Presence Of Surgical Site Infection Research Articles

Clinical relevance of positive intraoperative bacterial culture in tibial plateau leveling osteotomy in dogs: a retrospective study

BackgroundTibial plateau leveling osteotomy (TPLO) belongs to the most frequently used surgical method for the treatment of cranial cruciate ligament rupture in dogs. Surgical site infection (SSI) is one of the possible postoperative complications. The aim of this study was to evaluate the diagnostic value of intraoperative bacterial culture as a tool for the detection of intraoperative bacterial contamination progressing to infection development in canine TPLO. Electronic patient records from dogs who underwent TPLO between January 2018 to December 2020 were retrospectively reviewed. Intraoperative bacterial culture results, used antimicrobial drugs and presence of SSI were recorded.ResultsNinety-eight dogs were included in the study. SSI rate was 10.2%. All dogs who developed SSI (n = 10) had negative intraoperative bacterial cultures. None of the dogs with positive intraoperative bacterial culture (n = 6) developed SSI. The most cultured bacteria causing SSI was Staphylococcus pseudintermedius (n = 4).ConclusionsIntraoperative bacterial culture in dogs undergoing TPLO is not suitable as a predictor of surgical site infection.

Reinforced tissue matrix to strengthen the abdominal wall following reversal of temporary ostomies or to treat incisional hernias.

Abdominal wall deficiencies or weakness are a common complication of temporary ostomies, and incisional hernias frequently develop after colostomy or ileostomy takedown. The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence. Biologic meshes have also been used to enhance healing, particularly in contaminated conditions. Reinforced tissue matrices (RTMs), which include a biologic scaffold of native extracellular matrix and a synthetic component for added strength/durability, are designed to take advantage of aspects of both synthetic and biologic materials. To date, RTMs have not been reported to reinforce the abdominal wall following stoma reversal. To evaluate the effectiveness of using an RTM to reinforce the abdominal wall at stoma takedown sites. Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma. Following hernia repair and proximal stoma closure, RTM (OviTex® 1S permanent or OviTex® LPR) was placed to reinforce the abdominal wall using a laparoscopic, robotic, or open surgical approach. Post-operative follow-up was performed at 1 month and 1 year. Hernia recurrence was determined by physical examination and, when necessary, via computed tomography scan. Secondary endpoints included length of hospital stay, time to return to work, and hospital readmissions. Evaluated complications of the wound/repair site included presence of surgical site infection, seroma, hematoma, wound dehiscence, or fistula formation. The observational study cohort included 16 male and 12 female patients with average age of 58.5 years ± 16.3 years and average body mass index of 26.2 kg/m2 ± 4.1 kg/m2. Patients presented with a parastomal hernia (75.0%), incisional hernia (14.3%), or combined parastomal/incisional hernia (10.7%). Using a laparoscopic (53.6%), robotic (35.7%), or open (10.7%) technique, RTMs (OviTex® LPR: 82.1%, OviTex® 1S: 17.9%) were placed using sublay (82.1%) or intraperitoneal onlay (IPOM; 17.9%) mesh positioning. At 1-month and 1-year follow-ups, there were no hernia recurrences (0%). Average hospital stays were 2.1 d ± 1.2 d and return to work occurred at 8.3 post-operative days ± 3.0 post-operative days. Three patients (10.7%) were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues. Fistula and mesh infection were observed in two patients each (7.1%), leading to partial mesh removal in one patient (3.6%). There were no complications between 1 month and 1 year (0%). RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal, with no hernia recurrences and favorable outcomes after 1-month and 1-year.

Evaluation of Administration Prophylactic Antibiotic against Incidence of Surgical Site Infection in Post Appendectomy at Panembahan Senopati Hospital, Indonesia

Appendicitis is a prevalent abdominal surgical emergency in Indonesia, occurring at a rate of 5 per 1,000 people, with around 10 million cases each year. Appendectomy, the surgical removal of the vermiform, is the primary treatment for appendicitis but carries a high risk of surgical site infections. Prophylactic antibiotics are given to minimize the risk of infection resulting from surgery, administered in accordance with established guidelines. This study aims to evaluate the administration of antibiotic prophylactic against SSIs. This study used a mixed-methods approach to evaluate prophylactic antibiotic administration and the incidence of surgical site infection in post-appendectomy patients. The researchers conducted in-depth interviews with surgeons and nurses and an analytical observational study with a cross-sectional design, observing various indicators such as the timing and duration of prophylactic antibiotic administration and the presence of surgical site infections. The study found that the duration of antibiotic administration ≤24 hours had a higher number of infection-free patients (62.50%). The researchers analyzed the relationship between the duration of antibiotic administration and surgical site infection in post-appendectomy patients and found a significant relationship (p <0.05) at the hospital. There is a relationship between prophylactic antibiotic administration and surgical site infection. All patients were given prophylactic antibiotics with appropriate timing, duration, and method of administration.

Multifactorial assessment of leukocyte reduced platelet rich plasma injection in dogs undergoing tibial plateau leveling osteotomy: A retrospective study.

This study assessed the effects of concurrent intra-articular injection and Tibial Plateau Leveling Osteotomy (TPLO) plate surface treatment with leukoreduced platelet rich plasma (lPRP) on outcomes of dogs undergoing TPLO. A retrospective study of medical records for cases presenting from January 2018 to December 2020 was performed. Client-owned dogs with naturally occurring cranial cruciate ligament rupture that underwent TPLO surgery were divided into two groups. The lPRP group included cases that underwent intra-articular injection and plate surface treatment at the time of their TPLO. The control group (C) underwent TPLO without PRP treatment. Data analyzed included: presence of surgical site infection, implant removal rate, degree of change in OA progression score, lameness score progression and radiographic bone healing. The short- and long-term complication rate, hospitalization and antibiotic therapy were also compared between the groups. Descriptive statistics, comparison analyses (Chi square test, t-test, Fisher's exact test) and multi-level logistic regression models were used for statistical analysis. A total of 110 cases met the study inclusion criteria: 54 = lPRP, 56 = C. There were no significant differences between groups with regard to gender, age, presence of meniscal tear, weight, or body condition score. Significant findings included: improved radiographic healing of the osteotomy in the lPRP group, improved global OA scores in the lPRP group, and improved lameness score at recheck examination in the lPRP group. There was no significant difference between the lPRP and C group with regard to surgical site infection and implant removal rate. Concurrent intra-articular injection and plate surface treatment with leukocyte reduced PRP at the time of TPLO, is beneficial in slowing the progression of OA, hastening the radiographic evidence of osteotomy healing, and improved lameness score on recheck examination. Leukocyte reduced PRP was not a significant factor in reducing SSI or implant removal rate.

Incidence and outcomes of surgical site infection following emergency laparotomy during the COVID-19 pandemic in a low resource setting: A retrospective cohort

IntroductionSurgical site infection (SSI) is the commonest form of hospital acquired infection in sub-Saharan Africa, associated with increased morbidity and mortality. This study was aimed at determining the incidence and outcomes of surgical site infection following emergency laparotomy during the COVID -19 pandemic in a low resource setting. MethodsThis was a retrospective single Centre cohort of patients that had emergency laparotomy between July 2021–June 2022 (COVID period) and July 2018–June 2019 (pre-COVID period). Analysis was done using SPSS version 22 in which SSI rates were compared between the two periods using the chi squared test. Mortality, re-operation rates and length of hospital stay were also compared. ResultsOf the 453 patient files included in analysis, 244 (53.9%) were for the COVID period, while 209 (46.1%) were for the pre COVID period. The incidence of SSI was insignificantly higher in the COVID period (17.6% versus 16.7%; P = 0.901). Mortality was also insignificantly higher in the SSI group (3.8% versus 3.5%; P = 0.745). Presence of surgical site infection increased the risk for re-operation (P < 0.001) and prolonged hospital stay (P < 0.001). ConclusionSince the incidence and outcomes of surgical site infection appear not to have changed following the pandemic, the same measures that were previously used to prevent SSI could still be effective even during the pandemic if followed appropriately and combined with the COVID specific peri-operative care recommendations.

Comparison of Sublay and Onlay Mesh Repair in Terms of Post-Operative Complications

Objective: To compare Sublay and Onlay mesh repair in terms of post-operative complications among patients undergoing hernioplasty.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2020 to Jun 2021.&#x0D; Methodology: This study was conducted on 300 patients who underwent hernioplasty for anterior abdominal wall hernias at our hospital. They were randomly divided into two groups before the surgery. Group-A received only mesh repair, while Group-B received subway repair. They were followed up for two weeks for any post-operative complications. Post-operative pain, seroma formation, hematoma formation and the presence of surgical site infection were compared in both groups.&#x0D; Results: Out of 300 patients included in the final analysis, 189(63%) were male, and 111(37%) were female. About 163(54.4%) underwent subway repair, while 137(45.6%) underwent only repair. The commonest complication observed in patients was post-operative pain 68(22.7%), followed by surgical site infection 36(12%). Statistical analysis revealed that seroma formation, post-operative pain and surgical site infection were significantly observed more in patients undergoing only mesh repair than subway repair (p-value&lt;0.05).&#x0D; Conclusion: Post-surgical complications were commonly observed in patients within two weeks of surgery. In addition, patients undergoing Onlay mesh repair were more prone to have seroma formation, post-operative pain and surgical site infection than those undergoing Sublay repair.

Impact of surgical site infection on unplanned hospital readmissions, initiation of adjuvant treatment following surgery, and disease-free survival on patients with upper aerodigestive tract squamous cell carcinoma.

Unplanned hospital readmission (UHR) is an important indicator of the quality of the healthcare system in place. It has various implications for the patients and the healthcare system at large. In this article, we have attempted to understand the various factors influencing UHR and the start of adjuvant treatment following cancer surgery. In this study adult patients above 18 years of age with upper aerodigestive tract squamous cell carcinoma who underwent surgery at our center between July 2019 to December 2019 were included in the study. Various factors influencing UHR and delay in receiving adjuvant treatment were analyzed. A total of 245 patients satisfied the inclusion criteria. Surgical site infection (SSI) was the factor that had the maximum influence on the UHR (p < 0.002, OR: 5.6, 95% CI: [1.911-16.4]) and delaying the start of adjuvant treatment (p = 0.008, OR: 3.786, 95% CI: [1.421-10.086]) on multivariate analysis. Surgery lasting for >4 h and patients who had received prior treatment tended to develop SSI postoperatively. The presence of SSI also seemed to have had a negative influence on disease-free survival (DFS) as well. SSI is an important postoperative complication having major implications in terms of increased UHR and delays in starting adjuvant treatment which in turn is reflected as a poorer DFS among patients who develop SSI postoperatively.

The development and validation of screening tools for semi-automated surveillance of surgical site infection following various surgeries.

Surveillance of surgical site infections (SSIs) is essential for better prevention. We developed a screening method for SSIs in adults. The training dataset included data from patients who underwent orthopedic surgeries (N = 1,090), colorectal surgeries (N = 817), and abdominal hysterectomies (N = 523) during 2015-2018. The gold standard for the validation of the screening tool was the presence of SSI as determined by a trained infection control practitioner, via manual full medical record review, using the US Center for Disease Control and Prevention criteria. Using multivariable regression models, we identified the correlates of SSI. Patients who had at least one of these correlates were classified as likely to having SSI and those who did not have any of the correlates were classified as unlikely to have SSI. We calculated the sensitivity and specificity of this tool compared to the gold standard and applied the tool to a validation dataset (N = 1,310, years 2019-2020). SSI was diagnosed by an infection control specialist in 8.2, 5.2, and 31.2% of the patients in the training dataset who underwent hysterectomies, orthopedic surgeries and colorectal surgeries, respectively, vs. 6.2, 6.6, and 25.5%, respectively, in the validation dataset. The correlates of SSI after abdominal hysterectomy were prolonged hospitalization, ordering wound or blood culture, emergency room visit and reoperation; in orthopedic surgery, emergency room visit, wound culture, reoperation, and documentation of SSI, and in colorectal surgeries prolonged hospitalization, readmission, and ordering wound or blood cultures. Area under the curve was >90%. The sensitivity and specificity (95% CI) of the screening tool were 98% (88-100) and 58% (53-62), for abdominal hysterectomy, 91% (81-96) and 82% (80-84) in orthopedic surgeries and 96% (90-98) and 62% (58-66) in colorectal surgeries. The corresponding values for the validation dataset were 89% (67-97) and 75% (69-80) in abdominal hysterectomy; 85% (72-93) and 83% (80-86) in orthopedic surgeries and 98% (93-99) and 59% (53-64) in colorectal surgeries. The number of files needed to be fully reviewed declined by 61-66. The presented semi-automated simple screening tool for SSI surveillance had good sensitivity and specificity and it has great potential of reducing workload and improving SSI surveillance.

Overview of Rate and Risk Factors of Surgical Site Infection in a Tertiary Hospital in Liberia: A Prospective Cohort Study.

Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.

Rate of surgical site and urinary tract infections in dogs after cessation of antibiotics following spinal surgery.

Excessive use of antimicrobials and the increasing occurrence of antimicrobial resistance are major challenges in both human and veterinary medicine. The role of prophylactic antimicrobial therapy in orthopaedic and neurosurgeries in dogs can be questioned. The aim of this study was to evaluate the rate of surgical site infections (SSI) and urinary tract infections (UTI) in dogs after cessation of antibiotics following spinal surgery. Electronic patient records from January 2018 to December 2019 were retrospectively reviewed to identify dogs that underwent spinal surgery (n = 158). Antimicrobial drug use and the presence of SSI and UTI were recorded. Overall, SSI developed in 1.3% of dogs that underwent spinal surgery, while UTI developed in 8.2%. Multidrug-resistant (MDR) bacteria were detected in 5.1% of dogs. The rates of SSI, UTI and MDR did not differ significantly between dogs that received postoperative antimicrobial therapyandthosethatdidnot. The main limitation of this study was its retrospective design. Overall, the SSI rate in this study was low. Cessation of postoperative antimicrobial use in dogs followingspinal surgery did not havea negative effect on either SSI development or the occurrence of UTI.

Surgical site infection in emergency and elective patients and it’s major risk factor in resource limited tertiary care center

Postoperative surgical site infection (SSI) is major threat for surgeons. In this study, we measure the incidence of SSI in emergency and elective surgical patients and evaluation of any significant relation to anemia, hypoalbuminemia, Diabetes mellites, alcohol and tobacco user. This study was a prospective comparative study of 200 patients, studied during a twelve-month duration who were admitted and operated in our departments. Data collected including demographic profile and presence of SSI up to 30 postoperative days. In this prospective study of 200 patients (100 patients in each emergency and elective surgical case) surgical site infection was present in 17% (n=34) of patients, out of 34 SSI patients 64.7% (22 Patients) were male and 35.3% (12 Patients) were female. SSI was present in 73.5% and 26.5% of emergency and elective surgical cases respectively. Emergency and elective surgical cases were compared in SSI and non SSI cases and data showed a statistically significant difference (X2= 9.0716, P value .00256). Patients having SSI were compared with non SSI for anemia, hypoalbuminemia and diabetes mellites data showed statistically significant difference (X2=66.6, P value&lt; 0.00001, X2=78.5, P value&lt; 0.00001 and X2 =61.7, P value&lt; 0.00001 respectively).

Association Between Levels of Pre-operative Glycosylated Hemoglobin and Post-operative Surgical Site Infections After Elective Surgery in a Low-Income Country.

Introduction: Diabetic patients undergoing surgery are more susceptible to hospital-acquired infection, particularly surgical site infection (SSI). Good glycemic control in preoperative patients significantly decreases the risk of SSI. There is a scarcity of data from low-income countries studying the relation between perioperative glycated hemoglobin (HbA1c) levels and postoperative SSI. We aim to establish statistical relation between HbA1c and SSI which will help decrease post-operative infections and morbidity.Methods: This study was conducted in the surgical unit of Jinnah Sindh Medical University, Karachi, Pakistan, from August 2020 to April 2022. Patients who underwent elective surgical procedures (n= 1024) were included in the study and divided into two groups based on their HbA1c levels. Patients with HbA1c levels higher than 6.5% were classified as group A and those with HbA1c less than 6.5% belonged to group B. For statistical analysis, IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States) was used.Results: Group A comprised 579 (56.5%) patients. The presence of SSI in participants with HbA1c >6.5% was statistically significant (p-value: 0.011). Genderwise comparison with the presence of SSI was found to be insignificant (p-value: 0.28). Smoking was positively correlated with the absence of SSI. No significance in terms of presence or absence of SSI was found in the comparison of the type of wounds (p-value: 0.25).Conclusion: There is a positive relationship between raised HbA1c levels and the development of SSI. Our study emphasizes the importance of the use of HbA1c levels as a more accurate predictor of glycemic control in pre-operative patients rather than blood glucose levels. It is imperative that surgeons must check HbA1c levels before selecting patients for elective surgeries, especially in low-income countries where the healthcare burden is already huge.

Extended-course antibiotic prophylaxis in lower limb amputation: randomized clinical trial

Lower limb amputation (LLA) is typically described as 'clean surgery', but surgical-site infection (SSI) rates are high and there is significant variation in antibiotic prophylaxis practice. This study aimed to determine whether an extended period of antibiotic prophylaxis (5-day course) is superior to a short course (24 h) in preventing SSI in patients undergoing minor and major LLA. Patients undergoing minor and major amputation from a single vascular unit were recruited and randomized to receive either a 5-day or a 24-h prophylactic course of antibiotics. Patients with significant baseline infection were excluded. Outcomes included the incidence of SSI and impaired wound healing (IWH), both measured using ASEPSIS criteria, the need for further surgery, duration of hospital stay, and mortality up to 1 year. Some 161 patients were recruited to the study, and 152 were included in the analysis. A 5-day course of antibiotics was associated with a lower incidence of SSI (11.8 versus 39.5 per cent; P < 0.001) and lower incidence of IWH (22.4 versus 58 per cent; P < 0.001). Fewer patients receiving the 5-day course required amputation revisional surgery (6.6 versus 21 per cent; P = 0.010). Duration of hospital stay and mortality rates were similar. The presence of SSI (odds ratio (OR) 5.14, 95 per cent c.i. 1.96 to 13.45; P < 0.001) and IWH (OR 4.62, 1.68 to 12.72; P = 0.003) increased the need for revisional surgery. SSI increased the duration of hospital stay: median 28 (i.q.r. 16-40) versus 14 (9-21) days (P = 0.045). SSI and IWH are common after LLA and have a significant impact on outcome. A 5-day course of antibiotic prophylaxis was associated with a reduction in both SSI and IWH compared with a 24-h course, and this reduced the need for further surgery. Registration number: NCT02018094 (http://www.clinicaltrials.gov); EudraCT 2012-003146-32 (https://www.clinicaltrialsregister.eu).

Infection rate following elective oculoplastic surgery in a minor procedure setting: a single-centre retrospective study

ObjectiveA surgical site infection after oculoplastic surgery is a serious complication that can lead to endophthalmitis and vision loss. Although performing these procedures in a minor-surgery setting is common, there is a lack of evidence in the literature regarding the incidence of postoperative infections. The objective of this study was to determine the infection rate associated with elective outpatient oculoplastic procedures performed in a minor-surgery setting. MethodsA retrospective review was completed for all patients who underwent elective oculoplastic surgery in the minor-procedure room at the Misericordia Health Centre in Winnipeg between April and December 2018. Operations were performed by 2 senior oculoplastic surgeons. Data collected included the type of procedure, number of surgical incisions, type and number of sutures, use of prophylactic antibiotics, time to follow-up, complications, and presence of surgical site infection. ResultsReview of 539 patients showed an infection rate of 0.37% (2 of 539). Infection cases were an exposed orbital implant using a temporalis fascia graft and ptosis repair using a frontalis sling. Thirteen complications were identified, corresponding to a complication rate of 2.41% (13 of 539). ConclusionStudy results show an infection rate of 0.37% for elective oculoplastic surgery in a minor-procedure setting.

Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: A cohort study

BackgroundDespite the ubiquity of hand trauma, there remains insufficient published data to reliably inform these patients of surgical site infection (SSI) risk. We describe the risk of SSI in a single-centre cohort of patients with hand trauma, with an analysis of the impact of the coronavirus disease-2019 (COVID-19) pandemic.MethodsRetrospective data collection of consecutive patients who underwent surgery for hand and wrist trauma in a single plastic surgery centre over two, three-month periods. Demographic, injury and operative details, alongside prophylactic antibiotic use, were recorded. Burn injuries and wounds infected at presentation were excluded. Presence of SSI at 30 days (90 days if a surgical implant was used) was assessed.ResultsOverall, 556 patients – ‘Pre-COVID-19’ (n = 310) and ‘During COVID-19’ (n = 246) – were included. Risk of SSI was 3.6% in the aggregated cohort. Female patients were more likely to develop an SSI, even when adjusted for their greater prevalence of bite aetiologies (adj OR 2.5; 95% CI, 1.00–6.37 and p < 0.05). The absolute risk of SSI in the ‘Pre-COVID-19’ group was 2.3% and 5.3% in the ‘During COVID-19’ group. The relative risk of developing an SSI in the ‘During COVID-19’ group was 2.34 (95% CI, 0.95–5.78 and p = 0.06). Baseline characteristics were equivalent between the two groups.ConclusionThe risk of SSI in hand trauma is the same as the nationally estimated risk for all surgeries; 3–5%. Changes in presentation and practice associated with the first wave of the COVID-19 pandemic did not appear to alter the risk of SSI in patients undergoing surgery for hand trauma.

POST-OPERATIVE ORAL ANTIBIOTICS IN REDUCING FREQUENCY OF SURGICAL SITE INFECTION FOLLOWING NON-PERFORATED APPENDECTOMY IN POPULATION OF SOUTH WAZIRISTAN AGENCY, PAKISTAN

Background: Acute appendicitis is most frequent cause of acute abdomen in younger population, and surgical site infection (SSI) is commonest complication of appendectomy. The objective of this trial was to compare the efficacy of post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan.Materials Methods: The randomized placebo trial was conducted at Agency Headquarter Hospital, Wana, South Waziristan, Pakistan from October 1, 2016 to November 18, 2018. One hundred fifty (150) patients were randomly allocated into two groups, 75 in experimental group, to whom antibiotics were given and 75 in placebo group, to whom antibiotics were not given. Age groups and presence of SSI were two variables, being on nominal scale, were described by count and percentage with CI at 80%CL. McNemar chi-square test was applied to test the hypothesis to see the significance of difference between the experimental and placebo groups in terms of frequency of SSI at alpha .05.Results: SSI was present in nine (12%, 80%CI 7.19-16.80%) out of 75 cases in experimental group and in 12 (16%, 80%CI 10.57-21.42%) out of 75 cases in placebo group. McNemar chi-square test showed no significant difference between the experimental and placebo groups in terms of frequency of SSI (p=.2482).Conclusion: The results are comparable for post-operative oral antibiotics versus placebo in reducing the frequency of surgical site infection (SSI) following appendectomy for non-perforated appendicitis in population of South Waziristan Agency, Pakistan.

EFFECTS OF IRON DEFICIENCY ANEMIA IN SURGICAL SITE INFECTION

Objective: To determine effect of iron deficiency anemia on the patients developing surgical site infection at surgical department of a tertiary care setup in Pakistan.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Surgery, Pak Emirates Military Hospital Rawalpindi, from Nov 2018 to Mar 2019.&#x0D; Methodology: A total of 152 indoor hospitalized patients were included in the study. Surgical site infection was assessed by a consultant surgeon according to definitions provided by the Centers for Disease Control and Prevention (CDC) National nosocomial infections surveillance system. Iron deficiency anemia was classed on the basis of hemoglobin and ferritin levels.&#x0D; Results: Eighty six (56.6%) patients were male while 66 (43.4%) patients included in the study were female. Commonest surgical procedure was laparotomy 29 (19.1%) followed by the hernioplasty 27 (17.7%). Out of 152 patients undergoing surgery &amp; admitted in ward, 35 (23.1%) showed the presence of surgical site infection while 117 (76.9%) had no infection. Seventy eight (51.3%) patients had iron deficiency anemia while 74 (48.7%) patients were not anemic. History of transfusion during the surgery and presence of iron deficiency anemia was significantly associated with surgical site infection in the target population.&#x0D; Conclusion: Study exhibited high frequency of surgical site infection in the target population. Regular screening for anemia should be performed at surgery department and patients with history of transfusion during the surgery should be looked after especially. Iron deficiency anemia emerged as an independent factor associated with presence of surgical site infection among surgical patients.

Surgical site infection at chest tube drainage site following pulmonary resection for malignant lesions.

BackgroundWe sometimes experience postoperative surgical site infection (SSI) at the chest tube drainage site (CDS) after thoracotomy. The incidence of and risk factors for SSI at the CDS have remained unclear.MethodsWe conducted a prospective study to determine the incidence and risk factors for SSI at the CDS. We analyzed 99 patients who underwent lobectomy or segmentectomy for pulmonary malignant lesions.ResultsThere were 56 males and 43 females with an average age of 71 years. The postoperative drainage period was 2–15 days. Bacterial species were detected in secretions in 18 of 99 cases (18.2%). Older age was a risk factor for the detection of bacteria at the timing of chest tube removal. Eighteen cases (18.2%) were diagnosed with presence of SSI at the CDS at the timing of staple or suture removal. A pathological diagnosis of squamous cell carcinoma was regarded as a candidate risk factor for SSI. Eleven of 18 SSI patients showed delayed wound healing. A higher level of HbA1c was found in patients with delayed wound healing. Enterococcus faecalis infection may influence the development of complex SSI.ConclusionsWe identified the bacterial profiles, incidence of and risk factors for SSI at the CDS. More intense preoperative glycemic control and an understanding of the bacterial profile and may be useful for reducing the incidence of SSI chest tube drainage sites (CDS).

Comparison of post-operative pain in short versus long stitch technique for abdominal wall closure after elective laparotomy: a double-blind randomized controlled trial.

Conventional mass closure uses suture-to-wound length ratio of 4:1 ('long stitch', LS). 'Short stitch' (SS) has a suture-to-wound length ratio of more than 4 and incorporates only the linea alba, which may reduce tension and pain. We compared the post-operative pain after laparotomy closure using LS and SS. Patients undergoing elective midline laparotomy through standardized incisions in two tertiary hospitals from February 2017 to September 2018 were randomized to either LS or SS. The primary outcome was post-operative patient-controlled analgesia morphine usage at 24 h. Secondary outcomes were presence of surgical site infection and length of hospital stay (LOHS). Categorical variables were analysed using chi-squared analysis. Outcomes of study were tested for normal distribution. Skewed data were analysed using Mann-Whitney U-test. Eighty-six patients were recruited (42 SS and 44 LS). The median age was 66 (interquartile range (IQR) 15). Majority were males (62.8%) and Chinese (50%). The median incision length was 17 cm in both groups. The median patient-controlled analgesia morphine usage 24 h post-operatively did not differ significantly (SS 21 mg, IQR 28.3; LS 18.5 mg, IQR 33.8, P=0.829). The median pain score at rest (SS 1, IQR 1; LS 1, IQR 2, P=0.426) and movement (SS 3, IQR 1; LS 3, IQR 2, P=0.307) did not differ significantly. LOHS was shorter in the SS group (SS 6, IQR 4; LS 8, IQR 5, P=0.034). The rate of surgical site infection trended lower in the SS group with no statistical difference. There were no differences in post-operative pain between SS and LS but we found that there were shorter LOHS in SS arm as secondary outcome.

Outcome of restricted antibiotic policy in a tertiary-level paediatric surgical unit

Purpose:The purpose was to evaluate the effect of a more restrictive antibiotic policy on infective complications, mainly surgical-site infection (SSI) in clean and clean contaminated surgeries in children. Materials and Methods:The study included children who underwent clean or clean contaminated surgeries over a period of 18 months with a no-antibiotic or single dose of pre-operative antibiotic protocol, respectively. These were compared to historical controls in previous 18 months where the antibiotic policy was to continue the course for 3–5 days. The outcome looked for was presence of SSI or infection related to the operated organ.Results:A total of 933 (study group) patients were compared to 676 historic controls (control group). In the study group, 661 of 933 were clean surgeries and 272 were clean contaminated surgeries. In the study group, 490 of the 676 were clean surgeries and 186 were clean contaminated surgeries. Clean contaminated surgeries included urological surgeries, gastrointestinal tract surgeries and neurosurgeries, whereas clean surgeries were typically day-care surgeries. Comparing the infective outcomes in each type of surgery, there was no statistical difference between cases or controls in either subgroup.Conclusion:Antibiotic prophylaxis (AP) is not required for clean surgeries. For clean contaminated surgeries, just one dose of pre-operative AP is effective in preventing SSI.