Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta-analysis

Incidence and Risk Factors of Surgical Site Infection After Knee Arthroplasty; a Systematic Review and Meta-Analysis

Introduction

Surgical site infection (SSI) constitutes a substantial complication after knee arthroplasty, contributing to notable morbidity. This study aimed to review the existing literature on the incidence and risk factors of SSI following knee arthroplasty.

Methods

A systematic search was undertaken across various international electronic databases, including Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex and the Scientific Information Database. The search strategy involved the use of keywords derived from Medical Subject Headings, such as "incidence", "Surgical wound infection", "Surgical site infection", and "Arthroplasty", covering records from the earliest available up to March 17, 2024.

Results

The study incorporated a collective participant group of 1,366,494 knee arthroplasty procedures from twenty-three chosen studies. The pooled incidence rate of SSI after knee arthroplasty was 1.7% (95% confidence interval (CI): 1.1% to 2.6%; I²=99.687%; P<0.001). The Odds Ratio (OR) for the incidence of SSI in males was observed to be significantly higher than that in females (OR: 1.617; 95% CI: 1.380 to 1.894; Z=5.951; P<0.001). The pooled incidence of SSI among diabetic patients was 1.3% (95% CI: 0.6% to 2.8%; I²=99.126%; P<0.001).

Conclusion

Based on the main findings, SSIs continue to be a significant complication of knee arthroplasty, with an incidence of 1.1% to 2.6%. Male gender and diabetes mellitus were associated with an augmented probability of SSIs following knee arthroplasty.

The Bacterial Species Behind the Wound and Their Antibacterial Resistant Pattern: A Three-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana

BACKGROUND

Wound infections are often underestimated issues that can lead to chronic illnesses, and since the introduction of antibiotics, wound complications have become less common. However, due to the increased and irrational use of these antibiotics, the resistance in the bacterial isolates has become very common. This has led to reduced treatment options, delay in wound healing, and high treatment costs. This study aimed to investigate bacterial wound infections and their antibiotic resistance at St. Dominic Hospital, Ghana.

METHODS

A total of 517 records of wound swab culture and susceptibility testing, and patient demographics from 2020 to 2022 were collected from the microbiology unit of St. Dominic Hospital in the Eastern Region of Ghana. The data were entered into Microsoft Excel 2019, cleaned, and exported into IBM SPSS v26 for the statistical analysis. p < 0.05 was considered statistically significant for all analyses.

RESULTS

The overall prevalence of bacteriological agents causing wound infection in individuals who visited the St. Dominic Hospital from 2020 to 2022 was 70.21% (363/517), with S. aureus 79/363 (21.76%) being the most abundant isolate. Out of the 79 S. aureus isolated, 40 (50.63%) and 39 (49.37%) were resistant to ampicillin and cephalexin, respectively. More than 50% of the predominant Gram-negative isolate, K. pneumoniae, were resistant to clindamycin 45/72 (62.50%) but susceptible to levofloxacin 70/72 (97.22%), cefotetan 69/72 (95.83%), and chloramphenicol 67/72 (93.06%).

CONCLUSION

Antibacterial susceptibility patterns revealed significant resistance trends, particularly among Gram-negative isolates, emphasizing the urgent need for prudent antibiotic use and ongoing surveillance to combat resistance.

Prevalence of Surgical Site Infection After Hip Arthroplasty; a Systematic Review and Meta-Analysis

Introduction

One of the worrisome complications of hip arthroplasty is surgical site infection (SSI). This study aimed to investigate the prevalence of SSI after hip arthroplasty.

Methods

A comprehensive and systematic exploration was conducted across various international electronic databases, including Scopus, PubMed, and Web of Science, alongside Persian electronic databases such as Iranmedex and the Scientific Information Database (SID). This search strategy entailed the utilization of Medical Subject Headings-derived keywords such as "Prevalence," "Surgical wound infection," "Surgical site infection," and "Arthroplasty," spanning from the earliest records up to January 1, 2024. Each study's weight was assigned based on its inverse variance. A forest plot visualization was used to assess the studies' heterogeneity. Data on sample size and SSI frequency were compiled for each study to calculate the overall effect size.

Results

The study encompassed a cumulative participant cohort of 1,070,638 hip arthroplasty procedures drawn from seventeen selected studies. Notably, the female gender constituted 59.10% of the overall participant demographic. The aggregate SSI among patients undergoing hip arthroplasty was estimated to be 1.9% (95% CI: 1.3% to 2.8%; I2=99.688%; P<0.001). The results of the meta-regression analysis unveiled a statistically significant correlation between the prevalence of SSIs after hip arthroplasty and the year of publication (Coefficient=-0.0020; 95% CI: -0.0021 to -0.0018; Z=-19.39, P<0.001).

Conclusion

The study findings indicated a prevalence rate of 1.9% for SSI following hip arthroplasty. This prevalence underscores the importance of vigilance in infection prevention and management strategies within orthopedic surgery. However, it is essential to acknowledge the variability in SSI prevalence observed across diverse studies, which can be attributed to multifaceted factors, notably variances in patient populations and associated risk factors.

Prevalence of surgical site infection and risk factors in patients after knee surgery: A systematic review and meta-analysis

The present systematic review and meta-analysis aimed to determine the prevalence of surgical site infection (SSI) and risk factors in patients after knee surgery. A comprehensive and systematic search was carried out across various international electronic databases, including Scopus, PubMed and Web of Science, as well as Persian electronic databases like Iranmedex and the Scientific Information Database (SID). This search involved the utilization of keywords derived from Medical Subject Headings, such as 'Prevalence', 'Surgical wound infection', 'Surgical site infection' and 'Orthopaedics', spanning from the earliest records up to 1 October 2023. To assess the quality of the included studies, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was utilized. The study encompassed a combined participant pool of 11 028 individuals who underwent knee surgery across seven selected studies. The collective prevalence of SSI in patients who underwent knee surgery, as reported in the seven included studies, was determined to be 3.0% (95% CI: 1.2% to 7.5%; I2  = 96.612%; p < 0.001). The combined prevalence of SSI in patients with DM, as reported in six studies, was 5.1% (95% CI: 1.7% to 14.5%; I2  = 79.054%; p < 0.001). Similarly, the pooled prevalence of SSI in patients with HTN, drawn from four studies, was 1.8% (95% CI: 0.7% to 4.5%; I2  = 63.996%; p = 0.040). Additionally, the collective prevalence of SSI in patients with a history of tobacco use, based on findings from six studies, was 4.8% (95% CI: 1.4% to 15.2%; I2  = 93.358%; p < 0.001). Subgroup analysis was conducted within six studies, categorizing them by two countries, namely China and the USA. These analyses revealed that the prevalence of SSI following knee surgery was 3.0% in China and 2.0% in the USA. It is noteworthy that variations in SSI prevalence across different studies may be attributed to a multitude of factors, particularly varying risk factors among patient populations. To address this issue and mitigate the impact of SSI on knee surgery patients, it is advisable to develop tailored interventions.

Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta-analysis

The goal of this systematic review and meta-analysis is to provide an overview of the prevalence of surgical wound infection and related factors in patients after long bone surgery. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Prevalence", "Surgical wound infection", "Surgical site infection" and "Orthopedics" from the earliest to the May 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 71 854 patients undergoing long bone surgery participated in 12 studies. The pooled prevalence of surgical wound infection in patients who underwent long bone surgery reported in the 12 studies was 3.3% (95% CI: 1.5%-7.2%; I2  = 99.39%; p < 0.001). The pooled prevalence of surgical wound infection in male and female patients who underwent long bone surgery was 4.6% (95% CI: 1.7%-11.7%; p < 0.001; I2  = 99.34%) and 2.6% (95% CI: 1.0%-6.3%; I2  = 98.84%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with femur surgery sites reported in nine studies was 3.7% (95% CI: 2.1-6.4%; I2  = 93.43%; p < 0.001). The pooled prevalence of surgical wound infection in open and close fractures was 16.4% (95% CI: 8.2%-30.2%; I2  = 95.83%; p < 0.001) and 2.9% (95% CI: 1.5%-5.5%; I2  = 96.40%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD) was 4.6% (95% CI: 2.3%-8.9%; I2  = 81.50%; p < 0.001), 2.7% (95% CI: 1.2%-6.0%; I2  = 83.82%; p < 0.001) and 3.0% (95% CI: 1.4%-6.4%; I2  = 69.12%; p = 0.006), respectively. In general, the different prevalence of surgical wound infection in patients undergoing surgical treatment after long bone fracture may be caused by underlying factors (gender and co-morbidity) and fracture-related factors (surgery site and type of fracture).