Risk Of SSI Research Articles

Prolonged Umbilical Port Insertion Time Increases the Incidence of Umbilical Surgical Site Infection in Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia in Children.

Introduction: Umbilical surgical site infection (U-SSI) is the most common complication of laparoscopic percutaneous extraperitoneal closure (LPEC) for the treatment of inguinal hernia in children. Prolonged operative time is known to increase the risk of SSI in general pediatric surgery; however, the association between prolonged operative time and post-LPEC U-SSI is unclear. The present study aimed to elucidate the association between umbilical port insertion time and the incidence of U-SSI. Materials and Methods: The present study included all patients <16 years of age who underwent LPEC for the treatment of inguinal hernia between June 2018 and May 2023 at our institution. Those who underwent umbilical hernia repair or other procedures were excluded. We retrospectively collected and analyzed the following: patient demographics; operative data; and U-SSI data. The cutoff value for the umbilical port insertion time was determined using receiver operating characteristic analysis, and the incidence of U-SSI was compared based on the cutoff value, determined to be 8 minutes. Results: A total of 232 patients (133 boys; mean age, 4.6 ± 3.3 years) were eligible for the present study, 7 (3.0%) of which developed superficial incisional post-LPEC U-SSI within a median of 7.5 [4-19] days. The incidence of U-SSI was 20.0% in the long (≥8 minutes) versus 2.3% in the short (<8 minutes) umbilical port insertion time group (P = .03). Conclusion: Prolonged umbilical port insertion time (≥8 minutes) increases the incidence of post-LPEC U-SSI during the treatment of inguinal hernia in children.

Association between body composition and incisional surgical site infection after laparoscopic appendectomy for complicated appendicitis

PurposeSurgical site infection (SSI) is common after laparoscopic appendectomy, resulting in prolonged hospital stay and increased costs. This study examined the relationship between body composition parameters and risk of incisional SSI in patients with complicated appendicitis.MethodsWe included 411 patients who underwent laparoscopic surgery for complicated appendicitis at a single institution between March 2015 and October 2023. Body composition parameters were derived from preoperative computed tomography (CT). A nomogram was constructed based on the independent predictors of incisional SSI.ResultsOverall, 45 (10.9%) patients developed incisional SSI. Visceral fat area (VFA) was independently associated with risk of incisional SSI (hazard ratio 1.015, 95% confidence interval 1.010–1.020, P < 0.001). A nomogram integrating VFA and two other independent predictors (diabetes and conversion) demonstrated high discriminative (area under the curve = 0.793) and calibration abilities.ConclusionsCT-derived VFA could be a valuable predictor of incisional SSI in patients with complicated appendicitis undergoing laparoscopic surgery. A VFA-based nomogram may help in identifying patients at high risk of SSI.

Unveiling the dynamics of intraoperative contamination in total hip arthroplasty: the discrepancy between particulate and microbial contamination in surgical site infection risk

BackgroundSurgical site infection (SSI) is a major problem following total hip arthroplasty (THA). This study investigated the impact of a standard intraoperative routine where the surgical team wears full-body exhaust suits (space suits) within a laminar airflow (LAF)-ventilated operating room (OR) on environmental contamination. Our primary objective was to identify potential modifiable intraoperative factors that could be better controlled to minimize SSI risk.MethodsWe implemented an approach involving simultaneous and continuous air sampling throughout actual primary cementless THA procedures. This method concurrently monitored both airborne particle and microbial contamination levels from the time the patient entered the OR for surgery until extubation.ResultsAirborne particulate and microbial contamination significantly increased during the first and second patient repositionings (postural changes) when the surgical team was not wearing space suits. However, their concentration exhibited inconsistent changes during the core surgical procedures, between incision and suturing, when the surgeons wore space suits. The microbial biosensor detected zero median microbes from draping to suturing. In contrast, the particle counter indicated a significant level of airborne particles during head resection and cup press-fitting, suggesting these procedures might generate more non-viable particles.ConclusionsThis study identified a significant portion of airborne particles during the core surgical procedures as non-viable, suggesting that monitoring solely for particle counts might not suffice to estimate SSI risk. Our findings strongly support the use of space suits for surgeons to minimize intraoperative microbial contamination within LAF-ventilated ORs. Therefore, minimizing unnecessary traffic and movement of unsterile personnel is crucial. Additionally, since our data suggest increased contamination during patient repositioning, effectively controlling contamination during the first postural change plays a key role in maintaining low microbial contamination levels throughout the surgery. The use of sterile gowns during this initial maneuver might further reduce SSIs. Further research is warranted to investigate the impact of sterile attire on SSIs.

Role of rectal colonization by third-generation cephalosporin-resistant Enterobacterales on the risk of surgical site infection after hepato-pancreato-biliary surgery.

In this Spanish retrospective cohort study, previous 3GCR-E rectal colonization was associated with a higher risk of SSI after hepato-pancreato-biliary resection surgeries. Most of SSIs were caused by the colonizing bacteria, suggesting a rationale for adapted perioperative antibiotic prophylaxis in known 3GCR-E colonized patients.

Wound infection rate after skin closure of damage control laparotomy with wicks or incisional negative wound therapy: An EAST multi-center trial.

Damage control laparotomy (DCL) has a high risk of SSI and as an attempt to mitigate this, surgeons often leave the skin open to heal by secondary intention. A recent retrospective study showed that DCL wounds could be closed with the addition of wicks or incisional wound vacs with acceptable rates of wound infection. The aim of this prospective trial was to corroborate these results.This is a prospective multicenter observational trial performed by 7 institutions from July 2020 to April 2022. Adult patients who underwent DCL and fascia/skin closure with the addition of wicks or an incisional wound vac were included. Patients who died within seven days of DCL were excluded. Demographics, mechanism of initial presentation, wound classification, antibiotics given, surgical site infections, procedures performed, and mortality data was collected. Fisher's Exact test was used for categorical data and Wilcoxon Rank Sum test for continuous data. Mean days to closure was assessed using Student's t-test for independent groups. P-values <0.05 were considered indicative of statistical significance.Over the 21-month period, a total of 119 patients analyzed. Most patients were male (n = 66, 63 %), and the average age was 51 years. The average number of days the abdomen was kept open was 2.6. A majority of the DCLs were performed on acute care patients (n = 76, 63.8 %) and 92 patients (77.3 %) had a wound classification of contaminated or dirty. Most of the patients’ skin was closed with wicks in place (68.9 %). There was a 9.8 % infection rate in patient's skin closed with wicks versus 16.2 % closed with an incisional wound vac (p = 0.361).Although the wick group had a higher proportion of class III and IV wound types, patients primarily treated with wicks had a lower risk of wound infection compared to those treated with incisional wound VACs; however, this difference was not statistically significant.

Surgical site infection surveillance in knee and hip arthroplasty: optimizing an algorithm to detect high-risk patients based on electronic health records

BackgroundSurgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty.MethodsRetrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated.ResultsIn total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients’ median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation.ConclusionsDifferent algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance.

Drains in Abdominoplasties: The Less the Better?

Drains are traditionally inserted during surgery for reduction of fluid accumulation in the post-operative period. The appearance of drained fluids and their quantity can be early predictors of complications. Over the years, several studies have been conducted in attempt to determine the optimal number of drains that result in low rates of fluid accumulation with minimal impairment of quality of life. Determine the optimal number of suction drains in abdominoplasty procedures. Retrospective cohort study, analyzing all abdominoplasty patients operated by a single surgeon. Patients were stratified into 3 groups based on number of drains inserted at the end of the procedure. Rate of complications was compared between the groups and a multivariate logistic regression model was computed for the development of complications. Seven-hundred and forty three patients were included in the analysis of this study. No drains were inserted in 355 patients (45%), whereas a single drain was inserted in 153 (20.6%) 2 drains in 255 patients (34.4%). Patients for whom a single drain was inserted intra-operatively, experienced at a statistically significant lower rate, surgical site infections (OR = 0.235), hypertrophic scars (OR = 0.326), wound dehiscence (OR = 0.272), as compared to patients with no drains. On the contrary, insertion of single drain was associated with a statistically significant higher risk for development of seroma (OR = 6.276) and the need for revision surgery (OR = 2.452). Insertion of a single drain is associated with a lower risk of SSI and wound- dehiscence, but a greater risk for seroma development that requires surgical intervention. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Implementation of surgical site infection care bundle in patients undergoing gastrointestinal surgeries

PurposeSurgical site infection (SSI) is one of the frequent healthcare associated infections linked with significant morbidity, prolonged hospitalization, and death. SSI can be reduced by implementation of customized care bundle components as per standard guidelines. Hence this study was undertaken with the objective to implement care bundle in patients undergoing elective gastrointestinal surgeries and assess their impact on SSI rate. MethodsThe study was an interventional study conducted in the department of surgical gastroenterology for 8 months. Sample size was calculated to be 196 and only elective surgeries are included. CDC NHSN 2023 guidelines are used for surveillance of SSI and global guidelines for prevention of SSI was used for preparation of list of pre-operative, intraoperative and post-operative care bundle components and were implemented before the start of the study. ResultsOverall SSI rate and compliance to SSI care bundle in this study are 13.8% and 28.6%, respectively. When compared with the baseline SSI rate of 19.4%, there is reduction of 28.9% in SSI rate after the implementation of care bundle. Escherichia coli (54.2%) is the most commonly isolated organism. Care bundle non-compliant surgeries are associated with 2.3 times (relative risk-2.3) increased risk of SSI. There is fluctuating trend in compliance of care bundle and SSI rates across months. ConclusionThis study shows the importance of implementation of set of care bundle for prevention of SSI which can be customized and adapted for reducing SSI.

The effect of damage control laparotomy on surgical-site infection risks after emergent intestinal surgery

IntroductionDamage-control laparotomy has been widely used in general surgery. However, associated surgical-site infection risks have rarely been investigated. Damage-control laparotomy allows for additional opportunities for decontamination. We hypothesized that damage-control laparotomy would be associated with lower surgical-site infection risks compared with laparotomy with only primary fascial closure or with primary fascial and skin closure. MethodsPatients admitted for emergent intestinal surgery from 2006 to 2021 were included. Multivariate analyses were performed to identify surgical-site infection–associated risk factors. Although variables like laparotomy type (damage-control laparotomy, primary fascial closure, and primary fascial and skin closure) were provided by National Surgical Quality Improvement Program, other variables such as number of operations were retrospectively collected. P < .05 was considered significant. ResultsOverall, 906 patients were included; 213 underwent damage-control laparotomy, 175 primary fascial closure, and 518 primary fascial and skin closure. Superficial, deep, and organ-space surgical-site infection developed in 66, 6, and 97 patients, respectively. Compared with primary fascial and skin closure, both damage-control laparotomy (odds ratio, 0.30 [95% CI, 0.13–0.73], P = .008) and primary fascial closure (odds ratio, 0.09 [95% CI, 0.02–0.37], P = .001) were associated with lower superficial incisional surgical-site infection but not organ-space surgical-site infection risk (odds ratio, 0.80 [95% CI, 0.29–2.19] P = .667 and odds ratio, 0.674 [95% CI, 0.21–2.14], P = .502, respectively). Body mass index was associated with increased risk of superficial incisional surgical-site infection (odds ratio, 1.06 [95% CI, 1.03–1.09], P < .001) whereas frailty was associated with organ space surgical-site infection (odds ratio, 3.28 [95% CI, 1.29–8.36], P = .013). For patients who underwent damage-control laparotomy, the number of operations did not affect risk of either superficial incisional surgical-site infection or organ space SSI. ConclusionHerein, compared with primary fascial and skin closure, both damage-control laparotomy and primary fascial closure were associated with lower superficial but not organ space surgical-site infection risks. For patients who underwent damage-control laparotomy, number of operations did not affect surgical-site infection risks.

542 Reducing the Burden to Deliver Remote Postoperative Surveillance Using Machine Learning for Surgical-Site Infection (SSI)

Abstract Aim To develop novel methods for automated assessment of patient-generated data from remote postoperative wound (RPW) surveillance to reduce the burden of clinical triage for in-person assessment. Method This was a secondary analysis of an interventional study on RPW surveillance: “ImplementatioN of Remote Surgical wOund Assessment During the coviD-19 pandEmic” (INROADE). INROADE included adult patients undergoing gastrointestinal surgery, who could submit images of their surgical wound(s), and patient-reported symptoms of SSI for 30-days postoperatively. Separate models were developed to predict a clinical diagnosis of SSI within 48h based on patient-reported symptoms (logistic regression) and wound images (convolutional neural networks [CNN]). Model performance was evaluated using area under the curve (AUC), with 95% confidence intervals. The impact of implementation of automated assessment was simulated within the RPW surveillance pathway to “rule-out” responses needing clinician triage. Results Of 200 patients enrolled, there were 1529 responses with 3.3% (n=51) submitted within 48h of an SSI. There was excellent discrimination using logistic regression with patient-reported symptoms (AUC: 0.830, 0.765-0.894). 2,125 images were used to develop the CNN, which showed moderate discrimination to identify 48h SSI (AUC: 0.615, 0.556-0.674). Usage to screen out “low-risk” responses prior to clinical triage was estimated to half the staff-time to deliver (12.2h vs 25.5h), while maintaining diagnostic accuracy (AUC: 0.760 [0.685-0.834] vs 0.789 [0.717-0.861]). Conclusions Automated assessment can be successfully deployed within RPW surveillance pathways to reduce the burden on staff to deliver without compromising care and allow resources to be appropriately directed to those at greatest risk of SSI.

Enhanced Recovery After Surgery Cardiac Society turnkey order set for surgical-site infection prevention: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023

ObjectivesSurgical-site infections (SSIs) after cardiac surgery increase morbidity and mortality, consume health care resources, impair recovery, and diminish patients’ quality of life. Numerous guidelines and expert consensus documents have been published to address the prevention and management of SSIs. Our objective is to integrate these documents into an order set that will facilitate the adoption and implementation of evidence-based best practices for preventing and managing SSIs after cardiac surgery. MethodsSubject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set for SSI reduction. Orders derived from consistent class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the turnkey order set in bold type. Selected orders that were inconsistent class I or IIA, class IIB or otherwise supported by published evidence, were also included in italicized type. ResultsPreventative care begins with the preoperative identification of both modifiable and nonmodifiable SSI risks by health care providers. Assessment tools can be used to assist in identifying patients at a high risk of SSI. Preoperative recommendations include screening for and treating Staphylococcus aureus nasal carriage. Intraoperatively, tailored prophylactic intravenous antibiotics and maintaining blood glucose levels below 180 mg/dL are essential elements. Postoperative care includes maintaining normothermia, glucose control and patient engagement. ConclusionsDespite the well-documented advantages of a multidisciplinary care pathway for SSI in cardiac surgery, there are inconsistencies in its adoption and implementation. This article provides an order set that incorporates recommendations from existing guidelines to prevent SSI in the cardiac surgical population.

Risk factors related to surgical wound infection after caesarean section: A systematic review and meta‐analysis

AbstractSurgical site infection (SSI) is one of the common postoperative complications after caesarean section for pregnant women. Previous studies have investigated the risk factors for SSI in pregnant women undergoing caesarean delivery. Whereas big differences in research results exist, and the correlation coefficients of different research results are quite different. A meta‐analysis was conducted to examine the risk factors related to SSI in pregnant women undergoing caesarean delivery. We searched English databases to collect case–control studies or cohort studies published between 1 January 2015 and 15 November 2023, including PubMed, Web of Science and ScienceDirect. The risk of bias of the included studies was assessed via Newcastle‐Ottawa Scale. The analysis was performed using RevMan 5.4.1 tool. A total of 24 articles (n = 581, 895) were selected in this meta‐analysis. The following risk factors were presented to be significantly correlated with SSI in pregnant women following caesarean delivery: smoking (odds ratio [OR] = 1.64, 95% confidence interval [CI] [1.31, 2.04]), previous caesarean section (OR = 1.46, 95% CI [1.18, 1.82]), multiple vaginal examinations (OR = 2.92, 95% CI [1.91, 4.46]), membrane rupture (OR = 1.68, 95% CI [1.19, 2.38]), hypertensive disorders (OR = 1.85, 95% CI [1.33, 2.57]), diabetes mellitus (OR = 1.36, 95% CI [1.18, 1.57]), high body mass index (OR = 1.57, 95% CI [1.35, 1.84]). Occurrence of SSI is influenced by a variety of factors. Thus, we should pay close attention to high‐risk subjects and take crucial targeted interventions to lower the SSI risk after caesarean section. Owing to the limited quality and quantity of the included studies, more rigorous studies with adequate sample sizes are needed to verify the conclusion.

Audit of the use of WHO surgical safety checklist and assessment of attitudes towards it among surgical team personnel in a Tertiary Hospital in Nigeria

Introduction: The World Health Organization (WHO) Surgical Safety Checklist (SSC) launched in 2009 was developed to address preventable causes of morbidity and mortality in the perioperative period by promoting communication among all team members and ensuring that all necessary safety checks are done as and when due and that they are done appropriately. Studies have shown that implementation of the WHO checklist reduces the risk of SSI and preventable deaths by about 50%. Thus, it is encouraged that all hospitals, domesticate the tool to improve patient safety. The study aims to assess the level of usage of the WHO SSC, the gaps in its implementation and to evaluate the awareness, perception and acceptability of this tool among theatre staff personnel at a tertiary hospital in Nigeria. Materials and methods: We prospectively conducted an audit of the use of the WHO SSC at the main and emergency theatres, University College Hospital, Ibadan by observing the level of implementation of the different events in the WHO SSC using a pre-developed questionnaire. We subsequently conducted a survey on the awareness, perception and acceptability of the WHO SSC among the operating team personnel using a 15-item self-administered questionnaire. The data were analysed with SPSS. Results: A total of 117 surgeries were observed during the audit and 81 surgical team personnel took part in the survey. The WHO SSC was used in about half (52.1%) of the surgeries and it was sparingly used during minor surgeries (5.4%). The Sign Out Phase was the least completed phases of the checklist. The personnel administering the check list (usually the circulating nurse) did not ask the scrub nurse the required questions in more than half of the time (53.1–58.7%) in the Time Out Phase and this was significantly higher when compared with unasked questions to other professionals of the team (11.3–15.6%). In the Sign Out Phase, of the five questions, four questions were barely asked in about half of the time (44.6–76.8%). Eighty-one per cent personnel were surveyed, half (50%) were surgeons and about a quarter were anaesthetists (23%) and Nurses (27%). More than half of respondents (58%) have more than 5-year work experience in the hospital. Majority (65.4%) of members of the surgical team had not had any formal training on the WHO SSC. About a third of respondents (28%) who had made an error in surgery agreed that it could have been prevented by proper implementation of the WHO SSC. The respondents also agree that the sign out phase was completed in less than a third (27.2%) of the time. There was no difference in its awareness, perception and acceptability based on profession of the respondents. Conclusion: The WHO SSC should be made available at all theatres in the hospital and should be administered during all surgeries. There should be more formal training of members of the surgical team to improve implementation. Assessing for the barriers to the implementation of the WHO Safety Surgical Checklist is the logical next step to improve the use in our theatre.

Effect of preoperative hospital stay on surgical site infection in Chinese cranial neurosurgery

ObjectiveSurgical site infection(SSI)after neurosurgical procedure can be devastating. Delayed hospital stay has been identified as a potentially modifiable driver of SSI in general surgery patients. However, the relationship between preoperative length of stay and SSI has not been quantified previously in neurosurgery. This study aimed to clarify the association.DesignA Cohort study based on STROBE checklist.MethodThis observational study focused on cranial neurosurgery patients at a tertiary referral centers in China. Data collection from hospital information system conducted between 1 January 2016 and 31 December 2016 was used to examine the results of interest (n = 600). Logistic regression analysis explored association between preoperative length of stay and SSI, adjusting for potential confounders.ResultsOverall SSI prevalence was 10.8% and was significantly higher in the longer preoperative length of stay group. Besides preoperative length of stay, American Society of Anesthesiologists score, type of surgery, gross blood loss also significantly associated with SSI prevalence. Compared with 1 to 2 days, longer preoperative length of stay was associated with increased SSI prevalence after adjustment for confounders (3 to 4 days: odds ratio[OR], 0.975[95%CI, 0.417 to 2.281]; 5 to 6 days: OR, 2.830[95%CI, 1.092 to 7.332]; 7 or more days: OR, 4.039[95%CI, 1.164 to 14.015]; P for trend < 0.001). On the other hand, we found a positive association between preoperative length of stay to deep/space-organ SSI (OR = 1.404; 95% CI: 1.148 to 1.717; P for trend < 0.001), which was higher than superficial SSI (OR = 1.242; 95% CI: 0.835 to1.848; P for trend= 0.062).ConclusionsIn a cohort of patients from a single center retrospective surgical registry, a longer preoperative length of stay was associated with a higher incidence of cranial neurosurgical SSI. There is room for improvement in preoperative length of stay. This can be used for hospital management and to stratify patients with regard to SSI risk.

Intra-operative drug level monitoring of pre-operative antibiotic for surgical prophylaxis inthe patients of elective spinal surgery.

Single dose prophylaxis is good enough for general surgery with low risk patients. However, the evidence for the effectiveness of single dose anti-microbial prophylaxis (AMP) is not conclusive in high risk patients andspinal surgeries requiring instrumentation or the use of implants in particular. No studies have explored the various concentration of ceftriaxone in plasma and tissue as well during an ongoing spinal surgery. Therefore, the objective of study was to correlate the serum and tissue concentrations of ceftriaxone with the SSI and identify patients with increased risk of SSI. It was an open label prospective study in 50 consecutive patients who underwent elective spine surgery under prophylactic cover of ceftriaxone. Serum and tissue concentration were estimated by high pressure liquid chromatography during the ongoing surgery. Subjects were observed for any post-operative complications including SSI. Serum (p=0.002) and tissue (p=0.012) concentrations of ceftriaxone at the closure of spinal surgery were associated with SSI. Duration of the surgery (p=0.04) and use of implants (p=0.02) were also important surgery related risk factors. Serum and tissue concentrations of ceftriaxone atthe closure and duration of surgery and instrumentation or use of implants in the spinal surgery are good predictors of SSI.

POLYVALENT BACTERIOPHAGES AND OXYGENATED WATER – POSSIBILITIES FOR PREVENTION OF SURGICAL SITE INFECTION DURING EMERGENCY ABDOMINAL SURGERY

We carried out a single-center study of the effectiveness of polyvalent bacteriophages and oxygenated water for the prevention of SSI. The object was 88 patients who had undergone abdominal surgery for emergency abdominal pathology with a high risk of SSI &gt;30±3% (ACS NSQIP). Phages were administered topically and enterally, while OW only enterally. As a result of the study, it turned out that the combined use of PVBP and OW allows to normalize the induced enteral pathobiome, to reduce pathogen contamination, to enhance the protective capabilities of enterocytes, to stop intestinal failure in the early stages and to reduce the risk of SSI by more than 2 times.

DS27 Establishing clinician and patient perspectives on a proposed trial investigating antibiotics in skin surgery

Abstract Surgical site infection (SSI) following excision of ulcerated skin cancers is a well-recognized complication; however, the exact risk is unknown and there is no consensus on antibiotic prescribing in this setting. The EXCISE trial (EXamining antibiotics for ulCerated skIn cancer Surgical Excision) aims to address this evidence gap. An online survey was distributed to the UK Dermatology Clinical Trials Network (UKDCTN), British Society for Dermatological Surgery and plastic surgery, ear, nose and throat (ENT) and maxillofacial surgery networks (December 2022). The survey aimed to establish clinicians’ views about the proposed EXCISE trial. A focus group with patient representatives with lived experience of skin cancer surgery was also conducted (n = 5). Ninety questionnaire responses were received: six plastic surgeons (7%), 19 oral and maxillofacial surgeons (21%), four ENT surgeons (4%) and 61 dermatologists (68%). Sixty-five per cent of responders were consultants, and 34% were registrars. Seventy-one (79%) were willing to recruit to the EXCISE trial. Forty-eight (53%) agreed to randomize patients to 0 (no antibiotics), 1, 2, 3, 5 or 7 days of postoperative flucloxacillin. Thirty-seven (41%) agreed a 6–10% absolute increase in risk of SSI would justify a shorter course of antibiotics (1–3 days) with fewer side-effects. Thirty-three (37%) felt a 0–5% absolute risk increase would be acceptable, 17 (19%) felt an absolute risk increase of 11% or greater was acceptable, and three (3%) did not respond. Eighty-one (90%) agreed that if the EXCISE trial demonstrated a reduction in SSI, they would prescribe antibiotics, 61 (68%) would prescribe longer courses (5–7 days) and 17 (19%) would prescribe shorter courses (1–3 days). Patients reported a preference for shorter antibiotic courses (1–3 days) vs. longer (5–7 days) if there were fewer side-effects and no increased risk of infection. All patients agreed, in principle, to randomization to the proposed groups and highlighted the need to recruit from diverse socioeconomic backgrounds. They also suggested highlighting zero days of postoperative antibiotics often reflects usual practice to encourage participation. All participants agreed with the proposed 10% noninferiority margin. In summary, our data demonstrate acceptability of the proposed EXCISE trial among both clinicians and patients. An absolute noninferiority margin of 10% between SSIs occurring in the context of longer courses of antibiotics vs. shorter courses of antibiotics is acceptable to patients when associated with fewer side-effects. Clinicians showed mixed responses, suggesting that further work is required to explore the barriers and facilitators to prescribing and for future implementation. Acknowledgments: The study was developed with support from the UK Dermatology Clinical Trials Network (UK DCTN). The UKDCTN is grateful to the British Association of Dermatologists and the University of Nottingham for financial support of the network.

Impact of Perioperative Prophylaxis With Enterococcus Activity on Risk of Surgical-Site Infection After Pancreas Transplantation.

We performed a retrospective cohort study of PT recipients from 2010-2020 to examine the effect of perioperative antibiotic prophylaxis with Enterococcus coverage. Enterococcus coverage included antibiotics that would be active for penicillin-susceptible Enterococcus isolates. The primary outcome was SSI within 30 d of transplantation, and secondary outcomes were Clostridioides difficile infection (CDI) and a composite of pancreas allograft failure or death. Outcomes were analyzed by multivariable Cox regression. Of 477 PT recipients, 217 (45.5%) received perioperative prophylaxis with Enterococcus coverage. Eighty-seven recipients (18.2%) developed an SSI after a median of 15 d from transplantation. In multivariable Cox regression analysis, perioperative Enterococcus prophylaxis was associated with reduced risk of SSI (hazard ratio [HR] 0.58; 95% confidence interval [CI], 0.35-0.96; P = 0.034). Anastomotic leak was also significantly associated with elevated risk of SSI (HR 13.95; 95% CI, 8.72-22.32; P < 0.001). Overall, 90-d CDI was 7.4%, with no difference between prophylaxis groups (P = 0.680). SSI was associated with pancreas allograft failure or death, even after adjusting for clinical factors (HR 1.94; 95% CI, 1.16-3.23; P = 0.011). Perioperative prophylaxis with Enterococcus coverage was associated with reduced risk of 30-d SSI but did not seem to influence risk of 90-d CDI after PT. This difference may be because of the use of beta-lactam/beta-lactamase inhibitor combinations, which provide better activity against enteric organisms such as Enterococcus and anaerobes compared with cephalosporin. Risk of SSI was also related to anastomotic leak from surgery, and SSI itself was associated with subsequent risk of a poor outcome. Measures to mitigate or prevent early complications are warranted.

Dynamic control and timely correction of blood glucose levels in diabetic patients undergoing traumatic spinal vertebral fracture surgery to reduce surgery site infection

ObjectivesThis study was designed to clarify the impact of precise and dynamic control and timely correction of accurate blood sugar control in reducing the rate of post-spinal fracture surgery infections in impaired glucose tolerance or diabetic patients by posterior approach. MethodsIn this single-blinded clinical trial, a total of 290 patients with diabetes or impaired glucose tolerance candidate for traumatic spinal vertebral fracture by posterior approach (PSF) were randomly assigned to either a blood glucose control group (n = 145) or a control group (n = 145). The blood glucose control group received precise control of blood sugar levels before, during, and after surgery, while the control group did not. The incidence of SSI was compared between the two groups at one- and six months post-surgery using statistical tests and SPSS software version 22. ResultsBased on intergroup comparisons, the rate of infection at the site of surgery one month after spinal vertebral fracture surgery (PSF) in patients in the blood glucose control group was significantly higher than the control group (P < 0.05, 4.8%, and 11.7%). There was no significant difference between the rate of infection in the surgical site six months after spinal vertebral fracture surgery (PSF) in patients of the two groups studied (P > 0.05, 4.1%, and 4.8%). According to intragroup comparisons, there was no significant difference between the infection rate of the surgical site one month and six months after spinal vertebral fracture surgery in the patients of the blood sugar control group (P > 0.05). In patients in the control group, the infection rate at the surgery site of surgery 6 months after surgery was significantly lower than at the site of surgery one month after surgery (P < 0.05). Logistic multivariate regression analysis revealed that malnutrition variables, malignancy, duration of stay in the ICU after surgery, and blood sugar correction intervention statistically correctly contributed significantly to the classification of patients with infection and predicted the incidence of infection in Patients (P < 0.05). ConclusionAccurate and timely blood sugar control before, during, and after spinal vertebral fracture surgery by posterior approach is crucial in reducing the risk of SSI in diabetic or impaired glucose tolerance patients. The study highlights the importance of both dynamic control and timely correction of blood glucose levels, not only in the early postoperative period but also in preventing later infectious complications.

Prospective analysis of risk factors for perioperative infections in clean and clean-contaminated surgeries in dogs and cats with special reference to perioperative and postoperative antibiotic use

With every surgical procedure there is a risk of postoperative infection (surgical site infection = SSI). This risk of infection can be influenced by various factors, including perioperative antibiotic prophylaxis. In terms of antibiotic stewardship, antibiotics should only be used if there is a proven benefit for the patient. However, this advantage has not yet been conclusively proven, especially for clean and clean-contaminated surgeries. The aim of our study was to document various relevant influencing factors on the infection rate after clean and clean-contaminated surgeries in dogs and cats. In particular, it was documented to what extent a reduced use of antibiotics affects the infection rate in the context of all influencing factors. Over a period of eleven months, 807 clean and clean-contaminated surgeries in dogs and cats were prospectively analyzed with possible influencing factors (gender, ASA classification, underlying endocrinological diseases, duration of anesthesia, duration of surgery, type of surgery, perioperative antibiotic prophylaxis (POA), duration of hospitalization) affecting the infection rate. After surgery all cases were followed up either 30 or 90 days, if implants were used. The effect of the various factors was evaluated using multivariable logistic regression analysis. SSI was detected in 25/664 clean and 10/143 clean-contaminated surgeries. Longer hospitalization, without antimicrobial prophylaxis, and male animals had a significantly higher risk of SSI. In clean surgeries, SSI occurred in 2,3 % of all cases with POA and 5,3 % without POA. The SSI in clean-contaminated was 3,6 % with POA and 9 % without. This difference resulted mainly from the results of osteosynthesis, gastrointestinal and skin surgeries. However, other types of surgeries, such as castrations, neurological interventions, abdominal and thoracic surgeries, and surgeries in the head and neck region, showed comparable infection rates with and without POA.