Positive Bacterial Culture Results at a Dermatologic Surgery Center: A Single-Site Retrospective Review.

BACKGROUND: Typical prophylactic coverage of suspected cutaneous surgical-site infections (SSIs) predominantly covers gram-positive bacteria. Data regarding the frequency of infection with unusual bacteria, not covered by prophylaxis, are not available. OBJECTIVE: A retrospective 10-year review of culture-positive infections at a single academic site was performed. MATERIALS AND METHODS: All positive bacterial culture results at the Washington University Center for Dermatologic and Cosmetic Surgery between October 31, 2007, and October 31, 2017, were collected and analyzed. RESULTS: Coagulase-negative staphylococcus accounted for 20.8% of positive culture results. Staphylococcus aureus caused 45.4% of infections. The remaining 33.8% were due to non-S. aureus bacteria, most frequently with Pseudomonas aeruginosa (10.8%). Numerous other gram-negative organisms and unusual gram-positive organisms were cultured. The lower extremity and ear were the only sites more likely to be infected with non-S. aureus bacteria. Smokers and immunosuppressed individuals were not more likely to have an SSI with non-S. aureus bacteria. CONCLUSION: A significant proportion of all SSIs with positive culture results was due to bacteria that are not sensitive to beta-lactam prophylaxis. Broader coverage for suspected SSI should be considered, particularly on the lower extremity and ear.

A Survey of Mohs Tissue Tracking Practices.

BACKGROUND: There are little data regarding error within the multistep process of Mohs micrographic surgery (MMS). OBJECTIVE: A survey of Mohs surgeons was performed to evaluate variation in tissue handling and processing within the MMS process. METHODS AND MATERIALS: A 9-question electronic survey was distributed to members of the American College of Mohs Micrographic Surgery. A total of 97 responses were analyzed. RESULTS: Most surgeons personally transport the tissue (71.1%), most frequently in a specimen container (54.6%). Method of tissue identification during transportation varied significantly. Most surgeons personally hand-draw the map (77.1%). A diagram was most commonly used to convey tissue orientation to the histotechnician (65.4%). Only 31.3% of histotechnicians used labeling of blocks to identify tissue within the cryostat. Most respondents (72.2%) are the only surgeon processing tissue in the laboratory at one time; however, 28.9% reported performing 10 or more cases per day. CONCLUSION: Most respondents are responsible for tissue transport and mapping, which likely reduces potential error. However, the method of transport and labeling, as well as identification by the histotechnician, was more variable. Ultimately, having a consistent process and clear communication with personnel will help reduce potential error during Mohs surgery.

Adult-onset papular purpuric gloves and socks syndrome.

Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited exanthem that presents as painful or pruritic edema, erythema, petechiae, and purpura of the palms and soles with occasional extension to the dorsal hands and feet. The majority of PPGSS cases reported in the literature are associated with parvovirus B19 and occur in children and young adults. In a recent literature search, there were 11 PPGSS cases in adults with none reporting Epstein-Barr virus (EBV) as a viral etiology. However, there have been PPGSS cases related to EBV in children. We report the case of a 72-year-old man with PPGSS associated with Epstein-Barr virus. This case report serves as a reminder that PPGSS can present not only in the setting of pediatric and young adult parvovirus B19 infection, but also in immunocompetent adults with other viral infections.

Incisional negative pressure wound therapy significantly reduces surgical site infection in open colorectal surgery.

BACKGROUND: Surgical site infections in colorectal surgery remain a common problem, and are associated with an increase in cost of care and length of stay. OBJECTIVE: This study aims to evaluate the effect of known risk factors and the use of incisional negative pressure wound therapy on surgical site infection rates. DESIGN: This is a single-center retrospective study with the use of chart review. SETTINGS: The study took place at a tertiary academic medical center. PATIENTS: All patients undergoing open colectomy at a single institution from 2009 through 2011 were studied. MAIN OUTCOME MEASURES: The primary outcome measured was the presence or absence of surgical site infection. RESULTS: Overall, 69 of the 254 patients (27.2%) experienced surgical site infection; 4 (12.5%) surgical site infections were seen in patients undergoing incisional negative pressure wound therapy and 65 (29.3%) were seen in patients undergoing standard closure. Multiple logistic regression revealed 2 significant factors: diabetes mellitus increased the chance of surgical site infection (OR, 1.98; p < 0.05), and the use of incisional negative pressure wound therapy decreased the chance of surgical site infection (OR, 0.32; p < 0.05). Obesity was associated with a trend toward increasing surgical site infection (OR, 1.64; p = 0.10). LIMITATIONS: This study is limited by its retrospective nature and the high baseline prevalence of surgical site infection. CONCLUSIONS: Incisional negative pressure wound therapy appears to reduce surgical site infection in open colorectal surgery. Further study may be helpful to identify patient populations who would have the greatest benefit from this technique(see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A115).