1
|
Scheer VM, Jungeström MB, Serrander L, Kalén A, Scheer JH. Benzoyl peroxide treatment decreases Cutibacterium acnes in shoulder surgery, from skin incision until wound closure. J Shoulder Elbow Surg 2021; 30:1316-1323. [PMID: 33545336 DOI: 10.1016/j.jse.2020.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Most surgical site infections after shoulder surgery are caused by Cutibacterium acnes. Topically applied benzoyl peroxide (BPO) has for years been used to decrease the skin load of C acnes in treatment of acne vulgaris. The purpose of this study was to examine this effect on bacterial colonization in patients subjected to elective shoulder surgery at different stages of the procedure. METHODS A total of 100 patients scheduled for primary elective open shoulder surgery were randomized to prepare either with BPO or according to local guidelines-with soap (control group). Four skin swabs were taken in a standardized manner at different times, before and after surgical skin preparation, 1 in dermis, and finally after the skin was sutured. Before skin incision, 5 punch biopsies (3 mm in diameter and maximum 4 mm deep) were retrieved spaced 2 cm apart in the planned skin incision. On culturing, quantification of C acnes was made by serial dilutions. RESULTS Men had a 5-fold higher amount of C acnes on untreated skin. Treatment with BPO considerably lowered this count (P = .0001) both before and after skin disinfection compared to the control group. This positive effect of BPO persisted until skin closure, the point at which some recolonization of C acnes had occurred, but to a higher degree in the control group (P = .040). CONCLUSION Preoperative BPO treatment of the shoulder may be an effective method to decrease bacterial skin load of C acnes from skin incision until wound closure.
Collapse
Affiliation(s)
- Vendela M Scheer
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | | | - Lena Serrander
- Division of Clinical Microbiology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Kalén
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Orthopedics, Linköping University, Linköping, Sweden
| | - Johan H Scheer
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Orthopedics, Linköping University, Linköping, Sweden
| |
Collapse
|
2
|
Paredes I, Lagares A, San-Juan R, Castaño-León AM, Gómez PA, Jimenez-Roldán L, Panero I, Eiriz C, García-Perez D, Moreno LM, Perez-Nuñez A, Gonzalez-León P, Alén JAF. Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study. Acta Neurochir (Wien) 2020; 162:2857-2866. [PMID: 32720014 DOI: 10.1007/s00701-020-04508-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cranioplasty carries a high risk of surgical site infections (SSIs) for a scheduled procedure, particularly with antibiotic-resistant bacteria. METHODS The goal of this retrospective study was to measure the effect of tailored antibiotic prophylaxis on SSIs resulting from cranioplasties. The authors collected a prospective database of cranioplasties from 2009 to 2018. Risk factors for SSI were registered, as well as infection occurring during the first year postoperatively. A new protocol was initiated in 2016 consisting of antibiotic prophylaxis tailored to the colonizing flora of the skin of the scalp and decolonization of patients who were nasal carriers of methicillin-resistant S. aureus (MRSA); infection rates were compared. RESULTS One hundred nine cranioplasties were identified, 64 in the old protocol and 45 in the new protocol. Of the 109 cranioplasties, 16 (14.7%) suffered an infection, 14 (21.9%) in the old protocol group and 2 (4.4%) in the new protocol group (OR for the new protocol 0.166, 95% CI 0.036-0.772). Multiple surgeries (OR 3.44), Barthel ≤ 70 (OR 3.53), and previous infection (OR 3.9) were risk factors for SSI. Of the bacteria identified in the skin of the scalp, 22.2% were resistant to routine prophylaxis (cefazoline). Only one patient was identified as a nasal carrier of MRSA and was decolonized. CONCLUSIONS A high percentage of bacteria resistant to routine prophylaxis (cefazoline) was identified in the skin of these patients' scalps. The use of tailored antibiotic prophylaxis reduced significantly the infection rate in this particular set of patients.
Collapse
Affiliation(s)
- Igor Paredes
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Alfonso Lagares
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Ana María Castaño-León
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Pedro-Antonio Gómez
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Jimenez-Roldán
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Irene Panero
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Carla Eiriz
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Daniel García-Perez
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Miguel Moreno
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Angel Perez-Nuñez
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Pedro Gonzalez-León
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - José Antonio F Alén
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| |
Collapse
|
3
|
Aghdassi SJS, Gastmeier P. Novel approaches to surgical site infections: what recommendations can be made? Expert Rev Anti Infect Ther 2017; 15:1113-1121. [PMID: 29125385 DOI: 10.1080/14787210.2017.1404451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) are one of the most frequent healthcare-associated infections worldwide, representing a substantial burden on the healthcare system and the individual patient. Various risk factors for SSI have been identified, which can be separated into patient-related, procedure-related and other risk factors. Areas covered: Other risk factors relevant for SSI are the season in which surgery is performed, the volume of surgeries in a department, the working atmosphere in the operating room and the indications for surgery. Overall, the risk of SSI is higher during summertime. Higher-volume departments appear to be protective against SSI as does a calm working atmosphere. The frequency of certain types of surgery differs greatly among European countries. The decision to perform surgery appears to be dependent on the patient's condition as well as the healthcare system and financial incentives. Expert commentary: When possible, elective surgery should not be executed during summertime but during cooler times of year. Departments with a high volume of surgical procedures should be given preference. The establishment of a calm working atmosphere is beneficial to a surgeon's performance and can reduce SSI rates. The indications for performing surgery should be carefully reevaluated whenever possible.
Collapse
Affiliation(s)
- Seven Johannes Sam Aghdassi
- a Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin , Berlin , Germany.,b German National Reference Centre for Surveillance of Nosocomial Infections (NRZ) , Berlin , Germany
| | - Petra Gastmeier
- a Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin , Berlin , Germany.,b German National Reference Centre for Surveillance of Nosocomial Infections (NRZ) , Berlin , Germany
| |
Collapse
|
4
|
Abstract
BACKGROUND Health-care-associated infections (HAIs), infections that patients contract during the course of their hospitalization, are receiving a growing amount of attention. Heavy skin bacterial colonization aids in the transmission and development of HAIs. Nurses frequently use bathing with chlorhexidine gluconate (CHG) to reduce patients' cutaneous microbial burden. This intervention has been shown to have promising but mixed results in the prevention of HAIs. PURPOSE This article reviews the literature for evidence on the impact of CHG bathing on HAIs. METHOD A literature search was conducted to identify peer-reviewed studies and meta-analyses that examined the impact of CHG bathing on HAIs using PubMed and CINAHL with the following search terms: CHG bathing AND healthcare associated infections, surgical site infections ( SSIs), central line associated bloodstream infections ( CLABSIs), ventilator-associated pneumonias ( VAP), catheter-associated urinary-tract infections ( CAUTIs), and Clostridium difficile-associated disease. The initial search identified 23 articles for review. Additional studies were identified by searching references used in original studies or review articles on this topic. PRINCIPLE FINDINGS There is good evidence to support incorporating a CHG bathing regimen to reduce the incidence of CLABSIs, SSIs, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) HAIs. CONCLUSION As CHG becomes a standard practice to prevent HAIs, it is important to monitor for adverse reactions and evidence of resistance/susceptibility.
Collapse
Affiliation(s)
- Janette Denny
- 1 University of South Florida, St. Petersburg, FL, USA
| | - Cindy L Munro
- 1 University of South Florida, St. Petersburg, FL, USA
| |
Collapse
|
5
|
Cordioli RL, Cordioli E, Negrini R, Silva E. Sepsis and pregnancy: do we know how to treat this situation? Rev Bras Ter Intensiva 2015; 25:334-44. [PMID: 24553516 PMCID: PMC4031877 DOI: 10.5935/0103-507x.20130056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 11/21/2013] [Indexed: 12/18/2022] Open
Abstract
Sepsis is defined as an acute inflammatory response syndrome secondary to an
infectious focus. It has a high incidence, morbidity and mortality, causing
substantial financial costs, especially due to complications such as septic shock and
multiple organ dysfunction. The pathogen toxins associated with individual
susceptibility culminate with cytokine release, which promotes a systemic
inflammatory response that can progress to multiple organ dysfunction and eventual
patient death. Specifically, sepsis incidence, morbidity and mortality are lower in pregnant women,
as this group is typically younger with fewer comorbidities having a polymicrobial
etiology resulting in sepsis. Pregnant women exhibit physiological characteristics that may confer specific
clinical presentation and laboratory patterns during the sepsis course. Thus, a
better understanding of these changes is critical for better identification and
management of these patients. The presence of a fetus also requires unique approaches
in a pregnant woman with sepsis. Sepsis treatment is based on certain guidelines that were established after major
clinical trials, which, unfortunately, all classified pregnancy as a exclusion
criteria. Thus, the treatment of sepsis in the general population has been extrapolated to the
pregnant population, with the following main goals: maintenance of tissue perfusion
with fluid replacement and vasoactive drugs (initial resuscitation), adequate
oxygenation, control of the infection source and an early start of antibiotic
therapy, corticosteroid infusion and blood transfusion when properly indicated,
prophylaxis, and specifically monitoring and maintenance of fetal heath.
Collapse
Affiliation(s)
- Ricardo Luiz Cordioli
- Corresponding author: Ricardo Luiz Cordioli, Unidade de Terapia
Intensiva do Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701,
5º Andar - Morumbi, Zip code: 05652-900 - São Paulo (SP), Brazil.
E-mail:
| | | | | | | |
Collapse
|
6
|
Readmissions after cardiac surgery: experience of the National Institutes of Health/Canadian Institutes of Health research cardiothoracic surgical trials network. Ann Thorac Surg 2014; 98:1274-80. [PMID: 25173721 DOI: 10.1016/j.athoracsur.2014.06.059] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/08/2014] [Accepted: 06/13/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Readmissions are a common problem in cardiac surgery. The goal of this study was to examine the frequency, timing, and associated risk factors for readmission after cardiac operations. METHODS A 10-center cohort study prospectively enrolled 5,158 adult cardiac surgical patients (5,059 included in analysis) to assess risk factors for infection after cardiac operations. Data were also collected on all-cause readmissions occurring within 65 days after the operation. Major outcomes included the readmission rate stratified by procedure type, cause of readmission, length of readmission stay, and discharge disposition after readmission. Multivariable Cox regression was used to determine risk factors for time to first readmission. RESULTS The overall rate of readmission was 18.7% (number of readmissions, 945). When stratified by the most common procedure type, readmission rates were isolated coronary artery bypass grafting, 14.9% (n = 248); isolated valve, 18.3% (n = 337); and coronary artery bypass grafting plus valve, 25.0% (n = 169). The three most common causes of first readmission within 30 days were infection (17.1% [n = 115]), arrhythmia (17.1% [n = 115]), and volume overload (13.5% [n = 91]). More first readmissions occurred within 30 days (80.6% [n = 672]) than after 30 days (19.4% [n = 162]), and 50% of patients were readmitted within 22 days from the index operation. The median length of stay during the first readmission was 5 days. Discharge in 15.8% of readmitted patients (n = 128) was to a location other than home. Baseline patient characteristics associated with readmission included female gender, diabetes mellitus on medication, chronic obstructive pulmonary disease, elevated creatinine, lower hemoglobin, and longer operation time. More complex surgical procedures were associated with an increased risk of readmission compared with the coronary artery bypass grafting group. CONCLUSIONS Nearly 1 of 5 patients who undergo cardiac operations require readmission, an outcome with significant health and economic implications. Management practices to avert in-hospital infections, reduce postoperative arrhythmias, and avoid volume overload offer important targets for quality improvement.
Collapse
|
7
|
Martindale RG, McClave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape? JPEN J Parenter Enteral Nutr 2014; 37:5S-20S. [PMID: 24009250 DOI: 10.1177/0148607113496821] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Poor nutrition status has long been linked to increases in postoperative complications and adverse outcomes for the patient undergoing elective surgery. While optimal planning for nutrition therapy should be comprehensive spanning throughout the perioperative period, recent advances have focused on the concept of "prehabilitation" to best prepare the patient prior to the insult of surgery. Adding immune/metabolic modulating formulas the week of surgery with carbohydrate drinks to optimize glycogen deposition immediately prior to surgery, enhances patient recovery and return to baseline function. Such nutrition strategies should now be combined with a host of other practices (such as smoking cessation, weight loss, glucose control, and specialized exercise program) as part of a structured protocol to maximize patients' chances for a full and rapid recovery from their elective surgical procedure.
Collapse
Affiliation(s)
- Robert G Martindale
- Department of Surgery, University of Oregon Health Sciences University, Portland, Oregon, USA
| | | | | | | |
Collapse
|
8
|
Nuutila K, Katayama S, Vuola J, Kankuri E. Human Wound-Healing Research: Issues and Perspectives for Studies Using Wide-Scale Analytic Platforms. Adv Wound Care (New Rochelle) 2014; 3:264-271. [PMID: 24761360 DOI: 10.1089/wound.2013.0502] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/26/2013] [Indexed: 11/13/2022] Open
Abstract
Significance: Revealing the basic mechanisms in the healing process and then regulating these processes for faster healing or to avoid negative outcomes such as infection or scarring are fundamental to wound research. The normal healing process is basically known, but to thoroughly understand the very complex aspects involved, it is necessary to characterize the course of events at a higher resolution with the latest molecular techniques and methodologies. Recent Advances: Various animal models are used in wound-healing research. Rodent and pig models are the ones most often used, probably because of pre-existing sophisticated research methodologies and as the proper care and ethical use of these species are highly developed and organized to serve science throughout the world. Critical Issues: Since several animal models are used, their anatomical and physiological differences varyingly affect the translation of results on healing mechanisms. Hence, to avoid species-specific misinformation, more ways to study wound healing directly in humans are needed. Future Directions: Fortunately, novel techniques have enabled high-end molecular-level research even from small samples of tissue. Since these methods require only a small amount of patient skin, they make it possible to study wound healing directly in humans.
Collapse
Affiliation(s)
- Kristo Nuutila
- Institute of Biomedicine, Pharmacology, Biomedicum, University of Helsinki, Helsinki, Finland
| | - Shintaro Katayama
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
- Science for Life Laboratory, Solna, Sweden
| | - Jyrki Vuola
- Helsinki Burn Center, Töölö Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Esko Kankuri
- Institute of Biomedicine, Pharmacology, Biomedicum, University of Helsinki, Helsinki, Finland
| |
Collapse
|
9
|
Ramcharan A, Penders J, Smeets E, Rouflart M, Tiel FV, Bruggeman C, Baeten C, Breukink S, Tordoir J, Stobberingh E. Cross-sectional study on surveillance of surgical site infections after vascular surgery. Future Microbiol 2013; 8:1373-80. [DOI: 10.2217/fmb.13.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To determine the incidence and risk factors for surgical site infections (SSI) after vascular surgery, to evaluate the Dutch safety bundle to reduce adverse complications and to analyze causative microorganisms of SSIs. Materials & methods: The 3.5-year study was divided into two periods: the control period (before bundle implementation) and intervention period (after implementation). Postdischarge surveillance was performed until 30 days after surgery. Causative microorganisms from in-hospital wound swabs were determined. SSI rates between both periods were compared and a risk analysis was carried out by performing a logistic regression. Results: The study included 1719 operations. The in-hospital SSI rate increased significantly over time. Out of 140 SSIs, 39% were diagnosed postdischarge. Risk factors were diabetes, age >60 years and operations classified as contaminated or dirty. Pseudomonas aeruginosa susceptibility was the highest for gentamicin (97%). All Staphylococcus aureus were methicillin susceptible. Conclusion: As patient demographics are important to determine the effectiveness of infection preventive measures, (postdischarge) surveillance is important for developing SSI interventions.
Collapse
Affiliation(s)
- Amita Ramcharan
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - John Penders
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Ed Smeets
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Margriet Rouflart
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Frank van Tiel
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Cathrien Bruggeman
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Maastricht University, CAPHRI School for Public Health & Primary Care, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Cor Baeten
- Maastricht University Medical Centre, Department of Surgery, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Stéphanie Breukink
- Maastricht University Medical Centre, Department of Surgery, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jan Tordoir
- Maastricht University Medical Centre, Department of Surgery, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ellen Stobberingh
- Maastricht University Medical Centre, Department of Medical Microbiology, P Debyelaan 25, 6229 HX Maastricht, The Netherlands
| |
Collapse
|