Routine Intraoperative Cultures Research Articles

Long term assessment of antibiotic prophylaxis and biliary microbiome in pancreaticoduodenectomy.

Surgical site infections (SSI) can represent a major complication of pancreaticoduodenectomy (PD). We summarize the outcomes of process improvement efforts to reduce the SSI rates in PD that includes replacing Cefazolin with Ceftriaxone-Metronidazole as antibiotic prophylaxis. Additional efforts included current assessment of biliary microbiome and potential prophylactic failures based on bile cultures and suspected antibiotic allergies. A single-center review of PD patients from January-2012 to March-2021. Study groups were divided into Pre and Post May-2015 (Group 1 and 2, respectively) when Ceftriaxone-Metronidazole prophylaxis and routine intraoperative cultures were standardized. Univariate and multivariable analyses were conducted to assess groups' differences and association with SSI. Six hundred ninety patients identified [267(38.7%) and 423(61.3%) in Group 1 and Group2, respectively]. After antibiotic change, SSI rates decreased from 28.1% to 16.5% (incisional: 17.6%-7.5%, organ-space or abscess: 17.2%-13.0%), Group 1 and Group 2, respectively, P<0.001. Ceftriaxone-Metronidazole was used in 75.9% of patients Group 2. When adjusting for other covariates, an SSI-decrease was associated only with Ceftriaxone-Metronidazole (OR 0.34, P<0.001). Ongoing process improvement has resulted in decreased SSIs with Ceftriaxone-Metronidazole prophylaxis. The benefit of Ceftriaxone-Metronidazole is independent of the biliary microbiome. Improving prophylaxis for those with suspected penicillin allergy is warranted.

Long Term Assessment of Antibiotic Prophylaxis and Biliary Microbiome in Pancreaticoduodenectomy

Introduction: Surgical site infections (SSI) represent a potential major complication of pancreaticoduodenectomy. Quality improvement efforts should be directed at assessing SSI rates, surgical technique, and antibiotic prophylaxis. In addition, we added assessment of the biliary-microbiome as a mechanism to guide prophylaxis and therapy for SSI. This study aimed to analyze our SSI rates based on changes to our prophylaxis protocol and relationship to biliary-microbiome. Method: A Single-center-retrospective analysis was conducted for pancreaticoduodenectomy patients from January-2012 to March-2021. Study groups were divided into Pre and Post May-2015 when Ceftriaxone-Metronidazole prophylaxis and routine intraoperative cultures were standardized. Relevant variables were analyzed in univariate and multivariable logistic regression to demonstrate the association with developing SSI. Results: Six hundred ninety patients received antibiotic prophylaxis [267(38.7%) and 423(61.3%) in Pre and Post-May-2015 periods, respectively]. Ceftriaxone-Metronidazole use was 75.9% Post May-2015, which associated with SSI-decrease from 28.1%-16.5% (incisional: 17.6%-7.5%, organ-space or abscess: 17.2%-13.0%), Pre and Post periods, respectively, P<0.001. The multivariable analysis showed that SSI-decrease was associated only with Ceftriaxone-Metronidazole (OR 0.36, P<0.001). Post May-2015, SSIs in those not receiving Ceftriaxone-Metronidazole (Ciprofloxacin was the dominant alternative) were 28.7% vs. 12.6%, P<0.001. Intraoperative cultures were collected from 356(51.6%) patients, and SSI cultures were available from 69(47.6%) SSIs, Table 1. However, only 56% of positive SSI cultures were similar to those isolated intraoperatively. Conclusions: Ongoing process improvement has resulted in decreased SSIs with Ceftriaxone-Metronidazole prophylaxis. The benefit of Ceftriaxone-Metronidazole is independent of the biliary microbiome. Improving prophylaxis for those intolerant to Ceftriaxone-Metronidazole is warranted.Tabled 1FP14-3Table 1.Culture ResultsCeftriaxone-MetronidazoleOther ProphylaxisIntraoperative Cultures(n=253)SSI Cultures(n=13)Intraoperative Cultures(n=103)SSI Cultures(n=56)Negative culture92 (36.36%)1 (7.69%)41 (39.81%)9 (16.07%)Staphylococcus Species10 (3.95%)2 (15.38%)9 (8.74%)13 (23.21%)Enterococcus Species58 (22.92%)6 (46.15%)14 (13.59%)11 (19.64%)Pseudomonas aeruginosa9 (3.56 %)3 (23.08%)10 (9.71%)10 (17.86 %)Streptococcus Species38 (15.02%)018 (17.48%)10 (17.86%)Klebsiella Species31 (12.25%)1 (7.69%)14 (13.59%)11 (19.64 %)Escherichia coli18 (7.11%)2 (15.38%)5 (4.85%)7 (12.5%)Candida Species69 (27.27%)3 (23.08%)18 (17.48%)6 (10.71%) Open table in a new tab

Routine Intraoperative Bacterial Culture May Be Needed in Complicated Appendicitis.

PurposeChoosing the appropriate antibiotic is important for treatment of complicated appendicitis. However, increasing multidrug resistant bacteria have been a serious problem for successful treatment. This study was designed to identify bacteria isolated from patients with complicated appendicitis and reveal their susceptibilities for antibiotics and their relationship with patient clinical course.MethodsThis study included patients diagnosed with complicated appendicitis and examined the bacterial cultures and antimicrobial susceptibilities of the isolates. Data were retrospectively collected from medical records of Kangbuk Samsung Hospital from January 2008 to February 2018.ResultsThe common bacterial species cultured in complicated appendicitis were as follows: Escherichia coli (n=113, 48.9%), Streptococcus spp. (n=29, 12.6%), Pseudomonas spp. (n=23, 10.0%), Bacteriodes spp. (n=22, 9.5%), Klebsiella (n=11, 4.8%), and Enterococcus spp. (n=8, 3.5%). In antibiotics susceptibility testing, the positive rate of extended-spectrum beta lactamase (ESBL) was 9.1% (21 of 231). The resistance rate to carbapenem was 1.7% (4 of 231), while that to vancomycin was 0.4% (1 of 231). E. coli was 16.8% ESBL positive (19 of 113) and had 22.1% and 19.5% resistance rates to cefotaxime and ceftazidime, respectively. Inappropriate empirical antibiotic treatment (IEAT) occurred in 55 cases (31.8%) and was significantly related with organ/space surgical site infection (SSI) (7 of 55, P=0.005).ConclusionThe rate of antibiotic resistance organisms was high in community-acquired complicated appendicitis in Koreans. Additionally, IEAT in complicated appendicitis may lead to increased rates of SSI. Routine intraoperative culture in patients with complicated appendicitis may be an effective strategy for appropriate antibiotic regimen.

Should Culture Samples Be Taken During All Revision Total Ankle Arthroplasty (TAA)?

We recommend that intraoperative cultures be taken during revision total ankle arthroplasty (TAA). The result of intraoperative cultures should be interpreted together with clinical suspicion for infection and the results of the laboratory and imaging investigations. We also recommend that multiple tissue specimens be collected. Given a lack of evidence for routine intraoperative cultures for revision TAA literature, this recommendation is based on analogous evidence in the total hip and knee replacement literature. Consensus. Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

No association between positive intraoperative allograft cultures and infection rates after reconstructive knee ligament surgery

BackgroundSeveral reports of severe infections associated with allograft tissue in knee reconstructive surgery have led many surgeons to consider routine intraoperative culture of allograft tissue before implantation. Thus, the purpose of this study was to determine the prevalence of positive soft tissue allograft cultures in reconstructive knee surgery, and evaluate its association with surgical site infection. MethodsRetrospective study of 202 patients who underwent knee reconstructive ligament surgeries, including revisions, between January 2013 and July 2017. Intraoperative culture results were obtained and the report of a surgical site infection during follow-up was recorded. Patients without cultures were excluded. A priori power analysis was performed. The association between positive culture results and development of surgical site infection was evaluated using Fisher's Exact test (P < 0.05). ResultsA total of 300 allografts were implanted in 202 patients. Mean average follow-up was 32.9 ± 12.5 (range 13 to 57.9) months. Sixteen patients had positive intraoperative allograft cultures (7.9%). The most frequently isolated organism was Bacillus species (six cultures); none of these patients presented with clinical signs of infection. Nine patients developed surgical site infections and were treated with oral antibiotics, and one patient developed septic arthritis that required surgical debridement of the implanted graft; all of these patients had a negative soft tissue allograft culture. No significant association was found between a positive culture and surgical site infection (P = 0.43). ConclusionThere was no apparent association between positive intraoperative irradiated soft tissue allograft cultures and surgical site infection in reconstructive knee surgery.

Routine Culture of Soft Tissue Allografts in Knee Surgery; Do Positive Results Correlate with Clinical Infection?

Routine intraoperative culture of allograft tissue before implantation in knee ligamentous reconstruction surgery is commonly done by many surgeons. However, positive intraoperative cultures do not show correlation with clinical infection. Several infections and deaths associated with allograft tissue in knee reconstructive surgery have led many surgeons to consider routine intraoperative culture of allograft tissue before implantation. However, it's usefulness and correlation with clinical infection has not been completely established. Determine the incidence of positive soft tissue allograft cultures in reconstructive knee surgery, and evaluate possible correlation with clinical infection. Retrospective study of a series of patients that underwent knee reconstructive ligament surgery with at least one allograft between January 2012 and July 2015. Intraoperative culture results were obtained and clinical signs of infection were recorded 1-3 days after surgery and monthly during the first 6 months. Patients with less than 6 months follow up and without cultures were excluded. Correlation between positive results of cultures and clinical infection was performed with Fishers exact Test (p<0.05). Three-hundred allografts were implanted in 202 patients. Sixteen cultures (5.3%) were positive in 16 patients. The most frequently isolated organism was Bacillus spp (6 cultures); None of these patients presented clinical signs of infection. Eight patients had superficial wound infections treated with oral antibiotics and one septic arthritis required surgical debridement of the implanted graft; All of these 9 patients had a negative culture. No correlation between a positive culture and clinical infection was found (p<0.05). The incidence of positive soft tissue allograft cultures in reconstructive knee surgery is low, and does not correlate with clinical infection.

An Analysis of Scalp Thickness and Other Novel Risk Factors for Deep Brain Stimulator Infections

Introduction: Deep brain stimulator (DBS) infections are a persistent problem for patients undergoing this procedure. They may require further surgery, treatment with antibiotics, or even removal of the device. To date, no consensus exists on the best practices to avoid DBS infections or what factors predispose patients to an eventual infection. The goal of this study was to examine several patient factors for association with DBS infection.Methods: A single-center, single-surgeon quality improvement database was queried. All patients who experienced an infection were identified. The primary variable analyzed was scalp thickness. Other pre-specified, secondary variables included routine intraoperative cultures, operative time, diagnosis, and age.Results: None of the independent variables examined were significantly associated with DBS infections. Only two of the 46 infections qualified as surgical site infections as defined by the Centers for Disease Control.Conclusion: DBS infections are independent of all of the predictor variables analyzed. Surgical site infections, according to traditional definitions, are not the optimal definition for evaluating DBS infections/erosions. New studies must examine new variables that are not routinely gathered in this population. Also, because of the rare event rates and difficulty in randomizing patients to exposures, a large, multicenter registry may be the optimal study design to solve this clinical problem.

Evaluation of the Sagittal Saw Blade as an Intraoperative Fomite During Diabetic Foot Surgery

Surgical site infection is a major potential complication of all operative interventions, and the diabetic foot is particularly at risk for bacterial recontamination and infectious sequelae. The objective of this study was to identify whether the sagittal saw blade used during partial foot amputations and diabetic foot debridements carries the potential to serve as a bacterial fomite. We physically cultured the sagittal saw blade during 20 foot debridements involving the resection of bone in patients diagnosed with a diabetic foot infection. The culture was taken after the initial debridement and during the irrigation phase of the procedure. We observed 16 positive routine intraoperative culture results, with positive saw blade culture results in 15 (93.8%; 15/16) of these cases. In 14 (93.3%; 14/15) of these cases, the saw blade culture grew at least one of the same bacteria as our other routine intraoperative cultures. We observed 4 negative routine intraoperative culture results, with negative saw blade culture results in 3 (75.0%; 3/4) of these cases. This results in agreement between routine intraoperative cultures and saw blade culture of 85.0% (17/20). The results of this investigation demonstrate that the sagittal saw blade used for osseous resection during diabetic foot debridements and partial foot amputations carries the potential for intraoperative bacterial transmission. We recommend changing at least the sagittal saw blade if more bone is resected following irrigation, particularly if it is used to obtain a "clean margin" for microbiological or histological examination. Therapeutic, Level IV: Case series.

The need for culture swabs in laparoscopically treated appendicitis.

IntroductionAppendicitis remains the most common cause of an acute abdomen. Obtaining intra-abdominal cultures is routine surgical practice. There are studies showing no efficacy of such procedures in cases where open appendectomies are performed.AimThe goal of this study was to assess the need for obtaining intra-abdominal cultures during laparoscopic appendectomies.Material and methodsBetween 2007 and 2012, 369 patients were operated on with the diagnosis of histopathologically proven acute appendicitis. Sixty-two percent of them were operated on using laparoscopic techniques. The microbiological assessment was routinely done for the open procedures and in 42% of cases that underwent a laparoscopic operation.ResultsIn 57% (134) the swabbing results were negative. Among 43% (102) of the patients with a positive result, Escherichia coli was isolated in 76.5% (78), Proteus mirabilis in 13.7% (14), Pseudomonas aeruginosa in 4.9% (5) and Citrobacter freundii in 4.9% (5). Five cases had bacteria resistant to the antibiotic given preoperatively (that is 4.9% of all positive cultures and 1.4% of all operated patients). However, these cases did not affect the incidence of postoperative complications. Consideration of the postoperative morbidity showed that there was no statistically significant difference between the laparoscopic group with and without intra-operative swabbing (p > 0.05).ConclusionsThe postoperative patient outcome was more dependent on the pathology of the appendix than on the results of the microbiological assessment at the time of surgery. Hence, routine intra-operative cultures during laparoscopic appendectomies appear to have little value in patient management. Swabbing during laparoscopic procedures should be limited to only selected high-risk groups.

The Routine Culture of Allograft Tissue in Anterior Cruciate Ligament Reconstruction

Background Allograft tissue is an acceptable alternative to autograft tissue in anterior cruciate ligament (ACL) reconstruction. However, several infections associated with tissue procurement have led some to consider routine intraoperative cultures of allograft tissue before implantation. A positive culture result presents a treatment dilemma in the asymptomatic patient. Hypothesis Treatment of culture swab—positive allograft tissue is unnecessary if there is no evidence of clinical infection. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Retrospective analysis was performed on 247 cultures taken in 321 consecutive ACL reconstructions from a single surgeon. Allograft cultures were taken intraoperatively before antibiotic washing and implantation. All patients received standard prophylactic antibiotics consisting of intravenous vancomycin and perioperative cefazolin, and were routinely monitored in the postoperative period for signs of infection. Results Twenty-four of 247 (9.7%) cultures were positive after implantation. Sixteen of these (67%) grew organisms of high pathogenicity, whereas 8 (33%) were of low pathogenicity. Cultures were classified as poor, scant, or rare in all 24 patients. These patients did not receive additional antibiotics, and none went on to develop septic arthritis or wound complications. The 2 cases of septic arthritis had negative intraoperative cultures. Conclusions Treatment of low-virulence organisms or minimal growth high-virulence organisms is unnecessary if no evidence of clinical infection exists. The results may call into question the utility of routinely culturing allograft tissue as positive results did not correlate with infectious complications.

Campylobacter jejuni: unusual cause of cholecystitis with lithiasis. Case report and literature review

A 51-year-old man presented with acute cholecystitis and the routine intraoperative culture of the bile grew Campylobacter jejuni. The patient was cured by laparoscopic cholecystectomy without specific antimicrobial treatment. Cholecystitis owing to Campylobacter spp. could be missed because a culture for Campylobacter is not routinely requested nor is it cost effective to look for it in bile or gallbladder specimens. Moreover, the fastidious nature of these bacteria dictates against their recovery in routine culture. Because this is a rare infection at this site, a review of the literature on this infection is included.

Relevance of bacterial cultures of abdominal aortic aneurysm contents

To establish further insight into the relevance of intraoperative bacterial cultures of abdominal aortic aneurysm contents a study was performed of the rate of occurrence of prosthetic graft infection after aneurysm repair. Bacterial cultures were obtained from 216 patients, who were followed up for more than 3.5 years after operation and studied retrospectively in a single center analysis. Thrombus cultures yielded bacteria in 55 of 216 (25.5%) cases, including 11 of 44 (25%) cases with ruptured aneurysms. Prosthetic infections (4 of 216; 1.9%) occurred more frequently (p < 0.02) in patients with positive thrombus cultures (3 of 55; 5.5%) than in patients with negative cultures (1 of 161; 0.6%). In two patients the species isolated from the thrombus was also cultured from the vascular prosthesis, although in one graft infection other organisms were also isolated. The presence of bacteria in the intraluminal thrombus does not appear to be an important factor in the development of graft infection after primary elective and urgent abdominal aortic aneurysm repair. Therefore routine intraoperative cultures are unnecessary unless clinical signs of infective aortitis are present.

Intraoperative cholangiography. A review of indications and analysis of age-sex groups.

A retrospective review was performed of patients who had biliary tract stone formation as the primary diagnosis for hospitalization and indication for surgery. Five hundred and eighty-nine consecutive charts were reviewed of patients admitted between 1975 and 1979. Intraoperative cholangiography was performed in 166 patients of whom 22 had common duct exploration. Choledochotomy in this series was performed in 63 cases without utilizing pre-exploratory cholangiography. A normal intraoperative cholangiogram was found to be 100% accurate; however, an abnormal cholangiogram was associated with a 16% false positive rate of exploration of the common duct. The incidence of unsuspected common duct stones detected only by intraoperative cholangiography was 2.3%. Age-sex analysis confirms a 10-year mean age difference between men and women within the population of this study (p less than 0.001). This age-sex difference is maintained in patients without common duct pathology as well as in patients with sterile bile. However, the mean age difference between male and female patients with either demonstrable common duct obstruction by stones or infected bile as determined by routine intraoperative culture is not statistically significant. A review of the role of intraoperative cholangiography, and the experience at Northeastern Hospital is discussed.