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Toman J, Zachary Porterfield J, Randall MW, Kumar A, Farrior EH. Efficacy of 24 hours versus 5 days of prophylactic antibiotics for the prevention of surgical site infection in outpatient elective facial plastic surgery. JPRAS Open 2024; 40:68-76. [PMID: 38434944 PMCID: PMC10907514 DOI: 10.1016/j.jpra.2024.01.016] [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: 01/14/2023] [Accepted: 01/28/2024] [Indexed: 03/05/2024] Open
Abstract
Background The discovery of penicillin marked a paradigm shift in medicine with the ability to treat previously life-threatening infections. Increasing antibiotic resistance as well as the risk of adverse reactions to antibiotics, however, creates pressures for judicious use. There continues to be debate about the role of prophylactic antibiotics in facial plastic surgery. This study explores the role of prophylactic antibiotic administration in elective outpatient facial plastic surgery by comparing 5 days versus 24 hours of antibiotic prophylaxis. Method A retrospective cohort study of all consecutive patients undergoing cosmetic procedures at an outpatient facial plastic surgical center who received either 5 days or 24 hours of prophylactic antibiotics was performed. The primary outcome was the need for postoperative antibiotics within 6 weeks of surgery. Results 204 patients met the inclusion criteria: 104 in the 5-day group and 100 in the 24-hour prophylaxis group. The overall infection rate was 3.4%: 3% in the 24-hour group and 3.8% in the 5-day group (p = 0.77). Subgroup analysis of clean-contaminated cases (n = 85) showed the rate of postoperative infections was 4.3%, all within the 5-day group. In clean cases (n = 119), the rate of postoperative infections was 4.2% (n = 5): 4.8% (n = 3) in the 24-hour group versus 3.5% (n = 2) in the 5-day group. Conclusions The results show that decreasing the duration of antibiotics was not associated with an increased risk of postoperative infection. Given that antibiotics are an increasingly precious commodity with rising rates of resistance, this study supports the use of decreasing postoperative antibiotics to 24 hours.
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Affiliation(s)
- Julia Toman
- University of South Florida, Department of Otolaryngology Head and Neck Surgery Division Facial Plastics and Reconstructive Surgery Morsani College of Medicine
| | - J. Zachary Porterfield
- University of South Florida, Department of Internal Medicine - Division of Infectious Diseases & International Medicine
- University of KwaZulu-Natal, Department of Otorhinolaryngology School of Clinical Medicine
| | - Michael W Randall
- University of South Florida, Department of Otolaryngology Head and Neck Surgery Division Facial Plastics and Reconstructive Surgery Morsani College of Medicine
| | - Ambuj Kumar
- University of South Florida, Department of Internal Medicine Morsani College of Medicine
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Marais LC, Zalavras CG, Moriarty FT, Kühl R, Metsemakers WJ, Morgenstern M. The surgical management of fracture-related infection. Surgical strategy selection and the need for early surgical intervention. J Orthop 2024; 50:36-41. [PMID: 38162257 PMCID: PMC10755499 DOI: 10.1016/j.jor.2023.11.033] [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] [Received: 06/26/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
The aim of this narrative review is to describe the various surgical management strategies employed in fracture-related infection (FRI), to explore how they are selected and discuss the rationale for early surgical intervention. Surgical treatment options in patients with FRI include debridement, antibiotics and implant retention (DAIR), revision (exchange) or removal. In selecting a treatment strategy, a variety of factors need to be considered, including the condition of the bone, soft tissues, host and causative microorganism. Irrespective of the selected treatment strategy, prompt surgical intervention should be considered in order to confirm the diagnosis of an FRI, to identify the causative organism, remove necrotic or non-viable tissue that can serve as a nidus for ongoing infection, ensure a healthy soft tissue envelope and to prevent the vicious cycle of infection associated with skeletal and/or implant instability. Ultimately, the objective is to prevent the establishment of a persistent infection. Urgent surgery may be indicated in case of active, progressive disease with systemic deterioration, local progression of infection, deterioration of soft tissues, or progressive fracture instability. In case of static disease, the patient should be monitored closely and surgery can be performed on an elective basis, allowing adequate time for optimisation of the host through risk factor modification, optimisation of the soft tissues and careful planning of the surgery.
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Affiliation(s)
- Leonard C. Marais
- Department of Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Charalampos G. Zalavras
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Fintan T. Moriarty
- AO Research Institute Davos, Davos, Switzerland
- Center for Musculoskeletal Infections, Department of Orthopaedics and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - Richard Kühl
- Center for Musculoskeletal Infections, Department of Orthopaedics and Trauma Surgery, University Hospital Basel, Basel, Switzerland
- Department of Infectious Diseases and Hospital Hygiene, University Hospital Basel, Switzerland
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Mario Morgenstern
- Center for Musculoskeletal Infections, Department of Orthopaedics and Trauma Surgery, University Hospital Basel, Basel, Switzerland
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Chan V, Skaggs DL, Cho RH, Poon SC, Shumilak G. Characterizing antibiotic prophylaxis practices in pediatric deformity spinal surgery and impact on 30-day postoperative infection: an NSQIP pediatric database study. Spine Deform 2024:10.1007/s43390-024-00844-9. [PMID: 38499968 DOI: 10.1007/s43390-024-00844-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/09/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The aim of this study was to characterize antibiotic prophylaxis practices in pediatric patients who have received posterior arthrodesis for spinal deformity and understand how these practices impact 30-day postoperative infection rates. METHODS This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database for year 2021. Patients 18 years of age or younger who received posterior arthrodesis for scoliosis or kyphosis correction were included. The outcome of interest was 30-day postoperative infection. Fisher's exact test and multivariable regression analysis were used to analyze the impact of intravenous antibiotic prophylaxis, intraoperative intravenous antibiotic redosing after 4 h, postoperative antibiotic prophylaxis, intraoperative topical antibiotics on 30-day postoperative infection, and various antibiotic prophylaxis regimens. RESULTS A total of 6974 patients were included in this study. The 30-day infection rate was 2.9%. Presurgical intravenous antibiotic (11.5% vs. 2.7%, p = 0.005), postoperative antibiotic (5.7% vs. 2.4%, p < 0.01), and intraoperative topical antibiotic (4.0% vs. 2.7%, p = 0.019) were associated with significantly reduced infection rates. There was no significant difference in infection rates between patients that received cefazolin versus vancomycin versus clindamycin. The addition of Gram-negative coverage did not result in significant differences in infection rates. Multivariable regression analysis found postoperative intravenous antibiotics and intraoperative topical antibiotics to reduce infection rates. CONCLUSIONS We found the use of presurgical intravenous antibiotics, postoperative intravenous antibiotics, and intraoperative topical antibiotics to significantly reduce infection rates. Results from this study can be applied to future research on implementation of standardized infection prevention protocols. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Vivien Chan
- UCLA Health, Los Angeles, 1131 Wilshire Blvd Suite 100, Santa Monica, CA, 90401, USA.
| | - David L Skaggs
- Spine Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert H Cho
- Shriners Children's Southern California, Pasadena, CA, USA
| | - Selina C Poon
- Shriners Children's Southern California, Pasadena, CA, USA
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Lazic M, Jakovljevic A, Valente NA. PROPHYLACTIC ANTIBIOTICS DURING THE IMPLANT PROSTHETIC PHASE MAY NOT SUBSTANTIALLY DECREASE THE INCIDENCE OF INFECTIOUS COMPLICATIONS. J Evid Based Dent Pract 2024; 24:101963. [PMID: 38448124 DOI: 10.1016/j.jebdp.2023.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Does the Prosthetic Phase of Dental Implants Justify the Prescription of Preventive Antibiotics in Healthy Patients? A Systematic Review. Salgado-Peralvo AO, Uribarri A, Peña-Cardelles JF, Kewalramani N, Rodríguez JLG, Velasco-Ortega E. J Oral Implantol. 2023 Feb 1;49(1):93-101. SOURCE OF FUNDING The authors declared that no funding was received to support the study. TYPE OF STUDY/DESIGN Systematic review.
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Yamamura M, Ishii S, Akiyama S, Akiyama H, Nagumo T, Koeda S, Kinuta M, Nakamura M, Nishikubo S. Radiological findings associated with postoperative wound infection after extraction of impacted mandibular third molar: A retrospective study. J Stomatol Oral Maxillofac Surg 2024; 125:101761. [PMID: 38211769 DOI: 10.1016/j.jormas.2024.101761] [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] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Studies directly relating radiological findings to the risk of postoperative wound infection (PWI) in impacted mandibular third molars (M3) are limited and poorly understood. This study aimed to clarify the radiological risk of PWI. MATERIALS AND METHODS Twenty-six patients who developed PWI after M3 extraction were retrospectively analyzed using orthopantomography (OPG) and computed tomography (CT) before M3 extraction to determine the association between M3 impaction status and PWI. These were compared with an equal number of non-infected groups. Moreover, the possibility of assessing the same risk in OPG as in CT imaging was examined. RESULTS Multivariate analysis identified class III and position B of the Pell and Gregory classification system as independent risk factors for PWI. On CT, an axial overlap distance (AOD) >3.5 mm was significantly associated with PWI. Furthermore, the sagittal overlap distance (SOD) and AOD of the OPG were significantly greater in group III-B. A strong positive correlation was observed between SOD and AOD. CONCLUSION These results indicate that class III, position B, and an AOD >3.5 mm may be novel risk factors for M3 PWI. The strong correlation between SOD and AOD suggests that the risk assessment for PWI can be performed by evaluating OPG alone.
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Affiliation(s)
- Makiko Yamamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
| | - Shigeru Ishii
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan.
| | - Shingo Akiyama
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
| | - Hiroki Akiyama
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
| | - Tatsuhito Nagumo
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
| | - Satoko Koeda
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
| | - Mikihisa Kinuta
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
| | - Makiko Nakamura
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
| | - Shuichi Nishikubo
- Department of Advanced Oral Surgery, Yokohama Clinic, Kanagawa Dental University, 3-31-6 Tsuruya-cho, Kanagawa-ku, Yokohama City, Kanagawa 221-0835, Japan
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Campbell DH, Dowling TJ, Hah R, Alluri RK, Wang JC. Surgical strategies for spinal infections: A narrative review. N Am Spine Soc J 2023; 16:100293. [PMID: 38162170 PMCID: PMC10757275 DOI: 10.1016/j.xnsj.2023.100293] [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] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
The successful operative management of spinal infections necessitates a thoughtful approach. Ideal treatment combines the universal goals of any spine operation, which are decompression of the neural elements and stabilization of instability, with source control and eradication of infection. Techniques to treat infection have evolved independently and alongside advances in implant technology and surgical techniques. This review will seek to outline current thinking on approaches to both primary and secondary spinal infections.
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Affiliation(s)
- David H. Campbell
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Thomas J. Dowling
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - R. Kiran Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
| | - Jeffrey C. Wang
- Department of Orthopedic Surgery, Keck School of Medicine, USC Spine Center, University of Southern California, Los Angeles, 1450 San Pablo St #5400, Los Angeles, CA 90033, United States
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Watanabe R, Matsugaki A, Gokcekaya O, Ozasa R, Matsumoto T, Takahashi H, Yasui H, Nakano T. Host bone microstructure for enhanced resistance to bacterial infections. Biomater Adv 2023; 154:213633. [PMID: 37775399 DOI: 10.1016/j.bioadv.2023.213633] [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] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
Postoperative bacterial infection is a serious complication of orthopedic surgery. Not only infections that develop in the first few weeks after surgery but also late infections that develop years after surgery are serious problems. However, the relationship between host bone and infection activation has not yet been explored. Here, we report a novel association between host bone collagen/apatite microstructure and bacterial infection. The bone-mimetic-oriented micro-organized matrix structure was obtained by prolonged controlled cell alignment using a grooved-structured biomedical titanium alloy. Surprisingly, we have discovered that highly aligned osteoblasts have a potent inhibitory effect on Escherichia coli adhesion. Additionally, the oriented collagen/apatite micro-organization of the bone matrix showed excellent antibacterial resistance against Escherichia coli. The proposed mechanism for realizing the antimicrobial activity of the micro-organized bone matrix is by the controlled secretion of the antimicrobial peptides, including β-defensin 2 and β-defensin 3, from the highly aligned osteoblasts. Our findings contribute to the development of anti-infective strategies for orthopedic surgeries. The recovery of the intrinsically ordered bone matrix organization provides superior antibacterial resistance after surgery.
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Affiliation(s)
- Ryota Watanabe
- Teijin Nakashima Medical Co. Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama 709-0625, Japan; Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Aira Matsugaki
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Ozkan Gokcekaya
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Ryosuke Ozasa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
| | - Takuya Matsumoto
- Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Hiroyuki Takahashi
- Teijin Nakashima Medical Co. Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama 709-0625, Japan.
| | - Hidekazu Yasui
- Teijin Nakashima Medical Co. Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama 709-0625, Japan.
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka 565-0871, Japan.
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Mörlin V, Golmann D, Borgfeldt C, Bergman I. Antibiotic prophylaxis in posterior colporrhaphy does not reduce postoperative infection: a nationwide observational cohort study. Int Urogynecol J 2023; 34:2791-2797. [PMID: 37552239 DOI: 10.1007/s00192-023-05617-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to explore if antibiotic prophylaxis prevents postoperative infection after a posterior colporrhaphy. METHODS In this register-based nationwide cohort study data were collected from the "The Swedish National Quality Register of Gynecological Surgery" (GynOp). Women 18 years or older who underwent a primary posterior colporrhaphy between 1 January 2015 and 31 December 2020 were included. Patients undergoing any concomitant prolapse procedure, mesh surgery, or incontinence procedure were excluded. The cohort was divided into two groups based on administration of antibiotic prophylaxis (n = 1,218) or not (n = 4,884). The primary outcome of this study was patient-reported infectious complication requiring antibiotic treatment. Secondary outcome measures included patient satisfaction and prolapse-related symptoms at 1 year postoperatively. RESULTS A total of 7,799 patients who underwent posterior colporrhaphy and met the inclusion criteria and did not meet the exclusion criteria were identified in the register database. Of these patients 6,102 answered the primary outcome question (79%). In the antibiotic prophylaxis group a total of 138 reported a postoperative infection (11%) and in the no antibiotic prophylaxis group the corresponding data were 520 (11%). There were no significant differences regarding either the primary or the secondary outcomes between the study groups. CONCLUSION In this nationwide Swedish register study antibiotic prophylaxis was not associated with a reduced risk of postoperative infection after a posterior colporrhaphy.
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Affiliation(s)
- Vilhelm Mörlin
- Department of Women's and Children's Health, Division of Obstetrics, Department of Pelvic Cancer, Theme Cancer, Karolinska Institutet and Gynecology, Karolinska University Hospital, Eugeniavägen 3, A5:01, Mottagning Gynekologisk Cancer, 171 76, Stockholm, Sweden.
| | - Denise Golmann
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Science Lund, Lund University, Lund, Sweden
| | - Ida Bergman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
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Day W, Ch'en PY, Ratnasamy PP, Jeong S, Varthi AG, Grauer JN. The correlation of psoriasis and its treatment medications with lumbar discectomy postoperative infections. Spine J 2023; 23:1623-1629. [PMID: 37355045 DOI: 10.1016/j.spinee.2023.06.392] [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] [Received: 04/03/2023] [Revised: 06/07/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND CONTEXT Psoriasis is a chronic, autoimmune disease of the skin that affects approximately 3% of the US adult population. Patients with psoriasis may be predisposed to spine surgical site infections (SSI) related to the condition and/or related medications following surgeries such as lumbar laminotomy/discectomy. PURPOSE To assess the potential correlation of psoriasis and its related treatment medications on the risk of infection-related complications after lumbar laminotomy/discectomy. STUDY DESIGN Retrospective case control, national administrative database study. PATIENT SAMPLE Adult patients who underwent isolated single-level lumbar discectomy between 2010 and Q1 of 2021 were identified in the PearlDiver Mariner Ortho151 national administrative database (excluding those with concurrent diagnoses of fractures, neoplasms, or infections). OUTCOME MEASURES Ninety-day postoperative rates of surgical site infection and sepsis. METHODS Lumbar laminotomy/discectomy patients with versus without psoriasis were matched 1:4 based on age, sex, and Elixhauser Comorbidity Index. The risk of SSI and sepsis in the 90-day postoperative window between the cohorts were compared with multivariable analyses. Five-year reoperation rates were also compared with log rank test. The matched psoriasis cohort was further subdivided by psoriasis treatment regimens - no medication treatment (NT), topical therapies only (TT), topical therapies with oral systemic treatments (TT/OS), and topical therapies with biologics (TT/B). Multivariable logistic regression was used to assess the risk of SSI and sepsis within 90 days after lumbar laminotomy/discectomy for each treatment subgroup compared to patients without psoriasis. RESULTS In total, 2,262 patients with psoriasis who underwent single-level lumbar laminotomy/discectomy were identified and matched by age, sex, and Elixhauser Comorbidity Index to 9,044 patients without psoriasis. Multivariable logistic regression showed that, compared to the patients without psoriasis, patients with psoriasis had a 1.795 times higher chance of developing SSI (odds ratio [OR]) (p<.001) and sepsis (OR: 1.743, p=.027) within 90 days of surgery. Having psoriasis did not significantly correlate with 5-year reoperation rates. Of those with psoriasis, NT subcohort had 1,038 patients, TT subcohort 571 patients, TT/OS subcohort 226 patients, and TT/B subcohort 140 patients. Based on multivariable analysis and compared to nonpsoriasis patients, those in the NT, TT, TT/OS were not at greater odds of postoperative SSI or sepsis. Conversely, those in the TT/B subcohort were at significantly greater odds of SSI (OR: 3.102, p=.019) and sepsis (OR: 6.367, p=.027). CONCLUSIONS Of single-level lumbar laminotomy/discectomy patients with psoriasis, only those on topical therapies and biologics were at greater risk of postoperative SSI and sepsis. This subcohort warrants specific attention when undergoing lumbar laminotomy/discectomy and possibly holding such medications for a period prior to surgery may be warranted if possible.
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Affiliation(s)
- Wesley Day
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Peter Y Ch'en
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Philip P Ratnasamy
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA
| | - Seongho Jeong
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA
| | - Arya G Varthi
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics & Rehabilitation, Yale School of Medicine, 47 College St, New Haven, CT, USA.
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Wilkinson BG, Bangura A, Burke CE, O'Connor K, Gupta J, Demyanovich HK, Healey K, O'Hara NN, Schneiderman BA, Nascone JW, O'Toole RV. A deep surgical site infection risk score for patients with open tibial shaft fractures treated with intramedullary nail. Injury 2023; 54:110965. [PMID: 37572509 DOI: 10.1016/j.injury.2023.110965] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 06/09/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES To identify deep infection risk factors in patients with open tibial shaft fractures and to develop a scoring algorithm to predict the baseline deep infection risk in this patient population. METHODS A retrospective cohort study conducted at a single academic trauma center identified patients with open tibial shaft fractures treated with intramedullary nail fixation from December 2006 to October 2020. The primary outcome was a deep surgical site infection requiring surgical debridement. The outcome was identified by Current Procedural Terminology codes and confirmed with a medical chart review documenting evidence of a tibial draining wound or sinus tract. RESULTS Deep surgical site infection occurred in 13% of patients (97/769). Factors that predicted deep surgical site infection were identified. Gustilo-Anderson type IIIB or IIIC was the strongest predictor with a 12-fold increase in the odds of deep infection (OR 11.8, p < 0.001). Additional factors included age >40 years (OR 1.7, p = 0.03), American Society of Anesthesiologists score ≥3 (OR 1.9, p < 0.01), Gustilo-Anderson type IIIA vs. type I or II (OR 2.8, p = 0.004), and gunshot wounds (OR 2.9, p = 0.02). The risk scoring model predicted patients who would develop an infection with an acceptable level of accuracy (AUC 0.79). The risk score categorized patients from a low probability of deep infection 2%-6% with <10 points to high risk (58%-69%) with >40 points. CONCLUSIONS This risk score model predicts deep postoperative infection in patients with open tibial shaft fractures treated with intramedullary nails. The ability to accurately estimate deep infection risk at the time of presentation might aid patient expectation management and allow clinicians to focus infection prevention strategies on the high-risk subset of this population.
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Affiliation(s)
- Brandon G Wilkinson
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Abdulai Bangura
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Cynthia E Burke
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Katherine O'Connor
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Jayesh Gupta
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Haley K Demyanovich
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Kathleen Healey
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Brian A Schneiderman
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Jason W Nascone
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, United States.
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Pilskog K, Høvding P, Fenstad AM, Inderhaug E, Fevang JM, Dale H. Risk factors for fracture-related infection after ankle fracture surgery. Injury 2023; 54:111011. [PMID: 37688812 DOI: 10.1016/j.injury.2023.111011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/21/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Ankle fracture surgery comes with a risk of fracture-related infection (FRI). Identifying risk factors are important in preoperative planning, in management of patients, and for information to the individual patient about their risk of complications. In addition, modifiable factors can be addressed prior to surgery. The aim of the current paper was to identify risk factors for FRI in patients operated for ankle fractures. METHODS A cohort of 1004 patients surgically treated for ankle fractures at Haukeland University Hospital in the period of 2015-2019 was studied retrospectively. Patient charts and radiographs were assessed for the diagnosis of FRI. Binary logistic regression was used in analyses of risk factors. Regression coefficients were used to calculate the probability for FRI based on the patients' age and presence of one or more risk factors. RESULTS FRI was confirmed in 87 (9%) of 1004 patients. Higher age at operation (p < .001), congestive heart failure (CHF), p = 0.006), peripheral artery disease (PAD, p = 0.001), and current smoking (p = .006) were identified as risk factors for FRI. PAD and CHF were the risk factors displaying the strongest association with FRI with an adjusted odds ratio of 4.2 (95% CI 1.8-10.1) and 4.7 (95% CI 1.6-14.1) respectively. CONCLUSION The prevalence of FRI was 9% after surgical treatment of ankle fractures. The combination of risk factors found in this study demonstrate the need for a thorough, multidisciplinary, and careful approach when faced with an elderly or frail patient with an ankle fracture. The results of this study help the treating surgeons to inform their patients of the risk of FRI prior to ankle fracture surgery. LEVEL OF EVIDENCE Level III retrospective case-control study.
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Affiliation(s)
- Kristian Pilskog
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway.
| | - Pål Høvding
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Eivind Inderhaug
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway
| | - Jonas Meling Fevang
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway
| | - Håvard Dale
- Department of Orthopaedic Surgery, Haukeland University Hospital, Pb 1400, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Norway Pb 7804, Bergen 5020, Norway
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Morii T, Sato K, Ogura K, Kawai A. Incidence and risk of infection in malignant soft tissue tumor resection: Data from the nationwide soft tissue tumor registry. J Orthop Sci 2023:S0949-2658(23)00211-7. [PMID: 37599134 DOI: 10.1016/j.jos.2023.08.002] [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] [Received: 05/17/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Postoperative infection is a devastating complication in limb salvage surgery for malignant soft tissue tumors. The low absolute case numbers of these rare cancers represent a bottleneck for data collection and analysis. The administration of nationwide registry data is a practical option for the accumulation of cases. METHODS Data on malignant soft tissue tumor resection were extracted from the Bone and Soft Tissue Tumor Registry in Japan. The incidence of postoperative infection and its risk factors were analyzed. RESULTS A total of 14,460 cases were included. The incidence of infection was 2.6%. Significant risks for infection were male sex, lower extremity or trunk location, tumor diameter of over 10 cm, trans-compartmental invasion, high grade, autologous bone graft, myocutaneous flap, vascular reconstruction, reconstruction by prosthesis, postoperative radiotherapy, and delayed wound healing. CONCLUSIONS The incidence was lower than those in the previous studies, perhaps because of less frequent radiotherapy application. Some of the significant risk factors represented local invasiveness of the tumor, suggesting the importance of the preservation of soft tissue for infection prevention. The administration of nationwide registry data was informative for the analysis of infection in malignant soft tissue tumor resection.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Kenji Sato
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Shirai T, Tsuchiya H, Terauchi R, Tsuchida S, Shimomura S, Kajino Y, Takahashi K. Iodine-supported implants in prevention and treatment of surgical site infections for compromised hosts: a prospective study. J Orthop Surg Res 2023; 18:388. [PMID: 37245049 DOI: 10.1186/s13018-023-03868-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 04/13/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a common complication following orthopedic implantation. We developed an iodine coating for titanium implants to reduce implant-related infections and conducted a prospective clinical study to evaluate the efficacy and potential drawbacks of iodine-supported implants. PATIENTS AND METHODS Between July 2008 and July 2017, 653 patients (377 male and 27 female patients; mean age, 48.6) with postoperative infection or a compromised status were treated using iodine-loaded titanium implants. The mean follow-up period was 41.7 months. In 477 patients, iodine-supported implants were used to prevent infection and in 176 patients, to treat active infection (one-stage surgery, 89 patients; two-stage surgery, 87 patients). In the limbs and pelvis, the primary diagnoses included the following: 161 tumors, 92 deformities/shortening, 47 pseudarthrosis, 42 fractures, 32 infected TKA, 25 osteoarthritis, 21 pyogenic arthritis, 20 infected THA, and 6 osteomyelitis. In the spinal cases, there were 136 cases of tumors, 36 cases of pyogenic spondylitis, and 35 cases of degeneration. Five modes of implant failure were identified and classified as follows: soft tissue failure (type 1), aseptic loosening (type 2), structural failure (type 3), infection (type 4), and tumor progression (type 5). RESULTS The overall failure rate in our series was 26.3% (172/653). There were 101 mechanical failures, including 22 type 1, 20 type 2, and 59 type 3 failures. Non-mechanical causes accounted for 71 failures, including 45 type 4 and 26 type 5 failures. The overall incidence of infections was 6.8%. The mean time to the onset of infection after implantation was 9.1 months. The overall infection rate was 3.7% in the prevention cases and 15.3% in the treatment cases. There was no difference between one-stage replacement (14.6%) and two-stage replacement (16.0%). There were 11 cases of treatment for SSI of spine surgery, and the re-infection rate was 0% using iodine-coated instruments. CONCLUSIONS The five modes of failure of the iodine-supported implant were satisfactory compared with previous reports. In particular, because the infection rate of iodine-coated implants used for compromised hosts is low compared with other methods, postoperative infection is more easily controlled. It can be considered highly effective for spinal infections that require one-stage revision surgery. LEVEL OF EVIDENCE IV Trial registration Prospective, Observation study.
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Affiliation(s)
- Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan.
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Ryu Terauchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Seiji Shimomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
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Wang HJ, Hao MF, Wang G, Peng H, Wahid F, Yang Y, Liang L, Liu SQ, Li RL, Feng SY. Zein nanospheres assisting inorganic and organic drug combination to overcome stent implantation-induced thrombosis and infection. Sci Total Environ 2023; 873:162438. [PMID: 36842591 DOI: 10.1016/j.scitotenv.2023.162438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/11/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
The complication of stent implantation is the biggest obstacle to the success of its clinical application. In this study, we developed a combination way of 3D printing and the coating technique for preparation of functional polyurethane stents against stent implantation-induced thrombosis and postoperative infection. SEM, XPS, static water contact angle, and XRD demonstrated that the functional polyurethane stent had a 37 μm-thickness membrane composed of zein nanospheres (250-350 nm). Meanwhile, ZnO nanoparticles were encapsulated in zein nanospheres while heparin was adsorbed on the surface, causing 97.1 ± 6.4 % release of heparin in 120 min (first-order kinetic model) and 62.7 ± 5.6 % release of Zn2+ in 9 days (Korsmeyer-Peppas model). The mechanical analysis revealed that the functional polyurethane stents had about 8.61 MPa and 2.5 MPa tensile strength and bending strength, respectively. The in vitro biological analysis showed that the functional polyurethane stents had good EA.hy926 cells compatibility (97.9 ± 3.8 %), anti-coagulation response (comparable plasma protein, platelet adhesion and suppressed clotting) and sustained antibacterial activities by comparison with the bare polyurethane stent. The preliminary evaluation by rabbit ex vivo carotid artery intervention experiment demonstrated that the functional polyurethane stents could maintain blood circulation under the continuous stresses of blood flow. Meanwhile, the detailed data from the simulated implant infection experiment in vivo showed the functional polyurethane stents could effectively reduce microbial infection by 3-6 times lower and improve fibrosis and macrophage infiltration.
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Affiliation(s)
- Hua-Jie Wang
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China; School of Food Science, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China.
| | - Meng-Fei Hao
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China
| | - Guan Wang
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China
| | - Hao Peng
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China
| | - Fazli Wahid
- School of Biomedical Sciences and Biotechnology, Pak-Austria Fachhochshule: Institute of Applied Sciences and Technology, Mang, Khanpur Road, Haripur 22620, Pakistan
| | - Yan Yang
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China
| | - Lei Liang
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China
| | - Shan-Qin Liu
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China
| | - Ren-Long Li
- Xinxiang Key Laboratory of 3D Bioprinting and Precision Medicine, School of Chemistry and Chemical Engineering, Henan Institute of Science and Technology, Eastern HuaLan Avenue, Xinxiang, Henan 453003, PR China
| | - Shu-Ying Feng
- Medical College, Henan University of Chinese Medicine, No. 156, Jinshui East Road, Zhengzhou, Henan 450046, PR China
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Wei J, Gu H, Tong K. Intra-wound versus systemic vancomycin for preventing surgical site infection induced by methicillin-resistant S. aureus after spinal implant surgery in a rat model. J Orthop Surg Res 2023; 18:299. [PMID: 37055765 PMCID: PMC10100431 DOI: 10.1186/s13018-023-03779-5] [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] [Received: 02/06/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Systemic vancomycin administration pre-operatively for the infection prophylaxis of spinal implant surgery remains unsatisfactory. This study aimed to explore the efficacy and dosage of local use of vancomycin powder (VP) in preventing surgical site infections after spinal implant surgery in a rat model. METHODS Systemic vancomycin (SV; intraperitoneal injection, 88 mg/kg) or intraoperative intra-wound VP (VP0.5: 44 mg/kg, VP1.0: 88 mg/kg, VP2.0: 176 mg/kg) was applied after spinal implant surgery and methicillin-resistant S. aureus (MRSA; ATCC BAA-1026) inoculation in rats. General status, blood inflammatory biomarkers, microbiological and histopathological evaluation were performed during 2 weeks post-surgery. RESULTS No post-surgical deaths, wound complications and obvious signs of vancomycin adverse effects were observed. Bacterial counts, blood and tissue inflammation were reduced in the VP groups compared with the SV group. VP2.0 group showed better outcomes in weight gain and tissue inflammation than the VP0.5 and VP1.0 group. Microbial counts indicated that no bacteria survived in the VP2.0 group, whereas MRSA was detected in VP0.5 and VP1.0 groups. CONCLUSIONS Intra-wound VP may be more effective than systemic administration in preventing infection caused by MRSA (ATCC BAA-1026) after spinal implant surgery in a rat model.
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Affiliation(s)
- Jian Wei
- Department of Orthopedic Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China.
| | - Hanwen Gu
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Kai Tong
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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Ma Y, Tan B, Wang S, Ren C, Zhang J, Gao Y. Influencing factors and predictive model of postoperative infection in patients with primary hepatic carcinoma. BMC Gastroenterol 2023; 23:123. [PMID: 37046206 PMCID: PMC10099730 DOI: 10.1186/s12876-023-02713-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The purpose of this study was to explore the risk factors for postoperative infection in patients with primary hepatic carcinoma (PHC), build a nomogram prediction model, and verify the model to provide a better reference for disease prevention, diagnosis and treatment. METHODS This single-center study included 555 patients who underwent hepatobiliary surgery in the Department of Hepatobiliary Surgery of Tianjin Third Central Hospital from January 2014 to December 2021, and 32 clinical indicators were selected for statistical analysis. In this study, Lasso logistic regression was used to determine the risk factors for infection after liver cancer resection, establish a predictive model, and construct a visual nomogram. The consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve were used for internal validation, and decision curve analysis (DCA) was used to analyze the clinical applicability of the predictive model. The bootstrap method was used for intramodel validation, and the C-index was calculated to assess the model discrimination. RESULTS Among the 555 patients, 279 patients met the inclusion criteria, of whom 48 had a postoperative infection, with an incidence rate of 17.2%. Body mass index (BMI) (P = 0.022), alpha-fetoprotein (P = 0.023), total bilirubin (P = 0.016), intraoperative blood loss (P < 0.001), and bile leakage (P < 0.001) were independent risk factors for infection after liver cancer surgery. The nomogram was constructed and verified to have good discriminative and predictive ability. DCA showed that the model had good clinical applicability. The C-index value verified internally by the bootstrap method results was 0.818. CONCLUSION Postoperative infection in patients undergoing hepatectomy may be related to risk factors such as BMI, preoperative AFP level, TBIL level, intraoperative blood loss and bile leakage. The prediction model of the postoperative infection nomogram established in this study can better predict and estimate the risk of postoperative infection in patients undergoing hepatectomy.
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Affiliation(s)
- Yanan Ma
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Institute of Hepatobiliary Disease, Nankai University Affiliated Third Center Hospital, Jintang Road 83, Hedong District, Tianjin, 300170, China
| | - Bing Tan
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Sumei Wang
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Chaoyi Ren
- Department of Hepatobiliary Surgery, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Jiandong Zhang
- Department of Clinical Laboratory, Nankai University Affiliated Third Center Hospital, Tianjin, 300170, China
| | - Yingtang Gao
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Institute of Hepatobiliary Disease, Nankai University Affiliated Third Center Hospital, Jintang Road 83, Hedong District, Tianjin, 300170, China.
- Artificial Cell Engineering Technology Research Center, Tianjin, 300170, China.
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Abstract
BACKGROUND AND AIMS A deep sternal wound infection is a life-threatening complication after cardiac surgery. This study was conducted to describe the mortality associated with postoperative deep sternal wound infections after cardiac surgery and to find risk factors linked to increased mortality in 1 year follow-up. MATERIAL AND METHODS A total of 7973 open-heart surgeries were performed at Tampere University Hospital. Deep sternal wound infection patients were identified, their 1-year mortality status was recorded, and the related risk factors were analyzed. RESULTS We detected a total of 129 (1.6%) postoperative deep sternal wound infection patients. The 1-year mortality associated with a postoperative deep sternal wound infection was 20.2%. No preoperative or perioperative, statistically significant factors associated with increased 1-year mortality were found. A prolonged stay in an intensive care unit after surgery as well as stroke, delirium, wound secretion, and co-infection were associated with increased 1-year mortality. CONCLUSION The risk factors found for increased 1-year mortality were all postoperative. The quality of surgical treatment as well as precise postoperative care and evaluation remain the most important factors to decrease later mortality due to deep sternal wound infections.
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Affiliation(s)
- Eero Hämäläinen
- Faculty of Medicine and Health TechnologyTampere UniversityArvo Ylpön katu 34 33500 TampereFinland
| | - Jari Laurikka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Cardiothoracic Surgery, Tampere University Heart Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Otso Järvinen
- Department of Cardiothoracic Surgery, Tampere University Heart Hospital, Tampere, Finland
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Pilskog K, Høvding P, Inderhaug E, Fevang JM, Dale H. Fracture-related infection: Prevalence and application of the new consensus definition in a cohort of 1004 surgically treated ankle fractures. Injury 2023; 54:841-847. [PMID: 36610943 DOI: 10.1016/j.injury.2022.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Surgical treatment of ankle fractures comes with a substantial risk of complications, including infection. An unambiguously definition of fracture-related infections (FRI) has been missing. Recently, FRI has been defined by a consensus group with a diagnostic algorithm containing suggestive and confirmatory criteria. The aim of the current study was to report the prevalence of FRI in patients operated for ankle fractures and to assess the applicability of the diagnostic algorithm from the consensus group. PATIENTS AND METHODS Records of all patients with surgically treated ankle fractures from 2015 to 2019 were retrospectively reviewed for signs of postoperative infections. Patients with suspected infection were stratified according to confirmatory or suggestive criteria of FRI. Rate of FRI among patients with confirmatory and suggestive criteria were calculated. RESULTS Suspected infection was found in 104 (10%) out of 1004 patients. Among those patients, confirmatory criteria were met in 76/104 (73%) patients and suggestive criteria were met in 28/104 (27%) at first evaluation. Patients with clinical confirmatory criteria (N = 76) were diagnosed with FRI. Patients with suggestive criteria were further examined with either bacterial sampling at the outpatient clinic, revision surgery including bacterial sampling, or a wait-and-see approach. Eleven (39%) of the 28 patients had positive cultures and were therefore diagnosed as having FRI at second evaluation. In total 87 (9%) patients were diagnosed with FRI according to the consensus definition. Only 73 (70%) of the 104 patients with suspected FRI had adequate bacterial sampling. CONCLUSION The prevalence of FRI, applying the FRI-consensus criteria, for patients with surgically treated ankle fractures was 9%. Twenty-two percent of patients who met the confirmatory criteria had negative bacterial cultures. The current study shows that we did not have a systematic approach to patients with suspected FRI as recommended by the consensus group. A systematic approach to adequate bacterial sampling when FRI is suspected is paramount. The consensus definition of FRI and its diagnostic algorithm facilitates such an approach. LEVEL OF EVIDENCE Level III - retrospective cohort study.
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Affiliation(s)
- Kristian Pilskog
- Orthopedic Department, Haukeland University Hospital, Pb 1700, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Pb 7804, Bergen 5020, Norway.
| | - Pål Høvding
- Orthopedic Department, Haukeland University Hospital, Pb 1700, Bergen 5021, Norway
| | - Eivind Inderhaug
- Orthopedic Department, Haukeland University Hospital, Pb 1700, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Pb 7804, Bergen 5020, Norway
| | - Jonas Meling Fevang
- Orthopedic Department, Haukeland University Hospital, Pb 1700, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Pb 7804, Bergen 5020, Norway
| | - Håvard Dale
- Orthopedic Department, Haukeland University Hospital, Pb 1700, Bergen 5021, Norway; Department of Clinical Medicine (K1), University of Bergen, Pb 7804, Bergen 5020, Norway
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Peng X, Hao X, Zhu T. A nomogram to predict postoperative infection for older hip fracture patients. Arch Orthop Trauma Surg 2023; 143:847-55. [PMID: 34625815 DOI: 10.1007/s00402-021-04171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/05/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Postoperative infection is one of the most common postoperative complications in hip fracture surgery. It is related with increased morbidity and mortality. This study aimed at developing a nomogram to predict the individual probability of postoperative infection to facilitate perioperative decision-making. MATERIALS AND METHODS In this retrospective study, we included all patients over 65 years old admitted for hip fracture in West China Hospital of Sichuan University from 1 January 2015 to 31 December 2019. Univariate and multivariate logistic regression analyses were used to identify significant predictors. We used all-subsets regression to screen an optimal model, and visualized the model through drawing nomogram. To evaluate the model performance, we applied receiver operating characteristic curve and calibration curve. RESULTS We enrolled 677 older patients. 136 (20.1%) patients developed postoperative infection during hospitalization. Variables retained in the final model were albumin [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84-0.96], cholesterol (OR 1.49, 95% CI 1.04-2.15), blood phosphorus (OR 0.16, 95% CI 0.05-0.48), high-density lipoprotein (OR 0.42, 95% CI 0.19-0.89), surgery type (OR 2.27, 95% CI 1.35-3.90), smoking (OR 1.95, 95% CI 1.02-3.66), American Society of Anesthesiologists classification [class III (OR 1.02, 95% CI 0.55-1.93); class IV (OR 1.93, 95% CI 0.76-4.82)], and chronic pulmonary disease (OR 2.16, 95% CI 1.25-3.68). The C-index of the nomogram was 0.752 (95% CI 0.697-0.806). Calibration curve showed good agreement between predicted value and observed outcome. In the validation group, our nomogram showed an area under the receiver operating characteristic curve of 0.723 (95% CI 0.639-0.807). CONCLUSION Our nomogram showed good discrimination ability in predicting individual probability of postoperative infection among older patients with hip fracture surgery. The nomogram could help clinicians identify patients at high risk of postoperative infection before surgery.
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Alhashash M, Alkharsawi M, Shousha M. Incidence and local risk factors of infection after anterior sub-axial cervical spine surgery: retrospective database analysis of 4897 consecutive procedures. Arch Orthop Trauma Surg 2023; 143:717-27. [PMID: 34432096 DOI: 10.1007/s00402-021-04133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The anterior cervical spine approach is safe and effective in many cervical spine pathologies. It is considered one of the most common approaches in spine surgery. Postoperative infections after anterior cervical surgery are rare but serious. MATERIALS AND METHODS This study is a retrospective database analysis. In this study, the incidence, and the local risk factors of postoperative infection after anterior-only sub-axial cervical spine surgery in a high-volume spine center were analyzed. The data of patients operated in a teaching hospital is electronically stored in a comprehensive medical database program. Postoperative infection after anterior cervical surgery from C2 to C7 was calculated and analyzed. In the study period, 4897 patients were operated. Twenty-four infections after a primary aseptic operation were detected. Independent local risk factors were estimated. RESULTS Postoperative infection occurred in 24/4897 patients (0.49%). The incidence of infection after cervical trauma was 3% (7/229), after spinal cord injury 4.3% (2/46), with myelopathy 1.98% (11/556), and after revision surgery 1.25% (7/560). The incidence showed a significant increase (p = 0.00, 0.01, 0.02). In 14 of the postoperatively infected patients (58.3%) an oesophageal injury was diagnosed. Odds ratios (OR) with a confidence interval (CI) of 95% was calculated. Independent risk factors for the postoperative infections were: Cervical trauma (OR 8.59, 95% CI 3.52-20.93), revision surgery (OR 3.22, 95% CI 1.33-7.82), The presence of cervical myelopathy (OR 6.71, 95% CI 2.99-15.06), and spinal cord injury (OR 9.33, 95% CI 2.13-40.83). CONCLUSIONS Postoperative infection after anterior cervical surgery is low (0.49%). In addition to the general risk factor for infection, the local risk factors are trauma, myelopathy, spinal cord injury, and revision surgeries. In the case of postoperative infection, an oesophageal injury should be excluded.
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Boethun A, Vissing NH, Mathiasen R, Skjøth-Rasmussen J, Foss-Skiftesvik J. CNS infection in children with brain tumors: adding ventriculostomy to brain tumor resection increases risk more than 20-fold. Childs Nerv Syst 2023; 39:387-394. [PMID: 36536059 DOI: 10.1007/s00381-022-05799-8] [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] [Received: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the risk of central nervous system (CNS) infections in children undergoing neurosurgery for brain tumors. METHODS Single-center retrospective cohort study including all children with brain tumors undergoing neurosurgical treatment over an 11-year period. RESULTS A total of 274 patients undergoing 733 neurosurgical procedures were included. Overall, 12.8% of patients were diagnosed with a CNS infection during their course of treatment. CNS infections were more frequent among children treated with CSF diversion (p < 0.001) and independently associated with low age (OR/y 0.9 (CI 95% 0.769-0.941), intraventricular (OR 2.8, CI 95% 1.2-6.5), and high-grade tumors (OR 2.7, CI 95% 1.1-6.5). The majority of CNS infections occurred within 30 days of surgery, resulting in a postoperative CNS infection rate of 5.3%. Postoperative CNS infections were significantly more frequent following adjunct EVD placement during tumor resection compared to a stand-alone craniotomy (30.4% vs. 1.5%, RR 20.6, CI 95% 5.7-72.2). CONCLUSION CNS infections affect at least 12% of children with brain tumors and are associated with age, tumor location, and grade. Adding EVD to tumor surgery increases the risk of postoperative CNS infection, and reconsidering routine adjunct EVD placement is therefore advocated.
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Affiliation(s)
- Anna Boethun
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark. .,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.
| | - Nadja Hawwa Vissing
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - Jane Skjøth-Rasmussen
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jon Foss-Skiftesvik
- Department of Neurosurgery, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark. .,Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, 2100, Copenhagen, Denmark.
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Matsuda A, Yamada T, Takahashi G, Matsumoto S, Yokoyama Y, Sonoda H, Ohta R, Shinji S, Sekiguchi K, Kuriyama S, Kanaka S, Yoshida H. Postoperative infectious complications have a negative oncological impact in patients after stent placement with malignant large bowel obstruction. Int J Colorectal Dis 2023; 38:2. [PMID: 36602578 DOI: 10.1007/s00384-022-04290-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE In this study, we aimed to investigate the oncological impact of postoperative infection in patients with malignant large bowel obstruction managed by self-expandable metallic stent placement as a bridge to surgery. METHODS The cohort of this multicenter retrospective study comprised 129 patients with pathological stage II/III malignant large bowel obstruction who had undergone bridge to surgery. Patients were allocated to no-postoperative infection (n = 116) and postoperative infection groups (n = 13). RESULTS The postoperative infection group had a significantly greater proportion of men, fewer harvested lymph nodes, and longer postoperative hospital stays than did the no-postoperative infection group. Self-expandable metallic stent-related variables, including clinical failure, were not associated with postoperative infection. Male sex and low body mass index were identified as risk factors for postoperative infection by multivariate logistic regression. Three-year relapse-free survival rates were 75.5% and 30.8% in the no-postoperative infection and postoperative infection groups, respectively; this difference is statistically significant. Male sex, postoperative infection, and T4 were identified as independent prognostic factors by multivariate Cox proportional hazard analysis. The postoperative infection group had a significantly higher total recurrence rate and shorter interval to recurrence than did the no-postoperative infection group. CONCLUSION To the best of our knowledge, this is the first study to show that postoperative infection in bridge to surgery patients has a negative oncological impact. This finding indicates that further improvement in perioperative management of bridge to surgery patients is required to minimize postoperative infection and that patient-risk stratification and additional therapy would contribute to improving oncological outcomes.
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Affiliation(s)
- Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Goro Takahashi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yasuyuki Yokoyama
- Department of Digestive Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kanagawa, 211-8533, Kawasaki, Japan
| | - Hiromichi Sonoda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryo Ohta
- Department of Digestive Surgery, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kanagawa, 211-8533, Kawasaki, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kumiko Sekiguchi
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital, Tokyo, Tama, 206-8512, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Shintaro Kanaka
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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23
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Zileli M. Complication Avoidance in Spine Surgery. Acta Neurochir Suppl 2023; 130:141-156. [PMID: 37548734 DOI: 10.1007/978-3-030-12887-6_18] [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] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
The outcomes of spine surgery are closely related to postoperative morbidity. Therefore, an experienced surgeon must be aware of various complications and should apply all necessary preventive measures to avoid them. It is widely considered that complications of spine surgery are underreported and that their real incidence is much higher than expected. This review highlights methods to prevent various types of morbidity that may be encountered during different spinal procedures, considering general complications, approach-related complications, fusion- and implant-related complications, and systemic complications.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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24
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Yin RH, Zhang B, Zhou XH, Cao LP, Li M. Value of inflammatory mediator profiles and procalcitonin in predicting postoperative infection in patients with hypertensive cerebral hemorrhage. World J Clin Cases 2022; 10:12936-12945. [PMID: 36569019 PMCID: PMC9782956 DOI: 10.12998/wjcc.v10.i35.12936] [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: 10/19/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertensive cerebral hemorrhage (HICH) is a common clinical cerebrovascular disease and one of the most serious complications of hypertension. Early warning of the occurrence of infection during treatment and timely anti-infective treatment are of great significance for the early prevention and treatment of postoperative infection in patients with HICH. Changes in the levels of inflammatory mediators, which are closely related to the occurrence and development of postoperative infection, and procalcitonin (PCT), which is a sensitive indicator for diagnosing bacterial infections, are widely used in clinical practice.
AIM To explore the application value of inflammatory mediator profiles and PCT in predicting postoperative infection in patients with HICH.
METHODS A total of 271 patients who underwent HICH surgery at our hospital between March 2019 and March 2021 were selected and divided into the infection (n = 80) and non-infection (n = 191) groups according to whether postoperative infection occurred. The postoperative infection status and etiological characteristics of the infective pathogens in the infection group were analyzed. Changes in inflammatory mediator profile indices and PCT levels were compared between the two groups, pre- and postoperatively.
RESULTS A total of 109 strains of pathogenic bacteria were detected in the infection group, including 67 strains (61.47%) of gram-negative bacteria, 32 strains (29.36%) of gram-positive bacteria, and 10 strains (9.17%) of fungi. The main infection site of the patients in the infection group was the respiratory system (63.75%). Preoperative interleukin (IL)-4, IL-6, IL-10, tumor necrosis factor-α, interferon-γ, and PCT levels were higher in the infection group than in the non-infection group (P < 0.05), and there were no significant differences in the IL-2 Levels between the two groups (P > 0.05). The inflammatory mediator profile indices and PCT levels were higher in the two groups of patients on the first postoperative day than preoperatively (P < 0.05), and were higher than those in the non-infection group (P < 0.05). Logistic regression analysis showed that preoperative IL-6 and PCT levels correlated with postoperative infection (P < 0.05). Operating characteristic curve analysis results showed that the area under the curve (AUC) values of preoperative IL-6 and PCT levels in predicting postoperative infection in patients with HICH were 0.755 and 0.824, respectively. The AUC value of joint detection was 0.866, which was significantly higher than that of the single index (P < 0.05).
CONCLUSION Preoperative IL-6 and PCT levels are correlated with postoperative infection in patients with HICH. Their detection is clinically significant for early identification of patients at high risk for postoperative infection.
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Affiliation(s)
- Rang-Hua Yin
- Department of Surgery, Ji’an City Hospital of Traditional Chinese Medicine, Ji’an 343000, Jiangxi Province, China
| | - Bin Zhang
- Department of Surgery, Ji’an City Hospital of Traditional Chinese Medicine, Ji’an 343000, Jiangxi Province, China
| | - Xing-He Zhou
- Department of Surgery, Ji’an City Hospital of Traditional Chinese Medicine, Ji’an 343000, Jiangxi Province, China
| | - Lu-Ping Cao
- Department of Surgery, Ji’an City Hospital of Traditional Chinese Medicine, Ji’an 343000, Jiangxi Province, China
| | - Ming Li
- Department of Surgery, Ji’an City Hospital of Traditional Chinese Medicine, Ji’an 343000, Jiangxi Province, China
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Shirai D, Shinkawa H, Kabata D, Takemura S, Tanaka S, Amano R, Kimura K, Ohira G, Nishio K, Tauchi J, Kinoshita M, Kubo S. Laparoscopic liver resection reduces postoperative infection in patients with hepatocellular carcinoma: a propensity score-based analysis. Surg Endosc 2022; 36:9194-9203. [PMID: 35838833 DOI: 10.1007/s00464-022-09403-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study is aimed to compare the occurrence of postoperative infections between patients with hepatocellular carcinoma (HCC) undergoing laparoscopic liver resection (LLR) and those undergoing open liver resection (OLR). METHODS This study included 446 patients who underwent initial curative liver resection for HCC 5 cm or less in size without macroscopic vascular invasion. To adjust for confounding factors between the LLR and OLR groups, propensity score matching and inverse probability weighting (IPW) analysis were performed. The incidence rates of postoperative infection, including incisional surgical site infection (SSI), organ/space SSI, and remote infection (RI), were compared between the two groups. RESULTS An imbalance in several confounding variables, including period of surgery, extent of liver resection, difficult location, proximity to a major vessel, tumor size ≥ 3 cm, and multiple tumors, was observed between the two groups in the original cohort. After matching and weighting, the imbalance between the two groups significantly decreased. Compared with OLR, LLR was associated with a lower volume of intraoperative blood loss (140 vs. 350 mL, P < 0.001 in the matched cohort; 120 vs. 320 mL, P < 0.001 in the weighted cohort) and reduced risk of postoperative infection (2.0% vs. 12%, P = 0.015 in the matched cohort; 2.9% vs. 14%, P = 0.005 in the weighted cohort). Of the types of postoperative infections, organ/space SSI and RI were less frequently observed in the LLR group than in the OLR group in the matched cohort (1.0% vs. 6.0%, P = 0.091 for organ/space SSI; 0% vs. 6.0%, P < 0.001 for RI) and in the weighted cohort (1.2% vs. 7.8%, P < 0.001 for organ/space SSI; 0.3% vs. 5.1%, P = 0.009 for RI). CONCLUSIONS Compared with OLR, LLR for HCC might reduce postoperative infections, including organ/space SSI and RI.
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Affiliation(s)
- Daisuke Shirai
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigekazu Takemura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenjiro Kimura
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Go Ohira
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kohei Nishio
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Jun Tauchi
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiko Kinoshita
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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González-Díaz A, Gil-Moradillo J, Rosillo-Ramírez N, Varela-Rodríguez C, Rodríguez-Antolín A, Tejido-Sánchez Á. Analysis of patient outcomes after urological surgery during the second and third waves of SARS-CoV-2 pandemic in a high incidence area. J Healthc Qual Res 2022; 37:382-389. [PMID: 35624026 PMCID: PMC9069227 DOI: 10.1016/j.jhqr.2022.03.004] [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] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze surgical safety through postoperative COVID-19 incidence and mortality at the urology department of a tertiary hospital located in Madrid (Spain). METHODS Observational, prospective study including all patients undergoing urological surgery from 1st March 2020 to 28th February 2021. According to the hospital organization and local epidemiological situation we delimitate three epidemic waves. A set of screening and protective measures was applied from 4th May onwards. Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were collected. Telephone follow-up was performed at least 3 weeks after hospital discharge. RESULTS 940 urological surgeries were performed, 12 of them had to be rescheduled due to active or recent SARS-CoV-2 infection identified by the screening protocol. Thirty-one patients developed COVID-19 (3.3% incidence) and 7 died (22.6% mortality). The average time to onset of symptoms was 62.6 days after discharge, being 25 cases attributable to community transmission. The remaining 6 cases, due to in-hospital transmission, had worse outcomes. Five of them were identified during the first wave, especially when no preoperative PCR was obtained. In contrast, during the second and third waves, fewer and milder cases were diagnosed, with just 1 in-hospital transmission among 857 urological patients. CONCLUSIONS After implementing complete protective measures, postoperative in-hospital COVID-19 cases almost disappeared, even during the second and third waves. Most of the cases were due to community transmission and thus driven by the general epidemiological situation. While hospitals follow recommendations to avoid COVID-19 infection, urological surgery remains safe and can be maintained.
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Affiliation(s)
- A González-Díaz
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain.
| | - J Gil-Moradillo
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - N Rosillo-Ramírez
- Preventive Medicine Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - C Varela-Rodríguez
- Quality Healthcare Unit, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - A Rodríguez-Antolín
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
| | - Á Tejido-Sánchez
- Urology Service, University Hospital 12 de Octubre, Research Institute 12 de Octubre i+12 (imas12), Complutense University of Madrid (UCM), Madrid, Spain
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Zhu X, Li K, Zheng J, Xia G, Jiang F, Liu H, Shi J. Usage of procalcitonin and sCD14-ST as diagnostic markers for postoperative spinal infection. J Orthop Traumatol 2022; 23:25. [PMID: 35648304 PMCID: PMC9160164 DOI: 10.1186/s10195-022-00644-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 05/14/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Identifying biomarkers for early diagnosis of postoperative spinal infection is essential to avoid complications after spine surgery. The presented study evaluated serum levels of procalcitonin (PCT), C-reactive protein (CRP), and soluble CD14 subtype (sCD14-ST) in patients who underwent spinal surgery to assess the diagnosis values of PCT and sCD14-ST. METHODS Serum levels of PCT, CRP, and sCD14-ST were measured in 490 (289 male/201 female) patients who underwent spinal surgery (SS) before and 1 day after surgery. PCT and sCD14-ST levels of patients diagnosed with postoperative infection (PI) and patients diagnosed with postoperative non-infection (PN) were compared. RESULTS Serum levels of PCT, CRP, and sCD14-ST were significantly increased after surgery (F = 58.393, P = 0.000). In patients diagnosed as having a PI, serum levels of PCT and sCD14-ST were positively correlated with each other (r = 0.90, P < 0.01) and with operation duration (r = 0.92, 0.88, P < 0.01). Receiver operating characteristic (ROC) models showed that both PCT (AUC = 0.817, optimal cutoff: 0.69 ng/ml, P = 0.000) and sCD14-ST (AUC = 0.824, optimal cutoff: 258.27 pg/ml, P = 0.000) can distinguish PI versus PN patients well. CONCLUSION Our results demonstrated that serum levels of PCT and sCD14-ST have the potential to be used as a diagnostic markers for postoperative spinal infection.
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Affiliation(s)
- Xi Zhu
- Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Kaige Li
- Department of Surgery, School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Jianping Zheng
- Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Gen Xia
- Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Feng Jiang
- Department of Medicine, School of Medicine and Dentistry, Aab Cardiovascular Research Institute, University of Rochester, Rochester, NY, USA
| | - Huan Liu
- Department of Medicine, School of Medicine and Dentistry, Aab Cardiovascular Research Institute, University of Rochester, Rochester, NY, USA
| | - Jiandang Shi
- Department of Surgery, School of Clinical Medicine, Ningxia Medical University, Yinchuan, China.
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Zhao Y, Zhao Y, Zhang LQ, Feng GD. Postoperative infection of the skull base surgical site due to suppurative parotitis: A case report. World J Clin Cases 2022; 10:4991-4997. [PMID: 35801038 PMCID: PMC9198874 DOI: 10.12998/wjcc.v10.i15.4991] [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: 11/08/2021] [Revised: 03/03/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paraganglioma occurring at the lateral skull base is a rare tumor. Surgery is the primary treatment of benign paragangliomas. Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage.
CASE SUMMARY A 30-year-old man with a 1-year history of left-side progressive hearing loss, tinnitus, facial palsy, and choking failed conventional treatment and is the focus of this case report. Imaging revealed a mass around the left jugular foramen that was approximately 47 mm × 38 mm × 34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery. The tumor breached the meninges and occupied the cerebella pontine region. A two-stage surgery was designed for the resection of the mass. In the first-stage, the epidural portion of the mass was removed. The abdominal fat and the temporal muscle flap were transposed within the surgical site. The surgery was successful; however, 25 d after surgery, he developed suppurative parotitis, and the infection spread to the surgical site at the skull base. Broad-spectrum antibiotics were used, and debridement was deployed. After that, the wound was cleaned daily. Five months after the first-stage surgery, the wound was still unclosed, and there was intermittent purulent exudation within the surgical site. vacuum sealing drainage (VSD) was used, and the wound healed in a month. One year after the first surgery, the second-stage of the operation was performed to remove the intracranial portion of the tumor. Recurrence of the tumor was not detected after a 6-month follow-up.
CONCLUSION After a lateral skull base surgery, suppurative parotitis can spread into the operative cavity leading to infection of the surgical site. VSD can help to effectively heal the infected wound. A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.
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Affiliation(s)
- Yong Zhao
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yang Zhao
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li-Qin Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Guo-Dong Feng
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Sugamata N, Okuyama T, Takeshita E, Oi H, Hakozaki Y, Miyazaki S, Takada M, Mitsui T, Noro T, Yoshitomi H, Oya M. Surgical site infection after laparoscopic resection of colorectal cancer is associated with compromised long-term oncological outcome. World J Surg Oncol 2022; 20:111. [PMID: 35387666 PMCID: PMC8988355 DOI: 10.1186/s12957-022-02578-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/09/2022] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated the influence of infectious complications, particularly surgical site infection (SSI), on long-term oncological results after elective laparoscopic resection of colorectal cancer. Methods A total of 199 patients who underwent laparoscopic elective resection with negative resection margins for stage I–III colorectal cancer were retrospectively examined. The postoperative course was recorded based on hospital records, and cancer relapse was diagnosed based on radiological or pathological findings under a standardized follow-up program. The severity of complications was graded using Clavien-Dindo (CD) classification. Results SSI was found in 25 patients (12.6%), with 12 (6.0%) showing anastomotic leak. The postoperative relapse-free survival (RFS) rate was significantly lower in patients with SSI (49.2%) than in patients without SSI (87.2%, P<0.001). Differences in RFS were found after both colectomy and rectal resection (P<0.001 and P<0.001, respectively). RFS did not differ between patients who had major SSI CD (grade III) and those who had minor SSI CD (grades I or II). Multivariate Cox regression analysis identified the occurrence of SSI and pathological stage as independent co-factors for RFS (P<0.001 and P=0.003). Conclusion These results suggest that postoperative SSI compromises long-term oncological results after laparoscopic colorectal resection. Further improvements in surgical technique and refinements in perioperative care may improve long-term oncological results.
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Affiliation(s)
- Nana Sugamata
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takashi Okuyama
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
| | - Emiko Takeshita
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Haruka Oi
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Yuhei Hakozaki
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Shunya Miyazaki
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Musashi Takada
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takashi Mitsui
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takuji Noro
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Hideyuki Yoshitomi
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Masatoshi Oya
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
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Wandoren W, Roger PM, Blanchet P, Brureau L. Use of Antibiotic Prophylaxis for Polymicrobial Urine Culture before Urological Surgery: A Pilot Study. Urol Int 2022; 106:1272-1278. [PMID: 35263753 DOI: 10.1159/000522223] [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: 07/03/2021] [Accepted: 01/20/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Preoperative polymicrobial urine cultures are common, but the associated risk of nosocomial infection is currently unknown. We aimed to analyze the risk of postoperative infection in patients with preoperative polymicrobial urine cultures. METHODS This was a prospective cohort study conducted from November 2018 to October 2020. Polymicrobial urine cultures were defined by at least the presence of 3 bacteria without leukocyturia threshold on two consecutive samples in the month preceding the surgical procedure. Data on postoperative infections were collected during hospitalization until day 30. A postoperative infection was defined by the occurrence of clinical signs (fever, chills, and suppurated process on the surgical site) associated with the prescription of an antibiotic therapy. RESULTS Sixty-eight patients were included, and seven developed a postoperative infection with a microbe identified in blood or urine cultures. There was a significant association between leukocyturia ≥104 (p = 0.02) and the administration of intraoperative antibiotic prophylaxis (p < 0.001). In contrast, there was no significant association between postoperative infections for patients with polymicrobial preoperative urine cultures and having received or not an empirical antibiotic therapy. CONCLUSION The rate of postoperative infection in patients with polymicrobial urine culture before urological procedure was 10.2%. Further studies are needed to assess the antibiotic prophylaxis to be used in this situation.
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Affiliation(s)
- William Wandoren
- CHU de la Guadeloupe, Service d'Urologie, Pointe-à-Pitre, France
| | - Pierre-Marie Roger
- CHU de la Guadeloupe, Service d'infectiologie, Pointe-à-Pitre, France.,Faculté de Médecine, Université des Antilles, Pointe-à-Pitre, France
| | - Pascal Blanchet
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Laurent Brureau
- CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France
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Wise BT, Connelly D, Rocca M, Mascarenhas D, Huang Y, Maceroli MA, Joshi M, Castillo RC, O'Toole RV. Are deep infections that present before and after 90 days from orthopaedic trauma different? An analysis of the validity of the recent change in CDC criteria for infections. Injury 2022; 53:912-8. [PMID: 34732287 DOI: 10.1016/j.injury.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In 2016, the Centers for Disease Control and Prevention (CDC) changed the time frame for their definition of deep surgical site infection (SSI) from within 1 year to within 90 days of surgery. We hypothesized that a substantial number of infections in patients who have undergone fracture fixation present beyond 90 days and that there are patient or injury factors that can predict who is more likely to present with SSI after 90 days. METHODS A retrospective review yielded 452 deep SSI after fracture fixation. These patients were divided into two groups-those infected within 90 days of surgery and those infected beyond 90 days . Data were collected on risk factors for infection. Univariate and multiple logistic regression analyses were performed to compare the two groups. A randomly selected control group was used to build infection prediction models for both outcomes. The two outcomes were then modelled against each other to determine whether differences in predictors for early versus late infection exist. RESULTS Of the 452 infections, 144 occurred beyond 90 days (32% [95% CI, 28%-36%]). No statistically significant patient factors were found in multivariable analysis between the early and late infection groups. The need for flap coverage was the only injury characteristic that differed significantly between groups, with patients in the late infection group more likely to have needed a flap. When modelled against the control group and directly comparing the two models, predictors for early infection include male sex and fractures of the pelvis, acetabulum, or hip, whereas predictors of late infection include hepatitis C and/or human immunodeficiency virus (HIV) and admission to the intensive care unit (ICU). CONCLUSION Use of the recent CDC definition will underestimate the rate of actual postoperative infections when applied to orthopaedic trauma patients. Hepatitis C and/or HIV and ICU admission are predictors of late infection, whereas male sex and pelvis, acetabulum, or hip fractures are predictors of early infection. Patients who receive flap coverage may be more likely to present with late infection.
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Savary L, De Luca A, El Arid JM, Ma I, Soule N, Garnier E, Neville P, Chantepie A, Maakaroun Z, Lefort B. Systematic skin and nasal decolonization lowers Staphylococcus infection in pediatric cardiac surgery. Arch Pediatr 2022; 29:177-182. [PMID: 35094904 DOI: 10.1016/j.arcped.2022.01.009] [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: 07/15/2021] [Revised: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Postoperative infections occur in approximately 10% of pediatric cardiac surgeries, involving Staphylococcus species in most cases. Nasal decontamination of Staphylococcus with mupirocin has been reported to reduce postoperative Staphylococcus infections after cardiac surgery in adults, but the effect of preoperative decontamination in children undergoing cardiac surgery has not been sufficiently studied to reach consensus. METHODS We conducted a single-center retrospective study to evaluate the impact of systematic preoperative decolonization with intranasal mupirocin application and skin-washing with chlorhexidine soap on postoperative Staphylococcus infection in children undergoing cardiac surgery. Our population was divided into three groups according to decolonization protocol (group N: no decolonization; group T: targeted decolonization in Staphylococcus aureus [SA] carriers only; and group S: systematic decolonization). RESULTS A total of 393 children were included between October 2011 and August 2015 (122 in group N, 148 in group T, and 123 in group S). The Staphylococcus infection rate significantly decreased in group S compared to group N (0.8% vs. 7.7%; p < 0.05) and tended to decrease in group S compared to group T (0.8% vs. 4.7%; p = 0.06). Systematic decontamination also significantly reduced the rate of infections starting from the skin (including surgical site infections and bloodstream infections) compared to targeted decolonization or lack of decolonization, but had no effect on the rate of pulmonary infections. CONCLUSION The results of our study suggest that systematic preoperative skin and nasal decontamination, regardless of SA carriage status, could reduce the rate of postoperative Staphylococcus infections after cardiac surgery in children.
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Affiliation(s)
- L Savary
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France; Université François Rabelais, Tours, France
| | - A De Luca
- Université François Rabelais, Tours, France; Nutrition Pédiatrique - Unité Mobile de Nutrition, CHRU Tours, France; INSERM UMR 1069 "Nutrition, Croissance et Cancer", Tours, France
| | - J-M El Arid
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France
| | - I Ma
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France; Université François Rabelais, Tours, France
| | - N Soule
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France
| | - E Garnier
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France
| | - P Neville
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France
| | - A Chantepie
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France; Université François Rabelais, Tours, France
| | - Z Maakaroun
- Médecine interne et Maladies Infectieuses, CHRU Tours, France
| | - B Lefort
- Institut des Cardiopathies Congénitales de Tours, CHRU Tours, France; Université François Rabelais, Tours, France; INSERM UMR 1069 "Nutrition, Croissance et Cancer", Tours, France.
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Debono B, Gerson C, Le Moing V, Houselstein T, Bougeard R, Lonjon G, Lonjon N. Spine Surgery Infection, Litigation, and Financial Compensation: Analysis of 98 Claims Involving French Spine Surgeons Between 2015 and 2019. World Neurosurg 2021; 159:e161-e171. [PMID: 34902601 DOI: 10.1016/j.wneu.2021.12.022] [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: 11/11/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Since 2002, France has adopted the Patients' Rights Law, an alternative malpractice scheme creating a faster, less expensive out-of-court settlement ensuring compensation even in the absence of fault. We aimed to describe the implications of this system by analyzing 5 years of claims for infections related to spinal surgeries collected by the main insurer of French spine surgeons. METHODS We retrospectively analyzed 98 anonymized malpractice claims from 2015 to 2019 (20% of overall claims), including anonymized medical records of the patients, reports of the independent experts, final judgments, and entities supporting the compensation if any. RESULTS Claims included 8 deaths and 17 newly acquired neurological sequelae. The conclusions identified 22 faulty cases. The most frequent fault was a delay in diagnosis (10 cases), followed by inadequate surgical management (6 cases), inadequate antibiotic therapy (5 cases), and inadequate follow-up (1 case). Among the 67 cases (68.4%) proved not to be at fault, 10 were covered by the national solidarity fund because of their severity, and the remaining 57 were covered by hospitals. CONCLUSIONS Since the 2002 Patients' Rights Law, patients with postoperative infections have always received compensation. The out-of-court settlement offers the patients incurring morbidities the assurance of faster compensation. Although certainly subject to selection criteria, this procedure is free and does not necessitate the presence of a lawyer. The analysis of expert reports and the resulting court decisions imply prevention, anticipation, and collaboration of all health care providers and open an opportunity to improve their practices to limit these crucial followings.
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Affiliation(s)
- Bertrand Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Paris, France; Ramsay Santé-Hôpital Privé de Versailles, Versailles, France.
| | - Carole Gerson
- Compensation and Medical Communication Department, Mutuelle d'Assurances du Corps de Santé Français (MACSF), Paris, France
| | - Vincent Le Moing
- Department of Infectious and Tropical Diseases, Montpellier University Medical Center, Montpellier, France
| | - Thierry Houselstein
- Compensation and Medical Communication Department, Mutuelle d'Assurances du Corps de Santé Français (MACSF), Paris, France
| | - Renaud Bougeard
- Department of Neurosurgery, Clinique du Val d'Ouest, Ecully, France
| | - Guillaume Lonjon
- Department of Orthopedic Surgery, Orthosud, Clinique St-Jean-Sud de France, Santé Cite Group. St Jean de Vedas, Montpellier Metropole, France
| | - Nicolas Lonjon
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
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Marroquin-Herrera O, Rosales-Camargo SA, Morales-Sáenz LC, Alvarado-Gomez F. Clostridium perfringens in the spine: A rare cause of post-surgical infection. Surg Neurol Int 2021; 12:544. [PMID: 34877030 PMCID: PMC8645503 DOI: 10.25259/sni_1039_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Post-surgical infections of the spine occur in from 0% to 18% of cases. Postoperative spine infections due to Clostridium Perfringens (CP) resulting in necrotizing fasciitis are extremely rare. However, since they may be fatal, early and definitive treatment is critical. Case Description: A 62-year-old male with a T8-T9 Type C fracture, in ASIA Grade “E” (neurologically intact) underwent a posterior T6-T10 arthrodesis. However, 2 weeks postoperatively, he developed a postoperative thoracic wound infection; the cultures were positive for CP. As the patient developed necrotizing fasciitis, emergent debridement, negative pressure continued drainage, and initiation of appropriate antibiotic therapy were critical. Conclusion: Postoperative spinal infections due to CP with accompanying necrotizing fasciitis are extremely rare. As these infections may be fatal, they must be rapidly diagnosed and treated.
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Affiliation(s)
- Omar Marroquin-Herrera
- Department of Spine Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Cundinamarca, Colombia
| | | | - Luis Carlos Morales-Sáenz
- Department of Spine Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Cundinamarca, Colombia
| | - Fernando Alvarado-Gomez
- Department of Spine Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Cundinamarca, Colombia
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Park KJ, Chapleau J, Sullivan TC, Clyburn TA, Incavo SJ. 2021 Chitranjan S. Ranawat Award: Intraosseous vancomycin reduces periprosthetic joint infection in primary total knee arthroplasty at 90-day follow-up. Bone Joint J 2021; 103-B:13-17. [PMID: 34053300 DOI: 10.1302/0301-620x.103b6.bjj-2020-2401.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 11/05/2022]
Abstract
AIMS Infection complicating primary total knee arthroplasty (TKA) is a common reason for revision surgery, hospital readmission, patient morbidity, and mortality. Increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) is a particular concern. The use of vancomycin as prophylactic agent alone or in combination with cephalosporin has not demonstrated lower periprosthetic joint infection (PJI) rates, partly due to timing and dosing of intravenous (IV) vancomycin administration, which have proven important factors in effectiveness. This is a retrospective review of a consecutive series of primary TKAs examining incidence of PJI, adverse reactions, and complications using IV versus intraosseous (IO) vancomycin at 30-day, 90-day, and one-year follow-up. METHODS A retrospective review of 1,060 patients who underwent TKA between May 2016 to July 2020 was performed. There were 572 patients in the IV group and 488 in the IO group, with minimal 30 days of follow-up. Patients were followed up at regularly scheduled intervals (two, six, and 12 weeks). No differences between groups for age, sex, BMI, or baseline comorbidities existed. The IV group received an IV dose of 15 mg/kg vancomycin given over an hour preceding skin incision. The IO group received a 500 mg dose of vancomycin mixed in 150 ml of normal saline, injected into proximal tibia after tourniquet inflation, before skin incision. All patients received an additional dose of first generation cephalosporin. Evaluation included preoperative and postoperative serum creatinine values, tourniquet time, and adverse reactions attributable to vancomycin. RESULTS Incidence of PJI with minimum 90-day follow-up was 1.4% (eight knees) in the IV group and 0.22% (one knee) in IO group (p = 0.047). This preliminary report demonstrated an reduction in the incidence of infection in TKA using IO vancomycin combined with a first-generation cephalosporin. While the study suffers from limitations of a retrospective, multi-surgeon investigation, early findings are encouraging. CONCLUSION IO delivery of vancomycin after tourniquet inflation is a safe and effective alternative to IV administration, eliminating the logistical challenges of timely dosing. Cite this article: Bone Joint J 2021;103-B(6 Supple A):13-17.
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Affiliation(s)
- Kwan J Park
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Julien Chapleau
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Thomas C Sullivan
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Terry A Clyburn
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Stephen J Incavo
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
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Sakata H, Harada Y, Hiyama T, Kiuchi Y. Infectious necrotizing scleritis and proliferative vitreoretinopathy after scleral buckling in a patient with atopic dermatitis. Am J Ophthalmol Case Rep 2021; 22:101066. [PMID: 33748537 PMCID: PMC7966824 DOI: 10.1016/j.ajoc.2021.101066] [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: 09/09/2020] [Revised: 01/26/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To report a case of necrotizing scleritis and proliferative vitreoretinopathy due to an acute infection following scleral buckling for the management of rhegmatogenous retinal detachment in a patient with untreated atopic dermatitis. Observations A 40-year-old man with untreated atopic dermatitis presented with rhegmatogenous retinal detachment in his right eye. He underwent uncomplicated scleral buckling surgery with an encircling silicon sponge band, then noticed severe hyperemia and purulent discharge in the eye at 3 weeks after surgery. The silicon sponge was exposed and had migrated anteriorly. The patient was then diagnosed with post-scleral-buckling infection and underwent scleral buckle removal. Marked scleral thinning due to necrotizing scleritis was evident beneath the scleral buckle. Eye discharge culture findings were positive for Staphylococcus aureus. After removal of the scleral buckle, the patient's necrotizing scleritis improved, but he developed proliferative vitreoretinopathy. The patient then underwent pars plana vitrectomy, which resulted in reattachment of his retina. Conclusions and Importance Although postoperative infection within 1 month after scleral buckling is rare, surgeons should note that patients with atopic dermatitis are at high risk of postoperative infection after scleral buckling, leading to the development of sight-threatening complications such as necrotizing scleritis, which could lead to incomplete retinal attachment and proliferative vitreoretinopathy.
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Affiliation(s)
- Hajime Sakata
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 93125441, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 93125441, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 93125441, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, 93125441, Japan
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Qiao L, Zeng SQ, Zhang N. Effects of cooperative nursing and patient education on postoperative infection and self-efficacy in gastrointestinal tumors. World J Clin Cases 2021; 9:1610-1618. [PMID: 33728304 PMCID: PMC7942033 DOI: 10.12998/wjcc.v9.i7.1610] [Citation(s) in RCA: 2] [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: 11/19/2020] [Revised: 12/04/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal tumors have a high incidence rate. The application value of the cooperative nursing care system of medical care has received widespread attention in recent years. However, there are few studies on the value of the joint application of collaborative nursing care and self-efficacy education.
AIM To explore the effect of cooperative nursing care management/self-efficacy education on postoperative infection and self-efficacy in gastrointestinal tumor surgery patients.
METHODS A total of 102 patients with gastrointestinal tumors treated in our hospital from October 2018 to February 2020 were selected and divided into a conventional group (n = 51) and a combined group (n = 51) according to the nursing plan. The routine group adopted routine nursing, and the joint group adopted the medical care cooperative responsibility system nursing management combined with self-efficacy education. The self-efficacy scores, coping style scores, self-experience burden scores, and postoperative complication rates of the two groups before and after intervention were counted.
RESULTS After intervention, the daily life behavior management, cognitive symptom management, and disease management scores of the two groups were higher than those before the intervention, and those of the combined group were higher than those of the conventional group (all P = 0.000). After the intervention, the positive response scores of the two groups were higher than those before the intervention, the negative response scores were lower than those before the intervention, and the combined group was better than the conventional group (all P = 0.000). After the intervention, the two groups’ emotional, economic, and physical factor scores were lower than those before the intervention, and the combined group was lower than the conventional group (all P = 0.000). The incidence of infection in the combined group (1.96%) was lower than that in the conventional group (15.69%) (P = 0.036).
CONCLUSION Cooperative nursing care management and self-efficacy education improved the physical and mental states of gastrointestinal cancer surgery patients, change the response to disease, and reduce the risk of postoperative infection.
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Affiliation(s)
- Li Qiao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Shu-Qian Zeng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Ning Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Mann M, Wright CH, Jella T, Labak CM, Shammassian B, Srivatsa S, Wright J, Engineer L, Sajatovic M, Selman W. Cranial Surgical Site Infection Interventions and Prevention Bundles: A Systematic Review of the Literature. World Neurosurg 2021; 148:206-219.e4. [PMID: 33412319 DOI: 10.1016/j.wneu.2020.12.137] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cranial surgical site infections (cSSIs) are associated with significant morbidity. Measures to reduce cSSI are necessary to reduce patient morbidity as well as hospital costs and resource utilization. OBJECTIVE To identify and characterize interventions or bundled interventions aimed at reduction of the incidence of cranial surgical site infections. METHODS A systematic review of the literature was conducted according to the PRISMA guidelines. The search strategy included randomized trials, quasi-experimental studies, cohort studies, and case series published between 2000 and 2020 that evaluated interventions implemented to reduce cSSI. Bias assessments and data extraction were performed on included studies. RESULTS The initial search generated 1249 studies. Application of inclusion and exclusion criteria and review of references yielded 15 single-intervention and 6 bundled-intervention studies. The single interventions included handwashing protocols, use of vancomycin powder, hair washing and clipping practices, and incision closure techniques. Bundled interventions addressed a variety of preoperative, intraoperative, and postoperative changes. Despite a lack of strong evidence to support the adoption of statistically significant interventions, the use of vancomycin powder may be effective in reducing cSSI. In addition, bundled interventions that involved cultural changes, such as increased teaching/education, personal accountability, direct observation, and feedback, showed some success in decreasing SSI rates. CONCLUSIONS The strength of the conclusions is limited by small sample sizes, study heterogeneity, relatively low cSSI incidence, and high case variability. Some evidence supports the use of intraoperative vancomycin powder in adult noncranioplasty cases and the application of accountability, teaching, and surveillance of faculty, particularly those early in training.
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Affiliation(s)
- Michael Mann
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
| | - Tarun Jella
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Collin M Labak
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Berje Shammassian
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shaarada Srivatsa
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - James Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lilly Engineer
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Martha Sajatovic
- Department of Neurology, and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Warren Selman
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Tsujimoto H, Kobayashi M, Sugasawa H, Ono S, Kishi Y, Ueno H. Potential mechanisms of tumor progression associated with postoperative infectious complications. Cancer Metastasis Rev 2021; 40:285-296. [PMID: 33389285 DOI: 10.1007/s10555-020-09945-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/03/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
There is increasing evidence that postoperative infectious complications (PICs) are associated with poor prognosis after potentially curative surgery. However, the role that PICs play in tumor development remains unclear. In this article, we reviewed the literature for novel insights on the mechanisms of cancer progression associated with PICs. The Medline and EMBASE databases were searched for publications regarding the role of suppression of antitumor immunity by PIC in tumor progression and selected 916 manuscripts were selected for this review. In addition, a summary of the authors' own experimental data from this field was set in the context of current knowledge regarding cancer progression under septic conditions. Initially, sepsis/microbial infection dramatically activates the systemic immune system with increases in pro-inflammatory mediators, which results in the development of systemic inflammatory response syndrome; however, when sepsis persists in septic patients, a shift toward an anti-inflammatory immunosuppressive state, characterized by macrophage deactivation, reduced antigen presentation, T cell anergy, and a shift in the T helper cell pattern to a predominantly TH2-type response, occurs. Thus, various cytokine reactions and the immune status dynamically change during microbial infection, including PIC. We proposed three possible mechanisms for the tumor progression associated with PIC: first, a mechanism in which microbes and/or microbial PAMPs may be directly involved in cancer growth; second, a mechanism in which factors released from immunocompetent cells during infections may affect tumor progression; and third, a mechanism in which factors suppress host tumor immunity during infections, which may result in tumor progression. A more detailed understanding by surgeons of the immunological features in cancer patients with PIC can subsequently open new avenues for improving unfavorable long-term oncological outcomes associated with PICs.
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Affiliation(s)
- Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan.
| | - Minako Kobayashi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan
| | - Satoshi Ono
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Japan
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Rundgren J, Enocson A, Järnbert-Pettersson H, Mellstrand Navarro C. Surgical site infections after distal radius fracture surgery: a nation-wide cohort study of 31,807 adult patients. BMC Musculoskelet Disord 2020; 21:845. [PMID: 33339519 PMCID: PMC7749509 DOI: 10.1186/s12891-020-03822-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/23/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) after distal radius fracture (DRF) surgery have not previously been studied as the primary outcome in a large population with comparative data for different surgical methods. The aims of this study were 1) to compare SSI rates between plate fixation, percutaneous pinning and external fixation, and 2) to study factors associated with SSI. METHODS We performed a nation-wide cohort study linking data from the Swedish national patient register (NPR) with the Swedish prescribed drug register (SPDR). We included all patients ≥18 years with a registration of a surgically treated DRF in the NPR between 2006 and 2013. The primary outcome was a registration in the SPDR of a dispensed prescription of peroral Flucloxacillin and/or Clindamycin within the first 8 weeks following surgery, which was used as a proxy for an SSI. The SSI rates for the three main surgical methods were calculated. Logistic regression was used to study the association between surgical method and the primary outcome, adjusted for potential confounders including age, sex, fracture type (closed/open), and a dispensed prescription of Flucloxacillin and/or Clindamycin 0-8 weeks prior to DRF surgery. A classification tree analysis was performed to study which factors were associated with SSI. RESULTS A total of 31,807 patients with a surgically treated DRF were included. The proportion of patients with an SSI was 5% (n = 1110/21,348) among patients treated with plate fixation, 12% (n = 754/6198) among patients treated with percutaneous pinning, and 28% (n = 1180/4261) among patients treated with external fixation. After adjustment for potential confounders, the surgical method most strongly associated with SSI was external fixation (aOR 6.9 (95% CI 6.2-7.5, p < 0.001)), followed by percutaneous pinning (aOR 2.7 (95% CI 2.4-3.0, p < 0.001)) (reference: plate fixation). The classification tree analysis showed that surgical method, fracture type (closed/open), age and sex were factors associated with SSI. CONCLUSIONS The SSI rate was highest after external fixation and lowest after plate fixation. The results may be useful for estimation of SSI burdens after DRF surgery on a population basis. For the physician, they may be useful for estimating the likelihood of SSI in individual patients.
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Affiliation(s)
- Johanna Rundgren
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
| | - Anders Enocson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden
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González-Díaz A, Abad-López P, Peña-Vallejo E, Caro-González MP, Calzas-Montalvo C, Gil-Moradillo J, Miranda-Utrera N, Díez-Sebastián J, Varela-Rodríguez C, Rodríguez-Antolín A, Tejido-Sánchez A. Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases. Actas Urol Esp 2020; 44:665-73. [PMID: 33069489 DOI: 10.1016/j.acuro.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023]
Abstract
Introducción La pandemia por SARS-CoV-2 ha cambiado la práctica urológica a nivel mundial. Nuestro objetivo es describir los resultados en salud observados en los pacientes intervenidos en el Servicio de Urología de un hospital terciario, a lo largo de diferentes fases epidemiológicas. Métodos Estudio de cohortes observacional que incluye todos los pacientes intervenidos entre el 1 de marzo y el 14 de mayo. Según la organización hospitalaria, distinguimos 3 periodos: durante las primeras 2 semanas no hubo cambios (1.er periodo), en las 7 semanas siguientes solo se realizaron intervenciones urgentes previa extracción de exudado nasofaríngeo (2.o periodo), y tras el 4 de mayo se reanudó la cirugía electiva aplicando un protocolo de cribado multidisciplinar (3.er periodo). Las variables demográficas y basales, las quirúrgicas y perioperatorias, así como los resultados postoperatorios, se obtuvieron de forma retrospectiva (periodos 1 y 2) y prospectiva (periodo 3). El seguimiento telefónico se realizó al menos 3 semanas tras el alta hospitalaria. Resultados Se realizaron 103 cirugías urológicas y fueron diagnosticados de COVID-19 11 pacientes, 8 de ellos en el 1.er periodo. El diagnóstico era conocido en un paciente, mientras que los otros 10 desarrollaron la enfermedad en una media de 25 días tras la intervención y 16,6 días tras el alta. Cuatro de 7 pacientes trasplantados resultaron afectados. Se registraron 3 muertes por la enfermedad: una mujer de 69 años trasplantada y 2 varones mayores de 80 años con comorbilidades y alto riesgo anestésico a los que se realizó drenaje de absceso retroperitoneal y cirugía retrógrada intrarrenal, respectivamente. Conclusiones La infección por SARS-CoV-2 afectó principalmente a trasplantados renales o pacientes añosos con alto riesgo anestésico, durante las 2 primeras semanas de la pandemia. Tras implantar la PCR preoperatoria y un protocolo completo de cribado, los casos se redujeron de manera sustancial y se pudo operar con seguridad.
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Henkelmann R, Krause M, Alm L, Glaab R, Mende M, Ull C, Braun PJ, Katthagen C, Gensior TJ, Frosch KH, Hepp P. Effect of fracturoscopy on the incidence of surgical site infections post tibial plateau fracture surgery. Eur J Trauma Emerg Surg 2020; 46:1249-55. [PMID: 32935161 DOI: 10.1007/s00068-020-01486-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/04/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE Surgical treatment of tibial plateau fracture (TPF) is common. Surgical site infections (SSI) are among the most serious complications of TPF. This multicentre study aimed to evaluate the effect of fracturoscopy on the incidence of surgical site infections in patients with TPF. METHODS We performed a retrospective multicentre study. All patients with an AO/OTA 41 B and C TPF from January 2005 to December 2014 were included. Patients were divided into three groups: those who underwent arthroscopic reduction and internal fixation (ARIF), and those who underwent open reduction and internal fixation (ORIF) with fracturoscopy, and those treated with ORIF without fracturoscopy. The groups were compared to assess the effect of fracturoscopy. We characterised our cohort and the subgroups using descriptive statistics. Furthermore, we fitted a logistic regression model which was reduced and simplified by a selection procedure (both directions) using the Akaike information criterion (AIC). From the final model, odds ratios and inclusive 95% confidence intervals were calculated. RESULTS Overall, 52 patients who underwent fracturoscopy, 48 patients who underwent ARIF, and 2000 patients treated with ORIF were identified. The rate of SSI was 0% (0/48) in the ARIF group and 1.9% (1/52) in the fracturoscopy group compared to 4.7% (93/2000) in the ORIF group (OR = 0.40, p = 0.37). Regression analyses indicated a potential positive effect of fracturoscopy (OR, 0.65; 95% CI, 0.07-5.68; p = 0.69). CONCLUSION Our study shows that fracturoscopy is associated with reduced rates of SSI. Further studies with larger cohorts are needed to investigate this. LEVEL OF EVIDENCE Level III.
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Nishimuta H, Kusachi S, Watanabe M, Asai K, Kiribayashi T, Niitsuma T, Maruyama H, Tanemoto K. Impact of postoperative remote infection on length of stay and medical costs in hospitals in Japan. Surg Today 2020; 51:212-218. [PMID: 32892295 DOI: 10.1007/s00595-020-02113-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/25/2019] [Accepted: 06/29/2020] [Indexed: 01/28/2023]
Abstract
PURPOSE To analyze the impact of postoperative remote infections (PRIs) on medical expenditure. METHODS The subjects of this retrospective study were 338 patients who had undergone gastroenterological surgery at one of the 20 Japanese institutions within the Japan Society for Surgical Infection (JSSI) and mainly authorized as educational institutions. The patients were allocated to 169 pairs of those with a PRI (PRI (+) group) matched with those without a PRI (PRI (-) group). PRIs included pneumonia, urinary tract infection (UTI), catheter-associated blood stream infection (CA-BSI), and antibiotic-associated enteritis. RESULTS SSI developed in 74 of the 338 patients (22 without PRI and 52 with PRI). The SSI incidence was significantly higher in the PRI (+) group (p < 0.001). The difference in the median postoperative length of hospital stay was 15 days, indicating a significant prolongation in the PRI (+) group (p < 0.001). The PRI (+) group also had a higher rate of inter-hospital transfer (p < 0.01) and mortality (p < 0.001). Similarly, the difference in median postoperative medical fees was $6832.3, representing a significant increase in the PRI (+) group (p < 0.001). CONCLUSIONS The postoperative length of hospital stay is longer and the postoperative medical expenditure is higher for patients with a PRI than for those without a PRI.
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Affiliation(s)
- Hironobu Nishimuta
- Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Shinya Kusachi
- Department of Surgery, Tohokamagaya Hospital, 594 Awano, Kamagaya, Chiba, Japan.
| | - Manabu Watanabe
- Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Koji Asai
- Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Takaharu Kiribayashi
- Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Toru Niitsuma
- Department of Surgery, Toho University Medical Center Ohashi Hospital, Tokyo, Japan
| | - Hiroshi Maruyama
- Department of Surgery, Japan Medical University Tamanagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
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Tatsuoka T, Okuyama T, Takeshita E, Oi H, Noro T, Mitsui T, Yoshitomi H, Oya M. Early detection of infectious complications using C-reactive protein and the procalcitonin levels after laparoscopic colorectal resection: a prospective cohort study. Surg Today 2021; 51:397-403. [PMID: 32785845 DOI: 10.1007/s00595-020-02111-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The predictive values of the C-reactive protein (CRP) and procalcitonin (PCT) levels for postoperative infectious complications were investigated in patients who underwent elective laparoscopic resection of colorectal cancer. METHODS A total of 154 consecutive patients who underwent elective laparoscopic resection for colorectal cancer (CRC) were prospectively studied. The CRP and PCT levels on the first postoperative day (POD1) and the fourth postoperative day (POD4) were measured. Any correlations between the CRP and PCT levels on POD1 and POD4 with the occurrence of infectious complications were examined. RESULTS Infectious complications occurred in 18 (11.7%) patients. CRP on POD1 and CRP and PCT on POD4 were significantly higher in patients who developed infectious complications than in those who did not. The areas under the receiver operating characteristic curves of CRP on POD1 and CRP and PCT on POD4 were 0.597, 0.763 and 0.768, respectively. The cut-off values of CRP and PCT levels on POD4 were 14.33 mg/dl and 0,264 ng/ml, respectively. Whereas the positive predictive value of an elevated CRP level was high, the negative predictive value of an elevated PCT was high. CONCLUSION The CRP and PCT levels on POD4 are both considered to be useful for the early detection of infectious complications after laparoscopic resection of CRC.
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Abstract
A brain abscess is a focal accumulation of pus in the brain parenchyma arising from direct inoculation, contiguous spread from local anatomical structures or haematogenous seeding from a remote source of infection. It can result in significant morbidity and mortality, making early diagnosis and treatment vital. Only one fifth of patients present with the classic triad of headache, fever and focal neurological symptoms. More commonly patients show signs and symptoms of raised intracranial pressure alone, such as confusion or reduced conscious level, headache, nausea and vomiting, which can be a presentation of many intracranial pathologies. Distinguishing an abscess from other pathologies such as meningitis and tumours is crucial, as clinically these can present in similar ways, but their management and outcomes are very different. Diffusion-weighted magnetic resonance imaging brain scans can help localise the lesion and differentiate ring-enhancing lesions caused by a brain abscess from malignant tumours. Cerebral abscesses are considered a neurosurgical emergency; early stabilisation, diagnosis and management in a neurosurgical centre is important in reducing morbidity and mortality.
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Affiliation(s)
- Marta De Andres Crespo
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris McKinnon
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jane Halliday
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Taillandier P, Roingeard C, Violette J, Leclère FM, Faivre S. Septic shock caused by Gardnerella vaginalis and Atopobium vaginae. IDCases 2020; 21:e00876. [PMID: 32596133 DOI: 10.1016/j.idcr.2020.e00876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 01/06/2023] Open
Abstract
Although bacterial vaginosis is the most common and benign vaginal infection worldwide, some cases of severe acute infections have been described in the literature. We report the case of a 57-year-old French female who developed a life-threatening postoperative peritonitis after a total hysterectomy with adnexectomy in the context of the removal of leiomyosarcoma. The microbiological analysis of the peritoneal fluid identified Gardnerella vaginalis and Atobopium vaginae. The final diagnosis was a septic shock induced by an early onset peritonitis caused by Gardnerella vaginalis and Atobopium vaginae. The normal flora of the genital area could lead to a serious life threatening postoperative infection and should always be in the differential diagnosis.
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Khanal P, Guragain RP, Bhusal CL. Comparison of postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty: A randomized controlled trial. Int J Pediatr Otorhinolaryngol 2020; 131:109893. [PMID: 31981921 DOI: 10.1016/j.ijporl.2020.109893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/18/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare postoperative infection and graft uptake rate using single dose of intravenous co-amoxiclav versus no antibiotic in children undergoing myringoplasty. METHODS This is a prospective, randomized controlled study conducted in children of age 6-15 years with chronic otitis media (COM) mucosal, inactive type undergoing myringoplasty. Postoperative infection over a period of 4 weeks and status of graft at or around 3 months after surgery was studied as outcome measure. RESULTS Fifty five out of sixty children completed follow-up. The overall postoperative infection rate was 5.4%. Postoperative infection rate was 3.5% in children receiving prophylactic antibiotic and 7.4% in children receiving no antibiotic. There was no statistically significant difference in postoperative infection between two groups (P > 0.05). The overall graft uptake rate was 87.27%. It was 85.7% in antibiotic used group and 88.8% in non-antibiotic group with no statistically significant difference (P > 0.05). CONCLUSIONS Postoperative infection following myringoplasty in children is uncommon as it is a clean type of surgery. There was no statistically significant difference in postoperative infection and graft uptake rate by the use of prophylactic antibiotic in the intraoperative period. This study shows no benefit of a prophylactic antibiotic on postoperative infection or graft success in myringoplasty in children. TRIAL REGISTRATION NUMBER NCT03700814.
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Affiliation(s)
| | | | - Chop Lal Bhusal
- Ganesh Man Singh Memorial Academy of ENT-Head and Neck Studies, TUTH, Kathmandu, Nepal
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Saje A, Velnar T, Smrke B, Spazzapan P, Keše D, Kobal B, Beović B. Ureaplasma parvum ventriculitis related to surgery and ventricular peritoneal drainage. J Infect Chemother 2020; 26:513-515. [PMID: 32007385 DOI: 10.1016/j.jiac.2019.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/06/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
Ureaplasma spp. usually causes genitourinary infections; few reports in the literature describe extragenital infections, usually in immunocompromised patients. We present a case of Ureaplasma parvum ventriculitis in an immunocompetent patient related to ventriculoperitoneal drainage and surgery. Ureaplasma parvum was detected with broad range 16S rRNA PCR and cultured on A8 agar.
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Affiliation(s)
- Andreja Saje
- Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia.
| | - Tomaž Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Slovenia
| | - Barbara Smrke
- Department of Neurosurgery, University Medical Centre Ljubljana, Slovenia
| | - Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, Slovenia
| | - Darja Keše
- Institute of Microbiology and Immunology Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Borut Kobal
- Department of Gynaecology, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
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Pasick LJ, Valentino WL, Paknezhad H, Sataloff RT. Role of Peri- and Postoperative Antibiotics in Microscopic Laryngeal Surgery. J Voice 2019; 35:458-462. [PMID: 31870517 DOI: 10.1016/j.jvoice.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/06/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES There are no widely accepted guidelines for the use of peri- and postoperative antibiotics for microdirect laryngoscopy (MDL) to prevent postoperative surgical site infection (SSI). This study examines the incidence of not only SSI, but also respiratory and oropharyngeal infections among patients who underwent MDL. STUDY DESIGN Retrospective cohort. METHODS Medical records from a quaternary laryngology practice were reviewed retrospectively for patients who underwent MDL between October 2015 and December 2018. Adults who underwent MDL with excision of nonmalignant masses, vocal fold (VF) reconstruction with buccal graft, superficial VF injection, VF injection augmentation, use of carbon dioxide (CO2) or potassium titanyl phosphate (KTP) laser, and laryngeal dilation were included. Subjects were divided into three groups based on the use of antibiotics during the peri- or postoperative period. Group 1 did not receive peri- or postoperative antibiotics. Group 2 received perioperative antibiotics without postoperative antibiotics. Group 3 received both peri- and postoperative antibiotics. Antibiotic use was determined by surgeon policy, which changed over time, not by patient risk factors. Other data collected include demographics, medical comorbidities, surgical procedure, operative time, American Society of Anesthesiology class, incidence of SSI, respiratory or oropharyngeal infection, and postoperative antibiotic and steroid prescriptions for complications. RESULTS 190 surgeries met inclusion criteria. Groups 1, 2, and 3 consisted of 113, 57, and 20 subjects, respectively. No SSI were reported. Baseline characteristics of median age, American Society of Anesthesiology, wound class, and gender did not differ between groups. Groups were found to have differed in type of procedure performed, with a predominance of vocal fold excision and superficial injection in Group 1, injection laryngoplasty using autologous fat graft and laryngeal reconstruction in Group 3, and a combination of procedure types in Group 2. Laser treatment with CO2 and/or KTP was utilized in 35% of procedures. The mean operative times (total time in which the laryngoscope remained in the oral cavity) for Groups 1, 2, and 3 were 29 (SD = 13), 42 (SD = 23), and 73 minutes (SD = 78), respectively; this was significantly different among the three groups (P < 0.0001). By logistic regression models, operative time was not significantly associated with the overall use of antibiotics (Χ2 = 1.81, P = 0.18) or corticosteroid (Χ2 = .05, P = .82) prescriptions during follow-up. In Groups 1, 2, and 3, 11%, 14%, and 10% of patients, respectively, required a follow-up antibiotic prescription for non-SSI and 11%, 12%, and 0% of patients, respectively, required a follow-up corticosteroid prescription within 30 days postoperatively. There was no significant difference in patients with diabetes or pulmonary comorbidity and patients without comorbidity in use of postoperative antibiotic (P = .45) or corticosteroid (P > .99) prescription. Within 30 days of follow-up, patients in Group 1 experienced VF hemorrhage (defined as any subepithelial blood in the area of excision) at an incidence of 19%. Complications within 30 days of follow-up showed an incidence of substantial pain ranging between 2%-4% and respiratory or oropharyngeal infection between 10%-12%. Two patients in Group 2 reported emergency department visits for dyspnea. One patient in Group 3 was admitted for tongue and floor of mouth swelling secondary to prolonged suspension. CONCLUSION There were no incidents of SSI in this cohort. The need for follow-up antibiotic and/or corticosteroid prescription did not differ in relation to use or non-use of perioperative antibiotics, and neither did the incidence of respiratory or oropharyngeal infection. Longer operative time was associated with both peri- and postoperative antibiotic use, but there is no evidence yet that antibiotic use was necessary. These findings suggest that avoidance of routine perioperative and/or postoperative antibiotics may be appropriate; and further research should be encouraged.
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Affiliation(s)
- Luke J Pasick
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - William L Valentino
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Hassan Paknezhad
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
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Rodríguez Sánchez F, Arteagoitia I, Rodríguez Andrés C, Bruers J. Antibiotic prophylaxis prescribing habits in oral implant surgery in the Netherlands: a cross-sectional survey. BMC Oral Health 2019; 19:281. [PMID: 31830979 PMCID: PMC6909651 DOI: 10.1186/s12903-019-0981-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/19/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background There seems to be no consensus on the prescription of prophylactic antibiotics in oral implant surgery. The Dutch Association of Oral Implantology (NVOI) guidelines do not include a clear policy on prophylactic antibiotic prescriptions for oral implant surgery among healthy patients. The purpose of the study was to determine whether antibiotic prophylaxis is commonly prescribed in the Netherlands by general dentists, maxillofacial surgeons and oral implantologists in conjunction with oral implant surgery among healthy patients and to assess the type and amount of prophylactic antibiotic prescribed. Methods This observational cross-sectional study is based on a web survey. A questionnaire developed in the United States of America was translated and slightly adjusted for use in the Netherlands. It contained predominantly close-ended questions relating to demographics, qualifications, antibiotic type, prescription duration and dosage. An email including an introduction to the study and an individual link to the questionnaire was sent in February 2018 to a sample of 600 general dental practitioners and all 302 specialized dentists (oral implantologists, periodontists and maxillofacial surgeons) recognized by the NVOI. Overall, 902 questionnaires were anonymously sent. Finally, 874 potential participants were reached. Collected data were analyzed through descriptive statistics. Results In total, 218 (24.9%) participants responded to the questionnaire, including 45 females (20.8%) and 171 males (79.2%). Overall, 151 (69.9%) regularly placed oral implants. Of them, 79 (52.7%) prescribe antibiotics only in specific situations, 66 (43.7%) regularly, and 5 (3.3%) did not prescribe antibiotics at all. Overall, 83 participants who prescribe antibiotics did so both pre- and postoperatively (57.2%), 47 only preoperatively (32.4%) and 12 exclusively postoperatively (8.3%). A single dose of 2000 mg of amoxicillin orally one hour prior to surgery was the most prescribed preoperative regimen. The most frequently prescribed postoperative regimen was 500 mg of amoxicillin three times daily for five days after surgery. On average, participants prescribe a total of 7018 mg of antibiotics before, during or after oral implant surgery. Conclusions Antibiotic prophylaxis in conjunction with oral implant surgery is prescribed in the Netherlands on a large scale, and recommendations based on the last published evidence are frequently not followed.
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Affiliation(s)
- Fabio Rodríguez Sánchez
- Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), Barrio Sarriena, s/n, Lejona, 48940, Bilbao, Spain. .,Department of Oral Health Sciences, Periodontology, Catholic University of Leuven & University Hospitals Leuven, Leuven, Belgium.
| | - Iciar Arteagoitia
- Department of Stomatology, University of the Basque Country (UPV/EHU), Bilbao, Spain.,BioCruces Health Research Institute member, Cruces University Hospital, Barakaldo, Spain
| | - Carlos Rodríguez Andrés
- Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), Barrio Sarriena, s/n, Lejona, 48940, Bilbao, Spain
| | - Josef Bruers
- Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, the Netherlands.,Royal Dutch Dental Association (KNMT), Utrecht, the Netherlands
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