Risk Factors For Surgical Site Infection Research Articles

Incidence and Risk Factors for Surgical Site Infection after Femoral Neck Fracture Surgery: An Observational Cohort Study of 2218 Patients.

Background Surgical site infection (SSI) was a formidable challenge for surgical management of femoral neck fractures; however, there was a lack of studies with comprehensive variables. We conducted this study to investigate the incidence and risk factors of SSI in elderly patients with femoral neck fractures. Methods This was a retrospective study of patients who presented with femoral neck fractures and underwent surgery in our institution between January 2016 and April 2020. All data were collected from a previously validated database. Patients were divided into SSI and non-SSI groups. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for SSI. Results A total of 2218 patients with femoral neck fractures were enrolled in the study, of whom 22 (1%) developed SSI, including 15 (0.7%) superficial and 7 (0.3%) deep SSIs. After multivariable adjustment for confounding factors, patients with and without SSI significantly differ in terms of gender, prolonged time to surgery, CHE < 5 U/L, and injury mechanism. Conclusions Our results were helpful for stratification of SSI risk and improved management of hip fracture. Clinicians should be alert to patients with these factors and improve modifiable factors such as preoperative waiting time.

Risk factors of wound infection after lung transplantation: a narrative review.

Background and ObjectiveThe incidence of incision infection after lung transplantation is prominently high which affect the prognosis. Summarizing the risk factors related to incision infection after lung transplantation contribute to the control of incision infection by pre-controlling the risk factors. The objective is to summarize risk factors related to wound infection after lung transplantation.MethodsPubMed was used to research the literature relating to the risk factors to incision infection after lung transplantation through 1990 to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms combined entry terms. Two researchers conducted the literature retrieval independently. Two researchers independently evaluate the quality of the literature and summarize the indicators.Key Content and FindingsA total of 98 researches were collected from PubMed and 8 articles described the related risk factors of incision infection after lung transplantation. All of the 8 articles were retrospective studies, of which 4 articles were grouped by the delayed chest closure (DCC) execution and the other 4 articles were grouped by the surgical site infection (SSI) occurred. Two articles performed multivariate regression analysis to determine the independent risk factors of SSI after lung transplantation and the other 6 articles compared the SSI rate in different patients population. The integrated results showed that bronchoalveolar lavages (BALs), smoking status, body mass index (BMI), diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.ConclusionsBALs, smoking status, BMI, diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.

Impact of gender on surgical site infections in abdominal surgery: A multi-center study

Abstract Objective Male sex is controversially discussed as a risk factor for surgical site infections (SSI). The aim of the present study was to evaluate the impact of gender on SSI in abdominal surgery under elimination of relevant confounders. Methods Clinicopathological data of 6603 patients undergoing abdominal surgery from a multi-center prospective database of four Swiss hospitals including patients between 2015 and 2018 were assessed. Patients were stratified according to postoperative SSI and risk factors for SSI were assessed using univariate and multivariate analysis. Results In 649 of 6603 patients SSI was reported (9.8%). SSI was significantly associated with increased risk of reoperation (22.7% vs. 3.4%, p &amp;lt;0.001), higher mortality rate (4.6% vs. 0.9%, p &amp;lt;0.001) and higher rate of length of hospital stay &amp;gt; 75th percentile (57.0% vs. 17.9%, p &amp;lt;0.001). In univariate analysis male sex was a significant risk factor for SSI (p = 0.01). In multivariate analysis including multiple confounders’ such as comorbidities and perioperative factors there was no association between male sex and risk of SSI (OR 1.1 [CI 0.8–1.4]). BMI &amp;gt;= 30 kg/m2 (OR 1.8 [CI 1.3–2.3]), duration of surgery &amp;gt; 75th percentile (OR 2.3 [1.8–2.9]), high contamination level (OR 1.3 [1.0–1.6]), laparotomy (OR 1.3 [1.0–1.7]), previous laparotomy (OR 1.4 [1.1–1.7]), blood transfusion (OR 1.7 [1.2–2.4]), cancer (OR 1.3 [1.0–1.8]), malnutrition (OR 2.5 [1.8–3.4]) were independent risk factors for SSI in multivariate analysis. Conclusion Under elimination of relevant confounders there is no significant correlation between gender and risk of SSI after abdominal surgery. Independent risk factors for SSI as BMI &amp;gt;= 30 kg/m2, duration of surgery &amp;gt; 75th percentile, high contamination level, surgical approach or malnutrition should be considered during treatment.

Antibiotic Use, Incidence and Risk Factors for Orthopedic Surgical Site Infections in a Teaching Hospital in Madhya Pradesh, India.

Orthopedic surgeries contribute to the overall surgical site infection (SSI) events worldwide. In India, SSI rates vary considerably (1.6–38%); however, there is a lack of a national SSI surveillance system. This study aims to identify the SSI incidence, risk factors, antibiotic prescription and susceptibility patterns among operated orthopedic patients in a teaching hospital in India. Data for 1205 patients were collected from 2013 to 2016. SSIs were identified based on the European Centre for Disease Prevention and Control guidelines. The American Society for Anesthesiologists classification system was used to predict patients’ operative risk. Univariable and multivariable backward stepwise logistic regressions were performed. Overall, 7.6% of patients developed SSIs over three years. The most common SSIs causative microorganism was Staphylococcus aureus (7%), whose strains were resistant to penicillin (100%), erythromycin (80%), cotrimoxazole (80%), amikacin (60%) and cefoxitin (60%). Amikacin was the most prescribed antibiotic (36%). Male sex (OR 2.64; 95%CI 1.32–5.30), previous hospitalization (OR 2.15; 95%CI 1.25–3.69), antibiotic prescription during hospitalization before perioperative antibiotic prophylaxis (OR 4.19; 95%CI 2.51–7.00) and postoperative length of stay > 15 days (OR 3.30; 95%CI 1.83–5.95) were identified as significant risk factors. Additionally, preoperative shower significantly increased the SSI risk (OR 4.73; 95%CI 2.72–8.22), which is unconfirmed in the literature so far.

Open and Closed Approaches to Skin Closure After Nonelective Open Colorectal Operations.

Optimal wound management strategies to reduce surgical site infections (SSIs) in nonelective open colorectal surgery (NOCS) remain controversial and variable. Our aim is to describe SSI and other 30-day outcome measures among patients with varying wound management techniques undergoing NOCS. All NOCS patients were extracted from the 2016 to 2018 ACS-NSQIP database. Outcomes of patients managed with all layers closed (ALC) were compared to patients managed with skin open (SO), using propensity score matching (PSM) to control for significant confounding risk factors for SSI. A total of 40,820 patients were included; 4622 patients managed with SO and 36,198 managed with ALC. Patients in the SO group were more likely to have a history of hypertension, renal failure, chronic obstructive pulmonary disease, smoking, obesity, and sepsis on presentation (P < .001). After PSM, no differences in risk factors remained; 4622 and 4344 patients were included in the SO and ALC cohorts, respectively. While ALC patients experienced a higher rate of superficial SSI (1.4% vs 7.3%, P < .001) and any wound complications (6.8% vs 10.8%, P < .001), the SO group had higher wound dehiscence (4.4% vs 2.8%, P < .001). There were no significant differences in deep wound infection. The SO group had longer average length of stay (14.7 vs 13.1days, P < .001), higher non-wound-related complications, discharge to SNF, and in-hospital mortality. Significant differences in SSI rates among NOCS patients with differing wound management techniques were observed. More notably, other important quality measures, such as length of stay, disposition, mortality, and non-wound-related complications were also significantly impacted by wound management strategy.

Complicated Abdominal Wall Hernias in the Elderly: Time Is Life and Comorbidities Matter.

Abdominal wall hernias represent a common problem that can present as surgical emergencies with increased morbidity and mortality. The data examining outcomes in elderly patients with hernia emergencies is scant. The 2007-2017 ACS-NSQIP database was queried. Patients ≥65years old with a diagnosis of acute complicated abdominal wall hernia were included. Univariable and multivariable analyses were used to identify independent predictors of 30-day mortality and surgical site infection (SSI). Main predictors of 30-day mortality were admission from nursing home or chronic care facility (OR = 1.62, 95% CI: 1.10-2.38, P = .014), transfer from outside ED (OR = 1.81, 95% CI: 1.31-2.51, P < .001), days from admission to operation (OR = 1.05, 95% CI: 1.02-1.08, P = .002), recent significant weight loss (OR = 1.95, 95% CI: 1.12-3.37, P = .018), pre-operative septic shock (OR = 4.13, 95% CI: 2.44-6.99, P < .001), ventilator dependence (OR = 2.50, 95% CI: 1.29-4.81, P = .006), and ASA status. When compared to open repair, laparoscopic repair emerged as protective against SSI (OR = .34, 95% CI: .17-.66, P = .001). Bowel resection (OR = 2.15, 95% CI: 1.63-2.84, P < .001) and increasing wound class were risk factors for SSI. In the elderly patient presenting with an acute complicated abdominal wall hernia, time to surgery is crucial for survival, and comorbidities influence outcome. Laparoscopy is an option in management due to its decreased risk of surgical site infection without increased mortality, whenever patient factors are favorable for this approach.

Selective decontamination of the digestive tract in colorectal surgery reduces anastomotic leakage and costs: a propensity score analysis

PurposeAnastomotic leakage (AL) and surgical site infection (SSI) account for most postoperative complications in colorectal surgery. The aim of this retrospective trial was to investigate whether perioperative selective decontamination of the digestive tract (SDD) reduces these complications and to provide a cost-effectiveness model for elective colorectal surgery.MethodsAll patients operated between November 2016 and March 2020 were included in our analysis. Patients in the primary cohort (PC) received SDD and those in the historical control cohort (CC) did not receive SDD. In the case of rectal/sigmoid resection, SDD was also applied via a transanally placed Foley catheter (TAFC) for 48 h postoperatively. A propensity score-matched analysis was performed to identify risk factors for AL and SSI. Costs were calculated based on German diagnosis-related group (DRG) fees per case.ResultsA total of 308 patients (154 per cohort) with a median age of 62.6 years (IQR 52.5–70.8) were analyzed. AL was observed in ten patients (6.5%) in the PC and 23 patients (14.9%) in the CC (OR 0.380, 95% CI 0.174–0.833; P = 0.016). SSI occurred in 14 patients (9.1%) in the PC and 30 patients in the CC (19.5%), representing a significant reduction in our SSI rate (P = 0.009). The cost-effectiveness analysis showed that SDD is highly effective in saving costs with a number needed to treat of 12 for AL and 10 for SSI.ConclusionSDD significantly reduces the incidence of AL and SSI and saves costs for the general healthcare system.

Determination of risk factors associated with surgical site infection in patients undergoing preperitoneal pelvic packing for unstable pelvic fracture.

BackgroundSeveral recent studies have shown that preperitoneal pelvic packing (PPP) effectively produces hemostasis in patients with unstable pelvic fractures. However, few studies have examined the rate of surgical site infections (SSIs) in patients undergoing PPP following an unstable pelvic fracture. The purpose of the present study was to evaluate factors associated with SSI in such patients.MethodsWe retrospectively reviewed the medical charts of 188 patients who developed hemorrhagic shock due to pelvic fracture between April 2012 and May 2021. Forty-four patients were enrolled in this study.ResultsSSI occurred in 15 of 44 patients (34.1%). The SSIs occurred more frequently in cases of repacking during the second-look surgery (0 vs. 4 [26.7%], P=0.010) and combined bladder-urethra injury (1 [3.4%] vs. 4 [26.7%], P=0.039). The incidence of SSIs was not significantly different between patients undergoing depacking within or after 48 hours (12 [41.4%] vs. 5 [33.3%], P=0.603). The mean time to diagnosis of SSI was 8.1±3.9 days from PPP. The most isolated organism was Staphylococcus epidermidis.ConclusionsRepacking and combined bladder-urethra injury are potential risk factors for SSI in patients with unstable pelvic fracture. Close observation is recommended for up to 8 days in patients with these risk factors. Further, 48 hours after PPP, removing the packed gauze on cessation of bleeding and not performing repacking can help prevent SSI. Additional analyses are necessary with a larger number of patients with the potential risk factors identified in this study.

Risk factors of postoperative surgical site infection in colon cancer based on a single center database

Objective: To explore the incidence and risk factors of postoperative surgical site infection (SSI) after colon cancer surgery. Methods: A retrospective case-control study was performed. Patients diagnosed with colon cancer who underwent radical surgery between January 2016 and May 2021 were included, and demographic characteristics, comorbidities, laboratory tests, surgical data and postoperative complications were extracted from the specialized prospective database at Department of General Surgery, Peking Union Medical College Hospital. Case exclusion criteria: (1) simultaneously multiple primary colon cancer; (2) segmental resection, subtotal colectomy, or total colectomy; (3) patients undergoing colostomy/ileostomy during the operation or in the state of colostomy/ileostomy before the operation; (4) patients receiving natural orifice specimen extraction surgery or transvaginal colon surgery; (5) patients with the history of colectomy; (6) emergency operation due to intestinal obstruction, perforation and acute bleeding; (7) intestinal diversion operation; (8) benign lesions confirmed by postoperative pathology; (9) patients not following the colorectal clinical pathway of our department for intestinal preparation and antibiotic application. Univariate analysis and multivariate analysis were used to determine the risk factors of SSI after colon cancer surgery. Results: A total of 1291 patients were enrolled in the study. 94.3% (1217/1291) of cases received laparoscopic surgery. The incidence of overall SSI was 5.3% (69/1291). According to tumor location, the incidence of SSI in the right colon, transverse colon, left colon and sigmoid colon was 8.6% (40/465), 5.2% (11/213), 7.1% (7/98) and 2.1% (11/515) respectively. According to resection range, the incidence of SSI after right hemicolectomy, transverse colectomy, left hemicolectomy and sigmoid colectomy was 8.2% (48/588), 4.5% (2/44), 4.8% (8 /167) and 2.2% (11/492) respectively. Univariate analysis showed that preoperative BUN≥7.14 mmol/L, tumor site, resection range, intestinal anastomotic approach, postoperative diarrhea, anastomotic leakage, postoperative pneumonia, and anastomotic technique were related to SSI (all P<0.05). Multivariate analysis revealed that anastomotic leakage (OR=22.074, 95%CI: 6.172-78.953, P<0.001), pneumonia (OR=4.100, 95%CI: 1.546-10.869, P=0.005), intracorporeal anastomosis (OR=5.288, 95%CI: 2.919-9.577,P<0.001) were independent risk factors of SSI. Subgroup analysis showed that in right hemicolectomy, the incidence of SSI in intracorporeal anastomosis was 19.8% (32/162), which was significantly higher than that in extracorporeal anastomosis (3.8%, 16/426, χ(2)=40.064, P<0.001). In transverse colectomy [5.0% (2/40) vs. 0, χ(2)=0.210, P=1.000], left hemicolectomy [5.4% (8/148) vs. 0, χ(2)=1.079, P=0.599] and sigmoid colectomy [2.1% (10/482) vs. 10.0% (1/10), χ(2)=2.815, P=0.204], no significant differences of SSI incidence were found between intracorporeal anastomosis and extracorporeal anastomosis (all P>0.05). Conclusions: The incidence of SSI increases with the resection range from sigmoid colectomy to right hemicolectomy. Intracorporeal anastomosis and postoperative anastomotic leakage are independent risk factors of SSI. Attentions should be paid to the possibility of postoperative pneumonia and actively effective treatment measures should be carried out.

Risk Factors for Surgical Site Infection in the Undeserved Population After Ventral Hernia Repair: A 3936 Patient Single-Center Study Using National Surgical Quality Improvement Project

Background: Ventral hernia repair (VHR) is one of the most common surgical procedures performed in the United States. Surgical site infections (SSI) carry significant morbidity for the patient and pose a very challenging problem for the surgeon, associated with up to 6.6% of cases. Thus, surgeons should be well versed in the risk factors implicated in SSI after VHR. Given the high burden of diabetes, obesity, and smoking in our patient population, we sought to study the rate of SSI and the risk factors that led to SSI in our population. Study Design: This is a retrospective study using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database for the years 2014-2019. We identified patients who underwent VHR at a single institution in the Bronx, New York. The rate of SSI was calculated, and then, risk factors for SSI were identified using logistic regression analysis. Results: A total of 3936 patients underwent VHR. Incisional hernias made up 41% of the cohort, and there were 37.4% laparoscopic repairs. During the 30-day follow-up, SSI was identified in 101 patients (2.6%). Factors associated with SSI include emergent surgery (adjusted odds ratio [aOR] = 2.57), body mass index >35 kg/m2 (aOR = 2.38), insulin-dependent diabetes mellitus (aOR = 2.36), and incisional hernia (aOR = 1.81). In addition, a laparoscopic approach was found to be a protective factor (aOR = 0.43, 95% confidence interval 0.25-0.75). Surprisingly, different from other studies, smoking cigarettes was not associated with SSI in our cohort. Conclusions: The rate of SSI after VHR in our institution is 2.6%, which is within that reported in the literature. Most of the variables associated with SSI are modifiable and are similar to those previously reported. Laparoscopic repairs appear to be protective for its occurrence.

Is There an Association between Intra-Operative Detection of Pathogens in Subcutaneous Tissue and Surgical Site Infections? Results from a Prospective Study.

Background: Surgical site infections (SSIs) are a common complication in visceral surgery. Pathogens causing SSIs vary depending on the type of surgery. Patients and Methods: Within the scope of the Reduction of Postoperative Wound Infections by Antiseptica (RECIPE) trial we analyzed the pathogens cultured in intra-operative, subcutaneous swabs and in swabs from SSI in a single-center, prospective, randomized controlled study. Definition of SSI complied with the criteria of the U.S. Centers for Disease Control and Prevention (CDC). Results: The overall rate of SSI was 28.2% in 393 patients. Colorectal surgery was performed in 68.2% of elective laparotomies. Pathogens were more often detected in intra-operative subcutaneous swabs in patients who developed SSIs than in patients who did not develop SSIs (64.4% vs. 38.0%; p < 0.001). Enterococci were found in 29.1% of intra-operative swabs in patients with SSIs, followed by Escherichia coli in 15.5%. A higher rate of Enterococcus faecium was found in patients with anemia versus those without anemia (9.2% vs. 2.3%; p = 0.006) and in patients who smoked versus those who did not (11.8% vs. 3.6%; p = 0.008). A positive subcutaneous swab (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.47-4.29; p = 0.001), pre-operative anemia (OR, 1.84; 95% CI, 1.08-3.13; p = 0.016), and renal insufficiency (OR, 2.15; 95% CI, 1.01-4.59; p = 0.048) were risk factors for SSIs. Conclusions: There is an association between the intra-operative detection of pathogens in subcutaneous tissue and the development of SSIs in visceral surgery. The most prevalent pathogens causing SSIs were enterococci and Escherichia coli. More efforts are justified to reduce subcutaneous colonization with pathogens, for example by using intra-operative wound irrigation with polyhexanide solution. This trial is registered at www.ClinicalTrials.gov (ID: NCT04055233).

Length of preoperative hospital stay is the dominating risk factor for surgical site infection in neurosurgery: A cohort data-driven analysis.

Background: The number of days of preoperative hospital stay (PHS) is a modifiable variable that has shown contradictory surgical site infection (SSI) risk factor results in neurosurgery. We sought to pinpoint the day of PHS length related with a marked increase of risk of SSI.Methods: From a tertiary teaching hospital, January 2015–December 2017, prospectively collected nonpercutaneous neurosurgery procedures with standard antibiotic prophylaxis and 1-year follow-up were evaluated. SSI risk factors were assessed through multiple logistic regression models with different thresholds of PHS.Results: A total of 1012 procedures were included in the study. Incidence of SSI was 4.4%. The median PHS was higher in those with SSI than in those without (1 day, interquartile range [IQR]: 7 vs. 0 days, IQR: 1, respectively, P = 0.002). By the amount of six days of PHS, this exposure risk past the threshold of significance for impact on wound infection (OR 2.8; CI 1.23–6.39, P = 0.014). Operative time past 4 h (OR 2.11; CI 1.12-3.98; P = 0.021), and in some models, previous surgery at same admission were also identified by multivariate analysis as increasing postoperative SSI risk.Conclusion: The gradual increase of the SSI OR associated with longer PHS days was the highest risk factor of SSI in our cohort of patients. Studies directed to reduce this complication should consider the PHS.

423 Effectiveness of prophylactic negative pressure wound therapy after caesarean section in reducing superficial surgical site infection – a case-control study

Introduction and aims of the study: The increasing number of caesarean sections worldwide1 makes impaired healing of wounds after the procedure a frequent problem. Assessed risk of surgical site infections (SSI) is about 2-15% and 90% of them are superficial SSI. 2 Closed incision Negative Pressure Wound Therapy (NPWT) is a method under evaluation mainly in obese women undergoing caesarean deliveries with discrepant results. From the ones stating that NWPT vacuum dressings are efficient3 to the ones claiming that prophylactic usage in obese women did not reduce the incidence of SSIs. 4 The aim of the study was to evaluate wound healing outcomes in high-risk patients after caesarean section treated with and without the use of NPWT. Methods: In 2019 we prepared a list of identifiable risk factors of inappropriate wound healing. When a patient history confirmed at least 3 risk factors, we used prophylactic NPWT for 5 days (V.A.C. dressing). Patients data were retrospectively analysed. Group 1 were patients with NPWT from 2020 to march of 2021. A control group was created from patients data from the same time frame (hospital database), matching the intervention group for age, BMI and risk factors of SSIs. Outcomes assessed were the presence of wound complications, need for antibiotic therapy, readmission to hospital, length of stay and additional surgical procedures. Results: Patients in both the intervention group (n=21) and control group (n=6323) were included to the study. There was only one inappropriate wound healing in the intervention group. Moreover, usage of VAC was connected with shorter hospital stay, with no readmission to hospital and fewer antibiotic therapies and additional surgical procedures in comparison to control group. Conclusion: Closed incision NWPT is effective way of SSIs prophylaxis when proper qualification to intervention. More studies are needed, especially prospective ones, with the bigger study sample.

Surgical site infection following minimally invasive lobectomy: Is robotic surgery superior?

BackgroundSurgical site infection (SSI) in thoracic surgery remains a significant cause of morbidity and prolonged hospitalization. Minimally invasive surgery (MIS) has significantly reduced the risk of SSI. We intended to compare whether there was difference between video‐assisted thoracic surgery (VATS) and robotic‐assisted thoracic surgery (RATS) in SSI and highlight possible factors influencing SSI in lobectomy.MethodsThis retrospective study analyzed patients who underwent minimally invasive lobectomy from January 2018 to December 2019. All patients' clinical characteristics and surgery‐related information which may be related to the likelihood of SSI were recorded.ResultsA total of 1231 patients' records were reviewed with 806 VATS and 425 RATS. SSI was classified as deep or superficial SSI. Eighty‐six (7.0%) patients were found to develop an SSI with 62 patients having deep infections and 24 had superficial infection. No statistical difference in the incidence rate and category of SSI was observed between patients undergoing VATS and RATS.ConclusionsThere was no difference in the incidence of SSI between VATS and RATS lobectomy. Male gender, heavy smoking, uncontrolled diabetes mellitus, body mass index (BMI) > 27.9, more blood loss, and the higher National Healthcare Safety Network (NHSN) risk index score (1 or 2) were the independent risk factors of SSI following minimally invasive lobectomy, while male gender, uncontrolled diabetes mellitus, BMI > 27.9, more blood loss and the higher NHSN risk index score (1 or 2) were the main predictors of deep SSI.

Incidence and risk factors of surgical site infections and related antibiotic resistance in Freetown, Sierra Leone: a prospective cohort study

BackgroundThere is limited information on surgical site infections (SSI) and the related antibiotic resistance needed to guide their management and prevention in Sierra Leone. In this study, we aimed to establish the incidence and risk factors of SSI and the related antibiotic resistance among adults attending a tertiary hospital, and a secondary health facility in Freetown, Sierra Leone.MethodsThis is a prospective cohort study designed to collect data from adult (18 years or older) patients who attended elective and emergency surgeries at two hospitals in Freetown between February and July, 2021. Data analysis was done using STATA version 16.ResultsOf 338 patients, 245 (72.5%) and 93 (27.5%) had their surgeries at the tertiary and secondary hospitals, respectively. Many were males 192 (56.8%), less than 35 years 164 (48.5%), and 39 (11.5%) developed an SSI. Of the 39 patients who acquired an SSI, 7 (17.9%) and 32 (82.1%) had their surgeries at the secondary and tertiary hospitals, respectively. The incidence of SSI is higher in contaminated 17 (43.6%) than in clean-contaminated 12 (30.8%) and clean 10 (25.6%) wounds. Wound swabs were collected in 29 (74.4%) patients, of which 18 (62.1%) had bacterial growth. In total, 49 isolates of 14 different bacteria including gram-negative 41 (83.7%) and gram-positive 8 (16.3%) isolates were identified. Of these, 32 (65.3%) were Enterobacteriaceae, 9 (18.4%) were Non-fermenting gram-negative bacilli and 10 (12.2%) were Enterococci. The most common isolates were Escherichia coli (12, 24.5%), Klebsiella pneumoniae (10, 20.4%), Acinetobacter baumannii (5, 10.2%), Klebsiella oxytoca (4, 8.2%) and Enterococcus faecalis (4, 8.2%). The Enterobacteriaceae were either resistance to carbapenems (4, 8.2%) or were extended-spectrum beta-lactamase (ESBL) producing organisms (29, 59.2%). Male sex [p = 0.031], an ASA score ≥ 2 [p = 0.020), administration of general anaesthesia [p = 0.018] and elevated fasting glucose [p = 0.033] were predictive of SSI.ConclusionThe incidence of SSI in this study is comparable to other low- and middle-income countries, but a substantial proportion of these postoperative wounds have an ESBL-producing Enterobacteriaceae. Therefore, routine surveillance of SSI and related antibiotic resistance is required in resource-limited settings.

Postoperative surgical site infection rate in patients with diabetes following Mohs micrographic surgery: a retrospective analysis.

Incidence of surgical site infection (SSI) following Mohs micrographic surgery (MMS) amongst patients with diabetes is largely unknown. Evaluate diabetes as a potential SSI risk factor in MMS by comparing SSI incidence in a cohort of patients with and without diabetes. A 5-year retrospective review to determine SSI rate in patients with diabetes compared to patients without diabetes. SSI incidence in patients with diabetes was further compared by A1c, and the impact of antibiotics on SSI rate was also examined. Overall rate of SSI was 1.47% (53/3597 cases). SSI rate amongst patients with diabetes was 1.95% (14/719 cases) compared to 1.35% (39/2878 cases) in patients without diabetes, with a non-significant odds ratio for SSI of 1.45 (95% CI = 0.78-2.68, P = 0.241). Multivariable logistic regression analysis revealed no difference in SSI. Stratification of diabetic patients by A1c into ≥7.0 and <7.0 compared to patients without diabetes yielded no statistically significant difference in SSI amongst all groups (P = 0.815). Whether an antibiotic was prescribed did not significantly impact SSI rate between groups. No significant difference in postoperative SSI was found in patients with diabetes compared to patients without diabetes following MMS regardless of degree of glycaemic control.

Risk factors for surgical site infection in patients after implant-related orthopedic procedures.

Surgical site infections (SSIs) in patients undergoing orthopedic surgeries limit the success of the treatment, and implant-related infections are considered one of the most difficult complications for treatment (1). Controlling the SSI risk factors opens an opportunity for proper assessment of the risk of SSI and how difficult it can be to avoid infection. Determination of factors associated with the risk of surgical site infection in patients undergoing orthopedic surgery. The work is based on a retrospective analysis of medical records of 4,314 patients undergoing orthopedic surgery in the traumatology and orthopedic surgery department of the City Hospital in Zabrze in 2014-2017. Surgical site infection has been diagnosed in 187 (4.3%) patients. A number of significant predictors of SSI have been revealed: body mass index with a 9% increase in the risk of SSI for each increase in BMI by 5kg/m2, positive history of orthopedic and non-orthopedic procedures in the past, with an increase in risk by 32% and 14%, respectively, waiting time in the ward for surgery, with an increase in the risk of SSI by 19% for each extension of hospitalization by 5 days, planned procedure and implantation endoprosthesis compared to osteosynthesis increased the risk by 15% and 9%, respectively. The only significant factor reducing the risk of SSI was the increased consumption of hand disinfectant. Here, for every 10 ml of increased consumption of this preparation, the risk of SSI was reduced by 28%. 1. The SSI risk is related to both factors that can be modified and factors that cannot be changed. 2. Promotion of hand disinfection among hospital staff should become a priority in the prevention of nosocomial infections in every healthcare facility.

Surgical Antimicrobial Prophylaxis in Neonates and Children with Special High-Risk Conditions: A RAND/UCLA Appropriateness Method Consensus Study.

Surgical site infections (SSIs), which are a potential complications in surgical procedures, are associated with prolonged hospital stays and increased postoperative mortality rates, and they also have a significant economic impact on health systems. Data in literature regarding risk factors for SSIs in pediatric age are scarce, with consequent difficulties in the management of SSI prophylaxis and with antibiotic prescribing attitudes in the various surgical procedures that often tend to follow individual opinions. The lack of pediatric studies is even more evident when we consider surgeries performed in subjects with underlying conditions that may pose an increased risk of complications. In order to respond to this shortcoming, we developed a consensus document to define optimal surgical antimicrobial prophylaxis (SAP) in neonates and children with specific high-risk conditions. These included the following: (1) colonization by methicillin-resistant Staphylococcus aureus (MRSA) and by multidrug resistant (MDR) bacteria other than MRSA; (2) allergy to first-line antibiotics; (3) immunosuppression; (4) splenectomy; (5) comorbidity; (6) ongoing antibiotic therapy or prophylaxis; (7) coexisting infection at another site; (8) previous surgery in the last month; and (9) presurgery hospitalization lasting more than 2 weeks. This work, made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, represents, in our opinion, the most up-to-date and comprehensive collection of recommendations relating to behaviors to be undertaken in a perioperative site in the presence of specific categories of patients at high-risk of complications during surgery. The application of uniform and shared protocols in these high-risk categories will improve surgical practice with a reduction in SSIs and consequent rationalization of resources and costs, as well as being able to limit the phenomenon of antimicrobial resistance.

Topical use of hyperoxygenated fatty acids decreases surgical site infection in patients following laparoscopic cholecystectomy. A randomized controlled trial

BackgroundTo date, the topically effect of hyperoxygenated fatty acids (HOFA) on the control of surgical site infection (SSI) is still unclear. ObjectiveTo assess the effect of topical application of a HOFA solution on the umbilical trocar site after laparoscopic cholecystectomy on SSI. The occurrence of trocar site incisional hernia (TSIH) was also analyzed. MethodsA prospective, double-blind, randomized trial was conducted in patients undergoing laparoscopic cholecystectomy, who also presented at least one of the following associated risk factors for SSI and TSIH such as Body Mass Index (BMI) above 30 kg/m2, Diabetes Mellitus (DM), age over 65 years and Chronic Obstructive Pulmonary Disease (COPD). Patients were randomly allocated to topical application of a HOFA solution (HOFA arm) or saline physiological solution (non-HOFA arm) during closure of the umbilical trocar site with a polypropylene mesh. SSI was the primary outcome. TSIH was also assessed as a secondary outcome. Results103 patients were included, 51 (49.5%) in the HOFA group and 52 (50.5%) in the non-HOFA group. SSI rate was significantly lower in the HOFA group in comparison with the non-HOFA group (19.6% vs. 3.8%; p = 0.028). TSIH rates were similar in both groups (3.8% vs. 2%). Multivariate analyses showed that only HOFA decreased significantly SSI rate. ConclusionTopical application of a HOFA solution at the umbilical trocar site after laparoscopy cholecystectomy decreased SSI rate.

Preoperative nutritional evaluation, surgical site infection, and prognosis in patients with oral cancer

The risk of postoperative infection after reconstructive oral cancer surgery is high and poses a problem in perioperative management. The objective of this study was to verify the association between preoperative nutritional indicators, surgical site infection (SSI), and long-term prognosis after reconstruction for oral cancer. Sixty-seven patients admitted to a dental hospital were enrolled. The following nutritional indicators were examined: serum albumin level, modified Glasgow Prognostic Score, Miki's Glasgow Prognostic Score, prognostic nutritional index, platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, and the Controlling Nutritional Status tool. Statistical analyses were conducted to determine potential risk factors for SSI. The Cox proportional hazards model demonstrated that SSI and platelet/lymphocyte ratio ≥211.4 were independent prognostic factors affecting survival. The results demonstrated that albumin <4.0 and platelet/lymphocyte ratio ≥211.4 were risk factors for SSI. Furthermore, albumin <4.0, platelet/lymphocyte ratio ≥211.4, and SSI were correlated with prognosis. Preoperative nutritional indicators were associated with SSI and prognosis in patients with oral cancer after reconstructive surgery. Preoperative nutritional therapy is crucial for improving therapeutic outcomes in patients with oral cancer who require reconstructive surgery.