Surgical Wound Infection Rates Research Articles

PLGA-Collagen Composite Synthesis with the Antibacterial Addition of <i>Jatropha</i> <i>curcas </i>L. Leaf Extract as Absorbable Surgical Suture Candidate

The prevalence rate of surgical wound infections caused by bacteria is an average of 9% of the 1.4 million patients worldwide. For this reason, a modification of an absorbable surgical suture coated with extract of Jatropha curcas L. leaves to kill and inhibit the growth of microorganisms needs to be made. The forming of multifilament fibers is done by electrospinning method. The test results of the functional groups showed the presence of interaction between PLGA-Collagen with the extract of Jatropha Curcas L. leaves indicated by an absorption band at 2924 cm-1 which showed the vibrations of C-H. The tensile test results showed that all samples were in the range of 19.5-87.1 MPa values which corresponded with the modulus of elasticity of the suture thread in the forehead and elbows. The MTT Assay results showed that the percentage of living cells of all samples was above 50%. The bacterial activity test showed that the inhibition zone were in the range of 5-10 mm. The optimal sample showed the degradation rate of 82.2% on the 60th day of the soaking period. It can be concluded that PLGA-collagen Jatropha curcas L. extracts is safe composite and has potential as antibacterial absorbable surgical sutures.

Rate of Wound Infection of Non-traumatic Emergency Laparotomy at a Teaching Hospital in Bangladesh: Experience of 100 cases

Background: Wound infection is an important issue for surgical operations. Objective: The purpose of the present study was to measure the rate of wound infection of non-traumatic emergency laparotomy cases.Methodology: This descriptive cohort study was carried out in the Department of Surgery at Dhaka Medical College, Dhaka from July 1997 to June 1998 for a period of 1(one) year. Pre-operative patients were carefully assessed for any host factors related to wound infection. Different per-operative factors that influence the rate of postoperative wound infection were also analyzed. Swabs were taken from the suspected postoperative wound and sent for bacteriological examination. Result: In this series, 100 cases of emergency laparotomies (non-traumatic) were analyzed. Bacteriological examination showed positive culture in most of the cases but three were found to be negative result. Wound infection rate of specific type of operation were 12.5%, 20.0%, 6.6%, 40.0%, 40.0%, 33.3%, 50.0%, 50.0%, and 100.0% in duodenal ulcer perforation, pre-pyloric and gastric ulcer perforation, acute appendicitis, burst appendix, ileal perforation, small intestinal obstruction due to bands and adhesions, volvulus of sigmoid colon, obstructed inguinal hernia, generalized peritonitis due to puerperal sepsis respectively. The overall surgical wound infection rate was 19.0%. Conclusion: The rate of wound infection of non-traumatic emergency laparotomy cases are frequently found in a well-established tertiary care teaching hospital. Bangladesh J Infect Dis 2015;2(1):9-12

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.

EFFECT OF CHECKLIST ON THE OCCURRENCE OF POSTOPERATIVE COMPLICATION ON SURGICAL PATIENT

Background: Surgical safety checklists (SSCs) are designed to improve inter professional communications and ultimately avoiding catastrophic errors that often characterizes the culture of surgical teams. However, data on effect of surgical checklists implementation are scarce in the study area. The purpose of this research project was to directly examine the effect of utilization surgical safety checklist on patient outcomes at University of Gondar Hospital, in Northwest Ethiopia. Material and methods: Institution based cross sectional study was done at Gondar university teaching hospitals from January to May 2013. We reviewed medical records of all consecutive patients admitted to the surgery department (N=403). For those who have clinical symptoms of surgical site infection a laboratory diagnosis were performed to compare occurrences of all postoperative complication among patients with and without utilization of surgical safety checklist. Results: During the study period from 403 patients operated, SSCs were attached for only 158 (39.2%) of the surgical patients. Post-operative complication were observed in 238 (59 %) of the patients and postoperative fever was the major complication accounting for 70 (17.3%) of all the complication. Surgical wound infection and pneumonia accounted for 47(16.6%) and 33(11.7%) respectively. S. aurous was the predominant isolated bacteria accounted for 7(30%), In addition, a statistically non-significant 11.2% decline the rate of surgical wound infection in the checklist group. In a logistic regression model of postoperative fever, the SSCs emerged as a significant independent predictor of this outcome: (OR = 0.49, 95% CI 0.31–0.75, and P value = 0.001). Conclusions and recommendation: patients with checklist have observed significant reductions of post operative complication particularly bacterial infection. It is possible to some extent that the improved usage of check list and preoperative prophylactic antibiotics may be implicated in the reduction of postoperative fever and bacterial infection.

‘Epidemiology of surgical site infection in a neurosurgery department’

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

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.

Postoperative Showering for Clean and Clean-contaminated Wounds: A Prospective, Randomized Controlled Trial.

To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery. Showering after surgery is a controversial issue for wound care providers and patients. We investigated the benefits and detriments of showering for postoperative wound care. Patients undergoing thyroid, lung, inguinal hernia, and face and extremity surgeries with clean or clean-contaminated wounds were included. The patients were randomized to allow showering (shower group) or to keep the wound dry (nonshower group) for postoperative wound care starting 48 hours after surgery. The primary endpoint was the rate of surgical wound infection. The secondary endpoints included the wound pain score, satisfaction with wound care, and cost of wound care. Between May 2013 and March 2014, there were 222 patients randomized to the shower group and 222 to the nonshower group. Two patients in each group were lost to follow-up. There were 4 superficial surgical site infections in the shower group and 6 in the nonshower group (4/220, 1.8% vs 6/220, 2.7%, P = 0.751). Postoperative pain scores were comparable between the 2 groups. Patients in the shower group were more satisfied with their method of wound care, and their wound care costs were lower when compared with the nonshower group. Clean and clean-contaminated wounds can be safely showered 48 hours after surgery. Postoperative showering does not increase the risk of surgical site complications. It may increase patients' satisfaction and lower the cost of wound care.

Disposable surgical face masks for preventing surgical wound infection in clean surgery.

Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. To determine whether the wearing of disposable surgical face masks by the surgical team during clean surgery reduces postoperative surgical wound infection. In December 2015, for this seventh update, we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched the bibliographies of all retrieved and relevant publications. There were no restrictions with respect to language, date of publication or study setting. Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing the use of disposable surgical masks with the use of no mask. Two review authors extracted data independently. We included three trials, involving a total of 2106 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. We identified no new trials for this latest update. From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

Pharyngocutaneous fistula: the incidence and the risk factors.

A pharyngocutaneous fistula is the most common complication following laryngectomy. A wide range of potential risk factors has been suggested. The purpose of this study was to determine the incidence and risk factors for the fistula at the Department of Otorhinolaryngology and Head and Neck Surgery in Ljubljana, Slovenia between 2007 and 2012. Charts from patients treated for head and neck cancer by laryngectomy were retrospectively reviewed. Comprehensive clinicopathologic data were collected including potential risk factors related to the patient, disease, surgery and postoperative period. The patients were categorised into the group with the fistula (a study group) and without it (a control group). The incidence of the fistula was calculated and the groups were statistically compared according to potential risk factors using the Chi square test, Fisher exact test, T test, Mann-Whitney U test and binary logistic regression analysis. Hundred fifty-eight patients were included. The incidence of the fistula was 30.4%. In the primary laryngectomy group the incidence was 22.6%, whereas in the salvage laryngectomy group 44.6% (p=0.006). The independent predictors for the fistula were history of head and neck cancer (p=0.001), invasion of piriform sinus (p=0.020) and surgical wound infection (p<0.001). The timing of surgical wound infection could be of some importance. In the PCF group, it started on the 5th postoperative day, whereas in the control group on the 7th postoperative day (p=0.063). Decreasing the rate of surgical wound infection could diminish the fistula rate.

A Study to Assess the Incidence of Post-Operative Complications among the Patients Undergone Abdominal Surgery in Dr. D. Y. Patil Medical Hospital Pimpri

Background - The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (stomach, kidney, liver, etc.) Diseases affecting the abdominal cavity are dealt with generally under their own names (e.g. appendicitis). Surgery is a stressful, complex event. Today as a result of advances in surgical techniques and instrumentation as well as in anesthesia, many surgical procedures that were once performed in an inpatient setting now takes place in an ambulatory or outpatient setting. Approximately 60% of elective surgeries are now performed in an ambulatory or outpatient setting. A study was conducted in Rajarajeshwari medical college hospital Bangalore This study aimed to determine the incidence of surgical site infection (SSI) in the abdominal surgeries and to identify risk factors associated with the development of SSI .All surgeries (1000 cases) where abdominal wall was opened were considered for the study. It was seen that overall surgical wound infection rate was 13.7%. The infection rate was more with emergency surgery (25.2%) when compared to elective surgery (7.6%). The surgical site infection rate increased as the risk index score increased from 0 to 3. SSI was more with early operative and post operative prophylaxis1 Aims and Objectives - To assess the incidence of post - operative complications among the patients undergone abdominal surgery. To correlate complications with demographic variable. Material and Methods : Data was collected from 100 patients with questionnaire and observation checklist to evaluate the post operative complications. Assessment done from 0day, 3day, 7day and follow up to observe post operative complications. Result: None of them had any post-operative DVT complication till day 7. On follow up, 14% of them had unilateral pitting edema. On day 0, 4% of them had adventitious breath sounds then it came down to 1% on day7 and remained same for follow up. On day 0, 8% of them had Sputum production, 2% of them, had Sputum production in follow up visit. 1% of them had abnormal respiratory rate on day3. 1% of them needed breathing efforts on day 0 and follow up visit. 1% of them had abnormal o2 saturation on day 0. 26% of them had swelling at the site of incision on day0, 14% of them had it on day3, and 4% on day7. 1% of them had necrotic tissue at wound on day 3 and day 7. 3% of them had Exudates / Discharge from wound on day 3 and 5% of them had it on day7. 6% of them had abnormal skin color surrounding the wound on day 0, 1% on day of follow up.2% of them had Gaping in wound on day 3. 39% of them had Elevated body Temperature on day 0, 2% of them had Elevated body Temperature on day 7. 4% of them had Pain at the incision site on follow up day. Conclusion: It can concluded that, none of them were any post-operative DVT complications till 7th day, in follow up visit, 17% of them had mild signs of DVT complications. Mild signs of respiratory complications, mild signs of wound complications selected, none of the patient were signs of complications of incisional hernia till day 7. In follow up visit, 4% of them were mild signs of complications of incisional hernia. Selected post operative complications among the patients following abdominal surgery.

Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study.

Antibiotic prophylaxis is commonly used in head and neck oncologic surgery, due to the clean-contaminated nature of these procedures. There is a wide variety in the use of prophylactic antibiotics regarding the duration of application and the choice of agent. The purpose of this study was to determine whether short-term or long-term antibiotic prophylaxis has an impact on the development of head and neck surgical wound infection (SWI). Retrospective chart review was carried out in 418 clean-contaminated head and neck surgical oncology cases at our department. More than 50 variables including tumour type and stage, type of surgical treatment, co-morbidities, duration and choice of antibiotic prophylaxis, and the incidence of SWI were analysed. Following descriptive data analysis, Chi square test by Pearson and Fisher's exact test were used for statistical evaluation. Fifty-eight of the 418 patients (13.9%) developed SWI. Patients with advanced disease and tracheotomy showed a significantly higher rate of SWI than those with early stage disease and without tracheotomy (p=0.012 and p=0.00017, respectively). However, there was no significant difference between the SWI rates in the short term and long term treatment groups (14.6 and 13.2%, respectively; p=0.689). Diabetes and body weight were not found to be risk factors for SWI. Long-term antibiotic prophylaxis was not associated with a decrease in SWI in the entire cohort of patients undergoing clean-contaminated major head and neck oncologic surgery. Our data confirmed the extent of surgery and tracheotomy as being risk factors for postoperative SWI.

Expandable proximal femoral nail versus gamma proximal femoral nail for the treatment of AO/OTA 31A1-3 fractures

IntroductionThe gamma-proximal femoral nail (GPFN) and the expandable proximal femoral nail (EPFN) are two commonly used intramedullary devices for the treatment of AO 31A1-3 proximal femur fractures. The aim of this study was to compare outcomes and complication rates in patients treated by both devices. Patients and methodsA total of 299 patients (149 in the GPFN group and 150 in the EPFN group, average age 83.6 years) were treated for AO 31A1-3 proximal femur fractures in our institution between July 2008 and February 2013. Time from presentation to surgery, level of experience of the surgeon, operative time, amount of blood loss and number of blood transfusions were recorded. Postoperative radiological variables, including peg/screw location, tip to apex distance and orthopaedic complications, as, malunion, nonunion, surgical wound infection rates, cutouts, periprosthetic fractures and the incidence of non-orthopaedic complications. Functional results were estimated using the modified Harris Hip Score, and quality of life was queried by the SF-36 questionnaire. ResultsThe GPFN and the EPFN fixation methods were similar in terms of functional outcomes, complication rates and quality of life assessments. More patients (107 vs. 73) from the GPFN group were operated within 48h from presentation (44.8h vs. 49.9h for the EPFN group, p=0.351), and their surgery duration and hospitalisation were significantly longer (18.5 days vs. 26 days, respectively, p<0.001). The GPFN patients were frequently operated by junior surgeons: 90% (135) while 50.6% (76) of the EPFN operations were performed by senior doctors. Other intraoperative measures were similar between groups. Cutout was the most common complication affecting 6.7% of the GPFN group and 3.3% of the EPFN group (p=0.182). ConclusionsGood clinical outcomes and low complication rates in the GPFN and the EPFN groups indicate essentially equivalent safety and reliability on the part of both devices for the treatment of proximal femoral fractures.

Stapling Versus Hand Suture for Gastroenteric Anastomosis in Roux-en-Y Gastric Bypass: a Randomized Clinical Trial.

Different anastomotic techniques have been evaluated during a laparoscopic Roux-en-Y gastric bypass (RYGB); however, no techniques have proven to be better than any other regarding complications and the percentage of weight loss (excess weight loss (%EWL)), and there are few controlled prospective studies to compare them. A randomized, prospective study was conducted in 238 patients undergoing RYGB for morbid obesity between July 2008 and September 2012 to compare the early and late postoperative complications between the two surgical techniques: gastrojejunal hand-sutured anastomosis (HSA) and circular-stapled anastomosis (CSA). Minimum follow-up was 24 months. The two groups of patients were similar for demographic data and preoperative comorbidities. There were no significant differences between the surgical techniques regarding %EWL at 3, 12, and 24 months. The patients with CSA had a greater frequency of postoperative gastrointestinal bleeding (GIB) (4.2 vs. 0%, p = 0.024) and surgical wound infection (11.1 vs. 3.4%, p = 0.025) than the patients with HSA, with no significant differences in the other early complications. There were no significant differences in either group for late complications (gastrojejunal anastomosis (GJA) stricture, marginal ulcer, GJA perforation, bowel obstruction, and eventration). No significant differences were observed in operative time, rate of reoperation and postoperative length of hospital stay. HSA and CSA were techniques with similar safety and effectiveness in our study. HSA had a lower rate of bleeding complications and surgical wound infection, although it does require greater experience in laparoscopic hand suturing.

Epidemiological Characteristics of Surgical Wound-Infections in Cancer Patients from Jalisciense Institute of Cancerology. México

Background: The surgical wound infections (SWI) are common in hospitals, depending on the type of surgery and the presence of risk factors, cancer patients have a higher prevalence of infection, (immune-compromised state in which it is located). A low rate of infection is one parameter to measure the quality of surgical services. The aim of the present work was to determine the epidemiological characteristics of SWI in cancer patients in the Jaliscience institute of cancerology. Original Research Article Velazquez-Brizuela et al.; BJMMR, 9(3): 1-7, 2015; Article no.BJMMR.17550 2 Study Design: A descriptive, retrospective study. Methodology: 46 patients were studied with SWI. Centers of disease control and prevention criteria for surgical wound infection were considered. Information was obtained from the Jaliscience Institute of Cancerology epidemiological department, using the hospital network for epidemiological surveillance (HNES) format record s, included microbiological results and clinical data. The statistical analysis were performed with the SPSS-20 program. Results: There were 2637 major surgeries from April 2008 thru December 2010. 46 had SWI. Frequency of service per 100 infected surgeries was: Gastroenterology 58.6%, Gynecology 32.6%, Urology 4.4, Head and Neck 2.2% and Traumatology 2.2%. Incidence by gender: men (1.1), women (0.83), with no significant difference. Average age of 51 years. The surgical-wound infected (SWI) were detected between 7.4±4.2 days. Average days stay 19 days. The results of microbiology cultures exhibited: Escherichia coli 53.3%, Pseudomonas aeruginosa 11.9%, Morganella morganii 4.8%, Enterococcus faecium 11.9%, Enterococcus faecalis 23.8%, Staphylococcus-coagulase-negative 7.1%, Streptococcus s-hemolytic 4.8%. Conclusion: Surgical wound infection rates were similar to that reported in other countries and below the rates reported in oncology hospitals in Mexico. It is important to note that a proper preventive approach and epidemiological surveillance are critical to avoid mortality of patients.

Removal of nail polish and finger rings to prevent surgical infection.

Surgical wound infections may be caused by the transfer of bacteria from the hands of surgical teams to patients during operations. Surgical scrubbing prior to surgery reduces the number of bacteria on the skin, but wearing rings and nail polish on the fingers may reduce the efficacy of scrubbing, as bacteria may remain in microscopic imperfections of nail polish and on the skin beneath rings. To assess the effect of the presence or absence of rings and nail polish on the hands of the surgical scrub team on postoperative wound infection rates. For this fifth update, we searched The Cochrane Wounds Group Specialised Register (searched 23 July 2014); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. Randomised controlled trials (RCTs) evaluating the effect of wearing or removing finger rings and nail polish on the efficacy of the surgical scrub and postoperative wound infection rate. All abstracts were checked against a checklist to determine whether they fulfilled the inclusion criteria. Full reports of relevant studies were obtained. Excluded trial reports were checked by all review authors to ensure appropriate exclusion. We identified: no new trials; no RCTs that compared wearing of rings with the removal of rings; and no trials of nail polish versus no nail polish that measured surgical infection rates. We found one small RCT (102 scrub nurses) that evaluated the effect of nail polish on the number of bacterial colony forming units left on hands after pre-operative surgical scrubbing. Nurses had either unpolished nails, freshly-applied nail polish (less than two days old), or old nail polish (more than four days old). There were no significant differences in the number of bacteria on hands between the groups before and after surgical scrubbing. No trials have investigated whether wearing nail polish or finger rings affects the rate of surgical wound infection. There is insufficient evidence to determine whether wearing nail polish affects the number of bacteria on the skin post-scrub.

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.

Surgical wound infection rates in Spain: Data summary, January 1997 through June 2012

The Indicadores Clínicos de Mejora Continua de la Calidad (INCLIMECC) program was established in Spain in 1997. INCLIMECC is a prospective system of health care-associated infection (HAI) surveillance that collects incidence data in surgical and intensive care unit patients. The protocol is based on the National Healthcare Safety Network (NHSN) surveillance system, formerly known as the National Nosocomial Infection Surveillance (NNIS) system, and uses standard infection definitions from the US Centers for Disease Control and Prevention. Each hospital takes part voluntarily and selects the units and surgical procedures to be surveyed. This report is a summary of the data collected between January 1997 and June 2012. A total of 370,015 patients were included, and the overall incidence of surgical wound infection (SWI) was 4.51%. SWI rates are provided by NHSN operating procedure category and NNIS risk index category. More than 27% of the patients received inadequate antibiotic prophylaxis, the main reason being unsuitable duration (57.05% of cases). Today, the INCLIMECC network includes 64 Spanish hospitals. We believe that an HAI surveillance system with trained personnel external to the surveyed unit is a key component not only in infection control and prevention, but also in a quality improvement system.

Renal transplantation: better fat than thin

BackgroundObesity has been a relative contraindication for renal transplantation. This study evaluates the impact of pretransplant body mass index (BMI) on renal transplant outcomes in a single institution in the era of modern immunosuppression. Materials and methodsA 10-y retrospective analysis was undertaken of 454 consecutive patients who received a renal transplant at Westmead Hospital from January 1, 2001 to December 31, 2010. The role of pretransplant BMI on patient survival, graft survival, surgical complications, and postoperative complications was studied. ResultsThe mean age of transplant of this study population was 45.4 ± 13.0 y. Live donation rate was 53.5%, and 60.6% were male. The median preoperative BMI was 25.6 (range, 14.3–51.4). One-year and 5-y patient survival were 97.4% and 86.6%, respectively, whereas 1-y and 5-y death-censored graft survival were 97.1% and 91.9%, respectively. Patients with BMI >30 did not exhibit any significant difference in survival or graft failure but had higher surgical wound infection rates (hazard ratio 3.95, P < 0.01). Patients with preoperative BMI <18.5 were associated with a six-fold increase in both death and death-censored graft failure (P < 0.01). ConclusionsPretransplant obesity increases wound infection but is not a contraindication to renal transplantation. Future prospective studies are required to further define the impact of low preoperative BMI <18.5.

Operating theatre quality and prevention of surgical site infections.

Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff Many international scientific societies have produced guidelines regarding the environmental features of operating theatres (positive pressure, exchanges of filtered air per hour, air-conditioning systems with HEPA filters, etc.) and issued recommendations on healthcare-associated infection, including SSI, concerning surveillance methods, intervention to actively prevent SSI and approaches to monitoring the implementation of such strategies. Therefore, the prevention of SSI requires a multidisciplinary approach and the commitment of all concerned, including that of those who are responsible for the design, layout and functioning of operating theatres.

Comparison of Laparoscopic and Open Adrenalectomy

Laparoscopic adrenalectomy is one of the most significant advances in the past 20 years for treating adrenal disorders. Laparoscopic adrenalectomy has been the golden standard procedure for all adrenal pathologies since it was first defined in 1992. Laparoscopic adrenalectomy is preferred and has advantages such as less postoperative pain, earlier resumption of oral intake, shorter hospital stay, earlier return to normal life and better esthetical results. In our study we compared morbidity and mortality rates of laparoscopic and open adrenalectomy cases. Material and methods : In Ankara University Faculty of Medicine General Surgery department 92 cases of adrenalectomy were performed between january 2000-july 2006. The patients were evaluated for age, sex, duration of perioperative hospital stay, resumption of oral intake, duration of operation, surgical wound infection, conversion rate and complications.Results : In patients who underwent laparoscopic surgery, rate of conversion to open surgery was 9.3% (4 patients). The mean operative duration in the laparoscopic adrenalectomy group was 150 minutes and the mean operative duration in the open adrenalectomy group was 120 minutes (p = 0.001). Surgical wound infection rate was 6% in the open adrenalectomy group and 2% in the laparoscopic adrenalectomy group. Mean perioperative hospital stay was 7.1 days in the open adrenalectomy group and 5.1 days in the laparoscopic adrenalectomy group. Time to resumption of oral intake was 2.42 days in the open adrenalectomy group and 1.05 days in the laparoscopic adrenalectomy group (p = 0.001). There was no perioperative mortality in none of the groups.Conclusion : Laparoscopic adrenalectomy is the golden standard surgical treatment for benign and selected malignant adrenal diseases. Laparoscopic adrenalectomy is a safe and effective technique and has advantages such as less postoperative pain, earlier resumption to oral intake, shorter hospital stay, earlier return to normal life and better esthetical results compared to open adrenalectomy.