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Tschelaut L, Assadian O, Strauss R, Matiasek J, Beer M, Angerler G, Berger-Grabner D, Presterl E. A survey on current knowledge, practice and beliefs related to preoperative antimicrobial decolonization regimens for prevention of surgical site infections among Austrian surgeons. J Hosp Infect 2018; 100:386-392. [PMID: 30031167 DOI: 10.1016/j.jhin.2018.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Various measures are considered to reduce the risk of surgical site infection (SSI), including preoperative decolonization. Details of preoperative decolonization practices in surgical departments have not been investigated in Austria. AIM To analyse the current situation of pre-surgical patient decolonization in national hospitals and to assess the current knowledge on this procedure among surgeons of different surgical disciplines. METHODS A 12-point structured questionnaire was distributed to all Austrian hospitals with at least one surgical department. FINDINGS Two-thirds (103/158; 65%) of responding surgeons stated that any type of preoperative decolonization is implemented in their surgical department. There was heterogeneity of different protocols, ranging from decolonization of only known S. aureus carriers, of a subgroup of patients, or universal decolonization of all patients before elective surgery. Octenidine was the most frequently used antimicrobial compound (60.2%), followed by mupirocin (38.8%), triclosan (14.6%), polyhexanide (12.6%), chlorhexidine (11.7%), and didecyldimonium chloride (7.8%). CONCLUSION Preoperative decolonization seems to be performed in Austrian hospitals on a routine basis. However, this measure is implemented using a variety of modalities, antimicrobial compounds, and staff. Since our survey also demonstrated that those who are better informed about preoperative decolonization are also those who are more convinced of the usefulness of the preventive measure, future activities should not only focus on generating more comparable studies in this field, but should also include targeted education.
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Affiliation(s)
- L Tschelaut
- Department of Business, IMC University of Applied Science, Krems, Austria
| | - O Assadian
- Department for Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria; Austrian Society for Infection Control, Vienna, Austria
| | - R Strauss
- Federal Ministry of Health and Women's Affairs, Department III/1, Vienna, Austria
| | - J Matiasek
- Department of Plastic and Reconstructive Surgery, St Josef Hospital Vienna, Austria
| | - M Beer
- University of Veterinary Medicine, Vienna, Austria
| | - G Angerler
- Unit for Hospital Hygiene, Orthopaedic Hospital Speising, Vienna, Austria
| | - D Berger-Grabner
- Department of Business, IMC University of Applied Science, Krems, Austria.
| | - E Presterl
- Department for Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria
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4
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Nelwan EJ, Sinto R, Subekti D, Adiwinata R, Waslia L, Loho T, Safari D, Widodo D. Screening of methicillin-resistant Staphylococcus aureus nasal colonization among elective surgery patients in referral hospital in Indonesia. BMC Res Notes 2018; 11:56. [PMID: 29357913 PMCID: PMC5778668 DOI: 10.1186/s13104-018-3150-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/09/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) colonization is associated with serious surgical site infection in high-risk patients. High prevalence of MRSA colonization was reported in many settings, nonetheless local data is required. The purpose of this study is to identify the prevalence and risk factor of MRSA nasal carriage in adult patients in National Referral Hospital in Indonesia before underwent elective surgical procedure. RESULTS From 384 patients, 16.9% patients of them had undergone orthopaedic surgery, 51.3% had received antibiotics within the previous 3-month and 41.1% patients had history of hospitalization within the previous 1 year. Total of 21.6% patients were on invasive devices for at least 48 h before the operation; 24.2% had an open wound; 19.3% patients were referred from other hospital/ward. Of these patients, solid tumor without metastasis was the most common factor identified by the Charlson index (38.3%). Nasal colonization of Gram-positive bacteria was detected in 76.8%; S. aureus in 15.6% of patients (n = 60). MRSA was identified in three isolates (0.8%) by both culture and polymerase chain reaction (PCR) tests. Due to low prevalence of MRSA nasal carriage, this finding supports the recommendation to not routinely apply mupirocin for nasal decolonization on patient planned for surgery in Indonesia.
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Affiliation(s)
- Erni J Nelwan
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya 6, Jakarta, 10430, Indonesia.
| | - Robert Sinto
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya 6, Jakarta, 10430, Indonesia
| | - Decy Subekti
- Eijkman Oxford Clinical Reseach Unit, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - Randy Adiwinata
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya 6, Jakarta, 10430, Indonesia
| | - Lia Waslia
- Eijkman Oxford Clinical Reseach Unit, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - Tonny Loho
- Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya 6, Jakarta, 10430, Indonesia
| | - Dodi Safari
- Eijkman Institute for Molecular Biology, Jl. Diponegoro No. 69, Jakarta, 10430, Indonesia
| | - Djoko Widodo
- Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya 6, Jakarta, 10430, Indonesia
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6
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Pepper J, Meliak L, Akram H, Hyam J, Milabo C, Candelario J, Foltynie T, Limousin P, Curtis C, Hariz M, Zrinzo L. Changing of the guard: reducing infection when replacing neural pacemakers. J Neurosurg 2017; 126:1165-1172. [DOI: 10.3171/2016.4.jns152934] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Infection of deep brain stimulation (DBS) hardware has a significant impact on patient morbidity. Previous experience suggests that infection rates appear to be higher after implantable pulse generator (IPG) replacement surgery than after the de novo DBS procedure. In this study the authors examine the effect of a change in practice during DBS IPG replacements at their institution.
METHODS
Starting in January 2012, patient screening for methicillin-resistant Staphylococcus aureus (MRSA) and, and where necessary, eradication was performed prior to elective DBS IPG change. Moreover, topical vancomycin was placed in the IPG pocket during surgery. The authors then prospectively examined the infection rate in patients undergoing DBS IPG replacement at their center over a 3-year period with at least 9 months of follow-up.
RESULTS
The total incidence of infection in this prospective consecutive series of 101 IPG replacement procedures was 0%, with a mean follow-up duration of 24 ± 11 months. This was significantly lower than the authors' previously published historical control group, prior to implementing the change in practice, where the infection rate for IPG replacement was 8.5% (8/94 procedures; p = 0.003).
CONCLUSIONS
This study suggests that a change in clinical practice can significantly lower infection rates in patients undergoing DBS IPG replacement. These simple measures can minimize unnecessary surgery, loss of benefit from chronic stimulation, and costly hardware replacement, further improving the cost efficacy of DBS therapies.
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Affiliation(s)
- Joshua Pepper
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Lara Meliak
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Harith Akram
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Jonathan Hyam
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Catherine Milabo
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Joseph Candelario
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Thomas Foltynie
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Patricia Limousin
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
| | - Carmel Curtis
- 3Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; and
| | - Marwan Hariz
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
- 4Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ludvic Zrinzo
- 1Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London
- 2Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London
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7
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Pitsiou G, Kioumis I, Zarogoulidis K, Lazaridis G, Papaiwannou A, Tsirgogianni K, Karavergou A, Lampaki S, Rapti A, Trakada G, Zissimopoulos A, Karaiskos T, Madesis A, Drosos G, Zarogoulidis P. Prophylactic antibiotic administration for post cardiothoracic surgery sternal wounds: a retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:56. [PMID: 25861611 DOI: 10.3978/j.issn.2305-5839.2015.03.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cardiothoracic surgery sternal infections are difficult to treat situations. Until now there are no clear guidelines which or if an antibiotic could be used as prophylactic treatment. PATIENTS AND METHODS We collected retrospectively data from 535 patients from our hospital which underwent cardiothoracic surgery and recorded several biological parameters and technical aspects of the surgery. RESULTS It was observed that patients to whom vancomycin was administered had less post surgery infection than those to whom begalin was administered. Male who were treated with vancomycin it was observed that they had 1.67 chances to be treated properly than female. Patients which were hospitalized for more than 7 days before surgery had 62.6% higher chances for post surgery infection. CONCLUSIONS It was observed that vancomycin can be used as a prophylactic treatment for cardiothoracic surgeries acting efficiently against sternal wounds.
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Affiliation(s)
- Georgia Pitsiou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kioumis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Zarogoulidis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Lazaridis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonis Papaiwannou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Tsirgogianni
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Karavergou
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Lampaki
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Rapti
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Trakada
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Zissimopoulos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Drosos
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul Zarogoulidis
- 1 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 2 Department of Medical Oncology, Aristotle University School of Medicine, Thessaloniki, Greece ; 3 2nd Pulmonary Clinic of "Sotiria" Hospital, Athens, Greece ; 4 Pulmonary Laboratory of Alexandra Hospital University of Athens, Athens, Greece ; 5 Nuclear Medicine Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece ; 6 Thoracic Surgery Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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