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Takeda M, Morita Y, Akai T, Murakami T, Booka E, Matsumoto T, Katahashi K, Takaoka M, Kikuchi H, Hiramatsu Y, Inuzuka K, Kurachi K, Takeuchi H. Effects of povidone-iodine wound irrigation on surgical site infection in gastroenterological surgery: A randomized controlled trial. Surgery 2024; 176:371-378. [PMID: 38825398 DOI: 10.1016/j.surg.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The irrigation efficacy of a povidone-iodine solution to prevent surgical site infection is still controversial. We assessed the irrigation effect with a povidone-iodine solution on the incidence of surgical site infection after gastroenterological surgery. METHODS This study is a single-center, prospective, randomized, blinded-end point superiority trial for surgical wound irrigation. Patients undergoing gastroenterological surgery were randomly assigned in a 1:1 replacement ratio using computer-generated randomization. Patients were grouped according to their surgical wound treatment into the control group using the normal sterile saline and the povidone-iodine group using 10% povidone-iodine solution after the NS solution. The main finding was 30-day surgical site infections assessed in the full analysis set. RESULTS From November 2020 to December 2022, 697 of 894 patients were eligible for the study, among which 347 were in the povidone-iodine group and 350 in the control group. Thirty-day surgical site infections occurred in 100 (14%) patients-54 (16%) in the povidone-iodine group and 46 (13%) in the control group (odds ratio, 1.229; 95% CI, 0.800-1.889; P = .406). Superficial incisional surgical site infections occurred in 30 (9%) and 15 (4%) patients, respectively (odds ratio, 2.154; 95% CI, 1.134-4.090; P = .026). Only 3 patients (1%) in the control group developed adverse skin reactions. CONCLUSION This study examined the irrigation efficacy of povidone-iodine for surgical site infection prevention compared to control in gastroenterological surgery. Povidone-iodine wound irrigation has shown no additional beneficial effect on the occurrence of surgical site infections.
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Affiliation(s)
- Makoto Takeda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiya Akai
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Murakami
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuto Katahashi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masayo Takaoka
- Data Ops Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunori Inuzuka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Krane F, Heck VJ, Leyendecker J, Klug K, Klug A, Hackl M, Kircher J, Müller LP, Leschinger T. The Future of Total Elbow Arthroplasty: A Statistical Forecast Model for Germany. Healthcare (Basel) 2024; 12:1322. [PMID: 38998857 PMCID: PMC11241371 DOI: 10.3390/healthcare12131322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
This study provides a statistical forecast for the development of total elbow arthroplasties (TEAs) in Germany until 2045. The authors used an autoregressive integrated moving average (ARIMA), Error-Trend-Seasonality (ETS), and Poisson model to forecast trends in total elbow arthroplasty based on demographic information and official procedure statistics. They predict a significant increase in total elbow joint replacements, with a higher prevalence among women than men. Comprehensive national data provided by the Federal Statistical Office of Germany (Statistisches Bundesamt) were used to quantify TEA's total number and incidence rates. Poisson regression, exponential smoothing with Error-Trend-Seasonality, and autoregressive integrated moving average models (ARIMA) were used to predict developments in the total number of surgeries until 2045. Overall, the number of TEAs is projected to increase continuously from 2021 to 2045. This will result in a total number of 982 (TEAs) in 2045 of mostly elderly patients above 80 years. Notably, female patients will receive TEAs 7.5 times more often than men. This is likely influenced by demographic and societal factors such as an ageing population, changes in healthcare access and utilization, and advancements in medical technology. Our projection emphasises the necessity for continuous improvements in surgical training, implant development, and rehabilitation protocols.
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Affiliation(s)
- Felix Krane
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Vincent Johann Heck
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jannik Leyendecker
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Kristina Klug
- Department of Psychology, Goethe-University Frankfurt, Theodor-W.-Adorno Platz 6, PEG, 60629 Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Michael Hackl
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jörn Kircher
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Admiralitätstrasse 3-4, 20459 Hamburg, Germany
- Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
| | - Lars Peter Müller
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Tim Leschinger
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Zhang H, Zhao Y, Du Y, Yang Y, Zhang J, Wang S. Early mobilization can reduce the incidence of surgical site infections in patients undergoing spinal fusion surgery: A nested case-control study. Am J Infect Control 2024; 52:644-649. [PMID: 38232902 DOI: 10.1016/j.ajic.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND To examine the influence of early mobilization on the risk of surgical site infections (SSI) in patients undergoing spinal fusion surgery. METHODS The retrospective cohort consisted of all consecutive patients who underwent spinal fusion surgery at our institution. For each case of SSI, 2 control patients without SSI at the corresponding index date were selected. Mobilization was predefined as "delayed" if it occurred more than 36 hours postoperatively. To account for potential confounding variables, we performed further adjustments using conditional logistic regression models. Subgroup analyses were conducted to evaluate the robustness of the statistical associations. RESULTS Following the predefined statistical protocol and matching criteria, we matched 236 control cases to the SSI cases. Upon adjustment for confounding factors, our findings revealed that the risk of SSI was 120% higher in the group beginning mobilization more than 36 hours after surgery compared to the group beginning mobilization within 36 hours postoperatively (odds ratio = 2.206, 95% confidence interval 1.169-4.166, P = .015). In subgroup analyses, this statistical trend remained consistent. CONCLUSIONS Early mobilization within 36 hours following spinal fusion surgery significantly reduces the risk of SSI. This pattern of reduced risk remains consistent among patients with degenerative diseases or spinal deformities.
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Affiliation(s)
- Haoran Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Zhang H, Zhao Y, Du Y, Yang Y, Zhang J, Wang S. Optimal time window for initiating cefuroxime surgical antimicrobial prophylaxis in spinal fusion surgery: a nested case-control study. Spine J 2024; 24:961-968. [PMID: 38301900 DOI: 10.1016/j.spinee.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND CONTEXT Surgical site infections (SSI) are one of the common complications following spinal fusion surgery. Unfortunately, several studies had shown conflicting results regarding optimal timing of surgical antimicrobial prophylaxis (SAP) administration. Due to limitations in population homogeneity and sample size, these studies have not provided significant statistical correlations or clear practical recommendations. PURPOSE The purpose of the study was to investigate the impact of timing of cefuroxime SAP on the risk of SSI in patients undergoing spinal fusion surgery, and to determine the optimal timing of administration. DESIGN Retrospective nested case-control study. PATIENT SAMPLE We retrospectively analyzed consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021. OUTCOME MEASURE In the current study, the primary outcome measure was SSI. METHODS This was a retrospective nested case-control study. All consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021 formed a retrospective cohort. For each SSI case, 2 controls free of SSI at the time of the index date of their corresponding case were selected, matched by age, sex, and calendar year. Electronic record and radiographic data were reviewed retrospectively in electronic database. SAP related data included timing of administration, preoperative dose, intraoperative second dose, and postoperative use. To examine the effects of mismatched variables, we further adjusted for possible confounding factors using conditional logistic regression models. Subsequently, subgroup analyses were conducted to assess the robustness of the statistical associations. RESULTS According to the preplanned statistical scheme and matching factors, we matched 236 controls for these SSI cases, and the subsequent statistical analysis was performed on these 354 patients. After adjusting for confounding factors, the results indicated that the risk of SSI was 70% higher in the group receiving SAP 31 to 60 minutes before incision compared to the group receiving SAP 0 to 30 minutes before incision (OR=1.732, 95%CI 1.031-2.910, p=.038). Additionally, the risk of SSI was 150% higher in the group receiving SAP 61 to 120 minutes before incision compared to the group receiving SAP 0 to 30 minutes before incision (OR=2.532, 95%CI 1.250-5.128, p=.010). In subgroup analysis, this statistical trend persisted for both deformity surgeries and different SSI classifications. CONCLUSION Administering cefuroxime SAP within 30 minutes before skin incision significantly reduces the risk of SSI, whether they are deep or superficial, in spinal fusion surgery. This pattern remains consistent among spinal deformity patients.
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Affiliation(s)
- Haoran Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, China
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1st Shuai Fu Yuan, Dongcheng District, Beijing, China.
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Egerci OF, Yapar A, Dogruoz F, Selcuk H, Kose O. Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05301-w. [PMID: 38635048 DOI: 10.1007/s00402-024-05301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
The increasing frequency of total hip (THA) and knee arthroplasties (TKA) is marred by the rise in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with PJIs incurring costs over $1.62 billion as of 2020 and individual case management averaging $90,000. SSIs additionally burden the U.S. healthcare economy with billions in expenses annually. PJI prevalence in primary THA and TKA ranges from 0.5% to 2.4%, spiking to 20% in revisions and representing 25% of TKA revision causes. Projections estimate up to 270,000 annual PJI cases by 2030. Often caused by gram-positive bacteria, particularly methicillin-resistant staphylococci, these infections demand preventive measures. This review dissects PJI prevention across preoperative, intraoperative, and perioperative phases, aligning with evidence-based CDC and WHO guidelines. Preoperative measures include managing diabetes, obesity, tobacco use, Staphylococcus aureus screening and nasal decolonization, nutritional optimization, and management of inflammatory arthropathies. Intraoperatively, antibiotic prophylaxis, skin preparation, operative room environmental controls, surgical technique precision, and irrigation options are scrutinized. Perioperative concerns focus on anticoagulation, blood management, and infection risk mitigation. Integrating these strategies promotes a patient-centric care model, aiming to reduce PJI incidence, improve patient outcomes, and increase care cost-effectiveness in joint arthroplasty.
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Affiliation(s)
- Omer Faruk Egerci
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Aliekber Yapar
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey.
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Pugazhendhi AS, Seal A, Hughes M, Kumar U, Kolanthai E, Wei F, Schwartzman JD, Coathup MJ. Extracellular Proteins Isolated from L. acidophilus as an Osteomicrobiological Therapeutic Agent to Reduce Pathogenic Biofilm Formation, Regulate Chronic Inflammation, and Augment Bone Formation In Vitro. Adv Healthc Mater 2024; 13:e2302835. [PMID: 38117082 DOI: 10.1002/adhm.202302835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/31/2023] [Indexed: 12/21/2023]
Abstract
Periprosthetic joint infection (PJI) is a challenging complication that can occur following joint replacement surgery. Efficacious strategies to prevent and treat PJI and its recurrence remain elusive. Commensal bacteria within the gut convey beneficial effects through a defense strategy named "colonization resistance" thereby preventing pathogenic infection along the intestinal surface. This blueprint may be applicable to PJI. The aim is to investigate Lactobacillus acidophilus spp. and their isolated extracellular-derived proteins (LaEPs) on PJI-relevant Staphylococcus aureus, methicillin-resistant S. aureus, and Escherichia coli planktonic growth and biofilm formation in vitro. The effect of LaEPs on cultured macrophages and osteogenic, and adipogenic human bone marrow-derived mesenchymal stem cell differentiation is analyzed. Data show electrostatically-induced probiotic-pathogen species co-aggregation and pathogenic growth inhibition together with LaEP-induced biofilm prevention. LaEPs prime macrophages for enhanced microbial phagocytosis via cathepsin K, reduce lipopolysaccharide-induced DNA damage and receptor activator nuclear factor-kappa B ligand expression, and promote a reparative M2 macrophage morphology under chronic inflammatory conditions. LaEPs also significantly augment bone deposition while abating adipogenesis thus holding promise as a potential multimodal therapeutic strategy. Proteomic analyses highlight high abundance of lysyl endopeptidase, and urocanate reductase. Further, in vivo analyses are warranted to elucidate their role in the prevention and treatment of PJIs.
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Affiliation(s)
| | - Anouska Seal
- Biionix Cluster, University of Central Florida, Orlando, FL, 32827, USA
| | | | - Udit Kumar
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center (NSTC), University of Central Florida, Orlando, FL, 32826, USA
| | - Elayaraja Kolanthai
- Advanced Materials Processing and Analysis Centre, Nanoscience Technology Center (NSTC), University of Central Florida, Orlando, FL, 32826, USA
| | - Fei Wei
- Biionix Cluster, University of Central Florida, Orlando, FL, 32827, USA
| | | | - Melanie J Coathup
- Biionix Cluster, University of Central Florida, Orlando, FL, 32827, USA
- College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
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Rooha A, Shetty S, Bajaj G, Jacob NL, George VM, Bhat JS. Development and validation of educational multimedia to promote public health literacy about healthy cognitive aging. Health Expect 2023; 26:2571-2583. [PMID: 37635370 PMCID: PMC10632613 DOI: 10.1111/hex.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVES Health literacy (HL) about healthy cognitive aging is essential in preventing cognitive decline and promoting cognitive well-being. It is important that one such HL module should be scientifically designed, delivered in a technically sound manner to the audience, and specific to the context. The present study thus aimed at developing and validating educational multimedia about cognitive health. METHODS The study followed a methodological framework and was carried out across three phases, that is, identification of themes, development and validation of educational script and design, and validation of educational multimedia. The module was scripted based on the Integrated HL framework and the recommendations made during the modified nominal group technique among the research team. Seven speech-language pathologists (SLPs), with expertise in the field of cognitive sciences, and 15 representatives of the general public validated the module using the Educational Content Validation Instrument in Health and the Patient Education Materials Assessment Tool for Audiovisual Materials questionnaire. RESULTS The scientific content of the educational script received satisfactory agreements among the experts (content validity index [CVI]: 0.93) and representatives of the general public (CVI: 0.86). The technical aspects of the educational multimedia were rated to have high understandability (experts: 92.8%; representatives of general public: 98.8%) and actionability (experts and representatives of general public 100%). CONCLUSION Overall, the developed educational multimedia scored optimally with respect to the objective, structure, relevance of the content, actionability and understandability of the multimedia. The developed module holds the potential to be used at community and national level health educational programs or awareness campaigns to enhance public knowledge and beliefs pertaining to cognitive health. PATIENT OR PUBLIC CONTRIBUTION SLPs with expertise in the field of cognitive science and representatives from the general public were included to validate and obtain feedback on the developed educational multimedia.
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Affiliation(s)
- Aysha Rooha
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Shreya Shetty
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Gagan Bajaj
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Nidhi L. Jacob
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Vinitha M. George
- Department of Audiology and Speech Language PathologyNational Institute of Speech and HearingTrivandrumKeralaIndia
| | - Jayashree S. Bhat
- Department of Audiology and Speech Language PathologyNitte Institute of Speech and Hearing, DeralakatteMangaloreKarnatakaIndia
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Schmökel H. Balancing the prevention of surgical site infections with responsible antimicrobial use in companion animal practice. Vet Rec 2023; 192:330-331. [PMID: 37084223 DOI: 10.1002/vetr.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Hugo Schmökel
- Evidensia Specialist Animal Hospital, Strömsholm, Sweden
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Caldwell M, Hughes M, Wei F, Ngo C, Pascua R, Pugazhendhi AS, Coathup MJ. Promising applications of D-amino acids in periprosthetic joint infection. Bone Res 2023; 11:14. [PMID: 36894568 PMCID: PMC9998894 DOI: 10.1038/s41413-023-00254-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
Due to the rise in our aging population, a disproportionate demand for total joint arthroplasty (TJA) in the elderly is forecast. Periprosthetic joint infection (PJI) represents one of the most challenging complications that can occur following TJA, and as the number of primary and revision TJAs continues to rise, an increasing PJI burden is projected. Despite advances in operating room sterility, antiseptic protocols, and surgical techniques, approaches to prevent and treat PJI remain difficult, primarily due to the formation of microbial biofilms. This difficulty motivates researchers to continue searching for an effective antimicrobial strategy. The dextrorotatory-isoforms of amino acids (D-AAs) are essential components of peptidoglycan within the bacterial cell wall, providing strength and structural integrity in a diverse range of species. Among many tasks, D-AAs regulate cell morphology, spore germination, and bacterial survival, evasion, subversion, and adhesion in the host immune system. When administered exogenously, accumulating data have demonstrated that D-AAs play a pivotal role against bacterial adhesion to abiotic surfaces and subsequent biofilm formation; furthermore, D-AAs have substantial efficacy in promoting biofilm disassembly. This presents D-AAs as promising and novel targets for future therapeutic approaches. Despite their emerging antibacterial efficacy, their role in disrupting PJI biofilm formation, the disassembly of established TJA biofilm, and the host bone tissue response remains largely unexplored. This review aims to examine the role of D-AAs in the context of TJAs. Data to date suggest that D-AA bioengineering may serve as a promising future strategy in the prevention and treatment of PJI.
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Affiliation(s)
- Matthew Caldwell
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Megan Hughes
- School of Biosciences, Cardiff University, CF10 3AT, Wales, UK
| | - Fei Wei
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Christopher Ngo
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Raven Pascua
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Abinaya Sindu Pugazhendhi
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Melanie J Coathup
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA.
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Turkki OM, Sunesson KW, den Hertog E, Varjonen K. Postoperative complications and antibiotic use in dogs with pyometra: a retrospective review of 140 cases (2019). Acta Vet Scand 2023; 65:11. [PMID: 36879277 PMCID: PMC9987112 DOI: 10.1186/s13028-023-00670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Pyometra is commonly seen in intact bitches and is usually treated by ovariohysterectomy. Few studies have reported the frequency of postoperative complications, particularly beyond the immediate postoperative period. Swedish national antibiotic prescription guideline provides suggestions about which antibiotics should be used and when in individuals undergoing surgery. Studies on how well clinicians adhere to these guidelines, and on the outcome for these patients, have not been evaluated for cases of canine pyometra. This retrospective study conducted at a private Swedish companion animal hospital assessed complications that developed within 30 days of pyometra surgery, and whether clinicians followed the current national guidelines in regard to antibiotic use. We also assessed whether antibiotic use affected the rate of postoperative complications seen in this cohort of dogs, where antibiotics were predominantly used in cases presenting with a more severely depressed general demeanour. RESULTS The final analysis included 140 cases, 27 of which developed complications. In total, 50 dogs were treated with antibiotics before or during surgery and in 90 cases, antibiotics were either not given at all or treatment was initiated postoperatively (9/90) due to a perceived risk of infection developing. Superficial surgical site infection was the most common complication, followed by an adverse reaction to the suture material. Three dogs died or were euthanised during the immediate postoperative period. Clinicians adhered to national antibiotic prescription guidelines on when antibiotics should be given in 90% of cases. SSI only developed in dogs that were not given pre- or intra-operative antibiotics, while suture reactions did not appear to be affected by antibiotic use. Ampicillin/ amoxicillin was used in 44/50 cases given antibiotics before or during surgery, including most cases showing signs of concurrent peritonitis. CONCLUSION Serious complications following the surgical treatment of pyometra were uncommon. Excellent adherence to national prescription guidelines was observed (90% of cases). SSI was relatively common and only seen in dogs that were not given antibiotics before or during surgery (10/90). Ampicillin/ amoxicillin was an effective first choice antimicrobial in cases requiring antibiotic treatment. Further studies are needed to identify cases benefiting from antibiotic treatment, as well as the duration of treatment needed to reduce the infection rate while also avoiding unnecessary preventive treatment.
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Affiliation(s)
- Outi Marita Turkki
- AniCura Small Animal Hospital Bagarmossen, Ljusnevägen 17, 12848, Bagarmossen, Sweden.
| | | | - Erik den Hertog
- Hertog Veterinary Research Support, Achterweteringseweg 30, 3738 MA, Maartensdijk, the Netherlands
| | - Katarina Varjonen
- AniCura Small Animal Hospital Albano, Rinkebyvägen 21B, 18236, Danderyd, Sweden
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Prevention Techniques Have Had Minimal Impact on the Population Rate of Prosthetic Joint Infection for Primary Total Hip and Knee Arthroplasty: A National Database Study. J Arthroplasty 2023; 38:1131-1140. [PMID: 36858132 DOI: 10.1016/j.arth.2023.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Several studies over the years have offered modalities that may greatly decrease the rate of periprosthetic joint infection when implemented. As a result, one would expect a drastic decrease in infection rate among the implementing population with its widespread use. The purpose of this study was to assess whether there exists a decrease in infection rate over time, after accounting for available confounding variables, within a large national database. METHODS A large national database from 2005 to 2019 was queried for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). In total, 221,416 THAs and 354,049 TKAs were performed over the study period. Differences in 30-day infection rate were assessed with time and available preoperative risk factors using multinominal logistic regressions. RESULTS Rate of infection overall trended downward for both THA and TKA. After accounting for confounding variables, odds of THA infection marginally decreased over time (odds ratio 0.968 [0.952-0.985], P < .0001), while the odds of a TKA infection marginally increased with time (odds ratio 1.037 [1.020-1.054], P < .0001). CONCLUSION Individual peer-reviewed publications have presented infection control modalities demonstrating dramatic decreases in infection rate while analysis at a population level shows almost no changes in infection rate over a 15-year time period. This study supports continued investigation for influential modalities in preventing periprosthetic joint infection and care in patient selection for primary hip and knee arthroplasty.
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Impact of Preoperative Quality of Life and Related Factors on the Development of Surgical Site Infections Following Primary Total Joint Arthroplasty: A Prospective Case-Control Study with a Five-Year Follow-Up. Adv Orthop 2023; 2023:7010219. [PMID: 36777623 PMCID: PMC9911246 DOI: 10.1155/2023/7010219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction As surgical site infections (SSIs) after joint arthroplasty contribute to increased morbidity and mortality, they require further surgical intervention, prolonged hospitalisation, and antimicrobial treatment. The aim of our study is to examine the association between preoperative quality of life (QoL) and other predictive factors on the development of SSIs after primary arthroplasty. Methods This is a prospective study that enrolled 56 patients with hip and knee primary osteoarthritis who underwent joint replacement. Data were collected from January to March 2017, including patient demographic characteristics, comorbidities, laboratory results, and perioperative clinical data. The patients' QoL was evaluated preoperatively by applying the knee injury and osteoarthritis outcome score (KOOS) and the hip disability and osteoarthritis outcome score (HOOS) for total knee replacement (TKR) and total hip replacement (THR), respectively. A 5-year follow-up was conducted to assess the clinical status of the patients. Results 66.1% of patients underwent TKR, with 4.9 ± 1.2 days of hospitalisation, 16% of them required autologous blood transfusion, while 33.9% of patients were treated with THR, with 5.7 ± 1 days hospitalisation and 36.8 of them required this type of transfusion. 16 patients were diagnosed with SSIs, with the older of them (>65 years old) presenting lower probability (odds ratio: 0.13, 95% CI: 0.03-0.62) requiring treatment with additional antibiotics, while revision surgery was performed in 3 of these cases, following periprosthetic joint infection (PJI). Overall preoperative QoL was not statistically associated with SSIs, but low QoL scores were associated with higher rates of SSIs and increased levels of postoperative pain (p = 0.009 < 0.05). Conclusions The duration of each operation (>90 min), the length of hospitalisation (>4 days), and the presence of comorbidities including hypothyroidism and recurrent urinary tract infections were associated with a high risk for SSIs following arthroplasties. On the contrary, this study revealed no association between other comorbidities, including heart coronary disease, hypertension, and diabetes mellitus, with close monitoring of plasma glucose and SSIs. Moreover, the younger the patients, the more likely they were to require treatment with antibiotics. Overall, high QoL index scores were mainly accompanied by low rates of postoperative SSIs and pain.
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13
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Knee Arthroscopy After Prior Total Knee ArthroplastyType of Study: Narrative Review. J Am Acad Orthop Surg 2023; 31:57-63. [PMID: 36580044 DOI: 10.5435/jaaos-d-21-01094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/19/2022] [Indexed: 12/30/2022] Open
Abstract
Total knee arthroplasty (TKA) results in substantial improvement for most patients with end-stage arthritis of the knee; however, approximately 20% of patients have an unsatisfactory result. Although many problems contributing to an unsatisfactory result after TKA are best addressed by revision TKA, some problems may be effectively addressed with arthroscopic treatment. The categories of pathology that can be addressed arthroscopically include peripatellar soft-tissue impingement (patellar clunk syndrome and patellar synovial hyperplasia), arthrofibrosis, and popliteus tendon dysfunction. Recognizing these disease entities and the role of arthroscopic surgery in the treatment of these lesions may be helpful in achieving a good outcome in certain patients who are unsatisfied with their knee arthroplasty.
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14
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Israel SK, Jaramillo E, Liska WD. Preclosure povidone-iodine lavage in total hip replacement surgery: Infection outcomes and cost-benefit analysis. Vet Surg 2023; 52:33-41. [PMID: 36411945 DOI: 10.1111/vsu.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/16/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report the outcomes and cost-benefit analysis of preclosure povidone-iodine lavage (PrePIL) used to reduce the risk of infection following total hip replacement (THR) surgery. STUDY DESIGN Retrospective study. ANIMALS One thousand six hundred ninety-nine dogs, 17 cats. METHODS The medical records of 2213 consecutive THR cases were reviewed to determine the incidence of infection. The last 102 were treated with PrePIL using a commercially sourced 0.035% povidone-iodine solution. Postoperative infection rates were compared. A cost-benefit analysis was used to calculate if a PrePIL protocol is economically feasible. RESULTS Twenty-one THRs out of 2111 (0.99%) that did not have PrePIL developed infection. Infection occurred in none of the 102 PrePIL cases. Cost analysis revealed a PrePIL break-even cost at $49.74 and a break-even infection rate of 0.949%. No complications were identified related to the use of PrePIL. CONCLUSION Preclosure povidone-iodine lavage appeared to be efficacious in lowering THR infection rates, and it appeared to be safe for this use based on our 102 consecutive cases. The cost of the PrePIL was minimal compared to the overall cost to resolve THR infection and the potential effect on hip function prognosis. The math formulas developed can be used by surgeons to calculate cost effectiveness and break-even cost based on their THR infection rate, and to compare to the cost of a THR revision and infection resolution. CLINICAL SIGNIFICANCE At current costs, PrePIL can be used in 2415 THR cases at a similar cost of a single revision surgery and resolution of a periprosthetic infection.
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15
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Effect of commonly used lavage solutions on the polymerization of bone cement. Orthop Traumatol Surg Res 2022; 108:103243. [PMID: 35158106 DOI: 10.1016/j.otsr.2022.103243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/22/2021] [Accepted: 02/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Little is known about the impact irrigation solutions have on the material properties of cement used in hip and knee arthroplasty. We sought to compare the effect of three commonly used lavage solutions on cement polymerization. METHODS Ten groups were used for cure and mechanical testing: two cement controls, and eight cement groups mixed with test solutions. Test solutions included a commercially available benzalkonium chloride/citric acid solution (BCS), chlorhexidine gluconate (0.05%) (CHG), povidone-iodine 0.35%, and normal saline added at cement mixing onset. Cement dough-time, set-time, and compression testing were performed following The American Society for Testing and Materials guidelines. RESULTS Povidone-iodine had shorter dough-time (1min 34sec, sd 1min 5sec) versus controls (1min 56sec, sd 1min 35sec), p=0.0419. Cement exposed to all lavage samples had significantly reduced set-time. Compressive strength was reduced for all surgical lavages (p<0.001). Pairwise testing revealed that all lavage treatments reduced offset strength versus controls (p<0.001). CONCLUSION Bone cement exposed to lavage solutions during the cement mixing-phase showed accelerated set-times and decreased compressive strength. If bone is not dry, and cement has not finished mixing at the time of application, cement curing time may be shortened. Additionally, bone cement should reach dough phase prior to pre-closure surgical lavage. LEVEL OF EVIDENCE III; case control study.
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16
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So E, Juels CA, Seidenstricker C, Walker R, Scott RT. Postoperative Infection Rates After Total Ankle Arthroplasty: A Comparison With and Without the Use of a Surgical Helmet System. J Foot Ankle Surg 2022; 61:802-806. [PMID: 34974981 DOI: 10.1053/j.jfas.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/17/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
Following total joint arthroplasty, surgical site infections (SSI) and periprosthetic joint infections (PJI) are associated with increased patient morbidity and healthcare utilization. Current positive-pressure surgical sterile helmet system (SHS) were developed as a feasible, useful version of the body exhaust system.The use of SHS has not yet been proven to decrease infection rates in the orthopedic literature. The primary purpose of this study is to compare the infection rates between patients who underwent total ankle arthroplasty (TAA) with a surgical team wearing SHS versus without SHS.A retrospective chart review in patients undergoing primary TAA with the surgeon wearing SHS (Group 1) or standard surgical attire (Group 2) was conducted. The primary outcome was postoperative SSI and PJI. The rate of wound complications, revision rates, and associated procedures were also analyzed. We identified 109 patients in Group 1 and 151 patients in Group 2. The rate of SSI was 12.8% in Group 1 and 14.6% in Group 2 (p = .411). The rate of PJI was 0.92% in Group 1 and 2.6% in Group 2 (p = .411). There was no difference in revision rates between the two groups. This study suggests that SHS does not appear to protect against postoperative SSI or PJI after TAA. Conversely, we did not find a higher infection rate compared to standard surgical attire despite recent in-vitro studies suggesting SHS as a source of wound contamination. The utility of SHS does not appear to influence the prevalence of postoperative SSI or PJI.
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Affiliation(s)
- Eric So
- Bryan Health, Lincoln, NE; Ohio Innovation Group, Columbus, OH.
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17
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Crespi Z, Hasan AI, Pearl A, Ismail A, Awad ME, Irfan FB, Jaffar M, Patel P, Saleh KJ. Current Guidelines and Practice Recommendations to Prevent Hospital-Acquired Conditions After Major Orthopaedic Surgeries. JBJS Rev 2022; 10:01874474-202203000-00012. [PMID: 35290253 DOI: 10.2106/jbjs.rvw.21.00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $40,000 per patient with an HAC. » Current guidelines for the prevention of venous thromboembolism and surgical site infection consist primarily of antithrombotic prophylaxis and antiseptic technique, respectively. » The prevention of catheter-associated urinary tract infection (CA-UTI) and in-hospital falls and trauma is done best via education. In the case of CA-UTI, this consists of training staff about the indications for catheters and their timely removal when they are no longer necessary, and in the case of in-hospital falls and trauma, advising the patient and family about the patient's fall risk and communicating the fall risk to the health-care team. » Blood incompatibility is best prevented by implementation of a pretransfusion testing protocol. Pressure ulcers can be prevented via patient positioning, especially during surgery, and via postoperative skin checks.
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Affiliation(s)
- Zachary Crespi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | - Ahmad I Hasan
- School of Medicine, Wayne State University, Detroit, Michigan.,FAJR Scientific, Northville, Michigan
| | - Adam Pearl
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Aya Ismail
- FAJR Scientific, Northville, Michigan.,University of Michigan, Dearborn, Michigan
| | - Mohamed E Awad
- FAJR Scientific, Northville, Michigan.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Furqan B Irfan
- Michigan State University-College of Osteopathic Medicine, Detroit, Michigan
| | - Muhammed Jaffar
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Padmavathi Patel
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- FAJR Scientific, Northville, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
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Otieku E, Fenny AP, Asante FA, Bediako-Bowan A, Enemark U. Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study. BMJ Open 2022; 12:e057468. [PMID: 34980632 PMCID: PMC8724807 DOI: 10.1136/bmjopen-2021-057468] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study. DESIGN Before and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire. SETTING Korle-Bu Teaching Hospital (KBTH), Ghana. PARTICIPANTS All prospective patients who underwent surgical procedures at the general surgical unit of the KBTH. MAIN OUTCOME MEASURES The primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel. RESULTS Before-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually. CONCLUSION The intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.
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Affiliation(s)
- Evans Otieku
- Economics Division, Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Greater Accra, Ghana
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ama Pokuaa Fenny
- Economics Division, Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Greater Accra, Ghana
| | - Felix Ankomah Asante
- Economics Division, Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Greater Accra, Ghana
| | - Antoinette Bediako-Bowan
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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19
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Siddiqi A, Abdo ZE, Rossman SR, Kelly MA, Piuzzi NS, Higuera CA, Schwarzkopf R, Springer BD, Chen AF, Parvizi J. What Is the Optimal Irrigation Solution in the Management of Periprosthetic Hip and Knee Joint Infections? J Arthroplasty 2021; 36:3570-3583. [PMID: 34127346 DOI: 10.1016/j.arth.2021.05.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Thorough irrigation and debridement using an irrigation solution is a well-established treatment for both acute and chronic periprosthetic joint infections (PJIs). In the absence of concrete data, identifying the optimal irrigation agent and protocol remains challenging. METHODS A thorough review of the current literature on the various forms of irrigations and their additives was performed to evaluate the efficacy and limitations of each solution as pertaining to pathogen eradication in the treatment of PJI. As there is an overall paucity of high-quality literature comparing irrigation additives to each other and to any control, no meta-analyses could be performed. The literature was therefore summarized in this review article to give readers concise information on current irrigation options and their known risks and benefits. RESULTS Antiseptic solutions include povidone-iodine, chlorhexidine gluconate, acetic acid, hydrogen peroxide, sodium hypochlorite, hypochlorous acid, and preformulated commercially available combination solutions. The current literature suggests that intraoperative use of antiseptic irrigants may play a role in treating PJI, but definitive clinical studies comparing antiseptic to no antiseptic irrigation are lacking. Furthermore, no clinical head-to-head comparisons of different antiseptic irrigants have identified an optimal irrigation solution. CONCLUSION Further high-quality studies on the optimal irrigation additive and protocol for the management of PJI are warranted to guide future evidence-based decisions.
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Affiliation(s)
- Ahmed Siddiqi
- A Division of Ortho Alliance NJ, Orthopaedic Institute of Central Jersey, Manasquan, NJ; Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ; Department of Orthopedic Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | - Zuhdi E Abdo
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ
| | - Stephen R Rossman
- Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Michael A Kelly
- Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Carlos A Higuera
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Ran Schwarzkopf
- Department of Orthopedics, New York University Langone Medical Center, New York, NY
| | - Bryan D Springer
- Department of Orthopedics, Atrium Musculoskeletal Institute, OrthoCarolina Hip and Knee Center, Charlotte, NC
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Javad Parvizi
- Department of Orthopedics, Rothman Orthopedics, Philadelphia, PA
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20
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Li CK, Liang WW, Wang HM, Guo WT, Qin XS, Zhao J, Zhou WB, Li Y, Wang H, Huang RK. Gunsight sutures significantly reduce surgical-site infection after ileostomy reversal compared with linear sutures. Gastroenterol Rep (Oxf) 2021; 9:357-362. [PMID: 34567568 PMCID: PMC8460110 DOI: 10.1093/gastro/goaa075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background Surgical-site infection (SSI) was one of the most common post-operative morbidities of ileostomy reversal. Although several skin-closure procedures had been developed to reduce the rate of SSI, the optimal procedure remains unclear. In this study, we compared the effect of two surgical techniques for wound closure following ileostomy reversal: gunsight suture (GS) and linear suture (LS). Methods A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study. These patients were divided into two groups: the LS group and the GS group. We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI. Results Both groups successfully underwent surgery. The rate of SSI was significantly lower in the GS group (n = 2, 0.02%) than in the LS group (n = 16, 12.00%, P = 0.007). The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group (8.1 ± 3.2 vs 10.8 ± 5.4 days, P < 0.001). Multivariate analysis showed that GS was an independent protective risk factor for SSI (odds ratio = 0.212, P = 0.048). Conclusions Compared with the LS technique, the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery. The GS technique may be recommended for wound closure following ileostomy reversal.
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Affiliation(s)
- Chuang-Kun Li
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wei-Wen Liang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Huai-Ming Wang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wen-Tai Guo
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiu-Sen Qin
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Jie Zhao
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wen-Bin Zhou
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yang Li
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Hui Wang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Rong-Kang Huang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
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21
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Hespanha ACV, Minto BW, Cardozo MV, Menezes MPD, Tasso JB, Moraes PC. Contamination by antimicrobial-resistant enterobacteria isolated from cell phones and hands in a veterinary hospital. Acta Vet Hung 2021; 69:216-222. [PMID: 34546965 DOI: 10.1556/004.2021.00037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022]
Abstract
Hospital infections are of great relevance in human and animal health, and fomites are important in the spread of pathogens in hospital units. The aim of this study was to investigate the frequency of enterobacteria in the operating room of a veterinary hospital, the potential cross-contamination of samples, and to characterise the susceptibility profile of the isolates to antimicrobials. Sixty-five samples were collected from five different surgical procedures. These samples came from the hands and cell phones of the surgical team and pet owners, operating tables, and patients. Species detection was performed through polymerase chain reaction, genetic diversity by pulsed-field gel electrophoresis (PFGE), and susceptibility to antimicrobials through an antibiogram. Escherichia coli and Proteus mirabilis isolates were obtained from eight samples, from the hands of the anaesthesiologist, the pet owner, and the surgeon; the surgeon's, the nurse's and the anaesthesiologist's cell phones, and two surgical tables. Furthermore, PFGE showed high genetic diversity among the isolates, which showed multidrug resistance. The identification of multidrug-resistant E. coli and P. mirabilis on cell phones of the surgical team is a major concern and, although no direct correlation was found, the isolation of these bacteria inside the clean area of the operating room shows the possibility of nosocomial transmission from cell phones to susceptible patients.
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Affiliation(s)
- Ana Carolina Valentim Hespanha
- 1 Department of Veterinary Clinic and Surgery, Faculty of Agrarian and Veterinary Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane, s/n, Jaboticabal, SP, 14884-900, Brazil
| | - Bruno Watanabe Minto
- 1 Department of Veterinary Clinic and Surgery, Faculty of Agrarian and Veterinary Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane, s/n, Jaboticabal, SP, 14884-900, Brazil
| | - Marita Vedovelli Cardozo
- 2 Department of Veterinary Pathology, Faculty of Agrarian and Veterinary Sciences, São Paulo State University (UNESP), Jaboticabal, São Paulo, Brazil
| | - Mareliza Possa De Menezes
- 1 Department of Veterinary Clinic and Surgery, Faculty of Agrarian and Veterinary Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane, s/n, Jaboticabal, SP, 14884-900, Brazil
| | - Júlia Banhareli Tasso
- 1 Department of Veterinary Clinic and Surgery, Faculty of Agrarian and Veterinary Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane, s/n, Jaboticabal, SP, 14884-900, Brazil
| | - Paola Castro Moraes
- 1 Department of Veterinary Clinic and Surgery, Faculty of Agrarian and Veterinary Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane, s/n, Jaboticabal, SP, 14884-900, Brazil
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22
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Hachenberg J, Acis E, Auer-Schmidt MM, Warm M, Malter W, Thangarajah F, Eichler C. Preoperative Octenidine Application in Breast Reconstruction Surgery. In Vivo 2021; 35:549-554. [PMID: 33402508 DOI: 10.21873/invivo.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Postoperative infection in implant-based reconstructive breast surgery is a common problem. The preoperative application of a disinfecting washing agent may reduce postoperative infection rates. This retrospective analysis aimed to evaluate whether preoperative Octenisan® application yields a reduction in postoperative complications or infection rates in breast reconstructive surgery. PATIENTS AND METHODS Between 2016 and 2019, 127 women received implant-based breast reconstruction at the municipal hospital of Cologne, Holweide, Germany. A total of 197 treatments were performed. After giving consent, patients were asked to use Octenisan® wash lotion for five days before breast reconstructive surgery. All patients were asked by a simple questionnaire whether they performed showering and washing according to the proposed protocol. In 96 cases patients did adhere to the protocol. In 101 cases they did not. Patient cohorts were then divided into patients who had applied Octenisan® wash lotion and patients who had not. Endpoints were defined as minor complications with no implant loss and major complications with consecutive implant loss. RESULTS Patient adherence to the application regimen was 48.7%. Overall minor complications occurred in 34.4% with preoperative Octenidine usage and 36.6% without preoperative Octenidine usage. Major complications happened in 7% with preoperative Octenidine and 5% without Octenidine. Overall, there was no significant difference concerning minor or major complication rates. CONCLUSION Preoperative washing protocols involving the Octenisan® wash lotion is relatively cheap and easy to follow. There is evidence that washing protocols result in a reduction of S. aureus infections leading to a better perioperative outcome. Octenisan® is safe to use in implant-based breast reconstructive surgery and is not associated with higher risks for patients. Our study did not yield any significant reduction in perioperative and postoperative complication and infection rates. This is attributed to a relatively low study population. Wash lotion compliance was only 48.7%. Proper patient education is crucial. With those preliminary data, it is now possible to design a larger analysis since patient adherence to washing protocol with Octenisan® wash lotion has been established.
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Affiliation(s)
- Jens Hachenberg
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany;
| | - Ellen Acis
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | | | - Mathias Warm
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany.,German Center for Material Science in Gynecology and Senology (DZMGS), Cologne, Germany
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Donahue BS. Commentary: Preoperative nutritional status and mortality from cardiac surgery: Do we have your attention yet? J Thorac Cardiovasc Surg 2021; 164:1150-1151. [PMID: 34561101 DOI: 10.1016/j.jtcvs.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Brian S Donahue
- Division of Pediatric Cardiac Anesthesia, Departments of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn.
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Medina Garzón M, Castaño Plata MC, Moreno Herrera CC. Preparación de la piel para la prevención de la Infección del Sitio Operatorio: Revisión de Alcance. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: La Infección del sitio operatorio genera un impacto económico y social debido a los altos costos durante la recuperación, la estancia hospitalaria y la afectación de la calidad de vida, por esto, es necesario identificar las intervenciones y recomendaciones para la preparación de la piel, encaminadas a la prevención de la infección del sitio operatorio, basado en la evidencia científica. Materiales y Métodos: Se realizó una revisión sistemática de alcance en el marco del Instituto Joanna Briggs y los parámetros Prisma-P. En las bases de datos Medline, OVID, Pubmed, Scielo, BVS y Cochrane, publicadas entre los años 2010–2019, en los idiomas inglés, portuges y español. Resultados: Se analizaron 28 artículos. De estos, se identificaron 6 de la categoría general incluidas las guías de prevención de infección del sitio operatorio, 6 para el baño preoperatorio, 6 para la realización del rasurado y 10 de asepsia y antisepsia. Discusión: Con respecto al baño preoperatorio, es una práctica recomendada internacionalmente, la evidencia demuestra que esta actividad no representa ningún beneficio; en la categoría de rasurado, la recomendación es no remover el vello a menos que sea absolutamente necesario. Frente a la asepsia del sitio quirúrgico, el aporte es más que todo informativo acerca de los antisépticos y se recomienda el uso de la clorhexidina. Conclusiones: De acuerdo a la revisión sistemática de alcance de la literatura, no se evidencia una estandarización en las recomendaciones e intervenciones, para la preparación de la piel en la prevención de Infección del Sitio Operatorio.
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Chen CH, Chen TH, Lin YS, Chen DW, Sun CC, Kuo LT, Shao SC. The impact of systemic lupus erythematosus on the risk of infection after total hip arthroplasty: a nationwide population-based matched cohort study. Arthritis Res Ther 2020; 22:214. [PMID: 32928288 PMCID: PMC7488693 DOI: 10.1186/s13075-020-02300-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We aimed to assess the impact of systemic lupus erythematosus (SLE) on the risk of infection after total hip arthroplasty (THA). METHODS We identified patients undergoing primary THA (1996-2013) in Taiwan National Health Insurance Research Database (NHIRD). Patients were then divided into the SLE and control groups according to the diagnosis of SLE. We used 1:1 propensity score to match the control to the SLE group by age, sex, and comorbidities. The primary outcome was infection, including early and late superficial wound infection and periprosthetic joint infection (PJI). The secondary outcome was in-hospital complications. RESULTS We enrolled 325 patients in each group. In the primary outcome, the incidence of early superficial wound infection and PJI was comparable between the SLE and matched-control group. However, the incidence of late superficial wound infection and PJI in the SLE group was higher than that in matched-control group (11.4% vs. 5.5%, P = 0.01; 5.2% vs 2.2%, P = 0.04, respectively). Furthermore, the SLE group had a higher risk for late superficial wound infection and PJI (hazard ratio = 2.37, 95% confidence interval (CI) 1.35-4.16; HR = 2.74, 95% CI 1.14-6.64, respectively) than the matched-control. Complications other than infection and in-hospital mortality cannot be compared because of very low incidence. CONCLUSIONS SLE is a risk factor for developing late superficial wound infection and PJI, but not for early postoperative complications following THA. Clinical presentations should be monitored to avoid misdiagnosis of PJI in SLE patients after THA.
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Affiliation(s)
- Chien-Hao Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Keelung, Taiwan.,Biostatistical Consultation Center of Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Dave W Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Research and Development, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. No. 6 West Sec, Chia-Pu Road, Putz City, Chiayi, Taiwan. .,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Shih-Chieh Shao
- Biostatistical Consultation Center of Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nodzo SR, Boyle KK, Frisch NB. Nationwide Organism Susceptibility Patterns to Common Preoperative Prophylactic Antibiotics: What Are We Covering? J Arthroplasty 2019; 34:S302-S306. [PMID: 30745218 DOI: 10.1016/j.arth.2019.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many periprosthetic joint infections (PJIs) are caused by organisms not susceptible to first-generation cephalosporins. We sought to evaluate the national susceptibility patterns of organisms to cefazolin and, or oxacillin, clindamycin, and vancomycin using antibiogram data. METHODS Publically available regional and state antibiograms were evaluated for antibiotic susceptibility patterns to commonly infecting gram-positive organisms. The number of isolates tested in each antibiogram and percent of strains susceptible to oxacillin, clindamycin, and vancomycin were recorded. Oxacillin is used as a surrogate to cefazolin in antibiograms. A comparison of antibiotic susceptibilities was performed. RESULTS Seven state and 38 regional antibiograms were reviewed. Oxacillin was a sensitive antibiotic in 99.2 ± 4.8% of methicillin-sensitive Staphylococcus aureus (MSSA) isolates, 0 ± 0% of methicillin-resistant Staphylococcus aureus (MRSA) isolates, 44.5 ± 13.7% of coagulase-negative staphylococcus organism isolates (CNS), and 30.6 ± 10.5% of Staphylococcus epidermidis isolates. Clindamycin was a sensitive antibiotic in 75.8 ± 8.4% of MSSA isolates, 60.2 ± 13.2% of MRSA isolates, 60.3 ± 11.4% of CNS isolates, and 56.2 ± 6.5% of S epidermidis isolates. Vancomycin was a sensitive antibiotic in 99.9 ± 0.4% of MSSA isolates, 99.8 ± 0.4% of MRSA isolates, 99.8 ± 0.5% of CNS isolates, and 99.6 ± 0.7% of S epidermidis isolates. Clindamycin was significantly less sensitive in MSSA isolates as compared with oxacillin and vancomycin (P < .0001). Oxacillin was significantly less sensitive in CNS, S epidermidis, and MRSA isolates as compared with clindamycin and vancomycin (P < .0001). CONCLUSION The national clindamycin susceptibility pattern is limited to MSSA and may not have an optimal susceptibility profile suitable for use as a prophylactic antibiotic. Cefazolin continues to have excellent coverage against MSSA.
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Affiliation(s)
- Scott R Nodzo
- Mike O'Callaghan Medical Center, Department of Orthopedics, Las Vegas, NV
| | - K Keely Boyle
- Department of Orthopedics, University at Buffalo, Buffalo, NY
| | - Nicholas B Frisch
- Ascencion Crittenton Hospital, Department of Orthopedics, Rochester, MI
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Ogunmoyole T, Oladele FC, Aderibigbe A, Johnson OD. Hepatotoxicity of Telfaria occidentalis root extracts on wistar albino rat. Heliyon 2019; 5:e01617. [PMID: 31111107 PMCID: PMC6512833 DOI: 10.1016/j.heliyon.2019.e01617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/21/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022] Open
Abstract
The present study investigates the toxicity of Telfaria occidentalis root extracted with different solvents. This was with a view to validating its widely acclaimed use as poison in traditional parlance. Air-dried powdered root of Telfaria occidentalis was extracted separately with distilled water, methanol and diethyl ether. Twenty albino rats were randomly placed into four groups of five animals per group: Group I served as the positive control and were administered distilled water only while groups II, III and IV animals were administered 50 mg/kg body weight of aqueous, methanolic and diethyl ether extracts respectively for two weeks. Activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), superoxide dismutase and catalase were assayed in the liver homogenate and serum. Levels of total cholesterol, HDL-cholesterol, LDL-cholesterol as well as lipid peroxidation were also measured in the liver and serum of animals. Results showed that the level of AST, ALT, ALP as well as LDL-cholesterol and HDL-cholesterol in the serum of group IV animals increased significantly relative to the control group. Antioxidant enzyme biomarkers such as catalase and superoxide dismutase as well as lipid peroxidation were significantly increased in the serum of group IV animals relative to the control. The study concluded that toxicity of root extract of Telfaria occidentalis is solvent-dependent.
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Affiliation(s)
- Temidayo Ogunmoyole
- Department of Medical Biochemistry, College of Medicine, Ekiti State University, Ado Ekiti, Nigeria
| | | | - Ayonbo Aderibigbe
- Department of Medical Biochemistry, College of Medicine, Ekiti State University, Ado Ekiti, Nigeria
| | - Olaitan Daniel Johnson
- Department of Science Laboratory Technology, Auchi Polytechnic, Auchi, Edo State, Nigeria
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