Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data.

Our study aimed to evaluate changes in the epidemiology of pathogens causing surgical site infections (SSIs) in England between 2000 and 2013 in the context of intensified national interventions to reduce healthcare-associated infections introduced since 2006. National prospective surveillance data on target surgical procedures were used for this study. Data on causative organism were available for 72% of inpatient-detected SSIs meeting the standard case definitions for superficial, deep and organ-space infections (9767/13 531) which were analysed for trends. A multivariable logistic linear mixed model with hospital random effects was fitted to evaluate trends by pathogen. Staphylococcus aureus was the predominant cause of SSI between 2000 (41%) and 2009 (24%), decreasing from 2006 onwards reaching 16% in 2013. Data for 2005-2013 showed that the odds of SSI caused by S. aureus decreased significantly by 14% per year [adjusted odds ratio (aOR) 0·86, 95% confidence interval (CI) 0·83-0·89] driven by significant decreases in methicillin-resistant S. aureus (MRSA) (aOR 0·71, 95% CI 0·68-0·75). However a small significant increase in methicillin-sensitive S. aureus was identified (aOR 1·06, 95% CI 1·02-1·10). Enterobacteriaceae were stable during 2000-2007 (12% of cases overall), increasing from 2008 (18%) onwards, being present in 25% of cases in 2013; the model supported these increasing trends during 2007-2013 (aOR 1·12, 95% CI 1·07-1·18). The decreasing trends in S. aureus SSIs from 2006 and the increases in Enterobacteriaceae SSIs from 2008 may be related to intensified national efforts targeted at reducing MRSA bacteraemia combined with changes in antibiotic use aimed at controlling C. difficile infections.

The Burden of Surgical Site Infection at Hospital Universiti Sains Malaysia and Related Postoperative Outcomes: A Prospective Surveillance Study.

Surgical site infections (SSIs) are the most common healthcare-associated infections that occur among surgical patients. Surgical site infections result in longer hospital stays, hospital readmissions, and higher death and morbidity rates. The current study was designed to highlight the importance of such surveillance studies in a Malaysian surgical population with a motive to evaluate and revise concurrent infection control and prevention policies by exploring the burden of surgical site infection and identifying its associated risk factors for future considerations. In this prospective observational cohort study, a total of 216 patients admitted to a surgical ward were identified and studied. Of these 216 patients, 142 elective procedures and 74 emergency procedures were included in the study, of which 13 patients (9.2%) undergoing elective procedures and 15 (20.3%) patients undergoing emergency procedures were SSI positive (OR: 2.5, p = 0.02). Among surgical site infections, 21 were superficial and 7 were deep incisional SSI. No case of organ/space SSI was identified. The time taken for SSIs to develop ranged from 2-17 days with a median of 6 days. Risk factors such as presence of comorbidities (p = 0.011), major co-existing medical diagnosis ≥2 (p = 0.02), and pre-existing infection (p = 0.027) were statistically significant. SSI-positive patients experienced an increase in the post-operative length of hospital stay. In the current population, it was seen that identifying patients who were at high risk of malnutrition via MUST and the NNIS risk index will help clinicians in identifying high risk patients and in managing their patients appropriately. Identifying patients who were at high risk of malnutrition will also improve postoperative outcomes considerably.

Role of single or double ringed circumferential wound protectors in reducing surgical site infections following colorectal resections. A systematic review.

Objective: The objective of this article is to explore whether the use of single or double ringed wound protectors (WP) in patients undergoing colorectal resection (CRR) are associated with reduced risk of surgical site infections (SSI). Materials and methods: Analysis was conducted according to PRISMA guidelines. With the help of expert local librarians, systematic search of medical databases like MEBASE, MEDLINE and PubMed was conducted to find appropriate randomized controlled trials (RCT) according to predefined inclusion criteria. The analysis of the pooled data was done using the principles of meta-analysis on statistical software RevMan version 5. Result: Twelve RCT on 2425 patients fulfilled the inclusion criteria. There were 1216 patients in the WP group and 1209 patients in the no-WP group. In the random effects model analysis, the use of WP during CRR was associated with the reduced risk of SSI [odds ratio 0.60, 95% CI (0.41-0.90), z = 2.49, P = 0.01]. However, there was significant heterogeneity (Tau2 = 0.22; Chi2 = 25.87, df = 11; (p = 0.007; I2 = 57%) among included studies. Conclusion: Use of WP seems to reduce the risk of SSI and therefore, may routinely be used during both open and laparoscopic CRR.

Early versus delayed debridement for surgical site infection after oncological neurosurgery.

Background: There are no guidelines on the management of surgical site infection (SSI) in neurosurgery. This study sought to analyze whether early debridement improved survival compared to antibiotic therapy alone in patients with postcraniotomy infections after oncological neurosurgeries. Methods: We retrospectively reviewed patient records from 2011 to 2019 to identify patients that had been reoperated for the debridement of SSI after brain tumor resection. If SSI was suspected but not clinically evident, the diagnosis was confirmed by cerebrospinal fluid (CSF) analysis or contrast-based imaging examinations. Immediately after diagnosis, broad-spectrum antibiotics were started for all patients. Results: Out of 81 SSI cases, 57 underwent debridement. Two patients were reoperated 3 times, and three had two surgeries, resulting in a total of 64 procedures. The number of days between SSI diagnosis and surgical intervention did not influence mortality in both univariate and multivariable analyses (Hazard ratio [HR] 1.03, 95% CI 0.93-1.13). Early debridement (<24 h) did not influence rates of antibiotic prescription at discharge (P = 0.53) or hospital length of stay (LOS) (P = 0.16). Higher neutrophil-lymphocyte ratios (NLRs) were associated with the lower survival (HR 1.05, 95% Confidence interval [CI] 1.01-1.08). Multiple cutoffs were tested and values above 3.5 are more significantly associated with worse outcomes (HR 2.2; 95%CI 1.1-4.2). Conclusion: Early debridement does not seem to influence the survival, rates of antibiotic at discharge, or hospital LOS of patients presenting with SSI after neurosurgery for intracranial tumors. High NLRs are strong predictors of worse prognosis in this population.

Risk factors of surgical site infection in elective laparotomy in a tertiary care center: an observational study.

INTRODUCTION: Surgical site infections (SSI) encompass 20-25% of all hospital-acquired infections with their prevalence ranging from 2.5 to 41.9% across the world. Prevalence and risk factors of SSI vary greatly between countries and between healthcare institutions within a country. There is limited data on the pattern and risk factors of SSI in the Indian healthcare scenario. This study is an attempt to identify risk factors of SSI in patients who underwent elective laparotomy in the general surgery department of a tertiary care hospital in India. METHODOLOGY: This is an observational cross-sectional retrospective study, conducted over 5 years from January 1, 2015, to December 31, 2019. A total of 112 patients who underwent elective laparotomy in the department of general surgery, were enrolled in the study. Data collection was done from hospital case records and discharge summaries of patients. RESULTS AND DISCUSSION: Out of the 112 patients, a total of 16 patients (14.29%) developed surgical site infections. Preoperative serum total protein (W-465.500, P 0.012) and length of hospital stay (W=1235.000, P≤0.001) were found to have a significant association with surgical site infection. Age, gender, smoking, comorbidity, class of surgical wound and, preoperative albumin did not show any significant association with the development of SSI. Escherichia coli was the predominant organism isolated in culture. CONCLUSION: Measures to curtail SSI can only be adopted after a thorough understanding of its prevalence and predictors. The characteristics and pattern of SSI will help identify prevalent organisms, their resistance pattern and will aid in formulating antibiotic policy tailor-made for the healthcare institution.

Risk Factors for Surgical Site Infections in Patients Undergoing Emergency Surgery: A Single-centre Experience.

BACKGROUND/AIM: Surgical site infections (SSI) are associated with increased morbidity and mortality, and they occur more frequently during unplanned emergency surgical (ES) procedures rather than elective. Our aim was to determine the incidence of SSI within our ES cohort and to identify risk factors for SSI. PATIENTS AND METHODS: Data from consecutive patients undergoing ES in a single institution during a 5-year period were prospectively collected and analyzed. RESULTS: A total of 838 consecutive patients were included. The median age was 52 (IQR=25-71) years and some 368 (44%) were female. 157 (18.7%) of those patients developed SSI. The most commonly isolated pathogen was E. Coli (55.4%) followed by Staphylococcus Aureus (40.1%). The 30-day mortality rate of patients who presented SSIs was 14.6% compared to 6.8% of patients without SSI (p=0.002). Multivariable analysis showed that the type of wound, American Society of Anesthesiology score, severity and duration of surgery >90 min were independent risk factors for the occurrence of SSI. CONCLUSION: Identification of modifiable causative factors for SSI within an ES unit is paramount as they can critically impact postoperative outcomes.

Surgical Protocol for Infections, Nonhealing Wound Prophylaxis, and Analgesia: Development and Implementation for Posterior Spinal Fusions.

OBJECTIVE: To analyze the effects of a surgical protocol for infections, nonhealing wound prophylaxis, and analgesia among patients who underwent posterior spinal fusion at a single tertiary-care neurosurgical center. METHODS: This prospective study was conducted in the neurosurgery department of a tertiary-care neurosurgical center and compared a control group of patients who had posterior spinal fusion within 3 months before implementation of a surgical protocol with a study group of patients enrolled within 1 year after protocol implementation. The protocol included a surgical safety checklist, control of modifiable risks associated with surgical site infection, administration of intrawound vancomycin and local analgesia, and standard closure. Postoperative pain, demand for analgesics, and postoperative surgical site infections were assessed among patients before and after the introduction of the protocol. RESULTS: The control group (n = 35; 30 women; median age, 40 years [interquartile range, 31-54 years]) experienced a higher-than-predicted rate of minor surgical infections and nonhealing wounds (12 patients; 34%). In the study group (n = 113; 74 women; median age, 45 years [interquartile range, 37-54 years]), 11 patients (10%) had minor surgical infections and nonhealing wounds. Introduction of the protocol was associated with a 24% absolute risk reduction for minor surgical site infection and a significant decrease in pain on postoperative days 1 and 2 (P < 0.01 for both). Interpersonal communication improved among specialists involved in patient management. CONCLUSIONS: The protocol was effective in reducing postoperative pain and the rate of surgical site infection among patients with posterior spinal surgeries.

Occurrence of Surgical Site Infections at a Tertiary Healthcare Facility in Abuja, Nigeria: A Prospective Observational Study.

Surgical site infection (SSI) is one of the most frequent complications of surgical interventions. Several factors have been identified as major determinants of occurrence of SSIs. The present study determined the occurrence and possible risk factors associated with SSIs at a tertiary healthcare facility in Abuja, Nigeria. All patients scheduled for operation in the hospital during the study period and who consented to participate willingly in the study were observed prospectively for the occurrence of SSI based on criteria stipulated by the United States Centre for Disease Control and Prevention (CDC). Data on sociodemographic characteristics, lifestyle, surgical procedure and co-morbidity were collected into a pre-tested data collection tool and analysed using IBM SPSS Statistics software v.24. Predictors of SSIs were identified using multivariate logistic regression model and p-value less than 0.05 was considered statistically significant. Of the 127 surgical patients that met the inclusion criteria comprising 65 (51.2%) females and 62 (48.8%) males between 1 and 83 years with mean age of 25.64 ± 1.66 years, 35 (27.56%; 95% Confidence Interval (CI): 0.205⁻0.360) developed SSIs. Prolonged post-operative hospital stays (p < 0.05), class of wound (p < 0.0001) and some comorbid conditions were found to be significantly associated with higher SSI rate. The SSI rate was highest among patients that had Kirschner-wire insertion (75.0%), followed by an unexpectedly high infection rate among patients that had mastectomy (42.9%), while lower percentages (33.3%) were recorded among patients that had exploratory laparotomy and appendicectomy. The overall magnitude of SSIs in this facility is high (27.6%; 95% CI: 0.205⁻0.360). Several factors were found to be independent predictors of occurrence of SSI. The findings thus highlight the need for improved surveillance of SSIs and review of infection control policies of the hospital.

Antibioticoprofilaxia em cirurgia adominal: quando recomendar? Posicionamento do Colégio Brasileiro de Cirurgia Digestiva / Antibiotic prophylaxis for abdominal surgery: when to recommend? brazilian college of digestive surgery position paper

ABSTRACT BACKGROUND: Surgical antibiotic prophylaxis is an essential component of perioperative care. The use of prophylactic regimens of antibiotics is a well-established practice that is encouraged to be implemented in preoperative/perioperative protocols in order to prevent surgical site infections. AIMS: The aim of this study was to emphasize the crucial aspects of antibiotic prophylaxis in abdominal surgery. RESULTS: Antibiotic prophylaxis is defined as the administration of antibiotics before contamination occurs, given with the intention of preventing infection by achieving tissue levels of antibiotics above the minimum inhibitory concentration at the time of surgical incision. It is indicated for clean operations with prosthetic materials or in cases where severe consequences may arise in the event of an infection. It is also suitable for all clean-contaminated and contaminated operations. The spectrum of action is determined by the pathogens present at the surgical site. Ideally, a single intravenous bolus dose should be administered within 60 min before the surgical incision. An additional dose should be given in case of hemorrhage or prolonged surgery, according to the half-life of the drug. Factors such as the patient's weight, history of allergies, and the likelihood of colonization by resistant bacteria should be considered. Compliance with institutional protocols enhances the effectiveness of antibiotic use. CONCLUSION: Surgical antibiotic prophylaxis is associated with reduced rates of surgical site infection, hospital stay, and morbimortality.

RESUMO RACIONAL: A antibioticoprofilaxia é um componente importante dos cuidados perioperatórios. OBJETIVOS: Abordar os principais aspectos da antibioticoprofilaxia em cirurgia digestiva. RESULTADOS: Ela é definida como a redução da carga de bactérias no sítio operatório através da obtenção de níveis séricos de antibiótico acima da concentração inibitória mínima no momento da incisão cirúrgica. Está indicada em cirurgias limpas com próteses e nas quais a consequência de uma eventual infecção seja grave, bem como em todas as cirurgias limpas-contaminadas e contaminadas. O espectro de ação do antibiótico deve ser de acordo com a flora esperada no sítio cirúrgico e deve ser administrado 60 minutos antes da incisão, em bolus, por via endovenosa e preferencialmente em dose única. Nos casos de hemorragia importante ou cirurgias mais longas, uma nova dose pode ser administrada. O peso do paciente, a história de alergia a medicamentos e a possibilidade de colonização por bactérias multirresistentes devem ser levados em conta. A aderência a protocolos institucionais aumenta a chance de uso adequado da antibioticoprofilaxia. CONCLUSÕES: A antibioticoprofilaxia está associada à redução das taxas de infecção do sítio cirúrgico, tempo de internação e morbidade.

Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward.

PURPOSE: Healthcare-associated infections (HAIs) in urological patients have special features due to specific risk factors. Our objective was to evaluate the characteristics and risk factors for HAIs in patients hospitalized in a Urology ward. MATERIALS AND METHODS: We evaluated prospectively, from 2012 to 2015, the incidence, types and risk factor for HAIs, microbiological and resistance patterns. RESULTS: The incidence of HAIs was 6.3%. The most common types were urinary infections (70.5%) and surgical site infections (22.1%). Univariate analysis showed an increased risk of HAIs among patients with American Society of Anesthesiologists physical status classification system III-IV (odds ratio [OR], 1.39; p<0.001), immunosuppression (OR, 1.80; p=0.013), previous urinary infection (OR, 4.46; p<0,001), and urinary catheter before admission (OR, 1.74; p<0.001). The surgical procedures with the highest incidence of HAIs were radical cystectomy (54.2%) and renal surgery (8.7%). The most frequently isolated microorganisms were Escherichia coli (25.1%), Enterococcus spp. (17.5%), Klebsiella spp. (13.5%) and Pseudomonas aeruginosa (12.3%). Enterococcus sp was the most common microorganism after radical cystectomy and in surgical site infections, E. coli showed resistance rates of 53.5% for fluoroquinolones, 9.3% for amikacin. The percentage of extended-spectrum betalactamase producing E. coli was 24.7%. Klebsiella spp. showed resistance rates of 47.8% for fluoroquinolones, 7.1% for amikacin and 4.3% for carbapenems. Enterococcus spp showed resistance rates of 1.7% for vancomycin and; P. aeruginosa of 33.3% for carbapenems and 26.2% for amikacin. CONCLUSIONS: Comorbidities, previous urinary infections, and urinary catheter are risk factors for HAIs. The microorganisms most commonly isolated were E. coli, Enterococcus and P. aeruginosa. Prospective monitoring may decrease the incidence of infections.

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

STUDY DESIGN: Retrospective review of prospectively collected data. PURPOSE: To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. OVERVIEW OF LITERATURE: SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. METHODS: All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. RESULTS: A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. CONCLUSIONS: Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.

Diabetes mellitus is associated with increased risk of surgical site infections: A meta-analysis of prospective cohort studies.

BACKGROUND AND OBJECTIVE: Observational studies have suggested an association between diabetes mellitus and the risk of surgical site infections (SSIs), but the results remain inconclusive. We conducted a meta-analysis of prospective cohort studies to elucidate the relationship between diabetes mellitus and SSIs. METHODS: We searched PubMed, Embase, and Web of Science databases and reviewed the reference lists of the retrieved articles to identify relevant studies. Associations were tested in subgroups representing different patient characteristics and study quality criteria. The random-effect model was used to calculate the overall relative risk (RR). RESULTS: Fourteen prospective cohort studies (N = 91,094 participants) were included in this meta-analysis, and the pooled crude RR was 2.02 (95% confidence interval, 1.68-2.43) with significant between-study heterogeneity observed (I(2) = 56.50%). Significant association was also detected after we derived adjusted RRs for studies not reporting the adjusted RRs and calculated the combined adjusted RR of the 14 studies (RR, 1.69; 95% confidence interval, 1.33-2.13). Results were consistent and statistically significant in all subgroups. Stratified analyses found the number of confounders adjusted for, sample size, and method of diabetes case ascertainment might be the potential sources of heterogeneity. Sensitivity analysis further demonstrated the robustness of the result. CONCLUSIONS: This meta-analysis suggests diabetes mellitus is significantly associated with increased risk of SSIs. Future studies are encouraged to reveal the mechanisms underlying this association.

Methicillin-resistant S. aureus (MRSA), extended-spectrum (ESBL)- and plasmid-mediated AmpC ß-lactamase -producing Gram-negative bacteria associated with skin and soft tissue infections in hospital and community settings.

AIM: To investigate the characteristics of meticillin-resistant S. aureus (MRSA), extended-spectrum (ESBL), and plasmid-mediated AmpC beta-lactamase producing Gram-negative bacteria causing skin and soft tissue infections (SSTIs) in hospital and outpatient settings of Zenica-Doboj Canton, Bosnia and Herzegovina. METHODS: Antibiotic susceptibility was determined by disc-diffusion and broth microdillution methods according to CLSI guidelines. MecA gene was detected by PCR, and genetic characterization of MRSA was performed using spa-typing and the algorithm based upon repeat patterns (BURP). Double-disk-synergy test was used to screen for ESBLs. PCR was used to detect blaESBL alleles. Genetic relatedness of the strains was tested by PFGE. RESULTS: Seventeen in-patients with MRSA, 13 with ESBL-producing Gram-negative bacteria and three patients co-infected with both, were detected. Five MRSA and 16 ESBL-producing Gram-negative bacteria were found in outpatient samples. Klebsiella spp. was isolated in 11 in- and seven outpatients. MLST CC152 was the most prevalent MRSA. Seven (38.9%) Klebsiella spp. yielded amplicons with primers specific for SHV, TEM-1 and CTX-M group 1 ß-lactamases. Eight K. pneumonia (44.4%) and 16 (64%) MRSA (including the in- and outpatient) strains were clonally related. CONCLUSION: The presence of MRSA and ESBL-producing organisms causing SSTIs in the community poses a substantial concern, due to the high morbidity and mortality associated with possible consequent hospital infections.

Laparoscopic vs mini-incision open appendectomy.

AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre. METHODS: The data of patients who underwent appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale of pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded. Patients with surgery converted from laparoscopic appendectomy (LA) to mini-incision open appendectomy (MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physical examination, laboratory values, and radiological tests (abdominal ultrasound or computed tomography). All operations were performed with general anaesthesia. The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients. RESULTS: Of the 243 patients, 121 (49.9%) underwent MOA, while 122 (50.1%) had laparoscopic appendectomy. There were no significant differences in operation time between the two groups (P = 0.844), whereas the visual analog scale of pain was significantly higher in the open appendectomy group at the 1(st) hour (P = 0.001), 6(th) hour (P = 0.001), and 12(th) hour (P = 0.027). The need for analgesic medication was significantly higher in the MOA group (P = 0.001). There were no differences between the two groups in terms of morbidity rate (P = 0.599). The rate of total complications was similar between the two groups (6.5% in LA vs 7.4% in OA, P = 0.599). All wound infections were treated non-surgically. Six out of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient required surgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain. CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.

Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study.

Left ventricular assist device (LVAD) therapy improves survival, hemodynamic status, and end-organ perfusion in patients with refractory advanced heart failure. Hospital readmission is an important measure of the intensity of LVAD support care. We analyzed readmissions of 148 patients (mean age, 53.6 ± 12.7 yr; 83% male) who received a HeartMate II LVAD from April 2008 through June 2012. The patients had severe heart failure; 60.1% were in Interagency Registry for Mechanically Assisted Circulatory Support class 1 or 2. All patients were observed for at least 12 months, and readmissions were classified as planned or unplanned. Descriptive and multivariate regression analyses were used to identify predictors of unplanned readmission. Twenty-seven patients (18.2%) had no readmissions or 69 planned readmissions, and 121 patients (81.8%) had 460 unplanned readmissions. The LVAD-related readmissions were for bleeding, thrombosis, and anticoagulation (n=103; 49.1%), pump-related infections (n=60; 28.6%), and neurologic events (n=28; 13.3%). The readmission rate was 2.1 per patient-year. Unplanned readmissions were for comorbidities and underlying cardiac disease (54.3%) or LVAD-related causes (45.7%). In the unplanned-readmission rate, there was no significant difference between bridge-to-transplantation and destination-therapy patients. Unplanned readmissions were associated with diabetes mellitus (odds ratio [OR]=3.3; P=0.04) and with shorter mileage from residence to hospital (OR=0.998; P=0.046). Unplanned admissions for LVAD-related sequelae and ongoing comorbidities were common. Diabetes mellitus and shorter distance from residence to hospital were significant predictors of readmission. We project that improved management of comorbidities and of anticoagulation therapy will reduce unplanned readmissions of LVAD patients in the future.

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte / Prevention and treatment of surgical site infections in neurosurgery: state of the art

RESUMEN El manejo adecuado de las infecciones del sitio operatorio (ISO) en neurocirugía es fundamental para la disminución de la carga de morbilidad y mortalidad en estos pacientes. La sospecha y confirmación diagnóstica asociadas al aislamiento microbiológico son esenciales para asegurar el tratamiento oportuno y el adecuado gerenciamiento de antibióticos. En esta revisión se presenta de forma resumida los puntos fundamentales para la prevención y el tratamiento de infecciones del sitio operatorio en neurocirugía y se incluye un apartado sobre el uso de antibióticos intratecales/intraventriculares.

SUMMARY The adequate management of surgical wound infections in neurosurgery is fundamental for reducing the burden of morbidity and mortality in these patients. The suspicion and diagnostic confirmation associated with microbiological isolation are essential to ensure timely treatment and proper management of antibiotics. Therefore, in this review we present, in a synthetic manner, the main points for the prevention and treatment of surgical site infections in neurosurgery, which includes a section on the use of intrathecal/intraventricular antibiotics.

Pattern of pathogens from surgical wound infections in a Nigerian hospital and their antimicrobial susceptibility profiles.

BACKGROUND: In surgical patients, infection is an important cause of morbidity and mortality. A prospective study to find the pattern of microorganisms responsible for post operative wound infections and their antibiotic susceptibility profile was therefore conducted. SETTING AND METHODS: Surgical wards in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Isolation, identification and antimicrobial susceptibility screening of organisms were done employing standard microbiological techniques. RESULTS: Bacterial pathogens were isolated from all the specimens while the yeast Candida species (spp) was isolated from 12.4%. Staphylococcus aureus was the most frequent organism isolated accounting for 23 (18.3%) of a total of 126 isolates. Other organisms were Pseudomonas aeruginosa and Bacillus spp 11.1% each; Escherichia coli 10.3%; Candida spp 8.7%; Coagulase negative staphylococci 8.7%; Pseudomonas spp 6.3%; Serratia odorifera 4.7%; Bacteroides 4.0%; Enterococcus spp 3.2%; the remaining isolates were other enterobacteria. Sensitivity of the bacterial isolates to antibiotics varied. In general, resistance to the ß-lactam antibiotics was above 98%, whilst more than 70% of isolates were resistant to erythromycin, fusidic acid and tobramycin. CONCLUSIONS: The infections were polymicrobic and multidrug resistant. The quinolones, ciprofloxacin and ofloxacin, should be used as frontline drugs in the management of surgical wound infections at the hospital.

A study of post-caesarean section wound infections in a regional referral hospital, oman.

OBJECTIVES: The aim of this study was to determine the incidence of surgical site infections (SSI) in patients undergoing a Caesarean section (CS) and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patient's quality of life by increasing morbidity and extending hospital stays. METHODS: A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean (PCS) SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSI. Controls (220) were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSI. Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. RESULTS: The total number of PCS wound infections was 211 (2.66%). There was a four-fold higher incidence of premature rupture of the membranes (37, 17.53%) and a three-fold higher incidence of diabetes (32, 15.16%) in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus (66, 31.27%) and the Gram-negative Escherichia coli group (40, 18.95%). The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 (19.90%), while 47 (22.27%) yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. CONCLUSION: Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques.

Surgical site infections.

Surgical site infections are a major contributor to morbidity and mortality in postsurgical care. Risk for surgical site infection is multifactorial and includes a host of microbial, patient-related, and procedure-related factors. Prevention of surgical infection relies on optimization of patient factors and use of a variety of evidence-based pharmacologic and nonpharmacologic measures. At the forefront of these measures is antimicrobial prophylaxis, which has been shown to be effective at reducing risk of surgical site infection. As guidelines for prevention of surgical site infection become increasingly complex and nuanced, surgical infection outcomes are increasing tied to quality outcome and performances measures.

S-plasty for pilonidal disease: modified primary closure reducing tension.

PURPOSE: S-plasty for pilonidal disease reduces the tension on the midline by distributing it diagonally and flattening the natal cleft. The aim of this study was to evaluate the outcomes of S-plasty on simple midline primary closure and the clinical features of pilonidal patients in a low incidence country. METHODS: S-plasty was applied on 17 patients from July 2008 to October 2010. Data of these patients were collected with computerized prospective database forms during a perioperative period and via telephone interview for follow-up. Surgical site infection (SSI) was defined according to the Center for Disease Control guidelines. The severity of surgical site infection was graded. RESULTS: All patients were treated with primary S-plasty. Two patients (11.7%) developed low grade SSI. The average healing time after S-plasty was 18.1 days. No recurrences were observed. The mean follow-up period was 13.5 months (range, 6 to 33 months). CONCLUSION: We have shown that primary S-plasty for pilonidal disease is simple, and its surgical outcomes are compatible to the results of other surgical treatments. We present primary S-plasty as a feasible treatment option in a low incidence country.