Type Of Surgical Site Infection Research Articles

IMPLEMENTING “BUNDLED INTERVENTIONS” IN REDUCING SURGICAL SITE INFECTIONS AMONG PATIENTS UNDERGOING SURGERY FOR GYNECOLOGICAL INDICATIONS – A PROSPECTIVE STUDY

Objective: Surgical site infection (SSI) is the most common infection among surgical patients. This study evaluated the impact of bundled interventions in reducing SSI rates in gynecological surgery. Therefore, it is a vital tool to improve patient safety. Methods: One hundred study participants were taken in the tertiary care hospital and divided into Group I and Group II. In Group I, 50 patients were involved in elective OT with bundled interventions, and in Group II, 50 controls operated in identical OT without bundled intervention. Incidence of SSI, type of SSI, antibiotic usage, need for secondary suturing, duration, etc., was noticed. Results: Our findings showed that six out of fifty cases developed the symptoms with a 10% SSI rate. Two had superficial SSI, and three had deep SSI. None of the patients had organ space SSI. In the control group, the SSI rate was 12%. The bundled intervention was associated with a significant reduction in infection rate. Conclusion: The study indicates that SSIs are associated with severe morbidity and mortality. It is a straightforward, feasible approach to the reduction of the SSI rate.

Comparing the efficacy of chlorhexidine and povidone-iodine in preventing surgical site infections: A systematic review and meta-analysis.

Surgical site infections (SSIs) post-surgery impact patient health and raise healthcare costs. This meta-analysis examines the efficacy of antiseptics, chlorhexidine and povidone-iodine, in reducing SSIs, including various types, to settle ongoing debates on their comparative effectiveness. A systematic literature search conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was executed on four established databases without temporal restrictions. Only randomized controlled trials (RCTs) including patients aged 18 years or older undergoing clean or potentially contaminated surgeries were included. Two independent evaluators carried out study selection, data extraction and quality assessment, adhering to Cochrane Collaboration's risk of bias tool. Statistical analyses were performed using chi-square tests and the I2 index to evaluate heterogeneity, and meta-analyses were conducted employing either fixed-effects or random-effects models as warranted by the heterogeneity assessments. A total of 16 RCTs were included after rigorous selection from an initial pool of 1742 articles. The studies demonstrated low levels of heterogeneity, supporting the use of a fixed-effects model. Chlorhexidine exhibited statistically lower rates of overall SSIs (RR 0.75; 95% CI 0.64-0.88; p < 0.001), superficial SSIs (RR 0.62; 95% CI 0.47-0.82; p < 0.001) and deep SSIs compared to povidone-iodine. The study furnishes compelling evidence in favour of chlorhexidine as a more efficacious antiseptic agent over povidone-iodine in minimizing the risk of various types of SSIs.

Implementation of protocol to reduce surgical site infections in arthroplasty with hip prosthesis.

Introduction: A surgical site infection (SSI) is a type of SSI that occurs after surgery in the area of the body where surgery is performed, involves the skin, tissues and organs and implant material, and has signs and symptoms of infection. The prevention of SSI should be a priority element for surgical services and health centers where preoperative, intraoperative and postoperative risk should be considered.Objective: To analyze the impact of the implementation of a protocol to reduce the incidence of surgical site infection in hip prosthesis arthroplasties, with the implementation of a protocol for ES decolonization and treatment of infections prior to surgery.Methods: An experimental type study was conducted, in which a pre-surgical protocol was applied, with a multidisciplinary team to reduce total hip prosthesis SSIs, comparing the pre-implementation period, from January to December 2017, with the period from January 2018 to December 2021.Results: the rate of SSI in the pre-implementation period was 22 % (10 cases), in the period that the intervention was performed 3% (2 cases). Disease motivating surgery: hip fracture: 50%, Osteoarthrosis: 49 %, hip dysplasia: 1%.Conclusions: In this study, the intervention was positive, a statistically significant reduction in the rate of SSI was found in the period after the implementation of the protocol with greater adherence to pre-surgical bathing, and the performance of SA decolonization, as well as hospital stay as a protective factor.

Central Adjudication Committee and Clinical Site Investigator Agreement on Outcomes in the PARITY Trial: A Secondary Analysis of the PARITY Trial Data.

The detection of a surgical site infection (SSI) in patients with metal implants requires a high degree of clinical acumen. The inherent subjectivity of SSI diagnosis poses a challenge in the design of surgical trials because this subjectivity raises concern for outcome assessment bias. Central Adjudication Committees (CACs) are often utilized to minimize the variability in outcome assessment. Little research has been done to determine the reliability of outcome assessment in trials utilizing a CAC. In the present study, we determined the agreement between the study CAC and the clinical site investigators for the primary and secondary outcome assessments. The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial was a multicenter, blinded, parallel 2-arm, randomized controlled trial that aimed to determine the effect of a 5-day versus 1-day postoperative prophylactic antibiotic regimen on the rate of SSI in patients undergoing surgical excision of tumors in the femur or tibia. The blinded PARITY CAC adjudicated all primary and secondary outcomes identified during the 1-year study follow-up. In the present secondary analysis, the Cohen kappa statistic was utilized to determine the level of agreement. The primary outcome of SSI diagnosis demonstrated a substantial level of agreement between the CAC and the site investigators (0.699; 95% confidence interval [CI], 0.595 to 0.803]). Categorization of the SSI (i.e., superficial, deep, or organ space) showed moderate agreement (0.470; 95% CI, 0.382 to 0.558). Secondary outcomes such as the types of reoperations and the indication for reoperation typically showed substantial to almost perfect agreement, whereas antibiotic-related complications showed fair agreement (0.241; 95% CI, 0.000 to 0.474). Although there was a substantial level of agreement between the PARITY CAC and site investigators on the diagnosis of an SSI, as well as typically at least substantial agreement on the causes and types of reoperations, there was less agreement regarding the type of SSI and the occurrence of an antibiotic-related complication. Therefore, the CAC appears to have provided value when adjudicating the depth of infection and when determining the causality of medical complications associated with antibiotics. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Multidisciplinary Strategies With Real-Time Fluorescence Images and Negative Pressure Wound Therapy to Manage Organ/Space Surgical Site Infection in Transplanted Kidneys

Surgical site infection (SSI) after kidney transplantation can severely compromise graft function and prolong hospital stay. Organ/space SSI (osSSI) is a severe type of SSI associated with a significantly higher mortality rate. This study aims to provide new strategies of managing (osSSI) after kidney transplant and other high-risk wound infections. This is a single-center, retrospective study that analyzed the treatment outcomes of 4 patients who developed osSSI after kidney transplant at Shuang-Ho Hospital. The management strategy included real-time fluorescence imaging with MolecuLight, negative-pressure wound therapy (NPWT) with Si-Mesh, and incisional NPWT (iNPWT). The average length of hospital stay was 18 days (range, 12-23 days). During hospitalization, all patients obtained high-quality debridement under real-time fluorescence image confirmation. The average duration of NPWT was 11.8 days (range, 7-17 days) and iNPWT was 7 days. All transplanted kidneys were preserved with normal function after 6 months of follow-up. Our strategies with real-time fluorescence imaging provide a novel and effective method that can be used in adjunct with the standard of care for managing osSSI after kidney transplantation. More studies are warranted to validate the efficacy of our approach.

Surgical site infections

<h2>Abstract</h2> Surgical site infections (SSIs) are infections at the site of surgery within 30 or 90 days of the operation, depending on the procedure. They are a significant complication of both elective and emergency surgery and are the second highest cause of hospital-acquired infections. They have a huge cost to the NHS and lead to increased morbidity and mortality. Significant research has been done to find the causes and help create solutions, culminating in international guidelines published by the World Health Organization (WHO) in 2016. This article will discuss the different types of SSIs, the common causes and infective organisms and what the WHO have suggested we can do to prevent them.

Dressing to prevent surgical site infection in adult patients with cancer: a systematic review with meta-analysis.

To identify the most effective dressing for application to surgical wounds with primary closure to prevent surgical site infection (SSI) in adult patients with cancer undergoing elective surgeries. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, with online searches conducted in the CINHAL, Cochrane Central, LILACS, PubMed, Scopus, Embase, Livivo, and Web of Science databases. An additional search was conducted in gray literature using Google Scholar. The risk of bias was assessed using RoB 2.0. The certainty of evidence was evaluated using the Grading of Recommendations Assessment and Development and Evaluation, and the results were synthesized in a descriptive manner and using meta-analysis. Eleven randomized clinical trials were conducted to compare different types of dressing-silver dressing with absorbent dressing (n = 3), mupirocin dressing with paraffin/no dressing (n = 1), honey-based dressing with absorbent dressing (n = 1), vitamin E and silicone-containing dressing with absorbent dressing (n = 1), and negative pressure wound therapy with absorbent dressing (n = 4)-and compare the usage duration of absorbent dressing (n = 1). Nine trials presented a low risk of bias, and two were classified as having uncertain bias. Compared with absorbent dressing, silver dressing did not reduce the risk of developing any type of SSI in 894 clinical trial participants (risk relative RR: 0.72; 95% confidence interval [CI] [0.44, 1.17] p = 0.18). Compared with absorbent dressing, negative pressure wound therapy did not reduce the risk of developing any type of SSI in the 1041 participants of two clinical trials (RR 0.68; 95% CI [0.31, 1.26] p = 0.22). The certainty of evidence of the three meta-analyses was considered low or very low for the prevention of SSI. We believe that this low certainty of evidence can be improved by conducting new studies in the future. There is no evidence regarding which dressing is the most effective in preventing SSI in adult patients with cancer.

Efficacy of Prophylactic Negative-Pressure Wound Therapy with Delayed Primary Closure for Contaminated Abdominal Wounds.

Prophylactic negative-pressure wound therapy (NPWT) to prevent surgical site infection (SSI) may be effective for severely contaminated wounds. We investigated the safety and efficacy of NPWT with delayed primary closure (DPC) for preventing SSI. For patients with contaminated and dirty/infected surgical wounds after an emergency laparotomy, the abdominal fascia was closed with antibacterial absorbent threads and the skin was left open. Negative pressure (-80 mmHg) was applied through the polyurethane foam, which was replaced on postoperative days 3 and 7. DPC was performed when sufficient granulation was observed. The duration and adverse events of NPWT, the development of SSI, and the postoperative hospital stay were retrospectively reviewed. We analyzed the cases of patients with contaminated (n = 15) and dirty/infected wounds (n = 7). The median duration of NPWT was 7 days (range 5-11 days). NPWT was discontinued in one (4.5%) patient due to wound traction pain. SSI developed in seven patients (31.8%), with incisional SSI in one (4.5%) and organ/space SSI in six (27.3%). The median postoperative hospital stay was 17 days (range 7-91 days). There was no significant relationship between postoperative hospital stay and wound classification (P=0.17) or type of SSI (P=0.07). Prophylactic NPWT with DPC was feasible and may be particularly suitable for severely contaminated wounds, with a low incidence of incisional SSI.

Effect of oral antimicrobial prophylaxis on surgical site infection after elective colorectal surgery: multicentre, randomised, double blind, placebo controlled trial

ObjectiveTo investigate whether oral antimicrobial prophylaxis as an adjunct to intravenous antibiotic prophylaxis reduces surgical site infections after elective colorectal surgery.DesignMulticentre, randomised, double blind, placebo controlled trial.Setting11 university and non-university...

Risk Factors Associated with Surgical Site Infection following Cesarean Section in Tertiary Care Hospital, Nepal.

Background Cesarean section (CS) is one of the most performed surgeries in obstetrics. Surgical site infection is the major cause of morbidity and mortality causing an increase in the duration of hospitalization as well as the cost of admission for the patient. Objective To determine incidence of surgical site infection following cesarean section, classify them according to CDC criteria, and identify the different risk factors. Methodology. This is a case-control study conducted at the Department of Obstetrics and Gynecology at Tribhuvan University Teaching Hospital (TUTH), main campus of Institute of Medicine (IOM), Kathmandu, Nepal. Surgical site infections (SSI) in patients who underwent cesarean sections from February 2019 to August 2019 were taken as cases, while the patients who underwent cesarean section before or after the procedure and did not develop SSI comprised the controls. Visual inspection during ward rounds, reports from laboratory, and postprocedure follow-ups for up to 30 days formed the basis of identifying infections on the patients. Risk factors were identified by bivariate and multivariate logistic regression. Results Out of 1135 cases of cesarean sections, 97 of them developed SSI with incidence rate of 8.54%. Among them, 94.85% were superficial incisional and 5.15% were deep incisional type of SSI with no organ space type. Cases had higher mean age 26.88 ± 4.38 years compared to 24.81 ± 5.08 years in controls. Host-related risk factors which led to higher odds of developing surgical site infection (SSI) were obesity with adjusted odds ratio (AOR) 15.72 (confidence interval (CI): 4.60-53.67), diabetes/hypertension in pregnancy with AOR 4.75(CI 1.69-13.32), and other medical diseases with AOR 9.38 (CI 2.89-30.46). Duration of the rupture of membrane for more than 18 hours with AOR 8.38 (CI 1.48-47.35), more than five per vaginal (PV) examination with AOR 1.93 (95% CI 1.03-3.64), and in labor status with AOR 6.52 (CI 1.17-36.38) were some procedure-related factors resulting into higher odds of infection. Conclusion Multiple risk factors like age, obesity, medical complications during pregnancy, occurrence of labor status during cesarean section, prolonged duration of rupture of membrane for more than 18 hours, and more than five vaginal examinations before the procedure increases the chance of surgical site infection (SSI) following cesarean section.

Effect of Personal Protective Equipment (PPE) on Surgical Site Infection in Emergency Laparotomy: An Observational Study From a Tertiary Care Centre.

BackgroundIn the era of the coronavirus disease 2019 (COVID-19) pandemic, the use of full personal protective equipment (PPE) is advocated for patients undergoing emergency surgery in whom the infection status is unknown. This study aims to determine whether PPE has any influence on the rate of surgical site infection (SSI) in patients undergoing emergency exploratory laparotomy.MethodologyMedical records of operated emergency cases in the general surgery department from 1st April 2020 to 24th February 2021 were studied. The surgeries done were divided into two groups: those done with full PPE (group A) and those done without full PPE (group B). The various parameters studied were the patient demography, presence of comorbidities, diagnosis, surgery done, class of surgery performed, the use of PPE, the post-operative presence, and type of SSI. Statistical analysis was done using SPSS software version 27.0 (IBM Corp., Armonk, NY). Chi-squared test was used to find the association of SSI with the use of PPE. Fisher’s exact test was used to explore the association between SSI with various comorbidities, surgery performed, and the class of surgery performed.ResultsA total of 126 patients underwent emergency exploratory laparotomy during the study period. A total of 61 patients were in group A and 65 patients in group B. A significant association was noted between the use of full PPE and the development of SSI (p = 0.032). Diabetes mellitus, history of alcohol intake, and the class of surgery performed were found to be significantly associated with the development of SSI.ConclusionA significant association in the occurrence of SSI with the use of full PPE was observed.

An interventional nationwide surveillance program lowers postoperative infection rates in elective colorectal surgery. A cohort study (2008–2019)

BackgroundColorectal surgery is associated with the highest rate of surgical site infection (SSI). This study analyses the effectiveness of an interventional surveillance program on SSI rates after elective colorectal surgery. Material and methodsCohort study showing temporal trends of SSI rates and Standardized Infection Ratio (SIR) in elective colorectal surgery over a 12-year period. Prospectively collected data of a national SSI surveillance program was analysed and the effect of specific interventions was evaluated. Patient and procedure characteristics, as well as SIR and SSI rates were stratified by risk categories and type of SSI analysed using stepwise multivariate logistic regression models. ResultsIn a cohort of 42,330 operations, overall cumulative SSI incidence was 16.31%, and organ-space SSI (O/S–SSI) was 8.59%. There was a 61.63% relative decrease in SSI rates (rho = −0.95804). The intervention which achieved the greatest SSI reduction was a bundle of 6 measures. SSI in pre-bundle period was 19.73% vs. 11.10% in post-bundle period (OR 1.969; IC 95% 1.860–2.085; p < 0.0001). O/S–SSI were 9.08% vs. 6.06%, respectively (OR 1.547; IC 95% 1.433–1.670; p < 0.0001). Median length of stay was 7 days, with a significant decrease over the studied period (rho = −0.98414). Mortality of the series was 1.08%, ranging from 0.35% to 2.0%, but a highly significant decrease was observed (rho = −0.67133). ConclusionsDetailed analysis of risk factors and postoperative infection in colorectal surgery allows strategies for reducing SSI incidence to be designed. An interventional surveillance program has been effective in decreasing SIR and SSI rates.

Prospective study on incidence of surgical site infections in patients undergoing major abdominal surgeries in our hospital

Introduction: There are two types of surgical site Infections – Major and Minor type. Major SSI is one in which there is significant quantity of pus spontaneously discharged or which needs a another surgical procedure to drain pus and also presents with signs of Acute Inflammation.Minor SSI is one in which there is pus discharge is small in amount or having infected serous fluid but without signs of Inflammation. Aims and Objective: To study about incidence of SSI in patients undergoing Emergency Laparotomy. Materials and Methods: Prospective observational study conducted in RMMCH, Chidambaram from September 2019 to November 2021. Results: SSI seen in 239 patients out of 311, more in males when compared with females. SSI patients had Increased Morbidity and Increased length of stay in Hospital. Anaemic patients undergoing Laparotomy had Increased risk of surgical site Infection. Conclusions: Patients with Surgical Site Infections had Increased Morbidity and Increased Length of Stay in Hospital. Much more care must be given to minimise the incidence of Surgical Site Infection.

Surgical Site Infection in a Tertiary Care Teaching Hospital

Introduction: Surgical site infections [SSIs] are the Third most common nosocomial infections, According to the National Nosocomial Infections Surveillance, patients who are hospitalized account for 15 to 18 percent of all nosocomial infections .increased mortality and morbidity rates associated with Surgery.&#x0D; Surgical wounds are divided into four categories: clean, clean-contaminated, contaminated and dirty wounds.&#x0D; Materials and Methods: This was a retrospective study, done throughout for two years period, from June 2018 to May 2020 .785 patients underwent surgery in the Dept. of General Surgery in Saveetha Medical College and Hospital, Thandalam.&#x0D; Were taken as part of this study. Elective surgical procedures were performed on 495 patients. And 290 were taken to the hospital for emergency treatment. An in-depth examination of these cases was conducted, taking into account the date of admission, clinical features, history, types of surgery [emergency or elective], pre-operative preparation, drain used, and its type and postoperative findings.&#x0D; Results: Surgical Site Infections were found in 58 cases out of 785 surgeries. In elective clean and contaminated patients, the overall postoperative SSI rate is 4.34 percent of all cases, whereas emergency cases account for 12.41 percent. According to the research, that the most prevalent type of surgical site infection is superficial surgical site infection accounting for 72.1 percent of all SSIs in elective cases and 61.11 percent in emergency cases, and deep surgical site infection accounting for 23.25 percent of elective cases and 30.55 percent of emergency cases.&#x0D; Conclusion: The most common bacteria found in elective surgical wounds are E. coli. Proteus mirabilis is the most prevalent organism isolated from emergency surgical wounds. A shift in the pre-operative period antibiotics may even diminish the occurrence. Pre-existing medical conditions like diabetes mellitus wound type, operation time, emergency procedures, and wound contamination all had a significant impact on the development of surgical site infection.

A STUDY OF SURGICAL SITE INFECTION AFTER GASTROINTESTINAL SURGERY

Background: Surgical site infection (SSI) is one of the most common complications of abdominal surgery. The goal of this study was to evaluate the surgical site infection in patients undergoing gastrointestinal surgery.&#x0D; Methods: This prospective study was conducted on100 patients of all age group and both sexes undergoing gastrointestinal surgery were analysed for surgical site infection.&#x0D; Result: 42 (21.00%) developed SSI post operatively, 13 patients developed SSI in the period of 3–4 days postoperatively, 21 patients developed the infection in the period of 5–6 days postoperatively, and 8 developed the infection one week after the operation. Most of SSI cases (95.24%) were detected during hospital stay periods and the remaining cases were detected in the post-discharge follow-ups. Superficial SSI was the most common type of SSIs (92.86%).&#x0D; Conclusion: The results showed a high prevalence of SSI among patients attending the gastrointestinal tract surgical unit and it was associated with the malignant diseases, intraoperative blood loss, intra-operative hypotension, presence of surgical drains, and long operative duration.&#x0D; Keywords: Infection, Gastrointestinal, Surgery

English

BACKGROUND Surgical site infections (SSI) represent a significant hurdle in the recovery and return to normalcy of patients. When considering abdominal surgeries in particular, SSI and its complications have been identified as one of the most important causes for postoperative morbidity. Treatment of SSI’s ideally begins with prevention and this can be done with the identification of risk factors. This allows for appropriate stratification and institution of steps to safeguard the patient against the development of SSI in the pre-surgical period. The objectives of the study were to compare the incidence, severity and microbiological profile of surgical site infections following emergency and elective abdominal surgeries. METHODS This study was a prospective observational study, conducted from December 2017 to May 2019 at Father Muller Medical College Hospital, Mangalore, among patients who underwent laparotomy (regardless of indication) in either an elective or emergency setting. Patients who had SSI were then stratified using the ASEPSIS wound scoring system and the Southampton wound assessment scale. The type of SSI was further documented in each patient. Other parameters such as duration of stay in the hospital, microbiological profile, interventions performed etc. were also recorded in the study. RESULTS 150 patients were enrolled in the study (84 female and 66 male), 23 patients (incidence of 15.33 %) developed an SSI (7 elective cases and 16 emergency cases), whereas 127 did not. Of the organisms cultured, the most common was found to be coagulase negative staphylococcus (CoNS, 7 cases) followed by E. coli (4 cases). CONCLUSIONS The following factors were found to significantly contribute to the development of SSI - nature of the surgery, i.e. elective vs. emergency (P-value 0.040), class of wound (Pvalue 0.001), underlying malignancy (P-value 0.030) and a concomitant urinary tract infection (UTI) (P-value 0.045). The following factors were not found to contribute to the development of a SSI - sex of the patient (P-value 0.108), age of the patient (Pvalue 0.699), presence of diabetes mellitus (DM) (P-value 0.816), chronic kidney disease (CKD) (P-value 0.904) and acute respiratory infection (ARI) (P-value 0.909).

Why are we still using antibiotic prophylaxis in elective laparoscopic cholecystectomy for the low-risk groups? a review of literature

Gallstone disease is one of the most common gastrointestinal conditions requiring surgery and more than 90% of cholecystectomies are done laparoscopically. The major complications of laparoscopic cholecystectomy are major bleeding, Bile duct injury, and wound infection or surgical site infection. The incidence of Surgical site infection in laparoscopic cholecystectomy (0.4-1.13%) is significantly low compared to open cholecystectomy (3-47%) and the probable reasons are the smaller incision and the use of trocar along with almost nil to minimal wound contamination as compared to open cholecystectomy. Port site infection is a type of surgical site infection (1.8%) and the Umbilical port site is the most common site followed by the epigastric port site. In spite of the low-risk of surgical site infection, many surgeons still practice antibiotic prophylaxis in elective laparoscopic cholecystectomy for low-risk patients. Antibiotic prophylaxis is a debatable topic in the low-risk group undergoing elective laparoscopic cholecystectomy.Meticulous preoperative skin preparation is one of the established local factors to prevent the occurrence of SSI.

881. Efficacy of Antibiotic Prophylaxis with Vancomycin in Cardiothoracic Surgery

BackgroundDue to the high incidence of methicillin-resistant Staphylococcus aureus (MRSA) at the Detroit Medical Center, vancomycin is now routinely part of the prophylaxis regimen for cardiothoracic (CT) surgery. The study aims to compare the rate and types of surgical site infections (SSIs) when vancomycin is added to cefazolin for CT surgery compared to cefazolin alone.MethodsThis was a retrospective cohort study conducted at two university-affiliated hospitals. Patients who underwent CT surgery between January 2008 and August 2017 and had a readmission for SSI within 90 days of procedure were included. Patients who received cefazolin were compared to patients who received both cefazolin and vancomycin for CT surgery prophylaxis. The primary outcome was incidence of SSIs within 90 days of surgery as defined by the Centers for Disease Control and National Healthcare Safety Network.ResultsOut of 828 patients who underwent CT surgeries, there were 32 patients readmitted within 90 days for SSI. SSI occurred in 4.7% of patients who received cefazolin monotherapy, and 2.4% of patients who received both cefazolin and vancomycin (p=0.095). There was no discernible difference in types of SSI between groups. Pathogens were isolated in 78% of SSIs, with 75% Gram-positive and 19% Gram-negative organisms. SSIs resulted in an average 9.8 days in the hospital and 28.9 days of antibiotic therapy, and led to a total of 15 additional procedures.ConclusionVancomycin added to cefazolin for prophylaxis in CT surgery resulted in lower incidence of SSI, however the difference was not statistically significant.Disclosures All Authors: No reported disclosures

Timing and Management of Surgical Site Infections in Patients With Open Fracture Wounds: A Fluid Lavage of Open Wounds Cohort Secondary Analysis.

Many studies report on the incidence or prevalence of fracture-related surgical site infections (SSIs) after open fractures; however, few studies report on their timing and management outcomes. To address this gap, we used data from the Fluid Lavage of Open Wounds trial to determine timing of diagnosis, management, and resolution of SSIs. All participants included in this analysis had an SSI after an open fracture. Participants were assigned to a group based on the type of SSI as follows: (1) those who developed a superficial SSI and (2) those who had either a deep or organ/space SSI. Descriptive statistics characterized the type, timing, and management of each SSI. Of the 2445 participants in the Fluid Lavage of Open Wounds trial, 325 (13.3%) had an SSI. Superficial SSIs were diagnosed significantly earlier [26.5 days, interquartile range (IQR) 12-48] than deep or organ/space SSIs (53 days, IQR 15-119). Of the 325 patients with SSIs, 174 required operative management and 151 were treated nonoperatively. For SSIs managed operatively, median time for infection resolution was 73 days (IQR 28-165), and on average, 1.73 surgeries (95% confidence interval 1.58-1.88) were needed during the 12 months follow-up. There were 24 cases whose SSIs were not resolved at the time of the final follow-up visit (12 months). Based on this study's findings and in contradistinction to the Centers for Disease Control and Prevention guidelines, after an open fracture, superficial SSIs were diagnosed at one month and deep/organ/space SSIs at 2 months. This information can allow for earlier infection detection. In addition, the knowledge that approximately 50% of the SSIs in our study required a reoperation and 3 months at a minimum to resolve will assist orthopaedic surgeons when counseling their patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of Surgical Skin Antisepsis on Surgical Site Infections in Patients Undergoing Gynecological Laparoscopic Surgery

Gynecological laparoscopies are one of the most common surgical procedures worldwide. Limited evidence exists on rates of surgical site infections in patients undergoing gynecological laparoscopies and strategies to prevent these infections. To compare rates of port-site infections, organ or space infections, and any type of surgical site infections among patients who underwent gynecological laparoscopies and received 1 of 3 types of skin preparation solutions. A double-blind randomized clinical trial was conducted between February 28, 2017, and November 26, 2018, at a tertiary university-affiliated referral center. A total of 661 patients 18 years or older who underwent an elective operative laparoscopy for treatment of nonmalignant gynecological disorders were randomly assigned in a 1:1:1 ratio to have their skin cleaned before surgery with alcohol-based chlorhexidine, alcohol-based povidone-iodine, or water-based povidone-iodine. Statistical analysis was performed from February 28, 2017, to November 26, 2018. Analyses were performed on a modified intention-to-treat basis. A total of 221 patients were randomized to have their skin prepared preoperatively with water-based povidone-iodine, 220 were randomized to alcohol-based povidone-iodine, and 220 were randomized to alcohol-based chlorhexidine. The patients were blinded to the solution used to clean their skin. Patients were followed up 1 and 4 weeks after surgery by a physician who was blinded to the skin preparation solution used at surgery. Evidence of infection according to Centers for Disease Control and Prevention criteria were documented. The primary outcome of this study was port-site infection 30 days after surgery. Secondary outcomes were organ or space infections and any type of surgical site infections; the study also aimed to prospectively describe rates of surgical site infections in gynecological laparoscopies. Of the 661 patients, 640 (96.8%; mean [SD] age, 36.2 [10.6] years) were examined after surgery by a physician at the study site and were included in the modified intention-to-treat analysis. The overall rate of port-site infection was 10.2% (65 of 640), rate of organ or space infection was 6.6% (42 of 640), and rate of any surgical site infection was 16.3% (104 of 640). The odds ratio for port-site infection for alcohol-based chlorhexidine vs water-based povidone-iodine was 1.13 (95% CI, 0.61-2.08), for alcohol-based chlorhexidine vs alcohol-based povidone-iodine was 1.34 (95% CI, 0.71-2.52), and for water-based povidone-iodine vs alcohol-based povidone-iodine was 1.19 (95% 0.62-2.27). Surgical site infections were more common than expected among patients who underwent gynecological laparoscopies. No skin preparation solution provided an advantage compared with the other solutions in reducing infection rates. http://anzctr.org.au Identifier: ACTRN12617000475347.