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Fakoya A, Afolabi A, Ayandipo O, Makanjuola O, Adepoju O, Ajagbe O, Afuwape OO. A Comparison of Chlorhexidine-Alcohol and Povidone-Iodine-Alcohol on the Incidence of Surgical Site Infection. Cureus 2024; 16:e51901. [PMID: 38333453 PMCID: PMC10849996 DOI: 10.7759/cureus.51901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Surgical site infection (SSI) persists as a global challenge, accounting for 20%-25% of all healthcare-associated infections. The SSI rate has been reported to range from 2.5% to 41.9%. Skin preparation with acceptable antiseptic preparations has a high recommendation from the Centers for Disease Control as an SSI preventive measure. AIM The aim was to compare the efficacy of 10% povidone-iodine in 70% isopropyl alcohol with 2% chlorhexidine in 70% isopropyl alcohol in preventing SSI. METHOD This prospective randomized study included patients who were followed up for 30 days looking for SSI. Swabs were taken from wounds that developed SSI. A culture of all swabs was done. RESULT One hundred and fifty-three patients were recruited into the study. Overall, eight (5.23%) of the 153 patients developed SSI. The SSI rate in clean wounds was 2.6%, while the SSI rate in clean-contaminated wounds was 7.9%. No statistically significant difference was found (p=0.141) between the two groups.
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Affiliation(s)
| | | | | | | | | | | | - Oludolapo O Afuwape
- Surgery/General Surgery, University College Hospital, University of Ibadan, Ibadan, NGA
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Im JH, Lee DY, Baek JH, Lee SJ, Jung S, Kim E, Kang DY, Lee JS. Comparison of Cefazolin/Metronidazole to Ampicillin/Sulbactam as Preoperative Antibiotics in Colorectal Surgery: A Retrospective, Single-Center Cohort Study. Antibiotics (Basel) 2023; 12:1381. [PMID: 37760678 PMCID: PMC10525786 DOI: 10.3390/antibiotics12091381] [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: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
AIM The use of prophylactic antibiotics prior to colorectal surgery reduces surgical site infections. Cefazolin and metronidazole are used as a standard regimen. Ampicillin/sulbactam may be an alternative, but current data are limited. We compared the efficacy of ampicillin/sulbactam with cefazolin and metronidazole as prophylactic antibiotics. METHODS Patients who underwent colorectal surgery at Inha University Hospital between 2010 and 2020 were treated prophylactically with cefazolin and metronidazole or ampicillin/sulbactam, and observed for 30 days following surgery. The primary outcome was surgical site infections. The secondary outcomes were deep/organ infections and the need for drainage. RESULTS SSIs occurred in 2.6% (17/646) of the ampicillin/sulbactam group, whose rate was not inferior to the occurrence in the group receiving cefazolin and metronidazole (3.8%, 21/556). There was no significant difference between the two groups in the secondary outcomes. CONCLUSIONS Compared to the cefazolin and metronidazole combination, ampicillin/sulbactam is not inferior as a preoperative prophylactic antibiotic regimen for colorectal surgery.
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Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
| | - Dong Yeop Lee
- Department of Preventive Medicine, Ulsan University Hospital, Ulsan 44033, Republic of Korea;
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
| | - Se Ju Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
| | - Sungtaek Jung
- Department of General Surgery, Shihwa Hospital, Siheung 15034, Republic of Korea;
| | - Eunjung Kim
- Infection Control Unit, Inha University Hospital, Incheon 22212, Republic of Korea;
| | - Dong Yoon Kang
- Department of Preventive Medicine, Ulsan University Hospital, Ulsan 44033, Republic of Korea;
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea; (J.H.I.); (J.H.B.); (S.J.L.)
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Bayardorj D, Promsatit P, Chirangi BM, Mahmoud E. Surgical Site Infections at Shirati KMT Hospital in Northeastern Tanzania. Cureus 2023; 15:e34573. [PMID: 36874320 PMCID: PMC9981550 DOI: 10.7759/cureus.34573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Despite improved guidelines for surgical practices and better surgical methods and tools, surgical site infection (SSI) is still a common cause of morbidity and mortality with increased rates in resource-limited nations. In Tanzania, there is limited data on SSI and associated risk factors for developing an effective surveillance system for SSI. In this study, we aimed to establish for the first time the baseline SSI rate and its associated factors at the Shirati KMT Hospital in Northeastern Tanzania. We collected hospital records of 423 patients who had undergone major and minor surgeries between January 1 and June 9, 2019, at the hospital. After accounting for incomplete records and missing information, we analyzed a total of 128 patients and found an SSI rate of 10.9% and performed univariate and multivariate logistic regression analyses for elucidating the relationship between risk factors and SSI. All patients with SSI had undergone major operations. Moreover, we observed trends of increased association of SSI with patients who are 40 or younger, female, and had received antimicrobial prophylaxis or more than one type of antibiotics. In addition, patients who had received an American Society of Anesthesiologists (ASA) score of II or III, as one category, or undergone elective operations or operations lasting longer than 30 minutes were prone to develop SSI. Although these findings were not statistically significant, both univariate and multivariate logistic regression analyses showed a significant correlation between clean contaminated wound class and SSI, consistent with previous reports. The study is the first to elucidate the rate of SSI and its correlated risk factors at the Shirati KMT Hospital. We conclude that, based on the obtained data, clean contaminated wound class is a significant predictor of SSI at the hospital and that an effective surveillance system for SSI should begin with adequate record keeping of all patients' hospitalization and an efficient follow-up system. Moreover, a future study should aim to explore more widespread SSI predictors such as premorbid illness, HIV status, duration of hospitalization prior to operation, and type of surgery.
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Affiliation(s)
- Dulguun Bayardorj
- Department of Global Health, College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | - Pichaya Promsatit
- Department of Global Health, College of Osteopathic Medicine, Touro University California, Vallejo, USA
| | | | - Eiman Mahmoud
- Department of Global Health, College of Osteopathic Medicine, Touro University California, Vallejo, USA
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Sangsuwan T, Jamulitrat S, Watcharasin P. Risk adjustment performance between NNIS index and NHSN model for postoperative colorectal surgical site infection: A retrospective cohort study. Ann Med Surg (Lond) 2022; 77:103715. [PMID: 35637982 PMCID: PMC9142714 DOI: 10.1016/j.amsu.2022.103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/27/2022] [Accepted: 05/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Risk stratifications to predict development of surgical site infections (SSI) are crucial methods before surgery. Hence, we aimed to compare the performance of risk adjustment between the former NNIS risk index and the new NHSN procedure-specific risk model for postoperative colorectal SSI. Materials and methods A retrospective cohort study was conducted. Data of post-colorectal SSI, indicating the use of the NNIS risk index for SSI adjustment, were retrieved from the medical records. Data were taken from patients who underwent colorectal surgery procedures between January 2005 and December 2016. Additional information regarding emergency colorectal surgery was retrieved to fulfill the requirements for calculation of the risks for SSI; via the new model. The predictive performance between the two models was compared using the means of the area under the receiver operating characteristic curve. Results In total 1989 patients were included. Fifteen patients were excluded; thus, the remaining number of procedures was 1974. Surgical site infections occurred in 85 (4.3%) procedures. In colectomy surgery, the means of area under the curve (AUC) yielded 0.6196 and 0.5976 for the NNIS risk index model and the new NHSN risk model, respectively; differences in the AUC were not statistically significant (p = 0.39). In rectal surgery, the means of the AUC yielded 0.516 and 0.49 for the NNIS risk index model and the new NHSN procedure-specific risk model, respectively; differences in the AUC were not statistically significant (p = 0.56). Conclusion The new NHSN procedure-specific risk model was not superior to the former NNIS risk index. The NHSN risk model was not superior to the NNIS risk index. The recommendation is for the application of the NNIS risk index be applied. This is the first reporting on the novel performance of CDC risk adjustment for colorectal SSI. This paper builds upon concerns for infectious, nosocomial surveillances; especially for low resources countries.
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Abstract
Surgical site infections (SSIs) are among the most common and most costly health care-associated infections, leading to adverse patient outcomes and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSI. In particular, improved adherence to evidence-based preventive measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI.
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Affiliation(s)
- Jessica Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC, USA.
| | - Deverick J Anderson
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC, USA
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Magnitude of Multidrug Resistance among Bacterial Isolates from Surgical Site Infections in Two National Referral Hospitals in Asmara, Eritrea. Int J Microbiol 2021; 2021:6690222. [PMID: 33727929 PMCID: PMC7935598 DOI: 10.1155/2021/6690222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 02/02/2023] Open
Abstract
Background The World Health Organization has emphasized the importance of understanding the epidemiology of MDR organisms from a local standpoint. Here, we report on a spectrum of bacteria associated with surgical site infections in two referral hospitals in Eritrea and the associated antibiotic susceptibility patterns. Methods This survey was conducted between February and May 2017. A total of 83 patients receiving treatment for various surgical conditions were included. Swabs from infected surgical sites were collected using Levine technique and processed using standard microbiological procedures. In vitro antimicrobial susceptibility testing was performed on Mueller–Hinton Agar by the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. The data were analyzed using SPSS version 20. Results A total of 116 isolates were recovered from 83 patients. In total, 67 (58%) and 49 (42%) of the isolates were Gram-positive and Gram-negative bacteria, respectively. The most common isolates included Citrobacter spp., Klebsiella spp., Escherichia coli, Proteus spp., Pseudomonas aeruginosa, Salmonella spp., Enterobacter spp., and Acinetobacter spp. In contrast, Staphylococcus aureus, CONS, and Streptococcus viridians were the predominant Gram-positive isolates. All the Staphylococcus aureus isolates were resistant to penicillin. MRSA phenotype was observed in 70% of the isolates. Vancomycin, clindamycin, and erythromycin resistance were observed in 60%, 25%, and 25% of the isolates, respectively. Furthermore, a high proportion (91%) of the Gram-negative bacteria were resistant to ampicillin and 100% of the Pseudomonas aeruginosa and Escherichia coli isolates were resistant to >5 of the tested antibiotics. The two Acinetobacter isolates were resistant to >7 antimicrobial agents. We also noted that 4 (60%) of the Klebsiella isolates were resistant to >5 antimicrobial agents. Possible pan-drug-resistant (PDR) strains were also isolated. Conclusion Due to the high frequency of MDR isolates reported in this study, the development and implementation of suitable infection control policies and guidelines is imperative.
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Meng L, Li J, He Y, Xiong Y, Li J, Wang J, Shi Y, Liu Y. The risk factors analysis and establishment of an early warning model for healthcare-associated infections after pediatric cardiac surgery: A STROBE-compliant observational study. Medicine (Baltimore) 2020; 99:e23324. [PMID: 33285709 PMCID: PMC7717841 DOI: 10.1097/md.0000000000023324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 08/10/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to identify the main risk factors for health-care-associated infections (HAIs) following cardiac surgery and to establish an effective early warning model for HAIs to enable intervention in an earlier stage.In total, 2227 patients, including 222 patients with postoperative diagnosis of HAIs and 2005 patients with no-HAIs, were continuously enrolled in Beijing Anzhen Hospital, Beijing, China. Propensity score matching was used and 222 matched pairs were created. The risk factors were analyzed with the methods of univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to test the accuracy of the HAIs early warning model.After propensity score matching, operation time, clamping time, intubation time, urinary catheter time, central venous catheter time, ≥3 blood transfusions, re-endotracheal intubation, length of hospital stay, and length of intensive care unit stay, still showed significant differences between the 2 groups. After logistic model analysis, the independent risk factors for HAIs were medium to high complexity, intubation time, urinary catheter time, and central venous catheter time. The ROC showed the area under curve was 0.985 (confidence interval: 0.975-0.996). When the probability was 0.529, the model had the highest prediction rate, the corresponding sensitivity was 0.946, and the specificity was 0.968.According to the results, the early warning model containing medium to high complexity, intubation time, urinary catheter time, and central venous catheter time enables more accurate predictions and can be used to guide early intervention after pediatric cardiac surgery.
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Affiliation(s)
- Lihui Meng
- Pediatric Cardiac Center, Department of Cardiac Surgery
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiachen Li
- Pediatric Cardiac Center, Department of Cardiac Surgery
| | - Yan He
- Pediatric Cardiac Center, Department of Cardiac Surgery
| | - Ying Xiong
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingming Li
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Shi
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yinglong Liu
- Pediatric Cardiac Center, Department of Cardiac Surgery
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Stapler versus polyamide sutures for skin closure for sternal wounds in coronary artery bypass graft surgery - our experience. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:83-86. [PMID: 32728370 PMCID: PMC7379225 DOI: 10.5114/kitp.2020.97264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/01/2020] [Indexed: 11/19/2022]
Abstract
Introduction Patients undergoing coronary artery bypass graft surgery constitute a large population of patients with anatomically similar incisions created under similar circumstances. Aim Our study aimed at analysing and comparing rates of surgical site infections (SSIs) at the sternotomy sites based on the material used for skin closure of the sternal wound with special emphasis on presence of risk factors such as diabetes (glycated haemoglobin (HbA1c) > 9) and obesity (body mass index (BMI) > 30 kg/m2) in the 2 respective groups. Material and methods This is a retrospective observational study. A total of 864 patients were included in the study. The patients were grouped into 2 groups depending on the sternal wound closure strategy used. One group consisted of patients in whom polyamide sutures were used for skin closure, while the other group comprised patients in whom skin staples were used for skin closure. Incidence of sternal wound SSIs in both groups was noted. Co-morbid conditions such as diabetes mellitus (with HbA1c > 9) and obesity (BMI > 30 kg/m2) were noted and analysed as contributory factors for SSIs. Results Group A comprised 432 patients out of whom 42 (9.72%) had sternal wound SSIs. Group B comprised the other 432 patients of whom only 20 (4.62%) developed sternal wound SSIs. Co-morbid conditions were analysed in each group. Group A showed SSI in 22/64 (34.3%) diabetic patients, 6/28 (21.8%) obese patients and 16/22 (72.72%) with diabetes and obesity. Group B showed SSIs in 6/56 (10.715) diabetics, 4/26 (6.01%) obese and 4/24 (16.67%) with diabetes and obesity. Conclusions By pairing staples and sutures, we observed a significantly lower incidence of total wound complications with suture than with staple closure.
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Manunga J, Olak J, Rivera C, Martin M. Prevalence of Methicillin-Resistant Staphylococcus aureus in Elective Surgical Patients at a Public Teaching Hospital: An Analysis of 1039 Patients. Am Surg 2020. [DOI: 10.1177/000313481207801019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of postoperative surgical site infections (SSIs). It is unclear, however, whether asymptomatic colonization or nosocomial acquisition of MRSA results in postoperative SSI. We conducted a retrospective review of patients screened for MRSA between May 2008 and October 2010 at our institution. End points included rates of MRSA infection, SSI, and the cost of routine MRSA screening of patients undergoing elective surgery. Of the 1039 patients screened preoperatively, 48 (4.6%) tested positive for MRSA by nasal or oral swab, whereas 991 (95.4%) tested negative. Forty-five (93.8%) MRSA-positive patients received vancomycin or linezolid and three (6.25%) received cefazolin peri-operatively. Three (6.25%) MRSA-positive patients developed postoperative SSIs. Two required rehospitalization for intravenous antimicrobials, whereas a third patient required removal of infected abdominal mesh. Twenty (2.02%) MRSA-negative patients and four (5.26%) unscreened patients developed non-MRSA SSIs. Regardless of MRSA status, none of 609 patients who had a laparoscopic procedure or inguinal hernia repair developed SSI. Twenty-two patients needed to be screened to obtain one positive test. The role of MRSA screening and longer perioperative coverage for MRSA-positive patients undergoing complex elective procedures remains to be determined.
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Affiliation(s)
- Jesse Manunga
- Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Jemi Olak
- Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Carmen Rivera
- Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Maureen Martin
- Department of Surgery, Kern Medical Center, Bakersfield, California
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Yu X, Chen M, Liu X, Chen Y, Hao Z, Zhang H, Wang W. Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease. BMC Infect Dis 2020; 20:64. [PMID: 31964345 PMCID: PMC6975050 DOI: 10.1186/s12879-020-4769-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/07/2020] [Indexed: 01/22/2023] Open
Abstract
Background The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). Methods We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children’s Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0–1 months old), infants (1–12 months old) and children (1–10 years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. Results A total of 11,651 subjects were included in the study. The overall nosocomial infection rate was 10.8%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 32.9, 15.4, and 5.2%, respectively. Multivariate logistic regression analysis found age (OR 0798, 95%CI: 0.769–0.829; P < 0.001), STS risk grade (OR 1.267, 95%CI: 1.159–1.385; P < 0.001), body mass index (BMI) <5th percentile (OR 1.295, 95%CI: 1.023–1.639; P = 0.032), BMI >95th percentile (OR 0.792, 95%CI: 0.647–0.969; P = 0.023), cardiopulmonary bypass (CPB) time (OR 1.008, 95%CI: 1.003–1.012; P < 0.001) and aortic clamping time (OR 1.009, 1.002–1.015; P = 0.008) were significantly associated with nosocomial infection in CHD infants. After adjusted for confounding factors, we found STS risk grade (OR 1.38, 95%CI: 1.167–1.633; P < 0.001), BMI < 5th percentile (OR 1.934, 95%CI: 1.377–2.715; P < 0.001), CPB time (OR 1.018, 95%CI: 1.015–1.022; P < 0.001), lymphocyte/WBC ratio<cut off value (OR 3.818, 95%CI: 1.529–9.533; P = 0.004) and AST>cut off value (OR 1.546, 95%CI: 1.119–2.136; P = 0.008) were significantly associated with nosocomial infection in CHD children. Conclusion Our study suggested STS risk grade, BMI, CPB duration, low lymphocyte/WBC or high neutrophil/WBC ratio were independently associated with nosocomial infection in CHD infant and children after cardiac surgery.
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Affiliation(s)
- Xindi Yu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Maolin Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Xu Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Zedong Hao
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China.
| | - Wei Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China.
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Matinyi S, Enoch M, Akia D, Byaruhanga V, Masereka E, Ekeu I, Atuheire C. Contamination of microbial pathogens and their antimicrobial pattern in operating theatres of peri-urban eastern Uganda: a cross-sectional study. BMC Infect Dis 2018; 18:460. [PMID: 30200891 PMCID: PMC6131813 DOI: 10.1186/s12879-018-3374-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microbial contamination of hospital environment, especially in operating theatres (OT) and other specialized units has greatly contributed to continuous and multiple exposure to nosocomial infections by patients and the public. We purposed to assess microbial contamination of operating theatres and antibacterial sensitivity pattern of bacteria isolated from theatres of Mbale Regional Referral Hospital, Eastern Uganda. METHODS We employed a laboratory based cross-sectional study design. Swabbing of different surfaces and settle plate establishment in 4 various operating theatres was carried out. A total of 109 samples were collected, 31 air samples and 78 swabs from four operating theatres. Samples were collected in the mornings after disinfection prior to start of daily operations. Antibacterial sensitivity testing of isolated bacterial pathogens was performed by Kirby Bauer disc diffusion method following standard operating procedure. Colony counts for the settle plates were carried out using a colony counter. RESULTS All the four theatres had their mean colony counts exceeding the acceptable limit of 5 cfu/dm2/h. Gynaecology theatre had up to 261 cfu/dm2/h and Ophthalmology operating theatre had approximately 43 cfu/dm2/h. A total of 14 different organisms were isolated with Pseudomonas spp. [23.9%]; Bacillus spp. [17.5%] and Aspergillus spp. [15.8%] being the most common contaminants respectively. Other isolates included Enterococcus spp., Rhizopus spp. and Coagulate Negative Staphylococcus isolates especially from settle plates. Most bacterial isolates showed considerable resistance to antibacterial agents. Pseudomonas spp. was resistant to chloramphenicol (53.6%) and cotrimoxazole (57.1%). Most of the bacterial pathogens were sensitive to imipenem [83.3%]. CONCLUSIONS There is moderate contamination of operating theatres of Mbale Regional Referral Hospital. Common organisms were Pseudomonas, Bacillus, and Aspergillus spps. Resistance was observed against chloramphenicol and cotrimoxazole. More caution is necessary to carefully disinfect the operating theatres at Regional referral settings and similar tertiary health care centres with more emphasis on obstetrics and gynecology theatres. Diagnosis and care of patients at such clinical settings should consider the possibility of antibiotic resistance.
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Affiliation(s)
- Sandra Matinyi
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Muwanguzi Enoch
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Deborah Akia
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Valentine Byaruhanga
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Edson Masereka
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Isaac Ekeu
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Collins Atuheire
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, P.O Box 7076, Uganda
- Department of Public Health, School of Allied Health Sciences, Kampala International University, Western Campus, Bushenyi, Uganda
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Alotaibi AF, Mekary RA, Zaidi HA, Smith TR, Pandya A. Safety and Efficacy of Antibacterial Prophylaxis After Craniotomy: A Decision Model Analysis. World Neurosurg 2017; 105:906-912.e5. [DOI: 10.1016/j.wneu.2017.05.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/21/2017] [Indexed: 10/19/2022]
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Kasatpibal N, Whitney JD, Dellinger EP, Nair BG, Pike KC. Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection. Surg Infect (Larchmt) 2017; 18:474-484. [DOI: 10.1089/sur.2016.164] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Nongyao Kasatpibal
- Division of Nursing Science, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
- Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, Washington
| | - Joanne D. Whitney
- Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, Washington
| | | | - Bala G. Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Kenneth C. Pike
- Department of Psychosocial Nursing and Community Health, School of Nursing, University of Washington, Seattle, Washington
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Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands. Infect Control Hosp Epidemiol 2017. [DOI: 10.1017/s0195941700045112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective.To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.Design.Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.Setting.Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.Results.We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).Conclusions.For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.
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Effect of Optimized Antibiotic Prophylaxis on the Incidence of Surgical Site Infection. Infect Control Hosp Epidemiol 2017. [DOI: 10.1017/s0195941700075275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective.To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.Design.Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.Methods.During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contamination class, duration of surgery, length of hospital stay before surgery, and urgency of surgery (elective or acute).Results.A total of 3,621 procedures were included in the study, of which 1,668 were performed before the intervention and 1,953 after. The overall SSI rate decreased from 5.4% to 4.5% (P = .22). Among the procedures included in the study, the largest proportion (55%) were total hip arthroplasty, and the smallest proportion (2%) were replacement of the head of the femur. SSI rates varied from 0% for vaginal hysterectomy to 21.1% for femoropopliteal or femorotibial bypass surgery. Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention (P>.1).Conclusions.An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery, as measured by SSI rate.
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17
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Surgical Site Infection (SSI) Rates Among Patients Who Underwent Mastectomy After the Introduction of SSI Prevention Policies. Infect Control Hosp Epidemiol 2017. [DOI: 10.1017/s0195941700045148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective.To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer.Methods.Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000.Results.The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (± SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6 ± 7.1 in 2000 to 9.2 ± 4.4 in 2001 (P< .001, Student's t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P =.001, Student's t test).Conclusions.Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.
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Privitera GP, Costa AL, Brusaferro S, Chirletti P, Crosasso P, Massimetti G, Nespoli A, Petrosillo N, Pittiruti M, Scoppettuolo G, Tumietto F, Viale P. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: A systematic review and meta-analysis. Am J Infect Control 2017; 45:180-189. [PMID: 27838164 DOI: 10.1016/j.ajic.2016.09.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/18/2016] [Accepted: 09/18/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most frequent health care-associated infections. One of the practices to reduce their incidence is preoperative skin antisepsis. Two of the most commonly active components used are chlorhexidine gluconate and povidone iodine. Of 3 reviews conducted between 2010 and 2012 comparing antiseptics, 2 were in favor of chlorhexidine; however, the latest was unable to draw conclusions. PURPOSE To verify whether recent evidence supports the hypothesis that chlorhexidine in preoperative antisepsis is more efficient than other antiseptics in reducing SSI rates. PROCEDURES We conducted a systematic review from 2000-2014 in all languages. The primary end point was SSI incidence and secondary skin bacterial colonization. RESULTS Nineteen studies were included. Meta-analysis were conducted for comparable studies for both outcomes. The results of the meta-analysis, including all of the studies in which chlorhexidine was compared with iodophor, were in favor of chlorhexidine for both SSI incidence (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.92) and bacterial skin colonization (RR, 0.45; 95% CI, 0.36-0.55). CONCLUSIONS There is moderate-quality evidence supporting the use of chlorhexidine for preoperative skin antisepsis and high-quality evidence that the use of chlorhexidine is associated with fewer positive skin cultures. Further rigorous trials will be welcomed to attain stronger evidence as to the best antiseptic to be used before surgery.
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Sanger PC, Simianu VV, Gaskill CE, Armstrong CAL, Hartzler AL, Lordon RJ, Lober WB, Evans HL. Diagnosing Surgical Site Infection Using Wound Photography: A Scenario-Based Study. J Am Coll Surg 2017; 224:8-15.e1. [PMID: 27746223 PMCID: PMC5183503 DOI: 10.1016/j.jamcollsurg.2016.10.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postoperative surgical site infections (SSI) are common and costly. Most occur post discharge, and can result in potentially preventable readmission or unnecessary urgent evaluation. Mobile health approaches incorporating patient-generated wound photos are being implemented in an attempt to optimize triage and management. We assessed how adding wound photos to existing data sources modifies provider decision making. STUDY DESIGN We used a web-based simulation survey using a convenience sample of providers with expertise in surgical infections. Participants viewed a range of scenarios, including surgical history, physical exam, and description of wound appearance. All participants reported SSI diagnosis, diagnostic confidence, and management recommendations (main outcomes) first without, and then with, accompanying wound photos. At each step, participants ranked the most important features contributing to their decision. RESULTS Eighty-three participants completed a median of 5 scenarios (interquartile range 4 to 7). Most participants were physicians in academic surgical specialties (n = 70 [84%]). The addition of photos improved overall diagnostic accuracy from 67% to 76% (p < 0.001), and increased specificity from 77% to 92% (p < 0.001), but did not significantly increase sensitivity (55% to 65%; p = 0.16). Photos increased mean confidence in diagnosis from 5.9 of 10 to 7.4 of 10 (p < 0.001). Overtreatment recommendations decreased from 48% to 16% (p < 0.001), and undertreatment did not change (28% to 23%; p = 0.20) with the addition of photos. CONCLUSIONS The addition of wound photos to existing data as available via chart review and telephone consultation with patients significantly improved diagnostic accuracy and confidence, and prevented proposed overtreatment in scenarios without SSI. Post-discharge mobile health technologies have the potential to facilitate patient-centered care, decrease costs, and improve clinical outcomes.
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Affiliation(s)
- Patrick C Sanger
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA.
| | - Vlad V Simianu
- Department of Surgery, University of Washington, Seattle, WA
| | | | | | - Andrea L Hartzler
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - Ross J Lordon
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA
| | - William B Lober
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA; Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA
| | - Heather L Evans
- Department of Surgery, University of Washington, Seattle, WA
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Perioperatif Antimikrobiyal Profilaksi Uygulamalarında Rehberlere Uyum: Çok Merkezli Bir Çalışma. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2017. [DOI: 10.21673/anadoluklin.268873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Evans HL, Bulger EM. Infectious Complications Following Surgery and Trauma. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Oriel BS, Chen Q, Wong K, Itani KMF. Effect of Hand Antisepsis Agent Selection and Population Characteristics on Surgical Site Infection Pathogens. Surg Infect (Larchmt) 2016; 18:413-418. [PMID: 27661850 DOI: 10.1089/sur.2016.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Selection of a pre-operative hand antisepsis agent has not been studied in relation to surgical site infection (SSI) culture data. In our hospital, we introduced an alcohol-based hand rub (ABR) in 2012 as an alternative to traditional aqueous surgical scrubs (TSS). It was the goal of this study to review any effect of this implementation on SSI pathogen characteristics. In addition, we sought to compare our SSI culture data with available National Healthcare Safety Network (NHSN) data. We hypothesized that SSI pathogens and resistant isolates are affected by surgical hand antisepsis technique. METHODS Data collected prospectively between 2007 and 2014 were retrospectively analyzed for two time periods at the Veterans Affairs Boston Healthcare System (VABHS): Before ABR implementation (TSS group) and after (ABR group). Pathogen distribution and pathogenic isolate resistance profiles were compared for TSS and ABR, and similar comparisons, along with procedure-associated SSI comparisons, were made between VABHS and NHSN. All VABHS data were interpreted and categorized according to NHSN definitions. RESULTS Compared with TSS (n = 4,051), ABR (n = 2,293) had a greater rate of Staphylococcus aureus (42.6% vs. 38.0%), Escherichia coli (12.8% vs. 9.9%), Pseudomonas aeruginosa (8.5% vs. 2.8%), and Enterobacter spp. (10.6% vs. 2.8%), and a lower rate of Klebsiella pneumoniae/K. oxytoca (4.3% vs. 8.5%) cultured from superficial and deep SSIs (p < 0.05). Of the S. aureus isolates, 35.0% and 44.4% were resistant to oxacillin/methicillin (MRSA) in ABR and TSS, respectively (p = 0.06). Looking at all SSIs, coagulase-negative staphylococci and K. pneumoniae/K. oxytoca at VABHS (4.0% and 10.4%, respectively) accounted for the biggest difference from NHSN (11.7% and 4.0%, respectively). Aside from MRSA, where there was no difference between VABHS and NHSN (42.9% vs. 43.7%, respectively; p = 0.87), statistically significant (p < 0.05) differences were observed among multi-drug-resistant K. pneumoniae/K. oxytoca (0% vs. 6.8%, respectively) and Escherichia coli (10.0% vs. 1.6%, respectively), as well as among extended-spectrum cephalosporin-resistant K. pneumoniae/K. oxytoca (4.8% vs. 13.2%, respectively) and Enterobacter (58.3% vs. 27.7%, respectively). VABHS had a greater proportion of SSIs in abdominal and vascular cases than did NHSN (48.6% vs. 22.5% and 13.2% vs. 1.5%, respectively). Overall, these differences were significant (p < 0.05). CONCLUSIONS The TSS and ABR groups differed in the distribution of pathogens recovered. Those differences, along with SSI pathogen distribution, pathogenic isolate resistance profiles, and procedure-associated SSIs between VABHS and NHSN, warrant further investigation.
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Affiliation(s)
- Brad S Oriel
- 1 Department of Surgery, Veterans Affairs Boston Healthcare System , West Roxbury, Massachusetts.,2 Department of Surgery, Tufts University School of Medicine , Boston, Massachusetts
| | - Qi Chen
- 3 Center for Healthcare Organization and Implementation Research (CHOIR) , VA Boston Healthcare System, Boston, Massachusetts
| | - Kevin Wong
- 1 Department of Surgery, Veterans Affairs Boston Healthcare System , West Roxbury, Massachusetts.,4 Department of Surgery, Boston University School of Medicine , Boston, Massachusetts
| | - Kamal M F Itani
- 1 Department of Surgery, Veterans Affairs Boston Healthcare System , West Roxbury, Massachusetts.,2 Department of Surgery, Tufts University School of Medicine , Boston, Massachusetts.,4 Department of Surgery, Boston University School of Medicine , Boston, Massachusetts.,5 Department of Surgery, Harvard Medical School , Boston, Massachusetts
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Oliveira ACD, Gama CS. [Evaluation of adherence to measures for the prevention of surgical site infections by the surgical team]. Rev Esc Enferm USP 2016; 49:767-74. [PMID: 26516746 DOI: 10.1590/s0080-623420150000500009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 07/06/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Evaluate pre- and intraoperative practices adopted by medical and nursing teams for the prevention of surgical infections. METHOD A prospective study carried out in the period of April to May 2013, in a surgical center of a university hospital in Belo Horizonte, Minas Gerais. RESULTS 18 surgeries were followed and 214 surgical gloves were analyzed, of which 23 (10.7%) had postoperative glove perforation detected, with 52.2% being perceived by users. Hair removal was performed on 27.7% of patients in the operating room, with the use of blades in 80% of the cases. Antibiotic prophylaxis was administered to 81.8% of patients up to 60 minutes prior to surgical incision. An average of nine professionals were present during surgery and the surgery room door remained open in 94.4% of the procedures. CONCLUSION Partial adhesion to the recommended measures was identified, reaffirming a need for greater attention to these critical steps/actions in order to prevent surgical site infection.
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Affiliation(s)
| | - Camila Sarmento Gama
- Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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24
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Mitt P, Lang K, Peri A, Maimets M. Surgical-Site Infections Following Cesarean Section in an Estonian University Hospital: Postdischarge Surveillance and analysis of Risk Factors. Infect Control Hosp Epidemiol 2016; 26:449-54. [PMID: 15954482 DOI: 10.1086/502566] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AbstractObjectives:To evaluate a multi-method approach to postdischarge surveillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.Design:Cross-sectional survey.Setting:Academic tertiary-care obstetric and gynecology center with 54 beds.Patients:All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.Methods:Infections were identified during hospital stay or by postdischarge survey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System.Results:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence interval [CI95)], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge surveillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI95, 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI95, 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI95, 1.2-11.8; P=.02).Conclusions:The high response rate validated the effectiveness of this kind of surveillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454).
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Affiliation(s)
- Piret Mitt
- Department of Internal Medicine and Infection Control, Tartu University Hospital, Tartu, Estonia.
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25
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Manniën J, van Kasteren MEE, Nagelkerke NJ, Gyssens IC, Kullberg BJ, Wille JC, de Boer AS. Effect of Optimized Antibiotic Prophylaxis on the Incidence of Surgical Site Infection. Infect Control Hosp Epidemiol 2016; 27:1340-6. [PMID: 17152032 DOI: 10.1086/509842] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 12/05/2005] [Indexed: 02/06/2023]
Abstract
Objective.To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.Design.Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.Methods.During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contamination class, duration of surgery, length of hospital stay before surgery, and urgency of surgery (elective or acute).Results.A total of 3,621 procedures were included in the study, of which 1,668 were performed before the intervention and 1,953 after. The overall SSI rate decreased from 5.4% to 4.5% (P = .22). Among the procedures included in the study, the largest proportion (55%) were total hip arthroplasty, and the smallest proportion (2%) were replacement of the head of the femur. SSI rates varied from 0% for vaginal hysterectomy to 21.1% for femoropopliteal or femorotibial bypass surgery. Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention (P>.1).Conclusions.An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery, as measured by SSI rate.
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Affiliation(s)
- Judith Manniën
- National Institute for Public Health and the Environment, Center for Infectious Disease Epidemiology, Bilthoven, The Netherlands.
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26
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Manniën J, Wille JC, Snoeren RLMM, van den Hof S. Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands. Infect Control Hosp Epidemiol 2016; 27:809-16. [PMID: 16874640 DOI: 10.1086/506403] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 08/02/2005] [Indexed: 11/03/2022]
Abstract
Objective.To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.Design.Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.Setting.Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.Results.We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).Conclusions.For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.
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Affiliation(s)
- Judith Manniën
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Zhang Y, Zheng QJ, Wang S, Zeng SX, Zhang YP, Bai XJ, Hou TY. Diabetes mellitus is associated with increased risk of surgical site infections: A meta-analysis of prospective cohort studies. Am J Infect Control 2015; 43:810-5. [PMID: 26234220 DOI: 10.1016/j.ajic.2015.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/03/2015] [Accepted: 04/07/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Observational studies have suggested an association between diabetes mellitus and the risk of surgical site infections (SSIs), but the results remain inconclusive. We conducted a meta-analysis of prospective cohort studies to elucidate the relationship between diabetes mellitus and SSIs. METHODS We searched PubMed, Embase, and Web of Science databases and reviewed the reference lists of the retrieved articles to identify relevant studies. Associations were tested in subgroups representing different patient characteristics and study quality criteria. The random-effect model was used to calculate the overall relative risk (RR). RESULTS Fourteen prospective cohort studies (N = 91,094 participants) were included in this meta-analysis, and the pooled crude RR was 2.02 (95% confidence interval, 1.68-2.43) with significant between-study heterogeneity observed (I(2) = 56.50%). Significant association was also detected after we derived adjusted RRs for studies not reporting the adjusted RRs and calculated the combined adjusted RR of the 14 studies (RR, 1.69; 95% confidence interval, 1.33-2.13). Results were consistent and statistically significant in all subgroups. Stratified analyses found the number of confounders adjusted for, sample size, and method of diabetes case ascertainment might be the potential sources of heterogeneity. Sensitivity analysis further demonstrated the robustness of the result. CONCLUSIONS This meta-analysis suggests diabetes mellitus is significantly associated with increased risk of SSIs. Future studies are encouraged to reveal the mechanisms underlying this association.
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Affiliation(s)
- Yu Zhang
- Department of Hospital Acquired Infection Control, Guangdong Academy of Medicine Science and Guangdong General Hospital, Guangzhou, China
| | - Qiu-Jian Zheng
- Department of Orthopaedics, Guangdong Academy of Medicine Science and Guangdong General Hospital, Guangzhou, China
| | - Sheng Wang
- Department of Anaesthesiology, Guangdong Academy of Medicine Science and Guangdong General Hospital, Guangzhou, China
| | - Shi-Xing Zeng
- Department of Orthopaedics, Guangdong Academy of Medicine Science and Guangdong General Hospital, Guangzhou, China
| | - You-Ping Zhang
- Department of Hospital Acquired Infection Control, Guangdong Academy of Medicine Science and Guangdong General Hospital, Guangzhou, China
| | - Xue-Jiao Bai
- Department of Hospital Acquired Infection Control, Guangdong Academy of Medicine Science and Guangdong General Hospital, Guangzhou, China
| | - Tie-Ying Hou
- Department of Hospital Acquired Infection Control, Guangdong Academy of Medicine Science and Guangdong General Hospital, Guangzhou, China.
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Subramanyam R, Schaffzin J, Cudilo EM, Rao MB, Varughese AM. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery. Spine J 2015; 15:1422-31. [PMID: 25796355 DOI: 10.1016/j.spinee.2015.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/30/2015] [Accepted: 03/07/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Risk factors for surgical site infection (SSI) in children derived from the studies in the adult population are potentially misleading because of differences in pathophysiology and management. PURPOSE This systematic review addresses the key question: What are the risk factors for SSI in pediatric patients undergoing scoliosis surgery? STUDY DESIGN This is a qualitative systematic literature review. PATIENT SAMPLE Retrospective and observational trials of children undergoing scoliosis surgery reported on the occurrence of risk factors for SSI and the occurrence of SSI. METHODS Pubmed (Medline), Ovid Evidence-Based Medicine Reviews (EBMR), Scopus, and Cumulative Index to Nursing and Allied Health (CINAHL) were searched electronically for relevant articles in all the languages between January 1, 1991 and August 27, 2012, and cross-references were checked. Two independent reviewers identified articles and appraised quality with the Agency for Healthcare Research and Quality (AHRQ) criteria based on a weighted scoring of 0 to 100. RESULTS Our search identified 135 abstracts and 14 studies meeting the inclusion criteria. The AHRQ grading showed that five articles were high quality with a score of greater than 67, and five articles were moderate quality with a score between 50 and 67. The percent agreement between the two independent reviewers was 84%, and kappa agreement score was 0.91 (95% confidence interval [CI]: 0.78-1.03). There were 76 risk factors identified, of which 22 factors were reported in more than one study. Odds ratios and 95% CIs were reported inconsistently. Pooled p analysis of high- and moderate-quality articles identified five risk factors predictive of SSI: inappropriate antibiotic use (p=.001), neuromuscular scoliosis (p=.014), instrumentation (p=.023), increased hospital stay days (p=.003), and residual postoperative curve (p=.003). CONCLUSIONS The systematic review identified inappropriate antibiotic use, neuromuscular scoliosis, instrumentation, increased hospital stay days, and residual postoperative curve as risk factors for SSI after pediatric scoliosis surgery.
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Affiliation(s)
- Rajeev Subramanyam
- Department of Anesthesiology and Department of Pediatrics, 3333 Burnet Ave, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA.
| | - Joshua Schaffzin
- Department of Pediatrics, Hospital Medicine, 3333 Burnet Ave, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Elizabeth M Cudilo
- Weill Cornell Medical College, New York Presbyterian Hospital, Department of Anesthesiology, 525 E 68th Street, New York, NY 10065, USA
| | - Marepalli B Rao
- Department of Biostatistics, 247 Kettering Lab, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Anna M Varughese
- Department of Anesthesiology and Department of Pediatrics, 3333 Burnet Ave, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Scognamiglio F, Travan A, Rustighi I, Tarchi P, Palmisano S, Marsich E, Borgogna M, Donati I, de Manzini N, Paoletti S. Adhesive and sealant interfaces for general surgery applications. J Biomed Mater Res B Appl Biomater 2015; 104:626-39. [PMID: 25891348 DOI: 10.1002/jbm.b.33409] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 12/16/2022]
Abstract
The main functions of biological adhesives and sealants are to repair injured tissues, reinforce surgical wounds, or even replace common suturing techniques. In general surgery, adhesives must match several requirements taking into account clinical needs, biological effects, and material features; these requirements can be fulfilled by specific polymers. Natural or synthetic polymeric materials can be employed to generate three-dimensional networks that physically or chemically bind to the target tissues and act as hemostats, sealants, or adhesives. Among them, fibrin, gelatin, dextran, chitosan, cyanoacrylates, polyethylene glycol, and polyurethanes are the most important components of these interfaces; various aspects regarding their adhesion mechanisms, mechanical performance, and resistance to body fluids should be taken into account to choose the most suitable formulation for the target application. This review aims to describe the main adhesives and sealant materials for general surgery applications developed in the past decades and to highlight the most important aspects for the development of future formulations.
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Affiliation(s)
| | - Andrea Travan
- Department of Life Sciences, University of Trieste, Italy
| | | | - Paola Tarchi
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Eleonora Marsich
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | | | - Ivan Donati
- Department of Life Sciences, University of Trieste, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
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Yang I, Ung N, Nagasawa DT, Pelargos P, Choy W, Chung LK, Thill K, Martin NA, Afsar-Manesh N, Voth B. Recent Advances in the Patient Safety and Quality Initiatives Movement. Neurosurg Clin N Am 2015; 26:301-15, xi. [DOI: 10.1016/j.nec.2014.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Non-aqueous glycerol monolaurate gel exhibits antibacterial and anti-biofilm activity against Gram-positive and Gram-negative pathogens. PLoS One 2015; 10:e0120280. [PMID: 25799455 PMCID: PMC4370562 DOI: 10.1371/journal.pone.0120280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/23/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Skin and surgical infections due to Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii are causes of patient morbidity and increased healthcare costs. These organisms grow planktonically and as biofilms, and many strains exhibit antibiotic resistance. This study examines the antibacterial and anti-biofilm activity of glycerol monolaurate (GML), as solubilized in a non-aqueous vehicle (5% GML Gel), as a novel, broadly-active topical antimicrobial. The FDA has designated GML as generally recognized as safe for human use, and the compound is commonly used in the cosmetic and food industries. METHODS In vitro, bacterial strains in broths and biofilms were exposed to GML Gel, and effects on bacterial colony-forming units (CFUs) were assessed. In vivo,subcutaneous incisions were made in New Zealand white rabbits; the incisions were closed with four sutures. Bacterial strains were painted onto the incision sites, and then GML Gel or placebo was liberally applied to cover the sites completely. Rabbits were allowed to awaken and were examined for CFUs as a function of exposure time. RESULTS In vitro, GML Gel was bactericidal for all broth culture and biofilm organisms in <1 hour and <4 hour, respectively; no CFUs were detected after the entire 24 h test period. In vivo, GML Gel inhibited bacterial growth in the surgical incision sites, compared to no growth inhibition in controls. GML Gel significantly reduced inflammation, as viewed by lack of redness in and below the incision sites. CONCLUSIONS Our findings suggest that 5% GML Gel is useful as a potent topical antibacterial and anti-inflammatory agent for prevention of infections.
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Miller LG, McKinnell JA, Vollmer ME, Spellberg B. Impact of Methicillin-Resistant Staphylococcus aureus Prevalence among S. aureus Isolates on Surgical Site Infection Risk after Coronary Artery Bypass Surgery. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/522269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective.Cephalosporins are recommended for antibiotic prophylaxis to prevent cardiothoracic surgical site infections (SSIs) except in patients withβ-lactam allergy or in settings with a “high” prevalence of methicillin-resistantStaphylococcus aureus(MRSA) among S.aureusisolates (hereafter, “MRSA prevalence”); however, “high” remains undefined. We sought to identify the MRSA prevalence at which glycopeptide prophylaxis would minimize SSIs relative toβ-lactam prophylaxis.Methods.We developed a decision analysis model to estimate SSI likelihood when either glycopeptides orβ-lactams were used for prophylaxis in cardiothoracic surgery. Event probabilities were derived from a systematic literature review. A similar cost-minimization model was also developed.Results.At 0% MRSA prevalence, SSI probability was 3.64% with glycopeptide prophylaxis and 3.49% withβ-lactam prophylaxis. At MRSA prevalences of 10%, 20%, 30%, or 40%, SSI probabilities with glycopeptide prophylaxis did not change, but they were 3.98%, 4.48%, 4.97%, and 5.47% withβ-lactam prophylaxis. The threshold of MRSA prevalence at which glycopeptide prophylaxis minimized SSI probability and cost was 3%. In sensitivity analyses, variations in most model estimates only modestly affected the threshold.Conclusion.Glycopeptide prophylaxis minimizes the risk of SSIs and cost when MRSA prevalence exceeds 3%. At very low MRSA prevalence (between 3% and 10%), the SSI minimization provided by glycopeptide prophylaxis is small and may be within the error of the model. Given the current MRSA prevalence in most community and healthcare settings, clinicians should consider routine prophylaxis with vancomycin. Our findings may have important policy implications, as benefits in cardiothoracic surgery antibiotic prophylaxis must be weighed against the limitations of increased glycopeptide use.
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Yang Z, Wang J, Wang W, Zhang Y, Han L, Zhang Y, Nie X, Zhan S. Proportions of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in patients with surgical site infections in mainland China: a systematic review and meta-analysis. PLoS One 2015; 10:e0116079. [PMID: 25602284 PMCID: PMC4300093 DOI: 10.1371/journal.pone.0116079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sufficient details have not been specified for the epidemiological characteristics of Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus (MRSA) among surgical site infections (SSIs) in mainland China. This systematic review aimed to estimate proportions of S. aureus and MRSA in SSIs through available published studies. METHODS PubMed, Embase and four Chinese electronic databases were searched to identify relevant primary studies published between 2007 and 2012. Meta-analysis was conducted on the basis of logit-transformed metric for proportions of S. aureus and MRSA, followed by pre-defined subgroup meta-analysis. Random-effects meta-regression was also conducted to explore the impact of possible factors on S. aureus proportions. RESULTS 106 studies were included, of which 38 studies involved MRSA. S. aureus accounted for 19.1% (95%CI 17.2-21.0%; I(2) = 84.1%) of all isolates in SSIs, which was roughly parallel to 18.5% in the United States (US) (P-value = 0.57) but significantly exceeded those calculated through the surveillance system in China (P-value<0.001). In subgroup analysis, S. aureus in patients with thoracic surgery (41.1%, 95%CI 26.3-57.7%; I(2) = 74.4%) was more common than in those with gynecologic surgery (20.1%, 95%CI 15.6-25.6%; I(2) = 33.0%) or abdominal surgery (13.8%, 95%CI 10.3-18.4%; I(2) = 70.0%). Similar results were found in meta-regression. MRSA accounted for 41.3% (95%CI 36.5-46.3%; I(2) = 64.6%) of S. aureus, significantly lower than that in the US (P-value = 0.001). MRSA was sensitive to vancomycin (522/522) and linezolid (93/94), while 79.9% (95%CI 67.4-88.4%; I(2) = 0%) and 92.0% (95%CI 80.2-97.0%; I(2) = 0%) of MRSA was resistant to clindamycin and erythromycin respectively. CONCLUSION The overall proportion of S. aureus among SSIs in China was similar to that in the US but seemed higher than those reported through the Chinese national surveillance system. Proportions of S. aureus SSIs may vary with different surgery types. Commonly seen in SSIs, MRSA tended to be highly sensitive to vancomycin and linezolid but mostly resistant to clindamycin and erythromycin.
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Affiliation(s)
- Zhirong Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Shantou-Oxford Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, China
| | - Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Weiwei Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yuelun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Lizhong Han
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Xiaolu Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- * E-mail:
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Wukich DK, Crim BE, Frykberg RG, Rosario BL. Neuropathy and poorly controlled diabetes increase the rate of surgical site infection after foot and ankle surgery. J Bone Joint Surg Am 2014; 96:832-9. [PMID: 24875024 PMCID: PMC4018772 DOI: 10.2106/jbjs.l.01302] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This prospective study was designed to evaluate the frequency of surgical site infection in patients treated with foot and ankle surgery. Our hypothesis was that patients with complications of diabetes are at increased risk for surgical site infection compared with patients without diabetes and patients with diabetes who do not have diabetic complications. Another goal was to compare the association of neuropathy with surgical site infection in both nondiabetic and diabetic patients. METHODS Two thousand and sixty consecutive surgical cases were evaluated. Group 1 included nondiabetic patients without neuropathy, Group 2 included nondiabetic patients with neuropathy, Group 3 included patients with diabetes but no diabetic complications, and Group 4 included patients with diabetes who had at least one complication of diabetes. RESULTS The surgical site infection rate in this study was 3.1%. Patients with complicated diabetes had a 7.25-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy and a 3.72-fold increased risk compared with patients with uncomplicated diabetes. Patients with complicated diabetes had a nonsignificant 1.54-fold higher rate of surgical site infection compared with nondiabetic patients with neuropathy. Nondiabetic patients with neuropathy had a significant 4.72-fold increased risk of surgical site infection compared with nondiabetic patients without neuropathy. Despite this, nondiabetic patients with neuropathy did not have a significantly higher rate of surgical site infection than patients with uncomplicated diabetes, and the frequency of surgical site infection in the group with uncomplicated diabetes was not significantly different from that in the nondiabetic patients without neuropathy. Multivariable logistic regression analysis demonstrated that peripheral neuropathy and a hemoglobin A1c of ≥8% were independently associated with surgical site infection. CONCLUSIONS Complicated diabetes increases the risk of surgical site infection after foot and ankle surgery. Patients who had diabetes without complications did not have a greater risk of surgical site infection compared with nondiabetic patients without neuropathy. The presence of neuropathy increases the risk of surgical site infection even in patients without diabetes. Poor long-term glycemic control is also associated with an increased risk of surgical site infection. LEVEL OF EVIDENCE Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dane K. Wukich
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 2100 Jane Street, Pittsburgh, PA 15203. E-mail address for D.K. Wukich:
| | - Brandon E. Crim
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 2100 Jane Street, Pittsburgh, PA 15203. E-mail address for D.K. Wukich:
| | - Robert G. Frykberg
- Phoenix VA Healthcare System, 650 East Indian School Road, Phoenix, AZ 85012
| | - Bedda L. Rosario
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, 127 Parran Hall, Pittsburgh, PA 15213
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Quraishi SA, Bittner EA, Blum L, Hutter MM, Camargo CA. Association between preoperative 25-hydroxyvitamin D level and hospital-acquired infections following Roux-en-Y gastric bypass surgery. JAMA Surg 2014; 149:112-8. [PMID: 24284777 DOI: 10.1001/jamasurg.2013.3176] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Postoperative hospital-acquired infections (HAIs) may result from disruption of natural barrier sites. Recent studies have linked vitamin D status and barrier site integrity. OBJECTIVE To investigate the association between preoperative vitamin D status and the risk for HAIs. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis was performed using propensity score methods to construct a matched-pairs cohort to reduce baseline differences between patients with 25-hydroxyvitamin D (25[OH]D) levels less than 30 ng/mL vs 30 ng/mL or greater. Multivariable logistic regression analysis was then performed to examine the association between 25(OH)D levels and HAIs while adjusting for additional perioperative factors. Locally weighted scatterplot smoothing was used to depict the relationship between increasing 25(OH)D levels and the risk for HAIs. This study was conducted in a single, teaching hospital in Boston, Massachusetts, and involved 770 gastric bypass surgery patients between January 1, 2007, and December 31, 2011. EXPOSURES Preoperative 25(OH)D levels. MAIN OUTCOMES AND MEASURES Association between preoperative 25(OH)D levels and the risk for postoperative HAIs. RESULTS The risk for HAIs was 3-fold greater (adjusted odds ratio, 3.05; 95% CI, 1.34-6.94) in patients with 25(OH)D levels less than 30 ng/mL vs 30 ng/mL or greater. Further adjustment for additional perioperative factors did not materially change this association. Locally weighted scatterplot smoothing analysis depicted a near inverse linear relationship between vitamin D status and the risk for HAIs for 25(OH)D levels around 30 ng/mL. CONCLUSIONS AND RELEVANCE In our patient cohort, a significant inverse association was observed between preoperative 25(OH)D levels and the risk for HAIs. These results suggest that preoperative 25(OH)D levels may be a modifiable risk factor for postoperative nosocomial infections. Prospective studies must determine whether there is a potential benefit to preoperative optimization of vitamin D status.
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Affiliation(s)
- Sadeq A Quraishi
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward A Bittner
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Livnat Blum
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mathew M Hutter
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Shokouhi S, Alavi Darazam I, Sharifi G, Gachkar L, Amirsardari A, Samadian M. Statins and postoperative infections: a randomized clinical trial. Jundishapur J Microbiol 2014; 7:e9456. [PMID: 25147705 PMCID: PMC4138621 DOI: 10.5812/jjm.9456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 04/25/2013] [Accepted: 05/05/2013] [Indexed: 11/23/2022] Open
Abstract
Background: Observational studies, rather than randomized trials, revealed that statins might be associated with other benefits. Objectives: The present study aimed at evaluating the preventive effects of lovastatin when used as a prophylactic agent for early and late infective complications after surgery. Patients and Methods: A total of 149 patients undergoing elective intracranial and spinal surgeries, were enrolled in a double- blind randomized clinical trial in the department of neurosurgery of a teaching hospital. An amount of 20 mg lovastatin and the same dose of placebo, one day before the operation and three days after the surgery, were used for cases and controls, respectively. The patients were evaluated for local and systemic infections during hospitalization and 10, 30, 60 and 90 days after discharge. Results: A total of 149 patients, 78 men and 71 women with a mean age of 40.3 ± 16.5, were assigned to prophylactic protocols. 46 and 103 patients were in the case and control groups, respectively. Eight episodes of infection were detected, including six bacterial meningitis and two episodes of hospital- acquired pneumonia. All of the patients with documented postoperative infections were part of the placebo group, however, there were no significant statistical differences between the groups (P = 0.059). Conclusions: In spite of the differences between the two groups, the results did not significantly support the preventive effect of statins in postoperative infections.
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Affiliation(s)
- Shervin Shokouhi
- Department of Infectious Disease, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Shervin Shokouhi, Department of Infectious Disease, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran, Tel: +98-9141491958, E-mail:
| | - Ilad Alavi Darazam
- Department of Infectious Disease, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Giv Sharifi
- Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Latif Gachkar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Anahita Amirsardari
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Samadian
- Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Goi T, Ueda Y, Nakazawa T, Sawai K, Morikawa M, Yamaguchi A. Measures for preventing wound infections during elective open surgery for colorectal cancer: scrubbing with gauze. Int Surg 2014; 99:35-9. [PMID: 24444266 PMCID: PMC3897338 DOI: 10.9738/intsurg-d-13-00144.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In addition to the general surgical-site infection prevention measures in colorectal cancer surgery, we performed a simple subcutaneous scrubbing procedure with gauze at the time of abdominal closure, which reduced the incidence of wound infections. There are 289 patients whose primary colon cancer lesions were removed by elective surgeries. They were divided into Group A (74 patients with no wound infection prevention measures who were treated from 2002 to 2003), Group B (76 patients with wound infection prevention measures who were treated from 2007 to 2008), and Group C (139 patients with subcutaneous scrubbing with gauze plus the measures in Group B who were treated from 2009 to 2012). The incidence in Group A was 23%, while the corresponding values in Group B and Group C were 14.5% and 2.9%, respectively. The incidence of wound infections was substantially reduced by additional subcutaneous scrubbing with a saline solution and gauze during closure of a surgical incision. This very simple procedure was considered useful for surgical site infection prevention.
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Affiliation(s)
- Takanori Goi
- First Department of Surgery, University of Fukui, Fukui, Japan
| | - Yuki Ueda
- First Department of Surgery, University of Fukui, Fukui, Japan
| | | | - Katsuji Sawai
- First Department of Surgery, University of Fukui, Fukui, Japan
| | | | - Akio Yamaguchi
- First Department of Surgery, University of Fukui, Fukui, Japan
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Post-discharge surveillance of wound infections by telephone calls method in a Sudanese Teaching Hospital. J Infect Public Health 2013; 6:339-46. [PMID: 23999331 DOI: 10.1016/j.jiph.2013.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Surveillance of wound infections has been shown to be a powerful preventive tool, and feedback to the clinical staff reduces wound infection rates. The main objectives of this study were to identify the applicability of telephone calls as a method of post-discharge wound infection surveillance, and to identify patients and procedures characteristics associated with loss for follow-up after hospital discharge. MATERIALS AND METHODS This was a prospective cohort study conducted in Khartoum Teaching Hospital, Sudan. Patients, aged >18 years admitted for elective clean and clean-contaminated surgery during March 1st to 31st October 2010 were recruited. 1-month surveillance of wound infections was conducted with telephone interviews. RESULTS Overall 3656 patients were operated on. Of them 1769 (48.4%) were eligible {mean age 37.8+14 years; females, n=1472 (83.3%)}. The performed surgical interventions were 1814. Of these 1277 (70.4%) were clean-contaminated and 537 (29.6%) were clean. Patients who successfully completed the follow-up were 1387 (78.4%), while 368 (20.8%) were lost, and 14 (0.8%) died. The percentage of male patients (85.3%) who successfully completed the follow-up was significantly higher than females (77.8%); (P=0.002). Wound infection was detected in 15 (0.8%) cases during hospital stay and 110 (6.2%) others after hospital discharge. CONCLUSIONS The majority of wound infections in the current study appeared in post-discharge period; this emphasis the need for establishment of surveillance program in the hospital. Surveillance of wound infections using telephone calls is applicable in this setting and can be used as an alternative method to clinic-based diagnosis of wound infections.
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van Ramshorst GH, Vos MC, den Hartog D, Hop WCJ, Jeekel J, Hovius SER, Lange JF. A comparative assessment of surgeons' tracking methods for surgical site infections. Surg Infect (Larchmt) 2013; 14:181-7. [PMID: 23485257 DOI: 10.1089/sur.2012.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The incidence of surgical site infections (SSI) is considered increasingly to be an indicator of quality of care. We conducted a study in which daily inspection of the surgical incision was performed by an independent, trained team to monitor the incidence of SSI using U.S. Centers for Disease Control and Prevention (CDC) definitions, as a gold-standard measure of care. In the department of surgery, two registration systems for SSI were used routinely by the surgeon: An electronic and a plenary tracking system. The results of the independent team were compared with the outcomes provided by two registration systems for SSI, so as to evaluate the reliability of these systems as a possible alternative for indicating quality of care. METHODS The study was an incidence study conducted from May 2007 to January 2009 that included 1,000 adult patients scheduled to undergo open abdominal surgery in an academic teaching hospital. Surgical incisions were inspected daily to check for SSI according to definitions of health care-associated infections established by the CDC. Follow-up after discharge was done at the outpatient clinic of the hospital by telephone or letter in combination with patient diaries and reviews of patient charts, discharge letters, electronic files, and reported complications. Univariate and multivariable analyses were done to identify putative risk factors for missing registrations. RESULTS Of the 1,000 patients in the study, 33 were not evaluated. Surgical site infections were diagnosed in 26.8% of the 967 remaining patients, of which 18.0% were superficial incisional infections, 5.4% were deep incisional infections, and 3.4% were organ/space infections. More than 60% of SSIs were unreported in either of the department's two tracking systems for such infections. For these two systems, independent major risk factors for missing registrations were (1) the lack of occurrence of an SSI, (2) transplantation surgery, and (3) admission to non-surgical departments. CONCLUSIONS Most SSIs were not tracked with the department's two systems. These systems proved poor alternatives to the gold-standard method of quantifying the incidence of Surgical Site Infection SSI and, therefore, the quality of care. Both protocolized wound assessment and on-site documentation are mandatory for realistic quantification of the incidence of SSI.
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Takemoto Y, Li TS, Kubo M, Ohshima M, Kurazumi H, Ueda K, Enoki T, Murata T, Hamano K. The mobilization and recruitment of c-kit+ cells contribute to wound healing after surgery. PLoS One 2012; 7:e48052. [PMID: 23155375 PMCID: PMC3498273 DOI: 10.1371/journal.pone.0048052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/18/2012] [Indexed: 11/24/2022] Open
Abstract
Delayed wound healing is a serious clinical problem in patients after surgery. A recent study has demonstrated that bone marrow-derived c-kit-positive (c-kit+) cells play important roles in repairing and regenerating various tissues and organs. To examine the hypothesis that surgical injury induces the mobilization and recruitment of c-kit+ cells to accelerate wound healing. Mice were subjected to a left pneumonectomy. The mobilization of c-kit+ cells was monitored after surgery. Using green fluorescent protein (GFP+) bone marrow-transplanted chimera mice, we investigated further whether the mobilized c-kit+ cells were recruited to effect wound healing in a skin puncture model. The group with left pneumonectomies increased the c-kit+ and CD34+ stem cells in peripheral blood 24 h after surgery. At 3 days after surgery, the skin wound size was observed to be significantly smaller, and the number of bone marrow-derived GFP+ cells and GFP+/c-kit+ cells in the wound tissue was significantly greater in mice that had received pneumonectomies, as compared with those that had received a sham operation. Furthermore, some of these GFP+ cells were positively expressed specific markers of macrophages (F4/80), endothelial cells (CD31), and myofibroblasts (αSMA). The administration of AMD3100, an antagonist of a stromal-cell derived factor (SDF)-1/CXCR4 signaling pathway, reduced the number of GFP+ cells in wound tissue and completely negated the accelerated wound healing. Surgical injury induces the mobilization and recruitment of c-kit+ cells to contribute to wound healing. Regulating c-kit+ cells may provide a new approach that accelerates wound healing after surgery.
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Affiliation(s)
- Yoshihiro Takemoto
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Alasmari FA, Tleyjeh IM, Riaz M, Greason KL, Berbari EF, Virk A, Baddour LM. Temporal trends in the incidence of surgical site infections in patients undergoing coronary artery bypass graft surgery: a population-based cohort study, 1993 to 2008. Mayo Clin Proc 2012; 87:1054-61. [PMID: 23127732 PMCID: PMC3532679 DOI: 10.1016/j.mayocp.2012.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/30/2012] [Accepted: 05/21/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the incidence of and temporal trends in surgical site infections (SSIs) in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS A population-based cohort study was conducted to describe the epidemiologic features of SSI in Olmsted County, Minnesota, between January 1, 1993, and December 31, 2008, using the Rochester Epidemiology Project. Period-specific incidence rates (in-hospital or within 30 days outside the hospital) were calculated. Logistic regression analysis was used to adjust for potential confounders that could affect temporal trends in SSI incidence rates. RESULTS During the 16-year study, of 1424 residents of Olmsted County who underwent CABG surgery, 1189 (83%) had isolated CABG and 235 (17%) had combined CABG and valve surgery. The overall SSI incidence rate was 7.0% (95% confidence interval [CI], 5.7%-8.4%). The incidence rate of superficial sternal SSI was 2.0% (95% CI, 1.2%-2.7%) and of deep sternal SSI was 1.5% (95% CI, 0.9%-2.2%). The leg harvest site infection rate was 3.6% (95% CI, 2.6 %-4.5%). The incidence rate decreased over time with a statistically significant linear trend. The adjusted odds ratio (95% CI) of SSI showed a decreasing linear trend: 0.39 (0.19-0.81) vs 0.50 (0.27-0.93) vs 0.83 (0.48-1.42) vs reference for 2005-2008 vs 2001-2004 vs 1997-2000 vs 1993-1996. CONCLUSION In this population-based surveillance study of patients undergoing CABG surgery, the incidence of SSI decreased markedly between 1993 and 2008 in patients in Olmsted County. The factors responsible for this decrease are the focus of ongoing investigations.
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Kasatpibal N, Senaratana W, Chitreecheur J, Chotirosniramit N, Pakvipas P, Junthasopeepun P. Implementation of the World Health Organization surgical safety checklist at a university hospital in Thailand. Surg Infect (Larchmt) 2012; 13:50-6. [PMID: 22390354 DOI: 10.1089/sur.2011.043] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compliance with the World Health Organization (WHO) surgical safety checklist may reduce preventable adverse events. However, compliance may be difficult to implement in Thailand. This study was conducted to examine compliance with the WHO checklist at a Thai university hospital. METHODS A descriptive study was conducted among 4,340 patients undergoing surgery in nine departments from March to August 2009. The compliance rates were computed. RESULTS The highest compliance rate (91.4%) during the sign-in period was with patients' confirmation of their identity, operative site, procedure, and consent. However, only 19.4% of the surgical sites were marked. In the time-out period, surgical teams had introduced themselves by name and role in 79% of the operations; and in 95.7% of the cases, the patient's name, the incision site, and the procedure had been confirmed. Antibiotic prophylaxis had been given within 60 min before the incision in 71% of the cases. For 83% of the operations, the surgeons reviewed crucial events whereas only 78.4% were reviewed by the anesthetists. Sterility had been confirmed by the operating room nurses for every patient, but the essential imaging was displayed at a rate of only 64.4%. In the sign-out period, nurses correctly confirmed the name of the procedure orally in 99.5% of the cases. Instrument, sponge, and needle counts were completed and the specimen was labeled in most cases, 96.8% and 97.6%, respectively. Equipment-related problems were identified in 4.4% of the cases, and 100% of them were addressed. The surgeon, anesthetist, and nurse reviewed the key concerns for recovery and management of the patient at the rate of 85.1%. CONCLUSIONS The WHO checklist can be implemented in a developing country. However, compliance with some items was extremely low, reflecting different work patterns and cultural norms. Additional education and enforcement of checklist use is needed to improve compliance.
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Mawalla B, Mshana SE, Chalya PL, Imirzalioglu C, Mahalu W. Predictors of surgical site infections among patients undergoing major surgery at Bugando Medical Centre in Northwestern Tanzania. BMC Surg 2011; 11:21. [PMID: 21880145 PMCID: PMC3175437 DOI: 10.1186/1471-2482-11-21] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 08/31/2011] [Indexed: 11/24/2022] Open
Abstract
Background Surgical site infection (SSI) continues to be a major source of morbidity and mortality in developing countries despite recent advances in aseptic techniques. There is no baseline information regarding SSI in our setting therefore it was necessary to conduct this study to establish the prevalence, pattern and predictors of surgical site infection at Bugando Medical Centre Mwanza (BMC), Tanzania. Methods This was a cross-sectional prospective study involving all patients who underwent major surgery in surgical wards between July 2009 and March 2010. After informed written consent for the study and HIV testing, all patients who met inclusion criteria were consecutively enrolled into the study. Pre-operative, intra-operative and post operative data were collected using standardized data collection form. Wound specimens were collected and processed as per standard operative procedures; and susceptibility testing was done using disc diffusion technique. Data were analyzed using SPSS software version 15 and STATA. Results Surgical site infection (SSI) was detected in 65 (26.0%) patients, of whom 56 (86.2%) and 9 (13.8%) had superficial and deep SSI respectively. Among 65 patients with clinical SSI, 56(86.2%) had positive aerobic culture. Staphylococcus aureus was the predominant organism 16/56 (28.6%); of which 3/16 (18.8%) were MRSA. This was followed by Escherichia coli 14/56 (25%) and Klebsiella pneumoniae 10/56 (17.9%). Among the Escherichia coli and Klebsiella pneumoniae isolates 9(64.3%) and 8(80%) were ESBL producers respectively. A total of 37/250 (14.8%) patients were HIV positive with a mean CD4 count of 296 cells/ml. Using multivariate logistic regression analysis, presence of pre-morbid illness (OR = 6.1), use of drain (OR = 15.3), use of iodine alone in skin preparation (OR = 17.6), duration of operation ≥ 3 hours (OR = 3.2) and cigarette smoking (OR = 9.6) significantly predicted surgical site infection (SSI) Conclusion SSI is common among patients admitted in surgical wards at BMC and pre-morbid illness, use of drain, iodine alone in skin preparation, prolonged duration of the operation and cigarette smoking were found to predict SSI. Prevention strategies focusing on factors associated with SSI is necessary in order to reduce the rate of SSI in our setting.
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Affiliation(s)
- Brian Mawalla
- Department of Microbiology/Immunology Weill Bugando University College of Health Sciences, Mwanza, Tanzania.
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Miller LG, McKinnell JA, Vollmer ME, Spellberg B. Impact of methicillin-resistant Staphylococcus aureus prevalence among S. aureus isolates on surgical site infection risk after coronary artery bypass surgery. Infect Control Hosp Epidemiol 2011; 32:342-50. [PMID: 21460485 DOI: 10.1086/658668] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Cephalosporins are recommended for antibiotic prophylaxis to prevent cardiothoracic surgical site infections (SSIs) except in patients with β-lactam allergy or in settings with a "high" prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among S. aureus isolates (hereafter, "MRSA prevalence"); however, "high" remains undefined. We sought to identify the MRSA prevalence at which glycopeptide prophylaxis would minimize SSIs relative to β-lactam prophylaxis. METHODS We developed a decision analysis model to estimate SSI likelihood when either glycopeptides or β-lactams were used for prophylaxis in cardiothoracic surgery. Event probabilities were derived from a systematic literature review. A similar cost-minimization model was also developed. RESULTS At 0% MRSA prevalence, SSI probability was 3.64% with glycopeptide prophylaxis and 3.49% with β-lactam prophylaxis. At MRSA prevalences of 10%, 20%, 30%, or 40%, SSI probabilities with glycopeptide prophylaxis did not change, but they were 3.98%, 4.48%, 4.97%, and 5.47% with β-lactam prophylaxis. The threshold of MRSA prevalence at which glycopeptide prophylaxis minimized SSI probability and cost was 3%. In sensitivity analyses, variations in most model estimates only modestly affected the threshold. CONCLUSION Glycopeptide prophylaxis minimizes the risk of SSIs and cost when MRSA prevalence exceeds 3%. At very low MRSA prevalence (between 3% and 10%), the SSI minimization provided by glycopeptide prophylaxis is small and may be within the error of the model. Given the current MRSA prevalence in most community and healthcare settings, clinicians should consider routine prophylaxis with vancomycin. Our findings may have important policy implications, as benefits in cardiothoracic surgery antibiotic prophylaxis must be weighed against the limitations of increased glycopeptide use.
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Affiliation(s)
- Loren G Miller
- Infectious Diseases Clinical Outcomes Research Unit (ID-CORE), Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA.
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Wagner D, Nigg A, Sturm L, Sinwell GM, Depestel DD. Implementation of Weight-Based Antimicrobial Dosing for Surgical Site Infection Prophylaxis. Hosp Pharm 2011. [DOI: 10.1310/hpj4607-494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgical site infections (SSIs) increase morbidity, mortality, and health care costs. Morbid obesity has been identified as an independent risk factor; it has been demonstrated that higher doses of antimicrobials are warranted to achieve adequate tissue concentrations. In 2008, the University of Michigan Health System (UMHS) implemented weight-based dosing such that patients with a documented weight of ≥80 kg would receive a larger initial dose of antibiotic for surgical prophylaxis. This process included a pharmacy dose optimization program provided by an operating room pharmacy where pharmacists could automatically increase the dose based on weight if the initial order was noncompliant with institutional guidelines. The objectives of the study were to assess rates of compliance with the guidelines prior to and after implementation. This study was a retrospective evaluation of SSI prophylaxis dosing in obese patients prior to (April through June 2008) and after (September through November 2008) implementation of a dose optimization program. After implementation, there was a 29.7% increase in weight-based antibiotic surgical prophylaxis; pharmacy intervention accounted for 15% of the change. The implementation of a dose optimization program could prove to be cost-effective by ensuring patients receive the correct weight-based antibiotic and by perhaps reducing the incidence of SSIs.
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Affiliation(s)
- Deborah Wagner
- Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Andrea Nigg
- Oregon Health and Science University, Portland, Oregon
| | - Lisa Sturm
- Infection Control, University of Michigan Health System, Ann Arbor, Michigan
| | - Gail M. Sinwell
- Clinical Information & Decision Support Service, Office of Clinical Affairs, University of Michigan Health System, Ann Arbor, Michigan
| | - Daryl D. Depestel
- Department of Medical Affairs, Cubist Pharmaceuticals, Inc, Lexington, Massachusetts (at the time of this work: Department of Clinical, Social and Administrative Sciences, University of Michigan College of Pharmacy, and Infectious Diseases Pharmacist, Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, Michigan)
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Surgical Site Infection Rates Following Laparoscopic Urological Procedures. J Urol 2011; 185:1289-93. [DOI: 10.1016/j.juro.2010.11.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Indexed: 12/27/2022]
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Degrate L, Garancini M, Misani M, Poli S, Nobili C, Romano F, Giordano L, Motta V, Uggeri F. Right colon, left colon, and rectal surgeries are not similar for surgical site infection development. Analysis of 277 elective and urgent colorectal resections. Int J Colorectal Dis 2011; 26:61-9. [PMID: 20922541 DOI: 10.1007/s00384-010-1057-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical site infections (SSIs) are the most common infections in colorectal surgery. Although some studies suggest that rectal surgery differs from colon surgery for SSI incidence and risk factors, the National Nosocomial Infection Surveillance system categorizes all colorectal surgeries into only one group. The aim of this study was to determine incidence, characteristics, and risk factors of SSIs according to the subclassification of colorectal surgery into right colon surgery (RCS), left colon surgery (LCS), and rectum surgery (RS). METHODS From November 2005 to July 2009, all patients requiring colorectal resectioning were enrolled into our program. The outcome of interest was an SSI diagnosis. Univariate and multivariate analyses were performed to determine SSI predictors in each group. RESULTS Two hundred seventy-seven consecutive colorectal resections were analyzed. SSI rates were 8% in RCS, 18.4% in LCS, and 17.6% in RS. LCS and RS showed significantly higher SSI incidences (p = 0.022) and greater rates of organ/space infections compared to RCS (p = 0.029). Predictors of SSI were steroid use among RCS, age greater than 70 years, multiple comorbidities, steroid use, non-neoplastic colonic disease, urgent operation, ostomy creation, postoperative intensive care among LCS, preoperative chemoradiation, heart disease, and prolonged operation among RS patients. On multivariate analysis, the coupled LCS and RS groups showed an increased risk for SSI compared to RCS (OR, 2.57). CONCLUSIONS SSI incidences, characteristics, and risk factors seem to be different among RCS, LCS, and RS. A tailored SSI surveillance program should be applied for each of the three groups, leading to a more competent SSI recognition and reduction of SSI incidence and related costs.
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Affiliation(s)
- Luca Degrate
- Department of General Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
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[Incidence of surgical site infection after open heart surgery]. ACTA CHIRURGICA IUGOSLAVICA 2010; 57:45-8. [PMID: 20954311 DOI: 10.2298/aci1002045m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite modem surgical techniques, preoperative preventive use of antibiotics and optimal treatment of operative site, surgical site infections (SSI) are significant medical problem in the countries worldwide. OBJECTIVE The aim of this paper was to estimate the frequency of SSI after open heart surgery and to identify the most frequent causes of these infections. MATERIAL AND METHODS A prospective cohort study was performed during the period from January 2008 to December 2009 at the Clinic of Cardiovascular Surgery of the Institute of Cardiovascular Diseases, Vojvodina. The surveillance was consistent throughout the study period. During hospitalization, patients were evaluated daily by the infection control nurse. Isolation, identification and sensitivity tests of causative agents to antimicrobial drugs, obtained from patients' material, were carried out by standard microbiological methods. The descriptive epidemio-logical method was used. The incidence rates of hospital infections were calculated. RESULTS During the study period, among 23 patients, 24 SSIs were registered. The average incidence rate of patients with SSI was 0.98% and SSI rate was 1.02% (ranged from 0% to 3.7%). There was no difference in the incidence rates according to gender (p = 0.65).The mean age of patients with SSI was 64.7 years. Except one, all patients had the ASA score higher than 2. The patients with SSIs were hospitalized approximately 3.8 times longer than the patient without SSI (p = 0.03). The most common causes of SSI were: Staphylococcus aureus (30%), coagulasa-negative Staphylococcus spp, Acinetobacter spp (8%), Enterococcus spp and Klebsiella pneumoniae. CONCLUSION Although the incidence rate of hospital infections is low, it is necessary to maintain continuous surveillance of surgical site infections and to implement the preventive measures.
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Hranjec T, Swenson BR, Sawyer RG. Surgical site infection prevention: how we do it. Surg Infect (Larchmt) 2010; 11:289-94. [PMID: 20518648 DOI: 10.1089/sur.2010.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Efforts to prevent surgical site infection (SSI) employ methods that are valid scientifically, but each institution and each surgeon also incorporates methods believed to be useful although this has not been proved by clinical trials. METHODS The surgical literature was reviewed, as were practices at the University of Virginia that the authors believe are of value for the prevention of SSI. RESULTS Preventive antibiotics are established measures. A case can be made for increasing the dose in patients with a large body mass, and antibiotics probably should be re-administered during procedures lasting longer than 3 h. Chlorhexidine showers for the patient are not proven; however, they are inexpensive and of potential benefit. Hair removal is always done with clippers and in the operating room at the time of the procedure. No scientific case can be made specifically for using antiseptic at the surgical site before the incision. Keeping the blood glucose concentration and the core body temperature near normal probably are important, but how close to normal is unclear. Transfusion enhances SSI, but leukocyte reduction of transfused blood may be of benefit. Some evidence supports the value of antibacterial suture in preventing SSI. CONCLUSIONS Many proven and potentially valid methods are employed to prevent SSI. Coordinated and standardized protocols with good data collection can assist the multi-disciplinary efforts to reduce SSI within the unique practices of a given institution.
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Affiliation(s)
- Tjasa Hranjec
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA
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