Wound Sepsis Research Articles

Thoughts on comprehensive prevention and treatment of organ damage following severe burns

Organ damage is currently the leading cause of death directly hindering the further improvement of cure rate of severe burn patients. This paper introduces some thoughts on the comprehensive prevention and treatment of organ damage after severe burns in the following aspects: the effective prevention and treatment of shock to reduce the organ damage to ischemia and anoxia, the treatment of inhalation injury to prevent and treat respiratory failure, the strengthened prevention and treatment of infection and immune conditioning to prevent the uncontrolled inflammatory response, the active treatment of burn wounds to prevent and treat wound sepsis, the strengthened support of organ function and nutrition to modulate the hypermetabolism, the strengthened research of basic and translational medicine for precise implementation. The author hopes this paper will be a meaningful reference for readers.

Silver sulfadiazine loaded breathable hydrogel sponge for wound healing.

Objectives Patients with serious injury need special care and treatment to control the infection, as wound sepsis is one of the major causes of death. Silver sulfadiazine (SSD) is widely used as an antimicrobial agent which promotes healing and re-epithelialization. However, due to certain drawbacks such as inflammation and cytotoxicity, the need for novel drug delivery modality emerges. The objective of this study was to develop natural polymeric (chitosan and gelatin) hydrogel sponges containing SSD and evaluate its efficacy in wound healing using animal models. Methods SSD containing hydrogel sponges were prepared by solvent casting technique. Scanning electron microscopy (SEM) and Differential scanning calorimetry (DSC) were used to evaluate morphological characteristics of the hydrogel sponges. Anti-thrombogenic property, drug release studies, drug release kinetics, antimicrobial property, and wound healing effect were also studied in detail. Results The optimized batch of hydrogel sponges (CG4) consists of 1% SSD wt., 10% wt. Gelatin, 1% wt. Chitosan and honey 7.5% wt. as plasticizer. At the 12th hour, in vitro and ex vivo drug release was found to be 76.994±0.67% and 24.22±0.57% respectively. CG4 batch had enhanced in vitro antimicrobial activity as compared to conventional marketed cream. The developed SSD hydrogel sponges showed a faster rate of wound healing as compared to a marketed cream. Animals treated with CG4 formulation showed complete angiogenesis and re-epithelialization by 8th day, whereas 12days were required for complete wound healing with marketed cream. Conclusions The prepared hydrogel sponges can serve as a potential alternative for wound healing dressing as compared to the marketed product.

Innovations in Infection Prevention and Treatment.

Background: Patients with large, acute burn injuries are a major challenge for clinicians. The loss of skin barrier protection against micro-organisms combined with the induced immunosuppression after burn injury makes this population especially vulnerable to infection. For burn-injured patients who survive immediate management considerations and burn resuscitation after acute injury, sepsis remains the primary cause of death. The purpose of this article is to describe current strategies and innovations in burn sepsis prevention and management. Methods: This work reviews the current understanding of the systemic inflammatory response to burn injury and burn sepsis as well as current strategies in insolation and infection prevention, newer burn unit design strategies in the context of infection prevention, and novel therapies being considered in topical antimicrobial wound care management. Results: A review of burn sepsis is key to understanding current paradigms and innovation in burn management and prevention. Key management principles begin from the time of injury and persist throughout the patient's hospital course. This includes use of personal protective equipment, burn unit design considerations, and knowledge of critical care principles such as central venous catheter management strategies. Innovations on wound dressing types, forms, and use have been key to better controlling burn wound sepsis and improving wound healing. Products incorporating nanotechnology, novel anions, oxygen, and even light have been key to introducing previously unconsidered methods to fight or prevent infection. Conclusion: Understanding the pathophysiology and source identification of sepsis from burn wounds has been a key contributor in developing innovative prevention and therapeutic strategies in burn management. The emergence of drug-resistant pathogens and the difficulty of systemic antibiotic agents to reach poorly vascularized wounds have further reinforced the need to anticipate management strategies moving forward. A proactive, multidisciplinary approach is necessary to minimize the morbidity and mortality associated with infection control.

The Potential Value of Performing Preoperative Urinalysis Prior to Total Knee Arthroplasty

BackgroundAlthough the practice of checking a urinalysis prior to elective total knee arthroplasty (TKA) is relatively common, very little has been reported on the association between a preoperative urinary tract infection (UTI) and adverse events in primary TKA. The goal of this study is to investigate the risk of postoperative complication following TKA as it relates to preoperative UTI. MethodsPatients undergoing TKA were queried in the National Surgical Quality Improvement Program. Morbid events were classified as minor (transfusion, pneumonia, wound dehiscence, UTI, and renal insufficiency) and serious (wound infection, thromboembolic event, renal failure, myocardial infarction, prolonged ventilation, unplanned intubation, sepsis, and death). Risk factors for adverse events were analyzed in both univariate and multivariate fashion. ResultsA total of 203,851 patients undergoing TKA met inclusion criteria and 507 patients had a UTI present at time of surgery (UTI PATOS). A propensity matched analysis controlling for age, gender, body mass index, operative year, and American Society of Anesthesiologists score identified 507 patients without a UTI PATOS to serve as the control group. Following adjustment for baseline characteristics, operative year, and American Society of Anesthesiologists score, UTI PATOS was associated with increased risk for serious adverse events (odds ratio [OR] 2.746, 95% confidence interval [CI] 1.546-4.878, P = .0006), occurrence of any morbid event (OR 1.894, 95% CI 1.299-2.761, P = .0009), and reoperation (OR 4, 95% CI 2.592-6.169, P < .0001). ConclusionThis study suggests that a UTI present at time of TKA increases the risk of multiple postoperative complications and reoperation.

A review of the epidemiology, post-neurosurgical closure complications and outcomes of neonates with open spina bifida

Background. Spina bifida (SB) is a neural tube defect (NTD) that has an increased risk of fatal and disabling effects if not repaired early, i.e. within the first 24 to 48 hours of life. Its diagnosis holds an increased burden for the patient and the caregiver owing to secondary complications. The effects of the disease are detrimental even with early repair, because of the long-term disabling nature of the disease. Objective. This retrospective study aimed to assess the effects of demographics, immediate post-surgical complications and impact of time to surgical intervention on the outcome of neonates with open SB (OSB) admitted to the neonatal intensive care unit (NICU) at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal, South Africa (SA), between January 2011 and December 2015. Methods. A retrospective chart review was conducted at the NICU of IALCH. All neonates diagnosed with SB were identified. The study period was from 1 January 2011 to 31 December 2015. Data were collected from the IALCH electronic database. All neonates with SB admitted to the IALCH NICU were included; any patient who presented beyond the neonatal period (i.e. &gt;28 days) was excluded from the study. Data collected included maternal demographics. Additionally, neonatal history was reviewed and post surgery complications evaluated. Outpatient management post discharge was reviewed. Results. One hundred and fifty neonates were included (58% male). The mean (standard deviation) maternal age was 26.7 (6.6) years. Only 10% had an antenatal diagnosis of OSB. Seventy-eight percent were born at term and 22% prematurely. The lumbar/sacral region was the most commonly affected. More males (14%) had thoraco/lumbar lesions than females (7.8%). Forty-eight percent presented before 3 days of life (early presentation). In the late-presentation group, there was an association with wound sepsis ( p =0.003). Twenty-five percent were repaired between days 0 and 3 of life and 75% after 3 days. Postoperative complications in patients whose open SBs were repaired beyond 3 days of life were not statistically significant compared with those with early repair; all were p &gt;0.05. There was a borderline association of prolonged hospitalisation with wound sepsis ( p =0.07). Long-term outcomes showed that 68% had lower limb dysfunction, 18% urological complications, 14% limb deformity, and 11% hydrocephalus. A minority had psychomotor (7%) and developmental (15%) disorders. Ten percent required readmission secondary to shunt complications, and 7% died. Conclusion. SB remains a significant disease burden that affects outcome and survival of neonates in SA. Lack of good antenatal care, which includes early ultrasound and timely referral to centres, are barriers to good outcomes. Long-term follow-up is also necessary to prevent morbidity.

Study of negative pressure wound therapy in management of abdominal wound dehiscence

Background: Postlaparotomy Abdominal wound dehiscence (AWD) occurs in 0.25% to3%. Many technique are being used to manage AWD like surgical revision with open dressing/closed irrigation, temporary covering with ‘Bagota bag’, saline soak gause dressing, absorbable/permanent mesh. Negative-pressure wound therapy (NPWT) is a recent modality of treatment of wound. It involves controlled application of sub atmospheric pressure to local wound environment, using sealed wound dressing connected to vacuum pump. This study aimed at finding the effectiveness of negative pressure wound therapy in management of abdominal wound dehiscence over conventional methods of wound management.Methods: This was hospital based non randomised comparative prospective interventional study carried between July 2017 to November 2019, includes all patients admitted in GMCH, Nagpur Hospital having post laparotomy AWD, excluding the patients having enter ocutaneous fistula and patient not giving consent for VAC application. Total n=60 cases were included in study. Out of 60, 30 were taken as cases in whom intervention was done by applying vaccum assisted closure (VAC) therapy and 30 were control.Results: All 60 patients had undergone laparotomy of this patients 30 patients was applied NPWT and efficacy plotted on the parameter of, wound sepsis, wound contraction, length of hospital stay and extension of time therapy. It was found that 90% patients had negative c/s post VAC dressing, compared to 26% in post ns dressing, there was MWC of 0.86 cm in post VAC patients compared to 0.14 cm in post NS dressing, MHS was 18.9 days in cases and was 28 days in controls,13 patients had complete fascial closure in cases whereas none in controls.Conclusions: NPWT significantly reduces the hospital stay of patients, it causes faster and higher degree of wound contraction, reduces wound sepsis thereby reducing morbidity of patients.

Role of prophylactic antibiotics in elective surgeries and postoperative surgical infections

Background: Health care associated infections (HAIs) present a significant source of preventable morbidity and mortality. More than 30% of all HAIS are represented by surgical site infections (SSIs) making them most common sub types between 1.9% and 2.7% of all surgical patients. Joseph Lister “the man who made surgery safe” introduced antiseptic method for safe surgeries. As many are now considering antibiotics “wonder drug” which covers the surgical techniques and having asepsis. Extensive indiscriminate use of antibiotics has resulted in developing resistance.Methods: Study conducted in about 100 cases in various surgical units having various surgical procedures. Only clean cases are taken. A single stat dose of first generation cephalosporin 1gm given IV at the time of giving anesthesia. Postoperative any signs and symptoms like infections, fever with chills, wound discharge are observed. If any evidence of wound infection is present, accordingly sent for culture and sensitivity and suitable antibiotics are given.Results: In our study 5 patients had fever with serous discharge 2 patients showed no growth, 3 patients had got growth positive (2- staphylococcus aurous, 1- pseudomonas). Hence our infection rate is 3%.Conclusions: Single dose prophylaxis has got definite advantage to overcome the postoperative wound sepsis. Prolonged antibiotic therapy should be avoided as it has got no added advantaged over single dose antibiotic.

Effects of two dimensional gray-scale blood flow imaging combined with color Doppler flow imaging in guiding arterial puncture and catheterization through wounds in patients with large burns

Objective: To explore the effects of two dimensional gray-scale blood flow imaging (hereinafter referred to as " B-flow" ) combined with color Doppler flow imaging (CDFI) in guiding arterial puncture and catheterization through wounds in patients with large burns. Methods: Sixty-seven patients with large burns who met the inclusion criteria and hospitalized in the First Hospital of Jilin University from January 2017 to January 2019 were enrolled in the prospectively randomized control study. According to the random number table, CDFI alone group was allocated with 35 patients (23 males and 12 females) and B-flow+ CDFI group with 32 patients (22 males and 10 females), aged 19-60 and 18-58 years, respectively. According to the progress of the disease, arterial puncture and catheterization were performed in the right time. During the operation, CDFI was used alone for guidance in patients of CDFI alone group, while B-flow and CDFI were used together for guidance in patients of B-flow+ CDIF group. Based on the first time of catheterization, the catheterization location, one-time catheterization success rate, post-back stitching re-catheterization success rate, catheterization failure rate, catheterization duration, and incidences of wound sepsis, catheter-related bloodstream infection, and arterial thrombosis within post catheterization day (PCD) 3 of patients in the two groups were recorded. Data were statistically analyzed with the independent-sample t test, chi-square test or Fisher's exact probability test. Results: (1) All the patients underwent catheterization through wounds, and there was no statistically significant difference in catheterization location of patients between the two groups (χ(2)=0.574, P>0.05). The one-time catheterization success rate of patients in B-flow+ CDFI group was 81.25% (26/32), which was obviously higher than 51.43% (18/35) in CDFI alone group (χ(2)=6.594, P<0.05). The catheterization failure rate of patients in B-flow+ CDFI group was 3.12% (1/32), which was obviously lower than 20.00% (7/35) in CDFI alone group (P<0.05). The post-back stitching re-catheterization success rate of patients was similar between the two groups (χ(2)=1.029, P>0.05). (3) The catheterization duration of patients was (15.7±1.1) min in B-flow+ CDFI group, which was obviously shorter than (17.1±2.2) min in CDFI alone group (t=11.316, P<0.01). (4) Within PCD 3, the incidences of wound sepsis and catheter-related bloodstream infection of patients in CDFI alone group were 2.86% (1/35) and 0, close to 0 and 3.12% (1/32) in B-flow+ CDFI group (P>0.05); the incidence of arterial thrombosis of patients in B-flow+ CDFI group was 0, which was obviously lower than 20.00% (7/35) in CDFI alone group (P<0.05). Conclusions: Compared with CDFI alone, B-flow combined with CDFI can improve the success rate of arterial puncture and catheterization through wounds in large area burn patients, shorten the catheterization duration, and effectively reduce the incidence of arterial thrombosis after catheterization, with a good clinical application value.

Burn Infection and Burn Sepsis.

Background: Infection is the most common complication and cause of death in patients suffering burn injuries. These patients are susceptible to infection and burn wound sepsis secondary to the alterations in their physiology. Diagnosis and management of infections rely on physical examination, cultures, and the pathology of the burn wound. Method: We performed an electronic search for articles in the Google Scholar and PubMed databases using the search terms "burn sepsis," "burn infection," and "burn critical care." Results: Multiple factors increase burn patients' risk of invasive infection and sepsis, including underlying factors and co-morbidities, the percent total body surface area of the burn, delays in burn wound excision, and microbial virulence/bacterial count. Organisms causing burn wound infection differ, depending on the time since injury and its location; and diagnosis is multi-factorial. The most common pathogens remain Staphylococcus and Pseudomonas spp. Conclusion: Overall, the recognition of burn sepsis is based on clinical findings. Treatment consists of a combination of local dressings, early burn excision, and systemic antimicrobial therapy. The mortality rate has decreased significantly over the past 10 years, but continued efforts at timely management and infection prevention are essential.

Comparative study of cesarean section in secondary and tertiary healthcare levels

Objective To clarify the prevalence of cesarean section (CS) in Menoufia University Hospital and Menouf General Hospital regarding the rate, indications, and complications of CS. Background CS rate is rising worldwide with increasing concern especially in developed countries. It is associated with higher maternal and neonatal morbidity. Patients and methods This was a retrospective analytical study. The rates of CS in both Menoufia University Hospital and Menouf General Hospital were reviewed from 2013 to 2017, and detailed patient records in both hospitals were reviewed from January 2017 to December 2017. Robson Ten Group Classification System was applied to categorize the different indications of CS. Results There was a significant rise in CS rate in both hospitals every year. In Menoufia University Hospital, it increased from 48.50% in 2013 to 59.43% in 2017, and in Menouf General Hospital, it increased from 45.95% in 2013 to 53.50% in 2017. The most common indication in both hospitals was a previous CS. According to Robson Ten Group Classification System, the most common group in both hospitals was group five. The most common maternal complication in both hospitals was postpartum hemorrhage, but the rate of cesarean hysterectomy was more common in Menoufia University Hospital. Wound sepsis was more common in Menouf General Hospital than Menoufia University Hospital. Conclusion Rate of CS in Menoufia University Hospital is higher than Menouf General Hospital owing to its nature as a tertiary care and referral hospital for difficult and complicated cases.

Hyperoxemia reduces cerebrovascular accidents post coronary artery bypass graft surgery: a retrospective cohort study

Cerebrovascular accidents (CVAs) including strokes and transient ischaemic attacks (TIAs) form a major portion of perioperative morbidity in patients undergoing coronary artery bypass graft (CABG) surgery. The aim of this article was to: (I) to examine the relationship between providing increased intraoperative partial pressure of arterial oxygen (PaO 2 ) and the risk of perioperative CVA following CABG surgery; (II) to examine the relationship between intraoperative PaO 2 and other perioperative adverse outcomes. This was a retrospective cohort study involving 2,253 consecutive CABG patients located within a single cardiothoracic unit of a tertiary hospital. All patients underwent CABG surgery. A multivariate analysis was undertaken to assess the relationship between the PaO 2 (intra-operative mean and nadir) and its associated risk of perioperative CVA. Results were reported as odds ratios (OR) with 95% confidence interval (95% CI). There was a significant (but clinically limited) inverse correlation between average intra-operative PaO 2 and reducing peri-operative CVA (OR 0.99; P=0.029; 95% CI: 0.98–1.00), indicating a reduction in stroke risk with increasing PaO 2 . There was no significant association with PaO 2 nadir and CVA. There was no significant association between increasing hyperoxia and the following adverse events: pneumonia, prolonged postoperative ventilation, perioperative myocardial infarction or cardiac arrest, sternal wound infection, sepsis and renal failure. We report a significant inverse correlation between increasing average intra-operative PaO 2 and reducing peri-operative CVA. Further, hyperoxia was not associated with any adverse effects or infective outcomes. This finding is likely to have preventative and therapeutic implications through reducing stroke risk.

Post cardiac surgery sternal wound sepsis burden, risk factors and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A five-year experience

Purpose: Sternal wound infection (SWI) is associated with significant morbidity and mortality in post-operative cardiac patients. We aimed to describe the burden, risk factors and outcomes of SWI in post-operative paediatric cardiac patients at a tertiary children’s hospital. Methods: We conducted a retrospective record review of cardiac surgeries via median sternotomy over a 5-year period to identify cases of SWI. Results: Between 2011 and 2016, 1 319 patients underwent median sternotomy. Thirty four (2.6%) patients developed SWI; 18 (13%) patients developed deep sternal wound infection (DSWI), and 16 (12%) developed superficial sternal wound infections (SSWI). Twenty two (16%) of SWIs were apparent within a week postsurgery before discharge, and the remaining were readmitted post-discharge. Seven (0.5%) patients died from complications. Conclusion: Significant morbidity was associated with SWI. Furthermore, with a mortality rate of 20% in the case of DSWI, we strongly support quality improvement procedures such as the Sternal Wound Prevention Bundle (SWPB) that was introduced in late 2014. However, the rate of SWI implies that ongoing monitoring and evaluation of the SWPB is necessary and more stringent adherence to the protocol may result in better outcomes .

Comparison of outcomes between primary and secondary lung decortication

BackgroundWith the view to compare the outcomes between primary and secondary lung decortication, we examined all the patients admitted with empyema thoracis in our unit. The primary decortication was defined as a primary procedure, without prior attempt of pleural space evacuation with either chest tube or previous decortication. Secondary decortication was defined as a failed lung re-expansion after initial pleural space drainage or failed primary decortication. Anecdotally, secondary decortication is associated with increased complications and length of hospital stay. From literature search, there is currently no study that directly compared outcomes of these two procedures; hence, the rationale to conduct this study.MethodsAll patients presented to our unit with empyema thoracis from 1st January 2011–31st December 2014, were included in a retrospective quantitative descriptive study. A total number of 160 patients were analyzed and eighty patients underwent each of the procedures (primary and secondary decortication). A comparison of prospective outcomes of the two groups was made. Fisher Exact test was used to compare percentages including the rates of complications between primary and secondary decortication. Mean values were compared using the t-test. The frequencies of other variables were also determined.ResultsThere was significant statistical difference in the length of hospital stay (ICU and Ward) and between patients who underwent primary as opposed to secondary decortication. The frequencies of complications (chest wall abscess, recurrent empyema, wound sepsis and wound dehiscence) were higher for secondary decortication, but without statistical significance. There was significant statistical difference in terms of age, CD4 count (only for HIV patients) and Adenosine deaminase (ADA) between patients who underwent primary instead of secondary decortication.ConclusionsThe patient who underwent secondary lung decortication had a more prolonged hospital stay than those who had primary decortication. There were increased frequencies of complication in secondary decortication group, though without statistical significant difference (P=0.456). The patients who underwent secondary decortication had poor nutritional state compared to those who had primary decortication, with significant statistical difference (P=0.0370).

Interrupted Versus Continuous Suture Technique in End-to-End Stentless Biliary Reconstruction

Abstract Background: A wide variety of techniques to restore biliary-enteric continuity after biliary injuries, the biliary tree is most commonly anastomosed to the jejunum; either as (Roux-en-Y or a simple loop anastomosis) or less commonly to the duodenum. The anastomosis may be performed to the bile duct, common hepatic duct, 1st or 2nd order hepatic duct branches, or to the gallbladder. Anastomoses may be performed in an end-to-side or side-to-side fashion, using continuous or interrupted sutures. Stents may be deployed across the anas-tomosis. Aim of Study: Biliary strictures and injuries; present a surgical technical challenge for Hepato-biliary surgeons. High biliary strictures are difficult to treat and re-stenosis rates reported of 10 - 30% following corrective repair, Complication rates; mostly due to inflammation, ischemia and tension at the anastomosis site. A combined prospective and retrospective study to evaluate the outcome of bile duct reconstruction using a continuous and interrupted suture technique for anastomosis. A combined prospective and retrospective study to evaluate the outcome of bile duct reconstruction using a continuous and interrupted suture technique for anastomosis.. Patients and Methods: A total number of 30 patients presented with biliary injuries, biliary strictures or stenosis permitted for surgical interventions in a General Surgical Department of Al-Azhar University Hospitals from February 2015 to May 2019, 15 patients were performed by continuous suture as (Group A), and 15 patents performed by interrupted suture technique as (Group B). Data and Statistical Analysis: Data on our series of bile duct anastomosis with either distal biliary duct or small bowel performed including: Surgical procedure, diagnosis, co-morbidities, peri-operative morbidity, and clinical symptoms after repair, liver function tests and the need for surgical or radiological interventions following surgery were evaluated as a prospectively collected on an institutionally approved electronic database. Non-parametric data were described as median and range and parametric data as average and standard deviation. The outcome measures were assessed: peri-operative morbidity, clinical symptoms after repair, liver function tests and the need for surgical or radiological interventions following surgery.Results: End-to-ends Biliary reconstruction, Hepatico-, Choledocho jejnostomy anastomoses were performed. In (Group A) 15 patients underwent biliary reconstruction using the continuous suture technique. The median operative time was 140 minutes (range 60-300 minutes). Post-operative morbidity was present in three patients (12.5%), shows post-operative biliary leak, wound sepsis, post-operative fever in sequence. In 14 (98.25%) of the 15 patients, there has been no recurrence of jaundice, cholangitis or biliary dilatation on abdominal ultrasonography and liver function tests improved and have returned to normal without further surgical or radiological intervention. Out of anastomoses, there were two patients in (group A) who developed leakage, and 3 patients who developed a stricture for an incidence of 1.75% and 3.25% respectively. Our overall biliary complication rate was 4%, which is lower than previously reported. Conclusions: A continuous suture technique of biliary anastomoses results in an extremely low incidence of common significant complications.

A Systematic Approach to Perioperative Smoking Cessation

Background: There is compelling evidence that smoking leads to poor postoperative outcomes including increased incidence of wound infection, respiratory infection, sepsis, cardiac arrest, and mortality. There is also compelling evidence that smoking cessation before surgery leads to improved outcomes. A recent meta-analysis found that brief smoking interventions may be insufficient to change postoperative outcomes. However, more intensive evidence-based smoking cessation interventions do improve postoperative outcomes and lead to long-term smoking abstinence. From a healthcare perspective, this raises a question of how to best provide effective perioperative smoking cessation treatment to a population. Methods: Duke University Health System recently developed a systematic approach to perioperative smoking cessation. In this report, we outline evidence-based principles for perioperative smoking cessation and describe initial results from a perioperative smoking cessation program. Results: In the first 100 days of the Duke Perioperative Smoking Cessation Program, we received 420 referrals. Participants had a mean pack-year history of 50.3 (packs/day×years smoking; SD 32.5), a mean Fagerström Test for Nicotine Dependence score of 4.5 (SD 2.5), and a mean expired breath carbon monoxide of 11.8 (SD 7.5) parts per million. Mean days from initial perioperative smoking cessation visit to surgery was 21.4 (SD 22.3). Discussion: This model of perioperative smoking cessation is in the early stages of development; however, evidence-based perioperative smoking cessation services can be effective across a health system.

The Prevalence, Risk Factors, and Bacterial Profile of Cesarean Surgical Site Infections at a University Teaching Hospital in South Western Uganda

Introduction: The single most important risk factor for post-partum maternal infection is Cesarean section (C/S) with a 5-20-fold greater risk for infection compared to a vaginal delivery. Post Cesarean wound infection is diagnosed in 2.5 to 16 percent of patients. Early wound infections (in the first 24 to 48 hours) are usually due to group A or B beta-hemolytic streptococcus and are characterized by high fever and cellulitis while later infections are likely due to Staphylococcus epidermises or aureus, Escherichia coli, or Proteus species. Objectives: To determine the prevalence, risk factors and bacterial profile of wound sepsis following Cesarean at Mbarara Regional Referral Hospital (MRRH). Methods: A cross sectional study of mothers who delivered by Cesarean at MRRH was conducted. Mothers were recruited consecutively until the sample size was achieved. The main dependent variable was wound sepsis confirmed by a positive culture for microorganisms. Results: Of the 359 mothers recruited in the study, 54 (15.5%) developed Cesarean wound sepsis. The risk factors associated with post Cesarean wound sepsis were severe anemia, lack of preoperative antibiotics use, poor antenatal attendance, mothers referred from peripheral health facilities, abnormal Body Mass Index (BMI), diabetes mellitus, more than five vaginal examinations, prolonged rupture of membranes before C/S, and prolonged labour. Staphylococcus aureus was isolated in 48.2% of all the septic cases and most of the bacterial isolates were susceptible to ceftriaxone, ceftazidime, ciprofloxacin and nalidixic acid and resistant to penicillin. Conclusion: The prevalence of post Cesarean wound sepsis is high with staphylococcus aureus being the most common bacteria isolated in infected wounds. Most of the bacteria were susceptible to third generation cephalosporins and quinolones. Antibiotics use was protective against developing wound sepsis.

Circulation of Vancomycin-Resistant Enterococci in Health Facilities of the Karachay-Cherkess Republic

Introduction. Gram-positive enterococci are an integral part of the normal intestinal microflora. However, if they get into wounds or sterile cavities of the body, they may induce various diseases including wound infections, urethritis, peritonitis, sepsis, pyelonephritis, or damage other organs. These microorganisms also induce nosocomial infections and are among the causative agents of health care-associated infections (HAIs); thus, it is critical to control the spread of enterococci. Our purpose was to monitor circulation of vancomycin-resistant enterococci (VRE) in health facilities of the Karachay-Cherkess Republic (KCR) in 2016-2018. Materials and methods. We studied VRE strains isolated in the Microbiological Laboratory of the Center for Hygiene and Epidemiology in the Karachay-Cherkess Republic. During three years, the total of 281 strains of vancomycin-resistant enterococci were isolated from various biological materials received from obstetric, surgical, pediatric, and therapeutic hospitals and from outpatients undergoing treatment in polyclinics of the Karachay-Cherkess Republic. Results. According to our data, VRE rates per 100 examined patients were 2.34 in 2016, 3.4 in 2017, and 3.03 in 2018, and were comparable to the rates registered in the Russian Federation in the range of 3% to 22.7%. Discussion. When analyzing circulation of vancomycin-resistant enterococci, we established that the highest VRE rate (4.24 per 100 examined patients) was observed in maternity hospitals, while the lowest rate of 0.67% was observed in therapeutic departments. When studying sensitivity of 281 isolated VRE strains to eight antibacterial drugs, no strain resistant to all antibiotics was revealed. Sensitivity to linezolid, ampicillin, and penicillin was observed in 92.6%, 79.0%, and 66.2% of strains. Sensitivity to ciprofloxacin, gentamicin, tetracycline, and nitrofurantoin was 50% or less. VRE were mainly isolated from urine and discharge from the cervical canal and pharynx.

A perspective in the management of myelomeningocoele in the KwaZulu-Natal Province\xa0of South Africa

BackgroundMyelomeningocoele (MMC) is common in the developing world. The purpose of this study was to investigate the clinical characteristics and management of myelomeningocoele and to identify factors contributing to outcomes.MethodsThis was a retrospective, observational study of consecutive children diagnosed with MMC managed in the Paediatric Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital. Multiple logistic regression analysis identified clinical characteristics, demographics and surgical variables that were associated with outcome.ResultsA total of 309 children were managed during this period (M:F 1.3:1). The most common sites were lumbar, lumbo-sacral and sacral. Mean age at surgical repair was 4.7 ± 15.6 months. Two hundred and eight children had ventriculomegaly, of whom 158 had symptomatic hydrocephalus, requiring CSF diversion. Fifty-eight (21%) patients developed wound sepsis, of whom 13 (22%) developed meningitis (p = 0.001). The time to wound sepsis was 9.5 ± 3.6 days. The commonest organism isolated was Staphylococcus aureus followed by MRSA. Thirty-two patients (23%) developed shunt malfunction and three (11%) developed ETV malfunction. Twenty children (9%) demised during the admission period. Death was associated with meningitis (p < 0.0001), and meningitis itself was associated with wound sepsis (p < 0.0001). Hospital stay was 20.4 ± 16 days. Wound sepsis (p = 0.002) and meningitis (p < 0.0001), respectively, were associated with prolonged hospital stay.ConclusionThere was a slight male preponderance and hydrocephalus occurred in two thirds of cases. Wound sepsis and meningitis were associated poor outcomes.

Assessment of post operative complication in patients underwent splenectomy

Background: Splenectomy is usually performed for patients with severe splenic trauma. The present study assessed complication in patients of splenectomy. Materials & Methods: The present study was conducted on 125 patients of both genders who underwent splenectomy. In all cases laparoscopic splenectomy was performed as per standardized operating procedure. Post operative complications were recorded Results: Out of 125 patients, males were 70 and females were 55. The operative time was 134.2 minutes, transfusion was required in 45 patients and hospital stay was 4.2 days. Complications were hemoperitoneum in 2, pneumonia in 1, wound sepsis in 6, urinary infection in 2, atelactasis in 1, catheter sepsis in 2 and post operative ileus in 4 patients. The difference was significant (p< 0.05). Conclusion: Authors found that common complications were hemoperitoneum, pneumonia, wound sepsis, urinary infection, atelactasis, catheter sepsis and post operative ileus.

Factors affecting occurrence of post intubation and post tracheostomy tracheal stenosis in intensive care units

Objective: Iatrogenic tracheal stenosis is a life threatening iatrogenic complication of prolonged endotracheal intubation and tracheostomy in intensive care units (ICUs). It is one of the toughest morbidities in otolaryngology.Aim of the Study: This prospective observational study was conducted to detect the factors affecting occurrence of tracheal stenosis in patients subjected to tracheostomy after endotracheal intubation in ICUs.Patients and Methods: Sixty eight patients were included in this prospective study. They were admitted to (ICUs) and were subjected to endotracheal intubation, mechanical ventilation and tracheostomy due to prolonged intubation during their stay in (ICUs). The patients were followed up after being discharged for six months to detect incidence and factors affecting occurrence of tracheal stenosis. They were followed up using flexible fiber optic tracheobronchoscopy under local anesthesia, just after weaning from mechanical ventilation three and six months later.Results: Of the studied patients, 50 patients had no tracheal stenosis until the end of follow up period (without tracheal stenosis (WTS) group) while, 18 patients had tracheal stenosis (TS group). The mean duration of mechanical ventilation in WTS group (12.1 ± 7.6 days) was statistically shorter than that of TS groups (16.6 ± 10.4 days) (P = 0.048). Tracheostomy stoma wound sepsis was recorded in 4 patients in TS group and in 2 patients in WTS group.Conclusion: The main predisposing factors for post intubation and post tracheostomy tracheal stenosis are tracheostomy stomal wound sepsis and prolonged duration of mechanical ventilation. In contrary, tracheal cartilage injury during tracheostomy, age, sex and reason for mechanical ventilation was found to have no role in occurrence of tracheal stenosis.