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Widmer AF, Atkinson A, Kuster SP, Wolfensberger A, Klimke S, Sommerstein R, Eckstein FS, Schoenhoff F, Beldi G, Gutschow CA, Marschall J, Schweiger A, Jent P. Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis: A Randomized Clinical Trial. JAMA 2024; 332:541-549. [PMID: 38884982 PMCID: PMC11184497 DOI: 10.1001/jama.2024.8531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/22/2024] [Indexed: 06/18/2024]
Abstract
Importance Preoperative skin antisepsis is an established procedure to prevent surgical site infections (SSIs). The choice of antiseptic agent, povidone iodine or chlorhexidine gluconate, remains debated. Objective To determine whether povidone iodine in alcohol is noninferior to chlorhexidine gluconate in alcohol to prevent SSIs after cardiac or abdominal surgery. Design, Setting, and Participants Multicenter, cluster-randomized, investigator-masked, crossover, noninferiority trial; 4403 patients undergoing cardiac or abdominal surgery in 3 tertiary care hospitals in Switzerland between September 2018 and March 2020 were assessed and 3360 patients were enrolled (cardiac, n = 2187 [65%]; abdominal, n = 1173 [35%]). The last follow-up was on July 1, 2020. Interventions Over 18 consecutive months, study sites were randomly assigned each month to either use povidone iodine or chlorhexidine gluconate, each formulated in alcohol. Disinfectants and skin application processes were standardized and followed published protocols. Main Outcomes and Measures Primary outcome was SSI within 30 days after abdominal surgery and within 1 year after cardiac surgery, using definitions from the US Centers for Disease Control and Prevention's National Healthcare Safety Network. A noninferiority margin of 2.5% was used. Secondary outcomes included SSIs stratified by depth of infection and type of surgery. Results A total of 1598 patients (26 cluster periods) were randomly assigned to receive povidone iodine vs 1762 patients (26 cluster periods) to chlorhexidine gluconate. Mean (SD) age of patients was 65.0 years (39.0-79.0) in the povidone iodine group and 65.0 years (41.0-78.0) in the chlorhexidine gluconate group. Patients were 32.7% and 33.9% female in the povidone iodine and chlorhexidine gluconate groups, respectively. SSIs were identified in 80 patients (5.1%) in the povidone iodine group vs 97 (5.5%) in the chlorhexidine gluconate group, a difference of 0.4% (95% CI, -1.1% to 2.0%) with the lower limit of the CI not exceeding the predefined noninferiority margin of -2.5%; results were similar when corrected for clustering. The unadjusted relative risk for povidone iodine vs chlorhexidine gluconate was 0.92 (95% CI, 0.69-1.23). Nonsignificant differences were observed following stratification by type of surgical procedure. In cardiac surgery, SSIs were present in 4.2% of patients with povidone iodine vs 3.3% with chlorhexidine gluconate (relative risk, 1.26 [95% CI, 0.82-1.94]); in abdominal surgery, SSIs were present in 6.8% with povidone iodine vs 9.9% with chlorhexidine gluconate (relative risk, 0.69 [95% CI, 0.46-1.02]). Conclusions and Relevance Povidone iodine in alcohol as preoperative skin antisepsis was noninferior to chlorhexidine gluconate in alcohol in preventing SSIs after cardiac or abdominal surgery. Trial Registration ClinicalTrials.gov Identifier: NCT03685604.
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Affiliation(s)
- Andreas F. Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andrew Atkinson
- Pediatric Research Centre, University Children’s Hospital Basel, Basel, Switzerland
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Stefan P. Kuster
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Aline Wolfensberger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Steffi Klimke
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Friedrich S. Eckstein
- Department of Cardiac Surgery, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Florian Schoenhoff
- Department of Cardiac Surgery, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian A. Gutschow
- Department of Visceral and Transplantation Surgery, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jonas Marschall
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri
- Department of Infectious Diseases, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Philipp Jent
- Department of Infectious Diseases, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
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Liu B, Wei G, Hu L, Zhang Q. A novel web-based risk calculator for predicting surgical site infection in HIV-positive facture patients: a multicenter cohort study in China. Front Cell Infect Microbiol 2024; 14:1408388. [PMID: 38988810 PMCID: PMC11233529 DOI: 10.3389/fcimb.2024.1408388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
Background Surgical site infection (SSI) is a common complication in HIV-positive fracture patients undergoing surgery, leading to increased morbidity, mortality, and healthcare costs. Accurate prediction of SSI risk can help guide clinical decision-making and improve patient outcomes. However, there is a lack of user-friendly, Web-based calculator for predicting SSI risk in this patient population. Objective This study aimed to develop and validate a novel web-based risk calculator for predicting SSI in HIV-positive fracture patients undergoing surgery in China. Method A multicenter retrospective cohort study was conducted using data from HIV-positive fracture patients who underwent surgery in three tertiary hospitals in China between May 2011 and September 2023. We used patients from Beijing Ditan Hospital as the training cohort and patients from Chengdu Public Health and Changsha First Hospital as the external validation cohort. Univariate, multivariate logistic regression analyses and SVM-RFE were performed to identify independent risk factors for SSIs. A web-based calculator was developed using the identified risk factors and validated using an external validation cohort. The performance of the nomogram was evaluated using the area under the receiver operating characteristic (AUC) curves, calibration plots, and decision curve analysis (DCA). Results A total of 338 HIV-positive patients were included in the study, with 216 patients in the training cohort and 122 patients in the validation cohort. The overall SSI incidence was 10.7%. The web-based risk calculator (https://sydtliubo.shinyapps.io/DynNom_for_SSI/) incorporated six risk factors: HBV/HCV co-infection, HIV RNA load, CD4+ T-cell count, Neu and Lym level. The nomogram demonstrated good discrimination, with an AUC of 0.890 in the training cohort and 0.853 in the validation cohort. The calibration plot showed good agreement between predicted and observed SSI probabilities. The DCA indicated that the nomogram had clinical utility across a wide range of threshold probabilities. Conclusion Our study developed and validated a novel web-based risk calculator for predicting SSI risk in HIV-positive fracture patients undergoing surgery in China. The nomogram demonstrated good discrimination, calibration, and clinical utility, and can serve as a valuable tool for risk stratification and clinical decision-making in this patient population. Future studies should focus on integrating this nomogram into hospital information systems for real-time risk assessment and management.
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Affiliation(s)
- Bo Liu
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, National Center for Infectious Diseases, Beijing, China
| | - Guo Wei
- Department of Surgery, Chengdu Public Health Clinical Medical Center, Chengdu, China
| | - Liqiang Hu
- Department of Orthopaedics, Changsha First Hospital, Xiangya Medical College, Changsha, China
| | - Qiang Zhang
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, National Center for Infectious Diseases, Beijing, China
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Pepper M, Campbell OMR, Woodd SL. Current Approaches to Following Up Women and Newborns After Discharge From Childbirth Facilities: A Scoping Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300377. [PMID: 38599685 PMCID: PMC11057794 DOI: 10.9745/ghsp-d-23-00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The postpartum period is critical for the health and well-being of women and newborns, but there is limited research on the most effective methods of post-childbirth follow-up. This scoping review synthesizes evidence from high-, middle-, and low-income countries on approaches to following up individuals after discharge from childbirth facilities. METHODS Using a systematic search in Ovid MEDLINE, we identified quantitative studies describing post-discharge follow-up methods deployed up to 12 months postpartum. We searched for English-language, peer-reviewed articles published between January 1, 2007 and November 2, 2022, with search terms covering 2 broad areas: "postpartum/postnatal period" and "surveillance." We single-screened titles and abstracts and double-extracted all included articles, recording study design and location, population, health outcome, method, timing and frequency of data collection, and percentage of study participants reached. RESULTS We identified 1,654 records, of which 31 studies were included. Eight studies used in-person visits to follow up participants, 10 used telephone calls, 7 used self-administered questionnaires, and 6 used multiple methods. Across studies, the minimum length of follow-up was 1 week after delivery, and up to 4 contacts were made within the first year after delivery. Follow-up (response) rates ranged from 23% to100%. Postpartum infection was the most common outcome investigated. Other outcomes included maternal (ill-)health, neonatal (ill-)health and growth, maternal mental health and well-being, care-giving/-seeking behaviors, and knowledge and intentions. CONCLUSION Our scoping review identified multiple follow-up methods after discharge, ranging from home visits to self-administered electronic questionnaires, which could be implemented with high response rates. The studies demonstrated that post-discharge follow-up of women and newborns was feasible, well received, and important for identifying postpartum illness or complications that would otherwise be missed. Therefore, the identified methods have the potential to become an important component of fostering a continuum of care and measuring and addressing postpartum morbidity.
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Affiliation(s)
- Maxine Pepper
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Susannah L Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Cho SY, Kim Z, Chung DR, Cho BH, Chung MJ, Kim JH, Jeong J. Development of machine learning models for the surveillance of colon surgical site infections. J Hosp Infect 2024; 146:224-231. [PMID: 37094715 DOI: 10.1016/j.jhin.2023.03.025] [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: 11/10/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Conventional surgical site infection (SSI) surveillance is labour-intensive. We aimed to develop machine learning (ML) models for the surveillance of SSIs for colon surgery and to assess whether the ML could improve surveillance process efficiency. METHODS This study included cases who underwent colon surgery at a tertiary center between 2013 and 2014. Logistic regression and four ML algorithms including random forest (RF), gradient boosting (GB), and neural networks (NNs) with or without recursive feature elimination (RFE) were first trained on the entire cohort, and then re-trained on cases selected based on a previous rule-based algorithm. We assessed model performance based on the area under the curve (AUC), sensitivity, and positive predictive value (PPV). The estimated proportion of reduction in workload for chart review based on the ML models was evaluated and compared with the conventional method. RESULTS At a sensitivity of 95%, the NN with RFE using 29 variables had the best performance with an AUC of 0.963 and PPV of 21.1%. When combining both the rule-based algorithm and ML algorithms, the NN with RFE using 19 variables had a higher PPV (28.9%) than with the ML algorithm alone, which could decrease the number of cases requiring chart review by 83.9% compared with the conventional method. CONCLUSION We demonstrated that ML can improve the efficiency of SSI surveillance for colon surgery by decreasing the burden of chart review while providing high sensitivity. In particular, the hybrid approach of ML with a rule-based algorithm showed the best performance in terms of PPV.
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Affiliation(s)
- S Y Cho
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Z Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - D R Chung
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - B H Cho
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Republic of Korea; Institute of Biomedical Informatics, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - M J Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J H Kim
- Department of Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - J Jeong
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
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Plummer TA, Zepeda JA, Reese SM. Addressing an increase in surgical site infections during the COVID-19 pandemic-Identifying opportunities during a chaotic time. Am J Infect Control 2023; 51:1309-1313. [PMID: 37355097 PMCID: PMC10286569 DOI: 10.1016/j.ajic.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Health care systems saw increases in device-associated infections and decreases in surgical site infections (SSI) during the COVID-19 pandemic. However, following an increase in SSIs, an acute care hospital assessed the risk and preventative factors of SSIs among patients. METHODS A retrospective cohort study on surgeries performed between January 2020 and September 2021 analyzed associations of SSI with risk and preventive factors utilizing χ2, t-tests, and odds ratios. A secondary analysis was utilized to determine the association of case urgency and prevention practice performance. RESULTS There was a significant difference in the administration of correct perioperative antibiotic selection between SSI (78.1%) and non-SSI (86.2%) along with 2.9 greater odds of developing an SSI with incorrect perioperative antibiotics. Patients who had urgent cases were significantly less likely than elective to receive preoperative chlorhexidine gluconate wipes (81.6%, 61.5%, respectively), correct antibiotic selection and timing (93.2%, 70.8%, respectively) and chlorhexidine and alcohol skin preparation (81.6%, 67.5%, respectively). DISCUSSION Disruption of perioperative workflow during the COVID-19 pandemic likely resulted in an increase in SSI. Numerous opportunities were identified for focused prevention efforts. CONCLUSIONS The next steps include implementing strategies to improve SSI prevention and establish a culture that can withstand workflow disruptions to maintain a safe environment during significant changes.
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Affiliation(s)
- Traci A Plummer
- Colorado School of Public Health, University of Colorado Anschutz, Colorado School of Public Health, Aurora, CO
| | | | - Sara M Reese
- Clinical Excellence, Intermountain Health, Clinical Excellence, Broomfield, CO.
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McMillan AT, Ho NX, Izard C, Matteucci PL, Totty JP. The incidence and cost implications of surgical site infection following lymph node surgery for skin malignancy. J Plast Reconstr Aesthet Surg 2023; 87:341-348. [PMID: 37925925 DOI: 10.1016/j.bjps.2023.10.086] [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: 06/28/2023] [Revised: 09/23/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Lymph node surgery is commonly performed in the staging and treatment of metastatic skin cancer. Previous studies have demonstrated sentinel lymph node biopsy (SLNB) and, particularly, lymph node dissection (LND) to be plagued by high rates of wound complications, including surgical site infection (SSI) and seroma formation. This study evaluated the incidence of wound complications following lymph node surgery and provided the first published cost estimate of SSI associated with lymph node surgery in the UK. PATIENTS AND METHODS A retrospective cohort study of 169 patients with a histological diagnosis of primary skin malignancy who underwent SLNB or LND of the axilla and/or inguinal region at a single tertiary centre over a 2 year period was conducted. Demographic, patient risk factor, and operation characteristics data were collected and effect on SSI and seroma formation was analysed. Cost-per-infection was estimated using National Health Service (NHS) reference and antibiotic costs. RESULTS A total of 146 patients underwent SLNB with a SSI rate of 4.1% and a seroma incidence of 12.3%. Twenty-three patients underwent LND with a SSI rate of 39.1% and a seroma incidence of 39.1%. Seroma formation was strongly associated with the development of SSI in both the SLNB (odds ratio (OR) = 18.0, p < 0.001) and LND (OR = 21.0, p = 0.007) group. The median additional cost of care events and treatment of SSI in the SLNB and LND groups was £199.46 and £5187.04, respectively. CONCLUSION SSI remains a troublesome and costly event following SLNB and LND. Further research into perioperative care protocols and methods of reducing lymph node surgery morbidity is required and could result in significant cost savings to the NHS.
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Affiliation(s)
- Angus T McMillan
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom.
| | - Ning Xuan Ho
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom
| | - Charlie Izard
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom
| | - Paolo L Matteucci
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom
| | - Joshua P Totty
- Department of Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom; Centre for Clinical Sciences, Hull York Medical School, Hull HU6 7RX, United Kingdom
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Eder M, Sommerstein R, Szelecsenyi A, Schweiger A, Schlegel M, Atkinson A, Kuster SP, Vuichard-Gysin D, Troillet N, Widmer AF. Association between the introduction of a national targeted intervention program and the incidence of surgical site infections in Swiss acute care hospitals. Antimicrob Resist Infect Control 2023; 12:134. [PMID: 37996935 PMCID: PMC10668371 DOI: 10.1186/s13756-023-01336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND In Switzerland, the national surgical site infection (SSI) surveillance program showed a modest decrease in SSI rates for different procedures over the last decade. The study aimed to determine whether a multimodal, targeted intervention program in addition to existing SSI surveillance is associated with decreased SSI rates in the participating hospitals. METHODS Prospective multicenter pre- and postintervention study conducted in eight Swiss acute care hospitals between 2013 and 2020. All consecutive patients > 18 years undergoing cardiac, colon, or hip/knee replacement surgery were included. The follow-up period was 30 days and one year for implant-related surgery. Patients with at least one follow-up were included. The intervention was to optimize three elements of preoperative management: (i) hair removal; (ii) skin disinfection; and (iii) perioperative antimicrobial prophylaxis. We compared SSI incidence rates (main outcome measure) pre- and postintervention (three years each) adjusted for potential confounders. Poisson generalized linear mixed models fitted to quarter-yearly confirmed SSIs and adjusted for baseline differences between hospitals and procedures. Adherence was routinely monitored through on-site visits. RESULTS A total of 10 151 patients were included, with a similar median age pre- and postintervention (69.6 and IQR 60.9, 76.8 years, vs 69.5 and IQR 60.4, 76.8 years, respectively; P = 0.55) and similar proportions of females (44.8% vs. 46.1%, respectively; P = 0.227). Preintervention, 309 SSIs occurred in 5 489 patients (5.6%), compared to 226 infections in 4 662 cases (4.8%, P = 0.09) postintervention. The adjusted incidence rate ratio (aIRR) for overall SSI after intervention implementation was 0.81 (95% CI, 0.68 to 0.96, P = 0.02). For cardiac surgery (n = 2 927), the aIRR of SSI was 0.48 (95% CI, 0.32 to 0.72, P < 0.001). For hip/knee replacement surgery (n = 4 522), the aIRR was 0.88 (95% CI, 0.52 to 1.48, P = 0.63), and for colon surgery (n = 2 702), the aIRR was 0.92 (95% CI, 0.75 to 1.14, P = 0.49). CONCLUSIONS The SSI intervention bundle was associated with a statistically significant decrease in SSI cases. A significant association was observed for cardiac surgery. Adding a specific intervention program can add value compared to routine surveillance only. Further prevention modules might be necessary for colon and orthopedic surgery.
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Affiliation(s)
- Marcus Eder
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Rami Sommerstein
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | | | - Alexander Schweiger
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Medicine and Infectious Diseases, Cantonal Hospital Zug, Zug, Switzerland
| | - Matthias Schlegel
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andrew Atkinson
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Stefan P Kuster
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Danielle Vuichard-Gysin
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Infectious Diseases, Thurgau Hospital Group, Muensterlingen and Frauenfeld, Switzerland
| | - Nicolas Troillet
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Andreas F Widmer
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
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Bielicki I, Schmid H, Atkinson A, Kahlert CR, Berger C, Troillet N, Marschall J, Bielicki JA. Association between perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in paediatric uncomplicated appendectomy: a Swiss retrospective cohort study. Antimicrob Resist Infect Control 2023; 12:106. [PMID: 37749585 PMCID: PMC10521383 DOI: 10.1186/s13756-023-01312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the association between post-appendectomy SSI rates and the two most commonly used regimens for perioperative antimicrobial prophylaxis in Swiss children. METHODS We conducted a retrospective cohort study, analysing data from the Swiss national SSI surveillance database with a study period from 2014 to 2018. All hospitals undertaking paediatric appendectomies in Switzerland participate in the surveillance. We compared the cumulative incidence and odds of post-appendectomy SSI within 30 days of surgery in children ≤ 16 years of age undergoing appendectomy for uncomplicated appendicitis and receiving perioperative antimicrobial prophylaxis with cefuroxime plus metronidazole or with amoxicillin/clavulanic acid using multivariable adjusted logistic regression and propensity-score matching. RESULTS A total of 6207 cases were recorded in the study time frame. Overall SSI cumulative incidence was 1.9% (n = 119). 4256 children (54.9% male, median (IQR) age 12 [10, 14] years) received either cefuroxime plus metronidazole (n = 2348, 53.8% male) or amoxicillin/clavulanic acid (n = 1491, 57.0% male). SSI cumulative incidence was 1.1% (25/2348) among children receiving cefuroxime plus metronidazole and 2.8% (42/1491, p < 0.001) when receiving amoxicillin/clavulanic acid. The administration of cefuroxime plus metronidazole was associated with statistically significantly lower SSI odds compared to amoxicillin/clavulanic acid (aOR 0.35, 95%CI [0.20, 0.61], p < 0.001), and this was confirmed upon propensity-score matching. CONCLUSION We found lower odds of post-appendectomy SSI in children receiving cefuroxime plus metronidazole compared to amoxicillin/clavulanic acid. Treating amoxicillin/clavulanic acid as the baseline, only 55 children need to receive cefuroxime plus metronidazole perioperative prophylaxis to avert one SSI. Existing guidelines recommending amoxicillin/clavulanic acid may need to be revised. Trial registration ISRCTN47727811, registered retrospectively.
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Affiliation(s)
- Isabella Bielicki
- Department of Paediatric Surgery, University of Basel Children's Hospital, Basel, Switzerland
| | - Hanna Schmid
- Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Andrew Atkinson
- Paediatric Research Centre, University of Basel Children's Hospital, Basel, Switzerland
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christian R Kahlert
- Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
- Swissnoso, The National Centre for Infection Control, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Swissnoso, The National Centre for Infection Control, Bern, Switzerland
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Julia A Bielicki
- Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland.
- Paediatric Research Centre, University of Basel Children's Hospital, Basel, Switzerland.
- Institute for Infection and Immunity, St George's University of London, London, UK.
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Stavropoulou E, Atkinson A, Eisenring MC, Fux CA, Marschall J, Senn L, Troillet N. Association of antimicrobial perioperative prophylaxis with cefuroxime plus metronidazole or amoxicillin/clavulanic acid and surgical site infections in colorectal surgery. Antimicrob Resist Infect Control 2023; 12:105. [PMID: 37726838 PMCID: PMC10510121 DOI: 10.1186/s13756-023-01307-y] [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: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE To compare intravenous (IV) amoxicillin/clavulanic acid (A/CA) to IV cefuroxime plus metronidazole (C + M) for preventing surgical site infections (SSI) in colorectal surgery. BACKGROUND Given their spectra that include most Enterobacterales and anaerobes, C + M is commonly recommended as prophylaxis of SSI in colorectal surgery. A/CA offers good coverage of Enterobacterales and anaerobes as well, but, in contrast to C + M, it also includes Enterococcus faecalis which is also isolated from patients with SSI and could trigger anastomotic leakage. METHODS Data from a Swiss SSI surveillance program were used to compare SSI rates after class II (clean contaminated) colorectal surgery between patients who received C + M and those who received A/CA. We employed multivariable logistic regression to adjust for potential confounders, along with propensity score matching to adjust for group imbalance. RESULTS From 2009 to 2018, 27,922 patients from 127 hospitals were included. SSI was diagnosed in 3132 (11.2%): 278/1835 (15.1%) in those who received A/CA and 2854/26,087 (10.9%) in those who received C + M (p < 0.001). The crude OR for SSI in the A/CA group as compared to C + M was 1.45 [CI 95% 1.21-1.75]. The adjusted OR was 1.49 [1.24-1.78]. This finding persisted in a 1:1 propensity score matched cohort of 1835 patients pairs with an OR of 1.60 [1.28-2.00]. Other factors independently associated with SSI were an ASA score > 2, a longer duration of operation, and a reoperation for a non-infectious complication. Protective factors were female sex, older age, antibiotic prophylaxis received 60 to 30 min before surgery, elective operation, and endoscopic approach. CONCLUSIONS Despite its activity against enterococci, A/CA was less effective than C + M for preventing SSI, suggesting that it should not be a first choice antibiotic prophylaxis for colorectal surgery.
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Affiliation(s)
- Elisavet Stavropoulou
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Christine Eisenring
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases and Infection Prevention, Kantonsspital Aarau, Aarau, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Laurence Senn
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland.
- Infection Prevention and Control Unit, Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland
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Sommerstein R, Troillet N, Harbarth S, de Kraker ME, Vuichard-Gysin D, Kuster SP, Widmer AF. Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections. JAMA Netw Open 2023; 6:e2317370. [PMID: 37289455 PMCID: PMC10251212 DOI: 10.1001/jamanetworkopen.2023.17370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Importance World Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited. Objective To assess whether earlier vs later timing of administration of cefuroxime SAP is associated with the occurrence of surgical site infections (SSI). Design, Setting, and Participants This cohort study included adult patients who underwent 1 of 11 major surgical procedures with cefuroxime SAP, documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 158 Swiss hospitals. Data were analyzed from January 2021 to April 2023. Exposures Timing of cefuroxime SAP administration before incision was divided into 3 groups: 61 to 120 minutes before incision, 31 to 60 minutes before incision, and 0 to 30 minutes before incision. In addition, a subgroup analysis was performed with time windows of 30 to 55 minutes and 10 to 25 minutes as a surrogate marker for administration in the preoperating room vs in the operating room, respectively. The timing of SAP administration was defined as the start of the infusion obtained from the anesthesia protocol. Main Outcomes and Measures Occurrence of SSI according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models adjusted for institutional, patient, and perioperative variables were applied. Results Of 538 967 surveilled patients, 222 439 (104 047 men [46.8%]; median [IQR] age, 65.7 [53.9-74.2] years), fulfilled inclusion criteria. SSI was identified in 5355 patients (2.4%). Cefuroxime SAP was administered 61 to 120 minutes prior to incision in 27 207 patients (12.2%), 31 to 60 minutes prior to incision in 118 004 patients (53.1%), and 0 to 30 minutes prior to incision in 77 228 patients (34.7%). SAP administration at 0 to 30 minutes was significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.85; 95% CI, 0.78-0.93; P < .001), as was SAP administration 31 to 60 minutes prior to incision (aOR, 0.91; 95% CI, 0.84-0.98; P = .01) compared with administration 61 to 120 minutes prior to incision. Administration 10 to 25 minutes prior to incision in 45 448 patients (20.4%) was significantly associated with a lower SSI rate (aOR, 0.89; 95% CI, 0.82-0.97; P = .009) vs administration within 30 to 55 minutes prior to incision in 117 348 patients (52.8%). Conclusions and Relevance In this cohort study, administration of cefuroxime SAP closer to the incision time was associated with significantly lower odds of SSI, suggesting that cefuroxime SAP should be administrated within 60 minutes prior to incision, and ideally within 10 to 25 minutes.
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Affiliation(s)
- Rami Sommerstein
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Nicolas Troillet
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Stephan Harbarth
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Marlieke E.A. de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
| | - Danielle Vuichard-Gysin
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Thurgau, Muensterlingen and Frauenfeld, Switzerland
| | - Stefan P. Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andreas F. Widmer
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
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11
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Damonti L, Atkinson A, Fontannaz L, Burnham JP, Jent P, Troillet N, Widmer A, Marschall J. Influence of environmental temperature and heatwaves on surgical site infection after hip and knee arthroplasty: a nationwide study. J Hosp Infect 2023; 135:125-131. [PMID: 36996907 DOI: 10.1016/j.jhin.2023.03.014] [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: 01/23/2023] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Previous studies reported higher incidence of surgical site infection (SSI) after procedures performed in summer or with high temperatures. However, no study used detailed climate data to assess this risk after hip and knee arthroplasty, and no study specifically investigated the role of heatwaves. AIM To assess the impact of higher environmental temperatures and heatwaves on SSI rates after hip and knee arthroplasty. METHODS Data on hip and knee arthroplasty procedures performed between 01/2013 - 09/2019 in hospitals participating in the Swiss SSI surveillance were linked to climate data extracted from weather stations located in their vicinity. The association between temperature, heatwaves and SSI was studied using mixed effects logistic regression models fitted at the patient level. Poisson mixed models were fitted for both calendar year and month of the year to investigate the SSI incidence trajectory over time. RESULTS We included 116,981 procedures performed in 122 hospitals. Significantly higher SSI rates were observed for procedures performed in the summertime (incidence rate ratio 1.39, 95% CI [1.20-1.60], p<0.001; reference: autumn) or in calendar months in which the mean temperature was above 20°C (reference 05-10°C; odds ratio 1.59, 95% CI [1.27, 1.98] p<0.001). We observed a slight but non-significant increase in the rate of SSI during heatwaves (1.44% versus 1.01%, p=0.2). CONCLUSION SSI rates after hip and knee replacement appear to increase with higher environmental temperature. To establish if, and to what extent, heatwaves increase the risk of SSI, studies involving geographical areas with larger variability in temperature are needed.
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Affiliation(s)
- Lauro Damonti
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Andrew Atkinson
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lionel Fontannaz
- Federal Office of Meteorology and Climatology MeteoSwiss, Bern, Switzerland
| | - Jason P Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, U.S
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Troillet
- Department of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Andreas Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University of Basel Hospitals and Clinics, Basel, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, U.S
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12
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Focusing on the follow-up for detecting surgical site infections after total joint arthroplasty and cardiac surgery: A cohort study from the Swiss national surveillance system, 2009-2018. Infect Control Hosp Epidemiol 2022; 43:1951-1952. [PMID: 35510368 DOI: 10.1017/ice.2022.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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Better Operating Room Ventilation as Determined by a Novel Ventilation Index is Associated With Lower Rates of Surgical Site Infections. Ann Surg 2022; 276:e353-e360. [PMID: 35946824 PMCID: PMC9534050 DOI: 10.1097/sla.0000000000005670] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim was to assess the impact of operating room (OR) ventilation quality on surgical site infections (SSIs) using a novel ventilation index. BACKGROUND Previous studies compared laminar air flow with conventional ventilation, thereby ignoring many parameters that influence air flow properties. METHODS In this cohort study, we surveyed hospitals participating in the Swiss SSI surveillance and calculated a ventilation index for their ORs, with higher values reflecting less turbulent air displacement. For procedures captured between January 2017 and December 2019, we studied the association between ventilation index and SSI rates using linear regression (hospital-level analysis) and with the individual SSI risk using generalized linear mixed-effects models (patient-level analysis). RESULTS We included 47 hospitals (182 ORs). Among the 163,740 included procedures, 6791 SSIs were identified. In hospital-level analyses, a 5-unit increase in the ventilation index was associated with lower SSI rates for knee and hip arthroplasty (-0.41 infections per 100 procedures, 95% confidence interval: -0.69 to -0.13), cardiac (-0.89, -1.91 to 0.12), and spine surgeries (-1.15, -2.56 to 0.26). Similarly, patient-level analyses showed a lower SSI risk with each 5-unit increase in ventilation index (adjusted odds ratio 0.71, confidence interval: 0.58-0.87 for knee and hip; 0.72, 0.49-1.06 for spine; 0.82, 0.69-0.98 for cardiac surgery). Higher index values were mainly associated with a lower risk for superficial and deep incisional SSIs. CONCLUSIONS Better ventilation properties, assessed with our ventilation index, are associated with lower rates of superficial and deep incisional SSIs in orthopedic and cardiac procedures. OR ventilation quality appeared to be less relevant for other surgery types.
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14
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Jurt J, Floquet L, Hübner M, Moulin E, Senn L, Demartines N, Grass F. Implementing a surgical site infection prevention bundle for emergency appendectomy: Worth the effort or waste of time? Surgery 2022; 172:11-15. [PMID: 35221108 DOI: 10.1016/j.surg.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/16/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate feasibility and impact of an intraoperative surgical site infection prevention bundle for emergency appendectomy. METHODS Consecutive adult patients undergoing emergency appendectomy were prospectively included during a 10-year study period (2011-2020). The care bundle was implemented as of November 1, 2018, and focused on 4 intraoperative items (disinfection, antibiotic prophylaxis, induction temperature control >36.5°C, and intracavity lavage). The primary outcome was the compliance to bundle items. Thirty-day surgical site infections were assessed by the independent Swiss National SSI Surveillance Program (2011 to October 2018) and by an institutional audit (November 2018-2020). Independent risk factors for surgical site infection were identified through multinominal logistic regression analysis. RESULTS Of 1,901 patients, 449 (23.6%) were included after bundle implementation. Overall surgical site infection rate was 111 (5.8%). In 42 patients with surgical site infection (37.8%), antibiotic treatment alone was done, and additional surgical management was necessary in 31 patients (27.9%), computed tomography-guided drainage in 30 patients (27%), and bedside wound opening in 9 cases (8.1%). Overall compliance to the bundle was 79.9%. Overall surgical site infection rates were decreased after bundle implementation (17/449 [3.8%] vs 94/1,452 [6.5%], P = .038), mainly due to a decrease in superficial incisional infections (P = .014). Independent risk factors for surgical site infection were surgical duration ≥60 minutes (odds ratio: 1.66, P = .018), contamination class IV (odds ratio: 2.64, P < .001), and open or converted approach (odds ratio: 4.0, P < .001), and the bundle was an independent protective factor (odds ratio: 0.58, P = .048). CONCLUSION Implementation of an intraoperative surgical site infection prevention bundle was feasible and might have a beneficial impact on surgical site infection rates after emergency appendectomy.
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Affiliation(s)
- Jonas Jurt
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
| | - Laura Floquet
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
| | - Estelle Moulin
- Department of Hospital Preventive Medicine, Lausanne University Hospital CHUV, Switzerland
| | - Laurence Senn
- Department of Hospital Preventive Medicine, Lausanne University Hospital CHUV, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland.
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
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15
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Semiautomated surveillance of deep surgical site infections after colorectal surgeries: A multicenter external validation of two surveillance algorithms. Infect Control Hosp Epidemiol 2022; 44:616-623. [PMID: 35726554 DOI: 10.1017/ice.2022.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Objective:
Automated surveillance methods increasingly replace or support conventional (manual) surveillance; the latter is labor intensive and vulnerable to subjective interpretation. We sought to validate 2 previously developed semiautomated surveillance algorithms to identify deep surgical site infections (SSIs) in patients undergoing colorectal surgeries in Dutch hospitals.
Design:
Multicenter retrospective cohort study.
Methods:
From 4 hospitals, we selected colorectal surgery patients between 2018 and 2019 based on procedure codes, and we extracted routine care data from electronic health records. Per hospital, a classification model and a regression model were applied independently to classify patients into low- or high probability of having developed deep SSI. High-probability patients need manual SSI confirmation; low-probability records are classified as no deep SSI. Sensitivity, positive predictive value (PPV), and workload reduction were calculated compared to conventional surveillance.
Results:
In total, 672 colorectal surgery patients were included, of whom 28 (4.1%) developed deep SSI. Both surveillance models achieved good performance. After adaptation to clinical practice, the classification model had 100% sensitivity and PPV ranged from 11.1% to 45.8% between hospitals. The regression model had 100% sensitivity and 9.0%–14.9% PPV. With both models, <25% of records needed review to confirm SSI. The regression model requires more complex data management skills, partly due to incomplete data.
Conclusions:
In this independent external validation, both surveillance models performed well. The classification model is preferred above the regression model because of source-data availability and less complex data-management requirements. The next step is implementation in infection prevention practices and workflow processes.
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Abbas M, Gaïa N, Buchs NC, Delaune V, Girard M, Andrey DO, Meyer J, Schrenzel J, Ris F, Harbarth S, Lazarevic V. Changes in the gut bacterial communities in colon cancer surgery patients: an observational study. Gut Pathog 2022; 14:2. [PMID: 34983654 PMCID: PMC8729125 DOI: 10.1186/s13099-021-00477-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023] Open
Abstract
Background Colon surgery has been shown to modulate the intestinal microbiota. Our objective was to characterize these changes using state-of-the-art next generation sequencing techniques. Methods We performed a single-centre prospective observational cohort study to evaluate the changes in the gut microbiota, i.e., taxon distribution, before and after elective oncologic colon surgery in adult patients with different antimicrobial prophylaxis regimens (standard prophylaxis with cefuroxime/metronidazole versus carbapenems for extended-spectrum beta-lactamase-producing Enterobacterales [ESBL-E] carriers). We obtained rectal samples on the day of surgery, intraoperative luminal samples, and rectal or stoma samples 3 days after surgery. We performed metataxonomic analysis based on sequencing of the bacterial 16S rRNA gene marker. Similarities and differences between bacterial communities were assessed using Bray–Curtis similarity, visualised using principal coordinates analysis and statistically tested by PERMANOVA. Comparison of taxa relative abundance was performed using ANCOM. Results We included 27 patients between March 27, 2019 and September 17, 2019. The median age was 63.6 years (IQR 56.4–76.3) and 44% were females. Most (81%) patients received standard perioperative prophylaxis as they were not ESBL carriers. There was no significant association between ESBL carriage and differences in gut microbiome. We observed large and significant increases in the genus Enterococcus between the preoperative/intraoperative samples and the postoperative sample, mainly driven by Enterococcus faecalis. There were significant differences in the postoperative microbiome between patients who received standard prophylaxis and carbapenems, specifically in the family Erysipelotrichaceae. Conclusion This hypothesis-generating study showed rapid changes in the rectal microbiota following colon cancer surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13099-021-00477-7.
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Affiliation(s)
- Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Nadia Gaïa
- Genomic Research Laboratory, Division of Infectious Diseases, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Vaihere Delaune
- Division of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Myriam Girard
- Genomic Research Laboratory, Division of Infectious Diseases, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Diego O Andrey
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Genomic Research Laboratory, Division of Infectious Diseases, University Hospitals and University of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.,Laboratory of Bacteriology, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Division of Infectious Diseases, University Hospitals and University of Geneva, Geneva, Switzerland
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THOMPSON O, W-DAHL A, LINDGREN V, GORDON M, ROBERTSSON O, STEFÁNSDÓTTIR A. Similar periprosthetic joint infection rates after and before a national infection control program: a study of 45,438 primary total knee arthroplasties. Acta Orthop 2022; 93:3-10. [PMID: 34533104 PMCID: PMC8815852 DOI: 10.1080/17453674.2021.1977532] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Strenuous efforts to minimize postoperative infection rates have been made, including the Swedish nationwide initiative Prosthesis Related Infections Shall be Stopped (PRISS). This study calculated the incidence rate of periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) before and after PRISS. Patients and methods - All 45,438 primary TKAs registered in the Swedish Knee Arthroplasty Register (SKAR) during 2007-2008 and 2012-2013 were included. Matched data on antibiotic prescriptions were obtained from the Swedish Prescribed Drug Register (SPDR). All patients with ≥ 28 days of continuous antibiotic treatment within 2 years of primary surgery had their medical charts reviewed to identify cases of PJI. The incidence rate was calculated by dividing the number of PJIs by the total time at risk during each time period and presented as percentages with 95% confidence interval (CI). Results - 644 PJIs were identified, equaling a 2-year incidence rate of 1.45% (CI 1.34-1.57). The incidence rate was 1.44% (CI 1.27-1.61) before PRISS and 1.46% (CI 1.31-1.61) after. Diagnosis was made within 30 days of primary TKA in 52%, and within 90 days in 73% of cases. 603 cases were reoperated on or revised. Median time from operation to diagnosis was 29 days (1-716), for both time periods. Debridement with exchange of the insert was performed in 32% and 63% of cases before and after PRISS, respectively. Interpretation - We found similar incidence rates before and after the PRISS initiative without any statistically significant difference. Time to diagnosis was similar during both time periods. The project may have contributed to increased compliance with treatment protocols.
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Affiliation(s)
- Olof THOMPSON
- Infectious Diseases, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Annette W-DAHL
- Swedish Knee Arthroplasty Register, Lund, Sweden,Department of Clinical Sciences Lund, Lund University, Division of Orthopedics
| | - Viktor LINDGREN
- Department of Molecular Medicine and Surgery, Section of Orthopedics, Karolinska Institute, Stockholm, Sweden
| | - Max GORDON
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden
| | - Otto ROBERTSSON
- Swedish Knee Arthroplasty Register, Lund, Sweden,Department of Clinical Sciences Lund, Lund University, Division of Orthopedics
| | - Anna STEFÁNSDÓTTIR
- Department of Clinical Sciences Lund, Lund University, Division of Orthopedics,Department of Orthopedics, Skåne University Hospital, Lund, Sweden
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Sommerstein R, Atkinson A, Kuster SP, Vuichard-Gysin D, Harbarth S, Troillet N, Widmer AF. Association Between Antimicrobial Prophylaxis With Double-Dose Cefuroxime and Surgical Site Infections in Patients Weighing 80 kg or More. JAMA Netw Open 2021; 4:e2138926. [PMID: 34910149 PMCID: PMC8674749 DOI: 10.1001/jamanetworkopen.2021.38926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Many guidelines recommend a weight-adopted dose increase of cefuroxime for surgical antimicrobial prophylaxis (SAP). However, the evidence that this approach is associated with lower rates of surgical site infection (SSI) is limited. OBJECTIVE To assess whether double-dose cefuroxime SAP was associated with a decreased SSI rate in patients weighing at least 80 kg. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients (>18 years) weighing at least 80 kg who underwent 9 major surgical procedures with a cefuroxime SAP administration from the Swissnoso SSI surveillance system between January 2015 and December 2019 at 142 Swiss hospitals. The follow-up was 30 days for all surgical procedures and 1 year for implant-related operations. EXPOSURES Cefuroxime SAP dose (1.5 vs 3.0 g). MAIN OUTCOMES AND MEASURES Overall SSI. A mixed-effects logistic regression adjusted for institutional, epidemiological, and perioperative variables was applied. Results were stratified by weight categories as well as by wound contamination classes. RESULTS Of 41 076 eligible patients, 37 640 were included, with 22 625 (60.1%) men and a median (IQR) age of 61.9 (49.9-71.1) years. The outcome SSI was met by 1203 patients (3.2%). Double-dose cefuroxime was administered to 13 246 patients (35.2%) and was not significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.89; 95% CI, 0.78-1.02; P = .10). After stratification by weight category, double-dose SAP vs single-dose SAP was associated with lower SSI rates among 16 605 patients weighing at least 80 to less than 90 kg (aOR, 0.76; 95% CI, 0.61-0.97; P = .02) but not in the other weight categories (≥90 to <100 kg, 10 342 patients: aOR, 1.12; 95% CI, 0.87-1.47; P = .37; ≥100 to <120 kg, 8099 patients: aOR, 0.99; 95% CI, 0.76-1.30; P = .96; ≥120 kg, 2594 patients: aOR, 0.65; 95% CI, 0.42-1.04; P = .06). After stratification by contamination class, double-dose SAP was associated with lower SSI rates among 1946 patients with contaminated wounds (aOR, 0.49; 95% CI, 0.30-0.84; P = .008) but not those with clean wounds (25 680 patients; aOR, 0.92; 95% CI, 0.76-1.12; P = .44) or clean-contaminated wounds (10 014 patients; aOR, 0.90; 95% CI, 0.73-1.12; P = .37) compared with a single dose. CONCLUSIONS AND RELEVANCE In this study, double-dose SAP with cefuroxime for patients weighing at least 80 kg was not consistently associated with a lower SSI rate.
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Affiliation(s)
- Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Danielle Vuichard-Gysin
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Infectious Diseases, Cantonal Hospital Thurgau, Switzerland
| | - Stephan Harbarth
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nicolas Troillet
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Andreas F. Widmer
- Swissnoso, the National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
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Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, Thalib L, Andersson AE, Griffin B, Ware R, Chaboyer W. Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients. Int J Surg 2021; 95:106136. [PMID: 34655800 DOI: 10.1016/j.ijsu.2021.106136] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Establishing worldwide incidence of general surgical site infections (SSI) is imperative to understand the extent of the condition to assist decision-makers to improve the planning and delivery of surgical care. This systematic review and meta-analysis aimed to estimate the worldwide incidence of SSI and identify associated factors in adult general surgical patients. MATERIALS AND METHODS A systematic review was undertaken using MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library to identify cross-sectional, cohort and observational studies reporting SSI incidence or prevalence. Studies of less than 50 participants were excluded. Data extraction and quality appraisal were undertaken independently by two review authors. The primary outcome was cumulative incidence of SSI occurring up to 30 days postoperative. The secondary outcome was the severity/depth of SSI. The I2 statistic was used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Subgroup, meta-regression sensitivity analyses were used to explore the sources of heterogeneity. Publication bias was assessed using Hunter's plots and Egger's regression test. RESULTS Of 2091 publications retrieved, 62 studies were included. Of these, 57 were included in the meta-analysis across six anatomical locations with 488,594 patients. The pooled 30-day cumulative incidence of SSI was 11% (95% CI 10%-13%). No prevalence data were identified. SSI rates varied across anatomical location, surgical approach, and priority (i.e., planned, emergency). Multivariable meta-regression showed SSI is significantly associated with duration of surgery (estimate 1.01, 95% CI 1.00-1.02, P = .014). CONCLUSIONS and Relevance: 11 out of 100 general surgical patients are likely to develop an infection 30 days after surgery. Given the imperative to reduce the burden of harm caused by SSI, high-quality studies are warranted to better understand the patient and related risk factors associated with SSI.
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Affiliation(s)
- Brigid M Gillespie
- Griffith University Menzies Health Institute Queensland, National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Australia Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Australia Griffith University Menzies Health Institute Queensland, Australia Gold Coast Hospital and Health Service, Department of Surgery, Australia Griffith University Faculty of Health, School of Nursing and Midwifery, Australia Princess Alexandra Hospital, Division of Surgery, QLD, Australia Gold Coast University Hospital, Patient Safety in Nursing, QLD, Australia Istanbul Aydın University, Department of Biostatistics, Faculty of Medicine, Istanbul, Turkey Sahlgrenska Academy, Institute of Health Care Sciences, Sweden Sahlgrenska University Hospital, Department of Orthopaedics, Sweden
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20
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Malheiro R, Peleteiro B, Correia S. Beyond the operating room: do hospital characteristics have an impact on surgical site infections after colorectal surgery? A systematic review. Antimicrob Resist Infect Control 2021; 10:139. [PMID: 34593035 PMCID: PMC8485500 DOI: 10.1186/s13756-021-01007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hospital characteristics have been recognized as potential risk factors for surgical site infection for over 20 years. However, most research has focused on patient and procedural risk factors. Understanding how structural and process variables influence infection is vital to identify targets for effective interventions and to optimize healthcare services. The aim of this study was to systematically review the association between hospital characteristics and surgical site infection in colorectal surgery. Main body A systematic literature search was conducted using PubMed, Scopus and Web of Science databases until the 31st of May, 2021. The search strategy followed the Participants, Exposure/Intervention, Comparison, Outcomes and Study design. The primary outcome of interest was surgical site infection rate after colorectal surgery. Studies were grouped into nine risk factor typologies: hospital size, ownership affiliation, being an oncological hospital, safety-net burden, hospital volume, surgeon caseload, discharge destination and time since implementation of surveillance. The STROBE statement was used for evaluating the methodological quality. A total of 4703 records were identified, of which 172 were reviewed and 16 were included. Studies were published between 2008 and 2021, and referred to data collected between 1996 and 2016. Surgical site infection incidence ranged from 3.2 to 27.6%. Two out of five studies evaluating hospital size adjusted the analysis to patient and procedure-related risk factors, and showed that larger hospitals were either positively associated or had no association with SSI. Public hospitals did not present significantly different infection rates than private or non-profit ones. Medical school affiliation and higher safety-net burden were associated with higher surgical site infection (crude estimates), while oncological hospitals were associated with higher incidence independently of other variables. Hospital caseload showed mixed results, while surgeon caseload and surveillance time since implementation appear to be associated with fewer infections. Conclusions Although there are few studies addressing hospital-level factors on surgical site infection, surgeon experience and the implementation of a surveillance system appear to be associated with better outcomes. For hospitals and services to be efficiently optimized, more studies addressing these variables are needed that take into account the confounding effect of patient case mix.
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Affiliation(s)
- Rui Malheiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal. .,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
| | - Bárbara Peleteiro
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Sofia Correia
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-091, Porto, Portugal.,Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina, Universidade do Porto (University of Porto Medical School), Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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21
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Rakic M, Jaboyedoff M, Bachmann S, Berger C, Diezi M, do Canto P, Forrest CB, Frey U, Fuchs O, Gervaix A, Gluecksberg AS, Grotzer M, Heininger U, Kahlert CR, Kaiser D, Kopp MV, Lauener R, Neuhaus TJ, Paioni P, Posfay-Barbe K, Ramelli GP, Simeoni U, Simonetti G, Sokollik C, Spycher BD, Kuehni CE. Clinical data for paediatric research: the Swiss approach : Proceedings of the National Symposium in Bern, Switzerland, Dec 5-6, 2019. BMC Proc 2021; 15:19. [PMID: 34538238 PMCID: PMC8450032 DOI: 10.1186/s12919-021-00226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Continuous improvement of health and healthcare system is hampered by inefficient processes of generating new evidence, particularly in the case of rare diseases and paediatrics. Currently, most evidence is generated through specific research projects, which typically require extra encounters with patients, are costly and entail long delays between the recognition of specific needs in healthcare and the generation of necessary evidence to address those needs. The Swiss Personalised Health Network (SPHN) aims to improve the use of data obtained during routine healthcare encounters by harmonizing data across Switzerland and facilitating accessibility for research. The project "Harmonising the collection of health-related data and biospecimens in paediatric hospitals throughout Switzerland (SwissPedData)" was an infrastructure development project funded by the SPHN, which aimed to identify and describe available data on child health in Switzerland and to agree on a standardised core dataset for electronic health records across all paediatric teaching hospitals. Here, we describe the results of a two-day symposium that aimed to summarise what had been achieved in the SwissPedData project, to put it in an international context, and to discuss the next steps for a sustainable future. The target audience included clinicians and researchers who produce and use health-related data on children in Switzerland. KEY HIGHLIGHTS The symposium consisted of state-of-the-art lectures from national and international keynote speakers, workshops and plenary discussions. This manuscript summarises the talks and discussions in four sections: (I) a description of the Swiss Personalized Health Network and the results of the SwissPedData project; (II) examples of similar initiatives from other countries; (III) an overview of existing health-related datasets and projects in Switzerland; and (IV) a summary of the lessons learned and future prospective from workshops and plenary discussions. IMPLICATIONS Streamlined processes linking initial collection of information during routine healthcare encounters, standardised recording of this information in electronic health records and fast accessibility for research are essential to accelerate research in child health and make it affordable. Ongoing projects prove that this is feasible in Switzerland and elsewhere. International collaboration is vital to success. The next steps include the implementation of the SwissPedData core dataset in the clinical information systems of Swiss hospitals, the use of this data to address priority research questions, and the acquisition of sustainable funding to support a slim central infrastructure and local support in each hospital. This will lay the foundation for a national paediatric learning health system in Switzerland.
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Affiliation(s)
- Milenko Rakic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Manon Jaboyedoff
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sara Bachmann
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Christoph Berger
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Manuel Diezi
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Urs Frey
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Oliver Fuchs
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alain Gervaix
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Amalia Stefani Gluecksberg
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Michael Grotzer
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Heininger
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | | | - Daniela Kaiser
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Matthias V. Kopp
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Lauener
- Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas J. Neuhaus
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Paolo Paioni
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Klara Posfay-Barbe
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gian Paolo Ramelli
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Umberto Simeoni
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giacomo Simonetti
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Christiane Sokollik
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ben D. Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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Bekiari A, Pappas-Gogos G, Dimopoulos D, Priavali E, Gartzonika K, Glantzounis GK. Surgical site infection in a Greek general surgery department: who is at most risk? J Wound Care 2021; 30:268-274. [PMID: 33856911 DOI: 10.12968/jowc.2021.30.4.268] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Surgical site infections (SSIs) are associated with protracted hospitalisation, antibiotics administration, and increased morbidity and mortality. This work investigated the incidence rate of SSIs in the Department of General Surgery at the University Hospital of Ioannina, Greece, the associated risk factors and pathogens responsible. METHOD In this prospective cohort study, patients who underwent elective procedures under general anaesthesia were enrolled. Risk factors monitored included age, sex, body mass index, smoking, alcohol consumption, preoperative length of stay, chemoprophylaxis, intensive care unit (ICU) stay, American Society of Anesthesiology (ASA) score, and the National Nosocomial Infections Surveillance System (NNIS) basic SSI risk index. RESULTS Of the 1058 enrolled patients, 80 (7.6%) developed SSIs. Of the total cohort, 62.5% of patients received chemoprophylaxis for >24 hours. A total of 20 different pathogens, each with multiple strains (n=108 in total), were identified, 53 (49.5%) Gram-negative rods, 46 (42%) Gram-positive cocci, and nine (8.4%) fungi (Candida spp.). Escherichia coli was the prevalent microorganism (24.3%). SSI-related risk factors, as defined by univariate analysis, included: ICU stay, ASA score >2 (p<0.001), NNIS score >0, and wound classes II, III, and IV. Also, serum albumin levels <3.5g/dl were associated with increased rate of SSIs. The multivariate model identified an NNIS score of >0 and wound classes II, III, and IV as independent SSI-related risk factors. CONCLUSION This study showed high SSI rates. Several factors were associated with increased SSI rates, as well as overuse of prophylactic antibiotics. The results of the present study could be a starting point for the introduction of a system for recording and actively monitoring SSIs in Greek hospitals, and implementation of specific guidelines according to risk factors.
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Affiliation(s)
- Anna Bekiari
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - George Pappas-Gogos
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Dimitrios Dimopoulos
- Department of Medical Physics, School of Medicine, University of Ioannina, Greece
| | - Efthalia Priavali
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Konstantina Gartzonika
- Department of Microbiology, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and School of Medicine, University of Ioannina, Greece
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23
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Surveillance quality correlates with surgical site infection rates in knee and hip arthroplasty and colorectal surgeries: A call to action to adjust reporting of SSI rates. Infect Control Hosp Epidemiol 2021; 42:1451-1457. [PMID: 33597070 DOI: 10.1017/ice.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The incidence of surgical site infections may be underreported if the data are not routinely validated for accuracy. Our goal was to investigate the communicated SSI rate from a large network of Swiss hospitals compared with the results from on-site surveillance quality audits. DESIGN Retrospective cohort study. PATIENTS In total, 81,957 knee and hip prosthetic arthroplasties from 125 hospitals and 33,315 colorectal surgeries from 110 hospitals were included in the study. METHODS Hospitals had at least 2 external audits to assess the surveillance quality. The 50-point standardized score per audit summarizes quantitative and qualitative information from both structured interviews and a random selection of patient records. We calculated the mean National Healthcare Safety Network (NHSN) risk index adjusted infection rates in both surgery groups. RESULTS The median NHSN adjusted infection rate per hospital was 1.0% (interquartile range [IQR], 0.6%-1.5%) with median audit score of 37 (IQR, 33-42) for knee and hip arthroplasty, and 12.7% (IQR, 9.0%-16.6%), with median audit score 38 (IQR, 35-42) for colorectal surgeries. We observed a wide range of SSI rates and surveillance quality, with discernible clustering for public and private hospitals, and both lower infection rates and audit scores for private hospitals. Infection rates increased with audit scores for knee and hip arthroplasty (P value for the slope = .002), and this was also the case for planned (P = .002), and unplanned (P = .02) colorectal surgeries. CONCLUSIONS Surveillance systems without routine evaluation of validity may underestimate the true incidence of SSIs. Audit quality should be taken into account when interpreting SSI rates, perhaps by adjusting infection rates for those hospitals with lower audit scores.
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Sommerstein R, Marschall J, Atkinson A, Surbek D, Dominguez-Bello MG, Troillet N, Widmer AF. Antimicrobial prophylaxis administration after umbilical cord clamping in cesarean section and the risk of surgical site infection: a cohort study with 55,901 patients. Antimicrob Resist Infect Control 2020; 9:201. [PMID: 33349269 PMCID: PMC7754587 DOI: 10.1186/s13756-020-00860-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother.
Methods Study design: Cohort. Setting: 75 participating Swiss hospitals, from 2009 to 2018. Participants: A total of 55,901 patients were analyzed. Main outcome measures: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors. Results SAP was administered before incision in 26′405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4–1.8%]) occurred before incision and 449 (1.7% [1.5–1.9%]) after clamping (p = 0.759). The adjusted odds ratio for SAP administration after clamping was not significantly associated with an increased SSI rate (1.14, 95% CI 0.96–1.36; p = 0.144) when compared to before incision. Supplementary and subgroup analyses supported these main results. Conclusions This study did not confirm an increased SSI risk for the mother in cesarean section if SAP is given after umbilical cord clamping compared to before incision.
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Affiliation(s)
- Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Swissnoso, National Center for Infection Control, Bern, Switzerland.
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.,Swissnoso, National Center for Infection Control, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynaecology, Bern University Hospital, University of Bern, Bern, Switzerland.,Swiss Society of Obstetrics and Gynaecology, Bern, Switzerland
| | - Maria Gloria Dominguez-Bello
- Department of Biochemistry and Microbiology, Rutgers School of Environmental and Biological Science, New Brunswick, NJ, USA
| | - Nicolas Troillet
- Swissnoso, National Center for Infection Control, Bern, Switzerland.,Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Andreas F Widmer
- Swissnoso, National Center for Infection Control, Bern, Switzerland. .,Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland.
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25
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Sommerstein R, Atkinson A, Kuster SP, Thurneysen M, Genoni M, Troillet N, Marschall J, Widmer AF. Antimicrobial prophylaxis and the prevention of surgical site infection in cardiac surgery: an analysis of 21 007 patients in Switzerland†. Eur J Cardiothorac Surg 2020; 56:800-806. [PMID: 30796448 DOI: 10.1093/ejcts/ezz039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Our goal was to determine the optimal timing and choice of surgical antimicrobial prophylaxis (SAP) in patients having cardiac surgery. METHODS The setting was the Swiss surgical site infection (SSI) national surveillance system with a follow-up rate of >94%. Participants were patients from 14 hospitals who had cardiac surgery from 2009 to 2017 with clean wounds, SAP with cefuroxime, cefazolin or a vancomycin/cefuroxime combination and timing of SAP within 120 min before the incision. Exposures were SAP timing and agents; the main outcome was the incidence of SSI. We fitted generalized additive and mixed-effects generalized linear models to describe effects predicting SSIs. RESULTS A total of 21 007 patients were enrolled with an SSI incidence of 5.5%. Administration of SAP within 30 min before the incision was significantly associated with decreased deep/organ space SSI [adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.54-0.98; P = 0.035] compared to administration of SAP 60-120 min before the incision. Cefazolin (adjusted OR 0.64, 95% CI 0.49-0.84; P = 0.001) but not vancomycin/cefuroxime combination (adjusted OR 1.05, 95% CI 0.82-1.34; P = 0.689) was significantly associated with a lower risk of overall SSI compared to cefuroxime alone. Nevertheless, there were no statistically significant differences between the SAP agents and the risk of deep/organ space SSI. CONCLUSIONS The results from this large prospective study provide substantial arguments that administration of SAP close to the time of the incision is more effective than earlier administration before cardiac surgery, making compliance with SAP administration easier. The choice of SAP appears to play a significant role in the prevention of all SSIs, even after adjusting for confounding variables.
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Affiliation(s)
- Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Maurus Thurneysen
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Michele Genoni
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Nicolas Troillet
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Andreas F Widmer
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
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Roth JA, Schwab C, Atkinson A, von Flüe M, Kettelhack C, Eckstein FS, Battegay M, Klimke S, Frei R, Widmer AF. Are three antiseptic paints needed for safe preparation of the surgical field? A prospective cohort study with 239 patients. Antimicrob Resist Infect Control 2020; 9:120. [PMID: 32736650 PMCID: PMC7393917 DOI: 10.1186/s13756-020-00780-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background Preoperative skin antisepsis is an essential component of safe surgery. However, it is unclear how many antiseptic paints are needed to eliminate bacteria prior to incision. This study compared microbial skin counts after two and three antiseptic paints. Methods We conducted a prospective cohort study in non-emergency patients receiving a cardiac/abdominal surgery with standardized, preoperative skin antisepsis consisting of an alcoholic compound and either povidone iodine (PI) or chlorhexidine (CHX). We obtained three skin swabs from the participant’s thorax/abdomen using a sterile template with a 25 cm2 window: After collection of the first swab prior to skin antisepsis, and once the second and third application of PI/CHX had dried out, we obtained a second and third swab, respectively. Our primary outcome was the reduction in microbial skin counts after two and three paints of PI/CHX. Results Among the 239 enrolled patients, there was no significant difference in the reduction of mean square root-transformed microbial skin counts with three versus two paints (P = 0.2). But distributions of colony forming units (CFUs) decreased from paint 2 to 3 in a predefined analysis (P = 0.002). There was strong evidence of an increased proportion of patients with zero CFU after paint 3 versus paint 2 (P = 0.003). We did not identify risk factors for insufficient reduction of microbial skin counts after two paints, defined as the detection of > 5 CFUs and/or ≥ 1 pathogens. Conclusions In non-emergency surgical patients, three antiseptic paints may be superior to two paints in reducing microbial skin colonization prior to surgery.
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Affiliation(s)
- Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
| | - Cyrill Schwab
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Bern, University of Bern, Bern, Switzerland.,Pediatric Pharmacology and Pharmacometrics Research, University Children's Hospital Basel, Basel, Switzerland
| | - Markus von Flüe
- University of Basel, Basel, Switzerland.,Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital Basel, Basel, Switzerland
| | - Christoph Kettelhack
- University of Basel, Basel, Switzerland.,Clarunis, University Center for Gastrointestinal and Liver Disorders, University Hospital Basel, Basel, Switzerland
| | - Friedrich S Eckstein
- University of Basel, Basel, Switzerland.,Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Steffi Klimke
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Reno Frei
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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27
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Roth JA, Juchler F, Dangel M, Eckstein FS, Battegay M, Widmer AF. Frequent Door Openings During Cardiac Surgery Are Associated With Increased Risk for Surgical Site Infection: A Prospective Observational Study. Clin Infect Dis 2020; 69:290-294. [PMID: 30321301 DOI: 10.1093/cid/ciy879] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Preliminary studies that analyzed surrogate markers have suggested that operating room (OR) door openings may be a risk factor for surgical site infection (SSI). We therefore aimed to estimate the effect of OR door openings on SSI risk in patients undergoing cardiac surgery. METHODS This prospective, observational study involved consecutive patients undergoing cardiac surgery in 2 prespecified ORs equipped with automatic door-counting devices from June 2016 to October 2017. Occurrence of an SSI within 30 days after cardiac surgery was our primary outcome measure. Respective outcome data were obtained from a national SSI surveillance cohort. We analyzed the relationship between mean OR door opening frequencies and SSI risk by use of uni- and multivariable Cox regression models. RESULTS A total of 301 594 OR door openings were recorded during the study period, with 87 676 eligible door openings being logged between incision and skin closure. There were 688 patients included in the study, of whom 24 (3.5%) developed an SSI within 30 days after surgery. In uni- and multivariable analysis, an increased mean door opening frequency during cardiac surgery was associated with higher risk for consecutive SSI (adjusted hazard ratio per 5-unit increment, 1.49; 95% confidence interval, 1.11-2.00; P = .008). The observed effect was driven by internal OR door openings toward the clean instrument preparation room. CONCLUSIONS Frequent door openings during cardiac surgery were independently associated with an increased risk for SSI. This finding warrants further study to establish a potentially causal relationship between OR door openings and the occurrence of SSI.
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Affiliation(s)
- Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Bern, Switzerland
| | - Fabrice Juchler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland
| | - Marc Dangel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland
| | - Friedrich S Eckstein
- University of Basel, Bern, Switzerland.,Department of Cardiac Surgery, University Hospital Basel, Bern, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Bern, Switzerland.,University of Basel, Bern, Switzerland.,Swissnoso, National Center for Infection Prevention, Bern, Switzerland
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Ouedraogo S, Kambire JL, Ouedraogo S, Ouangre E, Diallo I, Zida M, Bandre E. Surgical Site Infection after Digestive Surgery: Diagnosis and Treatment in a Context of Limited Resources. Surg Infect (Larchmt) 2020; 21:547-551. [PMID: 32053063 DOI: 10.1089/sur.2019.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Surgical site infections (SSIs) are responsible for substantial morbidity in patients who undergo digestive surgery. However, very little is known about the aspects of SSIs in sub-Saharan Africa. Methods: The purpose of this study was to assess the prevalence and identify the risk factors of SSI in patients who were treated in the Department of Digestive Surgery of Tenkodogo Hospital in Burkina Faso. We performed a prospective study from January 1, 2016 to December 31, 2016. All patients who underwent digestive tract surgery during this period were included and followed. Patients whose post-operative surgical sites were complicated by infection were identified. Surgical site infection was diagnosed according to the U.S. Centers for Disease Control and Prevention (CDC) definition. Bacteriologic sampling was performed in all included patients. Results: A total 964 patients underwent surgery during the study period and were included in the study. Seven hundred thirty-seven were females (76.4%), and 227 were males. The mean age of the included patients was 47.5 years (standard deviation [SD] = 9 years). One hundred fourteen patients presented with SSI, the incidence of which was 11.8%. The incidence of SSI was substantially higher in females than in males (63.2 vs. 36.8%, p < 0.05). The incidence was also higher in patients living below the poverty line (71.1 vs. 28.9%, p < 0.05). Clinically, the incidence of SSI was higher in emergency surgery than in scheduled surgery (84.2 vs. 15.8%, p < 0.05). Contaminated or dirty surgery was more risky than clean surgery (p < 0.05). With respect to bacteria, the most commonly isolated microbes were Escherichia coli (66.7%) and Staphylococcus aureus (15%). Treatment mainly consisted of appropriate antibiotic therapy and local care. Three deaths were recorded for a mortality rate of 2.6%. Conclusions: Surgical site infections are frequent in sub-Saharan environments. The risk factors seem to be clinical and social.
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Affiliation(s)
- Souleymane Ouedraogo
- Department of Surgery, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso.,Department of Medicine, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Jean Luc Kambire
- Department of Surgery, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso.,Department of Medicine, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Salam Ouedraogo
- Department of Surgery, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso.,Department of Medicine, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Edgar Ouangre
- Surgical Department, Hospital of Ouahigouya, Burkina Faso
| | - Ismaël Diallo
- Department of Surgery, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso.,Surgical Department, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Maurice Zida
- Department of Surgery, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso.,Surgical Department, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Emile Bandre
- Department of Surgery, University Ouaga 1 Pr Joseph Ki Zerbo, Ouagadougou, Burkina Faso.,Surgical Department, Teaching Hospital Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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29
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Chen T, Liu Z, Xue C, Tian W, Bai D, Chen YP. Association of Dysplastic Coronoid Process with Long-Face Morphology. J Dent Res 2019; 99:339-348. [PMID: 31826728 DOI: 10.1177/0022034519892551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Vertical malocclusion is a developmental condition, resulting from complex interactions among multiple etiological factors during the growth period. As a tricky dentofacial deformity clinically, long-face (LF) morphology is characterized by excessive vertical facial growth with severe disarrangement of jaws and teeth. Since the improvement of LF patients on facial profile and occlusion is often difficult and lacks long-term stability, it becomes important to unravel the etiology of LF pattern formation for early prevention and treatment. In the current studies, we identified a transgenic mouse model that exhibited a dysplastic coronoid process and LF morphology. Although the mutant mice exhibited jaw structures and occlusion comparable to controls at birth, they all acquired typical LF morphology with anterior open bite during postnatal growth, resembling clinical features of the selected skeletal class III patients. Since the coronoid process provides an insertion site for the temporalis attachment, we examined the initial development and differentiation of the temporalis and found identical results in both control and mutant mice before E17.5 when the temporal muscle makes attachment to the coronoid process. However, thereafter, we observed altered orientation and reduced size of the cross-sectional area of the temporalis in mutant mice, which persisted to the weaning stage. Biomechanical analysis and simulation modeling further support the idea that altered morphology of the coronoid process may impair the efficiency of the vertical temporalis contraction and appears to correlate with LF formation. Consistently, we present evidence that a dysplastic mandibular coronoid process was also seen in some human patients with skeletal III LF morphology. Taken together, the results presented in this study establish an association of the craniofacial bony structures with vertical patterning, which will have implications in earlier prediction for clinical precaution and intervention.
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Affiliation(s)
- T Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cell and Molecular Biology, Tulane University, New Orleans, LA, USA.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Z Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cell and Molecular Biology, Tulane University, New Orleans, LA, USA.,Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Xue
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - W Tian
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - D Bai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Y P Chen
- Department of Cell and Molecular Biology, Tulane University, New Orleans, LA, USA
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30
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Popp W, Alefelder C, Bauer S, Daeschlein G, Geistberger P, Gleich S, Herr C, Hübner NO, Jatzwauk L, Kohnen W, Külpmann R, Lemm F, Loczenski B, Spors J, Walger P, Wehrl M, Zastrow KD, Exner M. Air quality in the operating room: Surgical site infections, HVAC systems and discipline - position paper of the German Society of Hospital Hygiene (DGKH). GMS HYGIENE AND INFECTION CONTROL 2019; 14:Doc20. [PMID: 32047719 PMCID: PMC6997799 DOI: 10.3205/dgkh000335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years, there has been an ongoing discussion about the value of laminar airflow (LAF=low turbulence displacement ventilation) in the operating room for prevention of surgical site infections (SSI). Some publications, e.g., from the WHO, issued the demand to no longer build LAF ceilings in operating rooms. The present statement deals critically with this position and justifies the use of LAF ceilings in different ways: Many of the papers cited by the WHO and others for the case against LAF do not provide reliable data.The remaining studies which might be used for answering the question give quite different results, also in favor of LAF.The size of the LAF ceiling in many studies is not given or mostly too small in comparison to actual technical requirements.LAF in different countries can mean quite different techniques (e.g., the US in comparison to Germany) so that the results of studies that do not take this into account may not be comparable.LAF has positive effects in terms of reducing particulate and bacterial load, associated with increased airflow in the surgical working area. A reduction of carcinogenic substances in the air may also be assumed, which would increase workers' safety. Thus, this paper recommends building LAF ceilings in the future as well, depending on the operations intended. Further, this paper gives an overview of possible reasons for surgical site infections and highlights the importance of discipline in the operating theatre.
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Affiliation(s)
- Walter Popp
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Sonja Bauer
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | - Sabine Gleich
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Caroline Herr
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Lutz Jatzwauk
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | | | | | | | - Jörg Spors
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Peter Walger
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | - Markus Wehrl
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
| | | | - Martin Exner
- German Society for Hospital Hygiene (DGKH), Berlin, Germany
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31
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Böni L, Kuster SP, Bartik B, Zbinden R, Zingg PO, Achermann Y. Association of Cutibacterium avidum Colonization in the Groin With Obesity: A Potential Risk Factor for Hip Periprosthetic Joint Infection. Clin Infect Dis 2019; 67:1878-1882. [PMID: 29746626 DOI: 10.1093/cid/ciy379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/03/2018] [Indexed: 12/25/2022] Open
Abstract
Background An increase in the incidence of hip periprosthetic joint infections caused by Cutibacterium avidum has recently been detected after hip arthroplasty with an anterior surgical approach. We raised the question of whether skin colonization with C. avidum differs between the anterior and the lateral thigh as areas of surgical incision fields. Methods Between February and June 2017, we analyzed skin scrapings from the groin and the anterior and lateral thigh in patients undergoing a primary hip arthroplasty. We anaerobically cultured plated swab samples for Cutibacterium spp. for ≥7 days. Univariate logistic regression analysis was used to explore associations between body mass index (BMI) and colonization rate at different sites. Results Twenty-one of 65 patients (32.3%) were colonized with C. avidum at any site, mainly at the groin (n = 16; 24.6%), which was significantly higher at the anterior (n = 5; 7.7%; P = .009) or lateral (n = 6; 9.2%; P = .02) thigh. Patients colonized with C. avidum did not differ from noncolonized patients in age or sex, but their BMIs were significantly higher (30.1 vs 25.6 kg/m2, respectively; P = .02). Furthermore, increased BMI was associated with colonization at the groin (odds ratio per unit BMI increase, 1.15; 95% confidence interval; 1.03-1.29; P = .01). Conclusions The groin, rather than the anterior thigh, showed colonization for C. avidum in obese patients. Further studies are needed to evaluate current skin disinfection and draping protocols for hip arthroplasty, particularly in obese patients.
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Affiliation(s)
- Laura Böni
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
| | - Bianka Bartik
- Department of Orthopedics, University Hospital Balgrist
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Switzerland
| | | | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich
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32
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Baier C, Adelmund S, Schwab F, Lassahn C, Chaberny IF, Gossé F, Vonberg RP, Ebadi E. Incidence and risk factors of surgical site infection after total knee arthroplasty: Results of a retrospective cohort study. Am J Infect Control 2019; 47:1270-1272. [PMID: 31153712 DOI: 10.1016/j.ajic.2019.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022]
Abstract
Knee arthroplasty is commonly performed in the case of advanced osteoarthritis, and deep joint infections represent a severe complication following surgery. A 4-year retrospective cohort study was conducted to determine the incidence and risk factors for such surgical site infections. Of the 2439 patients included in the study, 84 of them (3.4%) developed infections. Postoperative bleeding, Ahlbäck's disease, obesity, smoking, and male gender were independent risk factors that should be considered when caring for those patients.
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33
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Rubeli SL, D’Alonzo D, Mueller B, Bartlomé N, Fankhauser H, Bucheli E, Conen A, Fandino J, Fux CA. Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery. Neurosurg Focus 2019; 47:E3. [DOI: 10.3171/2019.5.focus19272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe objective of this study was to quantify surgical site infection (SSI) rates after cranial neurosurgery in a tertiary care hospital, identify risk factors for SSI, and evaluate the impact of standardized surveillance and an infection prevention bundle (IPB).METHODSThe authors compared SSI rates during 7 months before and after the intervention. The IPB included standardized patient preparation, perioperative antibiotic/antiseptic use, barrier precautions, coaching of surgeons, and the implementation of a specialized technical operation assistant team.RESULTSThree hundred twenty-two unselected consecutive patients were evaluated before the IPB, and 296 were evaluated after implementation. Infection rates after 1 year decreased from 7.8% (25/322) to 3.7% (11/296, p = 0.03) with similar mortality rates (14.7% vs 13.8%, p = 0.8). The isolated bacteria included Staphylococcus aureus (42%), Cutibacterium acnes (22%), and coagulase-negative staphylococci (14%). Organ/space infections dominated with 67%, and mostly consisted of subdural empyema and meningitis/ventriculitis. Among the 36 SSIs, 13 (36%) occurred during hospitalization, and 29 (81%) within the first 3 months of follow-up. In multivariable analysis including established risk factors described in the literature, non-CNS neoplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.39–10.53), postoperative bleeding (OR 4.09, 1.44–11.62), operations performed by or under supervision of a senior faculty surgeon (OR 0.38, 0.17–0.84), and operations performed after the implementation of standardized surveillance and an IPB (OR 0.38, 0.17–0.85) significantly influenced the infection rate.CONCLUSIONSThe introduction of an IPB combined with routine surveillance and personal feedback was associated with a 53% reduced infection rate. The lower infection rates of senior faculty and the strong association between postoperative bleeding and infection underline the importance of both surgical experience as well as thorough supervision and coaching of younger surgeons.
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Affiliation(s)
| | | | - Beate Mueller
- Departments of 1Infectious Diseases and Hospital Hygiene,
| | | | | | - Evelin Bucheli
- Departments of 1Infectious Diseases and Hospital Hygiene,
| | - Anna Conen
- Departments of 1Infectious Diseases and Hospital Hygiene,
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Impact of health insurance status on surgical site infection incidence: A prospective cohort study. Infect Control Hosp Epidemiol 2019; 40:1063-1065. [PMID: 31309908 DOI: 10.1017/ice.2019.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Health insurance status may affect the risk for surgical site infection (SSI). A large prospective cohort study in a Swiss tertiary-care hospital did not find evidence of a difference in SSI risk in individuals with basic versus semiprivate or private insurance in a setting with universal health insurance coverage.
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35
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Performance of surgical site infection risk prediction models in colorectal surgery: external validity assessment from three European national surveillance networks. Infect Control Hosp Epidemiol 2019; 40:983-990. [PMID: 31218977 DOI: 10.1017/ice.2019.163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the validity of multivariable models for predicting risk of surgical site infection (SSI) after colorectal surgery based on routinely collected data in national surveillance networks. DESIGN Retrospective analysis performed on 3 validation cohorts. PATIENTS Colorectal surgery patients in Switzerland, France, and England, 2007-2017. METHODS We determined calibration and discrimination (ie, area under the curve, AUC) of the COLA (contamination class, obesity, laparoscopy, American Society of Anesthesiologists [ASA]) multivariable risk model and the National Healthcare Safety Network (NHSN) multivariable risk model in each cohort. A new score was constructed based on multivariable analysis of the Swiss cohort following colorectal surgery, then based on colon and rectal surgery separately. RESULTS We included 40,813 patients who had undergone elective or emergency colorectal surgery to validate the COLA score, 45,216 patients to validate the NHSN colon and rectal surgery risk models, and 46,320 patients in the construction of a new predictive model. The COLA score's predictive ability was poor, with AUC values of 0.64 (95% confidence interval [CI], 0.63-0.65), 0.62 (95% CI, 0.58-0.67), 0.60 (95% CI, 0.58-0.61) in the Swiss, French, and English cohorts, respectively. The NHSN colon-specific model (AUC, 0.61; 95% CI, 0.61-0.62) and the rectal surgery-specific model (AUC, 0.57; 95% CI, 0.53-0.61) showed limited predictive ability. The new predictive score showed poor predictive accuracy for colorectal surgery overall (AUC, 0.65; 95% CI, 0.64-0.66), for colon surgery (AUC, 0.65; 95% CI, 0.65-0.66), and for rectal surgery (AUC, 0.63; 95% CI, 0.60-0.66). CONCLUSION Models based on routinely collected data in SSI surveillance networks poorly predict individual risk of SSI following colorectal surgery. Further models that include other more predictive variables could be developed and validated.
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Cardiovascular daytime varying effect in cardiac surgery on surgical site infections and 1-year mortality: A prospective cohort study with 22,305 patients. Infect Control Hosp Epidemiol 2019; 40:727-728. [DOI: 10.1017/ice.2019.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractAfternoon aortic valve replacement surgery may provide perioperative myocardial protection and improve patient outcomes compared with morning surgery. The results of our large observational study based on Swiss cardiac surgical site infection surveillance data suggest that the current evidence is insufficient to generally promote afternoon cardiac surgeries.
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Keller S, Grass F, Tschan F, Addor V, Petignat C, Moulin E, Beldi G, Demartines N, Hübner M. Comparison of Surveillance of Surgical Site Infections by a National Surveillance Program and by Institutional Audit. Surg Infect (Larchmt) 2019; 20:225-230. [DOI: 10.1089/sur.2018.211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sandra Keller
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
| | - Franziska Tschan
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Valérie Addor
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
| | - Christiane Petignat
- Department of Hospital Preventive Medicine, Lausanne University HospitalCHUV, Lausanne, Switzerland
| | - Estelle Moulin
- Department of Hospital Preventive Medicine, Lausanne University HospitalCHUV, Lausanne, Switzerland
| | - Guido Beldi
- Department of Medicine and Visceral Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland
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Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopaedic unit, retrospective observatory study. INTERNATIONAL ORTHOPAEDICS 2019; 43:2009-2016. [PMID: 30680519 PMCID: PMC6698262 DOI: 10.1007/s00264-019-04298-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/08/2019] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aims of the study were to analyse the surgical site infections (SSIs) in patients operated at an orthopaedic ward and to describe the drug-resistance of the aetiology of those infections. Also, analyse the possibility of SSI control through microbiological surveillance. Additionally, we have studied the information inferred by aggregating cumulative antibiograms for the SSIs of the studied orthopaedic unit. DESIGN Cross-sectional studies carried out in 2013-2015. SETTING AND PATIENTS Orthopaedic and Trauma Surgery Unit in Sosnowiec, Poland; 5995 patients, 5239 operations. METHODS Retrospective laboratory-based data collection study of surgical site infections. RESULTS SSI incidence rate was 6.6%, in the implantations-hip prosthesis 5.8% and knee prosthesis 5.4%, about 6 times higher compared with European HAI-Net. SSIs were usually caused by Gram-positive bacteria (56%). The prevalence of MDR microorganisms was 22.6%, and mainly concerned the Gram-negative bacilli: 97.6% of Acinetobacter baumannii and 50.0% of Klebsiella pneumoniae were multidrug-resistant. On the basis of what the Formula for Rational Empiric Antimicrobial Therapy analysis has shown, the use of amikacin, imipenem and ciprofloxacin has been recommended as the most efficient in the empirical therapy of SSIs. CONCLUSIONS The infection control was a significant problem at the studied orthopaedic unit, as evidenced by the SSI incidence rate significantly higher than expected. We suggest implementing the infection control and prevention based on evidence-based medicine, and a unit-based surveillance. A cumulative unit-based antibiogram reflects the drug-susceptibility pattern for the strains from the infections acquired at the unit.
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Abbas M, de Kraker MEA, Aghayev E, Astagneau P, Aupee M, Behnke M, Bull A, Choi HJ, de Greeff SC, Elgohari S, Gastmeier P, Harrison W, Koek MBG, Lamagni T, Limon E, Løwer HL, Lyytikäinen O, Marimuthu K, Marquess J, McCann R, Prantner I, Presterl E, Pujol M, Reilly J, Roberts C, Segagni Lusignani L, Si D, Szilágyi E, Tanguy J, Tempone S, Troillet N, Worth LJ, Pittet D, Harbarth S. Impact of participation in a surgical site infection surveillance network: results from a large international cohort study. J Hosp Infect 2018; 102:267-276. [PMID: 30529703 DOI: 10.1016/j.jhin.2018.12.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale. AIM To determine the time-trend of SSI rates in surveillance networks. METHODS SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept. FINDINGS Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis. CONCLUSION In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.
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Affiliation(s)
- M Abbas
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - M E A de Kraker
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - E Aghayev
- Swiss RDL, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; Schulthess Klinik, Zürich, Switzerland
| | - P Astagneau
- Reference Centre for Prevention and Control of Healthcare-associated Infections, APHP University Hospital, Paris, France
| | - M Aupee
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - M Behnke
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Bull
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia
| | - H J Choi
- Division of Infectious Diseases, Office of Infection Control, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - S C de Greeff
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - S Elgohari
- National Infection Service, Public Health England, London, UK
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Harrison
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | - M B G Koek
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - E Limon
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain
| | - H L Løwer
- Norwegian Institute of Public Health, Department of Infectious Disease Epidemiology, Oslo, Norway
| | - O Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - K Marimuthu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Marquess
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - R McCann
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - I Prantner
- National Center for Epidemiology, Budapest, Hungary
| | - E Presterl
- Medical University of Vienna, Department of Infection Control and Hospital Epidemiology, Vienna, Austria
| | - M Pujol
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - J Reilly
- Healthcare Associated Infection, Antimicrobial Resistance, Decontamination and Infection Control Group, Health Protection Scotland, NHS National Services Scotland, Glasgow, UK; Safeguarding Health Through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - C Roberts
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | | | - D Si
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - E Szilágyi
- National Public Health and Medical Officer Service, Budapest, Hungary
| | - J Tanguy
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - S Tempone
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - N Troillet
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland; Service of Infectious Diseases, Central Institute of the Valais Hospital, Sion, Switzerland
| | - L J Worth
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia
| | - D Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - S Harbarth
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Troughton R, Birgand G, Johnson A, Naylor N, Gharbi M, Aylin P, Hopkins S, Jaffer U, Holmes A. Mapping national surveillance of surgical site infections in England: needs and priorities. J Hosp Infect 2018; 100:378-385. [DOI: 10.1016/j.jhin.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
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Costs versus earnings in colon surgery and coronary artery bypass grafting under a prospective payment system: Sufficient financial incentives to reduce surgical site infections? Infect Control Hosp Epidemiol 2018; 39:1246-1249. [PMID: 30131085 DOI: 10.1017/ice.2018.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Based on a surgical site infection (SSI) cohort at an academic center, we showed a median potentially preventable loss per non-SSI case of $17,916 in colon surgery and of $34,741 in coronary artery bypass grafting.
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Different Types of Heater-Cooler Units and Their Risk of Transmission of Mycobacterium chimaera During Open-Heart Surgery: Clues From Device Design. Infect Control Hosp Epidemiol 2018; 39:834-840. [PMID: 29804546 DOI: 10.1017/ice.2018.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVEWorldwide, Mycobacterium chimaera infections have been linked to contaminated aerosols from heater-cooler units (HCUs) during open-heart surgery. These infections have mainly been associated with the 3T HCU (LivaNova, formerly Sorin). The reasons for this and the risk of transmission from other HCUs have not been systematically assessed.DESIGNProspective observational study.SETTINGUniversity Hospital Basel, Switzerland.METHODSContinuous microbiological surveillance of 3 types of HCUs in use (3T from LivaNova/Sorin and HCU30 and HCU40 from Maquet) was initiated in June 2014, coupled with an epidemiologic workup. Monthly water and air samples were taken. Construction design was analyzed, and exhausted airflow was measured.RESULTS Mycobacterium chimaera grew in 8 of 12 water samples (66%) and 22 of 24 air samples (91%) of initial 3T HCUs in use, and in 2 of 83 water samples (2%) and 0 of 41 (0%) air samples of new replacement 3T HCUs. Moreover, 7 of 12 water samples (58%) and 0 of 4 (0%) air samples from the HCU30 were positive, and 0 of 64 (0%) water samples and 0 of 50 (0%) air samples from the HCU40 were positive. We identified 4 relevant differences in HCU design compared to the 3T: air flow direction, location of cooling ventilators, continuous cooling of the water tank at 4°C, and an electronic alarm in the HCU40 reminding the user of the next disinfection cycle.CONCLUSIONSAll infected patients were associated with a 3T HCU. The individual HCU design may explain the different risk of disseminating M. chimaera into the air of the operating room. These observations can help the construction of improved devices to ensure patient safety during cardiac surgery.Infect Control Hosp Epidemiol 2018;834-840.
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Ashraf I, Mohib Y, Hasan O, Malik A, Ahmad K, Noordin S. Surgical site infection surveillance following total knee arthroplasty: Tertiary care hospital experience. Ann Med Surg (Lond) 2018; 31:14-16. [PMID: 29922462 PMCID: PMC6004735 DOI: 10.1016/j.amsu.2018.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/02/2018] [Accepted: 04/05/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction Surgical Site Infection (SSI) after knee arthroplasty is a major cause of morbidity and mortality that increases the hospital stay, financial burden and mental anguish of the patient. Infection Control Unit at Aga Khan University Hospital (AKUH) incorporated total knee arthroplasty in its surgical care surveillance program and started collecting data in June 2012. The purpose of this study is to review Surgical Site Infection (SSI) rates in patients undergoing primary total knee replacement (TKR) surgery. Patients and methodology All patients from June 2012 to December 2013 undergoing knee arthroplasty at our hospital were included. Data was acquired from the hospital SSI database for knee arthroplasty surgery. Data was collected by SSI nurses for inpatients a well as post-discharge monitoring in clinics till 90 days post-op follow-up. The work has been reported in line with the PROCESS criteria. Results During this time period a total of 164 patients had primary TKR at AKUH. Out of these, 85 patients (52%) had bilateral TKR while 79 (48%) had unilateral TKR. The overall SSI was in 2 patients (1.2%). Conclusion Identifying SSIs is multidimensional. Since our 2 infected cases after TKR occurred after discharge, this highlights the importance of post-discharge surveillance and not limiting the surveillance for inpatients only. Furthermore, the SSI program may be effective in controlling postoperative wound infections. Surgical Site Infection (SSI) after knee arthroplasty is a major cause of morbidity and mortality. It increases the hospital stay, financial burden and mental anguish of the patient. The purpose of this study is to review SSI rates in patients undergoing primary total knee replacement. Identifying SSIs is multidimensional. The importance of post-discharge surveillance and not limiting the surveillance for inpatients only is highlighted here.
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Affiliation(s)
| | | | - Obada Hasan
- Department of Surgery, AKUH, Pakistan
- Corresponding author.
| | - Amina Malik
- Department Director's Off-Nursing Services, AKUH, Pakistan
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First Results of the Swiss National Surgical Site Infection Surveillance Program: Who Seeks Shall Find – ERRATUM. Infect Control Hosp Epidemiol 2017; 38:1389. [DOI: 10.1017/ice.2017.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Temporal trends and epidemiology of Staphylococcus aureus surgical site infection in the Swiss surveillance network: a cohort study. J Hosp Infect 2017; 98:118-126. [PMID: 28988937 DOI: 10.1016/j.jhin.2017.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Staphylococcus aureus is the leading pathogen in surgical site infections (SSI). AIM To explore trends and risk factors associated with S. aureus SSI. METHODS Risk factors for monomicrobial S. aureus SSI were identified from the Swiss multi-centre SSI surveillance system using multi-variate logistic regression. Both in-hospital and postdischarge SSI were identified using standardized definitions. FINDINGS Over a six-year period, data were collected on 229,765 surgical patients, of whom 499 (0.22%) developed monomicrobial S. aureus SSI; 459 (92.0%) and 40 (8.0%) were due to meticillin-susceptible S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA), respectively. There was a significant decrease in the rate of MSSA SSI (P = 0.007), but not in the rate of MRSA SSI (P = 0.70). Independent protective factors for S. aureus SSI were older age [≥75 years vs <50 years: odds ratio (OR) 0.60, 95% confidence interval (CI) 0.44-0.83], laparoscopy/minimally invasive surgery (OR 0.68, 95% CI 0.50-0.92), non-clean surgery [OR 0.78 (per increase in wound contamination class), 95% CI 0.64-0.94] and correct timing of pre-operative antibiotic prophylaxis (OR 0.80, 95% CI 0.65-0.98). Independent risk factors were male sex (OR 1.38, 95% CI 1.14-1.66), higher American Society of Anesthesiologists' score (per one-point increment: OR 1.30, 95% CI 1.13-1.51), re-operation for non-infectious reasons (OR 4.59, 95% CI 3.59-5.87) and procedure type: cardiac surgery, laminectomy, and hip or knee arthroplasty had two-to nine-fold increased odds of S. aureus SSI compared with other procedures. CONCLUSIONS SSI due to S. aureus are decreasing and becoming rare events in Switzerland. High-risk procedures that may benefit from specific preventive measures were identified. Unfortunately, many of the independent risk factors are not easily modifiable.
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Structure, Process, and Outcome Quality of Surgical Site Infection Surveillance in Switzerland. Infect Control Hosp Epidemiol 2017; 38:1172-1181. [DOI: 10.1017/ice.2017.169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVETo assess the structure and quality of surveillance activities and to validate outcome detection in the Swiss national surgical site infection (SSI) surveillance program.DESIGNCountrywide survey of SSI surveillance quality.SETTING147 hospitals or hospital units with surgical activities in Switzerland.METHODSSite visits were conducted with on-site structured interviews and review of a random sample of 15 patient records per hospital: 10 from the entire data set and 5 from a subset of patients with originally reported infection. Process and structure were rated in 9 domains with a weighted overall validation score, and sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the identification of SSI.RESULTSOf 50 possible points, the median validation score was 35.5 (range, 16.25–48.5). Public hospitals (P<.001), hospitals in the Italian-speaking region of Switzerland (P=.021), and hospitals with longer participation in the surveillance (P=.018) had higher scores than others. Domains that contributed most to lower scores were quality of chart review and quality of data extraction. Of 49 infections, 15 (30.6%) had been overlooked in a random sample of 1,110 patient records, accounting for a sensitivity of 69.4% (95% confidence interval [CI], 54.6%–81.7%), a specificity of 99.9% (95% CI, 99.5%–100%), a positive predictive value of 97.1% (95% CI, 85.1%–99.9%), and a negative predictive value of 98.6% (95% CI, 97.7%–99.2%).CONCLUSIONSIrrespective of a well-defined surveillance methodology, there is a wide variation of SSI surveillance quality. The quality of chart review and the accuracy of data collection are the main areas for improvement.Infect Control Hosp Epidemiol 2017;38:1172–1181
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