Superficial Incisional Surgical Site Infection Research Articles

Extended-duration antibiotics are not associated with a reduction in surgical site infection in patients with ovarian cancer undergoing cytoreductive surgery with large bowel resection

Objective(s)To evaluate whether extended dosing of antibiotics (ABX) after cytoreductive surgery (CRS) with large bowel resection for advanced ovarian cancer is associated with reduced incidence of surgical site infection (SSI) compared to standard intra-operative dosing and evaluate predictors of SSI. MethodsA retrospective single-institution cohort study was performed in patients with stage III/IV ovarian cancer who underwent CRS from 2009 to 2017. Patients were divided into two cohorts: 1) standard intra-operative dosing ABX and 2) extended post-operative ABX. All ABX dosing was at the surgeon's discretion. The impact of antibiotic duration on SSI and other postoperative outcomes was assessed using univariate and multivariable Cox regression models. ResultsIn total, 277 patients underwent cytoreductive surgery (CRS) with large bowel resection between 2009 and 2017. Forty-nine percent (n = 137) received standard intra-operative ABX and 50.5% (n = 140) received extended post-operative ABX. Rectosigmoid resection was the most common large bowel resection in the standard ABX (89.9%, n = 124) and extended ABX groups (90.0%, n = 126), respectively. No significant differences existed between age, BMI, hereditary predisposition, or medical comorbidities (p > 0.05). No difference was appreciated in the development of superficial incisional SSI between the standard ABX and extended ABX cohorts (10.9% vs. 12.9%, p = 0.62). Of patients who underwent a transverse colectomy, a larger percentage of patients developed a superficial SSI versus no SSI (21% vs. 6%, p = 0.004). Conclusion(s)In this retrospective study of patients with advanced ovarian cancer undergoing CRS with LBR, extended post-operative ABX was not associated with reduced SSI, and prolonged administration of antibiotics should be avoided unless clinically indicated.

Effects of povidone-iodine wound irrigation on surgical site infection in gastroenterological surgery: A randomized controlled trial

BackgroundThe irrigation efficacy of a povidone-iodine solution to prevent surgical site infection is still controversial. We assessed the irrigation effect with a povidone-iodine solution on the incidence of surgical site infection after gastroenterological surgery. MethodsThis study is a single-center, prospective, randomized, blinded-end point superiority trial for surgical wound irrigation. Patients undergoing gastroenterological surgery were randomly assigned in a 1:1 replacement ratio using computer-generated randomization. Patients were grouped according to their surgical wound treatment into the control group using the normal sterile saline and the povidone-iodine group using 10% povidone-iodine solution after the NS solution. The main finding was 30-day surgical site infections assessed in the full analysis set. ResultsFrom November 2020 to December 2022, 697 of 894 patients were eligible for the study, among which 347 were in the povidone-iodine group and 350 in the control group. Thirty-day surgical site infections occurred in 100 (14%) patients—54 (16%) in the povidone-iodine group and 46 (13%) in the control group (odds ratio, 1.229; 95% CI, 0.800–1.889; P = .406). Superficial incisional surgical site infections occurred in 30 (9%) and 15 (4%) patients, respectively (odds ratio, 2.154; 95% CI, 1.134–4.090; P = .026). Only 3 patients (1%) in the control group developed adverse skin reactions. ConclusionThis study examined the irrigation efficacy of povidone-iodine for surgical site infection prevention compared to control in gastroenterological surgery. Povidone-iodine wound irrigation has shown no additional beneficial effect on the occurrence of surgical site infections.

Do Hypoalbuminaemia Increase the Risk of Surgical Site Infection in Neck of Femur Fracture Patients: A Systematic Review and Meta-Analysis.

Serum albumin plays an important role in physiological and inflammatory haemostasis, and low serum levels are linked with an increased incidence of surgical site infections (SSI). Although this has been demonstrated in the spine and elective arthroplasty settings, there is a paucity of evidence with regard to the effect of low serum albumin on rates of SSI following surgery for adult patients suffering from traumatic and acute hip fractures. A systematic review was conducted using the PRISMA guidelines. Four databases were searched for randomised controlled trials (RCTs), cohort studies, and case-controlled studies. The risk of bias was assessed using the Newcastle-Ottawa Score (NOS). Data was collected and pooled using RevMan Web software. Results were reported as odds ratios (OR) with 95% confidence intervals (CI) and statistical significance of p <0.05. An inverse variance model was used in the meta-analysis. Six retrospective studies (five cohorts and one case-control) with a total of 43,059 patients were included. 45.3% (n=19 496) had low serum albumin (<3.5 g/dL). Hypoalbuminemia was associated with a significantly higher risk of any form of SSI (OR 1.25, p=0.008) and deep SSI (OR 1.76, p=0.05). There was no statistical significance between hypoalbuminemia and the incidence of superficial SSI (OR 1.06, p=0.77). Organ-space SSI was associated with hypoalbuminemia, although one study reported this with poor statistical significance (OR 8.74, p<0.054). Hypoalbuminemia increases the risk of most forms of surgical site infections, both superficial and deep. There is a weak conclusion to draw between the incidence of deep-space organ infections and low serum albumin.

Real-World Evidence of the Impact of a Novel Surgical Irrigant on Surgical Site Infections in Primary Total Knee Arthroplasty Performed at an Ambulatory Surgery Center.

Background: Total knee arthroplasty (TKA) is one of the most common inpatient and outpatient surgical procedures performed in the United States and is predicted to increase 401% by 2040. Surgical site infections (SSIs) at an incidence rate of approximately 2% are costly post-operative complications in TKA. Intra-operative surgical irrigants are used to decrease contaminating microbial bioburden within the surgical site to prevent SSI. The primary objective of this retrospective study was to evaluate the impact of a novel surgical irrigant called XPERIENCE® Advanced Surgical Irrigation (XP; Next Science, Jacksonville, FL) on SSI incidence in primary TKA performed at an ambulatory surgery center (ASC). Patients and Methods: Primary TKAs were performed at a free-standing ASC. The novel surgical irrigant was used intra-operatively to rinse away debris and micro-organisms from the surgical site. Retrospective data collation included SSI rates, complication rates, and re-admissions due to SSI within 90 days of index surgery. Results: Among the 524 primary TKA surgeries, one peri-prosthetic joint infection (PJI) was diagnosed within 90 days of index surgery and one superficial incisional SSI was diagnosed within 30 days of index surgery. The PJI was attributed to an exogenously acquired upper respiratory tract infection rather than due to the failure of intra-operative regimes. The 0.19% PJI incidence rate indicated significant efficacy of XP in decreasing PJI. An overall complication rate of 7.82% was noted with none of the complications associated with usage of the novel surgical irrigant. Conclusions: XPERIENCE is a promising intra-operative antimicrobial irrigant that can be easily incorporated into a broader infection prevention strategy.

Antimicrobial peptide dendrimers assisted Nanocomposite-Loaded lyotropic liquid crystalline for multimodal surgical site infection management

Superficial incisional surgical site infections (SISSIs) were a serious challenge leading to delayed wound healing and even systemic diseases. The high incidence of antibiotic resistance and unprotected wound lesions severely hindered the current therapeutical efficiency. In this study, an antibacterial nanocomposite PAMAM-PLL@AuNPs was designed to avoid antibiotic resistance, and a lyotropic liquid crystal system was used for local drug delivery and protecting lesions. The PAMAM-PLL was constructed with polyamide amine (PAMAM) as the core and polylysine (PLL) as the branch chain, which increased the antibacterial activity by 4 times. After being connected to gold nanoparticles (AuNPs), a further 2 times antibacterial activity improvement was achieved. PAMAM-PLL@AuNPs could eliminate bacteria by multimodal mechanisms, including causing leakage of intracellular substances, inducing intracellular reactive oxygen species and inhibiting bacterial metabolism. Thanks to their spontaneous phase transition and the mechanical response characteristics of the lattice structure, lyotropic liquid crystal with self-healing characteristics was employed to load PAMAM-PLL@AuNPs. The unique structure facilitated buffering external forces and accelerated wound healing. The excellent antibacterial and wound healing properties of the lyotropic liquid crystal drug delivery system were confirmed by a surgical incision infection model. This study is expected to provide a robust strategy for the treatment of SISSIs.

The Prevalence of Multidrug-Resistant Organisms in Patients with Surgical Site Infections in Riyadh, Saudi Arabia: A Cross-sectional Study at a Tertiary Care Hospital

Background: Multidrug-resistant (MDR) infections are a threat in patients undergoing surgery. This study was undertaken to determine the prevalence and possible predictors of MDR infections over a two-year period in patients with surgical site infection (SSI) at a tertiary care hospital in Riyadh, Saudi Arabia. Methods: We conducted a cross-sectional study from April 2016 to April 2018 by reviewing hospital records of patients with a diagnosis of SSI based on a physician report and laboratory findings. The isolation of MDR organisms (MDRO) from SSI was the primary outcome variable as well as other risk factors. Results: SSI was diagnosed in 55 out of 77 patients under study, with MDRO prevalence rate of 44%. Previous antibiotic use and hospitalization in the last 90 days were strongly associated with developing MDRO infection often due to ESBL producing Gram-negative bacterial pathogens. Superficial and deep incisional SSI were more frequent in patients compared to organ/space SSI. History of diabetes mellitus, duration of surgery and bacterial colonization at other body site also increased the likelihood of MDRO. Factors such as trauma, obesity, general anesthesia, and wound types were not found to increase the risk for MDRO. Conclusions: Our study identified recent antibiotic use and hospitalization as major risk factors for MDRO surgical site infections. Other predisposing factors include diabetes mellitus, duration of surgery and bacterial colonization. MDRO isolated include E. coli and Pseudomonas aeruginosa. Bacterial pathogens harboring multiple resistant mechanisms can complicate SSI adversely affecting clinical outcomes following routine surgical procedures.

Superficial surgical site infection in delayed primary vs primary. Wound closure in complicated appendicitis.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Wound infection is the most common post-operative complication encountered after open appendectomy. Various studies have compared the risk of superficial surgical site infection (SSI) in primary closure (PC) and delayed primary closure (DPC) of wounds. However, there is no uniform consensus regarding the method of wound closure.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study is to compare the two wound closure techniques.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and methods:&lt;/b&gt; This is a prospective study which enrolled 50 patients who underwent open appendectomy. The patients' demographics, characteristics, and operative findings were recorded. Those who were older than 18 years and had an appendectomy with a right lower quadrant incision were included. Patients with any comorbidity, morbid obesity, or pregnancy were excluded. Patients were randomized to undergo two techniques of wound closure: PC and DPC. During follow- -up at 1 week and 1 month, SSI, post-op pain, and LOS were compared among the two groups. Clinical assessment included the Visual Analog Scale (1-10) for pain.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; In our study, the incidence of SSI in the DPC group was significantly lower than in the PC group (p = 0.0002), while post-op pain and LOS were not significantly different between the two groups.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; We concluded that DPC was superior to PC in terms of reducing the incidence of superficial SSI, but with respect to post-op pain and LOS, the two techniques of wound closure were not different.&lt;/br&gt.

Randomized controlled trial of olanexidine gluconate and povidone iodine for surgical site infection after gastrointestinal surgery.

Antiseptics used at surgical sites are vital to preventing surgical site infections (SSI). In this study, a comparative investigation of the novel antiseptics olanexidine gluconate (OG) and povidone-iodine (PI) was conducted to determine whether OG is more effective than PI against SSI after gastrointestinal surgery. This prospective, randomized, single-blind, interventional, single-center study was conducted between August 2018 and February 2021. Patients scheduled for large-scale gastrointestinal surgeries were randomized into two groups and administered OG (OG group) or PI (PI group) as preoperative antiseptics. The primary endpoint was the SSI occurrence rate within 30 days after surgery. In total, 525 patients were enrolled in this study, of whom 256 and 254 were in the OG and PI groups, respectively. The total SSI occurrence rate in the OG group (10.8%; n = 26) and the PI group (13.0%; n = 33) was not significantly different (p = 0.335). The occurrence rate of superficial incisional SSI and organ/space SSI did not significantly differ between the groups; however, that of deep incisional SSI showed a significant difference, with 0.4% (n = 1) in the OG group and 4.3% (n = 11) in the PI group (p = 0.003). OG, as a preoperative skin antiseptic, did not reduce the occurrence rate of total SSI. However, deep incisional SSI may be reduced using OG.

Development of machine learning models for the detection of surgical site infections following total hip and knee arthroplasty: a multicenter cohort study

BackgroundPopulation based surveillance of surgical site infections (SSIs) requires precise case-finding strategies. We sought to develop and validate machine learning models to automate the process of complex (deep incisional/organ space) SSIs case detection.MethodsThis retrospective cohort study included adult patients (age ≥ 18 years) admitted to Calgary, Canada acute care hospitals who underwent primary total elective hip (THA) or knee (TKA) arthroplasty between Jan 1st, 2013 and Aug 31st, 2020. True SSI conditions were judged by the Alberta Health Services Infection Prevention and Control (IPC) program staff. Using the IPC cases as labels, we developed and validated nine XGBoost models to identify deep incisional SSIs, organ space SSIs and complex SSIs using administrative data, electronic medical records (EMR) free text data, and both. The performance of machine learning models was assessed by sensitivity, specificity, positive predictive value, negative predictive value, F1 score, the area under the receiver operating characteristic curve (ROC AUC) and the area under the precision–recall curve (PR AUC). In addition, a bootstrap 95% confidence interval (95% CI) was calculated.ResultsThere were 22,059 unique patients with 27,360 hospital admissions resulting in 88,351 days of hospital stay. This included 16,561 (60.5%) TKA and 10,799 (39.5%) THA procedures. There were 235 ascertained SSIs. Of them, 77 (32.8%) were superficial incisional SSIs, 57 (24.3%) were deep incisional SSIs, and 101 (42.9%) were organ space SSIs. The incidence rates were 0.37 for superficial incisional SSIs, 0.21 for deep incisional SSIs, 0.37 for organ space and 0.58 for complex SSIs per 100 surgical procedures, respectively. The optimal XGBoost models using administrative data and text data combined achieved a ROC AUC of 0.906 (95% CI 0.835–0.978), PR AUC of 0.637 (95% CI 0.528–0.746), and F1 score of 0.79 (0.67–0.90).ConclusionsOur findings suggest machine learning models derived from administrative data and EMR text data achieved high performance and can be used to automate the detection of complex SSIs.

Bacteriological Profile of Surgical Site Infection: A Descriptive Study at Deido District Hospital in Douala, Cameroon

Background: Surgical site infection (SSI) is defined as infections occurring within 30 days after a surgical operation, or within one year if an implant is left in place after the procedure. Surgical site infection is classified by the american center for disease control (CDC) into superficial incisional surgical site infections SSI, deep incisional SSI and organ/space SSI.&#x0D; Objectives: The objectives of this study were to determine the prevalence of post-surgical site infections, assess the risk factors, determine the various and most microorganisms encountered and study the antibiotic sensitivity in post-surgical site infection after post-surgical site infection in Deido district hospital Douala.&#x0D; Materials and Methods: we conducted a 3 months hospital based prospective study on general surgery, obstetric and gynecologic records admission at the Deido district Hospital Douala from February 1st 2020 to April 30th 2020. We included available files of the general surgery, obstetrics and gynecology. We excluded paediatrics and medical. The study was approved by the institutional ethic review board of the faculty of health sciences of the university of Bamenda.&#x0D; Results: We had 133 of post-surgical patients in general surgery, obstetric and gynecologic. The prevalence of post-surgical site infection was 32,3% (43/133). Male gender aged 50-60 years were more affected than female to developed SSI. Diabetes mellitus and immunodepression by the human immuno deficiency virus had respective prevalence of 48.1 and 81,8% and increased hosptal stay after operation. Peritonitis with perforation was the most involved (14%). The identified germs were Staphylococcus aureus (11,3%), followed by Escherichia coli (8%), Pseudomonas aeruginosa (3,8%) and pseudomonas spp (3%). Staphylococcus aureus was sensible to vancomycin (73,33%), netilmicin, amikacin (6o%). Escherichia coli was sensible to gentamycin, ciprofloxacin, augmentin with a prevalence of 63,64%. Pseudomonas aeruginosa was sensible to pristinacine (80%) and amikacin (60%). Pseudomonas spp was sensible to netilmicin, amikacin (75%) followed by gentamicin, levofloxacin and ofloxacin (50%).&#x0D; Conclusion: The prevalence of Post-surgical site infection was high, the clinical spectrum and bacterial sensitivity was diverse.

Preoperative and Intraoperative Risk Factors for Surgical Site Infection in Pediatric Cardiac Surgery.

Surgical site infection (SSI) is a major complication of pediatric cardiac surgery. If the risk of developing SSI can be predicted based on the patient's preoperative background, appropriate preoperative management to prevent the development of SSI can be achieved. We retrospectively studied cases for patients younger than 7 years of age among surgeries performed through a median sternotomy at Kagoshima University Hospital from April 2011 to March 2021. SSI was diagnosed according to the Centers for Disease Control and Prevention guidelines and classified into 3 types: superficial incisional SSI (SiSSI), deep incisional SSI (DiSSI) and mediastinitis. Of the 765 consecutive pediatric cardiac surgeries, 597 were included in the analysis based on the exclusion criteria. Of these, 17 (2.8%) developed SSI (3 SiSSI cases, 2 DiSSI cases and 12 mediastinitis cases), with Staphylococcus aureus as the major pathogen. Univariate analysis revealed that low preoperative serum protein ( P = 0.049) and low serum albumin levels ( P = 0.023) were risk factors for the development of SSI. No findings suggested impaired hepatic synthesis, inflammatory disease or protein loss from the kidney or intestinal tract. We concluded that malnutrition caused low serum protein and albumin levels. Low preoperative serum protein and albumin levels are risk factors for SSI development of SSI. Nutritional status should be regularly assessed in children scheduled for cardiac surgery, and interventions, such as nutritional guidance, should be considered if malnutrition is suspected.

Vaginal Reconstruction in the Pediatric Population: An Analysis of a National Database

ObjectiveIn the pediatric population, vaginoplasties can be performed in patients with either congenital malformations or acquired conditions. To our knowledge, there has been no study to date investigating the outcomes of vaginoplasty in the pediatric population using a nationwide database. Here, we present a national cohort study of perioperative characteristics and 30-day complications of vaginoplasty in pediatric patients. MethodsA level II retrospective, prognosis cohort study was performed using the Pediatric National Surgical Quality Improvement Program (NSQIP-P) database from 2012 to 2020. Data from patients age 0 to 18 who underwent vaginoplasty was queried using CPT code 57,335. Descriptive analysis was performed to elucidate patterns in patient demographics, perioperative characteristics, and 30-day postoperative outcomes. ResultsA total of 183 patients were identified. Median age was 2.41 years (IQR 0.9 to 12.1). In this population, 58.5% of patients had ASA class 2, and 33.3% ASA class 3. Congenital malformation was present in 75.9%. Average total length of stay was 2.7 days (SD = 3.8) and readmission rate was 7.86%. Complications included urinary tract infection (3.3%), bleeding/transfusions (2.2%), organ/space surgical site infection (1.1%), and superficial incisional surgical site infection (0.6%). The most common procedures performed simultaneously with vaginoplasty included cystourethroscopy (n = 66), clitoroplasty for intersex state (n = 58), and plastic repair of introitus (n = 22). ConclusionVaginoplasties in the pediatric population were found to have low rates of 30-day readmission and low incidence of 30-day postoperative complications. Further studies focusing on prospective clinical data related to pediatric vaginoplasty can help identify factors to improve long-term outcomes in this population.

The effect of Bdellovibrio bacteriovorus containing dressing on superficial incisional surgical site infections experimentally induced by Klebsiella pneumoniae in mice

Bdellovibrio bacteriovorus is a bacterial agent that stands out for its ability to act as a predator against gram-negative bacteria and has found application against antibiotic-resistant pathogens. The aim of this study is to determine the efficacy of Bdellovibrio bacteriovorus against antibiotic-resistant pathogens, particularly those causing infections in surgical incision sites. A total of 6 experimental groups were created in mice, and surgical area infections were initiated with Klebsiella pneumoniae in incision sites. The effects of antibiotics and Bdellovibrio bacteriovorus alone or in combination were compared to the control group. In the Bdellovibrio bacteriovorus treatment group, edema and redness were observed in all mice at 24th hours, in 20% of mice at 48th hours, and in none at the 72 nd h. A significant difference was observed in the Bdellovibrio bacteriovorus treatment groups in reducing Klebsiella pneumoniae burden in the incision area compared to antibiotics alone or Bdellovibrio bacteriovorus + antibiotics, (p < 0.001). Likewise, cytokine level determinations indicated that B. bacteriovorus applications generated a therapeutic response without inducing an inflammatory response.

Preoperative CT-Based Skeletal Muscle Mass Depletion and Outcomes after Total Laryngectomy.

To assess the role of preoperative CT-based skeletal muscle mass depletion on postoperative clinical outcomes and survival in patients who underwent total laryngectomy for cancer. Patients operated on between January 2011 and March 2020 were retrospectively included. Skeletal muscle area and intra- and inter-muscular fat accumulation were measured at the third lumbar vertebral level on preoperative CT scans. Skeletal muscle mass depletion was defined based on pre-established cut-off values. Their association with postoperative morbidity, length of stay (LOS), costs, and survival was assessed. A total of 84 patients were included, of which 37 (44%) had preoperative skeletal muscle mass depletion. The rate of postoperative fistula (23% vs. 35%, p = 0.348), cutaneous cervical dehiscence (17% vs. 11%, p = 0.629), superficial incisional surgical site infections (SSI) (12% vs. 10%, p = 1.000), and unplanned reoperation (38% vs. 37%, p = 1.000) were comparable between the two patient groups. No difference in median LOS was observed (41 vs. 33 days, p = 0.295), nor in treatment costs (119,976 vs. 109,402 CHF, p = 0.585). The median overall survival was comparable between the two groups (3.43 vs. 4.95 years, p = 0.09). Skeletal muscle mass depletion alone had no significant impact on postoperative clinical outcomes or survival.

Intraoperative techniques to prevent deep incisional or organ-space surgical site infection after emergency surgery for nonappendiceal perforation peritonitis: a prospective two-center observational study.

The rate of surgical site infection (SSI) after surgery for secondary peritonitis is very high. This study investigated the relationship between intraoperative procedures of emergency surgery for nonappendiceal perforation peritonitis and deep incisional or organ-space SSI. This prospective, two-center observational study included patients aged ≥ 20years who underwent emergency surgery for perforation peritonitis between April 2017 and March 2020. We compared patients with deep incisional or organ-space SSI (Group S) to patients without SSIs or with superficial incisional SSIs (Group C). Thereafter, we evaluated the association between intraoperative technical variables and deep incisional or organ-space SSI using a multivariate logistic regression model. All multivariate analyses were adjusted for potentially relevant risk factors (e.g., age, body mass index, diabetes, smoking habit, and National Nosocomial Infection Surveillance risk index). Of the 75 participants, 14 were in Group S and 61 were in Group C. The use of a wound protector device was significantly associated with decreased odds of deep incisional or organ-space SSI (adjusted odds ratios [AOR], 0.017; 95% confidence intervals [CI] 0.0014-0.19, p = 0.0011). A 1000ml increase in intra-abdominal lavage with normal saline was significantly associated with increased odds of deep incisional or organ-space SSI (AOR: 1.28, 95% CI 1.02-1.61, p = 0.033). Wound protector devices should be used in emergency surgery for nonappendiceal perforation peritonitis. Excessive intra-abdominal lavage with normal saline for peritonitis may have unsatisfactory benefits and increases the incidence of deep incisional or organ-space SSI.

Appropriateness of perioperative antibiotics in thyroid surgery

Introduction: Most of the guidelines do not recommend routine antibiotics prophylaxis in clean head and neck surgery like thyroidectomy. In contrary to the recommendation, antibiotics are being routinely prescribed in perioperative period for various duration in many centers of Nepal. This study was aimed to find out the need of postoperative antibiotics in surgeries for thyroid related problems.&#x0D; Method: Records of all patients who had undergone surgery for thyroid related problems from Jan, 2019 to Sept, 2022 were retrospectively reviewed for patterns of antibiotic use, apart from preincision antibiotic, in postoperative period which was classified as group A – no antibiotics, group B – shorter course of antibiotics (≤3 days) and group C – longer course of antibiotics (&gt;3 days). The occurrence of surgical site infection (SSI) was recorded.&#x0D; Result: During the study period, 77 patients underwent surgery for thyroid related problems, out of which five were excluded (records not found in four cases and one patient was ASA III). Two out of 72 (2.77 %) patients developed superficial incisional SSI which was managed conservatively. One patient in each group A (50) and group B (8) developed SSI.&#x0D; Conclusion: Postoperative antibiotics can be avoided safely even in our setup in clean head and neck surgeries like thyroidectomy without increase in the risk of SSI thus reducing the cost to the patients.

Consequences of Surgical Site Infections, Bacterial Etiologies and Associated Factors among Post-Operative Patients in a Tertiary Level Hospital

Background: Surgical site infections (SSIs) are infections that occurs one month after a surgery or one year after implant surgery or surgical procedure, either at the injury site or near the injury site. Surgical Site Infections are still a major global problem, especially in developing countries, where they cause increased morbidity and mortality. There is a dearth of information regarding SSIs, about its magnitude, bacteriological aetiologies and associated factors in this study hospital. Aim of the Study: The aim of the study to see the correlation among sterilization, antibiotic resistance and malnutrition with surgical site infection in a tertiary level hospital. Methods: This cross-sectional observational study was conducted in the Department of Surgery, Shaheed Suhrawardy Medical College and Hospital. Informed written consent, detailed history, physical examination and necessary investigations were performed. Total 160 admitted patients undergoing different surgical procedure were included in this study, irrespective of their age, sex, race and ethnic group. Data were collected by using a semi-structured questionnaire. Collected data were analyzed by the SPSS 25. Results: Average age of all patient was 36.10±12.15 years (range: 13-65 years), wherein maximum patients were aged &lt;40 years, male gender (56.3%), had normal BMI (61.3%) and non-smoker (62.07%). About 1/4th patients had diabetes mellitus. Maximum patients had undergone abdominal surgery (34.4%) followed by orthopedics and traumatology (20.6%), General surgery other than abdominal surgery (18.8%), Neurosurgery (13.8%), Vascular surgery (12.5%). Pre-operative waiting period for surgery was &lt;3 days in most of the cases (48.8%), followed by 3-7 days (31.3%) and &gt;7 days (20%). Mean operation duration was 1.49±0.73 hours. Twenty-nine patients (18%) developed SSI, of which 7% had deep incisional SSI, 6% had superficial incisional SSI and 5% had organ/space SSI. SSI culture reports showed that majority ....

Correlation among Sterilization, Antibiotic Resistance and Malnutrition with Surgical Site Infection in a Teritary Level Hospital

Background: Despite the advances made in asepsis, antimicrobial drugs, sterilization and operative techniques, surgical site infection (SSI) continues to be a major problem in all branches of surgery in the hospitals. However, there is no infection control policy that runs effectively in our country. Aim:This study was designed to see the correlation among sterilization, antibiotic resistance and malnutrition with surgical site infection in a tertiary level hospital. Methods: This cross-sectional observational study was conducted in the Department of Surgery, Shaheed Suhrawardy Medical College and Hospital. Informed written consent, detailed history, physical examination and necessary investigations were performed. Total 160 admitted patients undergoing different surgical procedure were included in this study, irrespective of their age, sex, race and ethnic group. Data were collected by using a semi-structured questionnaire. Collected data were analyzed by the SPSS 25. Results: Average age of all patient was 36.10±12.15 years (range: 13-65 years), wherein maximum patients were aged &lt;40 years, male gender (56.3%), had normal BMI (61.3%) and non-smoker (62.07%). About 1/4th patients had diabetes mellitus. Maximum patients had undergone abdominal surgery (34.4%) followed by orthopaedic and traumatology (20.6%),General surgery other than abdominal surgery (18.8%), Neurosurgery (13.8%), Vascular surgery (12.5%). Pre-operative waiting period for surgery was &lt;3 days in most of the cases (48.8%), followed by 3-7 days (31.3%) and &gt;7 days (20%). Mean operation duration was 1.49±0.73 hours. Twenty-nine patients (18%) developed SSI, of which 7% had deep incisional SSI, 6% had superficial incisional SSI and 5% had organ/space SSI. SSI culture reports showed that majority (93.1%) had positive culture growth, wherein 66.7% had single microorganism and rest 33.3% had multiple growth. Staphylococcus aureus (34.48%) was the most frequently found microorganism. surgical team sterility was properly maintained in maximum surgical procedures (71.9%). Besides, OT room and surgical instruments were also properly sterilized in most of the cases (65.6% and 70%, respectively). Older age, abnormal BMI, smoking history, DM, longer pre-operative waiting period and operation duration was significantly associated with development of SSI. Besides, surgical team sterility, OT room sterility and Instrument sterility were not properly maintained in most of the surgical procedures among SSI patients (65.52%, 68.97% and 58.62%, respectively). Conclusion: Abnormal BMI (underweight and overweight or obese) and poor sterilization had significant association with development of SSI. However, further studies are needed to establish and use the findings. J Shaheed Suhrawardy Med Coll 2021; 13(2): 143-149

The detection and prediction of surgical site infections using multi-modal sensors and machine learning: Results in an animal model.

Surgical Site Infection (SSI) is a common healthcare-associated infection that imposes a considerable clinical and economic burden on healthcare systems. Advances in wearable sensors and digital technologies have unlocked the potential for the early detection and diagnosis of SSI, which can help reduce this healthcare burden and lower SSI-associated mortality rates. In this study, we evaluated the ability of a multi-modal bio-signal system to predict current and developing superficial incisional infection in a porcine model infected with Methicillin Susceptible Staphylococcus Aureus (MSSA) using a bagged, stacked, and balanced ensemble logistic regression machine learning model. Results demonstrated that the expression levels of individual biomarkers (i.e., peri-wound tissue oxygen saturation, temperature, and bioimpedance) differed between non-infected and infected wounds across the study period, with cross-correlation analysis indicating that a change in bio-signal expression occurred 24 to 31 hours before this change was reflected by clinical wound scoring methods employed by trained veterinarians. Moreover, the multi-modal ensemble model indicated acceptable discriminability to detect the presence of a current superficial incisional SSI (AUC = 0.77), to predict an SSI 24 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.80), and to predict an SSI 48 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.74). In sum, the results of the current study indicate that non-invasive multi-modal sensor and signal analysis systems have the potential to detect and predict superficial incisional SSIs in porcine subjects under experimental conditions.

Comparison of olanexidine versus povidone-iodine as a preoperative antiseptic for reducing surgical site infection in both scheduled and emergency gastrointestinal surgeries: A single-center randomized clinical trial.

Surgical site infection (SSI) is one of the most common postoperative complications in gastrointestinal surgery. To clarify the superiority of 1.5% olanexidine, we conducted a randomized prospective clinical trial that enrolled patients undergoing gastrointestinal surgery with operative wound classes II-IV. To evaluate the efficacy of 1.5% olanexidine in preventing SSIs relative to 10% povidone-iodine, we enrolled 298 patients in each group. The primary outcome was a 30-day SSI, and the secondary outcomes were incidences of superficial and deep incisional SSI and organ/space SSI. In addition, subgroup analyses were performed. The primary outcome of the overall 30-day SSI occurred in 38 cases (12.8%) in the 1.5% olanexidine group and in 53 cases (18.0%) in the 10% povidone-iodine group (adjusted risk ratio: 0.716, 95% confidence interval: 0.495-1.057, p = 0.083). Organ/space SSI occurred in 18 cases (6.1%) in the 1.5% olanexidine group and in 31 cases (10.5%) in the 10% povidone-iodine group, with a significant difference (adjusted risk ratio: 0.587, 95% confidence interval: 0.336-0.992, p = 0.049). Subgroup analyses revealed that SSI incidences were comparable in scheduled surgery (relative risk: 0.809, 95% confidence interval: 0.522-1.254) and operative wound class II (relative risk: 0.756, 95% confidence interval: 0.494-1.449) in 1.5% olanexidine group. Our study revealed that 1.5% olanexidine reduced the 30-day overall SSI; however, the result was not significant. Organ/space SSI significantly decreased in the 1.5% olanexidine group. Our results indicate that 1.5% olanexidine has the potential to prevent SSI on behalf of povidone-iodine.