Surgical Site Infection In Adults Research Articles

A Randomized Controlled Trial of 2% Chlorhexidine Gluconate Skin Preparation Cloths for the Prevention of Surgical Site Infections in Adults Undergoing Spine Surgeries: Residual Reduction in Skin Bacterial Load for 4 Days.

Surgical site infections (SSI) result in increased morbidity and mortality, prolonged recovery, longer hospital length of stay for medication or possible additional surgeries, and escalated health care costs. The purpose of this randomized controlled trial was to compare SSI rates and overall skin flora burden between those using chlorhexidine (CHG) cloths versus soap and water preoperatively in the adult spine surgery population. Subjects were randomized preoperatively to use 2% CHG cloths versus soap and water the night before and morning of surgery prior to the operation. A skin culture was obtained at enrollment prior to any cleansing, again at post-operation day 4 or hospital discharge (whichever came first), and finally at the surgeons' postoperative visits. A blinded advanced practice nurse served as the assessor for SSI. Those enrolled in the research arm had more growth on their screening skin culture than the control arm (P = .02). While there was no difference in rates of SSI between groups, the CHG group had lower skin flora burden at hospital discharge (P = .004), indicating residual protection. Surgical incisions are most vulnerable to bacterial entry prior to 72 hours post-operation before completion of epithelialization, which establishes a barrier from microbes. The use of CHG, which has a residual impact for up to 4 days, could offer additional risk reduction for SSI development.

Updated meta-analysis on intraoperative inspired fraction of oxygen and the risk of surgical site infection in adults undergoing general and regional anesthesia

This updated meta-analysis aims at exploring whether the use of systematic high vs low intraoperative oxygen fraction (FiO2) may decrease the incidence of postoperative surgical site infection during general (GA) or regional anesthesia (RA). PubMed, Cochrane CENTRAL, ClinicalTrials.gov databases were searched from January 1st, 1999 and July, 1st 2022, for randomized and quasi-randomized controlled trials that included patients in a high and low FiO2 groups and reported the incidence of SSI. The meta-analysis was conducted with a DerSimonian and Laird random-effects model. Thirty studies (24 for GA and 6 for RA) totaling 18,055 patients (15,871 for GA and 2184 for RA) were included. We have low-to-moderate-quality evidence that high FiO2 (mainly 80%) was not associated with a reduction of SSI incidence compared to low FiO2 (mainly 30%) in all patients (RR 0.90, 95%CI 0.79–1.03). Moderate inconsistency existed between studies (I2 = 38%). Subgroup analyses showed a moderate protective effect in patients undergoing GA (RR 0.86, 95%CI 0.75–0.99) (low level of evidence), while high FiO2 was not associated with a reduction of SSI in patients undergoing RA (RR 1.17, 95%CI 0.90–1.52) (moderate level of evidence). Sensitivity analyses restricted to patients ventilated without nitrous oxide (n = 20 studies), to patients operated from abdominal surgeries (n = 21 studies), and to patients suffering from deep SSI (n = 13 studies), all showed the absence of any significant effect of high FiO2. As a conclusion there is no compelling evidence that high FiO2 can improve postoperative patient’s outcome on its own when good SSI prevention practices are properly applied. Recent well-designed and adequately powered randomized controlled trials add further weight to these results.

Intraoperative Hypothermia Is Not Associated with Surgical Site Infections after Total Hip or Knee Arthroplasty.

Maintaining perioperative normothermia decreases the post-surgery surgical site infection (SSI) rate. We investigated whether SSI is associated with intraoperative hypothermia in total hip (THA) and total knee (TKA) arthroplasties by retrospectively analyzing 297 THA and TKA cases. The patients' intraoperative core body temperature (BT) was measured by bladder catheter or forehead sensor. We evaluated the associations between SSI and intraoperative BT and other variables and patient characteristics. Fifty-six patients (18.8%) had hypothermia (BT <36°C); 43 developed SSI (14.5%); only five had hypothermia (11.6%). Intraoperative hypothermia and SSI were not significantly associated. The SSI group had more men (34.9% vs. 18.1%) and THA patients (77.4%), a longer mean surgical duration (174.3 vs. 143.5 mins), and a higher average BT (36.4°C vs. 36.2°C) than the no-SSI group. The SSI patients had a higher intraoperative BT. A multivariable analysis revealed that SSI was associated with male sex (OR 2.3, 95%CI: 1.031-4.921, p=0.042), longer surgery (OR, 1.01, 95%CI: 1.003-1.017, p=0.004), THA (OR 3.6, 95%CI: 1.258-10.085, p=0.017), and intraoperative BT >36.0°C (OR 3.6, 95%CI: 1.367-9.475, p=0.009). Intraoperative hypothermia was not associated with SSI in adults who underwent THA or TKA. These results suggest that hypothermia might not be the problem for SSI.

Effectiveness of supplemental oxygenation to prevent surgical site infections: A systematic review with meta-analysis.

Objective: to assess the effectiveness of supplemental oxygenation with high FiO2 when compared to conventional FiO2 in the prevention of surgical site infection. Method: an effectiveness systematic review with meta-analysis conducted in five international databases and portals. The research was guided by the following question: Which is the effectiveness of supplemental oxygenation with high FiO2 (greater than 80%) when compared to conventional FiO2 (from 30% to 35%) in the prevention of surgical site infections in adults? Results: fifteen randomized clinical trials were included. Although all the subgroups presented a general effect in favor of the intervention, colorectal surgeries had this relationship evidenced with statistical significance (I2=10%;X2 =4.42; p=0.352). Conclusion: inspired oxygen fractions greater than 80% during the perioperative period in colorectal surgeries have proved to be effective to prevent surgical site infections, reducing their incidence by up to 27% (p=0.006). It is suggested to conduct new studies in groups of patients subjected to surgeries from other specialties, such as cardiac and vascular. PROSPERO registration No.: 178,453.

Surgical site infection in adults undergoing major non-cardiac surgery and its association with anemia, severe bleeding and intraoperative transfusion: A preliminary report from a prospective registry

Introduction&#x0D; Surgical site infection (SSI) is among the most common healthcare-related infections. Given their greater morbidity and surgical complexity, patients undergoing major surgery are exposed to a high risk of SSI.&#x0D; Objective&#x0D; To determine the incidence of SSI in adult patients undergoing major elective non-cardiac surgery, and to identify risk factors associated with its occurrence within the first 30 days after surgery.&#x0D; Methods&#x0D; An analytical study was designed on the basis of a prospective institutional registry. Clinical and laboratory variables associated with perioperative management were recorded. An active search was conducted in order to find SSI episodes, renal failure and multiple organ dysfunction during the first 30 days after surgery. Adjusted logistic regression was done to identify potential associations between risk factors and the development of SSI.&#x0D; Results&#x0D; Overall, 1501 patients were included. The incidence of SSI during the first 30 days after surgery was 6.72% (95% CI 5.57-8.11). ASA III, abdominal surgery and longer procedures were more frequent in the SSI group. Association with the occurrence of SSI was documented for preoperative hemoglobin levels (adjusted OR 0.79 [95% CI 0.72-0.88], p = 0.04), intraoperative transfusion (adjusted OR 2,47 [95% CI 1.16-5.27], p = 0.02) and major blood loss (adjusted OR 3.80 [95% CI 1.63-8.88], p = 0.04).&#x0D; Conclusion&#x0D; Preoperative hemoglobin level, intraoperative transfusion and major bleeding are independent risk factors associated with the occurrence of SSI in adult patients undergoing major elective non-cardiac surgery.

Predictive factors for the development of surgical site infection in adults undergoing initial open inguinal hernia repair.

Despite being one of the most commonly performed general surgery procedures, surgical site infection (SSI) is still seen in primary, elective, open inguinal hernia repair. Studies have reported a wide range of infection rates, yet predictive risk factors have not been definitely identified leading to variability and controversy in the use of pre-operative antibiotics. In this study, the authors seek to identify factors predictive of SSI development in a large cohort of patients undergoing initial unilateral open inguinal repair. The American College of Surgery National Surgical Quality Improvement Program (ACS NSQIP) personal use file (PUF) database was queried for initial, open, reducible inguinal hernia repair cases in adults with clean surgical sites performed from 2012 to 2015 (CPT 49,505 and class one wound). Patient data were analyzed using univariate and multivariate analysis to identify factors predictive of surgical site infection. 57,951 cases were identified. 90.8% were men with an average age of 58.2years and a median operative time of 53.0min. Of all variables evaluated with univariate logistic regression, 17 demonstrated an association with surgical site infection. Performing multiple logistic regression on those 17 variables yielded 3 factors independently associated with surgical site infection: diabetes (OR 2.017, 95% CI 1.012-4.023), BMI ≥ 35kg/m2 (OR 2.587, 95% CI 1.123-5.964), and current smoking (OR 2.071, 95% CI 1.126-3.811). Diabetes, BMI ≥ 35kg/m2, and current smoking are significantly associated with an increased odds surgical site infection after initial, open, reducible inguinal hernia repair in adults with clean surgical sites.

Pre-operative skin antisepsis with chlorhexidine gluconate baths and wipes does not prevent postoperative surgical site infection in outpatient pediatric urologic inguinal and scrotal surgery

To reduce surgical site infections (SSI), many institutions utilize pre-operative antisepsis with chlorhexidine gluconate (CHG) baths and/or wipes. CHG reduces bacterial colonization of the skin, but it is unclear whether this reduces SSI, and current guidelines from the American College of Surgeons, the Centers for Disease Control, and the World Health Organization do not support this practice. There are several factors that increase the risk of SSI in adults, but there is limited understanding of these factors in pediatric patients. The primary objectives were to describe the proportion of pediatric patients undergoing hernia/hydrocele repair and/or orchiopexy who develop a postoperative (postop) SSIand to determine whether pre-operative CHG baths/wipes were associated with SSI. The secondary objectives were to identify other factors associated with SSIand to estimate the cost of CHG baths/wipes in this population. Pre-operative antisepsis with CHG baths/wipes was implemented at the authors institution in 2006. The authors performed a retrospective cohort study of patients aged 0-18 yearsundergoing hernia/hydrocele repair and/or orchiopexy by a pediatric urologist at their institution before (2004) and after (2008) the introduction of CHG. The authors compared the proportion of patients with SSI in the no CHG and CHG groups and evaluated for factors associated with SSI. Statistical analysis included Wilcoxon rank-sum test, Chi-squared test, and Fisher's exact test. The cost of CHG baths and wipes was estimated using institutional fees in 2018 US dollars. A total of 543 patients met inclusion criteria,203 in the no CHG group and 340 in the CHG group. The overall rate of SSI was 0.92%. There was no association between use of CHG and SSI. No patient or peri-operative factors were associated with development of SSI. There were no CHG-associated adverse events. The cost of materials was estimated at $3.29/patient ($1118.60 for 340 cases in 2008) in 2018 US dollars. SSI is not common in pediatric patients undergoing hernia/hydrocele repair or orchiopexy. In the present study, pre-operative antisepsis with CHG baths/wipes is not associated with a reduction in SSI and carries additional cost. To the authors knowledge, this is the first study to evaluate the use of pre-operative antisepsis with CHG baths/wipes in an exclusively pediatric population. In the study, CHG baths/wipes add cost with no clear benefit for reducing SSI in pediatric patients undergoing hernia/hydrocele repair and/or orchiopexy.

Interventions to prevent surgical site infection in adults undergoing cardiac surgery

Interventions to prevent surgical site infection in adults undergoing cardiac surgery

Changing antibiotic resistance patterns for Staphylococcus aureus surgical site infections.

Beta-lactam antibiotics such as cefazolin are first-line agents for preoperative prophylaxis, whereas clindamycin is often administered to patients with a reported penicillin allergy. 1 Recent studies have reported increased resistance to clindamycin in Staphylococcus aureus (SA) isolates from both pediatric and adult populations, and these changes may have implications for surgical site infection (SSI) prophylaxis and empirical management. 2 , 3 Antibiotic resistance trends of SA isolates recovered from SSIs in adults in the United States have not been recently described.

Medicine in small doses.

Reducing surgical site infections – from Listerism to NICE guidelines, 150 years on Joseph Lister was 40 and the Professor of Surgery at the University of Glasgow when his paper, ‘On a new method of treating compound fracture, abscess &c, with observations on the conditions of suppuration. I. Compound fractures’ (Lancet 1867; i: 326–9), was published 150 years ago. This was the first of five articles on the topic published in The Lancet that year. This series of articles were about his antiseptic system for healing wounds, involving the combination of carbolic acid spray over the surgical field, acid-soaked towels surrounding the incision and the instruments submerged in carbolic acid. His post-operative care included the placing of dressings soaked in carbolic acid, changed daily until the appearances of wound healing. He first applied these dressings in 1865, on James Greenlees, a young boy with a compound fracture of a tibia. The healing of the wounds with lack of suppuration encouraged Lister to experiment with other patients, with 9 of his first 12 attempts healing without evidence of suppuration. In the follow-up Lancet publications that year, he declared ‘upon this principle I have built a practice’. Lister based his principle on the germ theory of wound infection, from the writings of the French chemist, Louis Pasteur who proposed three methods to eradicate the germs: filtration, exposure to heat or exposure to solution/chemical solutions. Lister chose the last. Many surgeons in Britain, however, could not accept this simple theory of the singular cause of wound suppuration and what is more Pasteur was a chemist! Moreover, they found Lister's spray was cumbersome and unpopular with patients and surgeons. Indeed Lister's evidence was all based on clinical observation and he never published laboratory proof of the efficacy of his technique, and ultimately his techniques fell out of favour. However, Lister had may acolytes, one of his greatest being W. Watson-Cheyne who, in his article ‘Listerism and the development of operative surgery’ (BMJ 1902; 2: 1851), highlighted Lister's other significant contributions to surgery: the development of instruments more easily sterilizable and made of metal rather than the preferred wood and ivory, his flexibility in accepting the importance of steam sterilization of such instruments and the evolution from antisepsis to asepsis. By the end of the 19th century, antiseptic interventions had given way to aseptic techniques, with the acceptance of hand washing and the aseptic operating field. Large hospitals previously associated with higher mortality rates from sepsis now were safer and became the epicentre of medical care and heralded the birth of the major teaching hospitals (Barr J, Podolsky S. Lancet 2017; 389: 1002–3). So what has changed in preventing surgical site infection (SSI) in 150 years? The National Institute for Health and Care Excellence (NICE) provides evidence-based national guidance and advice to improve health and social care (www.nice.org.uk). It is apt that the NICE guidelines on surgical site infections: prevention and treatment were recently updated in February 2017 (www.nice.org.uk/guidance/cg74). The guidelines cover preventing and treating SSIs in adults, young people and children who are having a surgical procedure involving a cut through the skin, recommending effective methods to use before, during and after surgery to minimize the risk of infection. One of the updates relates to the application of intraoperative topical antiseptics/antimicrobials before wound closure, and there is lack of evidence to justify their use. We are still trying to emulate Lister! The most significant change in the management of SSIs has been the use of prophylactic antibiotics, to which Lister did not have access. One hundred and fifty years ago Lister made us aware of the importance of antisepsis and the germ theory as the aetiology of SSIs. We still follow his principles in the use of antiseptics for skin preparation, not that much different from his carbolic spray. Listerism lives on in the battle to reduce SSIs.

Perioperative warming therapy for preventing surgical site infection in adults undergoing surgery

Perioperative warming therapy for preventing surgical site infection in adults undergoing surgery

Preoperative Staphylococcus aureus Carriage and Risk of Surgical Site Infection After Cardiac Surgery in Children Younger than 1year: A Pilot Cohort Study.

Surgical site infections (SSI) increase length of stay, morbidity, mortality and cost of hospitalization. Staphylococcus aureus (SA) carriage is a known risk factor of SSI in adults, but its role in pediatrics remains uncertain. The main objective of this pilot prospective monocentric cohort study was to describe the prevalence of SA colonization in children under 1year old before cardiac surgery. The secondary objectives were to compare the incidence of SSI and other nosocomial infections (NI) between preoperative carriers and non-carriers. From May 2012 to November 2013, all children <1year old undergoing cardiac surgery under cardiopulmonary bypass underwent preoperative methicillin-resistant (MRSA) and methicillin-sensitive SA (MSSA) screening using real-time PCR. The only exclusion criterion was invalid PCR. All patients were followed up to 1year after the surgery regarding SSI and other nosocomial infections. Among the 68 studied patients, SA colonization prevalence was 26.5%, comprising 23.5% MSSA and 2.9% MRSA. There was no significant difference between colonized and non-colonized children regarding SSI rate (16.7 vs 20%; p=0.53), but ventilator-associated pneumonia rate was significantly higher among the SA carriers (22.2 vs 2%; p<0.05). The colonization rate was different depending on the age of the patients (p<0.05). This pilot study highlights that colonization with MSSA is frequent whereas MRSA prevalence is low in our population. In this cohort, there was no association between SA colonization and SSI incidence but further studies are needed to analyze this association.

The effectiveness of high FiO2 in preventing postoperative surgical site infections in adult patients undergoing abdominal surgery: a systematic review protocol

Review question/objective The overall objective of this review is to examine the effectiveness of high FiO2 in the prevention of postoperative surgical site infections in adult patients undergoing abdominal surgery. What is the effectiveness of a FiO2 of .80 in reducing the incidence of postoperative surgical site infections in adults undergoing abdominal surgery compared to a FiO2 of .40 or less? Inclusion criteria Types of participants This review will consider studies that include adult patients undergoing abdominal surgery. Abdominal surgery will be defined as any type of surgery that includes an incision made in the abdominal region whether open or laparoscopic and including but not limited to appendectomy, cesarean section and colorectal surgeries. Both inpatient and outpatient procedures will be included. Types of intervention(s)/phenomena of interest This review will consider studies that include the use of a higher than normal FiO2 of at least .80 versus a normal FiO2 of .40 or lower. Types of outcomes This review will consider studies that include the following outcome measure: -Incidence of infection within 14 days of abdominal surgery An infection will be defined by having, but not limited to, the following signs and symptoms: fever, purulent drainage, localized pain and a positive culture of the wound.

High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis

There has been recent interest in using high-concentration oxygen to prevent surgical site infections (SSIs). Previous meta-analyses in this area have produced conflicting results. With the publication of 2 new randomized controlled trials (RCTs) that were not included in previous meta-analyses, an updated review is warranted. Our objective was to perform a meta-analysis on RCTs comparing high- and low- concentration oxygen in adults undergoing open abdominal surgery. We completed independent literature reviews using electronic databases, bibliographies and other sources of grey literature to identify relevant studies. We assessed the overall quality of evidence using grade guidelines. Statistical analysis was performed on pooled data from included studies. A priori subgroup analyses were planned to explain statistical and clinical heterogeneity. Overall, 6 studies involving a total of 2585 patients met the inclusion criteria. There was no evidence of a reduction in SSIs with high-concentration oxygen (risk ratio 0.77, 95% confidence interval 0.50-1.19, p = 0.24). We observed substantial heterogeneity among studies. There is moderate evidence that high-concentration oxygen does not reduce SSIs in adults undergoing open abdominal surgery.

Perioperative Glycemic Control Regimens for Preventing Surgical Site Infections in Adults

Perioperative Glycemic Control Regimens for Preventing Surgical Site Infections in Adults

Preventing Surgical Site Infections: Is it just too Sweet?

Dear Editor, We read with interest the article by Diana et al. [1] on measures to prevent surgical site infections (SSI) by surgeons. The survey reported that nutritional screening is being regularly conducted by 50% of surgeons before major surgery. It also found widely differing strategies adopted by surgeons to prevent SSI, with low adherence to the National Institute for Health and Clinical Excellence of the United Kingdom (NICE) guidelines. It is well known that diabetic patients who undergo cardiac surgery have greater perioperative mortality and morbidity, including SSI, compared with nondiabetic patients. For patients in noncardiac surgical specialties, the association between diabetes and morbidity is less clear. In a recent study, we found that in our database of 1,343 surgical patients, those with diabetes had a 1.6 times greater risk of postoperative complications than did patients without diabetes [2]. In addition, the data affirm the relationship between the presence of diabetes and SSI in cardiac surgical patients in the Chinese Asian population [3]. However, it may not be a simple matter of whether the patient has diabetes or not, but good perioperative blood glucose control can be equally important. Numerous studies in cardiac and noncardiac surgical patients have supported tight glucose control in the perioperative period, for example by continuous insulin infusion, to reduce morbidity and SSI. Such measures may also benefit nondiabetic patients undergoing major surgery, as it has been found that the blood glucose levels in this population can rise significantly at induction of anesthesia until the early postoperative period [4]. Clearly, some of these patients may have had undiagnosed glucose intolerance or diabetes in the first instance. Interestingly, a recent Cochrane Systematic Review in 2009 found that there is insufficient evidence to support strict perioperative glycemic control for prevention of SSI in adults [5]. The conclusion was based on five randomized controlled trials that are heterogeneous and cannot be incorporated into a metaanalysis. A review of our own database (and available evidence) has led us to adopt the use of continuous insulin sliding scale for all cardiac and noncardiac patients undergoing major surgery in order to improve perioperative blood glucose control. Apart from nutritional screening, we would also advocate diabetic screening, which may help identify those susceptible to SSI. As suggested by the Cochrane Review, large, well-conducted randomized trials are required to answer the question of whether these measures can truly reduce SSI.

Overground physical therapy gait training for chronic stroke patients with mobility deficits; Promoting and supporting self‐care management for adults living in the community with physical chronic illness: a systematic review of the effectiveness and meaningfulness of the patient‐practitioner encounter; Peri‐operative glycaemic control regimens for preventing surgical site infections in adults; The effects of on‐screen, point of care computer reminders on

Overground physical therapy gait training for chronic stroke patients with mobility deficits; Promoting and supporting self‐care management for adults living in the community with physical chronic illness: a systematic review of the effectiveness and meaningfulness of the patient‐practitioner encounter; Peri‐operative glycaemic control regimens for preventing surgical site infections in adults; The effects of on‐screen, point of care computer reminders on

Peri-operative glycaemic control regimens for preventing surgical site infections in adults

Surgical site infections (SSIs) are associated with significant morbidity, mortality, and resource utilization and are potentially preventable. Peri-operative hyperglycaemia has been associated with increased SSIs and previous recommendations have been to treat glucose levels above 200 mg/dL. However, recent studies have questioned the optimal glycaemic control regimen to prevent SSIs. Whether the benefits of strict or intensive glycaemic control with insulin infusion as compared to conventional management outweigh the risks remains controversial. To summarise the evidence for the impact of glycaemic control in the peri-operative period on the incidence of surgical site infections, hypoglycaemia, level of glycaemic control, all-cause and infection-related mortality, and hospital length of stay and to investigate for differences of effect between different levels of glycaemic control. A search strategy was developed to search the following databases: Cochrane Wounds Group Specialised Register (searched 25 March 2009), The Cochrane Central Register of Controlled Trials, The Cochrane Library 2009, Issue 1; Ovid MEDLINE (1950 to March Week 2 2009); Ovid EMBASE (1980 to 2009 Week 12) and EBSCO CINAHL (1982 to March Week 3 2009). The search was not limited by language or publication status. Randomised controlled trials (RCTs) were eligible for inclusion if they evaluated two (or more) glycaemic control regimens in the peri-operative period (within one week pre-, intra-, and/or post-operative) and reported surgical site infections as an outcome. The standard method for conducting a systematic review in accordance with the Cochrane Wounds Group was used. Two review authors independently reviewed the results from the database searches and identified relevant studies. Two review authors extracted study data and outcomes from each study and reviewed each study for methodological quality. Any disagreement was resolved by discussion or by referral to a third review author. Five RCTs met the pre-specified inclusion criteria for this review. No trials evaluated strict glycaemic control in the immediate pre-operative period or outside the intensive care unit. Due to heterogeneity in patient populations, peri-operative period, glycaemic target, route of insulin administration, and definitions of outcome measures, combination of the results of the five included trials into a meta-analysis was not appropriate. The methodological quality of the trials was variable. In terms of outcomes, only one trial demonstrated a significant reduction in SSIs with strict glycaemic control, but the quality of this trial was difficult to assess as a result of poor reporting; furthermore the baseline rate of SSIs was high (30%). The other trials were either underpowered to detect a difference in SSIs, due to a low baseline rate (less than or equal to 5%), or did not report SSIs as a single outcome but as part of a composite. Of the three trials reporting hypoglycaemia (which was not consistently defined) all had a higher rate in the strict glycaemic control group but none attributed significant morbidity to the hypoglycaemia. Adequacy of glucose control between groups was measured differently among studies. Studies could not be compared due to differences in target ranges, and were susceptible to measurement bias due to differences in frequency of measurement and lack of blinding by the providers following the glycaemic protocols. Infection-related mortality was not reported in any of the trials, and no trials demonstrated a significant difference in all-cause mortality. Length of hospital stay was significantly reduced in the strict glycaemic control groups in only one trial. There is insufficient evidence to support strict glycaemic control versus conventional management (maintenance of glucose < 200 mg/dL) for the prevention of SSIs. No trials were found that evaluated strict glycaemic control in the immediate pre-operative period or outside the setting of an intensive care unit. The trials were limited by small sample size, inconsistencies in the definitions of the outcome measures and methodological quality. Further large randomised trials are required to address this question and may be most appropriately performed in patients at high risk for SSIs.

Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery

Use of single-dose antibiotic prophylaxis is associated with reduced antibiotic resistance, lower costs, and fewer problems with drug toxicity and superinfections. We tested the hypothesis that single doses of cefazolin are as effective as a 24-hour regimen of cefazolin in preventing surgical site infections in adults undergoing cardiac procedures. This random, prospective, clinical study included 838 adult patients undergoing elective coronary artery bypass grafting, valve operations, or both. These patients were randomly given a single dose of cefazolin (2 g) or a 24-hour treatment (2-g initial dose, followed by 1 g every 8 hours). Investigators blinded to the drug regimen diagnosed wound infections according to Centers for Disease Control and Prevention criteria. Patient clinical and demographic characteristics were noted, with follow-up for 12 postoperative months. The primary objective was to compare the incidence of surgical infections between groups up to 12 months postoperatively. A total of 419 patients received single-dose cefazolin, and another 419 received the 24-hour treatment. Surgical site infection occurred in 35 (8.3%) patients receiving single doses and 15 (3.6%) patients administered the 24-hour treatment (P = .004). We identified no differences between groups for mortality or duration of hospitalization (preoperative hospitalization, intensive care unit stay, and hospitalization after surgical intervention). The microorganisms isolated showed a similar distribution in both groups. The germs isolated were gram-positive cocci in 86% of the surgical site infections. Single-dose cefazolin used as antibiotic prophylaxis in cardiac surgery is associated with a higher surgical site infection rate than the 24-hour, multiple-dose cefazolin regimen.