Risk Of Surgical Wound Infection Research Articles

An Overview of Pre-Operative and Post-Operative Antibiotic Use in Inpatients in Orthopedic Surgery at Dr. H. Moch. Ansari Saleh Banjarmasin

Preoperative and postoperative antibiotics are included in prophylactic antibiotics, which aim to reduce the risk of surgical wound infection. Surgical Site Infection (SSI) is one of the problems of healthcare-associated infections (HAIs). Dr. Hospital H. Moch. Ansari Saleh Banjarmasin is a government hospital that provides many orthopedic surgical procedures and has data related to antibiotic use. This study aims to determine the description of the use of antibiotics as preoperative and postoperative prophylaxis. The research method included a descriptive observational study with a cross-sectional design on medical record data of surgical patients at Dr. RSUD. H. Moch. Ansari Saleh Banjarmasin in August–December 2023, which was taken using a purposive sampling technique with a retrospective approach. Results: 133 samples met the inclusion criteria. The majority of patients were aged 17–25 years (25.6%), the gender was predominantly male (62%), the length of stay was at most 2 days (40.6%), the type of surgery was clean (82%), and they did not have comorbidities (83%). Research shows that cefazolin is most widely used as preoperative prophylaxis by 123 people (92%) and postoperatively by 79 people (59.4%). The study concluded that the most widely used antibiotic for patients undergoing orthopedic surgery at RSUD, Dr. H. Moch. Ansari Saleh Banjarmasin, is cefazolin.

Keep calm and stay warm: a QI project to optimise perioperative temperature control in paediatric anaesthetics at the Evelina London Children’s Hospital

Background: Hypothermia is defined as a core body temperature <36°C.1 Complications of anaesthetic-related heat loss include delayed recovery and increased risk of surgical wound infection.2 Predominantly owing to a smaller weight-to-surface-area ratio,3 this is more common in paediatrics. With ∼45.1%4 of cases involving at least one hypothermic episode, it is vital that body temperature is regularly monitored and corrected throughout the perioperative period. We aimed to increase the percentage of anaesthetic charts with temperatures recorded at the correct time intervals according to the Evelina guidelines for perioperative temperature control by 20% by mid-February 2023. Methods: After an initial shadowing exercise observing temperature recording in practice, we created driver diagrams and completed two PDSA (plan-do-study-act) cycles: 1. a 30-min presentation to key stakeholders on the importance of perioperative temperature control and current local guidelines; 2. we displayed posters containing cycle 1 results and a summarised guideline flowchart. Data were collected over 18 weeks and analysed using descriptive statistics. Results: At baseline, 8.4% of temperature measurements were recorded correctly. After intervention 1, this increased to 8.8% and 13.6% after intervention 2. A 5.2% increase was noted overall. Conclusion: Our results indicate that reminder-based interventions can improve guideline compliance within a short timeframe and at low cost. However, we were unable to reach our aim. A questionnaire distributed to the team revealed that 75% (n=3) felt the interventions provided useful reminders of forgotten information while 56% (n=5) were absent from the presentation. Staff engagement should hence be prioritised in future. Further PDSA cycles may also consider reiterating the guidelines by other means (e.g. attaching reminders to anaesthetic desks). As many commented on paper charts being a hindrance for timely documentation, electronic prompts that indicate when recordings are to be made may also be considered. 1.Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Ochsner J 2011; 11: 259–702.Diaz M, Becker DE. Anesth Prog 2010; 57: 25–333.Nemeth M, Miller C, Bräuer A. Int J Environ Res Public Health 2021; 18: 75414.Görges M, Afshar K, West N, Pi S, Bedford J, Whyte SD, et al. Pediatr Anesth 2019; 29: 27–37

Preoperative and intraoperative risk factors of surgical wound infection in cardiac surgery: a retrospective study

Objective: To assess the significance of preoperative and intraoperative risk factors of surgical wound infection in cardiac surgery.Methods: The retrospective study included data obtained from 1,992 medical records of patients after cardiac surgery. All patients were divided into two groups: with (n=97, 4.9%) or without (n=1,895, 95.1%) infectious complications in the postoperative period. The rate of risk factors in both groups was compared and their impact on the surgical wound infection was assessed. Risk factors were analyzed in the groups of patients with superficial and deep forms of infection.Results: In the group of patients with surgical wound infection, males are more common than among the patients without it (82.5% vs. 70.95%). Patients with infection were more likely to have an obesity (43.3% vs. 30.3% without surgical wound infection) and chronic obstructive pulmonary disease (24.7% vs. 13.3%, respectively). In the patients with surgical wound infection, two internal mammary arteries were used more often (29.9% vs. 17.3% without surgical wound infection), the crossover variant of using two internal mammary arteries — 55.2% vs. 34.1% without surgical wound infection. According to the results, male gender and chronic obstructive pulmonary disease increase the risk of surgical wound infection twice as much, with obesity increasing this risk by 1.76 times. Using one of the internal mammary arteries may increase the chances of surgical wound infection by 1.7 times, while using two arteries — by 3.27 times. Increasing the number of factors in one patient may increase the chances of complications by 1.31 times.Conclusion: In cardiac surgery one should assess risk factors of surgical wound infection, plan the surgery (with or without internal mammary arteries), and evaluate the probability of infection complications with personalized approach. Received 2 February 2022. Revised 20 January 2023. Accepted 16 February 2023. Funding: The study had no sponsorship. Conflict of interest: The author declares no conflict of interest.

Effect of Supplemental Oxygen on Risk of Surgical Wound Infection

Background: There is a risk of different complication after the surgery but delaying in wound healing or infection is one of most common risk. Oxidative killing is a process of tissues partial pressure of oxygen throughout the observed values ranges. The main defense against foreign particles in result of surgery is oxidative killing through neutrophils. In a study by Greif et al4 indicated oxygen 80% during the surgery and after 2 hours later of surgery 50% risk get lesser as compared to the patient who had administrated with 30% oxygen.4 Another study proved that chances of risk for infection get increase in patients who were administrated oxygen 11 % as compared to the patients with 25% oxygen administration.5 The current study was conducted to test the hypothesis that supplemental oxygen decreases the risk of post-operative wound infection. Objective: The objective of the study was to determine the effects of supplemental oxygen on risk of surgical wound infection. Materials and Methodology: A randomized Clinical Trial- double- blinded was conducted at DHQ hospital, Karachi from March 1, 2011 to October, 31, 2016. A total of 300 subjects with age around 18 to 80 years who underwent elective colorectal surgery and satisfying the inclusion and exclusion criteria were recruited in the study. Non-probability Purposive sampling technique was used to collect the data. Double-blinded technique was used. Blinded investigators diagnosed the wounds infection by following the criteria of centers of disease control and prevention. Patients were randomly allocated in two groups by sealed-envelope method. Baseline assessment was performed on each patient which included patient’s medical history, physical examination and Lab tests i.e. complete blood picture and biochemical analysis. Characteristics for patient’s baseline and aesthetic treatment were confound factors. 3rd generation antibiotics cephalosporin were administrated 1 to 2 hours before of surgery. Patients of Group 1 received oxygen fraction of inspired oxygen FIO2 of 30 and group 2 of 80 percent. Randomly chosen concentration flow of oxygen 16l/min was given. Patient was breathing ambient air. Supplemental oxygen was given to maintain the patient’s oxygen saturation to 92% that is measured by pulse oximetry. Patient’s treatment was slandered with antibiotics and anesthesia administration. For wound evaluation, tools used were National nosocomial infection surveillance scale 6 and Efficacy of infection control,7 Wounds were checked for infection on daily basis by surgeons who were blinded. And wound thought to be infected when they full fill the criteria of Centers for Disease control and prevention standard. Main outcome measure was surgical site for infection and secondary outcomes were recovery of bowl function, duration of hospital stay, ambulation and ability to absorb the solid food. Statistical Analysis: Analysis was done on SPSS by applying parametric and non-parametric test according to normality. Results: Results showed no significant difference in %age Surgical infection site, Daily ASEPSIS value ≥20 at any time (p-value&lt;0.06), Admission in ICU (p-value= 0.74), Bowel function recovery (p-value=0.74), Solid food intake (p-value=0.54), Walking (p-value=0.57), Removal of Staples( 0.72), Duration of post-surgery hospitalization(p-value=0.09) of both the groups as p-value &gt;0.05 of all variables. Practical implication: If we provide pre-operative supplemental oxygen it will be helpful to decrease SSI. Conclusion: Patients who received supplemental oxygen showed significantly decrease in the risk of wound infection. Hence, Pre-operative supplemental oxygen proved to be an effective intervention to decrease SSI in the patients having rectal or colon surgery. Keywords: ASEPSIS, Surgical Wound, Infection, Supplemental Oxygen

Oncologic colorectal surgical site infection: oral or not oral antibiotic preparation, that is the question.

Surgical wound infection is the most frequent postoperative complication in abdominal surgery, especially at the colorectal level. The aim of this study is analysing the results of mechanical colon preparation combined with oral antibiotic versus mechanical colon preparation without antibiotic therapy in patients with colorectal cancer undergoing elective surgery. This retrospective cohort study had been developed from November 2017 to February 2020. We have included a total of 281 consecutive patients undergoing elective colon and rectal oncological surgeries by the same surgical group using laparoscopic and open approaches. Transanal minimally invasive surgery (TAMIS) and transanal total mesorectal excision (TaTME) approaches were excluded. Exposed patients undergoing colon and rectal cancer surgery received mechanical bowel preparation and oral antibiotics with three doses of neomycin 1g and erythromycin 500mg the day before surgery. The primary outcome was reduction in surgical wound infection rates before and after starting the oral antibiotic therapy from 17 to 6% (p < 0.05). As a secondary analysis, we evaluated the anastomotic dehiscence rate, corresponding with a decrease from 12 to 3% (p < 0.05). Mechanical bowel preparation combined with oral antibiotic therapy is still not unanimously carried out in all the medical hospitals. In this report, we show that mechanical bowel preparation in combination with oral antibiotic reduces the risk of surgical wound infection and anastomotic leakage in patients undergoing colon and rectal cancer surgery.

INFLAMMATION CHRONIQUE ET HYPERPLASIE BÉNIGNE DE LA PROSTATE: FACTEURS PRÉDICTIFS ET CONSÉQUENCES APRÈS CHIRURGIE OUVERTE CHRONIC INFLAMMATION AND BENIGN PROSTATIC HYPERPLASIA: PREDICTIVE FACTORS AND CONSEQUENCES AFTER OPEN SURGERY

Background: Chronic inflammation of the prostate has been observed on prostatic specimen after resection or a biopsy. The aim of this study was to determine the factors that can predict its existence in benign prostatic hyperplasia (BPH) and the consequences after open surgery. Method: We carried out a retrospective, observational, transversal study of patients who underwent prostatic adenomectomy in 2017 and 2018 in our department. Specimen with prostatic adenocarcinoma were excluded. &#x0D; Results: Of 51 operated patients, 31 (60.78%) had chronic inflammation within BPH. The mean delay between the beginning of symptoms and the surgery was 23.14 ± 35.62 months. &#x0D; Acute urinary retention was the main reason for consultation (78.43%). The mean duration of bladder catheter wear before surgery was 82.41 ± 220.36 months. Postoperative course was uneventful in 26(50.99%) patients. The mean postoperative stay was 5.86 ± 3.42 days. Surgical treatment delay (p = 0.000001), surgical wound infection (p = 0.002) and the length of postoperative stay (p = 0.002) had a significant correlation with prostatic chronic inflammation. &#x0D; Conclusion: The delay in surgical management was the main predictor of chronic inflammation in BPH. This factor increase the risk of surgical wound infection and an extended of postoperative stay.

Fibular nailing for fixation of ankle fractures in patients at high risk of surgical wound infection

BackgroundPostoperative infection is a severe complication after operative treatment of ankle fractures, associated with age, comorbidities, and severe soft tissue injuries. We assessed the efficacy of intramedullary fibular nailing for treating ankle fractures in patients at high risk of wound complications. Methods41 high-risk patients were included in the study. We retrospectively reviewed the medical records to assess the risk profile, the treatment data, and possible infections and re-operations. After a minimum of 2 years eight patients had died, three had advanced-staged dementia and two were lost to follow-up. Remaining 28 patients reported the functional outcome and QoL through patient-reported questionnaires. Radiographs and cone-beam computed tomography were performed, as well as range-of-motion was measured. ResultsNo surgical wound infections were found. The mean Olerud-Molander score was 67 points (SD 28 [20–100]). The osteoarthritis stages and the range-of-motion were significantly different between the injured and uninjured ankles, but we detected no significant effect on the QoL. ConclusionIntramedullary fibular fixation appeared to be a safe treatment choice for ankle fractures in high-risk patients. Level of evidenceIV

Red-blue light irradiation in the prevention of surgical wound infection after mandibular distraction using internal distractors in hemifacial microsomia: A randomized trial

BackgroundPostoperative infection is a complication of mandibular distraction osteogenesis (DO) in patients with hemifacial microsomia (HFM). The risk of surgical wound infection in DO is reported to be high due to the long duration of the distraction process. Treatment during the perioperative period is critical in combating infection. AimThis study aimed to evaluate the effectiveness of red-blue irradiation in the prevention of surgical wound infection after mandibular distraction. MethodsIn our single-centered, randomized clinical study, 118 patients diagnosed with HFM who had undergone DO between April 2016 and April 2018 were included. The patients were randomly divided into two groups: the experimental group received red-blue irradiation treatment and the control group received white-light irradiation. ResultsNone of the infections occurring in this study resulted in serious complications. The postoperative infection rate during the 4 weeks after DO in the experimental group was 1.7%, whereas that in the control group was 13.6% (p = 0.016) (based on a modified NHSN wound infection criterion). The total social cost during the active period for the experimental group was 3386840 RMB, 5.12% higher than for the control group (3221882 RMB). ConclusionsRed-blue irradiation is recommended as adjunctive therapy after mandibular distraction osteogeneis in HFM.

Infiltracija hirurške rane lokalnim anestetikom - infiltracija rane

A large number of surgical interventions are performed ambulatory under local infiltrative anesthesia. Local anesthetic wound infiltration provides anesthesia for minor surgical procedures and perioperatively improves analgesia after surgery in general anesthesia as part of a multimodal analgesic approach. The effect of a single block wound infiltration at the end of a surgical procedure in general or regional anesthesia provides additional analgesia for several hours. Infiltrative local anesthesia performed in a continuous modality reduces the use of analgesics, prolongs duration of analgesia and enhances the patient's mobilization. Benefits of local infiltrative anesthesia are described in inguinal hernioplasty, breast surgery, sternotomy, orthopedic, and gynecological surgery. However, in abdominal surgery, continuous infiltrative local anesthesia is combined with other analgesic modalities respecting complex innervation of the abdominal wall and intra-abdominal organs,. Wound infiltration is a safe technique without the risk of surgical wound infection. There is a lack of data about cost-benefit ratio when wound infiltration is used. In order for local infiltrative anesthesia to fully meet the expectations it is necessary to have mastery of the relatively simple technique, and the knowledge of when it is suitable to appply.

The association between gestational age at delivery, closure type and perinatal outcomes in neonates with isolated gastroschisis

Objective: The objective of this study was to examine the association between gestational age at delivery and closure type for neonates with gastroschisis. In addition, we compared perinatal outcomes among the cases of gastroschisis based on the following two factors: gestational age at delivery and abdominal wall closure technique.Methods: This was a retrospective cohort study of all fetuses with isolated gastroschisis that were diagnosed prenatally and delivered between September 2000 and January 2017, in a single tertiary care center. Neonates were compared based on the gestational age at the time of delivery: early preterm (less than 350/7 weeks), late preterm (350/7 – 366/7 weeks), and early term (370/6 – 386/7 weeks), using bivariate and multivariate analyses. The primary outcome was the type of abdominal wall closure: primary surgical closure or delayed closure using spring-loaded silo. Secondary outcomes included length of ventilatory support, length of parenteral nutrition, and length of hospital stay.Results: The analysis included 206 pregnancies complicated by gastroschisis. In univariate analysis, no differences were detected in primary closure rates of gastroschisis among the gestational age at delivery groups (67.4%, at <35 weeks, 70.8% at 350/7–366/7 weeks, 73.7% at 370/6–386/7 weeks, p = .865). However, for every additional 100 grams of neonatal live birth weight there was an associated 9% increased odds of primary closure (OR 1.09, 95% CI 1.14–1.19, p = .04). Delivery in the early preterm period compared to the other two groups, was associated with longer duration of ventilation support and longer dependence on the parenteral nutrition. Neonates who underwent primary closure had shorter ventilation support, shorter time to initiation of enteral feeds and to discontinue parenteral nutrition, and shorter length of stay. In multivariate analyses, controlling for gestational age at delivery and presence of bowel atresia, primary closure continued to be associated with the shorter duration of ventilation (by 5 days), earlier initiation of enteral feeds (by 7 days), shorter hospital stay (by 17 days) and lower odds of wound infection (OR = 0.37, 95% CI 0.15–0.97).Conclusions: Our study did not find an association between gestational age at delivery and the rates of primary closure of the abdominal wall defect; however later gestational age at delivery was associated with shorter duration of ventilatory support and parenteral nutrition dependence. In addition, we found that primary closure of gastroschisis, compared with delayed closure technique, was associated with improved neonatal outcomes, including shorter time to initiate enteral feeds and discontinue parenteral nutrition, shorter hospital stay, and lower risk of surgical wound infection. Therefore, postponing delivery of fetuses with gastroschisis until 37 weeks may be considered. Other factors besides the gestational age at delivery should be explored as predictors of primary closure in neonates with gastroschisis.

Vacuum-assisted management of surgical site infections after liver transplantation: 15-year experience in a tertiary hepatobiliary center.

Immune compromised as well as critically ill patients are at higher risk of surgical wound infection and dehiscence. Wound infections critically influence the outcomes after liver transplantation. In particular, it was shown that they significantly reduce the overall survival rate when compared to patients with uneventful wound healing, and their occurrence is associated with death or graft loss within 1-year post-transplantation. From January 2001 through December 2017, 763 patients underwent liver transplantation in our Institution, the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, "Policlinico" University Hospital, University of Modena and Reggio Emilia, Modena, Italy. We retrospectively analyzed data from our prospectively maintained database of patients treated with a negative pressure therapy device due to wound or abdominal infections. 13 patients underwent negative pressure treatments for surgical site infection after liver transplantation in our institution. Ten superficial "supra-fascial" applications (SF group) and three deeper abdominal (Ab group) were reported. Mean in-hospital stay for the SF group was 42.6days, ranging from 8 to 80, while for the Ab group was 62days (range 23-133), with an overall survival of 34 and 4.6months, respectively. A multifactorial multidisciplinary approach is needed in the prevention of surgical site infections instead of mere antimicrobial prophylaxis The application of negative pressure wound therapy may help in controlling the diffusion of the infection and preventing sepsis.

Perioperative hypothermia: a preventable complication

Hypothermia is a common and yet preventable complication from general anaesthesia.1 Although regarded by many as an inconsequential complication, mild perioperative hypothermia is associated with an increased risk of wound...

Topical antimicrobial prophylaxis in colorectal surgery for the prevention of surgical wound infection: a systematic review and meta-analysis.

Among the techniques investigated to reduce the risk of surgical wound infection or surgical space infection (SSI) in patients having colorectal surgery are topical application of antimicrobials (antibiotics and antiseptics) to the open wound or immediately after closure. The aim of the present study was to perform a systematic review of the literature on those treatments, with the exception of antibiotic ointments applied to closed skin, which are adequately assessed elsewhere, and a meta-analysis. Only randomized trials of patients having only colorectal surgery were included in this review. Studies were sought in MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, Clinical Trials.gov, and the World Health Organization Internet clinical trials register portal. In addition, reference lists of included studies and other published reviews were screened. Meta-analysis was performed for all included studies and subgroup analyses done for each individual intervention. Risk of bias was assessed for each included study, paying particular attention to the preoperative antibiotic prophylaxis used in each study. Sensitivity analyses were done to investigate heterogeneity of the analyses, excluding those studies with a significant risk of bias issues. Absolute risk reduction (RR) was calculated. The overall quality of the evidence for each individual intervention was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and was classified as high, moderate, low or very low. A total of 30 studies are included in this review with 5511 patients, 665 of whom had SSI. The interventions included: 10 studies of gentamicin impregnated sponge or beads wound inlays, 4 studies of chlorhexidine impregnated suture, 11 studies of direct wound lavage or powder application or injection of antibiotics before closure, 4 studies of ionized silver dressing applied to the closed skin, and 1 study of vitamin E oil applied to the open wound. All but one study used preoperative antibiotic prophylaxis in addition to topical procedures, although, in some studies, the systemic antibiotic prophylaxis was not the same between groups or varied significantly from the recommended guidelines. Use of gentamycin sponge did not decrease SSI (RR 0.93, 95% CI 0.75-1.16; low-quality evidence) even after including only the studies of abdominal wounds (RR 1.02, 95% CI 0.80-1.30; low-quality evidence). However, sensitivity analysis excluding studies at high risk of bias decreased the heterogeneity and increased the effect of the prophylaxis for all wounds (RR 0.5, 95% CI 0.33-0.78; low-quality evidence) and for abdominal wounds only (RR 0.38, 95% CI 0.20-0.72; moderate-quality evidence). Chlorhexidine impregnated suture showed no effect on SSI (RR 0.79, 95% CI 0.56-1.10; low-quality evidence) and an increased efficacy after sensitivity analysis (RR 0.42, 95% CI 0.22-0.79; low-quality evidence). Antibiotic lavage showed a significant decrease in SSI (RR 0.45, 95% CI 0.26-0.79; low-quality evidence) which increased after sensitivity analysis (RR 0.33, 95% CI 0.15-0.72; moderate-quality evidence). Application of silver dressing to the closed wound resulted in a decrease of SSI (RR 0.55, 95% CI 0.35-0.85; moderate-quality evidence). The one study of topical vitamin E oil applied to the open wound showed a significant risk reduction (RR 0.22, 95% CI 0.05-0.98; low-quality evidence). Each of these interventions appears to be effective in decreasing SSI, but the number of studies for each is small and the quality of evidence is very low to moderate. Within the various outcomes of GRADE assessment, even a moderate classification suggests that further studies may well have very different results.. No randomized trials exist of combinations of two or more of the above interventions to see if there is a combined effect. Future studies should make sure that the antibiotic used preoperatively is uniform within a study and is consistent with the current guidelines. Deviation from this leads to a significant heterogeneity and risk of bias.

Perioperative hair removal: A review of best practice and a practice improvement opportunity.

The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.

Hernia umbilical en pacientes cirróticos con ascitis. ¿Tratamiento conservador o quirúrgico?

Ascites is the most common complication in patients with liver cirrhosis. Umbilical hernias (HU) occur in 20% of these patients and 40% in those with severe ascites. HU occurs due to increased intra-abdominal pressure, weakening of the abdominal fascia and loss of muscle mass. In addition, they have a tendency to enlarge rapidly and present high risk of complications that threaten the patient’s life. The treatment of the uncomplicated HU is controversial, both the surgical management (herniorrhaphy) and the conservative management (control of ascites) present high rate of complications, consequently high morbidity and mortality. Currently, umbilical herniorrhaphy is recommended with prior control of ascites in uncomplicated HU management, it reduces the risk of surgical wound infection, evisceration, ascites drainage, peritonitis, and it reduces up to 41% of HU recurrence. The success of this approach also depends on the degree of liver dysfunction. The treatment of complicated HU is surgical (herniorrhaphy without mesh), with lower mortality rate compared to conservative management. Studies reveal advantages of umbilical herniorrhaphy laparoscopy (minimally invasive and stress-free) compared to open surgery; however there is still no evidence about it.

‘Epidemiology of surgical site infection in a neurosurgery department’

Objective: To know the rates of infection of the surgical wound in the Department of Neurosurgery between 2011 and 2014.Methods: An observational, prospective study was conducted of the rates of surgical wound infection among patients admitted for more than 48 h to the Neurosurgery Department of a tertiary-level university hospital between July 2011 and December 2014.Results: The study surveyed a total of 536 surgical procedures performed in 521 patients. The rate of diagnosed surgical site infection (SSI) was 4.85% (26 infections), below the established acceptable threshold of 5%. Of these, 65.38% were organ-space infections, 30.77% deep infections, and 7.69% superficial infections. Infection rates for each type of surgical procedure were 4.35% for spinal fusion, 0.00% for refusion of spine, 2.08% for laminectomy, 5.95% for ventricular shunt, and 5.14% for craniotomy. Antibiotic prophylaxis was evaluated as suitable in 80.22% of surgical procedures.Discussion and conclusions: Infection rates were lower when the surgery was elective, clean, the patient had a lower ASA, and when suitable antimicrobial prophylaxis was administered. The rate of suitable antimicrobial prophylaxis shows that there is room for improvement. In order to minimize the risk of surgical wound infection, all professionals involved in patient care need to know and apply current recommendations, especially those relating to proper hand hygiene and suitable antibiotic prophylaxis.

Antimicrobial prophylaxis for colorectal surgery.

Research shows that administration of prophylactic antibiotics before colorectal surgery prevents postoperative surgical wound infection. The best antibiotic choice, timing of administration and route of administration remain undetermined. To establish the effectiveness of antimicrobial prophylaxis for the prevention of surgical wound infection in patients undergoing colorectal surgery. Specifically to determine:1. whether antimicrobial prophylaxis reduces the risk of surgical wound infection;2. the target spectrum of bacteria (aerobic or anaerobic bacteria, or both);3. the best timing and duration of antibiotic administration;4. the most effective route of antibiotic administration (intravenous, oral or both);5. whether any antibiotic is clearly more effective than the currently recommended gold standard specified in published guidelines;6. whether antibiotics should be given before or after surgery. For the original review published in 2009 we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (Ovid) and EMBASE (Ovid). For the update of this review we rewrote the search strategies and extended the search to cover from 1954 for MEDLINE and 1974 for EMBASE up to 7 January 2013. We searched CENTRAL on the same date (Issue 12, 2012). Randomised controlled trials of prophylactic antibiotic use in elective and emergency colorectal surgery, with surgical wound infection as an outcome. Data were abstracted and reviewed by one review author and checked by another only for the single, dichotomous outcome of surgical wound infection.Quality of evidence was assessed using GRADE methods. This updated review includes 260 trials and 68 different antibiotics, including 24 cephalosporins and 43,451 participants. Many studies had multiple variables that separated the two study groups; these could not be compared to other studies that tested one antibiotic and had a single variable separating the two groups. We did not consider the risk of bias arising from attrition and lack of blinding of outcome assessors to affect the results for surgical wound infection.Meta-analyses demonstrated a statistically significant difference in postoperative surgical wound infection when prophylactic antibiotics were compared to placebo/no treatment (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.28 to 0.41, high quality evidence). This translates to a reduction in risk from 39% to 13% with prophylactic antibiotics. The slightly higher risk of wound infection with short-term compared with long-term duration antibiotic did not reach statistical significance (RR 1.10, 95% CI 0.93 to 1.30). Similarly risk of would infection was slightly higher with single-dose antibiotics when compared with multiple dose antibiotics, but the results are compatible with benefit and harm (RR 1.30, 95% CI 0.81 to 2.10). Additional aerobic coverage and additional anaerobic coverage both showed statistically significant improvements in surgical wound infection rates (RR 0.44, 95% CI 0.29 to 0.68 and RR 0.47, 95% CI 0.31 to 0.71, respectively), as did combined oral and intravenous antibiotic prophylaxis when compared to intravenous alone (RR 0.56, 95% CI 0.43 to 0.74), or oral alone (RR 0.56, 95% CI 0.40 to 0.76). Comparison of an antibiotic with anaerobic specificity to one with aerobic specificity showed no significant advantage for either one (RR 0.84, 95% CI 0.30 to 2.36). Two small studies compared giving antibiotics before or after surgery and no significant difference in this timing was found (RR 0.67, 95% CI 0.21 to 2.15). Established gold-standard regimens recommended in major guidelines were no less effective than any other antibiotic choice. This review has found high quality evidence that antibiotics covering aerobic and anaerobic bacteria delivered orally or intravenously (or both) prior to elective colorectal surgery reduce the risk of surgical wound infection.Our review shows that antibiotics delivered within this framework can reduce the risk of postoperative surgical wound infection by as much as 75%. It is not known whether oral antibiotics would still have these effects when the colon is not empty. This aspect of antibiotic dosing has not been tested.Further research is required to establish the optimal timing and duration of dosing, and the frequency of longer-term adverse effects such as Clostridium difficile pseudomembranous colitis.

Injectable Chitosan‐Based Scaffolds in Regenerative Medicine and their Clinical Translatability

Injectable scaffolds (IS) are polymeric solutions that are injected in vivo and undergo gelation in response to physiological or non-physiological stimuli. Interest in using IS in regenerative medicine has been increasing this past decade. IS are administered in vivo using minimally invasive surgery, which reduces hospitalization time and risk of surgical wound infection. Here, chitosan is explored as an excellent candidate for developing IS. A literature search reveals that 27% of IS publications in the past decade investigated injectable chitosan scaffolds (ICS). This increasing interest in chitosan stems from its many desirable physicochemical properties. The first section of this Progress Report is a comprehensive study of all physical, chemical, and biological stimuli that have been explored to induce ICS gelation in vivo. Second, the use of ICS is investigated in four major regenerative medicine applications, namely bone, cartilage, cardiovascular, and neural regeneration. Finally, an overall critique of the ICS literature in light of clinical translatability is presented. Even though ICS have been widely explored in the literature, very few have progressed to clinical trials. The authors discuss the current barriers to moving ICS into the clinic and provide suggestions regarding what is needed to overcome those challenges.

Use and Outcomes of Extended Antibiotic Prophylaxis in Urological Cancer Surgery

Although perioperative antibiotic prophylaxis prevents postoperative infectious complications, national guidelines recommend cessation of antibiotics within 24 hours after the procedure. Extended antibiotic prophylaxis beyond 24 hours may contribute to hospital acquired infections such as Clostridium difficile colitis. We evaluated practice patterns of antibiotic prophylaxis in genitourinary cancer surgery and assessed the impact of antibiotic prophylaxis on hospital acquired C. difficile infections. We identified 59,184 patients treated with radical prostatectomy, 27,921 who underwent partial or radical nephrectomy, and 5,425 treated with radical cystectomy for prostate, kidney and bladder cancers, respectively, from the Premier Perspective Database (Premier Inc., Charlotte, North Carolina) from 2007 to 2012. We constructed hierarchical linear regression models to identify patient and hospital factors associated with extended antibiotic prophylaxis. We evaluated the association between extended antibiotic prophylaxis and C. difficile infections for patients who underwent partial or radical nephrectomy and radical cystectomy with multivariate logistic regression. Surgery specific models demonstrated that hospital identity was associated with a substantial proportion of the variation in extended antibiotic prophylaxis (20% to 35% for radical prostatectomy, partial or radical nephrectomy, and radical cystectomy). Postoperative C. difficile colitis occurred in 0.02% of patients treated with radical prostatectomy, 0.23% of those treated with partial or radical nephrectomy and 1.7% of those treated with radical cystectomy. On multivariate analysis extended antibiotic prophylaxis was associated with higher odds of C. difficile infection after partial or radical nephrectomy (OR 3.79, 95% CI 2.46-5.84) and radical cystectomy (OR 1.64, 95% CI 1.12-2.39). Antibiotics may be overused after genitourinary cancer surgery and this overuse is associated with hospital acquired C. difficile colitis. Efforts are needed to encourage greater compliance with evidence-based approaches to postoperative care.

Antibiotic prophylaxis and incidence of endocarditis and mediastinitis in patients undergoing cardiac surgery

BackgroundMediastinitis and endocarditis after cardiac surgery are serious complications that increase short and long term morbidity and mortality and also costs. Antibiotic prophylaxis aims to reduce the risk of surgical...