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Troeman DPR, Hazard D, van Werkhoven CHW, Timbermont L, Malhotra-Kumar S, Wolkewitz M, Ruzin A, Sifakis F, Harbarth S, Kluytmans JAJW. Association of Staphylococcus aureus Bacterial Load and Colonization Sites With the Risk of Postoperative S. aureus Infection. Open Forum Infect Dis 2024; 11:ofae414. [PMID: 39113829 PMCID: PMC11304588 DOI: 10.1093/ofid/ofae414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/21/2024] [Indexed: 08/10/2024] Open
Abstract
Background The independent effects of extranasal-only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing Staphylococcus aureus (SA) on the risk of developing SA surgical site infections and postoperative bloodstream infections (SA SSI/BSIs) are unclear. We aimed to quantify these effects in this large prospective cohort study. Methods Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat, or perineum within 30 days before surgery. SA carriers and noncarriers were enrolled in a prospective cohort study in a 2:1 ratio. Weighted multivariable Cox proportional hazard models were used to assess the independent associations between different measures of SA carriage and occurrence of SA SSI/BSI within 90 days after surgery. Results We enrolled 5004 patients in the study cohort; 3369 (67.3%) were SA carriers. 100 SA SSI/BSI events occurred during follow-up, and 86 (86%) of these events occurred in SA carriers. The number of colonized bodily sites (adjusted hazard ratio [aHR], 3.5-8.5) and an increasing SA bacterial load in the nose (aHR, 1.8-3.4) were associated with increased SA SSI/BSI risk. However, extranasal-only carriage was not independently associated with SA SSI/BSI (aHR, 1.5; 95% CI, 0.9-2.5). Conclusions Nasal SA carriage was associated with an increased risk of SA SSI/BSI and accounted for the majority of SA infections. Higher bacterial load, as well as SA colonization at multiple bodily sites, further increased this risk.
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Affiliation(s)
- Darren P R Troeman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Derek Hazard
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Cornelis H W van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leen Timbermont
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexey Ruzin
- Microbial Sciences, R&D BioPharmaceuticals, AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Stephan Harbarth
- Infection Control Programme and WHO Collaborating Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jan A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Feather CB, Rehrig S, Allen R, Barth N, Kugler EM, Cullinane DC, Falank CR, Bhattacharya B, Maung AA, Seng S, Ratnasekera A, Bass GA, Butler D, Pascual JL, Srikureja D, Winicki N, Lynde J, Nowak B, Azar F, Thompson LA, Nahmias J, Manasa M, Tesoriero R, Kumar SB, Collom M, Kincaid M, Sperwer K, Santos AP, Klune JR, Turcotte J. To close or not to close? Wound management in emergent colorectal surgery, an EAST multicenter prospective cohort study. J Trauma Acute Care Surg 2024; 97:73-81. [PMID: 38523130 DOI: 10.1097/ta.0000000000004321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND This study aimed to determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS), and mortality in emergent colorectal surgery. METHODS A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS, and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, intensive care unit admission, vasopressor use, procedure details, and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates. RESULTS In total, 557 patients were included (SC, n = 262; SLC, n = 124; SO, n = 171). Statistically significant differences in body mass index, race/ethnicity, American Society of Anesthesiologist scores, EBL, intensive care unit admission, vasopressor therapy, procedure details, and wound class were observed across groups. Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group. After risk adjustment, SO was associated with increased risk of mortality (OR, 3.003; p = 0.028) in comparison with the SC group. Skin loosely closed was associated with increased risk of superficial SSI (OR, 3.439; p = 0.014), after risk adjustment. CONCLUSION When compared with the SC group, the SO group was associated with mortality but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Cristina B Feather
- From the Anne Arundel Medical Center and Doctors Community Medical Center (C.B.F., S.R., R.A., J.R.K., J.T.), Luminis Health, Annapolis, Maryland; Cooper University Hospital (N.B., E.M.K.), Camden, New Jersey; Maine Medical Center (D.C.C., C.R.F.), Portland, Maine; Yale New Haven Hospital (B.B., A.A.M.), New Haven, Connecticut; Crozer Chester Medical Center (S.S., A.R.), Upland; Hospital of the University of Pennsylvania (G.A.B., J.L.P.), Philadelphia, Pennsylvania; University of Texas Southwestern Medical Center (D.B.), Dallas, Texas; Loma Linda University Medical Center (D.S., N.W.), Loma Linda, California; Jackson Memorial Hospital (J.L., B.N.), University of Miami, Miami, Florida; St. Mary's Medical Center (F.A., L.A.T.), Florida Atlantic University, West Palm Beach, Florida; University of California at Irvine Health (J.N., M.M.), Orange; Zuckerberg San Francisco General Hospital (R.T., S.B.K.), UCSF, San Francisco, California; Medical City Plano (M.C.), Envision Health, Plano, Texas; OhioHealth Grant Medical Center (M.K., K.S.), Columbus, Ohio; and Texas Tech University Health Science Center (A.P.S.), Lubbock, Texas
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Moghadam MT, Mojtahedi A, Salamy S, Shahbazi R, Satarzadeh N, Delavar M, Ashoobi MT. Phage therapy as a glimmer of hope in the fight against the recurrence or emergence of surgical site bacterial infections. Infection 2024; 52:385-402. [PMID: 38308075 DOI: 10.1007/s15010-024-02178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Over the last decade, surgery rates have risen alarmingly, and surgical-site infections are expanding these concerns. In spite of advances in infection control practices, surgical infections continue to be a significant cause of death, prolonged hospitalization, and morbidity. As well as the presence of bacterial infections and their antibiotic resistance, biofilm formation is one of the challenges in the treatment of surgical wounds. METHODS This review article was based on published studies on inpatients and laboratory animals receiving phage therapy for surgical wounds, phage therapy for tissue and bone infections treated with surgery to prevent recurrence, antibiotic-resistant wound infections treated with phage therapy, and biofilm-involved surgical wounds treated with phage therapy which were searched without date restrictions. RESULTS It has been shown in this review article that phage therapy can be used to treat surgical-site infections in patients and animals, eliminate biofilms at the surgical site, prevent infection recurrence in wounds that have been operated on, and eradicate antibiotic-resistant infections in surgical wounds, including multi-drug resistance (MDR), extensively drug resistance (XDR), and pan-drug resistance (PDR). A cocktail of phages and antibiotics can also reduce surgical-site infections more effectively than phages alone. CONCLUSION In light of these encouraging results, clinical trials and research with phages will continue in the near future to treat surgical-site infections, biofilm removal, and antibiotic-resistant wounds, all of which could be used to prescribe phages as an alternative to antibiotics.
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Affiliation(s)
- Majid Taati Moghadam
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mojtahedi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shakiba Salamy
- Department of Microbiology, Faculty of Pharmacy, Islamic Azad University, Tehran, Iran
| | - Razieh Shahbazi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Naghmeh Satarzadeh
- Student Research Committee, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Delavar
- Vice President of Health and Executive Vice President, Rey Health Center, Tehran University of Medical Sciences, Tehran, Iran
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Kaul L, Abdo AI, Coenye T, Swift S, Zannettino A, Süss R, Richter K. In vitro and in vivo evaluation of diethyldithiocarbamate with copper ions and its liposomal formulation for the treatment of Staphylococcus aureus and Staphylococcus epidermidis biofilms. Biofilm 2023; 5:100130. [PMID: 37274173 PMCID: PMC10238467 DOI: 10.1016/j.bioflm.2023.100130] [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] [Received: 01/22/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Surgical site infections (SSIs) are mainly caused by Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis) biofilms. Biofilms are aggregates of bacteria embedded in a self-produced matrix that offers protection against antibiotics and promotes the spread of antibiotic-resistance in bacteria. Consequently, antibiotic treatment frequently fails, resulting in the need for alternative therapies. The present study describes the in vitro efficacy of the Cu(DDC)2 complex (2:1 M ratio of diethyldithiocarbamate (DDC-) and Cu2+) with additional Cu2+ against S. aureus and S. epidermidis biofilms in models mimicking SSIs and in vitro antibacterial activity of a liposomal Cu(DDC)2 + Cu2+ formulation. The in vitro activity on S. aureus and S. epidermidis biofilms grown on two hernia mesh materials and in a wound model was determined by colony forming unit (CFU) counting. Cu2+-liposomes and Cu(DDC)2-liposomes were prepared, and their antibacterial activity was assessed in vitro using the alamarBlue assay and CFU counting and in vivo using a Galleria mellonella infection model. The combination of 35 μM DDC- and 128 μM Cu2+ inhibited S. aureus and S. epidermidis biofilms on meshes and in a wound infection model. Cu(DDC)2-liposomes + free Cu2+ displayed similar antibiofilm activity to free Cu(DDC)2 + Cu2+, and significantly increased the survival of S. epidermidis-infected larvae. Whilst Cu(DDC)2 + Cu2+ showed substantial antibiofilm activity in vitro against clinically relevant biofilms, its application in mammalian in vivo models is limited by solubility. The liposomal Cu(DDC)2 + Cu2+ formulation showed antibiofilm activity in vitro and antibacterial activity and low toxicity in G. mellonella, making it a suitable water-soluble formulation for future application on infected wounds in animal trials.
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Affiliation(s)
- Laurine Kaul
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Road, Adelaide, SA, 5011, Australia
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104, Freiburg, Germany
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Adrian I. Abdo
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Road, Adelaide, SA, 5011, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
| | - Simon Swift
- Department of Molecular Medicine and Pathology, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Andrew Zannettino
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
- Precision Cancer Medicine Theme, South Australian Health & Medical Research Institute, North Terrace, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, Australia
| | - Regine Süss
- Institute of Pharmaceutical Sciences, Department of Pharmaceutics, University of Freiburg, Sonnenstr. 5, 79104, Freiburg, Germany
| | - Katharina Richter
- Richter Lab, Department of Surgery, Basil Hetzel Institute for Translational Health Research, University of Adelaide, 37 Woodville Road, Adelaide, SA, 5011, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA, 5000, Australia
- Institute for Photonics and Advanced Sensing, University of Adelaide, Adelaide, Australia
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Worku S, Abebe T, Alemu A, Seyoum B, Swedberg G, Abdissa A, Mihret A, Beyene GT. Bacterial profile of surgical site infection and antimicrobial resistance patterns in Ethiopia: a multicentre prospective cross-sectional study. Ann Clin Microbiol Antimicrob 2023; 22:96. [PMID: 37936207 PMCID: PMC10631106 DOI: 10.1186/s12941-023-00643-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Globally, surgical site infections (SSI) are the most commonly reported healthcare-associated infections. METHODS A multicentre study was conducted among patients who underwent surgical procedures at four hospitals located in Northern (Debre Tabor), Southern (Hawassa), Southwest (Jimma), and Central (Tikur Anbessa) parts of Ethiopia. A total of 752 patients clinically studied for surgical site infection were enrolled. The number of patients from Debre Tabor, Hawassa, Jimma, and Tikur Anbessa, hospitals was 172, 184, 193, and 203, respectively. At each study site, SSI discharge culture was performed from all patients, and positive cultures were characterized by colony characteristics, Gram stain, and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). An antimicrobial susceptibility test (AST) was done on Mueller-Hinton agar using the disk diffusion method. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered statistically significant. Data were analysed using STATA 16 software. RESULTS Among 752 wound discharge cultures performed, 65.5% yielded growth. Among these, 57.9% and 42.1% were Gram-negative and Gram-positive isolates, respectively. In this study, a total of 494 bacteria were isolated; Staphylococcus aureus (31%), Escherichia coli (20.7%), and Klebsiella pneumoniae (9.8%) were the most common. Rare isolates (0.8% each) included Raoultella ornithinolytica, Stenotrophomonas maltophilia, Alcalignes faecalis, Pantoea ecurina, Bacillus flexus, and Paenibacillus tylopili. Enterobacteriaceae showed high levels of resistance to most of the tested antibiotics but lower levels of ertapenem (32.9%), amikacin (24.3%), imipenem (20.3%), and meropenem (17.6%) resistance. Multidrug-resistant (MDR) frequency of Enterobacteriaceae at Debre Tabor, Hawassa, Jimma, and Tikur Anbessa hospitals was 84.5%, 96.5%, 97.3%, and 94%, respectively. Ages ≥ 61 years (AOR = 2.83, 95% CI: 1.02-7.99; P 0.046), prolonged duration of hospital stay (AOR = 4.15, 95% CI: 2.87-6.01; P 0.000), history of previous antibiotics use (AOR = 2.83, 95% CI: 1.06-2.80; P 0.028), history of smoking (AOR = 2.35, 95% CI: 1.44-3.83; P 0.001), emergency surgery (AOR = 2.65, 95% CI: 1.92-3.66; P 0.000), and duration of operation (AOR = 0.27, 95% CI: 0.181-0.392; P 0.000) were significant risk factors. CONCLUSION The most prevalent isolates from Gram-positive and Gram-negative bacteria across all hospitals were S. aureus and E. coli, respectively. Many newly emerging Gram-negative and Gram-positive bacteria were identified. Variation between hospitals was found for both SSI etiology type and MDR frequencies. Hence, to prevent the emergence and spread of MDR bacteria, standard bacteriological tests and their AST are indispensable for effective antimicrobial stewardship.
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Affiliation(s)
- Seble Worku
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Tamrat Abebe
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ashenafi Alemu
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Seyoum
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Göte Swedberg
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Alemseged Abdissa
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Tesfaye Beyene
- Bacterial and Viral Diseases Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Karapetyan K, Mei S, Choudhury A, Cottreau J. Overview of Antibiotic Prophylaxis in Orthopaedic and Cardiac Procedures. Orthop Nurs 2023; 42:312-316. [PMID: 37708530 DOI: 10.1097/nor.0000000000000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Antibiotic prophylaxis (AP) in surgical procedures is commonly used to prevent infections that may occur after operations. There are multiple factors that can contribute to increased risk of postsurgical complications that include prolonged hospitalization, reoperation, and readmissions. One of the strategies of decreasing the risk of bacterial contamination and developing infections is preprocedural antibiotic administration. When selecting an appropriate antibiotic, it is important to take into account surgery type and patient's characteristics which would also impact timing of administration and prophylaxis duration. Although surgical AP is significant for avoiding bacterial complications, it is also associated with some drawbacks such as increased antibiotic resistance and development of adverse reactions. Therefore, it is important to assess risks and benefits and select the most appropriate antibiotic regimen before initiating AP.
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Affiliation(s)
- Kristina Karapetyan
- Kristina Karapetyan, PharmD, PGY-2 Ambulatory Care Pharmacy Resident, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Sally Mei, PharmD, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Aeman Choudhury, PharmD, BCACP, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Jessica Cottreau, PharmD, BCPS, BCIDP, Chair and Associate Professor, Department of Pharmacy Practice, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Sally Mei
- Kristina Karapetyan, PharmD, PGY-2 Ambulatory Care Pharmacy Resident, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Sally Mei, PharmD, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Aeman Choudhury, PharmD, BCACP, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Jessica Cottreau, PharmD, BCPS, BCIDP, Chair and Associate Professor, Department of Pharmacy Practice, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Aeman Choudhury
- Kristina Karapetyan, PharmD, PGY-2 Ambulatory Care Pharmacy Resident, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Sally Mei, PharmD, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Aeman Choudhury, PharmD, BCACP, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Jessica Cottreau, PharmD, BCPS, BCIDP, Chair and Associate Professor, Department of Pharmacy Practice, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jessica Cottreau
- Kristina Karapetyan, PharmD, PGY-2 Ambulatory Care Pharmacy Resident, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Sally Mei, PharmD, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Aeman Choudhury, PharmD, BCACP, Clinical Pharmacy Practitioner, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
- Jessica Cottreau, PharmD, BCPS, BCIDP, Chair and Associate Professor, Department of Pharmacy Practice, Rosalind Franklin University of Medicine and Science, North Chicago, IL
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Davies H, Russell J, Varghese A, Holmes H, Soares MO, Woods B, Puig-Peiro R, Evans S, Tierney R, Mealing S, Sculpher M, Robotham JV. Developing a Modeling Framework for Quantifying the Health and Cost Implications of Antibiotic Resistance for Surgical Procedures. MDM Policy Pract 2023; 8:23814683231152885. [PMID: 36755742 PMCID: PMC9900655 DOI: 10.1177/23814683231152885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/26/2022] [Indexed: 02/07/2023] Open
Abstract
Background. Antimicrobial resistance (AMR) is a global public health threat. The wider implications of AMR, such as the impact of antibiotic resistance (ABR) on surgical procedures, are yet to be quantified. The objective of this study was to produce a conceptual modeling framework to provide a basis for estimating the current and potential future consequences of ABR for surgical procedures in England. Design. A framework was developed using literature-based evidence and structured expert elicitation. This was applied to populations undergoing emergency repair of the neck of the femur and elective colorectal resection surgery. Results. The framework captures the implications of increasing ABR by allowing for higher rates of surgical site infection (SSI) as the effectiveness of antibiotic prophylaxis wanes and worsened outcomes following SSIs to reflect reduced antibiotic treatment effectiveness. The expert elicitation highlights the uncertainty in quantifying the impact of ABR, reflected in the results. A hypothetical SSI rate increase of 14% in a person undergoing emergency repair of the femur could increase costs by 39% (-2% to 108% credible interval [CI]) and decrease quality-adjusted life-years by 11% (0.4% to 62% CI) over 15 y. Conclusions. The modeling framework is a starting point for addressing the implication of ABR on the outcomes and costs of surgeries. Due to clinical uncertainty highlighted in the expert elicitation process, the numerical outputs of the case studies should not be focused on but rather the framework itself, illustration of the evidence gaps, the benefit of expert elicitation in quantifying parameters with limited data, and the potential magnitude of the impact of ABR on surgical procedures. Implications. The framework can be used to support research surrounding the health and cost burden of ABR in England. Highlights The modeling framework is a starting point for assessing the health and cost impacts of antibiotic resistance on surgeries in England.Formulating a framework and synthesizing evidence to parameterize data gaps provides targets for future research.Once data gaps are addressed, this modeling framework can be used to feed into overall estimates of the health and cost burden of antibiotic resistance and evaluate control policies.
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Affiliation(s)
- Heather Davies
- Davies H. MSc, York Health Economics
Consortium Ltd, Enterprise House, Heslington, York, North Yorkshire YO10 5NQ,
UK; ()
| | - Joel Russell
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Angel Varghese
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Hayden Holmes
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Marta O. Soares
- Centre for Health Economics, University of
York, York. North Yorkshire, UK
| | - B. Woods
- Centre for Health Economics, University of
York, York. North Yorkshire, UK
| | - Ruth Puig-Peiro
- Office for Health Improvement and Disparities,
Department of Health and Social Care, UK
| | - Stephanie Evans
- Modelling and Evaluations Unit, HCAI & AMR,
UK Health Security Agency
| | - Rory Tierney
- Office for Health Improvement and Disparities,
Department of Health and Social Care, UK
| | - Stuart Mealing
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Mark Sculpher
- Centre for Health Economics, University of
York, York. North Yorkshire, UK
| | - Julie V. Robotham
- Modelling and Evaluations Unit, HCAI &
AMR, UK Health Security Agency
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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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Arputhanathan H, Hyde J, Atilola T, Queen D, Elliott J, Sibbald RG. A patient navigation model to improve complex wound care outcomes. Nurs Manag (Harrow) 2022; 53:31-41. [PMID: 36040731 DOI: 10.1097/01.numa.0000855956.26020.1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Helen Arputhanathan
- At Home and Community Care Support Services in Waterloo, Wellington, Canada, Helen Arputhanathan , Jane Hyde , and Temidayo Atilola are RNs. Douglas Queen is a wound care business consultant and researcher for WoundPedia and ECHO Wound Program in Canada. James Elliott is a researcher and advocate for WoundPedia and ECHO Wound Program. R. Gary Sibbald is a professor of medicine and public health at the University of Toronto in Ontario, Canada
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Abstract
OBJECTIVE To create a blended format model to navigate interprofessional team assessments of patients with complex wounds during COVID-19 as a quality improvement process. METHODS During clinical assessments, patients were interviewed in their homes with representation from their circle of care and primary nurse on site linked to a live virtual interprofessional blended remote team model (wound care nurse specialist, advanced wound care doctor). Eligible patients had completed a wound care clinical pathway without wound closure. Palliative patients with complex wounds and patients without precise/accurate diagnoses were also included. This process addressed the components of Wound Bed Preparation 2021: manage the cause, address patient-centered concerns, determine the ability to heal, optimize local wound care, and evaluate outcomes on an ongoing basis. RESULTS Since April 2020, 48 patients were referred to the Home and Community Care Support Services patient navigation interprofessional team. Patients' home-care services were initiated between 2012 and 2021. The team provided closure in 29% of patients and the wound surface area reduced in 66%. Pain was reduced in 73% of patients and appropriate infection management was implemented in 79%. In addition, nursing visits were reduced by 73% and there was a 77% decrease in supply usage. CONCLUSIONS This project validated the Wound Bed Preparation Paradigm 2021 as a process for assessing patients with complex wounds using a blended virtual and home-based assessment. Patient navigation with this blended model benefited patients and improved healthcare system utilization with projected cost savings.
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11
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Naylor NR, Evans S, Pouwels KB, Troughton R, Lamagni T, Muller-Pebody B, Knight GM, Atun R, Robotham JV. Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England. Front Public Health 2022; 10:803943. [PMID: 36033764 PMCID: PMC9413182 DOI: 10.3389/fpubh.2022.803943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 07/04/2022] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the "primary effects" of AMR. Previous estimates of the burden of AMR have largely ignored the potential "secondary effects," such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.
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Affiliation(s)
- Nichola R. Naylor
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, Antimicrobial Resistance (AMR) Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom,Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom,*Correspondence: Nichola R. Naylor
| | - Stephanie Evans
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Koen B. Pouwels
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom,The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, Oxford, United Kingdom
| | - Rachael Troughton
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom
| | - Theresa Lamagni
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Berit Muller-Pebody
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
| | - Gwenan M. Knight
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, Antimicrobial Resistance (AMR) Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Julie V. Robotham
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, United Kingdom,Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis division, United Kingdom Health Security Agency, London, United Kingdom
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12
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Naylor NR, Evans S, Pouwels KB, Troughton R, Lamagni T, Muller-Pebody B, Knight GM, Atun R, Robotham JV. Quantifying the primary and secondary effects of antimicrobial resistance on surgery patients: Methods and data sources for empirical estimation in England. Front Public Health 2022. [DOI: 10.5210.3389/fpubh.2022.803943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) may negatively impact surgery patients through reducing the efficacy of treatment of surgical site infections, also known as the “primary effects” of AMR. Previous estimates of the burden of AMR have largely ignored the potential “secondary effects,” such as changes in surgical care pathways due to AMR, such as different infection prevention procedures or reduced access to surgical procedures altogether, with literature providing limited quantifications of this potential burden. Former conceptual models and approaches for quantifying such impacts are available, though they are often high-level and difficult to utilize in practice. We therefore expand on this earlier work to incorporate heterogeneity in antimicrobial usage, AMR, and causative organisms, providing a detailed decision-tree-Markov-hybrid conceptual model to estimate the burden of AMR on surgery patients. We collate available data sources in England and describe how routinely collected data could be used to parameterise such a model, providing a useful repository of data systems for future health economic evaluations. The wealth of national-level data available for England provides a case study in describing how current surveillance and administrative data capture systems could be used in the estimation of transition probability and cost parameters. However, it is recommended that such data are utilized in combination with expert opinion (for scope and scenario definitions) to robustly estimate both the primary and secondary effects of AMR over time. Though we focus on England, this discussion is useful in other settings with established and/or developing infectious diseases surveillance systems that feed into AMR National Action Plans.
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13
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Snapshot of resistance and virulence features in ESCAPE strains frequently isolated from surgical wound infections in a Romanian hospital. REV ROMANA MED LAB 2022. [DOI: 10.2478/rrlm-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background: The aim of this study was to investigate the phenotypic features (adherence, biofilm formation, virulence, antibiotic susceptibility) and the genetic background of antibiotic resistance in nosocomial ESCAPE strains consecutively isolated from surgical wound infections in hospitalized patients.
Methods: 86 bacterial strains consecutively isolated from various wound infections were analysed by their antibiotic resistance (antibiotic susceptibility testing and PCR for certain antibiotic resistance genes), virulence, biofilm formation and cellular adherence.
Results: The bacterial isolates were identified as: Enterobacterales (n = 39) including Escherichia coli (n = 9), Klebsiella pneumoniae (n = 14) Proteus mirabilis (n = 7), followed by Staphylococcus aureus (n = 26) and Enterococcus faecalis (n = 20). Compared to other isolates, S. aureus strains exhibited the highest capacity to produce soluble virulence factors and to develop biofilms in vitro, with significant differences between methicillin resistant and methicillin susceptible isolates. Among enterobacterial isolates, K. pneumoniae strains expressed the highest capacity to develop biofilms. The assessment of bacterial adherence to HeLa cells revealed that all bacterial strains adhered to the cellular substrata, showing various adherence patterns. E. faecalis strains exhibited a low soluble virulence factors profile, a lower capacity to adhere to epithelial cells and to develop biofilms.
Conclusions: The present study could contribute to the understanding of the pathology of infected wounds, depending on the etio-logical agents, providing data with positive impact on the therapeutic management of surgical wounds infections.
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Briggs KB, Fraser JA, Svetanoff WJ, Staszak JK, Snyder CL, Aguayo P, Juang D, Rentea RM, Hendrickson RJ, Fraser JD, St Peter SD, Oyetunji TA. Review of Perioperative Prophylactic Antibiotic Use during Laparoscopic Cholecystectomy and Subsequent Surgical Site Infection Development at a Single Children's Hospital. Eur J Pediatr Surg 2022; 32:85-90. [PMID: 34942672 DOI: 10.1055/s-0041-1740461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES With the rise of antibiotic resistance, the use of prophylactic preoperative antibiotics (PPA) has been questioned in cases with low rates of surgical site infection (SSI). We report PPA usage and SSI rates after elective laparoscopic cholecystectomy at our institution. MATERIALS AND METHODS A retrospective review of children younger than 18 years who underwent elective outpatient laparoscopic cholecystectomy between July 2010 and August 2020 was performed. Demographic, preoperative work-up, antibiotic use, intraoperative characteristics, and SSI data were collected via chart review. SSI was defined as clinical signs of infection that required antibiotics within 30 days of surgery. RESULTS A total of 502 patients met the inclusion criteria; 50% were preoperatively diagnosed with symptomatic cholelithiasis, 47% with biliary dyskinesia, 2% with hyperkinetic gallbladder, and 1% with gallbladder polyp(s). The majority were female (78%) and Caucasian (80%). In total, 60% (n = 301) of patients received PPA, while 40% (n = 201) did not; 1.3% (n = 4) of those who received PPA developed SSI, compared with 5.5% (n = 11) of those who did not receive PPA (p = 0.01). Though PPA use was associated with a 77% reduction in the risk of SSI in multivariate analysis (p = 0.01), all SSIs were superficial. One child required readmission for intravenous antibiotics, while the remainder were treated with outpatient antibiotics. Gender, age, body mass index, ethnicity, and preoperative diagnosis did not influence the likelihood of receiving PPA. CONCLUSION Given the relatively low morbidity of the superficial SSI, conservative use of PPA is advised to avoid contributing to antibiotic resistance.
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Affiliation(s)
- Kayla B Briggs
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - James A Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Wendy Jo Svetanoff
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jessica K Staszak
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Charles L Snyder
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Pablo Aguayo
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Richard J Hendrickson
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Tolulope A Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri, United States
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15
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Sartelli M. Healthcare-associated infections in the surgical setting: How to prevent and treat them. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_53_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ousey K, Hodgson H, Rippon MG, Rogers AA. Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence. J Wound Care 2021; 30:980-992. [PMID: 34881992 DOI: 10.12968/jowc.2021.30.12.980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.
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Affiliation(s)
- Karen Ousey
- Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK
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17
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Misha G, Chelkeba L, Melaku T. Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study. Ann Clin Microbiol Antimicrob 2021; 20:33. [PMID: 33971896 PMCID: PMC8112062 DOI: 10.1186/s12941-021-00440-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Globally, surgical site infections are the most reported healthcare-associated infection and common surgical complication. In developing countries such as Ethiopia, there is a paucity of published reports on the microbiologic profile and resistance patterns of an isolates. OBJECTIVE This study aimed at assessing the bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at Jimma Medical Center in Ethiopia. METHODS A prospective cohort study was employed among adult patients who underwent either elective or emergency surgical procedures. All the eligible patients were followed for 30 days for the occurrence of surgical site infection (SSI). From those who developed SSI, infected wound specimens were collected and studied bacteriologically. RESULTS Of 251 study participants, 126 (50.2%) of them were females. The mean ± SD age of the patients was 38 ± 16.30 years. The overall postoperative surgical site infection rate was 21.1% and of these 71.7% (38/53) were culture positive. On gram stain analysis, 78% of them were Gram-negative, 11.5% were Gram-positive and 10.5% were a mixture of two microbial growths. Escherichia coli accounted for (21.43%), followed by Pseudomonas aeruginosa (19.05%), Proteus species (spp.) 14.29%), Staphylococcus aureus (11.90%), Klebsiella species (11.90%), Citrobacter spp. (9.5%), streptococcal spp. (7.14%), Coagulase-negative S. aureus (CoNS) (2.38%) CONCLUSION: Gram-negative bacteria were the most dominant isolates from surgical sites in the study area. Among the Gram-negative bacilli, Escherichia coli were the most common bacteria causing surgical site infection. As there is high antibiotic resistance observed in the current study, it is necessary for routine microbial analysis of samples and their antibiogram.
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Affiliation(s)
- Gemedo Misha
- Department of Pharmacy, College of Health Sciences, Arsi University, Assela, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia.
- Jimma Medical Center, Institute of Health, Jimma University, Jimma, Ethiopia.
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18
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Yan P, Daliri EBM, Oh DH. New Clinical Applications of Electrolyzed Water: A Review. Microorganisms 2021; 9:136. [PMID: 33435548 PMCID: PMC7827692 DOI: 10.3390/microorganisms9010136] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/21/2022] Open
Abstract
As the situation of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is still deteriorating, there has been a huge increase in the demand and use of disinfectants. Electrolyzed water (EW), as a novel broad-spectrum disinfectant and cleaner, has been widely used for several years. EW can be produced in an electrolysis chamber which contains dilute salt and tap water. It is an effective antimicrobial and antibiofilm agent, with several advantages such as on-the-spot, cheap, environmentally friendly and safe for human beings. Therefore, EW holds potential significance for high-risk settings in hospitals and other clinical facilities. EW can also be applied for wound healing, advanced tissue care, and dental clinics. The present review article highlights the latest developments and new perspectives of EW, especially in clinical fields. Furthermore, the main action modes of antibiofilm and antimicrobial will be summarized.
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Affiliation(s)
| | | | - Deog-Hwan Oh
- Department of Food Science and Biotechnology, Kangwon National University, Chuncheon 24341, Korea; (P.Y.); (E.B.-M.D.)
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19
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Numao N, Fujiwara R, Uehara S, Yasuoka S, Fujiwara M, Komai Y, Yuasa T, Yamamoto S, Fukui I, Yonese J. Intraoperative Only versus Extended Duration Use of Antimicrobial Prophylaxis for Infectious Complications in Radical Cystectomy with Intestinal Urinary Diversion. Urol Int 2020; 104:954-959. [PMID: 32814326 DOI: 10.1159/000509881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In spite of the high incidence of infectious complications (ICs), appropriate duration of antimicrobial prophylaxis (AMP) for radical cystectomy (RC) with intestinal urinary diversion (IUD) has not been established. We compared the incidence of ICs after RC with IUD in patients using only intraoperative AMP or extended duration AMP. Risk factors for ICs were also investigated. PATIENTS AND METHODS One hundred twenty-three consecutive patients who underwent RC with IUD were divided into 2 groups based on the AMP duration (intraoperative only vs. extended duration for a median of 3 days). Between the groups, the incidence of ICs was compared. Risk factors for ICs were investigated in multivariate analysis. RESULTS The IC rate was 44%. No significant difference was found in the rate of ICs between the groups. The IC rate was significantly higher in patients with lower estimated glomerular filtration rate (eGFR). Rates of ICs were 60 and 38% in patients with eGFR of less than 60 and equal or more than 60 mL/min/1.73 m2, respectively. CONCLUSIONS Our result indicates that AMP that is administered more than intraoperatively may be excessive in RC with IUD. Patients with a lower eGFR should be particularly cared for postoperative ICs.
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Affiliation(s)
- Noboru Numao
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan,
| | - Ryo Fujiwara
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shotaro Yasuoka
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinobu Komai
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Iwao Fukui
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Sartelli M, C. Hardcastle T, Catena F, Chichom-Mefire A, Coccolini F, Dhingra S, Haque M, Hodonou A, Iskandar K, Labricciosa FM, Marmorale C, Sall I, Pagani L. Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery. Antibiotics (Basel) 2020; 9:E497. [PMID: 32784880 PMCID: PMC7459633 DOI: 10.3390/antibiotics9080497] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons' compliance with best practices even more important.
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Affiliation(s)
| | - Timothy C. Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R. Mandela School of Clinical Medicine, Durban 4058, South Africa;
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, 43126 Parma, Italy;
| | - Alain Chichom-Mefire
- Department of Surgery and Obs/Gyn, Faculty of Health Sciences University of Buea, Buea P.O. Box 63, South West Province, Cameroon;
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Cisanello University Hospital, 56100 Pisa, Italy;
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs 33178, Trinidad and Tobago;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia;
| | - Adrien Hodonou
- Department of General Surgery, Regional Hospital Borgou, Faculty of Medicine, University of Parakou, Parakou P.O. Box 123, Benin;
| | - Katia Iskandar
- Department of Pharmacy, Lebanese, International University, Beirut 1106, Lebanon;
| | | | - Cristina Marmorale
- Department of Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar 3006, Senegal;
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, 39100 Bolzano, Italy;
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Iskandar K, Molinier L, Hallit S, Sartelli M, Catena F, Coccolini F, Craig Hardcastle T, Roques C, Salameh P. Drivers of Antibiotic Resistance Transmissionin Low- and Middle-Income Countriesfrom a "One Health" Perspective-A Review. Antibiotics (Basel) 2020; 9:E372. [PMID: 32630353 PMCID: PMC7400606 DOI: 10.3390/antibiotics9070372] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Antibiotic resistance is an ecosystem problem threatening the interrelated human-animalenvironmenthealth under the "One Health" framework. Resistant bacteria arising in onegeographical area can spread via cross-reservoir transmission to other areas worldwide either bydirect exposure or through the food chain and the environment. Drivers of antibiotic resistance arecomplex and multi-sectoral particularly in Lower- and Middle-income countries. These includeinappropriate socio-ecological behaviors; poverty; overcrowding; lack of surveillance systems; foodsupply chain safety issues; highly contaminated waste effluents; and loose rules and regulations. Inorder to examine the drivers of antibiotic resistance from a "one health" perspective, a literaturereview was conducted on three databases including PubMed, Medline and Google Scholar. A totalof 485 studies of potential relevance were selected, out of which 182 were included in this review.Results have shown that the aforementioned market failures are the leading cause for the negativeexternality of antibiotic resistance that extends in scope from the individual to the global ecosystem.Incremental and sustainable global actions can make the change, however, the problem willcontinue to prevail if governments do not prioritize the "One health" approach and if individual'saccountability is still denied in a world struggling with profound socio-economic problems.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1027, F-31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1027, Université Paul Sabatier Toulouse III, F-31000 Toulouse, France;
| | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Massimo Sartelli
- Department of surgery, University of Macerata, 62100 Macerata, Italy;
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, 43126 Parma, Italy;
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Cisanello University Hospital, 56100 Pisa, Italy;
| | - Timothy Craig Hardcastle
- Department of Trauma service, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa;
- Department of Surgery, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congela, Durban 4041, South Africa
| | - Christine Roques
- Departement of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR 5503, 31330 Toulouse, France;
- Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, 31330 Toulouse, France
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
- Faculty of Public Health, Lebanese University, Beirut 1103, Lebanon
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22
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Forrester JD, Berndtson AE, Santorelli J, Raschke E, Weiser TG, Coombs AV, Sawyer RG, Chou J, Knight HP, Valenzuela JY, Rickard J. Survey of National Surgical Site Infection Surveillance Programs in Low- and Middle-Income Countries. Surg Infect (Larchmt) 2020; 21:621-625. [PMID: 32397833 DOI: 10.1089/sur.2020.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgical site infection (SSI) surveillance programs are strongly recommended as a core component of effective national infection prevention and control (IPC) programs. Participation in national SSI surveillance (nSSIS) programs has been shown to decrease reported SSIs among high-income countries (HICs), and it is expected that the same is possible among low- and middle-income countries (LMICs). We sought to determine what, if any nSSIS programs exist among LMICs. Methods: A cross-sectional survey was performed to evaluate existence of nSSIS of World Bank-defined LMICs. A digital survey assessment for presence of national IPC and nSSIS programs was delivered to persons capable of identifying the presence of such a program. Statistical analysis was performed using STATA. Institutional Review Board approval was obtained for this study. Results: Of the 137 countries identified, 55 (40%) were upper middle income (UMI), 47 (34%) were lower middle income (LMI), and 34 (25%) were low income. Representatives from 39 (28%) LMICs completed the survey. Of these respondent countries, 13 (33%) reported the presence of a national IPC program. There was no difference between countries with IPC programs and those without with respect to country income designation, population size, World Health Organization region, or conflict status. Only five (13% of all respondents) reported presence of a nSSIS program. Conclusions: National surgical site infection surveillance programs are an integral component of a country's ability to provide safe surgical procedures. Presence of nSSIS was reported infrequently in LMICs. International governing bodies should be encouraged to guide LMIC leadership in establishing a nSSIS infrastructure that will help enable safe surgical procedures.
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Affiliation(s)
- Joseph D Forrester
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, La Jolla, California, USA
| | - Jarrett Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, La Jolla, California, USA
| | - Eric Raschke
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, La Jolla, California, USA
| | - Thomas G Weiser
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Andre V Coombs
- Section of Acute Care Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Robert G Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Jesse Chou
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Hunter P Knight
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Julie Y Valenzuela
- Division of Trauma Critical Care, Southside Hospital/Northwell Health, Glen Cove, New York, USA
| | - Jennifer Rickard
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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23
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Seyi-Olajide JO, Ameh EA. Global Health and Surgical Infection: From Neglect to Emerging Frontier. Surg Infect (Larchmt) 2020; 21:516-522. [PMID: 32315570 DOI: 10.1089/sur.2020.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: In past decades, surgical site infections (SSIs) were neglected and not given much global attention in low- and middle-income countries (LMICs). The risk and incidence of SSIs in LMICs continue to increase. Methods: We reviewed the limited quality data on SSIs and complicated intra-abdominal infections in these settings that have hampered advocacy and infection prevention and control efforts. Results: This review identifies the rising profile of global surgery that has resulted in efforts to scale up access to surgical care as well as increase surgical volumes to address unmet needs. The fallout of these efforts would be increasing SSI rates and a rising volume of laparotomies for intra-abdominal infections. Conclusion: Surgical infections are an emerging frontier in global health and surgery. There is an urgent need for global advocacy and investments in their prevention and control.
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Affiliation(s)
- Justina O Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
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