Correlation Between Clostridium perfringens Alpha- and NetB-Toxin and Chick Mortality in Commercial Broiler Farms During Different Anticoccidial Control Programs

Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis

Background

The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).

Methods

PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995.

Findings

We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis.

Interpretation

In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence.

Funding

Dutch Association for Quality Funds Medical Specialists.

Necrotizing Hepatitis Associated with Clostridium perfringens in Broiler Chicks

In this retrospective study we describe unusual cases of clostridial hepatitis associated with high mortality in young broiler chicks. Eleven cases of necrotizing hepatitis in broiler chicks from four companies were submitted to the Poultry Diagnostic and Research Center or the Georgia Poultry Laboratory Network between 2017 and 2020. In most flocks, increased 3-day mortality was followed by an elevated 7-day mortality. Gross lesions included green to dark brown discoloration of the liver, congested lungs, serosanguineous fluid in the caudoventral aspect of the abdomen, and emphysema in the yolk sacs. In birds older than a week of age, disease with neurologic signs became evident and consisted of tremors, stargazing, and incoordination. Histopathologic evaluation revealed multifocal to coalescing fibrinoheterophilic and necrotizing hepatitis associated with gram-positive, long, rod-shaped bacteria. Formalin-fixed liver samples from six cases out of eight cases tested were positive for Clostridium perfringens by immunohistochemistry. Liver samples from two cases were culture positive for Clostridium spp., and C. perfringens was isolated from one sample. Toxinotyping by PCR performed in seven samples revealed the presence of the genes that code for alpha toxin phospholipase C (cpa or plc) and necrotic enteritis toxin B-like (netB) in six samples and as well as C. perfringens large cytotoxin (tpeL) in one sample. Broiler breeders are the suspected source of the infection, and testing revealed C. perfringens in hatchery samples and among broiler breeder flocks. Antimicrobial therapy was coupled with enhanced sanitation at the farm and hatchery in that company, markedly decreasing the mortality and clinical signs. This is the first comprehensive evaluation of clostridial necrotizing hepatitis in newly hatched chicks, and the second ever reported in the literature.