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Abdallah S, Hammoud SM, Al Balushi H, Loon MM, Salcedo YE, Hassan MMU, Cheema MJ, Kadri F, Shehryar A, Rehman A, Ibrahim M. Effective Surgical Site Infection Prevention Strategies for Diabetic Patients Undergoing Surgery: A Systematic Review. Cureus 2024; 16:e59849. [PMID: 38854286 PMCID: PMC11157141 DOI: 10.7759/cureus.59849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/11/2024] Open
Abstract
Surgical site infections (SSIs) pose a significant clinical challenge, with heightened risks and severe consequences for diabetic patients undergoing surgical procedures. This systematic review aims to synthesize the current evidence on effective prevention strategies for mitigating SSI risk in this vulnerable population. From inception to March 2024, we comprehensively searched multiple electronic databases (PubMed, Medline, Embase, Cochrane Library, CINAHL) to identify relevant studies evaluating SSI prevention strategies in diabetic surgical patients. Our search strategy followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, utilizing a combination of keywords and Medical Subject Headings (MeSH) terms related to diabetes, surgical site infections, prevention strategies, and surgical procedures. Inclusion criteria focused on peer-reviewed clinical trials, randomized controlled trials, and meta-analyses published in English. The search yielded three studies meeting the eligibility criteria, subject to data extraction and qualitative synthesis. Key findings highlighted the efficacy of interventions such as optimized perioperative glycemic control, timely prophylactic antibiotic administration, and meticulous preoperative skin antisepsis in reducing SSI rates among diabetic surgical patients. The potential for personalized prevention approaches based on individual patient factors, such as diabetes type and surgical complexity, was explored. This systematic review underscores the importance of a multifaceted, evidence-based approach to SSI prevention in diabetic surgical patients, integrating strategies like glycemic control, antibiotic prophylaxis, and preoperative skin antisepsis. Furthermore, our findings suggest the potential benefits of personalized care pathways tailored to individual patient characteristics. Implementing these interventions requires interdisciplinary collaboration, adaptation to diverse healthcare settings, and patient engagement through culturally sensitive education initiatives. This comprehensive analysis informs clinical practice, fosters patient safety, and contributes to the global efforts to enhance surgical outcomes for this high-risk population.
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Affiliation(s)
| | - Sabri M Hammoud
- General Surgery, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, KWT
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Tan G, Li Y, Zhou G. The connotation between perioperative glycemic control approach and sternal wound infection in individuals with diabetes mellitus experiencing cardiac surgery: A meta-analysis. Int Wound J 2023; 20:3324-3330. [PMID: 37190865 PMCID: PMC10502249 DOI: 10.1111/iwj.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
A meta-analysis investigation to measure the connotation between perioperative glycemic control (GC) approach and sternal wound infection (SWI) in individuals with diabetes mellitus (DM) experiencing cardiac surgery (CS). A comprehensive literature inspection till February 2023 was applied and 2654 interrelated investigations were reviewed. The 12 chosen investigations enclosed 1564 individuals with DM and CS in the chosen investigations' starting point, 790 of them were using strict GC, and 774 were using moderate GC. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the Connotation between the perioperative GC approach and SWI in individuals with DM experiencing CS by the dichotomous and continuous approaches and a fixed or random model. Strict GC had significantly lower SWI (OR, 0.33; 95% CI, -0.22-0.50, P < .001) compared with those with moderate GC in individuals with DM and CS. Strict GC had significantly lower SWI compared with those with moderate GC in individuals with DM and CS. However, caused of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Gang Tan
- Department of Cardiovascular MedicineSichuan Academy of Medical Sciences & Sichuan Provincial People's HospitalSichuanChina
| | - Yongfang Li
- Department of EndoscopySichuan Academy of Medical Sciences & Sichuan Provincial People's HospitalSichuanChina
| | - Guangpeng Zhou
- Department of EndocrinologySichuan Academy of Medical Sciences & Sichuan Provincial People's HospitalSichuanChina
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Panduro-Correa V, Gomez-Gonzales W, Rabaan AA, Valencia-Martínez JC, Gutiérrez-Acuña Y, Chihuantito-Abal L, Zavaleta-Oliver J, Barboza JJ, Rodriguez-Morales AJ, Arteaga-Livias K. Antibiotic prophylaxis compliance differences in surgery and gynecology/obstetrics services in Huánuco, Peru. LE INFEZIONI IN MEDICINA 2023; 31:364-373. [PMID: 37701388 PMCID: PMC10495055 DOI: 10.53854/liim-3103-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/25/2023] [Indexed: 09/14/2023]
Abstract
Introduction Surgical site infections (SSIs) can increase mortality and morbidity in patients after surgery. Antibiotic prophylaxis is an effective measure to prevent SSIs, but inappropriate prescription is frequent. The objective of the study was to determine compliance with the clinical practice guideline for antibiotic prophylaxis in the general surgery and gynecology and obstetrics wards in the city of Huánuco, Peru. Methods An analytical cross-sectional study was carried out on all surgical interventions in the general surgery and gynecology and obstetrics services during the year 2019. Compliance was determined based on the chosen antibiotic, dose, time of administration, and duration of prophylaxis. Related factors considered were age, presence of co-morbidities, surgery performed, duration of surgery, types of procedure, anesthesia, as well as years as a surgeon and anesthesiologist. Results A total of 557 medical records of patients with a median age of 33 years undergoing surgery were collected,. Antibiotic prophylaxis was correctly followed in all aspects in 14.6% of cases in the general surgery service and only in 5.6% of cases in the gynecology and obstetrics service. The correct duration of prophylaxis was 11.6% and 19.7% in general surgery and gynecology and obstetrics, respectively. Conclusion Low compliance with institutional clinical practice guidelines for antibiotic prophylaxis was identified in both services. However, surgical interventions in the general surgery service presented better compliance with antibiotic prophylaxis compared to gynecology and obstetrics procedures.
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Affiliation(s)
- Vicky Panduro-Correa
- Facultad de Medicina, Universidad Nacional Hermilio Valdizán. Huánuco, Peru
- Escuela de Medicina Humana. Universidad Privada San Juan Bautista, Lima, Perú
| | | | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | | | | | | | | | | | - Alfonso J. Rodriguez-Morales
- Maestria en Epidemiologia Clínica y Bioestadística. Universidad Científica del Sur, Lima 15014, Perú
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- GIlbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Kovy Arteaga-Livias
- Escuela de Medicina, Filial Ica. Universidad Privada San Juan Bautista, Ica, Peru
- Maestria en Epidemiologia Clínica y Bioestadística. Universidad Científica del Sur, Lima 15014, Perú
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Bellon F, Solà I, Gimenez-Perez G, Hernández M, Metzendorf MI, Rubinat E, Mauricio D. Perioperative glycaemic control for people with diabetes undergoing surgery. Cochrane Database Syst Rev 2023; 8:CD007315. [PMID: 37526194 PMCID: PMC10392034 DOI: 10.1002/14651858.cd007315.pub3] [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] [Indexed: 08/02/2023]
Abstract
BACKGROUND People with diabetes mellitus are at increased risk of postoperative complications. Data from randomised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control, targeting near-normal blood glucose, in people with hyperglycaemia (with and without diabetes mellitus) being submitted for surgical procedures. However, there is limited evidence concerning this question in people with diabetes mellitus undergoing surgery. OBJECTIVES To assess the effects of perioperative glycaemic control for people with diabetes undergoing surgery. SEARCH METHODS For this update, we searched the databases CENTRAL, MEDLINE, LILACS, WHO ICTRP and ClinicalTrials.gov. The date of last search for all databases was 25 July 2022. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled clinical trials (RCTs) that prespecified different targets of perioperative glycaemic control for participants with diabetes (intensive versus conventional or standard care). DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias. Our primary outcomes were all-cause mortality, hypoglycaemic events and infectious complications. Secondary outcomes were cardiovascular events, renal failure, length of hospital and intensive care unit (ICU) stay, health-related quality of life, socioeconomic effects, weight gain and mean blood glucose during the intervention. We summarised studies using meta-analysis with a random-effects model and calculated the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, using a 95% confidence interval (CI), or summarised outcomes with descriptive methods. We used the GRADE approach to evaluate the certainty of the evidence (CoE). MAIN RESULTS A total of eight additional studies were added to the 12 included studies in the previous review leading to 20 RCTs included in this update. A total of 2670 participants were randomised, of which 1320 were allocated to the intensive treatment group and 1350 to the comparison group. The duration of the intervention varied from during surgery to five days postoperative. No included trial had an overall low risk of bias. Intensive glycaemic control resulted in little or no difference in all-cause mortality compared to conventional glycaemic control (130/1263 (10.3%) and 117/1288 (9.1%) events, RR 1.08, 95% CI 0.88 to 1.33; I2 = 0%; 2551 participants, 18 studies; high CoE). Hypoglycaemic events, both severe and non-severe, were mainly experienced in the intensive glycaemic control group. Intensive glycaemic control may slightly increase hypoglycaemic events compared to conventional glycaemic control (141/1184 (11.9%) and 41/1226 (3.3%) events, RR 3.36, 95% CI 1.69 to 6.67; I2 = 64%; 2410 participants, 17 studies; low CoE), as well as those considered severe events (37/927 (4.0%) and 6/969 (0.6%), RR 4.73, 95% CI 2.12 to 10.55; I2 = 0%; 1896 participants, 11 studies; low CoE). Intensive glycaemic control, compared to conventional glycaemic control, may result in little to no difference in the rate of infectious complications (160/1228 (13.0%) versus 224/1225 (18.2%) events, RR 0.75, 95% CI 0.55 to 1.04; P = 0.09; I2 = 55%; 2453 participants, 18 studies; low CoE). Analysis of the predefined secondary outcomes revealed that intensive glycaemic control may result in a decrease in cardiovascular events compared to conventional glycaemic control (107/955 (11.2%) versus 125/978 (12.7%) events, RR 0.73, 95% CI 0.55 to 0.97; P = 0.03; I2 = 44%; 1454 participants, 12 studies; low CoE). Further, intensive glycaemic control resulted in little or no difference in renal failure events compared to conventional glycaemic control (137/1029 (13.3%) and 158/1057 (14.9%), RR 0.92, 95% CI 0.69 to 1.22; P = 0.56; I2 = 38%; 2086 participants, 14 studies; low CoE). We found little to no difference between intensive glycaemic control and conventional glycaemic control in length of ICU stay (MD -0.10 days, 95% CI -0.57 to 0.38; P = 0.69; I2 = 69%; 1687 participants, 11 studies; low CoE), and length of hospital stay (MD -0.79 days, 95% CI -1.79 to 0.21; P = 0.12; I2 = 77%; 1520 participants, 12 studies; very low CoE). Due to the differences within included studies, we did not pool data for the reduction of mean blood glucose. Intensive glycaemic control resulted in a mean lowering of blood glucose, ranging from 13.42 mg/dL to 91.30 mg/dL. One trial assessed health-related quality of life in 12/37 participants in the intensive glycaemic control group, and 13/44 participants in the conventional glycaemic control group; no important difference was shown in the measured physical health composite score of the short-form 12-item health survey (SF-12). One substudy reported a cost analysis of the population of an included study showing a higher total hospital cost in the conventional glycaemic control group, USD 42,052 (32,858 to 56,421) compared to the intensive glycaemic control group, USD 40,884 (31.216 to 49,992). It is important to point out that there is relevant heterogeneity between studies for several outcomes. We identified two ongoing trials. The results of these studies could add new information in future updates on this topic. AUTHORS' CONCLUSIONS High-certainty evidence indicates that perioperative intensive glycaemic control in people with diabetes undergoing surgery does not reduce all-cause mortality compared to conventional glycaemic control. There is low-certainty evidence that intensive glycaemic control may reduce the risk of cardiovascular events, but cause little to no difference to the risk of infectious complications after the intervention, while it may increase the risk of hypoglycaemia. There are no clear differences between the groups for the other outcomes. There are uncertainties among the intensive and conventional groups regarding the optimal glycaemic algorithm and target blood glucose concentrations. In addition, we found poor data on health-related quality of life, socio-economic effects and weight gain. It is also relevant to underline the heterogeneity among studies regarding clinical outcomes and methodological approaches. More studies are needed that consider these factors and provide a higher quality of evidence, especially for outcomes such as hypoglycaemia and infectious complications.
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Affiliation(s)
- Filip Bellon
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gabriel Gimenez-Perez
- Endocrinology Section, Department of Medicine, Hospital General de Granollers, Granollers, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Esther Rubinat
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, University of Vic & Central University of Catalonia, Vic, Spain
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Arteaga-Livias K, Panduro-Correa V, Maguiña JL, Osada J, Rabaan AA, Lijarza-Ushinahua K, Barboza JJ, Gomez-Gonzales W, Rodriguez-Morales AJ. Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals. Antibiotics (Basel) 2023; 12:antibiotics12050808. [PMID: 37237711 DOI: 10.3390/antibiotics12050808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Surgical site infections (SSI) can be as high in gynecology and obstetrics surgeries compared to other areas. Antimicrobial prophylaxis is an effective tool in the prevention of SSIs; however, it is often not adequately administered, so this study aimed to understand the compliance and factors associated with the use of the clinical practice guidelines for antibiotic prophylaxis in gynecological surgeries in two hospitals in the city of Huanuco, Peru. METHODS An analytical cross-sectional study of all gynecologic surgeries performed during 2019 was performed. Compliance was determined based on the antibiotic chosen, dose, administration time, redosing, and prophylaxis duration. Age, hospital of origin, presence of comorbidities, surgery performed, as well as its duration, types of surgery, and anesthesia were considered as related factors. RESULTS We collected 529 medical records of patients undergoing gynecological surgery with a median age of 33 years. The prophylactic antibiotic was correctly indicated in 55.5% of cases, and the dose was correct in 31.2%. Total compliance with the five variables evaluated was only 3.9%. Cefazolin was the most commonly used antibiotic. CONCLUSION Low compliance with the institutional clinical practice guidelines for antibiotic prophylaxis was identified, showing that antimicrobial prophylaxis in the hospitals studied was inadequate.
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Affiliation(s)
- Kovy Arteaga-Livias
- Maestría en Epidemiologia Clinica y Bioestadistica, Universidad Científica del Sur, Lima 15014, Peru
| | - Vicky Panduro-Correa
- Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco 10000, Peru
- Escuela de Medicina, Universidad San Juan Bautista, Lima 15067, Peru
| | - Jorge L Maguiña
- Maestría en Epidemiologia Clinica y Bioestadistica, Universidad Científica del Sur, Lima 15014, Peru
| | - Jorge Osada
- Maestría en Epidemiologia Clinica y Bioestadistica, Universidad Científica del Sur, Lima 15014, Peru
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur 22610, Pakistan
| | - Kiara Lijarza-Ushinahua
- Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco 10000, Peru
- Sociedad Científica de Estudiantes de Medicina (SOCIEM-HCO), Universidad Nacional Hermilio Vadlizán, Huánuco 10000, Peru
| | - Joshuan J Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru
| | - Walter Gomez-Gonzales
- Escuela de Medicina-Filial Ica, Universidad Privada San Juan Bautista, Ica 11001, Peru
| | - Alfonso J Rodriguez-Morales
- Maestría en Epidemiologia Clinica y Bioestadistica, Universidad Científica del Sur, Lima 15014, Peru
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira 660005, Colombia
- GIlbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 36, Lebanon
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Qian W, Sun W, Xie S. Risk factors of wound infection after lung transplantation: a narrative review. J Thorac Dis 2022; 14:2268-2275. [PMID: 35813752 PMCID: PMC9264078 DOI: 10.21037/jtd-22-543] [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: 04/11/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
Background and Objective The incidence of incision infection after lung transplantation is prominently high which affect the prognosis. Summarizing the risk factors related to incision infection after lung transplantation contribute to the control of incision infection by pre-controlling the risk factors. The objective is to summarize risk factors related to wound infection after lung transplantation. Methods PubMed was used to research the literature relating to the risk factors to incision infection after lung transplantation through 1990 to 2022. The retrieval strategy were Medical Subject Heading (MeSH) terms combined entry terms. Two researchers conducted the literature retrieval independently. Two researchers independently evaluate the quality of the literature and summarize the indicators. Key Content and Findings A total of 98 researches were collected from PubMed and 8 articles described the related risk factors of incision infection after lung transplantation. All of the 8 articles were retrospective studies, of which 4 articles were grouped by the delayed chest closure (DCC) execution and the other 4 articles were grouped by the surgical site infection (SSI) occurred. Two articles performed multivariate regression analysis to determine the independent risk factors of SSI after lung transplantation and the other 6 articles compared the SSI rate in different patients population. The integrated results showed that bronchoalveolar lavages (BALs), smoking status, body mass index (BMI), diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation. Conclusions BALs, smoking status, BMI, diabetes, operation duration, thoracic drainage tube placement time and DCC were related to the SSI after lung transplantation.
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Affiliation(s)
- Weiwei Qian
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Sun
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shenglong Xie
- Department of Thoracic Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
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