Suspected Wound Infection Research Articles

A STUDY ON ANTIBIOGRAM OF BACTERIA ASSOCIATED WITH WOUND INFECTIONS

Background: Understanding the microbial nature in wound infections is an imperative part of an efcient management strategy to reduce morbidity, mortality and also to reduce treatment costs. Therefore, this study aimed to isolating, identifying and assessing the antibiotic susceptibility pattern of bacteria causing wound infections. Microbiological ass Methods: ays were performed on pus samples of patients with suspected wound infections for a period of one year. A total of 247 pus samples were processed and a Results: mong these, 175 (70.85%) were culture positive. Out of the total 220 isolates, S.aureus was predominant i.e., 66 isolates (30%) followed by Pseudomonas spp. 45 (20.45%). Klebsiella spp. 27 (12.27%), E.coli 25 (11.36%). Isolates of S.aureus which were predominant (66), were found to be 100% sensitive to Linezolid and were least to Penicillin (6.06%). Isolates of P.aeruginosa were maximally sensitive to Imipenem (95.5%) and least to Ticarcillin. Isolates among Enterobacteriaceae were maximally sensitive to Imipenem (92.68%) and were least to Ceftazidime (7.89%). Isolates of Acinetobacter spp. were maximally sensitive to Amikacin and Amoxyclav (80%) and showed maximum resistance to Ceftazidime (90%). Out of the 11 Enterococci isolated 10 (90.90%) were sensitive to Linezolid and Vancomycin Awareness about t Conclusion: he prevalent organisms in wound infections and their antibiograms help the clinicians to successfully treat wound infections. Thus, periodic surveillance of isolates involved in wound infection and their antibiotic susceptibility testing is recommended for effective management of patients

Current Microbial Isolates and Their Antimicrobial Susceptibility Pattern from Wound Infection in a Tertiary Care Hospital

Background: Wound infection is one of the leading cause of mortality and morbidity worldwide. Objectives: To identify the current microbial isolates and their antimicrobial susceptibility pattern from wound infection in a tertiary care hospital in Dhaka city. Materials & Methods: This retrospective study was conducted in the department of Microbiology at Holy Family Red Crescent Medical College Hospital, Dhaka from July 2019 to December 2020 for a period of one and half years. Written consent was taken from corresponding authority. Microsoft Excel software was used for data analysis. A total 134 wound swab / pus were collected from the patients who were visited in outpatient department and were admitted at inpatient department with suspected wound infection. All samples were processed aerobically on Blood agar, MacConkeys agar media and incubated at 370C for 24 hours. Organisms were identified by standard procedures including colony characters, Gram staining and biochemical reactions. Antimicrobial susceptibility testing of all the isolates were performed by Kirby Bauer’s disc diffusion method. Results: A total 134 samples were analyzed. Of them, predominant populations were male 76(56.72%) and remaining were female 58(43.28%). Out of 134 samples 102 (76.11%) was culture positive. Culture positive was observed higher in inpatient department (IPD) 80 (78.43%) than outpatient department (OPD) 22 (21.57%). Majority of isolates were Gram negative bacteria. Among them predominant bacteria was E. coli 26(25.49%) followed by Klebsiella spp. 24(23.53%), Pseudomonas spp. 15(14.71%) & Proteus spp. 04(3.92%). Among the Gram - positive isolates 30(29.41%) was Staph. aureus. E. coli showed higher sensitivity to meropenem 88.46% & gentamicin 80.76%. Other drugs showed sensitivity to amikacin 65.38%, amoxicillin/clavulenic acid 53.84%, tetracycline 46.15%, ceftriaxone & ceftazidime 42.30%, trimethoprime/ sulfamethoxazole 34.61% & cefuroxime 23.07%. In Klebsiella spp. meropenem showed higher sensitivity 79.16% & gentamycin 66.66%. Other drugs like amikacin showed 58.33%, trimethoprime/ sulfamethoxazole 45.83%, ceftazidime & ciprofloxacin 20.83% sensitivity. Low sensitivity 16.66% to amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, & tetracycline was found. Proteus spp. showed 75% sensitivity to meropenem. Cefuroxime, ceftriaxone, ciprofloxacin, ceftazidime, gentamycin, amikacin, trimethoprime/ sulfamethoxazole showed very low sensitivity 25% & amoxycillin/clavulanic acid showed 100% resistance. Pseudomonas spp. showed highest sensitivity 83.33% to piperacillin tazobactum, amikacin & imipenem, 77.77% to meropenem, 66.66% to gentamycin, 61.11% to ciprofloxacin, 50% to ceftazidime & 33.33% to cefepime. All the isolate of Staph. aureus was sensitive to amikacin 90%, amoxyclav 80%, cloxacillin 70%, ciprofloxacin 70%, gentamicin 63.33% & azythromycin showed lower sensitivity 43.33%. Conclusion: Most of the injectable antibiotics showed higher sensitivity which is an alarming sign for the clinician to treat wound infection. Periodic review of the bacteriological profile and antibiotic sensitivity pattern is highly essential. Antibiotic policy & infection control program should be included in every hospital to reduce this drug resistance. J Shaheed Suhrawardy Med Coll 2021; 13(1): 80-85

The use of ARTISS fibrin sealant in thyroid surgery: case series and review of the literature.

Abstract Introduction Many techniques have been described to reduce length of stay and complication rates in thyroid surgery. ARTISS is a fibrin sealant used as an adjunct to sutures or staples, whereby it simultaneously adheres and seals subcutaneous tissues. In the context of thyroid surgery, it can augment the closure of dead space beneath the strap muscles and the platysma flaps. Methods A single surgeon adopted this novel technique from February 2017. A retrospective audit of 72 thyroid cases using ARTISS was conducted. Data were collected on patient demographics, ASA grade, procedure, histology, drain insertion and output, length of stay and complications. Results 71 (99%) patients had a drain inserted. Of the 57 hemithyroidectomies, 13 (23%) patients had their drain removed and were discharged on the same day, 41 (65%) the next day and 3 (6%) remained at 2 days post-operatively. Of the 41 hemithyroidectomies who stayed one night, 21 (51%) patients had been operated on in the afternoon and were discharged the following morning. Of the 15 total thyroidectomies, 9 (60%) patients had their drain removed the following day and 6 (40%) at 2 days post-operatively. There was one post-operative superficial haematoma which did not require re-operation, another which required aspiration only, and one case of suspected wound infection treated with oral antibiotics. Conclusion The use of ARTISS fibrin sealant in this case series has been shown to be a safe and successful technique. Most patients are discharged within 24 hours of surgery and no cases required a return to theatre.

Risk Factors and Bacterial Profile of Abdominal Surgical Incisions- Changing Trends

Introduction: Surgical Site Infections (SSIs) remain a significant postoperative complication after abdominal surgeries, even with the advancement of infection control practices. The emergence of drug resistance to routine antibiotics was a challenge to infected wound management. Aim: To analyse the host risk factors and bacterial flora associated with abdominal surgical site infections and to evaluate the changes in the prevalence and antibiotic susceptibility pattern over the years. Materials and Methods: A cross-sectional study was done among 150 abdominal surgery cases admitted to a Government Medical College Thrissur, (referral hospital) in Kerala, India for one year, from September 2010 to August 2011. Host risk factors were analysed by clinical details and preoperative investigations. Samples were collected from the wound site on the third day of surgery using sterile swabs for bacteriological analysis. Repeated samples were taken in case of suspected wound infection to identify the types of pathogen if any. Statistical analysis was done using Microsoft excel and open Epi software. The results were compared with the similar studies conducted in this institution during 2015-2016 and 2016-2017 to know the changes in prevalence and antimicrobial sensitivity. Result: Out of 150 cases higher infection rate was found in patients >60 years 5 (17.2%), emergency surgeries 16 (21.6%), large intestinal surgeries 4 (44.4%), with diabetes 5 (26.32%), patients on steroids and obese 3 (37.5%). Colonisers were present in 34.7% abdominal surgical wounds. Infection rate of 14.7% in abdominal surgeries was reduced to 11.2% and 10% between the years 2015-16 and 2016-17 respectively. Higher infection rate was noticed in patients with premorbid risk factors. When compared with the similar studies conducted in the same institute, Pseudomonas and Acinetobacter with E. coli and S. aureus were found to be most common wound pathogens and resistance to ciprofloxacin and ceftriaxone were increased. Amikacin, piperacillin tazobactam and imipenem were useful but decreasing in sensitivity were noticed. Conclusion: Bacterial colonisation with endogenous flora was the primary source of SSIs. Good infection control practices, early identification of the pathogen and treatment with an appropriate antibiotics can reduce the development of resistant organisms and cross infection. The use of antimicrobials for prophylaxis and treatment needed to be modified according to the antimicrobial sensitivity report and local susceptibility pattern.

Microbial profiling of wound pathogens in isolates from an Egyptian hospital using a microarray chip

Chronic polymicrobial infections represent diagnostic challenges for both molecular and culture methods. Chronic wounds, inducing chronic pain and reducing the mobility of individuals, have a notable effect on the quality of life. At any given time, 1% of the population is usually affected and, therefore, multiple treatments are also required. Identification of the etiology of such infections facilitates the appropriate treatment. In this study, 20 wound samples were collected from 20 patients with suspected wound infection. The panel of the current assay targets 12 clinically relevant aerobic pathogens, commonly associated with chronic wound infection. Microbial wound infections were detected by both usual polymerase chain reaction (PCR) and subsequently testing using the DNA chip. In the current study, the results of culture-free bacterial identification using the two methods of DNA analyses were compared. By molecular detection using PCR, seven different bacterial species were identified: Citrobacter spp. (100%), Enterobacter spp. (100%), Klebsiella pneumoniae (100%), Pseudomonas aeruginosa (90%), Proteus spp. (80%), Escherichia coli (60%), and Staphylococcus aureus (10%). Mixed microbial infections were detected in all samples indicating four, five, or six different bacteria, identified in each sample. Microarray detection in comparison to PCR indicated 100% matching. These results demonstrate the possibility of fast identification of wound infection pathogens even in a mixed culture in a very short time, which in turn facilitates the proceeding steps for proper treatment.

Red weepy ears.

A Caucasian woman aged 18 years developed a well-defined erythematous vesicular eruption with clear non-purulent exudates on the ear lobules and adjacent inferior neck area (Figure 1). Both of her ears had been pierced two weeks earlier at an accredited piercing salon. This was her first piercing. She had been diligent with her care of the new piercings and had used an antiseptic spray given to her by the salon staff to apply to the area. She was otherwise medically well with no personal or family history of skin disease or atopy, and she was not taking any regular medications. The patient initially self-treated the rash by switching to another brand of antiseptic spray from a local pharmacy, which only exacerbated the eruption. The patient was then prescribed oral cephalexin 250 mg and mupirocin 2% ointment for a diagnosis of a suspected wound infection. The patient was also instructed to continue using the antiseptic spray and leave the earrings in. Both antiseptic sprays contained benzalkonium chloride as the main ingredient. There was no response to antibiotic therapy. Ultimately, the patient stopped using the antiseptic spray because of the stinging sensation when applied. Cessation of the antiseptic sprays brought significant improvement. The vesiculation and erythema drastically improved only three days after stopping the sprays (Figure 2).

2294. Comparative Evaluation of Ertapenem and Clindamycin Plus Gentamicin for the Treatment of Postpartum Endometritis

BackgroundClindamycin plus gentamicin (C/G) is the most commonly used regimen for the treatment of postpartum endometritis. With a similar spectrum of coverage and once daily dosing, ertapenem is an attractive alternative. The purpose of this study was to evaluate the efficacy of ertapenem compared with C/G, for the treatment of postpartum endometritis.MethodsThis was a retrospective chart review (IRB-approved) of patients treated with either ertapenem or C/G for endometritis, from July 2017 to July 2018. Patients receiving agents from both groups were excluded. Data collected included: demographics, ante- and intrapartum course, including efficacy parameters and antimicrobial use. Secondary objectives included a safety outcomes and patient quality analysis. Appropriate statistical analysis was performed.ResultsA total of 81 patients were included (40 in C/G arm, 41 in ertapenem arm). No differences in mean length of stay (5.98 vs. 5.61 days in C/G and ertapenem, P = 0.61), readmission within 14 days, or mortality were seen. No patients developed acute kidney injury, C. difficile infection, or ototoxicity. All patients in the ertapenem arm had appropriate dosing, compared with 27.5% in C/G arm (P < 0.0001). Inappropriate dosing in 79% of C/G group was attributed to under-dosing of gentamicin. For quality measures, patients in C/G arm had more nighttime interruptions (3 vs. 1 interruptions per patient). 46% of patient in the ertapenem group had no overnight interruptions compared with 0% in C/G group. There were 2 suspected wound infections in the C/G group, but none in ertapenem group.ConclusionNo difference in efficacy was seen between ertapenem and C/G for treatment of postpartum endometritis Ertapenem was associated with less inappropriate dosing and fewer nighttime interruptions Improvement in patient experience and reduction of nursing workload may outweigh the small additional cost of ertapenem.Disclosures All authors: No reported disclosures.

Early Clinical and Radiological Experience with a Ceramic Bone Graft Substitute in the Treatment of Benign and Borderline Bone Lesions

Substitutes for bone grafts experience increasing popularity, but the need for defect-filling following simple curettage of benign bone lesions is controversial. In this study, we wish to objectively report the radiological changes following bone defect-filling using a composite ceramic bone graft substitute, as well as the clinical results and complications. We evaluated 35 surgically treated benign bone lesions with subsequent defect-filling using two variants of a composite ceramic bone graft substitute (CERAMENT|BONE VOID FILLER or CERAMENT|G, BONESUPPORT AB, SWEDEN). After one year, a normal cortical thickness surrounding the defect was seen in approximately 80% of patients. Inside the defect-cavity, an almost complete product-resorption was seen after one year. The most common complication was a post-operative inflammatory soft-tissue reaction, seen in 7 patients (20%), which resolved without further treatment, although short-term antibiotic treatment was initiated at a local hospital in 6 patients, due to suspected wound infection. In summary, cortical thickness most commonly normalizes after bone tumor removal and filling of the bone defect using this particular composite ceramic bone graft substitute. The ceramic substitute undergoes resorption, which causes progressive changes in the radiological appearance inside the bone defect.

Detection of Bacterial Pathogen from Wound Infections and Study Some of their Virulence Factors

Wound infections are one of the most important and potentially serious complications that occur in the acute period following injury. In this study, (35) wound swaps were collected from (35) patients with suspected wound infection, during the period from December (2017) to March (2018). The results of this study revealed that (74.29%) of samples were positive for bacterial culture, while (25.71%) of a sample have no growth. The bacterial culture has shown that (38.46%) (10 isolates) of bacterial isolates were Staphylococcus aureus followed by Pseudomonas spp. (19.23%) (5 isolate), E. coli (19.23%) (5 isolate), Klebsiella (15.38%) (4 isolate) and Proteus (7.69%) (2 isolate). In-vitro, the susceptibility of bacteria towards some antibiotics included in this study revealed that the Ciprofloxacin, are the most effective antibiotics to different types of pathogenic bacteria, while all bacteria were resistant to Ampicillin.

Antimicrobial Utilization in Wound Infections in Tertiary Care Hospital

To identify the utilization pattern of antimicrobials in patients with suspected wound infections and skin and soft tissue infections (SSTI) according to WHO (World Health Organization) drug utilization indicators.This is a cross-sectional, record based study conducted in a tertiary care hospital after obtaining Institutional Ethical Committee approval. Patients of all ages admitted into N.R.I hospital between June to October 2017 suspected of wound and SSTIs were included in this study. Data of patients was collected from Medical records Department of the hospital. Analysis was done on 100 patients basing on inclusion criteria. Wound infections and SSTIs were found to be more common in males and in age group below 35 yrs. The major co-morbid conditions associated were diabetes and hypertension. Evaluation of prescriptions based on WHO drug utilization indicators showed that a total 201 antimicrobials were prescribed for 100 patients irrespective of positive or negative culture. Among antimicrobials, 31.8% were prescribed by their generic name.42.78 % were in the form of injections. 94.51 % of antimicrobials were in the National list of essential medicines 2015. Average duration of treatment given was for 7±3 days in the hospital. All the patients recovered well and got discharged. None of the patients died during the treatment among these 100 patients. The results obtained will be useful for implementing the modifications in the prescription for betterment of the patients and for the community.

Naja atra snakebite in Taiwan

Background: Naja atra snakebite is uncommon in Taiwan and causes distinct effects on its victims. Although the Taiwan government produces its own specific antivenom, little information on the management of N. atra snakebite is available.Materials and methods: We retrospectively evaluated 183 patients admitted to two medical centers. Of these, 45 were identified as definite cases of N. atra snakebite, 86 as suspected cases, and 52 as clinical cases. Demographic data, symptomatology, and management were compared between these case groups.Results: Symptomatology and management were similar in the three groups. Among the 183 patients, 10 (5.5%) were asymptomatic and nine (4.9%) had transient and partial ptosis or body weakness. The principal effects were local tissue swelling and pain in 173 patients (94.5%), followed by clinically suspected wound infection in 148 (80.9%), skin necrosis in 120 (65.6%), necrotizing soft tissue infection in 77 (42.1%), fever in 59 (32.2%), and gastrointestinal effects in 53 (29%). The median total dose of specific antivenom needed to treat N. atra envenoming was 10 vials. In the envenomed patients, debridement was required in 74 patients (42.8%), fasciotomy/fasciectomy in 46 (26.6%), and finger or toe amputation in seven (4%). The first operation was performed at a median of 3.5 days after the bite.Discussion and conclusions: Based on these typical manifestations, clinical diagnosis of N. atra snakebites may be feasible and practical. In contrast to other snakes of Elapidae family, N. atra bite did not cause serious neurological effects. Early surgical consultation should be obtained because half of the patients underwent surgery due to infectious complications. Acute compartment syndrome was the surgical indication in rare cases; however, overestimation of the incidence may have occurred. This syndrome should be confirmed by serial intracompartmental pressure monitoring instead of only physical examination, and a sufficient dose of antivenom should be given prior to surgical decompression.

Bacteriology of Naja atra Snakebite Wound and Its Implications for Antibiotic Therapy.

A total of 112 cases of Naja atra envenomation were examined at two referring hospitals: Taichung Veterans General Hospital in central Taiwan and Taipei Veterans General Hospital (VGH-TP) in northern Taiwan. Overall, 77% (86/112) of cases developed clinically suspected wound infections and 54% (61/112) required surgery secondary to tissue necrosis, finger or toe gangrene, and/or necrotizing fasciitis. Morganella morganii was the most abundant gram-negative bacterial strain isolated from bite wounds, followed by Proteus spp., Aeromonas hydrophila, Pseudomonas aeruginosa, and Providencia spp. in descending order; Enterococcus spp. were the most common gram-positive bacteria and Bacteroides spp. were the only anaerobic bacteria. A few episodes of bacteremia were caused by Bacteroides and Shewanella spp. There were no significant variations in the distribution of bacterial species between these two hospitals except for a higher incidence of M. morganii, Enterococcus spp., and polymicrobial infection observed at VGH-TP, which may have been related to variations in the fecal flora of prey and oral flora of individual snakes in different geographic areas in Taiwan. According to the susceptibility test involving various pathogens, first-line drug options for the management of N. atra snakebite wound infections may include monotherapy with ureidopenicillin or combination therapy with aminopenicillin and a third-generation cephalosporin or fluoroquinolone. A prospective evaluation of empiric antibiotic therapy for the management of N. atra snakebite should be considered.

Basocellular Carcinoma and Pyoderma Gangrenosum: A Case Report

Pyoderma gangrenosum is a rare acute noninfectious dermatosis. It can develop spontaneously, or be provoked by trauma, and can progress rapidly. The cause of pyoderma gangrenosum is unknown. It is thought to be a variant of vasculitis, and in about 50% of all cases it is associated with internal diseases, like colitis ulcerosa or Morbus Crohn. There is no test available, which can diagnose pyoderma gangrenosum with certainty. A biopsy can be taken, but the diagnosis is ultimately based on the clinical findings. The disease is treated with immunosuppressants, like Prednisone or Cyclosporine. This case report describes a 61-year old female, who was operated on for multiple basocellular carcinomas of the skin. Four days after the operation, the patient was admitted for a suspected wound infection. Despite multiple debridements and broad-spectrum antibiotics, the wounds progressively deteriorated. The diagnosis pyoderma gangrenosum was considered. A biopsy showed an acute inflammation with abscess formation, which supported the diagnosis. Prednisone therapy was started and the patient recovered completely. This case report shows an unusual example of pyoderma gangrenosum, which to our knowledge has not been described before.

P004. Management of partial breast defects following breast conserving surgery in patients with previous augmentation mammoplasty

P004. Management of partial breast defects following breast conserving surgery in patients with previous augmentation mammoplasty

Indications and practical implementation of microbiologic diagnostics in patients with chronic wounds.

Microbiology diagnostics are frequently performed in patients with chronic wounds. However, there is currently a lack of uniformity with respect to indications as well as the practical implementation of such workup. The fact that diagnostic results may be significantly affected by the sampling technique used as well as the preceding (wound) preparation underscores the need for uniform standards, which have been missing so far. In Germany, bacteriologic wound swabs are routinely performed, particularly with the intent to screen for multiresistant pathogens. For this indication, prior wound cleansing should be avoided, and sampling using the Essen Rotary technique provides a quick and easy-to-use option. If there is clinical suspicion of an infection, wound cleansing with sterile saline solution (0.9 %) and/or sterile cotton gauze should be carried out prior to obtaining bacteriologic swabs. While routine diagnostic biopsies are generally not required in chronic wound patients, they may be useful in case of clinically suspected wound infections, particularly in patients with deep ulcerations, diabetic foot syndrome, severe soft tissue infection, or fistula tissue. Moreover, biopsies are indispensable in the microbiology workup of specific pathogens such as mycobacteria, Leishmania, actinomycetes, Nocardia ssp. or molds.

Repair of a canine patellar ligament rupture using the ComPact UniLock 2.4/3.0 mm System

An 11-year old, female, Mix Breed dog was presented after being hit by a car with a rupture of the left patellar ligament. Due to a suspected wound infection close to the stifle joint, surgical repair was delayed for 10 days. The ruptured ligament was sutured and augmented with fascia lata. Additionally, two ComPact UniLock 2.4/3.0 mm plates connected with 1.0 mm orthopaedic wire were used to protect the primary repair. No immobilization of the stifle joint was needed. The implants were removed after 7 weeks, because of suspected infection and loosening. The successful utilization of an alternative surgical technique for the repair of the patellar ligament rupture in the dog has also been documented by pre- and post-operative temporal-spatial gait analysis (GaitFour®).

Percutaneous Insertion of Peritoneal Ports

To describe a technique for image-guided percutaneous insertion of peritoneal ports in patients without ascites who have undergone surgical debulking for stage III ovarian cancer. Between 2006 and 2010, 29 intraperitoneal ports were placed percutaneously in 29 patients who presented after debulking surgery for stage III ovarian cancer. Ultrasound and fluoroscopy guidance were used to assist in the port placement. We demonstrated a technical success rate of 100% in 29 patients. The ports remained in place for an average of 186 days; and during that time, only 2 complications (6.9%) arose. One patient presented with kinking and looping of the catheter/port reservoir connection, and the redundant loop was removed. The other patient presented with a suspected wound infection over the port pocket, and the port was removed. Placement of percutaneous intraperitoneal ports is feasible with an acceptably low complication rate of 6.9% in patients without abdominal ascites.

Calm, irritated or infected? The experience of the inflammatory states and symptoms of pin site infection and irritation during external fixation: a grounded theory study

To explore patients' experiences of the symptoms of suspected wound infection in external fixator pin sites. Pin site infection is painful and distressing and can threaten the success of treatment. It is difficult for patients and clinicians to differentiate between pin site infection and irritation or foreign body reaction to the pin. There is no validated outcome measure for infection that enables the success of interventions for prevention and management to be evaluated. There is a need to develop accurate patient-orientated assessment criteria. Qualitative design, using grounded theory. Following written informed consent, a theoretical sample of 16 adults with an external fixation device that had been in situ for at least 12 weeks was recruited. They had experienced a pin site infection in the previous four weeks. Data were collected using semistructured interviews, and data collection was stopped when saturation was achieved. Analysis took place using constant comparative analysis. Participants described three 'clinical states' of pin site wounds: calm, irritated and infected. They described the differences in each state in relation to pain, redness, swelling, discharge and general symptoms. Symptoms were absent or varied in intensity depending on whether the pin sites were calm, irritated or infected. This study provides insight into patients' experiences of the symptoms of pin site infection resulting in an emerging theory based on conceptualisation of this experience, which is that of dimensions of inflammatory pin site states. The detail given will enable clinicians and researchers to be more accurate in recognising infection and begins to clarify the difference between a wound that is irritated and a wound that is infected. The findings will enable the development of a patient-orientated outcome questionnaire for pin site infection. There is a need for patients and clinicians to be able to differentiate between infected, not infected and irritated pin sites.

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth. This paper is a report of a study of the effect of empowering surgical nurses to ensure that patients receive antibiotic prophylaxis after caesarean birth. Despite the consensus that single dose antibiotic prophylaxis is beneficial for women have either elective or non-elective caesarean delivery, hospitals need methods to increase compliance rates. In a study in Israel in 2007 surgical nurses were empowered to ensure that a single dose of cefazolin was given to the mother after cord clamping. A computerized system was used to identify women having caesarean births, cultures sent and culture results. Compliance was determined by chart review. Rates of compliance, suspected wound infections, and confirmed wound infections in 2007 were compared to rates in 2006 before the policy change. Relative risks were calculated dividing 2007 rates by those in 2006, and 95% confidence intervals were calculated using Taylor's series that does not assume a normal distribution. Statistical significance was assessed using the chi-square test. The compliance rate was increased from 25% in 2006 to 100% in 2007 (chi-square test, P < 0.001). Suspected wound infection rates decreased from 16.8% (186/1104) to 12.6% (137/1089) after the intervention (relative risk 0.75, 95% confidence interval, 0.61-0.92). Surgical nurses can ensure universal compliance for antibiotic prophylaxis in women after caesarean birth, leading to a reduction in wound infections.

Infection risk related to the use of medicinal leeches

To assess the incidence of postoperative wound infections related to treatment with medicinal leeches at Ghent University Hospital. A 2-year retrospective analysis of bacteriologic culture results of soft tissue infections in patients treated with medicinal leeches. Cultures of suspected wound infections were taken and susceptibility testing of isolates was performed on 17 of 47 patients (36.2%). Aeromonas was frequently isolated (18.5%). A high incidence of infection during and after application of medicinal leeches, despite their external decontamination, necessitates an antibiotic prophylaxis. In particular Aeromonas must be covered, as soft tissue infections with these bacteria can give serious complications. The prophylactic antibiotic should cover the most frequent isolated species taking into account the importance of Aeromonas and the susceptibility pattern. Based on the results, fluoroquinolones seem to be a good choice. The authors believe that practical recommendations to hospital pharmacists on prophylaxis during Hirudo medicinalis treatment, might enhance the safety of it's use by reducing the number of infections.