Prevention Of Postoperative Infection Research Articles

Effect of Different Local Antibiotic Regimens on Prevention of Postoperative Infection in Clean Surgical Wounds: A Systematic Review and Network Meta-analysis.

To compare the efficacy of several local antibiotic regimens in preventing surgical site infection (SSI) in clean surgical wounds. The authors searched CNKI (China National Knowledge Infrastructure), the VIP (VIP information resource integration service platform), Wanfang Data knowledge service platform (WANFANG), SinoMed, Cochrane Library, EMBASE, and PubMed. A total of 20 randomized controlled trials published between January 1, 2000 and April 1, 2021 were included in this meta-analysis. Authors extracted the name of the first author, publication date, country, type of surgery, follow-up time, mean age of participants, sample size of each group, interventions, outcome indicators, and study type from each article. The overall effectiveness of eight local managements in reducing the incidence of the SSI effect were compared through the SUCRA (surface under the cumulative ranking curve) probabilities. The results of a network meta-analysis demonstrated that gentamicin ointment (odds ratio [OR], 0.16; 95% CI, 0.04-0.60), mupirocin ointment (OR, 0.44; 95% CI, 0.21-0.94), and gentamicin soaking of the graft (OR, 0.63; 95% CI, 0.44-0.91) significantly reduced the incidence of SSI compared with control. Further, vancomycin soaking of the graft (86.7%) ranked first, followed by gentamicin ointment (81.1%), gentamicin irrigation (79.9%), mupirocin ointment (56.8%), triple antibiotic ointment (47.8%), gentamicin soaking of the graft (42.3%), and vancomycin powder (22.1%); ampicillin powder (17.8%) was the least effective drug. The findings indicate that local antibiotics combined with conventional antibiotics in the wound before wound closure are effective in reducing the incidence of SSI in clean surgical wounds. Vancomycin inoculation of the graft exhibited the best effect.

A Comparative Review of the Efficacy of 24-HourVersus 48-Hour Dose Regimen of Amoxicillin/Clavulanic Acid Prophylaxis forpostoperative infections following elective Caesarean Section at the University College Hospital, Ibadan, Nigeria: A Randomized Clinical Trial

Objectives: To compare the efficacy of 24hour versus 48hour prophylaxis of amoxicillin/clavulanic acid in the prevention of postoperative infections. Study Design: This study was a randomized controlled clinical trial conducted in a tertiary hospital in Ibadan, Nigeria. Two hundred and fifty -two pregnant women scheduled for elective caesarean section were randomly assigned into two groups. After the initial pre-incision antibiotic administration, group A received the Amoxicillin/Clavulanic Acid for 24 hours while group B received the same drug for 48hours. Main Outcomes: Participants were examined on the 3rd, 10th and 17th post-operative days for evidence of infections. All entry and analysis of data was by computer using the Statistical Package for Social Sciences version 22 (IBM, New York). Statistically significant differences were determined at p value of < 0.05. Results: The incidence of postoperative wound infection, postoperative fever and endometritis in this study was 5.2%, 9.1% and 5.6% respectively. There was no significant differences in the incidence of postoperative wound infection, postoperative fever and endometritis between the two regimens of antibiotics. Conclusion: A 24-hour prophylactic regimen of amoxicillin/clavulanic acid is adequate following caesarean section and prolonged use of antibiotics is generally unnecessary, costly and inadvertently increases antibiotics resistance

Recent trends in organ-preserving pancreatectomy: Itsproblems and clinical advantages compared with other standard pancreatectomies.

In this review article, we focus on recent papers on organ-preserving pancreatectomy procedures published since 2010. When comparing central pancreatectomy (CP) and distal pancreatectomy (DP), most studies have concluded that the CP group exhibited significantly lower incidence of new-onset diabetes or diabetes exacerbation than the DP group postoperatively. However, because of increased incidence of morbidities such as pancreatic fistula, the surgeon faces a considerable trade-off between increased short-term morbidity and long-term preservation of endocrine function. When the outcomes of two types of spleen-preserving DP (Kimura and Warshaw procedures) are compared, most studies mentioned the low incidence of postoperative gastric varices and splenic infarction with the Kimura procedure. Although there are several reports regarding the effect of spleen preservation on prevention of postoperative infections, no report on the contribution of spleen preservation to the prevention of overwhelming post-splenectomy infection is seen. The advantages of duodenum-preserving pancreatic head resection (DPPHR) concerning endocrine and exocrine functions continue to be subjects of discussion, mainly due to the limited number of institutions that have adopted this approach; however, DPPHR should be presented as an option for patients due to its low incidence of postoperative cholangitis. Organ-preserving pancreatectomy requires meticulous surgical techniques, and postoperative complications may increase with this surgery compared with standard pancreatectomy, which may be influenced by the surgeon's skill and the surgical facility where the procedure is performed. Nonetheless, this technique has significant long-term advantages in terms of endocrine and exocrine functions and its wider adoption in the future is expected.

Factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients: A single-center retrospective study.

At present, many studies have reported the risk factors for postoperative intracranial reinfection, including age, sex, time to surgery, duration of postoperative catheterization, emergency procedures, type of disease and cerebrospinal fluid leakage, but the academic community has not reached a unified conclusion. To find factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients. Ninety-four patients who underwent elective craniotomy from January 1, 2015 to December 31, 2022 in the Department of Neurosurgery, First Hospital of Jilin University, were included in this study. Of those, 45 patients were enrolled in the infection group, and 49 were enrolled in the control group. The clinical data of the patients were collected and divided into three categories, including preoperative baseline conditions, intraoperative characteristics and postoperative infection prevention. The data were analyzed using SPSS 26.0 software. There were 23 males and 22 females in the infection group with a mean age of 52.8 ± 15.1 years and 17 males and 32 females in the control group with a mean age of 48.9 ± 15.2 years. The univariate analysis showed that the infection group had higher systolic blood pressures and postoperative temperatures, fewer patients who underwent a supratentorial craniotomy, more patients with a history of hypertension and higher initial postoperative white blood cell counts than the control group, with statistically significant differences (P < 0.05). The multifactorial logistic regression analysis showed that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative infection in neurosurgical patients. The results obtained in this study indicated that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative neurological symptoms.

Post caesarian section surgical site infections. Review of current literature

Caesarean delivery rates have increased globally during the past three decades. Caesarean delivery is the most important obstetrical procedure performed with complications that consist of postpartum hemorrhage, endometritis, thromboembolic events or incision infections. While surgical site infections (SSIs) complicate 1.9% of all surgeries performed, the incidence of SSIs after caesarean delivery is significantly higher, almost 7-10%, constituting an important cause of increased morbidity, mortality, readmission, prolonged hospitalization and increased health care costs worldwide. Incisional infection after caesarean delivery happens in 2-7% of cases, necrotizing fasciitis in 0.18% and endometritis in 2-16%. Many risk factors for SSIs have been described. This review includes the several risk factors that have been identified in women who developed post-caesarean section surgical site infections. We also provide an overview of strategies for prevention of postoperative infections including antibiotic prophylaxis, surgical techniques, management of wound infections. Criteria of diagnosis for SSIs are also given, as well as current treatment regimens. Given the impact of maternal post-caesarean infection, it is important for gynecologists to understand how to prevent these postoperative infections, as well as recognize and treat them.

Postoperative Supplemental Oxygen in Liver Transplantation (PSOLT) does not reduce the rate of infections: results of a randomized controlled trial

BackgroundDespite inconsistent evidence, international guidelines underline the importance of perioperative hyperoxygenation in prevention of postoperative infections. Further, data on safety and efficacy of this method in liver transplant setting are lacking. The aim was to evaluate efficacy and safety of postoperative hyperoxygenation in prophylaxis of infections after liver transplantation.MethodsIn this randomized controlled trial, patients undergoing liver transplantation were randomly assigned to either 28% or 80% fraction of inspired oxygen (FiO2) for 6 postoperative hours. Infections occurring during 30-day post-transplant period were the primary outcome measure. Secondary outcome measures included 90-day mortality, 90-day severe morbidity, 30-day pulmonary complications, durations of hospital and intensive care unit stay, and 5-day postoperative bilirubin concentration, alanine and aspartate transaminase activity, and international normalized ratio (INR) (clinicatrials.gov NCT02857855).ResultsA total of 193 patients were included and randomized to 28% (n = 99) and 80% (n = 94) FiO2. With similar patient, operative, and donor characteristics in both groups, infections occurred in 34.0% (32/94) of patients assigned to 80% FiO2 as compared to 23.2% (23/99) of patients assigned to 28% FiO2 (p = 0.112). Patients randomized to 80% FiO2 more frequently developed severe complications (p = 0.035), stayed longer in the intensive care unit (p = 0.033), and had higher bilirubin concentration over first 5 post-transplant days (p = 0.043). No significant differences were found regarding mortality, duration of hospital stay, pulmonary complications, and 5-day aspartate and alanine transaminase activity and INR.ConclusionsPostoperative hyperoxygenation should not be used for prophylaxis of infections after liver transplantation due to the lack of efficacy.Trial registrationClinicalTrials.gov NCT02857855. Registered 7 July 2016.

SG-APSIC1207: Effectiveness of a surgical-site infection bundle in reducing postoperative infection in cesarean deliveries in a tertiary-care teaching hospital in Malaysia

Objectives: Surgical-site infections (SSIs) cause significant increases in mortality, morbidity, and prolonged hospitalization after cesarean deliveries. We assessed the effectiveness of the implementation of an SSI bundle in reducing postoperative infections in cesarean deliveries in a tertiary-care teaching hospital in Malaysia. Method: We conducted a quality-improvement study on all women who underwent labor and scheduled cesarean sections at the University Malaya Medical Center (UMMC) between May and December 2020. The preintervention period was May–June 2020 and the postintervention period was September–December 2020. Patients were followed for 90 days after their operation. Before the intervention, SSI rates and compliance with prevention practices were documented. A multidisciplinary team was formed, and education regarding the elements of the SSI prevention bundle was conducted before they were implemented. The care bundle focused on monitoring compliance with preoperative bathing, contact time for skin preparation, hair management, and antibiotics prophylaxis given within 60 minutes prior to incision, as well as patient education. Result: With the implementation of the SSI bundle, we observed a significant reduction in the SSI rate by 50%, from 7 per 100 procedures to 2 per 100 procedures. Compared with the preintervention period, overall compliance with bundle elements improved greatly for preoperative bathing (0 vs 95.7%) and contact time for skin preparation (0 vs 98.8%). In the postintervention period, the method of hair removal was documented, compared to no documentation during the preintervention period. The administration of prophylactic antibiotics within 60 minutes prior incision decreased from 99% to 92.3%. Conclusion: Implementation of an SSI prevention bundle successfully reduced the rate of SSI after cesarean section. The SSI prevention bundle together with improvements by multidisciplinary teams and a good patient-safety culture helped reduce SSI rates. Patient education on pre- and postoperative infection prevention also played an important role in reducing this infection rate.

PREFORMULATION STUDY OF CEFTRIAXONE AND CIPROFLOXACIN FOR LIPID BASED DRUG DELIVERY SYSTEMS

Several tests should be performed to rule out any potential physical or chemical interactions between the active pharmaceutical ingredient and the various excipients that might be utilized in the manufacturing of the drug formula. Fourier Transform infrared spectroscopy is a simple technique for the detection of changes within excipient-drug mixtures. In addition to speeding up the aging process of drugs and their possible interactions with excipients, isothermal stress testing was achieved. In this study, Ceftriaxone sodium (CTX), and Ciprofloxacin hydrochloride (CIPRO) as active ingredients were subjected to several tests to exclude any interaction with the excipients that could be used in the formulation of lipid base biodegradable antibiotic for prevention of post-operative infection. The compatibility was tested by using Fourier Transform infrared spectroscopy (FT-IR) and isothermal stability testing (IST). As a result, the IR spectral interpretation showed that the spectra obtained from the binary mixtures match the original spectra of API. Generally, there was no obvious and influential change of any characteristic peaks which confirms the absence of chemical interaction between the CTX or CIPRO and excipients. In the IST, the API – excipient mixture shows no significant change in physical properties. There was no change in color, gas formation, and liquefaction of the mixture stored under stress conditions. There was no significant change in the amount of API after storage in stressed conditions at statistical significance (p = 0.05). In conclusion, there are no notable interactions between API and the various excipients that could be employed to create biodegradable lipid-based delivery systems that are effective at preventing post-operative infection.

Effect on Cellular Vitality In Vitro of Novel APRF-Chlorhexidine Treated Membranes.

Chlorhexidine (CHX) has been used for some time in clinical practice as a local antiseptic agent with excellent efficacy. The combination of CHX with APRF (Advanced-platelet rich fibrin) membrane has the potential to stimulate tissue regeneration and to provide a bactericidal effect. We hypothesize that this may reduce the rate of infections development and protect cell viability. The aim of this study was two-fold-to create a stable APRF membrane treated with different concentrations of CHX (0.01% and 0.02%) and to monitor its effect on the viability of PDL cells in vitro. This benefits the introduction of a new protocol for APRF membrane production -CHX-PRF and enriches the available evidence on the effect of this antiseptic agent on PDL (Periodontal ligament) cells. APRF membranes were prepared by the addition of two concentrations (0.01% and 0.02%) of CHX. Membranes without the antiseptic were also prepared and used as control samples. PDL cells were cultivated on the membranes for 72 h. Cell number and vitality were examined by fluorescent cell viability assays. Our results demonstrated that a concentration of 0.01% CHX allowed the production of a stable APRF membrane. This concentration slightly reduced the viability of PDL cells to 96.7%, but significantly decreased the average number of cells attached to the membrane-149 ± 16.5 cells/field compared to controls -336 ± 26.9 cells/field. APRF-CHX 0.02% membranes were unstable, indicating a dose-dependent cytotoxic effect of CHX. The introduced novel protocol leads to the production of a new type of APRF membrane-CHX-PRF. The incorporation of an antiseptic into the APRF membrane can improve its bactericidal activity and might serve as an important step for the prevention of postoperative infections.

The efficacy of vancomycin-loaded biphasic calcium phosphate bone substitute in the promotion of new bone growth and the prevention of postoperative infection.

Background: Due to the increasing need for suitable alternatives to bone grafts, artificial bones made of biphasic calcium phosphate (BCP) are currently being extensively researched. These porous bone substitutes have also demonstrated considerable incorporation with the host bone, and new bone is able to grow within the porous structure. They therefore offer a potential therapeutic approach for bone defects. Methods: Vancomycin-loaded Bicera™, a BCP bone substitute, was investigated in order to prevent implant-associated osteomyelitis and postoperative infection after orthopedic surgery. The loading capacity of Bicera™ was measured to understand its potential antibiotic adsorption volume. An antibiotic susceptibility test was also carried out to analyze the effect of Bicera™ loaded with different concentrations of vancomycin on the growth inhibition of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin-loaded Bicera™ was implanted into rabbits with bone defects, and general gross, radiographic, and histological evaluation was undertaken at 4, 12, and 24weeks after implantation. Results: The maximum loading capacity of vancomycin-loaded Bicera™ was 0.9ml of liquid regardless of the vancomycin concentration. Antibiotic susceptibility tests showed that vancomycin-loaded Bicera™ inhibited the growth of MRSA for 6weeks. In addition, animal studies revealed that new bone grew into the vancomycin-loaded Bicera™. The percentage of new bone formation from 4 to 24weeks after implantation increased from 17% to 36%. Conclusion: Vancomycin-loaded Bicera™ could effectively inhibit the growth of MRSA in vitro. It was found to incorporate into the host bone well, and new bone was able to grow within the bone substitute. The results of this study indicate that vancomycin-loaded Bicera™ is a potential bone substitute that can prevent implant-associated osteomyelitis and postoperative infection.

Clinical Efficacy and Safety Analysis of Levofloxacin for the Prevention of Infection after Traumatic Osteoarthrosis and Internal Fixation: Systematic Review and Meta-Analysis.

Objective Levofloxacin has been widely used in clinical anti-infection treatment; however, its adverse reactions to levofloxacin were also obvious in patients. Herein we aimed to systematically evaluate the clinical efficacy and safety of systemic administration of levofloxacin in the prevention of postoperative infection after traumatic osteoarthrosis and internal fixation. Methods PubMed, Cochrane Library, OVID, EBSCO, CNKI, VIP database, and Wanfang Database were searched from December 1993 to December 2021. Meanwhile, China ADR Information Bulletin and WHO Pharmaceutical were searched manually. Newsletter and FDA Drug Safety Newsletter, also to retrieve the Websites of Chinese, Chinese, and drug regulatory authorities; To obtain data on adverse events in children with systemic administration of levofloxacin. The literature was screened according to inclusion and exclusion criteria. The risk of bias was evaluated for the included RCT literature. Results There was a statistical difference in the comparison of the incidence of fever between the experimental group and the control group (OR = 2.29, 95% CI (1.75,2.98),P < 0.00001, I2 = 0%, Z = 6.11); elevated white blood cell count (OR = 1.82, 95% CI (1.31,2.52),P=0.0003, I2 = 0%, Z = 3.60); incidence of wound infection (OR = 2.11, 95% CI (1.54,2.90),P < 0.00001, I2 = 0%, Z = 4.64); adverse drug reaction (OR = 1.82, 95% CI (1.21,2.74),P=0.004, I2 = 0%, Z = 2.86). Conclusion In the clinical use of levofloxacin, adverse drug reactions including fever, elevated white blood cell count, and wound infection should be concerned.

Practical Guidelines for the Appropriate Use of Antimicrobial Agents for Prevention of Surgical Site Infection in Various Neurosurgical Fields

Preoperative shaving and disinfection; postoperative wound care; and preoperative, intraoperative, and postoperative antibiotic use are the main methods used to prevent perioperative surgical site infection(SSI); however, a survey of neurosurgeons in Japan did not indicate that these guidelines were followed. There are several types of surgical procedures in the field of neurosurgery, including implant insertion, with little evidence of use of antimicrobial agents in such surgeries. Hence, there had been no guidelines for antimicrobial use in neurosurgery in Japan. However, practice guidelines for the appropriate use of antimicrobial agents for the prevention of postoperative infection in neurosurgery were published in 2020 and are discussed in this section.

197. Subtherapeutic perioperative levels of cefuroxime inside cannulated pedicle screw commonly used in spine surgery: results from an experimental microdialysis study

BACKGROUND CONTEXT Despite minimal invasive spine techniques, postoperative implant associated vertebral osteomyelitis remains a risk of great morbidity for the patient. Perioperative antibiotic prophylaxis is important for prevention of postoperative infection and local tissue concentrations can be measured with microdialysis. We hypothesized that cefuroxime concentrations in relation to a cannulated pedicle screws may be insufficient for prevention of postoperative infection. PURPOSE The aim was to compare perioperative cefuroxime concentrations inside a cannulated pedicle screw to the adjacent noninstrumented lumbar vertebral pedicle. STUDY DESIGN/SETTING In vivo experimental pharmacokinetics study of cefuroxime concentrations in an acute preclinical porcine model. PATIENT SAMPLE Not applicable. OUTCOME MEASURES The primary end-point was the time above cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 µg/mL (T>MIC4) METHODS Microdialysis probes were placed in a cannulated pedicle screw and the adjacent non-instrumented lumbar vertebral pedicle (L1) in 8 female pigs through a surgical posterior open lumbar approach. Following a single-dose intravenous cefuroxime administration (1.5 g), microdialysates and plasma were dynamically sampled over 8 hours. RESULTS Mean T>MIC4 (range) was 123 min (112-175) in plasma, 101 min (68-144) in the non-instrumented vertebral pedicle and 0 min (0-0) inside the cannulated pedicle screw. CONCLUSIONS A single-dose intravenous cefuroxime administration (1.5 g) seems insufficient for antibiotic prophylaxis inside a cannulated pedicle screw placed in the lumbar spine. Sufficient concentrations were achieved in the adjacent non-instrumented vertebral pedicle for up to 1.5-2 hours. Therefore, alternative dosing regimens should be considered in minimal invasive spine surgery longer than 1.5 hours and additional prophylactic strategies against infection may be applied in high-risk patients. FDA DEVICE/DRUG STATUS Cefuroxime (Approved for this indication) Despite minimal invasive spine techniques, postoperative implant associated vertebral osteomyelitis remains a risk of great morbidity for the patient. Perioperative antibiotic prophylaxis is important for prevention of postoperative infection and local tissue concentrations can be measured with microdialysis. We hypothesized that cefuroxime concentrations in relation to a cannulated pedicle screws may be insufficient for prevention of postoperative infection. The aim was to compare perioperative cefuroxime concentrations inside a cannulated pedicle screw to the adjacent noninstrumented lumbar vertebral pedicle. In vivo experimental pharmacokinetics study of cefuroxime concentrations in an acute preclinical porcine model. Not applicable. The primary end-point was the time above cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 µg/mL (T>MIC4) Microdialysis probes were placed in a cannulated pedicle screw and the adjacent non-instrumented lumbar vertebral pedicle (L1) in 8 female pigs through a surgical posterior open lumbar approach. Following a single-dose intravenous cefuroxime administration (1.5 g), microdialysates and plasma were dynamically sampled over 8 hours. Mean T>MIC4 (range) was 123 min (112-175) in plasma, 101 min (68-144) in the non-instrumented vertebral pedicle and 0 min (0-0) inside the cannulated pedicle screw. A single-dose intravenous cefuroxime administration (1.5 g) seems insufficient for antibiotic prophylaxis inside a cannulated pedicle screw placed in the lumbar spine. Sufficient concentrations were achieved in the adjacent non-instrumented vertebral pedicle for up to 1.5-2 hours. Therefore, alternative dosing regimens should be considered in minimal invasive spine surgery longer than 1.5 hours and additional prophylactic strategies against infection may be applied in high-risk patients.

Comparative effectiveness of oral antibiotics, probiotics, prebiotics, and synbiotics in the prevention of postoperative infections in patients undergoing colorectal surgery: A network meta-analysis.

Oral antibiotics (OAB), probiotics, prebiotics, and synbiotics are reported to be effective for preventing postoperative infection following colorectal surgery, but the comparative effectiveness between them has not been studied. To compare these interventions through a network meta-analysis. Ovid Medline, Embase, and the Cochrane Controlled Register of Trials (CENTRAL) were searched from inception to January 1, 2022 without any language restriction. Two reviewers independently screened the retrieved articles, assessed risk of bias, and extracted information from the included randomised controlled trials (RCTs). The primary outcome was infection rate, and the secondary outcome was anastomotic leakage rate. 4322 records were retrieved after literature search, and 20 RCTs recruiting 3726 participants were finally included. The analysis showed that usual care (UC) + Synbiotics ranked the most effective treatment (SUCRA=0.968), UC + OAB ranked the second (SUCRA=0.797), and UC + IAB ranked the third (SUCRA=0.678) for preventing postoperative infection rate, but only UC + OAB achieved statistical significance. UC + OAB was the most effective treatment (SUCRA=0.927) for preventing anastomotic leakage rate. Our study confirmed that preoperative administration of OAB was associated with lower infection rate and anastomotic leakage rate than placebo and UC alone. However, the beneficial effect of probiotics and synbiotics should still be investigated by large-scale randomised controlled trials.

Probiotics or Synbiotics for Preventing Postoperative Infection in Hepatopancreatobiliary Cancer Patients: A Meta-Analysis of Randomized Controlled Trials

Objective Postoperative infection of hepatopancreatobiliary cancer (HPBC) is a major cause of morbidity and mortality. Probiotics and synbiotics are potential prevention strategies, but evidence on the efficacy of probiotics or synbiotics in the prevention of postoperative infection for HPBC remains controversial. This study aimed to define the impact of probiotics or synbiotics on the incidence of postoperative infection in HPBC patients. Methods A systematic search of the Cochrane Library, PubMed, Embase, and Web of Science databases was conducted from inception to February 2, 2021 to identify randomized controlled trials (RCTs) evaluating the efficacy of probiotics or synbiotics in HPBC. Data were pooled and expressed as the risk ratio (RR) and mean difference (MD) with 95% confidence intervals. Results Eight RCTs involving 445 participants were included. Supplementation with probiotics or synbiotics significantly reduced the incidence of postoperative infection (RR 0.55) in HPBC patients, and both probiotics (RR 0.68) and synbiotics (RR 0.41) were effective in reducing the incidence of postoperative infection. In addition, probiotics or synbiotics can reduce duration of antibiotic use (MD −3.52) and length of hospital stay (MD −4.21). Conclusion Probiotics or synbiotics are effective strategies for the prevention of postoperative infection in HPBC patients.

What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations

Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.

Development of high-strength porous polyetheretherketone foam/nanosilver antibacterial composites for the prevention of postoperative infections in bone repair

Bacterial infection is one of the leading causes for the failure of orthopedic implants surgery. Herein, a high-strength porous polyetheretherketone foam/nanosilver (pf-PK-nAg) antibacterial composite was developed for the prevention or treatment of postoperative bacterial infections. The prepared pf-PK-nAg possesses an interconnected open-pore structure so that the nano-sliver particles are dispersed in the pore size uniformly by hydrothermal synthesis. In contrast to the traditional spray-coating method, pf-PK-nAg overcomes the shortcomings that the antibacterial effect decreases due to the detachment of the nano-silver at the scratched position after scratching. In vitro biocompatibility experiments show that the prepared materials have good biocompatibility. In vitro antibacterial experiments showed that pf-PK-nAg had strong antibacterial activity against Staphylococcus aureus and Escherichia coli and the antibacterial rate is 96.8% and 96.4% respectively. In addition, immunofluorescence imaging and hematoxylin-eosin staining (H&E) was performed through a subcutaneous infection model. The results showed that compared with the control group, there were fewer macrophages and neutrophils in the skin tissue around pf-PK-nAg, indicating that pf-PK-nAg has good antibacterial ability in vivo. Overall, the prepared pf-PK-nAg can serve as an effective platform for the antibacterial field of bone repair.

Consensus on diagnosis and treatment of postoperative infections in pediatric liver transplant recipients

With the breakthrough in surgical technology, pediatric liver transplantation (PLT) has achieved landmark development in China in recent years. In some high-volume centers, postoperative outcomes have even been comparable to the world-leading levels. However, postoperative infection remains a major factor affecting graft and recipient survivals. Thus, the Enhanced Recovery After Surgery Committee of the Chinese Research Hospital Association organized experts from multiple disciplines and formulated the consensus to improve the diagnosis, treatment and prevention of postoperative infections in PLT recipients. This consensus is based on the progress of domestic and international researches in this field and followed the principles of evidence-based medicine. It covers general and transplantation-specific infection, and is expected to provide reference for centers conducting or planning to conduct PLT.

Evaluasi Penggunaan Antibiotika Profilaksis Operasi Digestif Laparatomi di Rumah Sakit Kota Surabaya

Laparotomy is a major operation and causes a lot of injuries, so the risk of infection of the laparotomy surgery wound is quite high. Surgical Site Infection (ILO) or Surgical Site Infection (ITP). Prevention of postoperative infection in patients with clean-contaminated surgery, and some clean operations with the use of prophylactic antibiotics. The purpose of this study was to evaluate the use of prophylactic antibiotics in patients with laparotomy surgery in a hospital in Surabaya. The research method is descriptive operational with retrospective data. The results of this study obtained as many as 160 patients aged 46-55 years at 20.6%, the sex of the respondents were dominated by male sex 66.3%, and the diagnosis of generalized peritonitis was 46.9%. The use of prophylactic antibiotics is class I cephalosporin antibiotics (cefazolin) with a dose of 1000-2000 mg, which is by the 2011 Ministry of Health guidelines.

Can the hummingbird sign contribute to the diagnosis of idiopathic normal pressure hydrocephalus?

We read with great interest the article by Atalay et al. in which they illustrate the frequent presence of hummingbird signs in their patient group with idiopathic normal pressure hydrocephalus (iNPH) [1]. The results are substantially interesting; however, we believe that some points may be further deliberated for a better understanding of this crucial study. The authors declare that there are no commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest.