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Lee SJ, Lee R, Cho SY, Nho D, Ahn HL, Lee DG. Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea. Korean J Intern Med 2024; 39:399-412. [PMID: 38715230 PMCID: PMC11076883 DOI: 10.3904/kjim.2023.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 05/12/2024] Open
Abstract
Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.
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Affiliation(s)
- Soo Jin Lee
- Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul,
Korea
| | - Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dukhee Nho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hye Lim Ahn
- Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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2
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Yoo N, Mun JY, Kye BH, Kim CW, Lee JI, Park YY, Kang BM, Park BK, Kwak HD, Kang WK, Bae SU, Oh HK, Hong Y, Kim HJ. Plastic Wound Protector vs Surgical Gauze for Surgical Site Infection Reduction in Open GI Surgery: A Randomized Clinical Trial. JAMA Surg 2024:2817942. [PMID: 38656413 PMCID: PMC11044008 DOI: 10.1001/jamasurg.2024.0765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/02/2024] [Indexed: 04/26/2024]
Abstract
Importance Surgical site infections (SSIs) are prevalent hospital-acquired infections with significant patient impacts and global health care burdens. The World Health Organization recommends using wound protector devices in abdominal surgery as a preventive measure to lower the risk of SSIs despite limited evidence. Objective To examine the efficacy of a dual-ring, plastic wound protector in lowering the SSI rate in open gastrointestinal (GI) surgery irrespective of intra-abdominal contamination levels. Design, Setting, and Participants This multicenter, patient-blinded, parallel-arm randomized clinical trial was conducted from August 2017 to October 2022 at 13 hospitals in an academic setting. Patients undergoing open abdominal bowel surgery (eg, for bowel perforation) were eligible for inclusion. Intervention Patients were randomized 1:1 to a dual-ring, plastic wound protector to protect the incision site of the abdominal wall (experimental group) or a conventional surgical gauze (control group). Main Outcomes and Measures The primary end point was the rate of SSI within 30 days of open GI surgery. Results A total of 458 patients were randomized; after 1 was excluded from the control group, 457 were included in the intention-to-treat analysis (mean [SD] age, 58.4 [12.1] years; 256 [56.0%] male; 341 [74.6%] with a clean-contaminated wound): 229 in the wound protector group and 228 in the surgical gauze group. The overall SSI rate in the intention-to-treat analysis was 15.7% (72 of 458 patients). The SSI rate for the wound protector was 10.9% (25 of 229 patients) compared with 20.5% (47 of 229 patients) with surgical gauze. The wound protector significantly reduced the risk of SSI, with a relative risk reduction (RRR) of 46.81% (95% CI, 16.64%-66.06%). The wound protector significantly decreased the SSI rate for clean-contaminated wounds (RRR, 43.75%; 95% CI, 3.75%-67.13%), particularly for superficial SSIs (RRR, 42.50%; 95% CI, 7.16%-64.39%). Length of hospital stay was similar in both groups (mean [SD], 15.2 [10.5] vs 15.3 [10.2] days), as were the overall postoperative complication rates (20.1% vs 18.8%). Conclusions and Relevance This randomized clinical trial found a significant reduction in SSI rates when a plastic wound protector was used during open GI surgery compared with surgical gaze, supporting the World Health Organization recommendation for use of wound protector devices in abdominal surgery. Trial Registration ClinicalTrials.gov Identifier: NCT03170843.
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Affiliation(s)
- Nina Yoo
- Department of Surgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Yeon Mun
- Department of Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Hyeon Kye
- Department of Surgery, St Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chang Woo Kim
- Department of Surgery, Ajou University Hospital, Suwon, Korea
| | - Jae Im Lee
- Department of Surgery, Uijeongbu St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Youn Young Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Byung Mo Kang
- Department of Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Byung Kwan Park
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, College of Medicine, Chonnam National University, Gwangju, Korea
| | - Won-Kyung Kang
- Department of Surgery, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Uk Bae
- Department of Surgery, Keimyung University and Dongsan Medical Center, Daegu, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youngki Hong
- Department of Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Hyung Jin Kim
- Department of Surgery, EunPyeong St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Park YY, Lee SH. Korean perspectives of surgical site infection surveillance: an interim analysis of SSI rates in abdominal surgery before and after SSI prevention bundle education. J Hosp Infect 2024; 146:199-205. [PMID: 37301231 DOI: 10.1016/j.jhin.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Y Y Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea
| | - S-H Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea.
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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vicentini C, Elhadidy HSMA, Marengo N, Paladini G, Cornio AR, Zotti CM. Mortality and Case Fatality Rates Associated With Surgical Site Infections: A Retrospective Surveillance Study. Surg Infect (Larchmt) 2023; 24:734-740. [PMID: 37669111 DOI: 10.1089/sur.2023.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Background: Surgical site infections (SSIs) have been associated with increases in terms of costs, hospital stay, morbidity, and mortality. We aimed to assess trends in SSIs monitored through 10 years of surveillance activities in our region, and to describe mortality attributable to SSIs in the two most frequently monitored surgical procedures: colorectal surgery and hip arthroplasty. Methods: A retrospective cohort study was conducted among the 42 hospitals participating in the surveillance network of our region in northern Italy. All colorectal and hip arthroplasty procedures performed between January 1st, 2010, and December 31st, 2019, and monitored through the surveillance system were included in the study. Surgical site infection rates, overall mortality, case fatality rates (CFR), and mortality attributable to SSIs were evaluated overall and by year of participation in the surveillance program. Results: In total, 11,417 colon surgery and 20,804 hip arthroplasty procedures were included. Among colon surgery procedures, SSI rates decreased from 9.21% in 2010 to 5.7% in 2019. A significant decreasing trend was found for overall mortality (p = 0.008), which progressively decreased from 4.96% in 2010 to 2.96% in 2019. Among hip arthroplasty procedures, no significant trend emerged for SSI and mortality rates. Considering the 10-year period, the CFR was 6.62% and 3.7% for SSIs after colon surgery and hip arthroplasty procedures, respectively. Conclusions: The impact of SSIs on the clinical outcomes of patients undergoing surgery highlights the importance of SSI surveillance.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Noemi Marengo
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Giovanni Paladini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
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Zhai J, Cui J, Zhang J, Hu J, Yu Z. Kinetic simulation study of femtosecond laser processing of graphene oxide: first-principles. J Mol Model 2023; 29:265. [PMID: 37498391 DOI: 10.1007/s00894-023-05671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
CONTEXT Organic-inorganic nanoparticles have received extensive attention in various fields due to their unique physicochemical properties and biological activities. Among these nanoparticles, graphene oxide (GO) has emerged as a promising material, and thus, its application in biomedical fields is of great interest. Coating graphene oxide on the surface of implants can enhance its properties such as antibacterial and cell proliferation promotion, but the osteogenic properties of graphene oxide coating need further improvement, and the chance of acute inflammation triggered by local reactive oxygen species accumulation needs to be reduced. High-precision modulation of graphene oxide surface micro/nanomorphology and chemical composition can be achieved using femtosecond laser processing technology to improve its performance while also reducing the oxygen content of the graphene oxide surface to some extent. In this paper, the properties of graphene oxide were investigated by kinetic simulations based on the first-principle. The results show that the band gap of graphene oxide changes from 0.386 to 0.021 eV; the work function changes from 4.882 to 4.64 eV; the size and number of peaks in the radial distribution function decreases; and the intensity of the scatter X-ray peak becomes smaller under the action of femtosecond laser, indicating that the oxygen-containing functional groups on the surface of graphene oxide are disrupted, which provides a basis for its potential application in the medical field. METHODS To investigate the properties of graphene oxide, SEM, XPS, Raman, and FTIR characterizations were first used to determine the oxygen-containing functional group species on the surface of graphene oxide. The structural model of graphene oxide was then modeled for density flooding theory (DFT) simulations using Biovia Materials Studio software, which was implemented in the CASTEP code. Our DFT calculations were performed using the generalized gradient approximation (GGA) as parameterized by the Perdew-Burke Ernzerhof (PBE) exchange-correlation functional. Additionally, we employed the norm-conserving pseudopotential to treat core electrons.
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Affiliation(s)
- Jianwei Zhai
- College of Mechanical Engineering, Donghua University, Shanghai, 201620, China
| | - Jinye Cui
- College of Mechanical Engineering, Donghua University, Shanghai, 201620, China
| | - Jinhua Zhang
- College of Mechanical Engineering, Donghua University, Shanghai, 201620, China
| | - Jun Hu
- Institute of Artificial Intelligence, Donghua University, Shanghai, 201620, China.
| | - Zhou Yu
- Institute of Artificial Intelligence, Donghua University, Shanghai, 201620, China.
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Dale H, Fenstad AM, Hallan G, Overgaard S, Pedersen AB, Hailer NP, Kärrholm J, Rolfson O, Eskelinen A, Mäkelä KT, Furnes O. Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association. Acta Orthop 2023; 94:307-315. [PMID: 37378447 DOI: 10.2340/17453674.2023.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND PURPOSE The incidence of periprosthetic joint infection after total hip arthroplasty (THA) may be increasing. We performed time-trend analyses of risk, rates, and timing of revision due to infection after primary THAs in the Nordic countries from the period 2004-2018. PATIENTS AND METHODS 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 to 2018 were studied. Absolute risk estimates were calculated by Kaplan-Meier and cumulative incidence function methods, whereas adjusted hazard ratios (aHR) were assessed by Cox regression with the first revision due to infection after primary THA as primary endpoint. In addition, we explored changes in the time span from primary THA to revision due to infection. RESULTS 5,653 (1.0%) primary THAs were revised due to infection during a median follow-up time of 5.4 (IQR 2.5-8.9) years after surgery. Compared with the period 2004-2008, the aHRs for revision were 1.4 (95% confidence interval [CI] 1.3-1.5) for 2009-2013, and 1.9 (CI 1.7-2.0) for 2014-2018. The absolute 5-year rates of revision due to infection were 0.7% (CI 0.7-0.7), 1.0% (CI 0.9-1.0), and 1.2% (CI 1.2-1.3) for the 3 time periods respectively. We found changes in the time span from primary THA to revision due to infection. Compared with 2004-2008, the aHR for revision within 30 days after THA was 2.5 (CI 2.1-2.9) for 2009-2013, and 3.4 (CI 3.0-3.9) for 2013-2018. The aHR for revision within 31-90 days after THA was 1.5 (CI 1.3-1.9) for 2009-2013, and 2.5 (CI 2.1-3.0) for 2013-2018, compared with 2004-2008. CONCLUSION The risk of revision due to infection after primary THA almost doubled, both in absolute cumulative incidence and in relative risk, throughout the period 2004-2018. This increase was mainly due to an increased risk of revision within 90 days of THA. This may reflect a "true" increase (i.e., frailer patients or more use of uncemented implants) and/or an "apparent" increase (i.e., improved diagnostics, changed revision strategy, or completeness of reporting) in incidence of periprosthetic joint infection. It is not possible to disclose such changes in the present study, and this warrants further research.
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Affiliation(s)
- Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway.
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Søren Overgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; The Danish Hip Arthroplasty Register, Aarhus, Denmark
| | - Alma B Pedersen
- The Danish Hip Arthroplasty Register, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Nils P Hailer
- Section of Orthopaedics, Department of Surgical Sciences, Uppsala University Hospital, Sweden; The Swedish Arthroplasty Register, Gothenburg, Sweden
| | - Johan Kärrholm
- The Swedish Arthroplasty Register, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ola Rolfson
- The Swedish Arthroplasty Register, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland; The Finnish Arthroplasty Register, Helsinki, Finland
| | - Keijo T Mäkelä
- The Finnish Arthroplasty Register, Helsinki, Finland; Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Finland
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
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Moore AJ, Wylde V, Whitehouse MR, Beswick AD, Walsh NE, Jameson C, Blom AW. Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection. Bone Jt Open 2023; 4:226-233. [PMID: 37051823 PMCID: PMC10065846 DOI: 10.1302/2633-1462.44.bjo-2022-0155.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Aims Periprosthetic hip-joint infection is a multifaceted and highly detrimental outcome for patients and clinicians. The incidence of prosthetic joint infection reported within two years of primary hip arthroplasty ranges from 0.8% to 2.1%. Costs of treatment are over five-times greater in people with periprosthetic hip joint infection than in those with no infection. Currently, there are no national evidence-based guidelines for treatment and management of this condition to guide clinical practice or to inform clinical study design. The aim of this study is to develop guidelines based on evidence from the six-year INFection and ORthopaedic Management (INFORM) research programme. Methods We used a consensus process consisting of an evidence review to generate items for the guidelines and online consensus questionnaire and virtual face-to-face consensus meeting to draft the guidelines. Results The consensus panel comprised 21 clinical experts in orthopaedics, primary care, rehabilitation, and healthcare commissioning. The final output from the consensus process was a 14-item guideline. The guidelines make recommendations regarding increased vigilance and monitoring of those at increased risk of infection; diagnosis including strategies to ensure the early recognition of prosthetic infection and referral to orthopaedic teams; treatment, including early use of DAIR and revision strategies; and postoperative management including appropriate physical and psychological support and antibiotic strategies. Conclusion We believe the implementation of the INFORM guidelines will inform treatment protocols and clinical pathways to improve the treatment and management of periprosthetic hip infection. Cite this article: Bone Jt Open 2023;4(4):226–233.
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Affiliation(s)
- Andrew J. Moore
- University of Bristol, Bristol, UK
- Correspondence should be sent to Andrew J. Moore. E-mail:
| | | | | | | | - Nicola E. Walsh
- HAS - Allied Health Professions, University of the West of England, Bristol, UK
| | | | - Ashley W. Blom
- University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
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Sodhi N, Anis HK, Acuña AJ, Gold P, Garbarino L, Higuera CA, Mont MA. Early Infection Trends for Primary Total Knee Arthroplasty: A 5-Year Review. J Knee Surg 2023; 36:269-273. [PMID: 34261159 DOI: 10.1055/s-0041-1731736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to track the annual rates and trends of overall, deep, and superficial surgical site infections (SSIs) following total knee arthroplasty using the most recent results from a large and nationwide database. A total of 197,192 cases were performed between 2012 and 2016 from a nationwide database stratified into years and based on superficial and/or deep SSIs. Cohorts were analyzed individually and then combined to evaluate overall SSI rates. The infection incidence for each year was calculated. After a 6-year correlation and trends analysis, univariate analyses were performed to compare the most recent year, 2016, with each of the preceding 4 years. Overall, there was a downward trend in overall SSI rates over the study period (2012-2016, with the lowest rate occurring in the most recent year, 2016 [0.11%]). Additionally, there was a decreasing trend for superficial SSI, with the lowest superficial SSI incidence occurring in 2016 (0.47%) and the greatest incidence occurring in 2012 (0.53%). An overall trend of decreasing SSI rates was observed nationwide over the 5-year period evaluated. A similar decreasing trend was also noted specifically for deep SSI rates, which can be potentially more complicated to manage, and result in decreased implant survivorship. The down trending SSI rates observed give potential credence to the value for newer and developing SSI preventative therapies as well as improved medical and surgical patient management. Nevertheless, there is still room for improvement, and continued efforts are needed to further lower SSIs after total knee arthroplasty.
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Affiliation(s)
- Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Hiba K Anis
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Peter Gold
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Luke Garbarino
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Carlos A Higuera
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York City, New York
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Blom AW, Beswick AD, Burston A, Carroll FE, Garfield K, Gooberman-Hill R, Harris S, Kunutsor SK, Lane A, Lenguerrand E, MacGowan A, Mallon C, Moore AJ, Noble S, Palmer CK, Rolfson O, Strange S, Whitehouse MR. Infection after total joint replacement of the hip and knee: research programme including the INFORM RCT. Programme Grants Appl Res 2022. [DOI: 10.3310/hdwl9760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background
People with severe osteoarthritis, other joint conditions or injury may have joint replacement to reduce pain and disability. In the UK in 2019, over 200,000 hip and knee replacements were performed. About 1 in 100 replacements becomes infected, and most people with infected replacements require further surgery.
Objectives
To investigate why some patients are predisposed to joint infections and how this affects patients and the NHS, and to evaluate treatments.
Design
Systematic reviews, joint registry analyses, qualitative interviews, a randomised controlled trial, health economic analyses and a discrete choice questionnaire.
Setting
Our studies are relevant to the NHS, to the Swedish health system and internationally.
Participants
People with prosthetic joint infection after hip or knee replacement and surgeons.
Interventions
Revision of hip prosthetic joint infection with a single- or two-stage procedure.
Main outcome measures
Long-term patient-reported outcomes and reinfection. Cost-effectiveness of revision strategies over 18 months from two perspectives: health-care provider and Personal Social Services, and societal.
Data sources
National Joint Registry; literature databases; published cohort studies; interviews with 67 patients and 35 surgeons; a patient discrete choice questionnaire; and the INFORM (INFection ORthopaedic Management) randomised trial.
Review methods
Systematic reviews of studies reporting risk factors, diagnosis, treatment outcomes and cost comparisons. Individual patient data meta-analysis.
Results
In registry analyses, about 0.62% and 0.75% of patients with hip and knee replacement, respectively, had joint infection requiring surgery. Rates were four times greater after aseptic revision. The costs of inpatient and day-case admissions in people with hip prosthetic joint infection were about five times higher than those in people with no infection, an additional cost of > £30,000. People described devastating effects of hip and knee prosthetic joint infection and treatment. In the treatment of hip prosthetic joint infection, a two-stage procedure with or without a cement spacer had a greater negative impact on patient well-being than a single- or two-stage procedure with a custom-made articulating spacer. Surgeons described the significant emotional impact of hip and knee prosthetic joint infection and the importance of a supportive multidisciplinary team. In systematic reviews and registry analyses, the risk factors for hip and knee prosthetic joint infection included male sex, diagnoses other than osteoarthritis, high body mass index, poor physical status, diabetes, dementia and liver disease. Evidence linking health-care setting and surgeon experience with prosthetic joint infection was inconsistent. Uncemented fixation, posterior approach and ceramic bearings were associated with lower infection risk after hip replacement. In our systematic review, synovial fluid alpha-defensin and leucocyte esterase showed high diagnostic accuracy for prosthetic joint infection. Systematic reviews and individual patient data meta-analysis showed similar reinfection outcomes in patients with hip or knee prosthetic joint infection treated with single- and two-stage revision. In registry analysis, there was a higher rate of early rerevision after single-stage revision for hip prosthetic joint infection, but, overall, 40% fewer operations are required as part of a single-stage procedure than as part of a two-stage procedure. The treatment of hip or knee prosthetic joint infection with early debridement and implant retention may be effective in > 60% of cases. In the INFORM randomised controlled trial, 140 patients with hip prosthetic joint infection were randomised to single- or two-stage revision. Eighteen months after randomisation, pain, function and stiffness were similar between the randomised groups (p = 0.98), and there were no differences in reinfection rates. Patient outcomes improved earlier in the single-stage than in the two-stage group. Participants randomised to a single-stage procedure had lower costs (mean difference –£10,055, 95% confidence interval –£19,568 to –£542) and higher quality-adjusted life-years (mean difference 0.06, 95% confidence interval –0.07 to 0.18) than those randomised to a two-stage procedure. Single-stage was the more cost-effective option, with an incremental net monetary benefit at a threshold of £20,000 per quality-adjusted life-year of £11,167 (95% confidence interval £638 to £21,696). In a discrete choice questionnaire completed by 57 patients 18 months after surgery to treat hip prosthetic joint infection, the most valued characteristics in decisions about revision were the ability to engage in valued activities and a quick return to normal activity.
Limitations
Some research was specific to people with hip prosthetic joint infection. Study populations in meta-analyses and registry analyses may have been selected for joint replacement and specific treatments. The INFORM trial was not powered to study reinfection and was limited to 18 months’ follow-up. The qualitative study subgroups were small.
Conclusions
We identified risk factors, diagnostic biomarkers, effective treatments and patient preferences for the treatment of hip and knee prosthetic joint infection. The risk factors include male sex, diagnoses other than osteoarthritis, specific comorbidities and surgical factors. Synovial fluid alpha-defensin and leucocyte esterase showed high diagnostic accuracy. Infection is devastating for patients and surgeons, both of whom describe the need for support during treatment. Debridement and implant retention is effective, particularly if performed early. For infected hip replacements, single- and two-stage revision appear equally efficacious, but single-stage has better early results, is cost-effective at 18-month follow-up and is increasingly used. Patients prefer treatments that allow full functional return within 3–9 months.
Future work
For people with infection, develop information, counselling, peer support and care pathways. Develop supportive care and information for patients and health-care professionals to enable the early recognition of infections. Compare alternative and new treatment strategies in hip and knee prosthetic joint infection. Assess diagnostic methods and establish NHS diagnostic criteria.
Study registration
The INFORM randomised controlled trial is registered as ISRCTN10956306. All systematic reviews were registered in PROSPERO (as CRD42017069526, CRD42015023485, CRD42018106503, CRD42018114592, CRD42015023704, CRD42017057513, CRD42015016559, CRD42015017327 and CRD42015016664).
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fran E Carroll
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kirsty Garfield
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shaun Harris
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Setor K Kunutsor
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Charlotte Mallon
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew J Moore
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cecily K Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ola Rolfson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Strange
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Blom AW, Lenguerrand E, Strange S, Noble SM, Beswick AD, Burston A, Garfield K, Gooberman-Hill R, Harris SRS, Kunutsor SK, Lane JA, MacGowan A, Mehendale S, Moore AJ, Rolfson O, Webb JCJ, Wilson M, Whitehouse MR. Clinical and cost effectiveness of single stage compared with two stage revision for hip prosthetic joint infection (INFORM): pragmatic, parallel group, open label, randomised controlled trial. BMJ 2022; 379:e071281. [PMID: 36316046 PMCID: PMC9645409 DOI: 10.1136/bmj-2022-071281] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine whether patient reported outcomes improve after single stage versus two stage revision surgery for prosthetic joint infection of the hip, and to determine the cost effectiveness of these procedures. DESIGN Pragmatic, parallel group, open label, randomised controlled trial. SETTING High volume tertiary referral centres or orthopaedic units in the UK (n=12) and in Sweden (n=3), recruiting from 1 March 2015 to 19 December 2018. PARTICIPANTS 140 adults (aged ≥18 years) with a prosthetic joint infection of the hip who required revision (65 randomly assigned to single stage and 75 to two stage revision). INTERVENTIONS A computer generated 1:1 randomisation list stratified by hospital was used to allocate participants with prosthetic joint infection of the hip to a single stage or a two stage revision procedure. MAIN OUTCOME MEASURES The primary intention-to-treat outcome was pain, stiffness, and functional limitations 18 months after randomisation, measured by the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes included surgical complications and joint infection. The economic evaluation (only assessed in UK participants) compared quality adjusted life years and costs between the randomised groups. RESULTS The mean age of participants was 71 years (standard deviation 9) and 51 (36%) were women. WOMAC scores did not differ between groups at 18 months (mean difference 0.13 (95% confidence interval -8.20 to 8.46), P=0.98); however, the single stage procedure was better at three months (11.53 (3.89 to 19.17), P=0.003), but not from six months onwards. Intraoperative events occurred in five (8%) participants in the single stage group and 20 (27%) in the two stage group (P=0.01). At 18 months, nine (14%) participants in the single stage group and eight (11%) in the two stage group had at least one marker of possible ongoing infection (P=0.62). From the perspective of healthcare providers and personal social services, single stage revision was cost effective with an incremental net monetary benefit of £11 167 (95% confidence interval £638 to £21 696) at a £20 000 per quality adjusted life years threshold (£1.0; $1.1; €1.4). CONCLUSIONS At 18 months, single stage revision compared with two stage revision for prosthetic joint infection of the hip showed no superiority by patient reported outcome. Single stage revision had a better outcome at three months, fewer intraoperative complications, and was cost effective. Patients prefer early restoration of function, therefore, when deciding treatment, surgeons should consider patient preferences and the cost effectiveness of single stage surgery. TRIAL REGISTRATION ISRCTN registry ISRCTN10956306.
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Affiliation(s)
- Ashley W Blom
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Simon Strange
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Sian M Noble
- University of Bristol Medical School, Population Health Sciences, Canynge Hall, Bristol, UK
| | - Andrew D Beswick
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Amanda Burston
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Kirsty Garfield
- University of Bristol Medical School, Population Health Sciences, Canynge Hall, Bristol, UK
- University of Bristol Faculty of Health Sciences, Bristol Randomised Trials Collaboration, Canynge Hall, Bristol, UK
| | - Rachael Gooberman-Hill
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Shaun R S Harris
- University of Bristol Medical School, Population Health Sciences, Canynge Hall, Bristol, UK
- University of Bristol Faculty of Health Sciences, Bristol Randomised Trials Collaboration, Canynge Hall, Bristol, UK
| | - Setor K Kunutsor
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - J Athene Lane
- University of Bristol Medical School, Population Health Sciences, Canynge Hall, Bristol, UK
- University of Bristol Faculty of Health Sciences, Bristol Randomised Trials Collaboration, Canynge Hall, Bristol, UK
| | - Alasdair MacGowan
- Department of Medical Microbiology, Southmead Hospital, North Bristol NHS Trust, Bristol, Westbury-on-Trym, UK
| | - Sanchit Mehendale
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Andrew J Moore
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Ola Rolfson
- Department of Orthopaedics at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Jason C J Webb
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - Matthew Wilson
- The Exeter Hip Unit, Princess Elizabeth Orthopaedic Hospital, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Michael R Whitehouse
- University of Bristol Medical School, Translational Health Sciences, Musculoskeletal Research Unit, Level 1 Learning and Research Building, Southmead Hospital, Westbury-on-Trym, Bristol, UK
- National Institute for Health and Care Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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Takahashi T, Nishiura H. Increasing rates of laparoscopic gastrointestinal surgery and decreasing rates of surgical site infections: an observational study in Japan from 2012-2017. BMC Surg 2021; 21:370. [PMID: 34670525 PMCID: PMC8527652 DOI: 10.1186/s12893-021-01373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are the most common healthcare-associated infection, and gastrointestinal surgery is frequently followed by a high incidence of SSI. Epidemiological analysis of the temporal trends in SSI following gastrointestinal surgery has yet to be performed in Japan. Our purpose was to descriptively investigate these trends. METHODS Extracting national surveillance data from the Japan Nosocomial Infections Surveillance (JANIS) system, we analyzed the frequency of SSI events following gastrointestinal surgery, which consisted of seven surgical procedures, from 2012-2017. We calculated the standardized infection ratio to compute risk-adjusted SSI frequency, and used the trend test to detect time-dependent changes. RESULTS The frequency of SSI events, except for those associated with surgery of the upper gastrointestinal tract, revealed a decreasing time-dependent trend. The use of laparoscopic surgery increased dramatically over time (p < 0.01 for the six applicable surgical sites), while the frequency of SSI events during laparoscopic surgery remained unchanged. CONCLUSIONS The increasing use of laparoscopic surgery was identified, and the observation coincided with the decreasing trend in SSI, especially in lower gastrointestinal tract surgery. If the relationship is causal, the overall SSI incidence among previously healthy individuals is expected to decrease, because the use of laparoscopic surgery has large growth potential in Japan.
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Affiliation(s)
- Tomoko Takahashi
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan.,Infection Control Team, Sapporo Kousei Hospital, Kita3-Higashi8, Chuo-Ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan. .,Kyoto University School of Public Health, Yoshida-konoecho, Sakyoku, Kyoto, 606-8501, Japan.
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Bataille C, Venier AG, Caire F, Salle H, Le Guyader A, Pesteil F, Chauvet R, Marcheix PS, Valleix D, Fourcade L, Aubry K, Brie J, Robert PY, Pefau M, Ploy MC, D'Hollander-Pestourie N, Couve-Deacon E. Benefits of a 14-year surgical site infections active surveillance programme in a French teaching hospital. J Hosp Infect 2021; 117:65-73. [PMID: 34384860 DOI: 10.1016/j.jhin.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are the second most common healthcare-associated infection. Active SSI surveillance can help inform preventative measures and assess the impact of these measures. AIM We aimed to describe the evolution in trends over 14 years of prospective active SSI surveillance and implementations of SSI prevention measures in a French Teaching Hospital. METHODS We monitored and included in the study all surgical procedures performed from 2003 to 2016 in eight surgical units. The semi-automated surveillance method consisted of weekly collection of SSI declaration forms (pre-filled with patient and procedure administrative data and microbiology laboratory data), filled-in by surgeons and then monitored by the infection control practitioners. FINDINGS A total of 181,746 procedures were included in our analysis and 3270 SSIs recorded (global SSI rate 1.8%). The SSI rate decreased significantly from 3.0% in 2003 to 1.1% in 2016. This decrease was mainly in superficial SSIs and high infectious risk procedures. Higher SSI rates were observed for procedures associated with the usual risk factors. During this 14-year period, several evolutions in surgical practices occurred that might have contributed to this decrease. CONCLUSIONS With an overall decrease in SSI rate throughout the surveillance, our results revealed the benefits of an active and comprehensive hospital SSI surveillance programme for understanding the SSI rate trends, analysing local risk factors and assessing the effectiveness of prevention strategies. These findings also highlighted the importance of the collaboration between surgeons and infection control practitioners.
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Dale H, Høvding P, Tveit SM, Graff JB, Lutro O, Schrama JC, Wik TS, Skråmm I, Westberg M, Fenstad AM, Hallan G, Engesaeter LB, Furnes O. Increasing but levelling out risk of revision due to infection after total hip arthroplasty: a study on 108,854 primary THAs in the Norwegian Arthroplasty Register from 2005 to 2019. Acta Orthop 2021; 92:208-214. [PMID: 33228428 PMCID: PMC8158216 DOI: 10.1080/17453674.2020.1851533] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - Focus on prevention, surveillance, and treatment of infection after total hip arthroplasty (THA) in the last decade has resulted in new knowledge and guidelines. Previous publications have suggested an increased incidence of surgical revisions due to infection after THA. We assessed whether there have been changes in the risk of revision due to deep infection after primary THAs reported to the Norwegian Arthroplasty Register (NAR) over the period 2005-2019.Patients and methods - Primary THAs reported to the NAR from January 1, 2005 to December 31, 2019 were included. Adjusted Cox regression analyses with the first revision due to deep infection after primary THA were performed. We investigated changes in the risk of revision as a function of time of primary THA. Time was stratified into 5-year periods. We studied the whole population of THAs, and the subgroups: all-cemented, all-uncemented, reverse hybrid (cemented cup), and hybrid THAs (cemented stem). In addition, we investigated factors that were associated with the risk of revision, and changes in the time span from primary THA to revision.Results - Of the 108,854 primary THAs that met the inclusion criteria, 1,365 (1.3%) were revised due to deep infection. The risk of revision due to infection, at any time after primary surgery, increased through the period studied. Compared with THAs implanted in 2005-2009, the relative risk of revision due to infection was 1.4 (95% CI 1.2-1.7) for 2010-2014, and 1.6 (1.1-1.9) for 2015-2019. We found an increased risk for all types of implant fixation. Compared to 2005-2009, for all THAs, the risk of revision due to infection 0-30 days postoperatively was 2.2 (1.8-2.8) for 2010-2014 and 2.3 (1.8-2.9) for 2015-2019, 31-90 days postoperatively 1.0 (0.7-1.6) for 2010-2014 and 1.6 (1.0-2.5) for 2015-2019, and finally 91 days-1 year postoperatively 1.1 (0.7-1.8) for 2010-2014 and 1.6 (1.0-2.6) for 2015-2019. From 1 to 5 years postoperatively, the risk of revision due to infection was similar to 2005-2009 for both the subsequent time periodsInterpretation - The risk of revision due to deep infection after THA increased throughout the period 2005-2019, but appears to have levelled out after 2010. The increase was mainly due to an increased risk of early revisions, and may partly have been caused by a change of practice rather than a change in the incidence of infection.
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Affiliation(s)
- Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
- Department of Clinical Medicine, University of Bergen, Bergen;
| | - Pål Høvding
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Sindre M Tveit
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Julie B Graff
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Olav Lutro
- Department of Medicine, Stavanger University Hospital, Stavanger;
| | - Johannes C Schrama
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Tina S Wik
- Department of Orthopaedic Surgery, St Olav University Hospital, Trondheim;
| | - Inge Skråmm
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog;
| | - Marianne Westberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
- Department of Clinical Medicine, University of Bergen, Bergen;
| | - Lars B Engesaeter
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
- Department of Clinical Medicine, University of Bergen, Bergen;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
- Department of Clinical Medicine, University of Bergen, Bergen;
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Ryu M, Yoo H, Choi YK. National hospital quality measures for surgical site infections in South Korea: a survey among 20 expert physicians. Patient Saf Surg 2020; 14:29. [PMID: 32684979 PMCID: PMC7359616 DOI: 10.1186/s13037-020-00255-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/07/2020] [Indexed: 12/23/2022] Open
Abstract
Background Surgical site infection (SSI) is recognized as an important quality indicator for patient safety. In Korea, the use of prophylactic antibiotics for surgery is conducted as a national quality measures related to SSI prevention. The objective of the present study was to investigate physicians’ perceptions of hospital quality measures for SSI as well as identify obstacles that might hinder its implementation in South Korea. Method Online-based questionnaires were administered twice. Twenty physician experts who were members of the Healthcare Review and Assessment Committee that was constituted for the “Assessment of prophylactic use of antibiotics for surgery” participated in the study. The first survey comprised open-ended questions that were designed to elicit the physician who could hinder the implementation of SSI indicators. The second survey, which was developed on the basis of the initial survey’s results, consisted of 10 closed-ended questions about the feasibility of objective perception and the need for subjectivity, with regard to SSI. Results From among the 20 physicians, we collected data from 16 respondents in the first survey (response rate of 80%) and 15 respondents in the second survey (response rate of 75%).Thirty-one percent of the respondents supported hospital SSI evaluations, and 69% expressed objections. The obstacles that were perceived as being able to hinder hospital SSI evaluations pertained to difficulties in collecting data, unavailability of information, possibility of underreporting, and redundancy of the inquiry undertaken by the Korean National Healthcare-associated Infections Surveillance System-SSI. Physician experts provide significantly higher ratings for the clinical indicator, rate of readmission due to SSI, both in terms of feasibility and need, when evaluating the results of SSI prevention in hospitals. Conclusion The results of this study show that physicians perceive the need for QI development of hospital SSI measurements to prevent nation-wide SSIs in Korea. However, the feasibility of hospital SSI measurements is low. To develop QIs of hospital SSIs using health insurance claims data, it is necessary to develop a methodology for claims data-based surveillance systems and a data collection system in order to increase the sensitivity and validity of post-operative SSI detection.
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Affiliation(s)
- Mikyung Ryu
- College of Nursing and Public Health, Daegu University, 33 Seongdang-ro 50-gil, Nam-gu, Daegu, Seoul, 42400 South Korea
| | - Hyerim Yoo
- Review & Assessment Research Department, Health Insurance Review & Assessment Service, 60 Hyeoksin-ro, Wonju-si, Seoul, Gangwon-do 26465 South Korea
| | - Yun-Kyoung Choi
- Department of Nursing, Korea National Open University, 86, Daehak-ro, Jongno-gu, Seoul, 03087 South Korea
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Surveillance von nosokomialen Infektionen: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:228-41. [DOI: 10.1007/s00103-019-03077-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Vicentini C, Dalmasso P, Politano G, Furmenti MF, Quattrocolo F, Zotti CM. Surgical Site Infections in Italy, 2009–2015: Incidence, Trends, and Impact of Surveillance Duration on Infection Risk. Surg Infect (Larchmt) 2019; 20:504-509. [DOI: 10.1089/sur.2018.298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
| | - Paola Dalmasso
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
| | - Gianfranco Politano
- Control and Computer Engineering Department, Politecnico di Torino, Torino, Italy
| | | | | | - Carla Maria Zotti
- Department of Public Health and Paediatrics, Università di Torino, Torino, Italy
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Sodhi N, Anis HK, Garbarino LJ, Gold PA, Kurtz SM, Higuera CA, Hepinstall MS, Mont MA. Have We Actually Reduced Our 30-Day Short-Term Surgical Site Infection Rates in Primary Total Hip Arthroplasty in the United States? J Arthroplasty 2019; 34:2102-2106. [PMID: 31130444 DOI: 10.1016/j.arth.2019.04.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to track the 30-day postoperative annual rates and trends of (1) overall, (2) deep, and (3) superficial surgical site infections (SSIs) following total hip arthroplasty (THA) using a large nationwide database. METHODS The National Surgical Quality Improvement Program database was queried for all THA cases performed between 2012 and 2016. After an overall 5-year correlation and trends analysis, univariate analysis was performed to compare the most recent year, 2016, with the preceding 4 years. Correlation coefficients and chi-squared tests were used to determine correlation and statistical significance. RESULTS The lowest incidence of SSIs was in the most recent year, 2016 (0.81%), while the greatest incidence was in the earliest year, 2012 (1.12%), marking a 31% decrease (P < .01). The lowest rate was in the most recent year, 2016 (0.23%), marking a 26% decrease from 2012. The lowest superficial SSI incidence occurred in the most recent year, 2016 (0.58%), while greatest incidence was in 2012 (0.83%), marking a 31% decrease over time (P < .05). There was an inverse correlation among overall, deep, and superficial SSI rates with operative year. CONCLUSION The findings from this study suggest a decreasing trend in SSIs within 30 days following THA. Furthermore, deep SSIs, which can pose substantial threats to implant survivorship, have also decreased throughout the years. These results highlight that potentially through improved medical and surgical techniques, we are winning the fight against short-term infections, but that more can still be done.
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Affiliation(s)
- Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Luke J Garbarino
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, NY
| | - Peter A Gold
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, NY
| | - Steven M Kurtz
- Implant Research Center, Department of Biomedical Engineering, Drexel University, Philadelphia, PA
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
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Koutsogiannaki S, Hou L, Babazada H, Okuno T, Blazon-Brown N, Soriano SG, Yokomizo T, Yuki K. The volatile anesthetic sevoflurane reduces neutrophil apoptosis via Fas death domain-Fas-associated death domain interaction. FASEB J 2019; 33:12668-12679. [PMID: 31513427 DOI: 10.1096/fj.201901360r] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sepsis remains a significant health care burden, with high morbidities and mortalities. Patients with sepsis often require general anesthesia for procedures and imaging studies. Knowing that anesthetic drugs can pose immunomodulatory effects, it would be critical to understand the impact of anesthetics on sepsis pathophysiology. The volatile anesthetic sevoflurane is a common general anesthetic derived from ether as a prototype. Using a murine sepsis model induced by cecal ligation and puncture surgery, we examined the impact of sevoflurane on sepsis outcome. Different from volatile anesthetic isoflurane, sevoflurane exposure significantly improved the outcome of septic mice. This was associated with less apoptosis in the spleen. Because splenic apoptosis was largely attributed to the apoptosis of neutrophils, we examined the effect of sevoflurane on FasL-induced neutrophil apoptosis. Sevoflurane exposure significantly attenuated apoptosis. Sevoflurane did not affect the binding of FasL to the extracellular domain of Fas receptor. Instead, in silico analysis suggested that sevoflurane would bind to the interphase between Fas death domain (DD) and Fas-associated DD (FADD). The effect of sevoflurane on Fas DD-FADD interaction was examined using fluorescence resonance energy transfer (FRET). Sevoflurane attenuated FRET efficiency, indicating that sevoflurane hindered the interaction between Fas DD and FADD. The predicted sevoflurane binding site is known to play a significant role in Fas DD-FADD interaction, supporting our in vitro and in vivo apoptosis results.-Koutsogiannaki, S., Hou, L., Babazada, H., Okuno, T., Blazon-Brown, N., Soriano, S. G., Yokomizo, T., Yuki, K. The volatile anesthetic sevoflurane reduces neutrophil apoptosis via Fas death domain-Fas-associated death domain interaction.
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Affiliation(s)
- Sophia Koutsogiannaki
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Lifei Hou
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Hasan Babazada
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Toshiaki Okuno
- Department of Biochemistry, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Nathan Blazon-Brown
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sulpicio G Soriano
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Takehiko Yokomizo
- Department of Biochemistry, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Koichi Yuki
- Cardiac Anesthesia Division, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
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Chungsiriwattana W, Sangkhathat S, Kongkamol C, Suwalak N, Phainuphong P, Komet O, Darayon R. Decreasing Trend of Surgical Site Infections among Surgical Patients in a University Hospital in Thailand after an Active Surveillance Program. Surg Infect (Larchmt) 2019; 20:382-389. [PMID: 30801228 DOI: 10.1089/sur.2018.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Reports from high-quality healthcare systems have shown that active surveillance and management of factors associated with surgical site infection (SSI) decreased the incidence and improved overall outcomes. Methods: This study aimed to appraise the incidence trend of SSIs during the 10-year period between 2007 and 2016 in a university hospital in a middle-income country, focusing on six high-risk and high-volume procedures. The study also examined factors associated with SSIs and their impact on surgical outcomes. Results: A total of 10,139 procedures in 9,661 cases were reviewed. The overall incidence of SSI was 2.98%. The incidence increased substantially with increasing risk score according to the National Nosocomial Infection Surveillance (NNIS) system risk score. The incidence trend decreased over time during the 10-year period studied. The procedures with the highest SSI incidence were craniotomy, colonic surgery, and cholecystectomy, which were also the three procedures that had standardized infection ratios (SIR) higher than 1.0 in all risk score categories. Univariable analysis found that diabetes mellitus was the only risk factor associated with SSI (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.2-2.73). The majority of the positive cultures were gram-negative bacteria (45%) and 49% of all reported organisms were drug resistant. There were two important consequences of the infections: length of hospitalization increased substantially from 13 days to 24 days (p < 0.01) and patients with SSI had more than three times higher mortality rate (7% compared with 1.9%, p < 0.001). Conclusion: With active surveillance, the incidence of SSIs decreased to less than 2.0% over the 10-year study period. More intensive surveillance should implemented for operations with high SIR and cases with diabetes mellitus.
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Affiliation(s)
| | - Surasak Sangkhathat
- 1 Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chanon Kongkamol
- 2 Occupational Medicine Unit, Department of Family Medicine and Preventive Medicine Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Nonglak Suwalak
- 3 Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | | | - Ornanong Komet
- 3 Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
| | - Rungtip Darayon
- 3 Infection Control Unit, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
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Yadollahi M, Kashkooe A, Feyzi M, Bornapour S. Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran. Chin J Traumatol 2018; 21:267-272. [PMID: 29929766 PMCID: PMC6235789 DOI: 10.1016/j.cjtee.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 05/01/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Trauma-related injuries are the leading cause of death worldwide. Some risk factors make traumatic patients susceptible to infection. Furthermore, some mortality risk factors, including length of hospitalization and increasing age, were detected in non-traumatic infected patients. This study aimed to assess mortality risk factors among nosocomial infected traumatic patients in Rajaee trauma center, Shiraz, Iran. METHODS This prospective cohort study was conducted during a period of 2 years since April 2015 to March 2017 in Rajaee hospital, which is the center of emergency medical services for traumatic injuries in Shiraz, Iran. Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance system criteria were applied to define 5 types of nosocomial infections. The variables analyzed as the risk factors of infection and mortality included sex, age, mechanism of injury, site of injury, injury severity score (ISS), surgical intervention, length of hospitalization, intensive care unit (ICU) admission, and type of pathogen. Then, the incidence of nosocomial infection and also risk factors of mortality in traumatic patients were evaluated. All data analyses were performed using the statistical package for social sciences, version 15 (SPSS Inc., Chicago) and p ≤ 0.05 is considered to be statistically significant. RESULTS The incidence of nosocomial infection was 7.2% (p < 0.001). Pneumonia was the most common type of infection detected in our study. Infection led to a 7.8-fold increase in mortality of the traumatic patients (p < 0.001). Admission in intensive care units and old age were the main risk factors of mortality in infected traumatic patients. Old age, gunshot and motor vehicle accidents, trauma to extremities and abdomen, higher injury severity score, and prolonged hospitalization, made the traumatic patients more susceptible to infection. CONCLUSION The really high incidence of nosocomial infection in traumatic patients in Iran depends on some risk factors that should be considered. Also infection increases the mortality rate in the traumatic patients, which could be reduced by eliminating its risk factors.
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Affiliation(s)
- Mahnaz Yadollahi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author.
| | - Monireh Feyzi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Bornapour
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Sono T, Fujibayashi S, Izeki M, Shimizu Y, Masamoto K, Morizane K, Otsuki B, Tanida S, Nagao M, Ichiyama S, Matsuda S. Decreased rate of surgical site infection after spinal surgery with instrumentation using bundled approach including surveillance and intrawound vancomycin application. Medicine (Baltimore) 2018; 97:e12010. [PMID: 30142843 PMCID: PMC6112973 DOI: 10.1097/md.0000000000012010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Surgical site infections (SSIs) increase the risk of mortality, postsurgery, extend hospital stay, and increase the costs of healthcare. Our aim in this study was to evaluate the effectiveness of a multidisciplinary, evidence-based, surveillance program combined with intrawound application of vancomycin in lowering the incidence rate of SSI after spinal surgery with instrumentation.We conducted a retrospective analysis of 637 patients who underwent spinal fusion with instrumentation in our institution at 3 different time periods: prior to our surveillance program (control group), surveillance only (surveillance group 1), and surveillance combined with intrawound vancomycin application (surveillance group 2). The following covariates were considered in the evaluation of between-group differences in SSI rate: sex, age, surgical site, National Nosocomial Infection Surveillance (NNIS) risk index, American Society of Anesthesiologists (ASA) physical status classification, and other health comorbidities. The causative organism in cases of SSI was confirmed in all cases.The rate of SSI was significantly lower in the surveillance group 2 (1.4%) than in the control group (4.6%; P = .04). On multivariate logistic regression analysis, steroid use (adjusted odd's ratio (OR), 6.06; 95% confidence interval (CI), 1.45-23.6) and operative time (adjusted OR.1.01; 95% CI, 1.00-1.01) were identified as independent risk factors of SSI. Staphylococcus species and Propionibacterium acnes were the principal causative organisms.A bundled approach that includes surveillance and intrawound application of vancomycin is an effective strategy to lower the risk of SSI after spinal fusion with instrumentation. The use of steroid and longer operative time are risk factors of SSI.Our findings support the implementation of a program of surveillance, combined with intrawound vancomycin application, to reduce the incidence rate of SSIs in spinal surgery.
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Affiliation(s)
- Takashi Sono
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Masanori Izeki
- Department of Orthopaedic Surgery, Medical Research Institute, Kitano Hospital, Osaka
| | - Yu Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kazutaka Masamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Kazuaki Morizane
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Shimei Tanida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Miki Nagao
- Department of Infection Control and Prevention/Infection Control Team, Kyoto University Hospital, Japan
| | - Satoshi Ichiyama
- Department of Infection Control and Prevention/Infection Control Team, Kyoto University Hospital, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto
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Abstract
Prosthetic joint infection (PJI) poses a burden on patients and health care resources. PJI diagnosis can be challenging, owing to imperfect definition, alongside inadequate diagnostic techniques. In this review, we describe consensus definitions of PJI, approaches to diagnosis using methods available in Korea, and novel diagnostic methods.
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Affiliation(s)
- Kyung Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea.
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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24
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Li Y, Gong Z, Lu Y, Hu G, Cai R, Chen Z. Impact of nosocomial infections surveillance on nosocomial infection rates: A systematic review. Int J Surg 2017; 42:164-9. [PMID: 28476543 DOI: 10.1016/j.ijsu.2017.04.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND According to previously studies, nosocomial infections (NIs) surveillance could effectively reduce infection rates. As NIs surveillance systems have been implemented in some hospitals for several years, their impact on NIs need to be explored. Therefore, the purpose of this review is to evaluate the tendency of NI rates during the surveillance period and the impact of surveillance on NI rates. METHODS A systematic literature search of the PubMed database to identify papers that evaluated effect of surveillance on NIs, all kinds of NIs occurred during hospitalization or discharged were included. Exclude articles investigated the surveillance combined with other infection control measures. RESULTS Twenty-five articles were included. NI rates had different levels of reduction during surveillance period, the reduction were not limited by state, department, surveillance system, and NI type. Continuous surveillance had a positive impact on NI, OR/RR were ranged from 0.43 to 0.95. CONCLUSION Participation in NI surveillance is associated with reducing infection rates, though RCTs need to further prove the effective role of surveillance. Hospitals may consider to perform NIs surveillance systems according to its own conditions.
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Benenson S, Moses AE, Cohen MJ, Brezis M, Minster N, Schwartz C, Kandel L, Liebergall M, Mattan Y. A Practical Tool for Surveillance of Surgical-Site Infections: A 5-Year Experience in Orthopedic Surgeries. Infect Control Hosp Epidemiol 2017; 38:610-3. [PMID: 28069094 DOI: 10.1017/ice.2016.322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;38:610-613.
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