Prevention Of Postsurgical Infections Research Articles

Glycosiled hemoglobin a factor allied in the prevention of post-surgical infection of the diabetic foot

Glycosiled hemoglobin a factor allied in the prevention of post-surgical infection of the diabetic foot

Effects of Prolonged Empirical Antibiotic Administration on Post-Surgical Intestinal Bacterial Flora of Local Dogs Undergoing Non-Laparoscopic Gastrectomy

Prolonged post-surgical antibiotic administration may be of less advantage in prevention of post-surgical infections. This study therefore, aimed at investigating the prolonged effect of empiric administration of three most-prescribed antibiotics (amoxicillin, cefotaxime and oxytetracycline) by veterinary practices in Southwest Nigeria on intestinal bacterial population of dogs undergoing partial, non-laparoscopic gastrectomy. Using conventional quantitative and qualitative microbial culture procedures, the total bacterial populations were mostly too numerous to count (TNTC) before gastrectomy but log103-105 cfu/mL after, while control were log 105-107 cfu/mL after gastrectomy. On general-purpose, special, differential and selective culture media, total bacterial counts with increasing post-operative days were- amoxicillin (11 mg/kg) day 4: log 105-10-9/TNTC cfu/mL vs. day 8: log 103-105 cfu/mL; cefotaxime (25 mg/kg) day 4: log 103-108/TNTC/cfu/mL vs. day 8: log 102-105 cfu/mL; oxytetracycline (10 mg/kg) day 4: log 104-109 TNTC cfu/mL vs. day 8: log 102-106 cfu/mL. Total bacterial counts of control animals were- day 4: log 105-108/TNTC cfu/mL vs. day 8: log 105-109. Total qualitative populations of predominant, easily-recoverable aerobic and anaerobic rectal canine bacteria, >Bacillus, Citrobacter aerogenes, Clostridium, E. coli, Klebsiella, Enterobacter, Proteus, Pseudomonas, Salmonella, Shigella, Streptococcus, Staphylococcus and lactobacilli were significantly less after gastrectomy but reductions in post-operative bacterial populations were mostly more pronounced among the anaerobes (lactobacilli and Clostridium perfringens). No post-operative infection was recorded among all the experimental animals, including the control animals. In conclusion, this study confirmed significant reduction effect of prolonged empiric antibiotic administration on rectal (intestinal) bacterial populations of experimental local dogs that had partial, non-laparoscopic gastrectomy.

Porous orthopedic steel implant as an antibiotic eluting device: Prevention of post-surgical infection on an ovine model

Traumatology and orthopedic surgery can benefit from the use of efficient local antibiotic-eluting systems to avoid bacterial contamination of implanted materials. In this work a new percutaneous porous-wall hollow implant was successfully used as a local antibiotic-eluting device both in vitro and in vivo. The implant is a macroporous 316 L stainless steel filter tube with a nominal filtration cut-off size of 200 nm with one open end which was used to load the synthetic antibiotic linezolid and an opposite blind end. The antibiotic release kinetics from the device on a simulated biological fluid under in vitro conditions demonstrated an increased concentration during the first five days that subsequently was sustained for at least seven days, showing a kinetic close to a zero order release. Antibiotic-loaded implants were placed in the tibia of four sheep which were trans-surgically experimentally infected with a biofilm forming strain of Staphylococcus aureus. After 7 and 9 days post infection, sheep did not show any evidence of infection as demonstrated by clinical, pathological and microbiological findings. These results demonstrate the capability of such an antibiotic-loaded implant to prevent infection in orthopedic devices in vivo. Further research is needed to assess its possible use in traumatology and orthopedic surgery.

Exploring New Strategies for Infection Treatment

Although many improvements have been made regarding the prevention of post-surgical infection during the last few decades, implant-related infections remain an important and challenging clinical problem. With the ever-increasing number of total joint arthroplasties implanted annually and the increasing emergence of antibiotic-resistant bacteria, this challenge will be even greater in the near future. Whereas most resistant bacteria can still be treated with last-resort antibiotics such as linezolid and carbapenems, more and more multiresistant species for which there is currently no available antibiotic treatment are being found. This forces us to look at antimicrobial options outside of the traditional field of antibiotics. The efficacy of various potential new strategies has already been investigated in vitro and in vivo. These strategies included the use of antiseptics, antimicrobial peptides, silver, and autologous platelet-rich gel. Most studies have investigated the efficacy of these strategies in the prevention of implant-related infections rather than the treatment of such infections. Despite the promising results of some strategies, almost none have reached the clinical application phase. The authors of the current study investigated another novel strategy against implant-related infections—the use of bacteriophages as antimicrobial agents. Although the use of bacteriophages for this particular indication is novel, the use of bacteriophages to treat infection is actually …

Climate Change: It's Not About the Weather-Continuing Medical Education and Maintenance of Certification and Licensure.

Carol Havens, MD Jeffrey Mallin, MD State of Health Care in the US Many feel that the impending acceleration of global warming is the greatest threat that our species has ever faced. Less arguable but already having an impact is a drastic climate change in health care. Not only is it shaking up health care delivery and insurance, but its effects are visible on the education, training, certification, and accreditation systems of physicians and other health care professionals and organizations throughout the US. The US public is increasingly questioning medical care. Well-publicized cases of poor quality of care, wide variations in practice, embarrassing failures to achieve good patient outcomes (such as routine preventive care, hypertension control, management of chronic disease, and prevention of postsurgical infections), escalating health care costs, and interactions between physicians and commercial entities have led to increasing public outcry and legislative scrutiny. It seems as if Mother Nature’s vengeance is palpable already. In 2001, the Institute of Medicine described US health care in crisis, with 30-40% of patients not getting evidence-based care and with 25% of the care delivered not needed or actually harmful to patients. Evidence demonstrates overuse, underuse, and misuse, even in situations with appropriate access to care. A whole alphabet soup of health care-related organizations and groups has been trying to develop better methods of oversight in their areas of control. Fortunately, all those groups are also now aligning around the common goal of improving patient care and protecting the public through a focus on performance assessment and improvement. They are creating systems that actually support each other rather than generate differing and sometimes bewildering requirements. Realistically, physicians are only one part of the problem, and that means that we’re only one part of the solution. The systems and environments in which we practice, access to care, other health care professionals, and patients themselves play significant roles, too. But the challenge for us as physicians is to see how our role is changing and how the “be all and end all” is “Quality” of care (with a capital Q). There are many factors driving up the Quality of care, and these include respected quality constructs (such as, Plan-Do-Study-Act and Six Sigma), electronic health records (such as, Kaiser Permanente HealthConnect), clinical decision support systems, public reporting, and pay for performance. There is also a relatively new construct called Continuous Professional Development. Think of it as Continuing Medical Education (CME) Version 2.0.

Predicting bacterial populations based on airborne particulates: A study performed in nonlaminar flow operating rooms during joint arthroplasty surgery

Prevention of postsurgical infection is preferable to treatment. Prevention requires identification and control of the potential sources of microbial contamination. This study investigated whether the density of airborne particulates can predict the density of viable airborne bacteria at the surgery site. A standard particle analyzer was used to measure the number and diameter of airborne particulates during 22 joint arthroplasty surgeries. An impact air sampler and standard culture plates were used to identify and count colony-forming units (CFU). Particulate density averaged >500,000 particles/m(3) per 10-minute interval, and 1786 CFU were identified, primarily gram-positive cocci. A particle density > or = 10 microm explained 41% of the variation in CFU density. Particle and CFU density increased with longer surgery duration and higher staff counts. These findings support the use of environmental controls that isolate and protect the surgical site from airborne particulates and contamination.

Prevention of postsurgical infections: some like it hot

Purpose of the review The present review covers the literature on prevention of surgical site infections published during 2001. Only papers that offer new insights or question current recommendations are included. Recent findings The most interesting advances have been made in the preoperative preparation of the patient. In particular, the effects of preoperative warming of the patient, either generally or locally at the incision site, on the rate of surgical site infections are impressive and warrant further investigation. Also, the effects of strict control of perioperative blood glucose levels and of preoperative eradication of nasal carriage of Staphylococcus aureus should be studied in greater detail. Summary The protective effect of local and systemic warming before surgical procedures has been described in two well designed studies. Although a final judgement regarding effectiveness can only be made after more extensive investigations have been conducted, there appear to be few arguments against application of this cheap and safe measure. Thus, implementation of preoperative warming can be justified in settings associated with high rates of surgical site infections.

Prevention of postsurgical infections: some like it hot.

The present review covers the literature on prevention of surgical site infections published during 2001. Only papers that offer new insights or question current recommendations are included. The most interesting advances have been made in the preoperative preparation of the patient. In particular, the effects of preoperative warming of the patient, either generally or locally at the incision site, on the rate of surgical site infections are impressive and warrant further investigation. Also, the effects of strict control of perioperative blood glucose levels and of preoperative eradication of nasal carriage of Staphylococcus aureus should be studied in greater detail. The protective effect of local and systemic warming before surgical procedures has been described in two well designed studies. Although a final judgement regarding effectiveness can only be made after more extensive investigations have been conducted, there appear to be few arguments against application of this cheap and safe measure. Thus, implementation of preoperative warming can be justified in settings associated with high rates of surgical site infections.

Wirksamkeit und Verträglichkeit zweier Zephalosporine in der perioperativen Antibiotikaprophylaxe bei abdominalen und vaginalen Hysterektomien und gynäkologischen Laparotomien

Ziel der vorliegenden Untersuchung war es, die Wirksamkeit und Verträglichkeit zweier Zephalosporine in der perioperativen Antibiotikaprophylaxe bei Patientinnen, die einer abdominalen oder vaginalen Hysterektomie oder einer gynäkologischen Laparotomie unterzogen wurden, zu testen, um die Rate postoperativer Störungen der Wundheilung zu verringern. Insgesamt wurden 199 Patientinnen prospektiv in zwei Gruppen randomisiert. Die erste Gruppe (n = 100) erhielt perioperativ 1 g Cefotiam (Spizef^®) und 0,5 g Metronidazol (Clont^®) intravenös 30 min vor der Operation, während die zweite Gruppe (n = 99) 2 g Cefoxitin (Mefoxitin^®) intravenös erhielt, ebenfalls 30 min vor der Operation. Die Wirksamkeit der Prophylaxe wurde sowohl klinisch als auch aufgrund von laborchemischen Parametern objektiviert. Bei 97 Patientinnen (97%) der Cefotiam-Gruppe und bei 94 Patientinnen (94%) der Cefoxitin-Gruppe traten keine Wundheilungsstörungen auf. Keine postoperativen systemischen Infektionen wurden bei 81% der Cefotiam-Gruppe und 85% der Cefoxitin-Gruppe beobachtet. 98% der Patientinnen der Cefotiam-Gruppe und 97% der Patientinnen der Cefoxitin-Gruppe wiesen eine sehr gute bzw. gute Verträglichkeit der Medikation auf. In beiden Gruppen traten, durch die Antibiotikaprophylaxe bedingt, jeweils nur bei 3 Patientinnen Übelkeit bzw. Erbrechen auf. Die Untersuchung ergab im gesamten Kollektiv sehr niedrige Infektionsraten. Cefotiam in niedriger Dosierung und Metronidazol waren genauso wirksam wie Cefoxitin. Zephalosporine der zweiten Generation in Kombination mit Metronidazol können daher als sehr wirksame und nebenwirkungsarme Antibiotika bei der Prophylaxe lokaler Infektionen angesehen werden.

犬におけるサルファジメトキシンの応用

Sulfadimethoxin (SD) is regarded as a new longacting sulfonamide. In this investigation, the blood level of SD was determined following the administration by six different methods in dogs. The dru also examined for was effect on the prevention of post-surgical infection in dogs.The blood level rose very quickly to an effective extent after an intravenous, intramuscular, or subcutaneous injection of 40 mg of SD per kg of body weight. This effective level was maintained for more than 12 hours.In the case of an oral administration of the same dose, the blood level rose slowly, reaching only 5.3 mg%, on the average, after six hours, and fell down also quite slowly.When intravenous injections were combined with either subcutaneous or oral administration, the blood level rose quickly to an effective level, which was maintained for more than 24 hours. It was found that when an effective blood level was maintained for more than 24 hours, and when subcutaneous or oral administration was repeated every 24 hours, the effective blood level could be maintained for a long time.Fifteen cases of Mann-Williamson's experimental operation and forty cases of ovariectomy were subjected to clinical experiments in order to determine the effect of SD on the prevention of post-surgical infection. The operative wounds were observed to the point of complete healing, and satisfactory results were obtained.