Reduction In Wound Infection Rates Research Articles

The Wound Microbiology and the Outcomes of the Systemic Antibiotic Prophylaxis in a Mass Burn Casualty Incident.

This paper describes the wound microbiology and outcome of using systemic antibiotic prophylaxis (SAP) in mass burn casualties (MBC). The charts of 31 patients (mean age: 21 years, mean burn area: 42% of the total body surface area) injured in a dust explosion were reviewed for 1 month after the burn. Polymicrobial and rare pathogen wound infections (Acinetobacter junii, Aeromonas sobri, et al) were common in MBC due to sterility breech. Following the use of SAP for 2 to 14 days after admission, there was a reduction in wound infection rate from 45% at week 1 postburn to 10% at week 4. In addition, no blood stream infection occurred in the first week after the burns. Multidrug-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Candida albicans were the top three wound pathogens cultured. Multidrug-resistant microorganism infections were found in 39% of the patients, and the odds ratios for the these infections in burn patients with more than ≥40% total body surface area and in patients receiving two or more classes of antibiotics were 41.7 (95% confidence interval [CI] = 2.1-810.7, P = .01) and 9.9 (95% CI= 1.0-92.7, P = .04), respectively. Although SAP did not prevent wound or blood stream infections, no mortality occurred in our patients. A randomized controlled study is needed to investigate the impact of SAP on burn mortality in MBC.

Five Day Antibiotic Prophylaxis for Major Lower Limb Amputation Reduces Wound Infection Rates and the Length of In-hospital Stay

To compare wound infection, revision rates and hospital stay after major lower limb amputation between patients receiving 24 hours versus 5 days of prophylactic antibiotics. The outcomes of a consecutive series of 40 major lower limb amputations in patients receiving a short 24-hour course of combined prophylactic antibiotics (flucloxacillin/vancomycin + gentamicin/ciproxin + metronidazole) were retrospectively analysed. Following this a further consecutive group of 40 major lower limb amputations were studied prospectively following the institution of a 5-day combined regime using the same antibiotics. The 2 groups of patients were similar in terms of demographics, vascular risk factors and level of amputation. The 5-day antibiotic regime led to a significant reduction in wound infection rates (5% vs. 22.5%, P=0.023) and a reduced length of hospital stay (22 vs. 34 days, P=0.001). Revision rates were lower (2.5% vs. 10%) but did not reach statistical significance (P=0.36). More patients in the prospective 5-day antibiotic series were operated on by the vascular trainee. (77.5% vs. 55% P=0.033). This data supports the use of a prolonged 5-day course of combined antibiotics after major lower limb amputation. This appears to reduce stump infection rates leading to shorter in-hospital stay.

Reduction in wound infection rates by wound surveillance with postdischarge follow-up and feedback

Surgical wound surveillance with postdischarge follow-up is rarely done in the UK as it is seen as expensive. The aim of this study was to determine whether employing a dedicated team was effective and reduced costs. Infection data were collected prospectively with postdischarge follow-up at 2-3 months, and fed back to surgeons. Wound infection was defined using both ASEPSIS wound scoring and criteria of the US Centers for Disease Control (CDC) definitions. Over 4 years, 15 548 patient episodes were included. Postdischarge surveillance data were available for 79.9 per cent of the 15 154 records of patients who survived. There was a significant reduction in the rate of wound infection between the first and fourth years by ASEPSIS and CDC definitions: odds ratio 0.77 (95 per cent confidence interval (c.i.) 0.64 to 0.92) and 0.69 (95 per cent c.i. 0.57 to 0.83), respectively. The proportion of infections fell significantly in orthopaedic, cardiac and thoracic surgery. The annual budget for wound surveillance was pound 91,600. Changes in infection rates contributed pound 347,491 to the reduction in cost among the patients surveyed. Wound surveillance was associated with a reduction in rates of wound infection within 4 years. The cost reduction as a result of fewer infections exceeded the cost of surveillance after 2 years.

Antibioprophylaxie en chirurgie colorectale

In elective colorectal surgery, the benefit of preoperative antibiotic prophylaxis is well established, with a reduction in wound infection rate to less than 10 %. The antimicrobial agent used has to be active against aerobic and anaerobic pathogens such as Escheria coli and Bacteriodes fragilis. The efficacy of three schemes of administration : oral and/or parenteral prophylaxis associated with a mechanical preparation, has been demonstrated. Oral antibiotic administration is current practice in USA ; the most widely used oral regimen is the combination of crythromycin and neomycin given the day before surgery. Parenteral prophylaxis with a cephalosporin active against Bacteroides fragilis such as cefoxitin and cefotetan, is preferred in Europe. The issue of whether a systemic prophylaxis should be added to the oral regimen or not has not yet been resolved. However it seems that the association should be proposed in various situations : patients with a high risk factors score (rectal resection and operations lasting more than three hours), patients with incomplete mechanical preparation, delay of the onset of surgery after the last oral dose.

Antibiotic prophylaxis for cardiothoracic operations

Antistaphylococcal penicillins and first-generation cephalosporins have traditionally been the prophylactic antibiotics of choice for patients undergoing cardiothoracic operations. Recently published studies have claimed improved outcomes with respect to postoperative wound infection when second-generation cephalosporins were used for prophylaxis. The purpose of this study was to critically review the infectious outcomes of prospective, randomized, and controlled studies of cardiothoracic surgery prophylaxis by means of meta-analytic techniques. For each of 28 studies meeting the meta-analysis entry criteria, odds ratios with 95% confidence intervals were calculated to compare the prophylactic efficacy of the antibiotic regimens. Odds ratios were then pooled, and a summary odds ratio was calculated for each pairing of antibiotic treatments. Placebo-controlled trials of cardiothoracic prophylaxis demonstrated a consistent benefit to the administration of antibiotic prophylaxis, with an approximate fivefold reduction in wound infection rate. The second-generation cephalosporins, cefamandole and cefuroxime, performed better than cefazolin, with an approximate one and one-half-fold reduction in wound infection rate. Administration of prophylaxis beyond 48 hours was not associated with improved infectious outcomes.

Reducing wound infections. Improved gown and drape barrier performance.

A 21-month study involving 2181 clean and clean-contaminated general surgical procedures was performed to evaluate the effectiveness of a commercially available disposable gown and drape system vs a cotton system in reducing wound infection. The series in which the disposable spun-laced fiber system was used had a significantly lower overall infection rate (2.83% vs 6.5%) as well as better rates in clean (1.8% vs 3.8%) and clean-contaminated (4.8% vs 11.4%) procedures. This effect was independent of all other factors. The odds of developing a wound infection was 2 1/2 times higher with a cotton system than with a disposable system. Actual cost analysis from three types of hospitals showed lower costs with utilization of disposable gown and drape systems. Hospital charges were significantly higher for those patients developing wound infections. The results of the study demonstrated not only significant reduction in wound infection rates but also major cost savings when a disposable gown and drape system was used in the operating room.

The successful use of antibiotic prophylaxis in selected high-risk surgical patients under non-trial, everyday conditions

The use of prophylactic antibiotic protocols in the control of wound infection in high-risk surgical patients under everyday ward conditions was evaluated over a period of between one and three years. Patients undergoing hip or large bowel surgery, caesarian section or hysterectomy, had the highest wound infection rates and were chosen as the target groups for intervention. The overall reduction in wound infection rates in all the groups after intervention was from 12·7 to 7·4 per cent. Reduction in wound infection rates varied in each group: in hip surgery from 25·7 to 1·2 per cent, in caesarian section from 10·5 to 5·1 per cent and in abdominal hysterectomy from 9·0 to 3·2 per cent. Not all patients within each group were similarly affected. When subdivided into different risk groups, patients in the highest risk group generally showed little, if any, reduction in wound infection rate. The length of postoperative stay was shortened considerably after the introduction of the protocol for hip surgery and abdominal hysterectomy. Although the proportion of patients who received prophylactic antibiotics increased after the introduction of the protocols there was a concomitant decrease in the total amount of antibiotics used.