Wound Infection In Surgical Patients Research Articles

RISK FACTORS FOR OPERATIVE WOUND INFECTION IN PATIENTS UNDERGOING PEDIATRIC CARDIAC SURGERY


 Surgical wound infection is a significant complication in patients undergoing pediatric cardiac surgery, which can compromise the postoperative recovery process and increase morbidity. Several risk factors are associated with this condition, including patient characteristics, type of surgical procedure, hospital environment, and postoperative care practices. Understanding these factors is crucial to developing effective prevention strategies and optimizing clinical outcomes in this vulnerable population. Objective: To analyze and synthesize the available evidence on the risk factors for surgical wound infection in patients undergoing pediatric cardiac surgery. The aim is to identify patterns and gaps in the literature, contributing to a more comprehensive understanding of the elements that influence the occurrence of this specific complication. Methodology: The review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify studies published in the last 10 years, using the descriptors "pediatric heart surgery", "operative wound infection", "risk factors", "children" and "prevention ". Three inclusion criteria were established, considering original studies that addressed risk factors in pediatric cardiac surgery, while three exclusion criteria were applied to filter articles that did not meet the specific objectives of the review. Results: Results revealed a variety of risk factors, including patient age, length of surgery, presence of comorbidities, and infection control practices. The review highlighted the importance of specific preventive strategies for the pediatric population undergoing cardiac procedures. Conclusion: This systematic review provides a comprehensive overview of risk factors for surgical wound infection in pediatric cardiac surgery, emphasizing the need for personalized prevention approaches. The conclusions highlight the importance of targeting preventive interventions, adapting them to the unique characteristics of this population, aiming to improve clinical results and reduce the incidence of postoperative infections.

Effects of thoracoscopic lobectomy on surgical wound infection in patients with lung cancer: A meta‐analysis

AbstractThis meta‐analysis systematically evaluates the impact of thoracoscopic lobectomy on wound infection and complications in lung cancer patients. An extensive computerized search was conducted using PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for studies comparing thoracoscopic lobectomy with open thoracotomy in the treatment of lung cancer, covering the period up to September 2023. Two researchers independently screened the literature, extracted data and assessed the quality according to predefined inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. Ultimately, 21 studies involving 2118 lung cancer surgery patients were included. The analysis revealed that thoracoscopic lobectomy significantly reduced the incidence of wound infections (odds ratio [OR] = 0.22, 95% confidence interval [CI]: 0.13–0.37, p < 0.001) and complications (OR = 0.27, 95% CI: 0.21–0.36, p < 0.001) in lung cancer surgery patients, and also significantly shortened hospital stays (standardized mean difference = −2.07, 95% CI: −2.39 to −1.76, p < 0.001). This study indicates that compared with conventional open thoracotomy, thoracoscopic lobectomy in the treatment of lung cancer reduces the incidence of wound infections and complications and shortens hospital stays, demonstrating significant therapeutic efficacy and warranting broader clinical application.

Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta-analysis.

The goal of this systematic review and meta-analysis is to provide an overview of the prevalence of surgical wound infection and related factors in patients after long bone surgery. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Prevalence", "Surgical wound infection", "Surgical site infection" and "Orthopedics" from the earliest to the May 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 71 854 patients undergoing long bone surgery participated in 12 studies. The pooled prevalence of surgical wound infection in patients who underwent long bone surgery reported in the 12 studies was 3.3% (95% CI: 1.5%-7.2%; I2 = 99.39%; p < 0.001). The pooled prevalence of surgical wound infection in male and female patients who underwent long bone surgery was 4.6% (95% CI: 1.7%-11.7%; p < 0.001; I2 = 99.34%) and 2.6% (95% CI: 1.0%-6.3%; I2 = 98.84%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with femur surgery sites reported in nine studies was 3.7% (95% CI: 2.1-6.4%; I2 = 93.43%; p < 0.001). The pooled prevalence of surgical wound infection in open and close fractures was 16.4% (95% CI: 8.2%-30.2%; I2 = 95.83%; p < 0.001) and 2.9% (95% CI: 1.5%-5.5%; I2 = 96.40%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD) was 4.6% (95% CI: 2.3%-8.9%; I2 = 81.50%; p < 0.001), 2.7% (95% CI: 1.2%-6.0%; I2 = 83.82%; p < 0.001) and 3.0% (95% CI: 1.4%-6.4%; I2 = 69.12%; p = 0.006), respectively. In general, the different prevalence of surgical wound infection in patients undergoing surgical treatment after long bone fracture may be caused by underlying factors (gender and co-morbidity) and fracture-related factors (surgery site and type of fracture).

Prevalence of Wound Infection in Patients Undergoing Elective or Emergency Abdominal Surgery

Objective: To compare the surgical wound infection in patients undergoing elective or emergency abdominal surgeries. Study Design: Comparative study Place &amp; Duration of Study: Study was conducted at surgery department of Divisional Headquarter Teaching hospital Mirpur Azad Kashmir for eighteen months duration from June 2019 to November 2020. Materials and Methods: 150 patients of both genders with ages 15 to 65 years who received laparotomy treatment due to intra-abdominal infection or complicated appendicitis were included in this study. Patient’s medical history, age, sex and residency were recorded after taking informed consent. All the patients were divided into two groups, Group A contained 75 patients (Elective) and Group B contains 75 patients (emergency) received laparotomy. Deep surgical wound infection was examined at the 7th day after surgery and compared between both groups. Results: Ninety eight (65.3%) patients 49 in each group were males and 52 (34.7%) patients 26 in each group were females. In Group A and B 27 and 29 patients were ages 15 to 30 years, 33 and 31 patients had ages 36 to 45 years, 15 and 15 patients were ages between 46 to 60 years. 10 (13.3%) patients in Group A and 12 (16%) patients in group B had deep surgical infection within 1 week after surgery. Statistically there is no significant difference between the both groups (p&gt;0.356) Conclusion: It is concluded that the frequency of wound infection was high in emergency abdominal surgeries as compared to patients undergoing elective surgery, but the difference was not statistically significant. Keywords: Emergency laparotomy, Deep surgical site infection, PO Drain placement

Perioperative Allogeneic Red Blood Cell Transfusion and Wound Infections: An Observational Study.

It remains unclear whether the benefits of performing perioperative allogeneic red blood cell (RBC) transfusion outweigh the risks of postoperative wound infection. The aim of this study was to assess the impact of perioperative RBC transfusion as well as dose-response relationship on wound infections in surgical patients in a large cohort. As a retrospective observational study, the national Hospital Quality Monitoring System database was used to retrieve information about in-hospital surgical patients without limitations on surgical types in the People's Republic of China between 2013 and 2018. Patients were divided into the perioperative RBC transfusion and non-RBC transfusion groups, and wound infection rates (the primary end point) were compared. Secondary end points included in-hospital mortality, nosocomial infections, and length of hospital stay. Furthermore, patients who underwent RBC transfusion were subdivided into 6 groups based on the volume of transfused RBCs to investigate the dose-response relationship between RBC transfusions and wound infections. The association between RBC transfusion and patient outcomes were analyzed using multivariable logistic regression models adjusted for potential confounders. A total of 1,896,584 patients from 29 provinces were included, among whom 76,078 (4.0%) underwent RBC transfusions; the overall wound infection rate was 0.7%. After adjusting for confounding factors, perioperative RBC transfusion was associated with higher odds of wound infection (odds ratio [OR] = 2.24, 95% confidence interval [CI], 2.09-2.40; P < .001). As the volume of transfused RBCs increased, so did the odds of wound infection with a clear dose-response relationship (OR of >0 and ≤1 U, >1 and ≤2 U, >2 and ≤4 U, >4 and ≤8 U, >8 U transfusion compared with no RBC transfusion were 1.20, 95% CI, 0.76-1.91; 1.27, 95% CI, 1.10-1.47; 1.70, 95% CI, 1.49-1.93; 2.12, 95% CI, 1.83-2.45 and 3.65, 95% CI, 3.13-4.25, respectively). RBC transfusion was also found to be associated with higher odds of in-hospital mortality, nosocomial infection, and longer hospital stay. RBC transfusion was associated with an increased odd of postoperative wound infection in surgical patients, and a significant dose-related relationship was also observed. While there are still essential confounders not adjusted for and the results do not necessarily indicate a causal relationship, we still recommend to lessen perioperative blood loss and optimize blood conservation strategies.

Predictive model preparation for surgical wound infection in adult patients undergoing total hip arthroplasty in high complexity hospital for years 2012 and 2014

Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

Nomogram model of predicting postoperative surgical wound infection in patients with abdominal surgery

Objective To explore the risk factors for abdominal surgical wound infection, and to establish a nomogram model for the prediction of the risk factors. Methods A total of 2 931 patients underwent abdominal surgery were enrolled in this study from June 2014 to June 2017. The clinical data were collected. The univariate and multivariate logistic regression were used to analyse the risk factors for abdominal surgical wound infection. A predictive nomogram model was established using the R software. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the abdominal surgical wound infection. Results Of 2 931 enrolled patients, 84 of them had surgical wound infection and the infection rate was 2.87%. A total of 84 pathogens were detected, which approximately 59.52% of them were gram-negative bacteria. The multivariable logistic regression showed that age, malnutrition, diabetes mellitus, emergency operation, and unsuccessful rehabilitation education were independent risk factors for abdominal surgical wound infection (OR=4.196, 2.559, 2.949, 3.326, 1.198; P<0.05) . The nomogram model showed a C-index of 0.726 with good discrimination and accuracy. The ROC curve showed that the area under the curve (AUC) for the nomogram model was 0.735 (95%CI: 0.672-0.827) . Conclusions The established nomogram model has good discrimination and accuracy for predicting abdominal surgical wound infection. It is helpful for distinguishing high-risk populations and improving intervention strategies in clinical practice. Key words: Abdomen; Surgery; Surgical wound infection; Nomogram

Perioperative synbiotics administration decreases postoperative infections in patients with colorectal cancer: a randomized, double-blind clinical trial.

to evaluate the effect of perioperative administration of symbiotics on the incidence of surgical wound infection in patients undergoing surgery for colorectal cancer. We conducted a randomized clinical trial with colorectal cancer patients undergoing elective surgery, randomly assigned to receive symbiotics or placebo for five days prior to the surgical procedure and for 14 days after surgery. We studied 91 patients, 49 in the symbiotics group (Lactobacillus acidophilus 108 to 109 CFU, Lactobacillus rhamnosus 108 to 109 CFU, Lactobacillus casei 108 to 109 CFU, Bifi dobacterium 108 to 109 CFU and fructo-oligosaccharide (FOS) 6g) and 42 in the placebo group. surgical site infection occurred in one (2%) patient in the symbiotics group and in nine (21.4%) patients in the control group (p=0.002). There were three cases of intraabdominal abscess and four cases of pneumonia in the control group, whereas we observed no infections in patients receiving symbiotics (p=0.001). the perioperative administration of symbiotics significantly reduced postoperative infection rates in patients with colorectal cancer. Additional studies are needed to confirm the role of symbiotics in the surgical treatment of colorectal cancer.

Surgical wound infection in urology. Analysis of risk factors and associated microorganisms

ObjectivesOpen surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyze surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. Material and methodsThis was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analyzed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. ResultsFor genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam.In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E. coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus was resistant to ampicillin in 37.5%, and Extended-Spectrum Betalactamase-producing E. coli were isolated in 41.7%. ConclusionsWe found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E. coli are the most common pathogens, with high rates of resistance.

Infección de herida quirúrgica en urología. Análisis de factores de riesgo y microorganismos asociados

ObjectivesOpen surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. Material and methodsThis was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. ResultsFor genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam.In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. ConclusionsWe found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance.

Perioperative immunonutrition in normo-nourished patients undergoing laparoscopic colorectal resection.

To determine whether the joint implementation of immunonutrition and a laparoscopic approach improves morbidity, mortality, and length of stay (LOS) compared with dietary advice. Despite progress in recent years in the surgical management of patients with colorectal cancer, postoperative complications are frequent. Nutritional supplements enriched with immunonutrients have recently been introduced into clinical practice. However, the immunonutrition benefits in patients undergoing colorectal laparoscopic surgery are unknown. This study was a prospective, randomized trial with two parallel treatment groups receiving an immune-enhancing dietary supplement for 7days before colorectal resection and 5days postoperatively or dietary advice. A total of 128 patients were randomized. At baseline, both groups were comparable with respect to age, sex, surgical risk, comorbidities, and analytical and nutritional parameters. The median postoperative LOS was 5days and was not significantly different between the groups. Wound infection differed significantly between the groups (11.50 vs. 0.00%,p=0.006). No other differences between the groups were identified. The joint use of laparoscopy and supplementation with immunonutrients reduces surgical wound infection in patients undergoing colorectal surgery. This study is registered with ClinicalTrial.gov : NCT0239396.

Antimicrobial prophylaxis for colorectal surgery.

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

Single versus multiple doses of antibiotic prophylaxis in limb fracture surgery

There is no consensus with regard to optimum prophylactic antibiotic regimen in orthopaedic fracture surgery. A systematic review and meta-analysis were performed to determine if multiple-dose perioperative antibiotic prophylaxis is more effective than a single preoperative dose in the prevention of surgical wound infection in patients undergoing operative treatment of low-energy closed fractures. Medline, Medline in Process and other non-indexed citations, Embase, Cochrane database of systematic reviews and conference proceedings were searched. Studies were included if they were randomized or quasi-randomized trials comparing the results of a single antibiotic prophylaxis versus multiple doses of the same antibiotic in patients undergoing surgical fixation of closed fractures. Four studies were found to meet the searching criteria. The mean score for quality assessment of these studies was 16 (8-24 points). Only two out of four studies had detailed analysable data and therefore were included in the final analysis. 921 patients were pooled using a random-effects model. Compared to multiple-dose prophylaxis, administration of a single preoperative dose demonstrated no significant difference regarding the overall surgical site infection rate (risk ratio (RR) = 0.3, 95% confidence interval (CI): 0.07-1.25). Multiple-dose antibiotic prophylaxis is marginally more effective than single dose in reducing the incidence of deep surgical wound infection (risk ratio: 0.13, 95% CI: 0.02 to 0.99). There is lack of definite evidence that multiple-dose antibiotic prophylaxis is superior to single preoperative dose in low-energy closed fracture surgery.

Antimicrobial prophylaxis for colorectal surgery

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

Surgical site infection in elderly patients

Background The surgical site infection (SSI) is an unforeseen event that complicates patient post-operative care with a negative impact on results and may cause further surgery which could lead to the patient’s death [1]. Furthermore, the bacteriological analysis of the surgical wound could be a predictive method of the surgical site infection after elective abdominal surgery [2,3]. Moreover postoperative infections lead to a growth of hospital costs, home medical care, social and psychological. Starting from this background it is clear how SSI control has a professional, ethical and economic value. Antibiotic prophylaxis is useful in preventing wound infection and limiting the negative effects of infection on the patient. The aim of this study is to evaluate the role of age and antibiotic prophylaxis in the incidence of surgical wound infection in patients undergoing elective abdominal surgery. Microbiological analysis of wound, surgical treatment, hospital and anesthesiological risk were evaluated.

Factors Associated with Surgical Wound Infection in Patients for Elective Clean Surgery at the “Rafael Ángel Calderón Guardia” Hospital, Costa Rica

Aim: Hospital surgical wound infection (SWI) is one of the three most frequent causes of nosocomial infection worldwide, leading to high social and medical costs. This study aims to identify and quantify risk factors for SWI in a Costa Rican hospital. Methods: A cohort study of 488 elective patients operated between April and June 2006. The patients were divided in 2 groups: those in which operating room traffic was restricted, group A, and those in which it was not, group B. The statistical analysis was performed in 2 major phases: descriptive and analytical. In the first one, frequency measures (absolute and relative) were calculated; and the second one was carried out in 2 stages; both of them through unconditional logistic regression, univariate and multivariate analysis. Results: An overall incidence of 35.2 % (172/488) of SWI was found. The cumulative incidence in the unexposed was 31.8% (76/239), while in those exposed, it was 38.6% (96/249) (p=0.12). Only organ and bone/joint surgery presented a higher risk of SWI (OR 2.42; 95% CI:1.5-3.8), surgeries in unrestricted traffic rooms and diabetes had no association with the infection. Conclusion: Diabetes and depth of surgery should be taken into account in the profile of patients with increased risk of suffering SWI; furthermore, even though there was no epidemiological association between restricted operating room traffic and not restricted, and SWI, although the difference in incidence of SWI, was not statistically significant, it is advisable to restrict the transit of persons in operating rooms, according to international standards.

Risk Factors for Surgical Wound Infection in HIV-Positive Patients Undergoing Surgery for Orthopaedic Trauma

To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. The median follow-up period was 27 (range, 19-41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of more than or equal to 2 (p=0.041), and contaminated wounds (p=0.003). Identification of risk factors may help minimise morbidity in HIV-positive patients.

Guidelines for the treatment of venous ulcers

1. Co-chaired this panel2. University of South Florida, Tampa, FL3. Healthpoint Ltd., Fort Worth, TX4. University of California, San Francisco, CA5. University of Texas Medical Branch, Galveston, TX6. University of Cardiff, Cardiff, Wales, UK7. University of Pennsylvania, Philadelphia, PA8. Private practice, Warren, PA9. Private practice, Tamarac, FL10. University of Pittsburgh, Pittsburgh, PA11. St. Louis University, St. Louis, MO, and12. Washington University, St. Louis, MO

Wound tissue oxygen tension predicts the risk of wound infection in surgical patients

Wound tissue oxygen tension predicts the risk of wound infection in surgical patients