Risk Of Postoperative Infectious Complications Research Articles

Can post-operative antibiotic prophylaxis following elective laparoscopic cholecystectomy be completely done away with in the Indian setting? A prospective randomised study.

Premise and Objective:Elective laparoscopic cholecystectomy (LC) has low risk for post-operative infectious complications; still most clinicians use persistent post-operative prophylactic antibiotics out of habit, tradition, or simply as defensive practice due to evolving medicolegal implications of a large number of surgeries being showcased as daycare or next day discharge procedures. This randomised prospective trial was done to test the need for such prophylaxis in cases of elective LC in a rural/semi-urban setting.Materials and Methods:Two hundred and ten successive patients undergoing elective LC were randomised into groups receiving single dose of injection ceftriaxone at the time of induction of anaesthesia, (Group A = 112 cases) and those who in addition to above received injection ceftriaxone twice daily for 2 days postoperatively (Group B = 98 cases). Post-operative infectious complications between two groups were compared for variables such as age, sex, body mass index and bile/stone spillage.Results:There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, American Society of Anesthesiologists grade, duration of surgery and hospital stay. Intraoperative spillage of stones (9.8% [A]: 5.1% [B]) did not increase infectious complications even in the presence of positive bile culture (Group A, N = 7 vs. Group B, N = 3). An operative time of greater than 60 min was found to be associated with increased surgical site infection (P = 0. 0006).Conclusion:Single dose of ceftriaxone at the time of induction is adequate prophylaxis following elective LC even in the rural/semi-urban Indian setting and routine continued administration of antibiotic should be abandoned as it contributes to adverse reactions, drug resistance and unnecessary financial burden.

The Role of Hemoglobin A1c in Operative Patients

Patients with diabetes mellitus have abnormal carbohydrate metabolism and systemic complications. Up to 10% of patients who undergo surgery present with occult diabetes mellitus. With poor glucose control, serum and tissue proteins are glycosylated to produce advanced glycosylated end products (AGEs) that contribute to the development of rapidly progressive atherosclerosis and plaque progression. AGEs block nitric oxide activity and have been implicated in the vascular complications of diabetes. The glycosylated fraction of hemoglobin (HbA1c) is formed from the nonenzymatic glycation of hemoglobin residues and reflects long-term (3 months) glucose control and may be a useful screening tool to identify patients with undiagnosed diabetes. An elevated HbA1c is associated with an increased risk of postoperative infectious complications and risk of acute kidney injury, cerebrovascular accidents, and myocardial infarction during the perioperative period. This review contains 1 figure, 2 tables, and 42 references. Key words: HbA1c, perioperative hyperglycemia, glycosylated hemoglobin, surgical infection, Diabetes Mellitus, perioperative complications

Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn's disease.

BackgroundWe have previously demonstrated that blood transfusion (BT) was associated with post-operative complications in patients undergoing surgery for Crohn’s disease (CD), based on our institutional data registry. The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.MethodsAll CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP. Variables were defined according to the ACS NSQIP guidelines. The primary outcome was infectious complications, including superficial, deep and organ/space surgical site infection, wound dehiscence, urinary tract infection, pneumonia, systemic sepsis and septic shock. Multivariate analyses were performed to assess the risk factors for post-operative infections.ResultsAll 10 100 eligible patients were included and 611 (6.0%) received perioperative BT. BT patients were older, lighter in weight and more likely to be functionally dependent. BT patients were more likely to have post-operative infectious complications than those without BT, including superficial surgical site infection (SSI) (10.8% vs 7.4%, p=0.002), deep SSI (3.3% vs 1.6%, p=0.003), organ/space SSI (14.2% vs 5.4%, p<0.001), pneumonia (3.8% vs 1.3%, p<0.001), urinary tract infection (3.9% vs 2.2%, p=0.006), sepsis (11.5% vs 4.5%, p<0.001) and sepsis shock (3.1% vs 0.8%, p<0.001). Multivariate analysis showed that intra- and/or post-operative BT was an independent risk factor for post-operative infectious complications (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.8–2.7; p<0.001) and the risk increased with each administered unit of red blood cell (OR = 1.3, 95% CI: 1.2–1.5). Other independent factors were history of smoking, chronic heart disease, diabetes, hypertension and the use of corticosteroids. Pre-operative BT, however, was not found to be a risk factor to post-operative infections.Conclusions Intra- and/or post-operative, not pre-operative, BT was found to be associated with an increased risk for post-operative infectious complications in this CD cohort. Therefore, the timing and risks and benefits of BT should be carefully balanced.

Impact of Periapical Abscess on Infectious Complications in Patients Undergoing Extracorporeal Circulation Auxiliary to Open-Heart Surgical Procedures

ObjectiveExtracorporeal circulation auxiliary to open-heart surgeries (ECAOHS) may exert nonphysiological stresses on periapical abscessed tissues leading to hematogenous spread of microbes. The aim of this report was to estimate risk of postoperative infectious complications in patients with periapical abscesses and undergoing ECAOHS. MethodsA retrospective analysis of Nationwide Inpatient Sample (years 2009 and 2010) was conducted. All patients (aged 19 to 65 years) who underwent ECAOHS were selected. International Classification of Diseases-9-Clinical Modification codes were used to identify the presence of periapical abscess and infectious complications. Multivariable logistic regression models were used to examine the associations between the presence of periapical abscess and occurrence of infectious complications. ResultsA total of 265,235 patients underwent an ECAOH procedure. Of these, 431 patients had a periapical abscess. Septicemia developed in 16% of those with periapical abscess (compared with 4.2% in those without periapical abscess). Those with periapical abscess had higher rates of any of the infectious complications when compared with those without periapical abscess (30.2% vs 11.6%, respectively). After adjustment for multiple confounders, those with periapical abscess were associated with higher odds for developing septicemia (odds ratio = 2.51, 95% confidence interval = 1.06-5.91, P = .04) and any of the infectious complications (odds ratio = 2.23, 95% confidence interval = 1.08-4.59, P = .03) when compared with those who did not have periapical abscess. ConclusionsThose with periapical abscess are associated with higher odds for infectious complications when compared with those without periapical abscess.

Antibiotic prophylaxis in gynecological surgery. A literature review

Gynecological surgical procedures are associated with significant morbidity, and a major impact on the quality of life. The antibiotic prophylaxis should minimize the risk of postoperative infections complications, preventing in the same time the adverse effects of long-term antibiotic usage. The aim of this paper is to detail the current recommendations for antibiotic prophylaxis in gynecological surgical procedures performed by open abdominal or laparoscopic approach. We have performed a review of the English language literature from the PubMed/Medline database using the following search details: (“Antibiotic Prophylaxis”[Mesh]) AND “Gynecologic Surgical Procedures”[Mesh]. We used the similar articles function to find additional secondary resources. Antibiotic prophylaxis should not be performed in elective laparoscopic gynecological procedures without the opening of the uterus or vagina. During hysterectomy for benign or malignant disease, the first dose of antibiotic prophylaxis should be infused one hour prior to skin incision, excepting Vancomycin and Fluoroquinolone that should be started two hours before. The antibiotic should be repeated if the duration of the surgery lasts more than two half-lives of the drug or the intraoperative bleeding is greater than 1500 mL. The antibiotic prophylaxis should be discontinued within the first 24 hours after surgery. Timely administration of adequate antibiotics and a meticulous surgical technique are mandatory for effectively decreasing the risk of postoperative infectious complications. Thorough adherence to international recommendations for antibiotic prophylaxis discontinuation within 24 hours should minimize the adverse events of antibiotic usage.

Preoperative oral immunonutrition versus standard preoperative oral diet in well nourished patients undergoing pancreaticoduodenectomy

BackgroundPancreaticoduodenectomy is still associated to high morbility, especially due to pancreatic surgery related and infectious complications: many risk factors have already been advocated. Aim of this study is to evaluate the role of preoperative oral immunonutrition in well nourished patients scheduled for pancreaticoduodenectomy. MethodsFrom February 2014 to June 2015, 54 well nourished patients undergoing pancreaticoduodenectomy were enrolled for 5 days preoperative oral immunonutrition. A series of consecutive patients submitted to the same intervention in the same department, with preoperative standard oral diet, was matched 1:1. For analysis demographic, pathological and surgical variables were considered. Mortality rate, overall postoperative morbility, pancreatic fistula, post pancreatectomy haemorrhage, delayed gastric emptying, infectious complications and length of hospital stay were described for each groups. Chi squared test, Fisher's Exact test and Student's T test were used for comparison. Differences were considered statistically significant at p < 0.05. Statistics was performed using a freeware Microsoft Excel ® based program and SPSS v 10.00. ResultsNo statistical differences in term of mortality (2.1% in each groups) and overall morbility rate (41.6% vs 47.9%) occurred between the groups as well as for pancreatic surgery related complications. Conversely, statistical differences were found for infectious complications (22.9% vs 43.7%, p = 0.034) and length of hospital stay (18.3 ± 6.8 days vs 21.7 ± 8.3, p = 0.035) in immunonutrition group. ConclusionPreoperative oral immunonutrition is effective for well nourished patients scheduled for pancreaticoduodenectomy; it helps to reduce the risk of postoperative infectious complications and length of hospital stays.

Large Variation in Blood Transfusion Use After Colorectal Resection: A Call to Action.

Perioperative blood transfusions are associated with an increased risk of adverse postoperative outcomes through immunomodulatory effects. The purpose of this study was to identify factors associated with variation in blood transfusion use after elective colorectal resection and associated postoperative infectious complications This was a retrospective cohort study. The study included elective colorectal resections in New York State from 2001 to 2013. The study cohort consists of 125,160 colorectal resections. Patients who were admitted nonelectively or who were admitted before the date of surgery were excluded. Receipt of a perioperative allogeneic red blood cell transfusion and the secondary end points of postoperative pneumonia, surgical site infection, intra-abdominal abscess, and sepsis were measured. The overall rate of perioperative blood transfusion for the study cohort was 13.9%. The unadjusted blood transfusion rates ranged from 2.4% to 58.7% for individual surgeons and 2.9% to 32.8% for individual hospitals. After controlling for patient-, surgeon-, and hospital-level factors in a 3-level mixed-effects multivariable model, significant variation was still present across both surgeons (p < 0.0001) and hospitals (p < 0.0001), with a 16.8-fold difference in adjusted blood transfusion rates across surgeons and a 13.2-fold difference in adjusted blood transfusion rates across hospitals. Receipt of a blood transfusion was also independently associated with pneumonia (OR = 3.23 (95% CI, 2.92-3.57)), surgical site infection (OR = 2.27 (95% CI, 2.14-2.40)), intra-abdominal abscess (OR = 2.72 (95% CI, 2.41-3.07)), and sepsis (OR = 4.51 (95% CI, 4.11-4.94)). Limitations include the retrospective design and the possibility of miscoding within administrative data. Large surgeon- and hospital-level variations in perioperative blood transfusion use for patients undergoing colorectal resection are present despite controlling for patient-, surgeon-, and hospital-level factors. In addition, receipt of a blood transfusion was independently associated with an increased risk of postoperative infectious complications. These findings support the creation and implementation of perioperative blood transfusion protocols aimed at limiting unwarranted variation.

The Effect of Immunonutrition on the Postoperative Complications in Thymoma with Myasthenia Gravis.

Object. To test whether preoperative immunonutrition is efficacious in reducing postoperative complications in patients of thymoma with myasthenia gravis (MG). Material and Methods. A total of 244 patients operated on for thymoma with myasthenia gravis were prospectively assigned to two groups, each receiving seven-day preoperative and seven-day postoperative nutrition. The patients in immunonutrition group were given oral immunonutrition (IN). The patients in control group received oral standard nutrition. Immunonutritional and inflammatory biomarkers (IgA, IgG, IgM, CD3t, CD4t, CD8t, CD4t/CD8t ratio, NK-cell, prealbumin, albumin, white blood cells counts, and C-reactive protein) and clinical variables (age, gender, BMI, performance status, type of thymoma, type of MG, operative time, pathology, operative approach, postoperative complications, quantity of drainage, hospital stays) were examined. Results. A significant reduction in the length of hospital stay, quantity of drainage, and postoperative complications was observed in the IN group (p < 0.05). An increase in the level of IgA, IgG, IgM, CD3+T, CD4+T, CD4+T/CD8+T, WBC, CRP, and NK-cell in the IN group was observed after thymectomy, while a decrease was seen with regard to prealbumin and albumin (p < 0.05). Conclusion. Preoperative immunonutrition support is effective in reducing postoperative complications in patients of thymoma with MG. It helps to lower the risk of postoperative infectious complications and hospital stays.

Post-operative abdominal complications in Crohn's disease in the biological era: Systematic review and meta-analysis.

To perform a systematic review and meta-analysis on post-operative complications after surgery for Crohn's disease (CD) comparing biological with no therapy. PubMed, Medline and Embase databases were searched to identify studies comparing post-operative outcomes in CD patients receiving biological therapy and those who did not. A meta-analysis with a random-effects model was used to calculate pooled odds ratios (OR) and confidence intervals (CI) for each outcome measure of interest. A total of 14 studies were included for meta-analysis, comprising a total of 5425 patients with CD 1024 (biological treatment, 4401 control group). After biological therapy there was an increased risk of total infectious complications (OR = 1.52; 95%CI: 1.14-2.03, 8 studies) and wound infection (OR = 1.73; 95%CI: 1.12-2.67; P = 0.01, 7 studies). There was no increased risk for other complications including anastomotic leak (OR = 1.19; 95%CI: 0.82-1.71; P = 0.26), abdominal sepsis (OR = 1.22; 95%CI: 0.87-1.72; P = 0.25) and re-operation (OR = 1.12; 95%CI: 0.81-1.54; P = 0.46) in patients receiving biological therapy. Pre-operative use of anti-TNF-α therapy may increase risk of post-operative infectious complications after surgery for CD and in particular wound related infections.

Preoperative Antibiotic Prophylaxis Does Not Reduce the Risk of Postoperative Infectious Complications in Patients Undergoing Elective Hepatectomy.

Postoperative infection is not uncommon after hepatectomy. This study assessed the effectiveness of preoperative antibiotic prophylaxis in elective hepatectomy in a randomized clinical trial setting. A total of 120 patients who were scheduled to undergo elective hepatectomy were equally randomized to receive either intravenous cefuroxime 1.5g (group A) or placebo (group B) within 30min prior to skin incision. Overall, postoperative infection occurred in 26 (21.6%) of the 120 patients. There was no statistically significant difference between groups A and B in the incidence of overall infection (23.3 vs. 20.0%, P=0.658), surgical site infection (13.3 vs. 15%, P=0.793), and remote site infection (13.3 vs. 11.7%, P=0.783). The use of preoperative antibiotic prophylaxis as a routine practice in patients undergoing elective hepatectomy is unnecessary because it does not reduce the risk of postoperative infectious complications.

Factors affecting serum albumin in the perioperative period of colorectal surgery: a retrospective study.

BackgroundAlbumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. Hypoalbuminemia is a risk factor for mortality, postoperative complications, and prolonged hospital stay. The magnitude of the systemic inflammatory response during the perioperative period, as indicated by the acute-phase proteins—C-reactive protein (CRP) in particular—, may help identify the risk of postoperative infectious complication. The correlation between serum albumin and CRP with gastrointestinal cancer has been reported. However, it is unclear whether antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period in colorectal surgery. The primary endpoint of this study was to reveal that antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period of colorectal surgery.MethodsThirty-seven patients who underwent elective open colorectal surgery were included in this study. Correlations between preoperative CRP and serum albumin on postoperative day (POD) 3, between preoperative CRP and serum albumin on POD 7 and between CRP on POD 3 and serum albumin on POD 7 were examined. Relationships between preoperative CRP and hypoalbuminemia on POD 3, between preoperative CRP and hypoalbuminemia on POD 7 and between CRP on POD 3 and hypoalbuminemia on POD 7 were examined by receiver operating characteristic analysis.ResultsThree-quarters of patients were older than 65 years of age. Significant correlations were observed between preoperative CRP and serum albumin on POD 3 (p = 0.023), between preoperative CRP and serum albumin on POD 7 (p = 0.023) and between CRP on POD 3 and serum albumin on POD 7 (p < 0.001). The area under the receiver operating characteristic curve of CRP on POD 3 to development of hypoalbuminemia on POD 7 was 0.833 (95 % CI 0.679–0.987) with an optimal threshold of 12.43 mg/dL, sensitivity 75 % and specificity 80 %.ConclusionsThe present study revealed that antecedent CRP was associated with future serum albumin. Additionally, CRP on POD 3 could be useful in predicting the development of hypoalbuminemia on POD 7. This result suggests that CRP on POD 3 may be a valuable indicator for early nutritional intervention.

Effect of statins on preventing infectious complications after surgery: Systematic review and meta-analysis.

*These authors contributed equally to this work.A meta-analysis to investigate the association between preoperative statin use and the risk of postoperative infectious complications in patients undergoing surgery. PubMed(®) and Embase(®) databases were searched for relevant studies. Data were extracted using a standardized data collection form. The primary effect measure was the odds ratio (OR) of postoperative infectious complications. Summary OR were calculated. The analysis included 10 cohort studies with a total of 147 263 participants. Statin use was associated with a lower incidence of postoperative infectious complications in all studies (summary OR 0.917, 95% confidence intervals [CI] 0.862, 0.975, fixed-effects model; summary OR 0.731, 95% CI 0.584, 0.870, random-effects model); cardiac surgery (summary OR 0.673; 95% CI 0.535, 0.847); treatment in the USA (summary OR 0.678; 95% CI 0.597, 0.770); retrospective cohort studies (summary OR 0.664; 95% CI 0.521, 0.846). Preoperative statin use is associated with a reduced risk of postoperative infectious complications.

Metabolic dysfunction in lymphocytes promotes postoperative morbidity.

Perioperative lymphopenia has been linked with an increased risk of postoperative infectious complications, but the mechanisms remain unclear. We tested the hypothesis that bioenergetic dysfunction is an important mechanism underlying lymphopenia, impaired functionality and infectious complications. In two cohorts of patients (61-82years old) undergoing orthopaedic joint replacement (n=417 and 328, respectively), we confirmed prospectively that preoperative lymphopenia (≤1.3 x 10(9)·l(-1); <20% white cell count; prevalence 15-18%) was associated with infectious complications (relative risk 1.5 (95% confidence interval 1.1-2.0); P=0.008) and prolonged hospital stay. Lymphocyte respirometry, mitochondrial bioenergetics and function were assessed (n=93 patients). Postoperative lymphocytes showed a median 43% fall (range: 26-65%; P=0.029; n=13 patients) in spare respiratory capacity, the extra capacity available to produce energy in response to stress. This was accompanied by reduced glycolytic capacity. A similar hypometabolic phenotype was observed in lymphocytes sampled preoperatively from chronically lymphopenic patients (n=21). This hypometabolic phenotype was associated with functional lymphocyte impairment including reduced T-cell proliferation, lower intracellular cytokine production and excess apoptosis induced by a range of common stressors. Glucocorticoids, which are ubiquitously elevated for a prolonged period postoperatively, generated increased levels of mitochondrial reactive oxygen species, activated caspase-1 and mature interleukin (IL)-1β in human lymphocytes, suggesting inflammasome activation. mRNA transcription of the NLRP1 inflammasome was increased in lymphocytes postoperatively. Genetic ablation of the murine NLRP3 inflammasome failed to prevent glucocorticoid-induced lymphocyte apoptosis and caspase-1 activity, but increased NLRP1 protein expression. Our findings suggest that the hypometabolic phenotype observed in chronically lymphopenic patients and/or acquired postoperatively increases the risk of postoperative infection through glucocorticoid activation of caspase-1 via the NLRP1 inflammasome.

PD8-06 PERIOPERATIVE BLOOD TRANSFUSIONS AS A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AFTER UROLOGIC SURGERY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder I1 Apr 2015PD8-06 PERIOPERATIVE BLOOD TRANSFUSIONS AS A RISK FACTOR FOR INFECTIOUS COMPLICATIONS AFTER UROLOGIC SURGERY Richard Matulewicz, Daniel Oberlin, Irene Helenowski, Borko Jovanovic, and Shilajit Kundu Richard MatulewiczRichard Matulewicz More articles by this author , Daniel OberlinDaniel Oberlin More articles by this author , Irene HelenowskiIrene Helenowski More articles by this author , Borko JovanovicBorko Jovanovic More articles by this author , and Shilajit KunduShilajit Kundu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.921AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies have associated perioperative blood transfusions (BT) with significantly increased postoperative infection rates. The effect of BT on infection appears to be related to the state of immunosuppression it induces. We investigated the risk of short-term post-operative infectious outcomes of urologic surgery with perioperative BT. METHODS We identified patients undergoing the thirty most common urologic surgeries captured by the ACS-NSQIP database from 2006 to 2012. The association of preoperative and intraoperative/post operative transfusions with infectious outcomes (surgical site infections (SSI), urinary tract infection (UTI), pneumonia, sepsis/septic shock) was assessed by Chi-square test with continuity correction. Multivariate logistic regression controlling for diabetes, chronic steroid use, recent chemotherapy, and operative wound classification provided odds ratios for infectious outcomes. RESULTS A total of 41,858 cases of the 30 most common urologic operations were reviewed. 30,651 (73.2%) cases met inclusion criteria for review. 0.5% (157/30651) of patients had a transfusion of at least 1 unit of packed red blood cells (pRBC) within 72 hours prior to surgery. 3.7% (1133/30651) of patients received a BT of at least 1 unit pRBC intraoperatively or within 72 hours postoperatively. Multivariate analysis, controlling for potential confounding risks factors, found that preoperative transfusion is associated with a significantly increased risk of pneumonia, UTI, and post-operative sepsis (p<0.01, Table 1). Intraoperative and post-operative transfusion is associated with both superficial and deep SSI, organ space infection, UTI, and post-operative sepsis, including septic shock (p <0.01). CONCLUSIONS Although blood transfusions are beneficial in select patients with perioperative anemia, our study shows that BT is associated with a significantly increased risk of post-operative infectious complications. We found an increase risk of SSI, pneumonia, and sepsis among transfused patients undergoing urologic surgery. Prudent use of BT can potentially mitigate infectious complications. Transfusion Timing Infectious Outcome Odds Ratio Confidence Interval (95%) p value Preoperative Pneumonia 4.0 1.4-11.0 < 0.01 UTI 2.2 1.2-4.1 0.01 Postop Sepsis 2.9 1.2-7.2 0.02 Intraoperative/Postoperative Superficial SSI 4.7 3.2-6.9 < 0.01 Deep SSI 5.4 2.5-11.5 < 0.01 Organ Space Infection 8.0 5.1-12.7 < 0.01 Pneumonia 6.7 4.6-9.8 < 0.01 UTI 1.9 1.5-2.5 < 0.01 Postop Sepsis 6.4 4.8-8.7 < 0.01 Postop Septic Shock 5.6 3.3-9.6 < 0.01 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e192 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Richard Matulewicz More articles by this author Daniel Oberlin More articles by this author Irene Helenowski More articles by this author Borko Jovanovic More articles by this author Shilajit Kundu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Postoperative infection risk after splenectomy: A prospective cohort study

IntroductionSplenectomy is associated with a life-long risk for overwhelming infections. The risk for early post-operative infectious complications following traumatic and elective splenectomy is, however, understudied. This investigation aimed to determine if splenectomy increases the risk for post-operative infections. MethodsThis was a retrospective review of prospectively collected data on patients admitted to the surgical intensive care unit (SICU) between 1/2011 and 7/2013 investigating the risk for infectious complications in patients undergoing a splenectomy compared with those undergoing any other abdominal surgery. ResultsDuring the 30-month study period, a total of 1884 patients were admitted to the SICU. Of those, 33 (2%) had a splenectomy and 493 (26%) had an abdominal surgery. The two groups were well balanced for age, APACHE IV score >20, and past medical history, including diabetes mellitus, cardiac history, renal failure or immunosuppression. Patients undergoing splenectomy were more likely to have sustained a traumatic injury (30% vs. 7%, p < 0.01). After adjustment, splenectomy was associated with increased risk for infectious complications (49% vs. 29%, Adjusted Odds Ratio (AOR) [95% CI]: 2.7 [1.3, 5.6], p = 0.01), including intra-abdominal abscess (9% vs. 3%, AOR [95% CI]: 4.3 [1.1, 16.2], p = 0.03). On a subgroup analysis, there were no differences between traumatic and elective splenectomy with regards to overall infectious complications (50% vs. 46%, p = 0.84), although, abdominal abscess developed only in those who had an elective splenectomy (0% vs. 12%, p = 0.55). ConclusionSplenectomy increases the risk for post-operative infectious complications. Further studies identifying strategies to decrease the associated morbidity are necessary.

Multidrug resistant bacteriuria before percutaneous nephrolithotomy predicts for postoperative infectious complications.

Multidrug resistant (MDR) uropathogens are increasing in prevalence and may contribute to significant morbidity after percutaneous nephrolithotomy (PCNL). We investigate the presence of MDR bacteriuria and occurrence of postoperative infectious complications in patients who underwent PCNL at our institution. Retrospective review was performed of 81 patients undergoing PCNL by a single surgeon (RLS) between 2009 and 2013. Patient demographics, comorbidities, stone parameters on imaging, and microbial data were compiled. MDR organisms were defined as resistant to three or more of the American Urological Association Best Practice Statement antimicrobial classes for PCNL. Postoperative complications were graded by Clavien score and European Association of Urology infection grade. Univariate comparisons were analyzed between patients with and without a postoperative infectious complication. Multivariate logistic regression was performed to determine significant predictor variables for postoperative infectious complications. Of the 81 patients undergoing PCNL, 41/81 (51%) had positive preoperative urine culture, 24/81 (30%) had positive MDR urine culture, and 16/81 (19%) had a postoperative infectious complication. Multivariate analysis revealed a positive preoperative MDR urine culture significantly increased the risk of postoperative infectious complication (odds ratio [OR]=4.89, 95% confidence interval [CI] 1.134-17.8, P=0.016). The presence of more than one access tract during PCNL also predicted for infectious complications (OR=7.5, 95% CI 2.13-26.4, P=0.003) Of the 16 patients with a postoperative infection 3 (18%) had postoperative urine cultures discordant with the preoperative urine cultures. Our institution demonstrated a relatively high prevalence of MDR bacteriuria in patients undergoing PCNL and that MDR is a significant risk factor for postoperative infectious complications despite appropriate preoperative antibiotics. Further investigations regarding prophylaxis modalities and infection prevention strategies are needed.

Simple acute appendicitis versus non-perforated gangrenous appendicitis: is there a difference in the rate of post-operative infectious complications?

According to the 2002 Surgical Infection Society Guidelines on Antimicrobial Therapy for Intra-abdominal Infections, antimicrobial therapy is not recommended beyond 24 hours for the treatment of postoperative acute or gangrenous appendicitis without perforation. However, clinicians commonly consider gangrenous appendicitis to pose a greater risk of post-operative infectious complications, such as surgical site infections and intra-abdominal abscesses. This study examines the relative risk of post-operative infection between patients with simple and gangrenous appendicitis. A retrospective review of patients with either non-perforated gangrenous or simple appendicitis from 2010 to 2012 was performed at a large urban teaching hospital. The rate of post-operative intra-abdominal abscess formation, which was diagnosed on patient readmission to the hospital, was significantly greater in patients with non-perforated gangrenous appendicitis in comparison to those with simple non-perforated appendicitis. Also, patients with non-perforated gangrenous appendicitis received extended courses of post-operative antibiotics, despite SIS recommendations. The role of peri-operative antibiotics for non-perforated gangrenous appendicitis merits further study.

Biliary microflora in patients undergoing cholecystectomy.

The management of acute cholecystitis requires a sound knowledge of the biliary microflora. Bile samples were taken for culture according to a standard routine during all cholecystectomies performed from April 2007 to February 2009 in the Department of Surgery at Enköping Hospital. The use of antibiotics within the 3-mo period before surgery, indication for surgery, prophylactic antibiotics, and post-operative complications were recorded prospectively. Altogether, 246 procedures were performed during the study period, of which 149 (62%) were done on women. The mean (±SD) age of the study subjects was 49±16 y. Bacterial growth was seen in cultures from 34 (14%) of the subjects. The mean age of subjects with positive cultures was 64 y and that of subjects with negative cultures was 47 y (p<0.001). Positive culture was seen in 16 (31%) of the 51 patients who underwent operations for acute cholecystitis, whereas positive cultures were obtained in 18 of 195 patients without acute cholecystitis (9%) (p<0.001). Resistance to ampicillin was recorded in three of 34 (9%) of the cultures with bacterial growth, to co-trimoxazole in one of the 34 (3%) cultures, to fluoroquinolones in one of the 34 (3%) cultures, and to cephalosporins in one of the 34 (3%) cultures. Resistance to piperacillin-tazobactam was not observed in any of the cultures. In multivariable logistic regression analysis, a positive culture was the only factor significantly associated with risk for post-operative infectious complications (p<0.05). Bacterial growth in the bile is observed more often in patients undergoing surgery for acute cholecystitis. The microflora of the bile is probably important for the outcome of surgery, but further studies are required for assessing the effectiveness of measures for preventing infectious post-operative complications.

Impact of preoperative immunosuppressive agents on postoperative outcomes in Crohn's disease.

Immunosuppressive agents are essential in the management of Crohn's disease. Their safety before surgery, however, is still controversial. The aim of this study is to evaluate whether the preoperative use of immunosuppressive agents is associated with increased postoperative complications in Crohn's disease. A literature search of PubMed, EMBASE, and The Cochrane Library was undertaken in February 2013. All studies describing postoperative outcomes of patients undergoing bowel resections for Crohn's disease were included if they reported data comparing patients on preoperative immunosuppressive agents with an appropriate control group. All immunosuppressive agents used to manage Crohn's disease were studied. The main outcomes measured were total overall complications and total infectious complications. Twenty-one eligible studies (20 retrospective and 1 prospective) with 6899 patients were included. When individual studies were examined, only 2/14 (14%), 4/13 (31%), and 1/8 (13%) studies found an association between postoperative complications and preoperative anti-tumor necrosis factor agents, corticosteroids, and thiopurines. In meta-analyses, patients on anti-tumor necrosis factor agents (risk ratio, 1.29; 95% CI, 1.07-1.55), and corticosteroids (risk ratio, 1.55; 95% CI, 1.23-1.95) were found to have a higher risk of postoperative infectious complications. The use of anti-tumor necrosis factor agents was also significantly associated with wound infection (risk ratio, 1.62; 95% CI, 1.12-2.34) and septic shock (risk ratio, 1.81; 95% CI, 1.03-3.17). There was no association between the use of thiopurines or combined immunomodulator drugs and postoperative complications. Most studies were retrospectively designed, and there were large variations in the patient populations and outcome definitions. Patients with Crohn's disease on preoperative immunosuppressive agents are at higher risk for complications. Both corticosteroids and anti-tumor necrosis factor agents may increase the risk of infections and septic shock. A preoperative drug-free interval, when feasible, might be considered to reduce the risk of infections. The adoption of any operative strategies that modify these outcomes may additionally counter these risks.

PD28-01 DOES PRE-OPERATIVE MULTI-DRUG RESISTANT URINE CULTURE PREDICT INFECTIOUS COMPLICATIONS AFTER PERCUTANEOUS NEPHROLITHOTOMY?

You have accessJournal of UrologyStone Disease: Evaluation I1 Apr 2014PD28-01 DOES PRE-OPERATIVE MULTI-DRUG RESISTANT URINE CULTURE PREDICT INFECTIOUS COMPLICATIONS AFTER PERCUTANEOUS NEPHROLITHOTOMY? Nishant Patel, MD Omer Raheem, MD Michael Liss, MD David Wenzler, MD William Shi, Craig Schallhorn, BS Charles Lakin, MD Michelle Ritter, andMD Roger L. SurMD Nishant PatelNishant Patel More articles by this author , Omer RaheemOmer Raheem More articles by this author , Michael LissMichael Liss More articles by this author , David WenzlerDavid Wenzler More articles by this author , William ShiWilliam Shi More articles by this author , Craig SchallhornCraig Schallhorn More articles by this author , Charles LakinCharles Lakin More articles by this author , Michelle RitterMichelle Ritter More articles by this author , and Roger L. SurRoger L. Sur More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES American Urological Association (AUA) Best Practice guidelines are in place to minimize infectious complications from percutaneous nephrolithotomy (PCNL). Multidrug resistant (MDR) uropathogens are increasing in prevalence and may contribute to significant morbidity following PCNL. We sought to document the prevalence of MDR baceteruria in patients whom underwent PCNL at our institution and evaluate whether presence of MDR bacteruria predicts for post-operative infectious complications. METHODS A retrospective review was performed of 83 patients undergoing PNCL by a single surgeon (RLS) between 2009-2013. Patient demographics, comorbidities, stone parameters on imaging, and microbial data was compiled. MDR organisms were defined as resistance to three or more of the AUA Best Practice Statement antimicrobial classes for PCNL (cephalosporin, aminoglycoside, fluoroquinolone, penicillin, clindamycin). Complications, Clavien score, and presence of post-operative infectious complications (EUA infection grade) were recorded. Univariate comparisons were analyzed between patients with and without a post-operative infectious complication. Multivariate logistic regression was performed to determine predicting variables for post-operative infectious complications. RESULTS Of the 83 patients undergoing PCNL, 49% had positive preoperative urine culture and 29% had positive MDR urine culture. Patients who had a post-operative infectious complication compared to those that did not, had an increased prevalence of staghorn calculus (50% vs. 18.6%, p=0.006) and an increased prevalence of pre-operative MDR urine culture (50% vs 20.3%, p=0.015). Controlling for age, stone size, and presence of renal structure abnormalities, multivariate analysis revealed presence of staghorn calculus increased the risk of a post-operative infectious complications by 4.15 times (95% CI 1.39-12.44, p=0.011). A positive pre-operative MDR urine culture increased the risk of post-operative infectious complication by 3.65 times (95% CI 1.23-10.87, p=0.02) despite appropriate culture-specific antibiotics. CONCLUSIONS Our institution demonstrated a relatively high prevalence of multi-drug resistant bacteruria in patients undergoing PCNL. The presence of a staghorn calculus and positive MDR urine culture predicted for a post-operative infectious complication. The higher risk of complications should be provided to patients undergoing PCNL and warrant extra attention to post-operative care by urologists. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e769 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nishant Patel More articles by this author Omer Raheem More articles by this author Michael Liss More articles by this author David Wenzler More articles by this author William Shi More articles by this author Craig Schallhorn More articles by this author Charles Lakin More articles by this author Michelle Ritter More articles by this author Roger L. Sur More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...