861; 95% confidence interval [CI] 1.314-8.699; p = 0.010) and operation time (OR 4.414; 95% CI 1.635-12.376; p = 0.004) were identified as risk factors for postoperative infection. Additionally, biliary tract infections (60.00%) were primarily responsible for postoperative infection, with Escherichia coli (47.22%) being the predominant bacterial strain identified in bile cultures. Furthermore, biliary tract obstruction (OR 4.563; 95% CI 1.554-13.401; p = 0.006) and body mass index (BMI) (OR 1.186; 95% CI 1.015-1.386; p = 0.031) were determined to be independent risk factors for postoperative biliary tract infection. The occurrence of postoperative infection in patients undergoing choledochoscopy was primarily associated with the duration of the operation and the presence of preoperative biliary obstruction.

Corticosteroid Injections Administered Within 4 Weeks Prior to Hip Arthroscopy Are Associated With Higher Rates of Postoperative Infection

PurposeThe purpose of this study was to evaluate the association between the timing of intra-articular hip corticosteroid injections and the risk of postoperative infection in patients undergoing hip arthroscopy. MethodThe 2010-2021 PearlDiver M157 administrative claims database was queried for patients who underwent hip arthroscopy. Patients who received intra-articular corticosteroid injections within 12 weeks prior to arthroscopy were matched to those who did not 1:1 based on age, sex, and Elixhauser-Comorbidity Index, and the presence of diabetes mellitus, hypertension, obesity, and tobacco use. Those with injection prior to arthroscopy were subdivided based on having had the injection within 12 weeks prior to surgery. To verify that the corticosteroid injection and surgery were conducted in the hip joint, Current Procedural Terminology (CPT) codes were utilized. Using CPT coding and the International Classification of Diseases (ICD) 9th or 10th Revision, postoperative surgical site infection following corticosteroid injection was evaluated. The impact of the timing of preoperative corticosteroid injections on the incidence of postoperative infection was evaluated using multivariable logistic regression analysis. ResultsA total of 12,390 hip arthroscopy cases were identified, including 3,579 patients who received a corticosteroid injection 0-4 weeks prior to the surgery, 4,759 within 4-8 weeks prior to the surgery, and 4,052 within 8-12 weeks prior to the surgery. Compared to controls, patients who received a corticosteroid injection within 0-4 weeks preoperatively had a significantly higher rate of surgical site infection (OR 2.43; P=0.0001). No significant differences were observed in infection rates at the later time intervals (4-8 weeks or 8-12 weeks). Furthermore, in comparison to controls, patients who received a corticosteroid injection had a significantly higher rate of wound dehiscence (OR 1.84, P=0.0007). ConclusionIntra-articular corticosteroid injections within 4 weeks prior to hip arthroscopy were significantly associated with increased surgical site infection rates following hip arthroscopy surgery.

Impact of Metabolic Syndrome on Post-Operative Infection in Patients Undergoing Flexible Ureteroscopy Lithotripsy.

Background: To investigate retrospectively whether metabolic syndrome (MetS) of flexible ureteroscopy (fURS) lithotripsy can be used to predict post-operative infection. Patients and Methods: After screening, 1,110 patients who received fURS lithotripsy for upper urinary tract stones in our center between January 2015 and December 2022 were analyzed retrospectively. Patients were divided into MetS-positive group and MetS-negative group. Post-operative infection was divided into fever, urosepsis, and septic shock. Relevant data during the peri-operative period were collected. Univariable and multivariable logistic regression analyses were adopted to estimate the impact of metabolic syndrome on post-operative infection in patients undergoing fURS lithotripsy. Results: Among the 1,110 patients, 427 tested positive for MetS, whereas 683 tested negative. Eighty-eight patients suffered from fever (67 patients in the MetS-positive group and 21 in the MetS-negative group). Forty-nine patients had urosepsis (29 patients in the MetS-positive group and 20 in the MetS-negative group), of whom seven patients developed septic shock. No patient developed multiple organ failure or died because of infection. The prevalence of post-operative infections in the MetS-positive group was higher than that in the MetS-negative group (p < 0.001). Multivariable logistic regression analyses showed that diabetes mellitus, MetS-positive, positive urine culture, and longer operation time were positively correlated with post-operative fever. Positive MetS, positive urine culture, and longer operation time were strongly correlated with post-operative urosepsis. Conclusions: Metabolic syndrome was found to be associated with post-operative infection in patients undergoing fURS lithotripsy, suggesting it can serve as a predictive factor.

Healthcare-associated infections in postoperative patients with intracranial aneurysm in Ukraine.

Aim: to investigate the epidemiology, microbiology, and risk factors for healthcare-associated infections (HAIs) in postoperative patients with intracranial aneurysm in Ukraine. Materials and Methods: Retrospective cohort study was conducted from January 2018 to December 2022 in four tertiary care hospitals of Ukraine. The diagnostic criteria were based on specific HAI site were adapted from the CDC/NHSN case definitions. Results: Of 1,084 postoperative patients with intracranial aneurysm, 128 (11.4%) HAIs were observed. The most common of HAI type was possible ventilatorassociated pneumonia (38.2%) followed by central line-associated bloodstream infections (33.8%), catheter -associated urinary tract infection (18.5%), and surgical site infection (9.6%). Inpatient mortality from HAI was 5.1%. Emergency admission, mechanical ventilation, taking antiplatelet aggregation drugs, albumin reduction, hyperglycaemia, hyponatremia, surgical procedure, operation time > 4 h, mechanical ventilation, urinary catheter, and central venous catheterization were risk factors associated with HAI in patients with intracranial aneurysm surgery. A total of 26% cases of HAIs by MDROs were notified over the study period. Klebsiella spp. - essentially K. pneumoniae - were the most frequent, followed by Enterobacter spp. and Escherichia coli. Carbapenemase production in Enterobacterales constituted the most frequent mechanism of resistance, while ESBL-production in Enterobacterales and meticillin-resistance in Staphylococcus aureus (MRSA) were detected in 65,7% 62,3% and 20% of cases, respectively. Conclusions: The present study showed that HAIs is a common complication in postoperative patients with intracranial aneurysm in Ukraine and multidrugresistant organisms the major pathogen causing infection.

Effect of transverse colostomy versus ileostomy in colorectal anastomosis on post-operative wound complications: A meta-analysis.

A meta-analysis was conducted to evaluate the effect of colostomy or ileostomy on post-operative wound complications. The research was tested using Embase, PubMed and Cochrane Library databases. Included were randomized, controlled clinical trials (RCTs). A sensitivity analysis and a meta-analysis were carried out. The results indicated that there were no statistically significant differences in the reduction of wound infection between LC and LI. Out of 268 related studies, 5 publications were chosen and examined for compliance. Literature quality was evaluated throughout the trial. Studies with poor literature were excluded. The data were analysed with RevMan 5.3, and a decision was taken to analyse the data with either a stochastic or a fixed-effects model. There were no significant differences in the incidence of post-operative infection in patients with LC (OR, 0.79; 95% CI, 0.34, 1.81; p = 0.57), and the incidence of post-operative anastomotic fistulae (OR, 0.98; 95% CI, 0.30, 3.15; p = 0.97) was not significantly different from that with LI. These meta-analyses indicate that no significant reduction in the incidence of post-operative infections or anastomotic fistulae was observed by either LC or LI.

Effect of carboxymethyl chitosan/amorphous calcium phosphate complexes on postoperative infection in patients with spinal cord injury

To explore the postoperative rehabilitative effect of continuity of nursing care and nanomaterial oral nursing intervention in patients with spinal cord injuries (SCI). Eighty patients with SCIs from spinal fractures, who were treated in our hospital from January 2019 to August 2021, were randomly divided into control and nursing groups (n = 40 each). The control group patients received conventional nursing care, while the nursing group received continuity of care (regular timely follow-ups, guided diet and medication plans, and countermeasures for complications) and oral care using nanoscale carboxymethyl chitosan/amorphous calcium phosphate (CMC/ACP) composite particles. Perioperative indicators, complication rates, oral and dental scores, and satisfaction with nursing care were compared postoperatively between the two groups. Control group patients had significantly higher out of bed activity time, hospitalization time, hospitalization expenses, and incidence of complications than those in the nursing group. Additionally, they had higher serum levels of inflammatory markers (TGF-β1, IL-6, and TNF-α) than the nursing group (P &lt;0.05). On the other hand, the nursing group had higher oral scores and significantly lower buccal plaque index than the control group. Lastly, satisfaction rates were higher in the nursing group (97.5%) than in the control group. Continuity of care in SCI patients is an effective nursing approach to minimize the incidence of postoperative debilitating infections and related complications, and facilitate recovery. Additional oral care using nano-CMC/ACP composites can improve oral health in these patients.

Risk Factors for Post-Operative Multi-Drug-Resistant Organism Bacterial Infection in Patients With Stanford Acute Type A Aortic Dissection.

Background: To explore the risk factors for multi-drug-resistant organism (MDRO) infection in patients with Stanford acute type A aortic dissection (ATAAD). We conducted a retrospective cohort study using the data of post-operative patients with ATAAD in our hospital. Patients and Methods: This study included 82 post-operative patients with ATAAD in the past decade. They were divided into a MDRO group (n = 31) and a non-MDRO group (n = 51) according to whether they had acquired multi-drug-resistant (MDR) bacterial infection. Multivariable logistic regression was used to analyze the risk factors for MDR infections in patients with ATAAD. Results: The incidence of multi-drug-resistant bacterial infection was 37.80%. Seventeen factors, including hospital stay (p = 0.007), utilization of third-generation cephalosporins (p = 0.0068), antibiotic species of exposure (p = 0.0002), leukocyte-depleted red blood cell suspension dosage (p < 0.0001), fresh frozen plasma dosage (p < 0.0001), application of blood purification (p = 0.0493), and the total antibiotic days of exposure (p = 0.0001) diverged between the two groups (all p < 0.05). The logistic regression analysis revealed that the utilization of third-generation cephalosporins (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.01-5.33; p = 0.0478), antibiotic species of exposure (OR, 5.76; 95% CI, 1.45-22.83; p = 0.0128), leukocyte-depleted red blood cell suspension dosage (OR, 12.43; 95% CI, 2.71-57.07; p = 0.0012), and fresh frozen plasma dosage (OR, 5.05; 95% CI, 1.18-21.56; p = 0.0286) were independent variables for MDRO infections. Among the 23 drug-resistant bacteria detected, Acinetobacter baumannii was the main pathogen. Conclusions: Our study shows that the utilization of third-generation cephalosporins, antibiotic species of exposure, leukocyte-depleted red blood cell suspension dosage, and fresh frozen plasma dosage were independent risk factors for post-operative multi-drug-resistant infection in patients with ATAAD. Acinetobacter baumannii occupied the largest share of resistant bacteria that induce infection in post-operative patients with ATAAD.