Prevalence Of Surgical Site Infection Research Articles

Prevalence of post-caesarean section surgical site infections in Rwanda: A systematic review and meta-analysis.

Caesarean section (C-section) is the most performed major surgery worldwide. About 15% of births are delivered through C-section in Rwanda. The post-caesarean surgical section is one of the most frequent complications that follow a C-section. The purpose of this systematic review and meta-analysis is to estimate the pooled prevalence of surgical site infections following caesarean section deliveries in Rwanda. A comprehensive search was conducted across PubMed/MEDLINE, Google Scholar, DOAJ, AJOL and the Cochrane Library to identify primary studies on post-caesarean surgical site infections in Rwanda. Studies meeting predetermined criteria were included, and their quality was assessed using the JBI Critical Appraisal Tools. Heterogeneity was evaluated using I2 statistics, while publication bias was examined via funnel plots and statistical tests. Pooled prevalence was calculated using Jamovi 2.3.28 software, with subgroup analysis conducted to identify sources of heterogeneity. Statistical significance was set at p < 0.05. From 139 articles initially searched from the databases, only 17 studies with 8, 082 individuals were finally included in the systematic review and meta-analysis. Using the random-effects model, the pooled estimate of post C-section SSIs prevalence in Rwanda was 6.85% (95% CI 5.2, 8.5). Subgroup analysis based on publication year, sample size, hospital and study design showed no much difference in SSI prevalence. The current systematic review and meta-analysis indicates that post-caesarean surgical site infections are significant in Rwanda. A collaborative effort is required to lower post-C-section SSIs and provide the best surgical care in the country.

The use of triple antibiotic prophylaxis during total knee replacement surgeries in Awka, Nigeria

Introduction: Total knee arthroplasty periprosthetic joint infection (PJI) poses a significant challenge in orthopaedic surgery, often resulting in early failure and associated with high morbidity and mortality rates. Various treatment strategies exist, including debridement, antibiotic therapy, and prosthesis retention, with preventive measures such as antibiotic-impregnated cement and prophylactic antibiotics administration recommended by the American Academy of Orthopaedic Surgeons (AAOS). Methodology: This prospective cohort study was conducted in an orthopaedic hospital in Awka, Southeast Nigeria, spanning seven years (2014-2021). A total of 134 patients who underwent primary and revision knee arthroplasty were included. The hospital's antibiotic prophylaxis protocol for implant surgeries, including arthroplasties, involved a triple combination of ceftriaxone, ciprofloxacin, and metronidazole administered pre-, intra-, and postoperatively for a minimum of 7 days. Results: The study population had a mean age of 63.6 years, predominantly female (77.7%), and of Christian faith (100%). Most participants were of Igbo ethnicity (99.3%), married (90.7%), and engaged in business (37.7%). Severe osteoarthritis was the primary diagnosis in 97.0% of cases, while rheumatoid arthritis accounted for 3.0%. The triple antibiotic prophylaxis regimen resulted in only one case of superficial infection, with no instances of deep infection recorded. Conclusion: Triple antibiotics prophylaxis, comprising ceftriaxone, ciprofloxacin, and metronidazole, demonstrated effectiveness in preventing infections associated with total knee arthroplasty. This regimen maintained surgical site infection prevalence within acceptable limits for clean surgeries, without observable antibiotic resistance in the study population.

Prevalence of surgical site infection in orthopedic procedures, in an institution in the municipality of Pereira, 2022

Background The acquisition of healthcare-associated infections (HAI) is characterized by developing during the patient’s hospital stay and even after the hospital stay during the recovery period, as long as it is due to factors intrinsic to the hospitalization or medical treatment of the entity, as well as surgical techniques that require prophylactic treatment and medical surveillance. Methods Type and design of research: Quantitative, observational, descriptive, cross-sectional, retrospective. The population and sample is made up of patients who underwent orthopedic surgery in an institution in the municipality of Pereira, between January and December 2022. Results The results showed that there are significant differences between genders in the incidence of certain medical conditions and response to certain treatments. Women appear to be more prone to deep infections, use more chlorhexidine as an antiseptic, and show a higher prevalence of pathologic conditions compared to men. In addition, differences in the distribution of ASA classification and surgical wound type suggest possible health disparities between genders in the context of orthopedic surgery. Conclusions The importance of implementing infection prevention and control strategies adapted to specific contexts is evident. Despite the differences in the risk factors identified, both studies highlight the importance of optimizing antibiotic prophylaxis and adequately managing specific comorbidities to reduce the incidence of postsurgical infections. Furthermore, attention to perioperative surveillance and surgical time management are suggested as key areas to improve surgical outcomes in both cohorts of patients, as they can contribute significantly to the reduction of the incidence of SSIs in patients undergoing orthopedic procedures.

Prevalence of surgical site infections and antibiotic resistance pattern in a Tertiary care Orthopaedic unit

Introduction: Surgical site infections (SSIs) in orthopaedic surgeries pose a significant risk to outcomes. These infections ranging from superficial to periprosthetic joint complications result from various factors including patient-related conditions and environmental factors. Staphylococcus aureus, with increasing antibiotic resistance, is a predominant cause. Perioperative antibiotic prophylaxis recommended by the WHO is crucial. Establishing national surveillance considering local antibiotic resistance and continuous auditing are essential for formulating effective guidelines to prevent and manage SSIs. Methods: This is a retrospective study conducted at a tertiary care hospital from December 2022 to November 2023 at the orthopaedic unit. The study population was all the patients who had surgical site infections following clean orthopaedic surgeries during the study period. An institutional-level ethical clearance was obtained. Results: This retrospective study conducted at a tertiary orthopaedic unit in Jaffna, Sri Lanka, aimed to investigate surgical site infections (SSI) following clean orthopaedic surgeries. Analyzing data from 1676 surgeries over one year, the study identified 83 culture-proven SSIs, yielding an annual incidence of 4.95%. The majority of SSIs occurred in males (62.7%) and were associated predominantly with lower limb surgeries (83.1%). Contrary to global trends, Pseudomonas emerged as the most common causative organism (31.3%). Discussion: Notably, the study revealed significant variations in antibiotic sensitivity patterns among isolated organisms. While Pseudomonas exhibited sensitivity to a wide range of antibiotics, coliforms displayed resistance to several agents. This emphasizes regional and institutional differences in antibiotic resistance patterns. Conclusion: Continuous large-scale institutional audits are crucial for shaping effective antibiotic policies. The study underscores the dynamic nature of SSI aetiology, emphasizing the need for tailored preventive measures based on regional data.

Surgical site infection following cesarean section and its predictors in Ethiopia: A systematic review and meta-analysis.

Worldwide, surgery related deaths within 30 days of the procedure accounts the third contributor among all causes of deaths, with an estimated 4.2 million people annually and half of these deaths occur in low and middle income countries. To determine the pooled prevalence of surgical site infection following cesarean section and its predictors in Ethiopia. A systematic review and meta-analysis were conducted by using PRISMA guideline. An appropriate and comprehensive search of PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, HINARI and Scopus was done. This SRMA included all articles conducted in all regional state of Ethiopia reporting the prevalence/proportion/incidence of SSI after cesarean section and/or associated factors. All observational study designs were included in this SRMA. Articles which lack our outcome of interest: SSI following cesarean section and its predictors were excluded from this SRMA. The I2 statistic was used to quantify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effect model was used to estimate the pooled prevalence of SSI. Adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) was also considered to determine the association of identified variables with SSI. Statistical analysis was conducted using STATA version 17 software. Initially 6334 studies were identified and finally 19 studies were found eligible for the analysis. Studies with a score of 7 and above were included for the final systematic review and meta-analysis. The review was comprised of 14 cross sectional studies, 4 cohort and one case control studies. The pooled estimate of SSI in Ethiopia was 11.13% (95%CI, 9.29-12.97%). Prolonged labor (AOR = 3.16, 95% CI; (2.14-4.68)), chorioamnionitis (AOR = 4.26, 95% CI; (1.99-8.91)), prolonged PROM (AOR = 3.80, 95% CI; (2.51-5.62)), repeated vaginal examination (AOR = 3.80, 95% CI; (2.45-5.88)), decreased hemoglobin level (AOR = 4.57, 95%CI; (3.16-6.60)), vertical skin incision (AOR = 3.09, 95% CI; (2.04-4.67)) and general anesthesia (AOR = 1.82, 95% CI (1.21-2.75)) are significantly associated with SSI after cesarean section in Ethiopia. SSI after cesarean section in Ethiopia is high. Prolonged labor, chorioamnionits, prolonged PROM, repeated vaginal examination, decreased Hgb level, vertical skin incision and general anesthesia were positively associated. Thus, evidence based intra-partum care should be practiced.

Influence of urinary tract infections on the incidence of surgical site infections following hip fracture surgery: A systematic review and meta-analysis.

The prevalence of surgical site infections (SSIs) following hip fracture surgery poses a substantial challenge, compounding patient morbidity and healthcare costs. This systematic review and meta-analysis investigate the potential correlation between perioperative urinary tract infections (UTIs) and the subsequent risk of SSIs, aiming to illuminate the impact of UTIs on postoperative outcomes in this vulnerable population. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilising the PICO framework to define our search strategy across PubMed, Embase, Web of Science and the Cochrane Library. Our inclusion criteria encompassed randomised controlled trials, cohort studies and case-control studies that reported on SSIs following hip fracture surgery in patients with UTIs. Quality was assessed using the Newcastle-Ottawa Scale, and heterogeneity was quantified using the I2 statistic. A random-effects model was applied due to significant heterogeneity, and a sensitivity analysis assessed the stability of the results. Six studies met the inclusion criteria, demonstrating high methodological quality. The analysis included studies from 2016 to 2021, with sample sizes ranging from 402 to 31 621 participants. A significant association was found between UTIs and SSIs, with an odds ratio of 2.79 (95% CI: 1.72-4.54, p < 0.001). Sensitivity analysis confirmed the robustness of the results, and no publication bias was detected. Perioperative UTIs significantly increase the risk of SSIs in patients undergoing hip fracture surgery. Proactive treatment of UTIs may be crucial for reducing the incidence of SSIs and improving surgical outcomes in this demographic.

Safety and effectiveness of laparoscopic adult groin hernia repair in Africa: a systematic review and meta-analysis.

Surgery is the recommended treatment of groin hernia, and laparoscopic approach is increasingly accepted due to lower risk of chronic pain. This systematic review aims to evaluate results of laparoscopic groin hernia repair (LGHR) in Africa. We performed a literature search of published studies using electronic databases. Included African articles reported at least one of outcomes after LGHR in adult population. Newcastle-Ottawa Scale was used for quality assessment. A quantitative meta-analysis was performed to estimate the pooled prevalence of the post-operative outcomes. We included 19 studies from 6 countries which totalized 2329 hernia cases. Mean age was 44.5years and male patients were predominant (sex-ratio 19.8). The mean operative time was 69.1min. The pooled prevalence of conversion to open procedure was 2.578% (95% IC: 1.209-4.443). The pooled prevalence of surgical site infection and Hematoma/Seroma was respectively 0.626% (95%IC: 0.332-1.071) and 4.617% (95% IC: 2.990-6.577). The pooled prevalence of recurrence and chronic pain was respectively 2.410% (95% IC: 1.334-3.792) and 3.180% (95% IC: 1.435-5.580). We found that total morbidity for TAPP procedure was higher than TEP procedure (p = 0.0006; OR 1.8443). These results confirm that LGHR is safe and feasible and would be recommended in our African context.

Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta-analysis.

The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and risk factors in patients after knee surgery. A comprehensive and systematic search was carried out across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the Scientific Information Database (SID). This search involved the utilization of keywords derived from Medical Subject Headings, such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics', spanning from the earliest records up to 1 October 2023. To assess the quality of the included studies, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was utilized. The study encompassed a combined participant pool of 11 028 individuals who underwent knee surgery across seven selected studies. The collective prevalence of SSI in patients who underwent knee surgery, as reported in the seven included studies, was determined to be 3.0% (95% CI: 1.2% to 7.5%; I2 = 96.612%; p < 0.001). The combined prevalence of SSI in patients with DM, as reported in six studies, was 5.1% (95% CI: 1.7% to 14.5%; I2 = 79.054%; p < 0.001). Similarly, the pooled prevalence of SSI in patients with HTN, drawn from four studies, was 1.8% (95% CI: 0.7% to 4.5%; I2 = 63.996%; p = 0.040). Additionally, the collective prevalence of SSI in patients with a history of tobacco use, based on findings from six studies, was 4.8% (95% CI: 1.4% to 15.2%; I2 = 93.358%; p < 0.001). Subgroup analysis was conducted within six studies, categorizing them by two countries, namely China and the USA. These analyses revealed that the prevalence of SSI following knee surgery was 3.0% in China and 2.0% in the USA. It is noteworthy that variations in SSI prevalence across different studies may be attributed to a multitude of factors, particularly varying risk factors among patient populations. To address this issue and mitigate the impact of SSI on knee surgery patients, it is advisable to develop tailored interventions.

Prevalence of anaerobic bacteria in surgical site infections in Lagos University Teaching Hospital.

Surgical site infection (SSI) is the second most common cause of nosocomial infection, after urinary tract infection. Sequelae of SSI include increased healthcare costs and worse patient outcomes. There is a paucity of research studies on the impact of anaerobic organisms on SSIs in Nigeria. The aim of this study was to determine the role of anaerobic bacteria in SSI encountered at the Lagos University Teaching Hospital (LUTH). A total of 438 patients were consecutively recruited into this study from general surgery, obstetrics and gynaecology and paediatric units of the LUTH from 1 July through 31 December 2019. Two surgical wound specimens were collected from all patients with suspected SSIs. One was for anaerobic culture using Brucella blood agar incubated in an anaerobic jar that secured anaerobiosis using the anaerobic gas pack. The other swab was used for aerobic culture on blood agar incubated on air at 37oC. Identifications and antibiotic sensitivity testing were performed according to standard laboratory procedures. The overall incidence of SSI in the study was 12.3%. The incidence of anaerobic SSI was 1.1%. The distribution of anaerobic infections by medical specialty unit was as follows; general surgery (1.6%), obstetrics and gynaecology (0.8%) and paediatrics (0.9%). Bacteroides species was the only anaerobic isolate. The risk factors associated with the development of SSI by multiple logistic regression analysis were duration of surgery greater than 2 h (OR 1.418; 95% CI 1.834-9.286; P = 0.001) and NNIS risk index 2 and 3 - (OR 2.165; 95% CI 2.366-32.086; P = 0.001). The prevalence of anaerobic SSI was 1.1%. Duration of surgery greater than 2 h and NNIS risk index 2 and 3 were independent predictors of SSI.

Value of 18 F-FDG PET/CT to Identify Occult Infection in Presumed Aseptic Pseudarthrosis after Spinal Fusion: Correlation with Intraoperative Cultures.

Objective Fluorine-18 fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) has gained attention as an emerging tool in case of suspicion of infection on spine, whether native or instrumented. However, the diagnostic performance of 18 F-FDG PET/CT in clinically occult low-grade surgical site infection (SSI) after spinal fusion, an important risk factor for pseudarthrosis, remains unknown. Methods We retrospectively identified all the presumed aseptic patients with pseudarthrosis confirmed by revision surgery who underwent preoperative 18 F-FDG PET/CT scans performed between April 2019 and November 2022. These patients were presumed aseptic because they did not have clinical signs or laboratory tests suggestive of SSI, preoperatively. The PET/CT images were analyzed in consensus by two nuclear medicine physicians blinded to the clinical, biological, and imaging information. Visual assessment of increased uptake around cage/intervertebral disk space (and/or hardware) higher than background recorded from the first normal adjacent vertebra was interpreted as positive. Image data were also quantitatively analyzed by the maximum standardized uptake value as an index of 18 F-FDG uptake, and the ratio between the uptake around cage/intervertebral disk space (and/or hardware) and background recorded from the first normal adjacent vertebra was calculated. The final diagnosis of infection was based on intraoperative cultures obtained during pseudarthrosis revision surgery. Results Thirty-six presumed aseptic patients with surgically confirmed pseudarthrosis after spinal fusion underwent preoperative 18 F-FDG PET/CT scans. Cultures of samples from revisions found that 20 patients (56%) were infected. The most frequent isolated bacterium was Cutibacterium acnes ( C. acnes ) in 15 patients (75%), followed by coagulase-negative staphylococci (CNS) in 7 patients (33%). Two patients had co-infections involving both C. acnes and CNS. Of the 36 PET/CT studied in this study, 12 scans were true-negative, 10 true-positive, 10 false-negative, and 4 false-positive. This resulted in sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 50%, 75%, 71%, 55%, and 61%, respectively. Conclusion In presumed aseptic pseudarthrosis after spinal fusion, 18 F-FDG PET/CT offers good specificity (75%) but low sensitivity (50%) to identify occult SSI. The high prevalence (56%) of SSI, mostly caused by C. acnes (75%), found in our presumed aseptic cohort of patients supports the utility of systematic intraoperative cultures in revision cases for pseudarthrosis.

Frequency And Risk Factors For Developing Surgical Site Infection In Abbasi Shaheed Hospital

Introduction: Surgical site infections are the most common nosocomial infections worldwide and are also the common problem in developing countries. The impact of its prevalence contributes to morbidity and mortality and therefore the need to determine its prevalence is necessary. Finding out the prevalence of surgical site infections and the frequency of risk variables for surgical site infections in patients undergoing abdominal surgeries at Abbasi Shaheed Hospital in Karachi is the aim of this study. Methodology: This descriptive study was carried out from February 22, 2022- August 22, 2022 at the Abbasi Shaheed Hospital in Karachi with a sample size of 157 subjects with abdominal surgery fulfilling the inclusion criteria. Results: In our study, the mean age, length of operation and BMI were 49.87±8.74 years, 2.14±1.87 hours, 29.72±3 respectively with 61.1% of female and 38.9% male subjects. Out of 157 patients, 22 (14%) and 135 (86%) had and did not have surgical site infection. Conclusion: Patients and the healthcare systems are both heavily impacted by the effects of SSIs. A comprehensive strategy addressing pre-, intra-, and postoperative variables is necessary for the prevention of SSI. In order to lower SSI, hospital infection control procedures should be developed in conjunction with the establishment of an ongoing, long-term surveillance system to detect risk factors.

Prevalence of Surgical Site Infection (SSI) and Its Association With Vitamin D Deficiency.

Surgical site infections (SSIs) are one of the significant complications detected after surgical procedures. Recent studies have highlighted the antimicrobial, wound-healing, and immunological properties of vitamin D. Therefore, this study examined the association between levels of preoperative vitamin D and SSI occurrence in Saudi Arabia. We conducted this retrospective observational study among patients who underwent surgery at King Faisal Medical Complex, Saudi Arabia. We included data from patients who underwent surgery between January 2021 and October 2023 in the study. If vitamin D concentrations were not measured at admission, patients were excluded from the final analysis. The researchers performed statistical analysis using the computer program Statistical Package for Social Sciences (SPSS), version 26.0 (IBM Corp., Armonk, NY). The significant level was considered when the p-value was less than 0.05. The study included 130 patients with a mean (SD) age of 26.98 (9.3) years. Most patients were females (n = 92, 70.8%), had diabetes mellitus disease (n = 121, 93.1%), had a vitamin D deficiency (<30 ng/dl) (n = 106, 81.5%), and underwent cesarean section (n = 80, 61.5%). The mean (SD) vitamin D level among patients was 19.9 (9.7) ng/dl, and the mean (SD) hemoglobin level was almost normal (12.30 (2.1) g/dl). Out of 40.8% (n = 53) of patients, the most detected pathogenic bacteria was Escherichia coli, followed by Staphylococcus aureus (n = 11, 44%, and n = 7, 25%, respectively). Furthermore, vitamin D deficiency significantly impacted positive SSI; patients with insufficient levels had a higher infection rate compared to those with sufficient levels (n = 58, 54.7% vs. n = 7, 29.2%, p-value = 0.024). A longer surgery duration did not increase the risk of SSI (p-value = 0.047). Patients with class 3 wounds were more prone to SSI than those with class 2 wounds (n = 12, 100% vs. n = 53, 44.9%, p-value<0.001). This study provides important evidence supporting the relationship between vitamin D deficiency and SSI incidence. Patients with lower levels of vitamin D reported a higher incidence of SSIs. Healthcare providers should pay attention to the high prevalence of vitamin D deficiency among patients undergoing surgery. Screening for vitamin D deficiency and implementing convenient interventions to optimize vitamin D levels could help reduce the incidence of SSIs. Further research with larger sample sizes, more diverse populations, and different surgery types is necessary to validate these findings and explore additional factors influencing SSI development.

Lower bleeding volume contributes to decreasing surgical site infection in radical cystectomy: A propensity score-matched comparison of open versus robot-assisted radical cystectomy.

To compare the incidence of surgical site infections (SSI) between robot-assisted and open radical cystectomies and investigate the risk factors for SSI after radical cystectomies. Consecutive patients who underwent radical cystectomy between July 2008 and December 2022 were retrospectively reviewed. The prevalence and characteristics of SSI after open and robot-assisted radical cystectomies were compared, and the risk factors for SSI were investigated using propensity score matching. This study enrolled 231 patients (open: 145, robot-assisted: 86). In the robot-assisted group, urinary diversion was performed using an intracorporeal approach. SSI occurred in 34 (open: 28, robot-assisted: 6) patients, and the incidence was significantly lower in the robot-assisted group (19.3% vs. 7.0%, p = 0.007). After propensity score matching cohort (open: 34, robot-assisted: 34), increased bleeding volume, blood transfusion, and delayed postoperative oral feeding were significantly associated with SSI. Only increased bleeding volume remained a significant risk factor in the multivariate regression analysis (odds ratio, 1.13 [per 100 mL increase]; 95% confidence interval: 1.02-1.25; p = 0.001). The cutoff bleeding volume for predicting SSI was 1630 mL with an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.773, 0.73, and 0.75, respectively. The incidence of SSI after robot-assisted radical cystectomy was significantly lower than that after the open procedure. However, decreased bleeding volume, which was significantly associated with robot-assisted procedures, was an independent and more significant factor for reducing SSI after radical cystectomy than the differences of the surgical procedure even after propensity score matching.

Prevalence of and risk factors for surgical site infections after pancreaticoduodenectomy: a systematic review and meta-analysis.

Surgical site infections (SSIs) are one of the most common complications after pancreaticoduodenectomy (PD); however, the global prevalence and risk factors for SSIs after PD remain unknown. To investigate the prevalence of and risk factors for SSIs after PD. The PubMed, Embase, Cochrane Library, Web of Science, and Science Direct databases were systematically searched from inception to 1 December 2022. Observational studies reporting adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of risk factors for SSIs in patients undergoing PD were included. Two independent reviewers in teams performed data extraction, risk of bias assessment, and level of evidence analysis. The pooled results were estimated using a random-effects model. The I 2 statistic and Q χ 2 statistic were used to assess heterogeneity. Funnel plots, Egger's regression test, and the trim-and-fill method were used to determine publication bias. The primary outcomes were identifying risk factors for SSIs after PD. The secondary outcomes were the pooled prevalence rates of SSIs. A total of 98704 patients from 45 studies were included, and 80% of the studies were considered high quality. The estimated pooled prevalence of SSIs was 23% (0.19-0.27, I 2=97%). The prevalence of SSIs was found to be higher in Japan and lower in USA. Preoperative biliary stenting, higher body mass index (BMI), longer operation time, postoperative pancreatic fistula, soft pancreatic texture, perioperative blood transfusion, and cardiac disease were identified as significant risk factors for the development of SSIs after PD. Additionally, broad-spectrum antibiotics were a significant protective factor against SSIs. Subgroup analysis and sensitivity analysis showed that the results were robust. The prevalence of SSIs remains high and varies widely among regions. It is necessary to take effective preventive measures and carry out more prospective studies to further verify these results.

Plating versus Intramedullary Nailing of OTA/AO 43C1 and C2 Intra-articular Distal Tibia Fractures: A Propensity Score and Multivariate Analysis.

To compare rates of loss of reduction, nonunion, and infection in intra-articular distal tibia fractures (IADTF) treated with limited open reduction internal fixation and intramedullary nailing (IMN) as compared to open reduction internal fixation with plate and screws (PF). Retrospective Review. Level-I academic trauma center. 110 patients, age ≥ 18 with operatively treated OTA/AO 43C1 and C2 IADTF between 2013-2021. Loss of reduction, surgical site infection (SSI), nonunion, and patient-reported outcomes (PROs). 110 patients met the inclusion criteria (IMN 33, PF 77). There was no loss of reduction reported. 17 nonunions (15% overall; IMN 4/33, PF 13/77) and 13 SSIs (12% overall; IMN 2/33, PF11/77) were identified. Despite several risk factors being identified for nonunion and SSI in bivariate analysis, only open fracture remained significant as a risk factor for both nonunion (OR 0.09 for closed fracture, 95% CI 0.02-0.56, p=0.009) and SSI (OR 0.07 for closed fracture, 95% CI 0.06-0.26, p=0.012) in the multivariate model. Propensity scoring based on presurgical variables was significantly different between patients that received IMN vs PF (p=0.03); however, logistic regression incorporating the propensity score revealed no significant association with nonunion and SSI. Adjusting for the propensity score, there remained no association comparing IMN versus PF with nonunion and SSI (p=0.54 and p=0.17, respectively). There was also no difference in PROs between IMN and PF (Physical function: p=0.25, Pain interference: p=0.21). Overall nonunion and SSI prevalence in our cohort was 15% and 12%, respectively, in operatively treated OTA/AO 43C1 and C2 IADTF. An open fracture is a significant risk factor for nonunion and SSI. Metaphyseal fixation via IMN or PF in IADTF did not affect the loss of reduction, nonunion, SSI, and PROs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Late and Persistent Symptoms Suggestive of Surgical Site Infections After Cesarean Section: Results from a Prospective Cohort Study in Rural Rwanda.

Background: Women in low-resource settings will likely develop late surgical site infections (SSIs), diagnosed after post-operative day (POD) 10. We measured SSI prevalence and predictors of late and persistent SSIs-suggestive symptoms among women who delivered via cesarean section (c-section). Patients and Methods: Women who underwent c-sections at Kirehe District Hospital (KDH) between September 2019 and February 2020 were prospectively enrolled. Data were collected on POD1, POD11, and POD30. Logistic regression identified factors associated with persistent and late SSI symptoms. Results: In total, 808 women were study enrolled. Of these, 646 women physically attended the POD11 clinic visit follow-up, while 671 received the POD30 telephone-based follow-up review. Thirty-three (5.0%) women were diagnosed with an SSI on POD11, and 39 (5.3%) had an SSI diagnosis during POD11 to POD30, giving a cumulative prevalence of 10.3% late SSI rate. Of 671, 400 (59.9%) reported at least one SSI-associated symptom between POD11 and POD30. The reported symptoms included pain (56.6%), fever (19.4%), or incision drainage (16.6%). Of these, 200 women reported still having at least one of these symptoms on POD30. Of the 400 women with late SSI symptoms, 232 (58.0%) did not seek care, and of these, 80 (48.5%), 59 (35.8%), and 15 (8.9%) could not afford transport fare, did not believe symptoms were severe for a medical visit, and were not able to travel, respectively. Lower odds of late SSI-suggestive symptoms were reported among women with health insurance (adjusted odds ratio [aOR], 0.06; p = 0.013), whereas higher late SSI-suggestive symptoms odds were among women with wealthier socioeconomic status (aOR, 2.88; p = 0.004). Conclusions: Women in rural Rwanda are at risk of late and persistent SSI-suggestive symptoms. Financial barriers and the perception that their symptoms were not serious enough for the medical visit need education on early care seeking and interventions to mitigate financial barriers for optimizing perinatal care.

961. Prevalence of Surgical Site Infections and Bacteremia in Pediatric Patients Receiving Extracorporeal Membrane Oxygentaion

Abstract Background Extracorporeal membrane oxygenation (ECMO) is a well-known type of advanced life support used in critically ill patients with serious heart and/or lung problems. ECMO treatment is associated with multiple life-threatening complications. The objectives of this study were to identify the prevalence of surgical site infections (SSI) and bloodstream infections (BSI) along with the associated risk factors and outcomes in patients on ECMO. Methods In this retrospective study, clinical charts of patients were reviewed from January 2012 to April 2023. All admitted pediatric patients 14 years or less who received ECMO treatment were enrolled. Mann-Whitney and Fisher exact tests were used to assess mortality-related risk factors. Results A total of 165 patients were included in the study, 79 (47.88%) females and 86 (52.12%) males, with a median age of 4 [IQR 0.8-24] months. BSI were found in 33 (20%) of them, 10 (30.30%) were gram-positive, 25 (75.75%) were gram-negative, and 6 (18.18%) were fungi. Furthermore, 33 (20%) developed SSI. The overall mortality rate in this study is (50.30%) with a median duration from ECMO procedure initiation to death being 11 [IQR: 5-26] days. Most of mortalities (78.31%) were noticed in infants aged ≤24 months. Compared with patient with neither SSI nor BSI, patients with SSI and BSI had a higher mortality rates of 19 (22.89%) and 16 (19.28%) respectively. Additionally, other noted complications were mediastinitis 4 (2.42%), sternal osteomyelitis 2 (1.21%), infective endocarditis 4 (2.42%). Younger age and thrombocytopenia were found to be a mortality related risk factors (P value 0.04 and 0.01 respectively). Conclusion Our study found a high rate of bacteremia and SSI in pediatric patients receiving ECMO. Younger age, thrombocytopenia were the potential risk factors associated with higher mortality rates in this group. Disclosures All Authors: No reported disclosures

Prevalence of surgical site wound infection after spine surgery in nasal colonization of methicillin-resistant Staphylococcus aureus: A meta-analysis.

The purpose of the meta-analysis was to evaluate and compare the prevalence of surgical site infection (SSI) after spine surgery (SS) in nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random- or fixed-effect models. For the current meta-analysis, 14 examinations spanning from 2014 to 2022 were included, encompassing 18 410 people who were tested for nasal colonization after SS. MRSA-positive had a significantly higher SSI (OR, 3.65; 95% CI, 2.48-5.37, p < 0.001) compared with MRSA-negative in SS subjects. However, no significant difference was found between methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus negative (OR, 0.94; 95% CI, 0.32-2.79, p = 0.91), and Staphylococcus aureus positive and negative (OR, 2.13; 95% CI, 0.26-17.41, p = 0.48) in SS subjects. The examined data revealed that MRSA colonization had a significant effect on SSI; however, methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus had no significant effect on SSI in SS subjects. However, given that some comparisons included a small number of chosen studies, attention should be given to their values.

INCIDENCE AND PREDICTORS OF SURGICAL SITE INFECTION IN MAJOR ABDOMINAL SURGERIES AT A TERTIARY CARE CENTER IN DELHI

Objective: Surgical site infections (SSIs) are the third commonly stated nosocomial infections, with the prevalence rate of 14–16%. In India, the prevalence of SSIs in elective surgeries ranged from 3.83% to 39% and in cases of emergency surgeries, the prevalence ranged from 12.41% to 26.4%. This study was aimed to measure the occurrence of SSIs amid subjects experiencing major abdominal surgeries at tertiary care center in Delhi and to assess the predictors related to occurrence of SSIs in these subjects. Methods: In this cross-sectional study, data were collected over a period of 1 year at the Department of Surgery, Super Specialty Hospital in New Delhi. The, from January 2017 to January 2018. All major gastrointestinal surgeries were considered. Sociodemographic details, clinical history, and surgical details were taken. Results: Out of total 626 patients, 42 (6.7%) developed SSIs. The positive predictors of SSIs in our study were male gender, American Society of Anesthesiology grade of 2 and above, wound class of two and above, longer duration of surgery, emergency surgery, open surgery, laparoscopic converted to open surgery, presence of comorbidities, presence of hypoalbuminemia, and hypoproteinemia. Conclusion: SSIs seems to be a common source of perioperative morbidity and mortality, leading to increased hospital stay and cost of treatment. Proper planning and accordingly managing such case by case scenarios can lead to decreased incidence of SSIs and help reducing burden to the health system.

Effectiveness of Gentamicin Wound Irrigation in Preventing Surgical Site Infection During Lumbar Spine Surgery: A Retrospective Study at a Rural Teaching Hospital in India.

Surgical site infections (SSIs) are an opposing result of surgery and account for the majority of healthcare-related infections worldwide. It is one of the most common complications associated with open-spine surgery and is associated with high rates of mortality and high demand for healthcare resources. Surgical site infections are the result of a variety of reasons, which is why a range of prevention strategies have been proposed. Intraoperative wound irrigation (IOWI) is a simple procedure that involves moving a solution through an open wound to help hydrate the tissue. It is a type of prophylactic wound irrigation. It removes and dilutes bodily fluids, bacteria, and cellular debris. It may also act as a bactericidal agent when used with antibiotics and antiseptics. To evaluate the incidence of SSIin lumbar spine surgeries by comparing IOWI with normal saline containing gentamicin (NS-G) and normal saline (NS) alone. A hospital-based retrospective study was conducted among 40 patients who underwent elective lumbar spine surgery at the Department of Orthopaedics, RL Jalappa Hospital Centre, Kolar, Karnataka, India. Out of the total participants enrolled, 60% were males and 40% were females. There was no statistically significant difference found between mean age, mean BMI, mean hemoglobin level, mean WBC counts, and mean fasting blood sugar (FBS) levels among both groups. The overall prevalence of SSI among patients was 25%. In Group A (NS-G), the prevalence of SSI was 15%, and in Group B (NS), it was 35%. In total, 17.5% of study participants had superficial SSI, while 7.5% had deep SSI. Gentamicin, an aminoglycoside antibiotic, is bactericidal and efficient against gram-positive organisms likeStaphylococcus, the most frequent pathogen causing SSI in spine surgery. During lumbar spine surgery, IOWI with saline and gentamicin before closure is more effective in preventing SSI than simple saline irrigation.