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Scheurer F, Kaiser D, Kobe A, Smolle M, Suter D, Spirig JM, Müller D. The effect of preoperative embolization on giant cell tumors of the bone localized in the iliosacral region of the pelvis. Surg Oncol 2024; 55:102101. [PMID: 39018867 DOI: 10.1016/j.suronc.2024.102101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/05/2024] [Accepted: 05/27/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Giant cell tumors of the bone (GCTB) are aggressive neoplasms, with rare occurrences in the posterior pelvis and sacral area. Surgical challenges in this region include the inability to apply a tourniquet and limited cementation post-curettage due to proximity to neurovascular structures, leading to potential complications. This case-control study explores the impact of preoperative embolization on GCTB located in the iliosacral region. METHODS Five surgeries (January-December 2021) for pelvic GCTB (3 sacrum, 2 posterior ilium) were performed on four patients. Diagnosis was confirmed through preoperative CT-guided biopsies. One surgery involved curettage with PMMA cement filling, while four surgeries had curettage without cavity filling. Preoperative embolization of the tumor feeding vessel occurred approximately 16 h before surgery in two cases. Denosumab treatment was not administered. RESULTS Tumor volume, assessed by preoperative MRI, was comparable between patients with and without preoperative embolization (p = .14). Surgeries without embolization had a mean intraoperative blood loss of 3250 ml, erythrocyte transfusion volume of 1125 ml, and a mean surgical time of 114.5 min for two surgeries. Surgeries with preoperative embolization showed a mean intraoperative blood loss of 1850 ml, no erythrocyte transfusion requirement, and a mean surgical time of 68 min. CONCLUSION Curettage of GCTB in the posterior pelvis and sacrum presents challenges, with significant intraoperative blood loss impacting surgical time and transfusion needs. Preoperative embolization may be beneficial in reducing blood loss during surgery in these cases.
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Affiliation(s)
- Fabrice Scheurer
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland.
| | - Dominik Kaiser
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - Adrian Kobe
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland
| | - Maria Smolle
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - Daniel Suter
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
| | - José Miguel Spirig
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Switzerland
| | - Daniel Müller
- University Sarcoma Center Zürich (CCCZ), Balgrist University Hospital, University of Zurich, Switzerland
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Hu Z, Tian Z, Wei X, Chen Y. Letter to the editor: Dynamic insights into infection risk over time in two-stage implant-based breast reconstruction: a retrospective cohort study. Int J Surg 2024; 110:4520-4521. [PMID: 38767582 PMCID: PMC11254195 DOI: 10.1097/js9.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Zhe Hu
- Jining Medical University
| | | | - Xi Wei
- Jining Medical University
| | - Yueqin Chen
- Affiliated Hospital of Jining Medical University, Jining, People’s Republic of China
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Doğan CZ, Yalçın N, Cennet Ö, Metan G, Demirkan K, Yorgancı K. Optimization of appropriate antimicrobial prophylaxis in general surgery: a prospective cohort study. Eur J Med Res 2024; 29:340. [PMID: 38890673 PMCID: PMC11186073 DOI: 10.1186/s40001-024-01938-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Surgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to surgical antimicrobial prophylaxis (SAP) is paramount in mitigating the occurrence of SSIs. In this study, we aimed to evaluate the appropriateness of SAP use in patients undergoing surgical procedures in the field of general surgery according to the American Society of Health-System Pharmacists (ASHP) guideline and to determine the difference between the pre-training period (pre-TP) and the post-training period (post-TP) organized according to this guideline. METHODS It is a single-center prospective study conducted in general surgery wards between January 2022 and May 2023, with 404 patients pre-TP and 406 patients post-TP. RESULTS Cefazolin emerged as the predominant agent for SAP, favored in 86.8% (703/810) of cases. Appropriate cefazolin dosage increased significantly from 41% (129 patients) in pre-TP to 92.6% (276 patients) in post-TP (p < 0.001), along with a rise in adherence to recommended timing of administration from 42.2% (133 patients) to 62.8% (187 patients) (p < 0.001). The proportion of patients receiving antibiotics during hospitalization in the ward postoperatively decreased post-TP (21-14.3%; p = 0.012), as did antibiotic prescription at discharge (16.8-10.3%; p = 0.008). The incidence of SSI showed a slight increase from 9.9% in pre-TP to 13.3% in post-TP (p = 0.131). CONCLUSIONS Routine training sessions for surgeons emerged as crucial strategies to optimize patient care and enhance SAP compliance rates, particularly given the burden of clinical responsibilities faced by surgical teams.
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Affiliation(s)
- Cansu Zeynep Doğan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey
| | - Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey.
| | - Ömer Cennet
- Department of General Surgery, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06230, Ankara, Turkey
| | - Kaya Yorgancı
- Department of General Surgery, Faculty of Medicine, Hacettepe University, 06230, Ankara, Turkey
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Shen X, Gao Y, Zhang P, Zhu L, Jiang Z, Shi H, Xuan W, Qian Y, Gao Z. Subcutaneous Lumbar Spine Index (SLSI) as a Risk Factor for Surgical Site Infection After Lumbar Fusion Surgery: A Retrospective Matched Case-Control Study. Global Spine J 2024; 14:1498-1503. [PMID: 36529679 DOI: 10.1177/21925682221146503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN A retrospective matched case-control study. OBJECTIVE This study aims to investigate the value of Subcutaneous Lumbar Spine Index (SLSI) as a predictor of early surgical site infection (SSI) after lumbar intervertebral fusion surgery. METHODS A retrospective case-control study was performed on patients who underwent transforaminal lumbar interbody fusion (TLIF) from January 1, 2014 to December 31, 2019 in a single institution. Cases were defined as those who developed early SSI according to the US Center for Disease Control and Prevention criteria, and controls were matched from those patients without early SSI using the following matched criteria: gender, age, time of surgery and diabetes. Subcutaneous fat thickness (SFT) and SLSI were measured on preoperative MRI mid-sagittal T2 weighted images. RESULTS A total of 3615 patients who underwent TLIF were enrolled in this study. Thirty-three patients were included in early SSI, and sixty-six patients were selected as matched controls. Univariate analysis indicated that fusion levels (P = .007), operation time (P = .022), obesity (P = .013), SFT (P = .002) and SLSI (P = .001) were significantly associated with early SSI. Multiple logistic regression analysis revealed that multilevel fusion levels (P = .021), obesity (P = .035), a large SFT (P = .026) and a high SLSI (P = .012) were independent risk factors. Body mass index (BMI) and SLSI were moderately correlated (r2 = .55). ROC curve demonstrated that SLSI was more sensitive than SFT to predict the early SSI. CONCLUSION SLSI is a novel radiological risk factor for early SSI development and is a better indicator than SFT to predict early SSI risk after lumbar intervertebral fusion.
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Affiliation(s)
- Xu Shen
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yucheng Gao
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pei Zhang
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lei Zhu
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zanli Jiang
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hang Shi
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Wenbin Xuan
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yulei Qian
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zengxin Gao
- School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Department of Orthopedics, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Brach, Nanjing, China
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Boutefnouchet C, Aouras H, Khennouchi NCEH, Berredjem H, Rolain JM, Hadjadj L. Algerian postcaesarean surgical site infections: A cross-sectional investigation of the epidemiology, bacteriology, and antibiotic resistance profile. Am J Infect Control 2024; 52:456-462. [PMID: 37805027 DOI: 10.1016/j.ajic.2023.09.022] [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: 07/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are one of the most common health care-associated infections in low and middle-income countries. The aims of this cross-sectional descriptive study were to estimate the frequency of postcaesarean infection with associated clinical characteristics and the antibiotic resistance profile of bacterial isolates. METHODS Patients who underwent a cesarean section at the obstetrics and gynecology department of the hospital in Annaba, Algeria were included. Each woman was followed postoperatively for 30 days and sociodemographic data were collected. Culture-based microbiological methods were used to identify the causative bacteria and determine their antibiotic resistance phenotype and molecular characterization. RESULTS Among 1,810 patients, we recorded 36 (1.9%) SSIs. Most patients had undergone an emergency delivery (75%) and low educational level (72.2%). The most frequent maternal pathologies were Body Mass Index ≥ 30 (63.9%), scarred uteri (58.3%), anemia (55.6%), and an American Society of Anaesthesiologists score between II and III (33.3%). Of the 43 bacteria isolated, Enterobacteriaceae were the most frequent (62.8%), predominated by Escherichia coli strains (43.5%), a majority of which were extended-spectrum β-lactamases carriers (62.9%). Although gram-positive cocci were less frequent (37.2%), a majority of Enterococcus faecalis (56.2%) were observed and 2 strains of vancomycin-resistant Enterococcus faecium harboring the vanA gene were identified. CONCLUSIONS Extensive surveillance of at-risk populations should be integrated to prevent the occurrence of SSIs.
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Affiliation(s)
- Chahinez Boutefnouchet
- Laboratoire de Biochimie et Microbiologie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar-Annaba, Algeria; Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France
| | - Hayet Aouras
- Etablissement Hospitalier de Santé Abdallah Nouaouria "'El Bouni"' Annaba, Algeria
| | - Nour Chems El Houda Khennouchi
- Laboratoire de Biotechnologie des substances naturelles et applications, Université L'arbi Ben M'hidi, Oum El Bouaghi, Algeria
| | - Hajira Berredjem
- Laboratoire de Biochimie et Microbiologie Appliquée, Département de Biochimie, Faculté des Sciences, Université Badji Mokhtar-Annaba, Algeria
| | - Jean-Marc Rolain
- Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France
| | - Linda Hadjadj
- Aix Marseille University, IRD, APHM, MEPHI, Faculté de Médecine et de Pharmacie, Marseille Cedex 05, France; IHU Méditerranée Infection, France.
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Niebuhr D, Mattson T, Jensen NM, Viberg B, Steenstrup Jensen S. Risk factors for tibial infections following osteosynthesis - a systematic review and meta-analysis. J Clin Orthop Trauma 2024; 50:102376. [PMID: 38444773 PMCID: PMC10909754 DOI: 10.1016/j.jcot.2024.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Aim This study aimed to quantitatively summarise risk factors associated with surgical site infection (SSI) following surgically managed tibial fractures. Method We searched the Embase/Medline, Cochrane Library, and Scopus databases for relevant studies in October 2023. We included original studies investigating risk factors for SSI following surgically managed traumatic tibial fractures that included ≥10 adult patients with SSIs. Meta-analysis was performed when >5 studies investigated the same risk factor. The risk of bias was assessed using the critical appraisal checklist from Joanna Briggs Institute for cohort studies. Results This study included 42 studies comprising 24,610 patients with surgically managed tibial fractures and 2,418 SSI cases. The following were identified as significant risk factors for SSI (p < 0.05): compartment syndrome (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 2.4-6.0), blood transfusion (OR = 3.8, 95% CI: 2.1-6.6), open fracture (OR = 3.6, 95% CI: 2.5-5.1), Gustilo-Anderson classification >2 (OR = 3.1, 95% CI: 2.1-4.6), external fixation (OR = 2.9, 95% CI: 2.3-3.8), American Society of Anesthesiologists classification >2 (OR = 2.5, 95% CI: 1.5-4.1), polytrauma (OR = 2.4, 95% CI: 1.5-4.0), dual incision approach (OR = 2.1, 95% CI: 1.5-3.0), smoking (OR = 1.8, 95% CI: 1.5-2.1), male sex (OR = 1.6, 95% CI: 1.3-1.8), high energy trauma (OR = 1.5, 95% CI: 1.1-2.1), and prolonged surgery time (OR = 0.62, 0.43-0.82). Other factors, including diabetes, hypertension, and time to surgery, were not identified as risk factors for SSI. However, the included studies were generally of poor quality and at risk of bias. Conclusions The review provides a basis for preoperatively assessing a patient's risk of developing an SSI, which could be used to initiate adjusted antibiotic regimes and more frequent postoperative controls. Furthermore, it indicates the risk factors future research should include when adjusting for confounding factors.
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Affiliation(s)
- Diana Niebuhr
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
| | - Thomas Mattson
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Martin Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Vejle, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Signe Steenstrup Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Ali SM, Misra L, Sahoo MR, V S V, Mahapatra A, Rout B, Mishra SS. Bundle approach in emergency surgery for prevention of surgical site infections: a double-blinded randomized controlled trial. Langenbecks Arch Surg 2024; 409:62. [PMID: 38358547 DOI: 10.1007/s00423-024-03243-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Many studies have demonstrated significant antibiotic resistance by commonly isolated organisms. This is an eye-opener for the clinicians, who prescribe antibiotics day in and out. This situation shifts our attention towards the usage of antiseptic measures, which can at times play an important role in preventing and treating various infections. METHOD This is a double-blinded randomized controlled study that compares the bundle approach to the conventional approach for the prevention of surgical site infections in patients of peritonitis undergoing midline laparotomy in emergency. The bundle approach includes three measures, namely, painting of surgical site with chlorhexidine, dabbing the wound with povidone-iodine after the closure of the rectus sheath, and application of chlorhexidine-impregnated gauze piece over the skin wound. RESULTS The total sample size was 64 (32 in each arm). The rate of surgical site infection was significantly lower in the test arm (21.8%) as compared to the conventional arm (46.8%). The mean length of hospital stay was shorter by one day in the test arm, although, not significant. The isolates from the peritoneal fluid culture and wound culture were mostly gram-negative organisms. Most of the organisms exhibited resistance toward third generation cephalosporins, fluoroquinolones, and aminoglycosides. CONCLUSION Antibiotic resistance is a burning concern in today's world. Alternative methods of preventing infection in the form of using antiseptics should be sought. Although our study was limited to emergency cases, this bundle approach can be implemented in elective cases as well.
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Affiliation(s)
- SManwar Ali
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Leesa Misra
- Department of Obstetrics and Gynaecology, Government Medical College, Jajpur, Odisha, India
| | - Manash Ranjan Sahoo
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India.
| | | | - Ashoka Mahapatra
- Department of Microbiology, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Bikram Rout
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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Liu L, Jian Z, Wang M, Yuan C, Li Y, Ma Y, Jin X, Li H, He Y, Liu C, Li S, Wang K. Is antibiotic prophylaxis generally safe and effective in surgical and nonsurgical scenarios? Evidence from an umbrella review of randomized controlled trials. Int J Surg 2024; 110:1224-1233. [PMID: 38016138 PMCID: PMC10871558 DOI: 10.1097/js9.0000000000000923] [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: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The authors aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and nonsurgical scenarios and assess the strength of evidence. MATERIALS AND METHODS The authors performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence. RESULTS Seventy-five meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For nonsurgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in nonemergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation. CONCLUSIONS Antibiotic prophylaxis in surgical and nonsurgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.
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Affiliation(s)
- Linhu Liu
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
- West China Biomedical Big Data Centre, Sichuan University, Chengdu, People’s Republic of China
| | - Menghua Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Chi Yuan
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Ya Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
| | - Yazhou He
- West China School of Public Health and West China Fourth Hospital
| | - Changhai Liu
- Division of Infectious Diseases, State Key Laboratory of Biotherapy and Centre of Infectious Disease, West China Hospital
| | - Sheyu Li
- Chinese Evidence-based Medicine Centre, Cochrane China Centre and MAGIC China Centre
- Department of Endocrinology and Metabolism
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), and National Clinical Research Center for Geriatrics
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Fiore M, Corrente A, Di Franco S, Alfieri A, Pace MC, Martora F, Petrou S, Mauriello C, Leone S. Antimicrobial approach of abdominal post-surgical infections. World J Gastrointest Surg 2023; 15:2674-2692. [PMID: 38222012 PMCID: PMC10784838 DOI: 10.4240/wjgs.v15.i12.2674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/24/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023] Open
Abstract
Abdominal surgical site infections (SSIs) are infections that occur after abdominal surgery. They can be superficial, involving the skin tissue only, or more profound, involving deeper skin tissues including organs and implanted materials. Currently, SSIs are large global health problem with an incidence that varies significantly depending on the United Nations' Human Development Index. The purpose of this review is to provide a practical update on the latest available literature on SSIs, focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.
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Affiliation(s)
- Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Antonio Corrente
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Sveva Di Franco
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Aniello Alfieri
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Francesca Martora
- Unit of Virology and Microbiology, “Umberto I” Hospital, Nocera Inferiore 84018, Italy
| | - Stephen Petrou
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Claudio Mauriello
- Department of General Surgery, “Santa Maria delle Grazie” Hospital, Pozzuoli 80078, Italy
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
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Harikumar V, Anvery N, Haq M, Christensen RE, Ahmed A, Koza E, Ma M, Shi V, Dirr MA, Worley B, Brieva JC, Yoo SS, Alam M. Risk factors for hospital-based surgical site infections. Arch Dermatol Res 2023; 316:43. [PMID: 38091095 DOI: 10.1007/s00403-023-02773-5] [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: 09/06/2023] [Revised: 09/06/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Surgical site infections (SSIs) contribute to morbidity and are costly to the healthcare system. To identify factors associated with SSIs. Case-control study analyzing the Nationwide Readmission Database (NRD). We identified 45,445 SSIs. Infection rates were higher in those who were obese (BMI ≥ 30) (OR: 1.39, 95% CI 1.28-1.51), tobacco users (OR: 1.08, 95% CI 1.02-1.15), diagnosed with diabetes (OR: 1.16, 95% CI 1.10-1.22), with Elixhauser Comorbidity Index ≥ 2 (OR: 1.14, 95% CI 1.09-1.20), admitted to hospital for 4-6 days (OR: 1.35, 95% CI 1.29-1.42), in medium-size hospital (OR: 1.15, 95% CI 1.05-1.26), or large-size hospital (OR: 1.43, 95% CI 1.31-1.56). In contrast, patients who were 60-79 years old (OR: 0.78, 95% CI 0.73-0.84), 80 years or older (OR: 0.66, 95% CI 0.59-0.73), female (OR: 0.95, 95% CI 0.91-0.99), underweight (BMI < 18.5) (OR: 0.14, 95% CI 0.03-0.59), in a non-metropolitan hospital (OR: 0.83, 95% CI 0.75-0.91), self-pay (OR: 0.82, 95% CI 0.74-0.91), or covered by Medicare (OR: 0.86, 95% CI 0.80-0.91) had lower odds. Initial data entry to NRD is susceptible to human error. Patients who are obese, use tobacco, have multiple comorbidities, and have long hospital stays in medium-to-large-size hospitals are at risk of SSIs. Conversely, odds of SSIs are lower in females, age ≥ 60, BMI < 18.5, self-pay or Medicare (versus private insurance), or at smaller hospitals. Understanding factors associated with SSIs may help surgeons anticipate complications.
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Affiliation(s)
- Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Misha Haq
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Areeba Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Eric Koza
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Melissa Ma
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Victoria Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
- Florida Dermatology and Skin Cancer Centers, Lake Wales, FL, USA
| | - Joaquin C Brieva
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Simon S Yoo
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St Clair St, Ste 1600, Chicago, IL, 60611, USA.
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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11
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Yang L, Yi F, Xiong Z, Yang H, Zeng Y. Effect of preoperative hospital stay on surgical site infection in Chinese cranial neurosurgery. BMC Neurol 2023; 23:407. [PMID: 37978454 PMCID: PMC10655340 DOI: 10.1186/s12883-023-03431-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/07/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Surgical site infection(SSI)after neurosurgical procedure can be devastating. Delayed hospital stay has been identified as a potentially modifiable driver of SSI in general surgery patients. However, the relationship between preoperative length of stay and SSI has not been quantified previously in neurosurgery. This study aimed to clarify the association. DESIGN A Cohort study based on STROBE checklist. METHOD This observational study focused on cranial neurosurgery patients at a tertiary referral centers in China. Data collection from hospital information system conducted between 1 January 2016 and 31 December 2016 was used to examine the results of interest (n = 600). Logistic regression analysis explored association between preoperative length of stay and SSI, adjusting for potential confounders. RESULTS Overall SSI prevalence was 10.8% and was significantly higher in the longer preoperative length of stay group. Besides preoperative length of stay, American Society of Anesthesiologists score, type of surgery, gross blood loss also significantly associated with SSI prevalence. Compared with 1 to 2 days, longer preoperative length of stay was associated with increased SSI prevalence after adjustment for confounders (3 to 4 days: odds ratio[OR], 0.975[95%CI, 0.417 to 2.281]; 5 to 6 days: OR, 2.830[95%CI, 1.092 to 7.332]; 7 or more days: OR, 4.039[95%CI, 1.164 to 14.015]; P for trend < 0.001). On the other hand, we found a positive association between preoperative length of stay to deep/space-organ SSI (OR = 1.404; 95% CI: 1.148 to 1.717; P for trend < 0.001), which was higher than superficial SSI (OR = 1.242; 95% CI: 0.835 to1.848; P for trend= 0.062). CONCLUSIONS In a cohort of patients from a single center retrospective surgical registry, a longer preoperative length of stay was associated with a higher incidence of cranial neurosurgical SSI. There is room for improvement in preoperative length of stay. This can be used for hospital management and to stratify patients with regard to SSI risk.
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Affiliation(s)
- Lina Yang
- Department of operating room nursing, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Fengqiong Yi
- Department of Anesthesia and Surgery Center, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhongyu Xiong
- Department of Anesthesia and Surgery Center, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Huawen Yang
- Department of Anesthesia and Surgery Center, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yanchao Zeng
- Department of Anesthesia and Surgery Center, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Yuzhong District, Chongqing, 400016, China.
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12
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Sekkat H, Agouzoul H, Loudyi Z, Naddouri J, El Hamzaoui J, El Fakir S, Omari M, Bakali Y, Alaoui MM, Raiss M, Hrora A, Sabbah F. Digestive cancer surgery in low-mid income countries: analysis of postoperative mortality and complications in a single-center study. Langenbecks Arch Surg 2023; 408:414. [PMID: 37864631 DOI: 10.1007/s00423-023-03156-0] [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: 12/01/2022] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE This study aimed to analyze postoperative and 90-day morbidity and mortality and their risk factors in all digestive cancer curative intent resections of a single digestive surgical department in a low-mid income country. METHODS All consecutive patients who underwent a surgical resection for digestive cancer with a curative intent between January 1, 2021, and December 31, 2021, were included. This is a retrospective analysis of a prospective cancer surgery database managed during the period. Patterns and factors associated with increased morbidity and mortality were analyzed and presented in tabular and descriptive forms. RESULTS Seventy-six patients were included, 38 (50%) were men with a mean age of 59 years (±13.5). Forty patients (52.63%) had tumors locally advanced, staged CT3-CT4 on preoperative imagery. Thirty-three of our population (43.42%) had laparoscopic surgery (conversion rate at 12.12%). In immediate preoperative, the morbidity rate was 36.84%; among each, 7 patients (9.21%) had serious complications (>2 Clavien-Dindo grade), and mortality rate was 5.26%. At 90 days after surgery, morbidity remained the same, and mortality increased to 7.9%. Risk factors for increased morbidity and mortality were female gender, obesity, high levels of carcinoembryonic antigen, hypoalbuminemia, laparotomy approach, hand sewn anastomosis, prolonged operating time, and wide drainage (p < 0.05). CONCLUSIONS This study provides figures on mortality and morbidity related to digestive cancer curative surgery in a low-mid income country digestive department and discusses risk factors increasing postoperative complications and death.
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Affiliation(s)
- Hamza Sekkat
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
| | - Hassan Agouzoul
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Zineb Loudyi
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jaouad Naddouri
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jihane El Hamzaoui
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Samira El Fakir
- Statistics Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mohammed Omari
- Statistics Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Youness Bakali
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mouna Mhamdi Alaoui
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Farid Sabbah
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Ashoobi MT, Asgary MR, Sarafi M, Fathalipour N, Pirooz A, Jafaryparvar Z, Rafiei E, Farzin M, Samidoust P, Delshad MSE. Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study. Int Wound J 2023; 20:2640-2648. [PMID: 36896793 PMCID: PMC10410328 DOI: 10.1111/iwj.14137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro-Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre- and postoperative antibiotic use. Gram-positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection-associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.
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Affiliation(s)
- Mohammad Taghi Ashoobi
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Mohammad Reza Asgary
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Milad Sarafi
- Department of Vascular SurgeryRasool‐e‐Akram Hospital, Iran University of Medical SciencesTehranIran
| | - Narjes Fathalipour
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Amir Pirooz
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Zakiyeh Jafaryparvar
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Elahe Rafiei
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Mohaya Farzin
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Pirouz Samidoust
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
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Al-Said HM, Alghamdi A, Ashgar SS, Jalal NA, Faidah HS, Johargy AK, Momenah AM, Barhameen AA, Hariri SH, Bantun F, Althobiany E, Khidir EB. Isolation and Detection of Drug-Resistant Bacterial Pathogens in Postoperative Wound Infections at a Tertiary Care Hospital in Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:229-234. [PMID: 37533663 PMCID: PMC10393095 DOI: 10.4103/sjmms.sjmms_405_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/02/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
Background Surgical site infections (SSIs), especially when caused by multidrug-resistant (MDR) bacteria, are a major healthcare concern worldwide. For optimal treatment and prevention of antimicrobial resistance, it is important for clinicians to be aware of local drug-resistant bacterial pathogens that cause SSIs. Objective To determine the frequency patterns of drug-resistant bacterial strains causing SSIs at a tertiary care hospital in Saudi Arabia. Methods This retrospective study was conducted at the Microbiology laboratory of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, and included wound swab samples from all cases of SSI between January 01, 2017, and December 31, 2021. The swabs were processed for the identification of bacterial strains and their resistance pattern to antibiotics according to the Clinical and Laboratory Standards Institute. Results A total of 5409 wound swabs were analyzed, of which 3604 samples (66.6%) were from male. Most samples were from the Department of Surgery (43.3%). A total of 14 bacterial strains were isolated, of which 9 were Gram-negative bacteria. The most common isolates were Klebsiella pneumoniae, followed by Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and vancomycin-resistant S. aureus (VRSA). In terms of MDR in 2021, the highest rate of carbapenem-resistance was in A. baumannii (97%). MDR was as follows: A. baumannii, 97%; K. pneumoniae, 81%; E. coli, 71%; MRSA, 60%; P. aeruginosa, 33%; VRE, 22%; and VRSA, 2%. Conclusion This study showed that in the city of Makkah, Saudi Arabia, the rates of MDR bacteria are high, with the majority being Gram-negative.
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Affiliation(s)
- Hamdi M. Al-Said
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ahmed Alghamdi
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sami S. Ashgar
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Naif A. Jalal
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hani S. Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ayman K. Johargy
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Aiman M. Momenah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abeer A. Barhameen
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sumyya H. Hariri
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Farkad Bantun
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Essa Althobiany
- Department of Medical Microbiology, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Elshiekh B. Khidir
- Department of Laboratory Medicine, Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
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15
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Hajmohammadi K, Mohammadpour Y, Parizad N. Fighting postsurgical infection after myelomeningocele repair with medical honey (Medihoney): a case report. Childs Nerv Syst 2023; 39:1969-1976. [PMID: 36959360 DOI: 10.1007/s00381-023-05929-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
Surgical site infection (SSI) prolongs the treatment period, delays wound healing, increases antibiotic consumption, and leads to patient death in complicated cases. This case was a 10-day female infant born at 37-week- and 6-day of gestational age with a birth weight of 3700 g and Apgar 5/8 by emergency cesarean section due to spina bifida cystica with myelomeningocele (MMC). She was admitted to the neonatal intensive care unit (NICU) because of respiratory distress and hypotonic lower extremities on June 2, 2022. A cardiovascular and neurosurgery consult was okay for reconstructive surgery, and she had MMC repair surgery by a plastic surgeon on June 5, 2022. The surgical site was infected, and SSI had no improvement, despite regularly receiving wet and Vaseline gauze dressing and intravenous antibiotic therapy. We started the treatment using Medihoney™, honey antibacterial wound dressing, on SSI once a day for 2 weeks, then once every other day for the next 6 weeks. Her SSI was cured entirely after 2 months, and she was discharged from our wound treatment team in satisfactory general condition. Clinicians and wound care management teams could use honey antibacterial wound gel to treat SSI, particularly in newborns with weakened immune systems after spinal birth defects repair.
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Affiliation(s)
| | - Yousef Mohammadpour
- Department of Medical Education, School of Medicine, Urmia University of Medical Sciences, Urmia, IR, Iran
| | - Naser Parizad
- Patient Safety Research Center, Clinical Research Institute, Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Urmia University of Medical Sciences, Campus Nazlu, 11 KM Road Seru, Urmia, 575611-5111, West Azerbaijan, IR, Iran.
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16
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Hollander JJ, Dahmen J, Emanuel KS, Stufkens SA, Kennedy JG, Kerkhoffs GM. The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions. Cartilage 2023; 14:180-197. [PMID: 37144397 PMCID: PMC10416205 DOI: 10.1177/19476035231154746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE The primary aim was to determine and compare the complication rate of different surgical treatment options for osteochondral lesions of the talus (OLTs). The secondary aim was to analyze and compare the severity and types of complications. DESIGN A literature search was performed in MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome was the complication rate per surgical treatment option. Secondary outcomes included the severity (using the Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery) and types of complications. The primary outcome, the severity, and the sub-analyses were analyzed using a random effects model. A moderator test for subgroup-analysis was used to determine differences. The types of complications were presented as rates. RESULTS In all, 178 articles from the literature search were included for analysis, comprising 6,962 OLTs with a pooled mean age of 35.5 years and follow-up of 46.3 months. Methodological quality was fair. The overall complication rate was 5% (4%-6%; treatment group effect, P = 0.0015). Analysis resulted in rates from 3% (2%-4%) for matrix-assisted bone marrow stimulation to 15% (5%-35%) for metal implants. Nerve injury was the most observed complication. CONCLUSIONS In 1 out of 20 patients treated surgically for an OLT, a complication occurs. Metal implants have a significantly higher complication rate compared with other treatment modalities. No life-threatening complications were reported.
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Affiliation(s)
- Julian J. Hollander
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kaj S. Emanuel
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - John G. Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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17
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Alemayehu MA, Azene AG, Mihretie KM. Time to development of surgical site infection and its predictors among general surgery patients admitted at specialized hospitals in Amhara region, northwest Ethiopia: a prospective follow-up study. BMC Infect Dis 2023; 23:334. [PMID: 37198551 DOI: 10.1186/s12879-023-08301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Surgical site infection is an infection occurring within 30 days after surgery. It is recently reported that evidence-based information on the specific time when the majority of surgical site infections would develop is a key to early detect the infection as well as to preventing and early intervene against their pressing and fatal complications. Therefore, the current study aimed to determine the incidence, predictors, and time to development of surgical site infection among general surgery patients at specialized hospitals in the Amhara region. METHOD An institution-based prospective follow-up study was conducted. The two-stage cluster sampling procedure was used. A systematic sampling technique with a K interval of 2 was applied to prospectively recruit 454 surgical patients. Patients were followed up for 30 days. Data were collected using Epicollect5 v 3.0.5 software. Post-discharge follow-up and diagnosis were done by telephone call follow-up. Data were analyzed using STATA™ version 14.0. Kaplan-Meier curve was used to estimate survival time. Cox proportional regression model was used to determine significant predictors. Variables with a P-value less than 0.05 in the multiple Cox regression models were independent predictors. RESULT The incidence density was 17.59 per 1000 person-day-observation. The incidence of post-discharge Surgical site infection was 70.3%. The majority of surgical site infections were discovered after discharge between postoperative days 9 to 16. Being male (AHR: 1.98, 95% CI: 1.201 - 3.277, diabetes Mellitus (AHR: 1.819, 95% CI: 1.097 - 3.016), surgical history (AHR: 2.078, 95% CI: 1.345, 3.211), early antimicrobial prophylaxis (AHR: 2.60, 95% CI: 1.676, 4.039), American Society of Anesthesiologists score ≥ III AHR: 6.710, 95% CI: 4.108, 10.960), duration of the surgery (AHR: 1.035 95% CI: 1.001, 1.070), Age (AHR: 1.022 95% CI: 1.000, 1.043), and the number of professionals in the Operation Room (AHR: 1.085 95% CI: 1.037, 1.134) were found to be the predictors of time to development of Surgical site infection. CONCLUSION The incidence of surgical site infection was higher than the acceptable international range. The majority of infections were detected after hospital discharge between 9 to 16 postoperative days. The main predictors of Surgical site infection were Age, Sex, Diabetes Mellitus, previous surgical history, the timing of Antimicrobial prophylaxis, American Society of Anesthesiologists score, pre-operative hospital stay, duration of surgery, and the number of professionals in the operation room. Hence, hospitals should give great emphasis on pre-operative preparation, post-discharge surveillance, modifiable predictors, and high-risk patients, as they found in this study.
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Affiliation(s)
- Meron Asmamaw Alemayehu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu Mihretie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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18
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Wang Q, Cao M, Tao H, Fei Z, Huang X, Liang P, Liu B, Liu J, Lu X, Ma P, Si S, Wang S, Zhang Y, Zheng Y, Zang L, Chen X, Dong Z, Ge W, Guo W, Hu X, Huang X, Li L, Liang J, Liu B, Liu D, Liu L, Liu S, Liu X, Miao L, Ren H, Shi G, Shi L, Sun S, Tao X, Tong R, Wang C, Wang B, Wang J, Wang J, Wang X, Wang X, Xie J, Xie S, Yang H, Yang J, You C, Zhang H, Zhang Y, Zhao C, Zhao Q, Zhu J, Ji B, Guo R, Hang C, Xi X, Li S, Gong Z, Zhou J, Wang R, Zhao Z. Evidence-based guideline for the prevention and management of perioperative infection. J Evid Based Med 2023; 16:50-67. [PMID: 36852502 DOI: 10.1111/jebm.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND We have updated the guideline for preventing and managing perioperative infection in China, given the global issues with antimicrobial resistance and the need to optimize antimicrobial usage and improve hospital infection control levels. METHODS We conducted a comprehensive evaluation of the evidence for prevention and management of perioperative infection, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Revisions were made to the guidelines in response to feedback from the experts. RESULTS There were 17 questions prepared, for which 37 recommendations were made. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the meta-analysis results, recommendations were graded using the Delphi method to generate useful information. CONCLUSIONS This guideline provides evidence to perioperative antimicrobial prophylaxis that increased the rational use of prophylactic antimicrobial use, with substantial improvement in the risk-benefit trade-off.
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Affiliation(s)
- Qiaoyu Wang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Mingnan Cao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Hua Tao
- Department of Pharmacy, Beijing United Family Hospital, Beijing, P. R. China
| | - Zhimin Fei
- Department of Neurosurgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Xiufeng Huang
- Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Pixia Liang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Jianping Liu
- Centre for Evidence-Based Medicine, Beijing University of Chinese Medicine, Beijing, P. R. China
| | - Xiaoyang Lu
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China
| | - Penglin Ma
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, P. R. China
| | - Shuyi Si
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yuewei Zhang
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yingli Zheng
- Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Lei Zang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiao Chen
- Department of Pharmacy, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P. R. China
| | - Zhanjun Dong
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, P. R. China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Wei Guo
- Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Xin Hu
- Department of Pharmacy, Beijing Hospital, Beijing, P. R. China
| | - Xin Huang
- Department of Pharmacy, The First Affiliated Hospital of Shandong First Medical University/Shandong Province Qianfoshan Hospital, Jinan, P. R. China
| | - Ling Li
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Jianshu Liang
- Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Baoge Liu
- Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Dong Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, HUST, Wuhan, P. R. China
| | - Linna Liu
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi'an, P. R. China
| | - Songqing Liu
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Xianghong Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, P. R. China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Haixia Ren
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, P. R. China
| | - Guangzhi Shi
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Luwen Shi
- Department of Pharmaceutical Administration, School of Pharmaceutical Sciences, Peking University, Beijing, P. R. China
| | - Shumei Sun
- Department of Pediatrics, Nanfang Hospital of Southern Medical University, Guangzhou, P. R. China
| | - Xia Tao
- Department of Pharmacy, Second Affiliated Hospital of Naval Medical University, Shanghai, P. R. China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, P. R. China
| | - Cheng Wang
- Department of Pharmacy, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, P. R. China
| | - Bin Wang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - Jincheng Wang
- Orthopaedic Medical Center, The 2nd Hospital of Jilin University, Changchun, P. R. China
| | - Jingwen Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, P. R. China
| | - Xiaoling Wang
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiaoyan Wang
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Shouxia Xie
- Department of Pharmacy, Shenzhen People's Hospital, Shenzhen, P. R. China
| | - Hua Yang
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, P. R. China
| | - Jianxin Yang
- Department of Intervention Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Chao You
- Department of Neurosurgery, West China Hospital Sichuan University, Chengdu, P. R. China
| | - Hongyi Zhang
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Yi Zhang
- Department of Pharmacy, Tianjin First Central Hospital, Tianjin, P. R. China
| | - Chengson Zhao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Jiangsu Suzhou, P. R. China
| | - Qingchun Zhao
- Department of Pharmacy, General Hospital of Northern Theater Command, Shenyang, P. R. China
| | - Jiangguo Zhu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China
| | - Bo Ji
- Clinical Pharmacy, General Hospital of Southern Theatre Command of PLA, Guangzhou, P. R. China
| | - Ruichen Guo
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, P. R. China
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, P. R. China
| | - Xiaowei Xi
- Department of Gynecological Oncology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Sheyu Li
- Department of Endocrinology and Metabolism/China Evidence-based Medicine Center, West China Hospital Sichuan University, Chengdu, P. R. China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jianxin Zhou
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
| | - Rui Wang
- Department of Drug Clinical Trial, PLA General Hospital, Beijing, P. R. China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, P. R. China
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Irgang L, Barth H, Holmén M. Data-Driven Technologies as Enablers for Value Creation in the Prevention of Surgical Site Infections: a Systematic Review. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:1-41. [PMID: 36910913 PMCID: PMC9995622 DOI: 10.1007/s41666-023-00129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
Despite the advances in modern medicine, the use of data-driven technologies (DDTs) to prevent surgical site infections (SSIs) remains a major challenge. Scholars recognise that data management is the next frontier in infection prevention, but many aspects related to the benefits and advantages of using DDTs to mitigate SSI risk factors remain unclear and underexplored in the literature. This study explores how DDTs enable value creation in the prevention of SSIs. This study follows a systematic literature review approach and the PRISMA statement to analyse peer-reviewed articles from seven databases. Fifty-nine articles were included in the review and were analysed through a descriptive and a thematic analysis. The findings suggest a growing interest in DDTs in SSI prevention in the last 5 years, and that machine learning and smartphone applications are widely used in SSI prevention. DDTs are mainly applied to prevent SSIs in clean and clean-contaminated surgeries and often used to manage patient-related data in the postoperative stage. DDTs enable the creation of nine categories of value that are classified in four dimensions: cost/sacrifice, functional/instrumental, experiential/hedonic, and symbolic/expressive. This study offers a unique and systematic overview of the value creation aspects enabled by DDT applications in SSI prevention and suggests that additional research is needed in four areas: value co-creation and product-service systems, DDTs in contaminated and dirty surgeries, data legitimation and explainability, and data-driven interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00129-2.
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Affiliation(s)
- Luís Irgang
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Henrik Barth
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Magnus Holmén
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
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20
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Meng H, Xu B, Xu Y, Niu H, Liu N. Incidence and risk factors for surgical site infection following volar locking plating (VLP) of unstable distal radius fracture (DRF). J Orthop Surg Res 2022; 17:549. [PMID: 36529774 PMCID: PMC9762064 DOI: 10.1186/s13018-022-03440-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Volar locking plating (VLP) is the mainstay of treatment for distal radius fracture (DRF) but may be compromised by postoperative surgical site infection (SSI). This study aimed to identify the incidence and the risk factors for SSI following VLP of DRF. METHODS This retrospective study identified consecutive patients who underwent VLP for closed unstable DRFs in our institution between January 2015 and June 2021. Postoperative SSI was identified by inquiring the medical records, the follow-up records or the readmission medical records for treatment of SSI. The potential factors for SSI were extracted from the medical records. Univariate and multivariate logistic regression analyses were performed to identify the independent factors. RESULTS There were 930 patients included, and 34 had an SSI, representing an incidence of 3.7% (95% CI 2.4-4.9%). Patients with an SSI had threefold extended hospitalization stay (44.1 ± 38.2 versus 14.4 ± 12.5 days) as did those without. In univariate analysis, 18 variables were tested to be statistically different between SSI and non-SSI group. In multivariate analysis, 6 factors were identified as independently associated with SSI, including sex (male vs. female, OR 3.5, p = 0.014), ASA (III and IV vs. I, OR 3.2, p = 0.031), smoking (yes vs. no, OR 2.4, p = 0.015), bone grafting (OR 4.0, p = 0.007), surgeon volume (low vs. high, OR 2.7, p 0.011) and operation at night-time (vs. day-time, OR 7.8, p < 0.001). CONCLUSION The postoperative SSI of VLP of DRF was not uncommon, and the factors identified in this study, especially those modifiable, would help identify individual SSI risk, target clinical surveillance and inform patient counseling.
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Affiliation(s)
- Hongyu Meng
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China ,grid.452209.80000 0004 1799 0194Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China ,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Bin Xu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Yi Xu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Haiyun Niu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
| | - Ning Liu
- grid.452209.80000 0004 1799 0194Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051 Hebei People’s Republic of China
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21
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Many Common Pathogens are Present in the Operative Room Air During Surgery. J Arthroplasty 2022; 37:2427-2430. [PMID: 35843378 DOI: 10.1016/j.arth.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The main objective of this study was to assess the sanitary measures of operating theaters using next-generation sequencing. METHODS Air was sampled from the operating room for the whole duration of 10 surgical days of "clean" (no infection cases) procedures (6 hip/knee arthroplasty and 4 spine cases). Controls consisted of samples at the beginning of the day (1 hour before the surgery started) and at the end of the day after terminal cleaning. One additional control sample, consisting of a culture swab that was opened and exposed to the air for 5 seconds, was collected at each time point. All samples were sent for next-generation sequencing analysis (16S rRNA sequencing) for bacterial identification. RESULTS Overall, 306 samples were collected (159 controls and 147 experimental). Microbial DNA was detected in only 1 control sample, while 18 (12.2%) experimental samples were positive for microbial DNA. The most common organisms retrieved were Escherichia coli (6/18, 30%), Cutibacterium acnes (3/18, 15%), and Pseudomonas aeruginosa (2/18, 11.1%). There was no difference in positive samples between arthroplasty and spine cases (P > .05). CONCLUSION Microbial organisms are not uncommonly present in the operating room air during hip and knee arthroplasties and spine procedures.
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22
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Gomes ET, Carbogim FDC, Lins RS, Lins-Filho RLDM, Poveda VDB, Püschel VADA. Effectiveness of supplemental oxygenation to prevent surgical site infections: A systematic review with meta-analysis. Rev Lat Am Enfermagem 2022; 30:e3648. [PMID: 36228236 PMCID: PMC9545934 DOI: 10.1590/1518-8345.6106.3648] [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: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE to assess the effectiveness of supplemental oxygenation with high FiO2 when compared to conventional FiO2 in the prevention of surgical site infection. METHOD an effectiveness systematic review with meta-analysis conducted in five international databases and portals. The research was guided by the following question: Which is the effectiveness of supplemental oxygenation with high FiO2 (greater than 80%) when compared to conventional FiO2 (from 30% to 35%) in the prevention of surgical site infections in adults? RESULTS fifteen randomized clinical trials were included. Although all the subgroups presented a general effect in favor of the intervention, colorectal surgeries had this relationship evidenced with statistical significance (I2=10%;X2=4.42; p=0.352). CONCLUSION inspired oxygen fractions greater than 80% during the perioperative period in colorectal surgeries have proved to be effective to prevent surgical site infections, reducing their incidence by up to 27% (p=0.006). It is suggested to conduct new studies in groups of patients subjected to surgeries from other specialties, such as cardiac and vascular. PROSPERO registration No.: 178,453.
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Affiliation(s)
- Eduardo Tavares Gomes
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP,
Brazil., Universidade Federal de Pernambuco, Hospital das Clínicas, Recife,
PE, Brazil
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23
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Tao L, Chao Z, Jingyu J, Xigao C. Nano zinc oxide decorated latex drainage: A promising antibacterial material prevent retrograde infection associated with drainage. J Biomater Appl 2022; 37:795-804. [PMID: 35834398 DOI: 10.1177/08853282221114382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical site infections (SSI) represent a considerable burden for healthcare systems. Studies show retrograde infection of the drainage tube is an important cause of surgical site infection. To this end, Surgeons work in various ways to reduce the incidence of retrograde infections. Fast progress in nanoscience and nanotechnology is revolutionizing the field of medicine to improve the quality of life due to the myriad of applications stemming from their unique properties, including the antibacterial activity against pathogens. Herein, we investigate the antibacterial properties of a novel nanomaterial composed of nano zinc oxide-decorated latex drainages. These materials were produced by the hydrothermal method and characterized through field-emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD), and DLS (Dynamic light scattering techniques). Then inductively coupled plasma mass spectrometry (ICP-MS) measurements showed that nano zinc oxide on the surface of the latex drainages showed a gradient release process. The antimicrobial activity of nano zinc oxide -decorated latex drainage was evaluated against E. coli and Staphylococcus aureus, the main bacteriological agent in the retrograde infection associated with drainage. The results showed that slices and rods nano zinc oxide (SAR-ZnO) drainage tubes had the best antibacterial properties both in vivo and in vitro. In addition, the cell viability assay demonstrated that nano zinc oxide-decorated latex drainages exerted good biocompatibility. Therefore, SAR-ZnO drainage tubes can be a perfect nanomaterial against the retrograde infection associated with drainage.
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Affiliation(s)
- Li Tao
- Department of Orthopedics, 196534The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopedics, 196534Nanchang University, Nanchang, China
| | - Zhang Chao
- Department of Orthopedics, 196534The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopedics, 196534Nanchang University, Nanchang, China
| | - Jia Jingyu
- Department of Orthopedics, 196534The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopedics, 196534Nanchang University, Nanchang, China
| | - Cheng Xigao
- Department of Orthopedics, 196534The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopedics, 196534Nanchang University, Nanchang, China
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de Araújo LX, Perez da Silva Pereira P, Cantanhêde de Deus J, Oliveira Pontes D, Tavares Hang A, Gadelha Freitas JL, Moreira da Silva V, de Paula Paiva K, Moura de Souza CJ, Suaris Meireles CV, Delfino Rodrigues M, da Silva Tavares DT, Sanches Rosa MM. Fatores de risco nas neurocirurgias: um estudo de coorte no norte do Brasil. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: Pacientes neurocirúrgicos apresentam elevado risco de complicações locais e sistêmicas que podem aumentar o tempo de internação e o risco de morte. Este estudo tem como objetivo avaliar a incidência de infecções relacionadas à assistência à saúde e os fatores de risco associados em pacientes submetidos às neurocirurgias. Materiais e Métodos: Estudo de coorte prospectiva, realizado em um Hospital de grande porte do estado de Rondônia, no período de 2018 a 2019, incluindo 36 pacientes. Resultados: A incidência de infecções relacionada à assistência à saúde foi 19,4 a cada 100 pacientes (IC95%: 8,19 – 36,02). Ter utilizado sonda nasoenteral aumentou em 6,5 vezes o risco de IRAS (IC 95%: 1,26 – 33,5), a ventilação mecânica aumentou 5,52 vezes o risco (IC95%: 1,23 – 24,6), a presença de traqueostomia aumentou seis vezes (IC95%: 1,34 – 26,8) e realização de exame invasivo aumentou o risco em 6,79 para ter infecção (IC95%: 1,31 – 35,05). Na análise ajustada as variáveis não apresentaram significância estatística. Discussão: A incidência de infecções foi maior do que em regiões com melhores condições socioeconômicas o que pode estar relacionado à menor adesão de boas práticas na assistência. Conclusão: Nas neurocirurgias além das infecções de sítio cirúrgico outras topografias também devem ser consideradas para investigação de infecção. O uso de dispositivos invasivos foi associado à ocorrência de infecções relacionadas à assistência à saúde, portanto as boas práticas no seu uso são essenciais no momento da indicação e uso destes dispositivos.
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Salazar Maya ÁM. Nursing Care during the Perioperative within the Surgical Context. INVESTIGACION Y EDUCACION EN ENFERMERIA 2022; 40:e02. [PMID: 36264690 PMCID: PMC9714984 DOI: 10.17533/udea.iee.v40n2e02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The study describes basic nursing care during the perioperative. Introduces the origins of perioperative nursing, general care that must be practiced with patient in this context. During the preoperative, care related with risk assessment and preparation of patient from the emotional and physical point of view are important. The trans-operative is related with the anesthesia used, surgical position, preparation of the skin, maintenance of normothermia, among many others. The postoperative depends on the type of anesthesia and surgical procedure, emphasizing on airway permeability, hemodynamic stability, pain, and symptomatology being presented by patients until they are stable and suitable for transfer to another service or their home.
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26
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Ogce Aktaş F, Turhan Damar H. Determining Operating Room Nurses’ Knowledge and Use of Evidence-Based Recommendations on Preventing Surgical Site Infections. J Perianesth Nurs 2022; 37:404-410. [DOI: 10.1016/j.jopan.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/06/2021] [Accepted: 08/28/2021] [Indexed: 11/27/2022]
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Estimated Costs Associated with Surgical Site Infections in Patients Undergoing Cholecystectomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020764. [PMID: 35055586 PMCID: PMC8775602 DOI: 10.3390/ijerph19020764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/16/2022]
Abstract
Among healthcare-associated infections, surgical site infections (SSIs) are the most frequent in Spain. The aim of this work was to estimate the costs of SSIs in patients who underwent a cholecystectomy at the Hospital General Universitario de Alicante (Spain) between 2012-2017. This was a prospective observational cohort study. The Active Epidemiological Surveillance Program at our hospital recorded all the cholecystectomies performed. Risk factors associated with the development of SSIs were determined by multivariate analysis and two homogeneous comparison groups were obtained by using the propensity score. The number of extra days of hospital stay were recorded for patients with an SSI and with the cost per hospitalised day data, the additional cost attributed to SSIs was calculated. A total of 2200 cholecystectomies were considered; 110 patients (5.0%) developed an SSI. The average length of hospital stay was 5.6 days longer among patients with an SSI. The cost per SSI was EUR 1890.60 per patient, with the total cost for this period being EUR 207,961.60. SSIs after cholecystectomy lead to a prolongation of hospital stay and an increase in economic costs. It is essential to implement infection surveillance and control programs to reduce SSIs, improve patient safety, and reduce economic burden.
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Salahuddin M, Muddebihal F, Thirunavukkarasu A, Alanazi AAZ, Alrashdi AMS, Alrashidi AM, Alanazi WOH, Alruwaili AHR, Alruwaili AFJ, Alruwaili KN. Epidemiology and Risk Factors of Post Operative Site Infections in Surgical Patients: A Systematic Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/zoixqqgvc6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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29
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Tan H, Wong KY, Nyakuma BB, Kamar HM, Chong WT, Wong SL, Kang HS. Systematic study on the relationship between particulate matter and microbial counts in hospital operating rooms. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:6710-6721. [PMID: 34458973 PMCID: PMC8403507 DOI: 10.1007/s11356-021-16171-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/22/2021] [Indexed: 06/04/2023]
Abstract
In this study, a systematic procedure for establishing the relationship between particulate matter (PM) and microbial counts in four operating rooms (ORs) was developed. The ORs are located in a private hospital on the western coast of Peninsular Malaysia. The objective of developing the systematic procedure is to ensure that the correlation between the PMs and microbial counts are valid. Each of the procedures is conducted based on the ISO, IEST, and NEBB standards. The procedures involved verifying the operating parameters are air change rate, room differential pressure, relative humidity, and air temperature. Upon verifying that the OR parameters are in the recommended operating range, the measurements of the PMs and sampling of the microbes were conducted. The TSI 9510-02 particle counter was used to measure three different sizes of PMs: PM 0.5, PM 5, and PM 10. The MAS-100ECO air sampler was used to quantify the microbial counts. The present study confirms that PM 0.5 does not have an apparent positive correlation with the microbial count. However, the evident correlation of 7% and 15% were identified for both PM 5 and PM 10, respectively. Therefore, it is suggested that frequent monitoring of both PM 5 and PM 10 should be practised in an OR before each surgical procedure. This correlation approach could provide an instantaneous estimation of the microbial counts present in the OR.
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Affiliation(s)
- Huiyi Tan
- School of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | - Keng Yinn Wong
- School of Mechanical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
- Process Systems Engineering Centre (PROSPECT), Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia.
| | - Bemgba Bevan Nyakuma
- Department of Chemistry, Faculty of Sciences, Benue State University, Makurdi, Benue State, P. M. B 102119, Nigeria
| | - Haslinda Mohamed Kamar
- School of Mechanical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
| | - Wen Tong Chong
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Syie Luing Wong
- Dpto. Matemática Aplicada, Ciencia e Ingeniería de Materiales y Tecnología Electrónica, Universidad Rey Juan Carlos, C/ Tulipán s/n, Móstoles, Madrid, Spain
| | - Hooi Siang Kang
- School of Mechanical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, 81310, Skudai, Johor, Malaysia
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Nikinmaa S, Podonyi A, Raivio P, Meurman J, Sorsa T, Rantala J, Kankuri E, Tauriainen T, Pätilä T. Daily Administered Dual-Light Photodynamic Therapy Provides a Sustained Antibacterial Effect on Staphylococcus aureus. Antibiotics (Basel) 2021; 10:antibiotics10101240. [PMID: 34680821 PMCID: PMC8533018 DOI: 10.3390/antibiotics10101240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 01/12/2023] Open
Abstract
New means to reduce excessive antibiotic use are urgently needed. This study tested dual-light aPDT against Staphylococcus aureus biofilm with different relative ratios of light energy with indocyanine green. We applied single-light aPDT (810 nm aPDT, 405 aBL) or dual-light aPDT (simultaneous 810 nm aPDT and 405 nm aBL), in both cases, together with the ICG photosensitizer with constant energy of 100 or 200 J/cm2. Single-dose light exposures were given after one-day, three-day, or six-day biofilm incubations. A repeated daily dose of identical light energy was applied during biofilm incubations for the three- and six-day biofilms. Using 100 J/cm2 light energy against the one-day biofilm, the dual-light aPDT consisting of more than half of aBL was the most effective. On a three-day maturated biofilm, single-dose exposure to aPDT or dual-light aPDT was more effective than aBL alone. With total light energy of 200 J/cm2, all dual-light treatments were effective. Dual-light aPDT improves the bactericidal effect on Staphylococcus aureus biofilm compared to aPDT or aBL and provides a sustained effect. An increase in the relative ratio of aBL strengthens the antibacterial effect, mainly when the treatment is repeatedly applied. Thus, the light components' energy ratio is essential with dual-light.
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Affiliation(s)
- Sakari Nikinmaa
- Department of Neuroscience and Biomedical Engineering, Aalto University, 02150 Espoo, Finland;
- Koite Health Oy, 02150 Espoo, Finland;
| | - Anna Podonyi
- Department of Cardiac Surgery, University Hospital Southampton, Southampton SO16 6YD, Hampshire, UK;
| | - Peter Raivio
- Heart and Lung Center, Meilahti Hospital, 00290 Helsinki, Finland; (P.R.); (T.T.)
| | - Jukka Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00290 Helsinki, Finland; (J.M.); (T.S.)
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, 00290 Helsinki, Finland; (J.M.); (T.S.)
| | | | - Esko Kankuri
- Department of Pharmacology, University of Helsinki, 00290 Helsinki, Finland;
| | - Tuomas Tauriainen
- Heart and Lung Center, Meilahti Hospital, 00290 Helsinki, Finland; (P.R.); (T.T.)
- Department of Congenital Heart Surgery and Organ Transplantation, New Children’s Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Tommi Pätilä
- Department of Neuroscience and Biomedical Engineering, Aalto University, 02150 Espoo, Finland;
- Koite Health Oy, 02150 Espoo, Finland;
- Department of Congenital Heart Surgery and Organ Transplantation, New Children’s Hospital, University of Helsinki, 00290 Helsinki, Finland
- Correspondence: ; Tel.: +358-50-427-2291; Fax: +358-94-717-4479
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Kudou M, Nakanishi M, Kuriu Y, Arita T, Shimizu H, Kiuchi J, Katsurahara K, Ikoma H, Kubota T, Fujiwara H, Okamoto K, Otsuji E. The Effect of Preoperative Oral Antibiotics in the Prevention of Surgical Site Infection after Laparoscopic Colorectal Cancer Surgery: A Propensity Score Matching Study. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:319-326. [PMID: 34395946 PMCID: PMC8321581 DOI: 10.23922/jarc.2021-005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Objectives: Recent findings suggest that the combination of mechanical bowel preparation (MBP) and preoperative oral antibiotics (OA) decreases the risk of surgical site infection (SSI) in colorectal surgery; however, this remains controversial. The present study examined the efficacy of OA plus MBP in laparoscopic colorectal cancer (CRC) surgery using propensity score matching (PSM). Methods: A total of 1080 patients with CRC underwent MBP followed by laparoscopic surgery between 2007 and 2019. OA was administered to all patients with CRC who underwent colectomy from 2018. PSM was performed to compare the effects of OA plus MBP (OA) versus MBP only (non-OA) on the rate of superficial SSI. Results: Overall, 128 patients received OA. Significant differences were observed in age, the American Society of Anesthesiologists performance status (ASA-PS), liver disease, and preoperative serum albumin (Alb) between the OA and non-OA groups. The enrolled patients were matched using PSM into two groups based on the following factors: sex, age, body mass index, ASA-PS, diabetes mellitus, liver disease, Alb, and tumor location, which resulted in the disappearance of significant differences. A univariate analysis showed that blood loss of 100 g or more, non-OA, and preoperative chemotherapy or radiation correlated with SSI (p = 0.021, 0.010, 0.038). A multivariate analysis of these three variables identified blood loss of 100 g or more and non-OA as independent risk factors for SSI (hazard ratio (HR): 3.238, p = 0.031; HR: 2.547, p = 0.033). Conclusions: The present study revealed that OA plus MBP markedly reduced SSI rate. OA with MBP needs to be adopted in laparoscopic CRC surgery.
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Affiliation(s)
- Michihiro Kudou
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Surgery, Kyoto Okamoto Memorial Hospital, Kyoto, Japan
| | - Masayoshi Nakanishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Surgery, Matsushita Memorial Hospital, Osaka, Japan
| | - Yoshiaki Kuriu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohiro Arita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Shimizu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Kiuchi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keita Katsurahara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hisashi Ikoma
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Goldman L, McAlister SA, Keith A, Bone N, McSwain JM, Klineline DN, Hagedorn Wonder A. Collecting Site-Level Data on Organisms Causing Surgical Site Infections to Guide Quality Improvement. AORN J 2021; 113:389-396. [PMID: 33788227 DOI: 10.1002/aorn.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/26/2020] [Accepted: 09/28/2020] [Indexed: 11/07/2022]
Abstract
Surgical site infections (SSIs) negatively affect patients and health care organizations. We conducted a descriptive, correlational study at two hospitals that provide care to rural patients in one Midwestern state. The study purposes were to describe: types of organisms causing reportable organ/space SSIs that occurred within 30 days of an open or a laparoscopic abdominal surgery (N = 20), and commonalities in patient- and care-related factors to provide baseline information for site-level prevention efforts for quality improvement. We identified Escherichia coli in almost half of the SSI cases (n = 9, 45%). Common patient-related factors included ethnicity, smoking, and dirty or contaminated wounds. Common care-related factors included longer surgery times (> 60 minutes), unplanned surgeries, and procedures that involved the colon or small bowel. Personnel can use site-level data to monitor prevalent types of organisms causing SSIs, enabling an evidence-based, interdisciplinary approach to develop and test methods to enhance prevention.
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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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Yang J, Zhang X, Liang W. A retrospective analysis of factors affecting surgical site infection in orthopaedic patients. J Int Med Res 2021; 48:300060520907776. [PMID: 32281431 PMCID: PMC7155240 DOI: 10.1177/0300060520907776] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the factors affecting surgical site infections (SSI) in patients undergoing orthopaedic surgery. Methods The electronic medical records of patients undergoing orthopaedic surgery between September 2010 and July 2018 were retrospectively retrieved and reviewed. Logistic regression analyses were used to analyse the correlation between surgery-related variables and SSI. The odds ratio (OR) and 95% confidence interval (CI) were estimated for the risk factors. Results Clinical data from 25 954 patients were reviewed and 804 (3.1%) were found to have become infected at the surgical site. Older age (≥60 years) was a risk factor (OR 2.218) and younger age (<18 years) was a protective factor (OR 0.258). Diabetes mellitus (OR 6.560) and hypertension (OR 3.991) were independent risk factors. Compared with type II incisions, type I incisions had a lower risk for SSI (OR 0.031), while type III incisions had a greater risk of SSI (OR 2.599). Compared with upper limbs and hands, the feet had a lower risk of infection, while surgery performed at the spine and joints did not increase the risk as compared with foot surgery. Conclusion Older age, hypertension, diabetes mellitus and type III incisions were risk factors for SSI following orthopaedic surgery.
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Affiliation(s)
- Jun Yang
- Department of Orthopaedics and Traumatology, Yuxi Municipal Hospital of Traditional Chinese Medicine, Yuxi, Yunnan Province, China
| | - Xiangmin Zhang
- Department of Orthopaedics and Traumatology, Yuxi Municipal Hospital of Traditional Chinese Medicine, Yuxi, Yunnan Province, China
| | - Wangbo Liang
- Department of Orthopaedics and Traumatology, Yuxi Municipal Hospital of Traditional Chinese Medicine, Yuxi, Yunnan Province, China
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Guérin S, Nyangoh Timoh K, Khene ZE, Rousseau C, Codet YP, Braguet R, Trifard F, Bruneau L, Lavoue V, Pizzoferrato AC, Della Negra E, Corbel L. Outpatient laparoscopic sacrocolpopexy: Feasibility and patient satisfaction. J Gynecol Obstet Hum Reprod 2021; 50:102118. [PMID: 33737249 DOI: 10.1016/j.jogoh.2021.102118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Laparoscopic sacrocolpopexy is the standard surgery to correct apical pelvic organ prolapse. It is currently mainly practiced in the context of a conventional hospitalization, but more and more practitioners are developing it as an outpatient procedure. The objective of this study was to evaluate the feasibility of outpatient laparoscopic sacrocolpopexy and patient satisfaction. METHODS This was a retrospective study comparing outpatients with inpatients who had undergone laparoscopic sacrocolpopexy. The main outcome was the rate of unscheduled visits and the number of early readmissions (i.e., <1 month). Secondary outcomes were complication rates and patient satisfaction. RESULTS Eighty-four patients were included with 42 women in each group. The rate of unscheduled consultations was 16.7 % (n = 7/42) in the outpatient group and 21 % (n = 9/42) in the inpatient group. 2.4 % (n = 1/42) of outpatients and 4.8 % (n = 2/42) of inpatients were re-hospitalized within a month after surgery. The complication rate was not significantly different between the groups. In the outpatient group, 88.2 % of patients were satisfied compared with 97.5 % in the inpatient group (p = 0.17) CONCLUSIONS: Outpatient laparoscopic sacrocolpopexy can be considered a safe and satisfactory option.
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Affiliation(s)
- Sonia Guérin
- Department of Gynecology Obstetrics, Rennes University Hospital, Rennes, France; Department of Urology, Plérin Private hospital, Plérin, France.
| | | | | | - Chloé Rousseau
- Department of Clinical investigation, Rennes University Hospital, Rennes, France
| | | | - Raissa Braguet
- Department of Urology, Plérin Private hospital, Plérin, France
| | | | - Lucie Bruneau
- Departement of Gynecology Obstetrics, Plérin Private hospital, Plérin, France
| | - Vincent Lavoue
- Department of Gynecology Obstetrics, Rennes University Hospital, Rennes, France
| | | | | | - Luc Corbel
- Department of Urology, Plérin Private hospital, Plérin, France
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Intraoperative Fire Risk: Evaluating the 3-Minute Wait After Chlorhexidine-Alcohol Antiseptic Scrub. J Orthop Trauma 2021; 35:e31-e33. [PMID: 32618815 DOI: 10.1097/bot.0000000000001885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We sought to determine the flammability of the skin at different time intervals after chlorhexidine-alcohol antiseptic scrub application, to provide evidence for hospital protocols recommending a 3-minute drying time. METHODS Swine feet, which contain the skin, subcutaneous tissue, muscle, and bone, were used for an experimental cohort. The skin was prepped with chlorhexidine-alcohol solution. Attempted ignition with an open flame was then performed in the presence of visible pooling, as well as at time points 0, 30, 60, and 90 seconds after application, in addition to when the skin appeared visibly dry. Six samples were used for each time point tested. RESULTS At time 0 seconds and with gross pooling, ignition was achieved with all samples tested. However, at 30 seconds, only 2 of 6 samples were ignited (which appeared wet). No samples after 60 or 90 seconds were flammable. Samples appeared dry after an average of 40.5 seconds and were not able to ignite. CONCLUSIONS Although our findings do support that a chlorhexidine-alcohol antiseptic scrub is a potentially flammable surgical prep solution, we found little support for a 3-minute time cutoff. More importantly, the presence of pooling and persistently wet appearing prep is a more important fire risk than the time elapsed after prep application. Caution should be used when working with any flammable solution, and efforts to minimize chemical burns and combustion should be sought based on evidence.
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Mosleh S, Baradaranfard F, Jokar M, Akbari L, Aarabi A. Prevalence of surgical site infection after orthopaedic surgery with two types of drainage at three public hospitals in Iran. Int J Orthop Trauma Nurs 2020; 43:100842. [PMID: 34049832 DOI: 10.1016/j.ijotn.2020.100842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/11/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Orthopaedic surgical site infections (SSIs) are among the most important and prevalent because implanted devices are used in such surgeries which increase the risk of infection. This study aimed to examine the incidence of infection in orthopaedic surgeries and related factors in a group of public hospitals in Iran. METHODS This analytical cross-sectional study was condcuted in 2018. Data were collected about the incidence of infection and related factors including use/non-use of drains and well as types of drain . The presence of SSIs were determined using a researcher-devised Wound Infection Checklist (WIC) and microbial cultures. RESULTS Of 110 included patients undergoing orthopaedic surgeries, 18.2% had an infection. The highest rate of infection was associated with lower extremity surgeries following tibia and fibula fractures. The incidence of infection among individuals under the age of 35 years was also higher. Emergency procedures demonstrated a higher incidence of infection. No significant relationship was observed between use of wound drains and development of SSIs. CONCLUSION Reducing the incidence of orthopaedic infection can be achieved by focusing more attention on open fractures occurring in the lower extremity. Use of surgical drains for the sole purpose of reducing the rate of infection is not effective. Accordingly, infection provention protocols should be implemented in orthopaedic surgery units to control and reduce rates of infection.
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Affiliation(s)
- Sorour Mosleh
- Master of Science in Perioperative Care, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Baradaranfard
- Master of Science in Perioperative Care, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Jokar
- Department of nursing, Khomein University of Medical Sciences, Khomein, Iran
| | - Leila Akbari
- Faculty Member of the Operating Room Department, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akram Aarabi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
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Park HJ, Kim SM, Kim HR, Ji W, Choi CM. The value of preoperative spirometry testing for predicting postoperative risk in upper abdominal and thoracic surgery assessed using big-data analysis. J Thorac Dis 2020; 12:4157-4167. [PMID: 32944327 PMCID: PMC7475606 DOI: 10.21037/jtd-19-2687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Spirometry is used to evaluate postoperative outcomes in thoracic surgery. However, the clinical utility of spirometry for predicting postoperative complications has not been determined. We used big-data analysis to examine the relationship between pulmonary function tests and postoperative complications. Methods We retrospectively analysed clinical data from 31,827 patients who underwent spirometry within the 3 months prior to their surgery between January 2000 and December 2014 at a single tertiary referral hospital. The data were extracted in de-identified form via the automated clinical research information system. Surgical procedures included thoracic and upper abdominal surgery. Results Multivariable logistic regression analysis showed that type of surgery, older age (>65 years), low albumin and smoking were associated with postoperative infections [95% confidence interval (CI) of the odds ratio (OR) 1.27–1.60 (>65 years); 1.52–1.96 (low albumin); 1.40–1.98 (current smoker)]. Notably, lower forced vital capacity (FVC) was an independent risk factor for postoperative infection, prolonged intensive care unit stay, and in-hospital death, regardless of airflow limitation [OR 95% CI: 1.31–1.69 (FVC 50–80%); 2.02–4.24 (FVC <50%)]. Lower forced expiratory volume in 1 sec (FEV1) was also an independent risk factor for postoperative infection [OR 95% CI: 1.61–2.26 (FEV1 50–80%); 2.27–4.21 (FEV1 <50%)]. Airflow limitation assessed by FEV1 was negatively correlated with postoperative infection in multivariable analysis (OR 95% CI: 0.51–0.88). Conclusions Lower preoperative FVC could be used to predict postoperative infection and complications in thoracic and upper abdominal surgery regardless of airflow limitation.
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Affiliation(s)
- Hyung Jun Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Min Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Martins T, Amante LN, Vicente C, Sousa GMD, Caurio EP, Guanilo MEE, Girondi JBR. Nursing interventions to reduce surgical site infection in potentially contaminated surgeries: an integrative review. ESTIMA 2020. [DOI: 10.30886/estima.v18.848_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: Identify nursing interventions that contribute to the reduction of surgical site infections in potentially contaminated surgeries. Methods: Integrative review, carried out in four databases. There were 5,888 articles published in the period from January 2008 to July 2018, in English, Portuguese and Spanish, from which nine articles were selected after final analysis. Results: The nursing interventions appeared according to the perioperative periods: preoperative (55.55%), intraoperative (33.33%), postoperative (66.66%), being associated with: antibiotic therapy, trichotomy, alcoholic chlorhexidine bathing, hand hygiene, sterile glove/wear/ package change for fascia and skin closure, degermination, antisepsis, surgical classification, surgical time, care with dressings and drains, temperature and blood glucose control, patient education, discharge and post-hospital discharge orientation. Conclusions: Nursing interventions were identified in each perioperative period, proving to be essential for the qualification of nursing care and effective in reducing surgical site infection in potentially contaminated surgeries.
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Affiliation(s)
- Tatiana Martins
- Universidade Federal de Santa Catarina – Programa de Pós-Graduação em Enfermagem – Florianópolis (SC), Brazil
| | - Lúcia Nazareth Amante
- Universidade Federal de Santa Catarina – Programa de Pós-Graduação em Gestão do Cuidado em Enfermagem – Modalidade Profissional – Florianópolis (SC), Brazil
| | - Camila Vicente
- Universidade Federal de Santa Catarina – Residência Multiprofissional Integrada em Saúde – Florianópolis (SC), Brazil
| | | | | | | | - Juliana Balbinot Reis Girondi
- Universidade Federal de Santa Catarina – Programa de Pós-Graduação em Gestão do Cuidado em Enfermagem – Modalidade Profissional – Florianópolis (SC), Brazil
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Martins T, Amante LN, Vicente C, Sousa GMD, Caurio EP, Guanilo MEE, Girondi JBR. Intervenções de enfermagem para reduzir infecção do sítio cirúrgico em cirurgias potencialmente contaminadas: revisão integrativa. ESTIMA 2020. [DOI: 10.30886/estima.v18.848_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: Identificar as intervenções de enfermagem que contribuem para a redução das infecções de sítio cirúrgico (ISCs) em cirurgias potencialmente contaminadas. Métodos: Revisão integrativa, realizada em quatro bases de dados. Foram encontrados 5.888 artigospublicados no período de janeiro de 2008 a julho de 2018, nos idiomas inglês, português e espanhol, sendo selecionados nove artigos após análise final. Resultados: As intervenções de enfermagem apareceram conforme os períodos perioperatórios: pré-operatório (55,55%), intraoperatório (33,33%) e pós-operatório (66,66%), estando associadas à: antibioticoterapia, tricotomia, banho de clorexidina alcoólica, higiene das mãos, troca de luva estéril/vestimenta/pacote para fechamento da fáscia e da pele, degermação, antissepsia, classificação cirúrgica, tempo cirúrgico, cuidados com curativos e drenos, controle de temperatura e glicemia, educação do paciente, orientações na alta e pós-alta hospitalar. Conclusões: As intervenções de enfermagem foram identificadas em cada período do perioperatório, mostrando-se essenciais para a qualificação da assistência de enfermagem e eficazes na redução da infecção do sítio cirúrgicos em cirurgias potencialmente contaminadas.
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Affiliation(s)
- Tatiana Martins
- Universidade Federal de Santa Catarina – Programa de Pós-Graduação em Enfermagem – Florianópolis (SC), Brazil
| | - Lúcia Nazareth Amante
- Universidade Federal de Santa Catarina – Programa de Pós-Graduação em Gestão do Cuidado em Enfermagem – Modalidade Profissional – Florianópolis (SC), Brazil
| | - Camila Vicente
- Universidade Federal de Santa Catarina – Residência Multiprofissional Integrada em Saúde – Florianópolis (SC), Brazil
| | | | | | | | - Juliana Balbinot Reis Girondi
- Universidade Federal de Santa Catarina – Programa de Pós-Graduação em Gestão do Cuidado em Enfermagem – Modalidade Profissional – Florianópolis (SC), Brazil
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Probst P, Tran DTA, Hüttner FJ, Harnoss JC, Heger P, Ritter AS, Doerr-Harim C, Mihaljevic AL, Knebel P, Schneider M, Büchler MW, Diener MK. Randomised-controlled feasibility trial on abdominal wall closure techniques in patients undergoing relaparotomy (ReLap study; DRKS00013001). Langenbecks Arch Surg 2020; 405:427-434. [PMID: 32504207 PMCID: PMC7359135 DOI: 10.1007/s00423-020-01903-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/25/2020] [Indexed: 10/29/2022]
Abstract
BACKGROUND Patients undergoing relaparotomy are generally underrepresented in clinical trials, despite how common the procedure is in clinical practice. Specifically, techniques for re-do abdominal wall closure have never been evaluated in a randomised-controlled trial. The aim of this trial was to identify the optimal abdominal wall closure technique in patients undergoing relaparotomy. METHODS In this monocentric, randomised feasibility trial, patients scheduled for elective relaparotomy were randomised to abdominal wall closure with either the small stitches technique, using Monomax® 2-0, or the large stitches technique, using PDS II® 1 loop. Patients' postoperative courses were followed for 1 year after the index operation. Effectiveness and safety outcomes were compared at a level of significance of 5% between the two techniques. RESULTS A total of 100 out of 131 patients (76.3%) were evenly randomised to the small stitches and large stitches groups. The time for abdominal wall closure did not differ between the two techniques (small stitches 27.5 ± 9.5 min versus large stitches 25.3 ± 12.4 min; p = 0.334). The overall comprehensive complication index was 14.4 ± 15.5 in the small stitches group and 19.9 ± 23.4 in the large stitches group (p = 0.168). Specifically, rates of surgical site infection (small stitches 30.0% versus large stitches 36.0%; p = 0.524) and burst abdomen (small stitches 4.0% versus large stitches 0.0%; p = 0.495) did not differ. After 1 year, incisional hernia rate was 7.5% in the small stitches group and 10.0% in the large stitches group (p > 0.999). DISCUSSION Both abdominal wall closure techniques investigated in this trial were feasible in relaparotomy patients. This exploratory trial revealed no noticeable difference in the effectiveness or safety of the small stitches technique with Monomax® 2-0 versus the large stitches technique with PDS II® 1 loop. Therefore, surgeons should stay with their preferred suture technique in relaparotomy patients. TRIAL REGISTRATION Deutsches Register Klinischer Studien ( www.germanctr.de ): DRKS00013001.
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Affiliation(s)
- Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. .,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Dinh Thien-An Tran
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Julian C Harnoss
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Patrick Heger
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Colette Doerr-Harim
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.,The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Elshami M, Bottcher B, Awadallah I, Alnaji A, Aljedaili B, Abu Sulttan H, Hwaihi M. Determinants of surgeons' adherence to preventive intraoperative measures of surgical site infection in Gaza Strip hospitals: a multi-centre cross-sectional study. BMC Surg 2020; 20:21. [PMID: 32000748 PMCID: PMC6993375 DOI: 10.1186/s12893-020-0684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/21/2020] [Indexed: 11/22/2022] Open
Abstract
Background Surgical site infection (SSI) is one of the most common hospital-acquired infections and is associated with serious impact on the rates of morbidity, mortality as well as healthcare costs. This study examined factors influencing the application of several intraoperative preventive measures of SSI by surgeons and surgical residents in the Gaza Strip. Methods A cross-sectional study was conducted from December 2016 to February 2017 at the operation rooms of the three major hospitals located in the Gaza-Strip, Palestine. Inclusion criteria for patients were being adult (aged ≥18 years), no history of wound infection at time of operation and surgical procedure under general anaesthesia with endotracheal intubation. The association between different patient- and procedure-related SSI risk factors and adherence to several intraoperative SSI preventive measures was tested. Results In total, 281 operations were observed. The mean patient age ± standard deviation (SD) was 38.4 ± 14.6 years and the mean duration of surgery ± SD was 58.2 ± 32.1 minutes. A hundred-thirty-two patients (47.0%) were male. Location and time of the operation were found to have significant associations with adherence to all SSI preventive measures except for antibiotic prophylaxis. Type of operation had a significant association with performing all measures except changing surgical instruments. Patient age did not have a statistically significant association with adherence to any measure. Conclusion The results suggest that the surgeon could be a major factor that can lead to a better outcome of surgical procedures by reducing postoperative complications of SSI. Operating department professionals would benefit from clinical guidance and continuous training, highlighting the importance of persistent implementation of SSI preventive measures in everyday practice to improve the quality of care provided to surgical patients.
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Affiliation(s)
- Mohamedraed Elshami
- Physician, Ministry of Health, Gaza, Palestine. .,Graduate Student, Harvard Medical School, Boston, MA, USA.
| | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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Alamrew K, Tadesse TA, Abiye AA, Shibeshi W. Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital. Infect Dis (Lond) 2019; 12:1178633719892267. [PMID: 31819472 PMCID: PMC6882032 DOI: 10.1177/1178633719892267] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/09/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are infections that develop within 30 days after an operation or surveillance of surgical wound infection implementation within 90 days after surgery when an implant is placed. The objective of this study was to assess preoperative and postoperative antimicrobial use in St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia. METHODS A hospital-based cross-sectional study was undertaken in surgery wards of SPHMMC for 4 months by reviewing 413 patients' charts. All patients 13 years and older who were admitted and underwent different types of surgical procedures were included in the study. Epi info 7 was used for data entry, and then data were exported to Statistical Package for Social Sciences (SPSS) version 20.0 software for analysis. Descriptive analyses were computed and rate of SSI was calculated in this study. Moreover, bivariate analysis was done to examine the relationship between the outcome variable and predictor variables with a value of P < .2 retained for subsequent multivariate analyses using multiple logistic regressions. P value of <.05 was considered as statistically significant. RESULTS Out of 413 patients, 152 (36.8%) were operated for general surgery, and the remaining were for other types of surgeries. Most of the patients, 196 (79.7%), were managed by a single surgical antibiotic agent, followed by 2 agents (20.3%) for surgical prophylaxis indication. Surgical site infections occurred in 46 (11.1%) patients before discharge from the hospital. In those patients who need treatment for SSIs, almost half of them (49.5%) received combination therapy of ceftriaxone and metronidazole. Emergency surgical cases were 2.647 times more likely to develop SSIs than the elective surgical cases (adjusted odds ratio [AOR] = 2.647; 95% confidence interval [CI] = 1.406-4.983; P = .003). Patients who did not receive antibiotic prophylaxis were 2.572 times more likely to develop SSIs compared to those who received antibiotic prophylaxis (AOR = 2.572; 95% CI = 1.02-6.485; P = .045). Clean-contaminated and contaminated types of wound were a protective factor against SSI in our study. CONCLUSIONS This study indicated that most of the patients (72.1%) received surgical antimicrobial prophylaxis. The overall incidence rate of SSIs was 11.1% in the studied hospital. Ceftriaxone was the most commonly used drug. Being not receiving prophylaxis, wound class, and surgery types were significantly associated with the development of SSI.
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Affiliation(s)
- Kerebih Alamrew
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Assefa Tadesse
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfoalem Araba Abiye
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workineh Shibeshi
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Maleknejad A, Dastyar N, Badakhsh M, Balouchi A, Rafiemanesh H, Al Rawajfah O, Rezaie Keikhaie K, Sheyback M. Surgical site infections in Eastern Mediterranean region: a systematic review and meta-analysis. Infect Dis (Lond) 2019; 51:719-729. [PMID: 31361182 DOI: 10.1080/23744235.2019.1642513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Surgical site infections (SSIs) are the most common and costly type of hospital-acquired infections (HAIs) worldwide. Despite individual studies, there is also no clear statistics on the SSI prevalence rate in the East Mediterranean region. The aim of this study was to investigate the prevalence of SSI in the Eastern Mediterranean region. Methods: This systematic review and meta-analysis were performed by searching three international databases (Web of Science, PubMed and Scopus) from 1 January 2001 to 31 December 2018. The keywords used included 'Prevalence' OR 'incidence' OR 'surgical site infection' OR 'wound infection' OR 'Postoperative Wound Infections' and 'Middle east'. The Hoy et al.'s tool was used to evaluate the quality of the articles. Result: Out of 889 initial studies, 40 studies from 12 countries of the Eastern Mediterranean region were included in the final stage of the study. Based on the results of random effect method, the overall prevalence of SSI in 137,452 patients was 7.9% (95% Confidence Interval (CI): 7.1, 8.8; I2=96.7%). The prevalence of SSI in cardiac surgery and general surgery wards was 10 and 9.2%, respectively. The prevalence of SSI was lower in women than in males, although this difference was related to caesarean section. Conclusions: Considering the high prevalence of SSI in the Eastern Mediterranean region, timely diagnosis, proper prevention and postoperative control are necessary in the region using the same international guides in all countries.
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Affiliation(s)
- Abdulbaset Maleknejad
- Department of General Surgery, Clinical Immunology Research Center, Ali-Ebne Abitaleb Hospital, Zahedan University of Medical Sciences , Zahedan , Iran
| | - Neda Dastyar
- Department of Midwifery, Jiroft University of Medical Sciences , Jiroft , Iran
| | - Mahin Badakhsh
- Department of Midwifery, School of Nursing and Midwifery, Zabol University of Medical Sciences , Zabol , Iran
| | - Abbas Balouchi
- Student Research Committee, Nursing and Midwifery School, Iran University of Medical Sciences , Tehran , Iran
| | - Hosein Rafiemanesh
- Department of Epidemiology, Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Krzystek-Korpacka M, Zawadzki M, Lewandowska P, Szufnarowski K, Bednarz-Misa I, Jacyna K, Witkiewicz W, Gamian A. Distinct Chemokine Dynamics in Early Postoperative Period after Open and Robotic Colorectal Surgery. J Clin Med 2019; 8:jcm8060879. [PMID: 31248170 PMCID: PMC6616914 DOI: 10.3390/jcm8060879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 01/13/2023] Open
Abstract
Stress response to robot-assisted colorectal surgery is largely unknown. Therefore, we conducted a prospective comparative nonrandomized study evaluating the perioperative dynamics of chemokines: IL-8/CXCL8, MCP-1/CCL2, MIP-1α/CCL3, MIP-1β/CCL4, RANTES/CCL5, and eotaxin-1/CCL11 in 61 colorectal cancer patients following open colorectal surgery (OCS) or robot-assisted surgery (RACS) in reference to clinical data. Postoperative IL-8 and MCP-1 increase was reduced in RACS with a magnitude of blood loss, length of surgery, and concomitant up-regulation of IL-6 and TNFα as its independent predictors. RANTES at 8 h dropped in RACS and RANTES, and MIP1α/β at 24 h were more elevated in RACS than OCS. IL-8 and MCP-1 at 72 h remained higher in patients subsequently developing surgical site infections, in whom a 2.6- and 2.5-fold increase was observed. IL-8 up-regulation at 24 h in patients undergoing open procedure was predictive of anastomotic leak (AL; 94% accuracy). Changes in MCP-1 and RANTES were predictive of delayed restoration of bowel function. Chemokines behave differently depending on procedure. A robot-assisted approach may be beneficial in terms of chemokine dynamics by favoring Th1 immunity and attenuated angiogenic potential and postoperative ileus. Monitoring chemokine dynamics may prove useful for predicting adverse clinical events. Attenuated chemokine up-regulation results from less severe blood loss and diminished inflammatory response.
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Affiliation(s)
| | - Marek Zawadzki
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland.
| | - Paulina Lewandowska
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland.
| | | | - Iwona Bednarz-Misa
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland.
| | - Krzysztof Jacyna
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland.
| | - Wojciech Witkiewicz
- Department of Oncological Surgery, Regional Specialist Hospital, 51-124 Wroclaw, Poland.
- Research and Development Centre at Regional Specialist Hospital, 51-124 Wroclaw, Poland.
| | - Andrzej Gamian
- Department of Medical Biochemistry, Wroclaw Medical University, 50-368 Wroclaw, Poland.
- Laboratory of Medical Microbiology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland.
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Ansari S, Hassan M, Barry HD, Bhatti TA, Hussain SZM, Jabeen S, Fareed S. Risk Factors Associated with Surgical Site Infections: A Retrospective Report from a Developing Country. Cureus 2019; 11:e4801. [PMID: 31396469 PMCID: PMC6679712 DOI: 10.7759/cureus.4801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Any infection occurring at the site of a surgical incision superficially or deep within the fascia, within 30 days of a surgical procedure is termed as a surgical site infection (SSI). Due to limited resources, non-adherence to infection control guidelines and substandard sterilization practices, the incidence is higher in developing countries. The aim of this study is to estimate the incidence of surgical site infections in general surgeries at a tertiary care hospital in Pakistan and identify the predisposing risk factors. Methods This was a retrospective analysis that included all surgical records from June 1, 2018, to December 31, 2018. After exclusion, 882 records were included. The incidence of SSI and predisposing risk factors were noted. Data were entered and analyzed using SPSS v. 22.0 (IBM Corp, Armonk, NY, US). Results The incidence of SSI was 8.84% (n=78). SSIs were more common in older participants (11.4% vs. 6.4%; p=0.009), in patients with more than 24 hour of preoperative hospital stay (11.2% vs. 64%; p=0.013), in procedures of longer duration (1.53 ± 0.35 vs 2.57 ± 0.17; p<0.0001), and in emergency surgeries (19.2% vs. 7.5%; p=0.0001). The combined incidence of SSIs in American Society of Anesthesiologists (ASA) index III and above was 37 (47.4%) and that in I and II was 41 (52.6%) (p<0.00001). Conclusion This study has revealed a very high incidence of surgical site infections. These infections are more common in elderly patients, patients undergoing emergency surgeries, those with longer preoperative hospital stay and longer surgical duration, and patients with a high ASA index.
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Affiliation(s)
- Shahbaz Ansari
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | | | - Habiba D Barry
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Shah Jabeen
- Physiology, Liaquat College of Medicine and Dentistry, Karachi, PAK
| | - Sundus Fareed
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
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Knight SR, Ots R, Maimbo M, Drake TM, Fairfield CJ, Harrison EM. Systematic review of the use of big data to improve surgery in low- and middle-income countries. Br J Surg 2019; 106:e62-e72. [PMID: 30620075 PMCID: PMC6590290 DOI: 10.1002/bjs.11052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022]
Abstract
Background Technological advances have led to the generation of large amounts of data, both in surgical research and practice. Despite this, it is unclear how much originates in low‐ and middle‐income countries (LMICs) and what barriers exist to the use of such data in improving surgical care. The aim of this review was to capture the extent and impact of programmes that use large volumes of patient data on surgical care in LMICs. Methods A PRISMA‐compliant systematic literature review of PubMed, Embase and Google Scholar was performed in August 2018. Prospective studies collecting large volumes of patient‐level data within LMIC settings were included and evaluated qualitatively. Results A total of 68 studies were included from 71 LMICs, involving 708 032 patients. The number of patients in included studies varied widely (from 335 to 428 346), with 25 reporting data on 3000 or more LMIC patients. Patient inclusion in large‐data studies in LMICs has increased dramatically since 2015. Studies predominantly involved Brazil, China, India and Thailand, with low patient numbers from Africa and Latin America. Outcomes after surgery were commonly the focus (33 studies); very few large studies looked at access to surgical care or patient expenditure. The use of large data sets specifically to improve surgical outcomes in LMICs is currently limited. Conclusion Large volumes of data are becoming more common and provide a strong foundation for continuing investigation. Future studies should address questions more specific to surgery.
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Affiliation(s)
- S R Knight
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - R Ots
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - M Maimbo
- Department of General Surgery, Kitwe Teaching Hospital, Kitwe, Zambia
| | - T M Drake
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - C J Fairfield
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Surgical Informatics, Centre for Medical Informatics, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK
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Application of antimicrobial drugs in perioperative surgical incision. Ann Clin Microbiol Antimicrob 2018; 17:2. [PMID: 29397046 PMCID: PMC5797388 DOI: 10.1186/s12941-018-0254-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/19/2018] [Indexed: 01/10/2023] Open
Abstract
Infection in surgical incision often results in poor wound healing, and one of the main factors for wound infection is the use of antimicrobial agents. Rational use of antibiotics is one of the key factors to prevent incision infection in general surgery. The number of current clinical studies on antibiotic use before and during surgery is greater than that of systematic studies on antibiotic use after surgery. For the rational use of antibiotics and improvement of wound healing rate, researchers around the world have gradually focused on the use of antibiotics after surgery. Despite the familiarity on the concept of “rational use of antibiotics”, few clear and systematic studies were conducted to elucidate the effect of different antibiotics on wound healing. Therefore, this review focuses on the use of different types of antimicrobial agents in surgical wounds.
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