The Role of Preoperative Antibiotics in Surgical Site Infection (SSI) Rate after Class I/Clean Gynaecologic Surgery at an Academic Safety Net Hospital.

OBJECTIVES: Examine whether preoperative antibiotics in class I/clean abdominal gynaecologic surgery decrease the incidence of surgical site infections (SSI). METHODS: Retrospective cohort study at academic safety net hospital of patients undergoing class I laparoscopic or open gynaecologic surgery between November 2013 and September 2017. Performance improvement initiative to administer preoperative antibiotics to all surgical patients starting July 2016. RESULTS: In total, 510 patients were included: 283 in the antibiotic group and 227 in the no-antibiotic group. PRIMARY OUTCOME: incidence of SSI. Baseline characteristics were similar between groups once balanced by propensity score method. In unweighted analysis, incidence of SSI decreased from 9.3% (21/227) in the no-antibiotics group to 4.9% (14/283) in antibiotics group, but this was not statistically significant (odds ratio (OR) 0.51 CI 0.25-1.03, P = 0.0598). Following of inverse probability of treatment weighting adjustments in weighted analysis, incidence of SSI was found to be significantly lower in patients who received antibiotics compared to patients who did not receive antibiotics across entry types (4.6% vs. 9.8%, OR 0.45; CI 0.22-0.90, P = 0.023). Weighted analysis demonstrated in the exploratory laparotomy group patients who received antibiotics had a lower incidence of SSI compared to patients who did not receive antibiotics (5.1% vs. 18.7%, OR 0.23; CI 0.08-0.68, P = 0.008). In the laparoscopy group, there was no difference between groups (4.4% vs. 5.4%, OR 0.81; CI 0.3-2.16, P = 0.675). CONCLUSIONS: There is limited literature on SSI prevention/preoperative antibiotic use in class I gynaecologic surgeries. This study demonstrates antibiotics in class I procedures decrease SSI rates, specifically in open procedures. There was a lack of demonstrated benefit in laparoscopy.

Evaluation of MRI artifacts at 3 Tesla for 38 commonly used cosmetics.

PURPOSE: To evaluate MRI artifacts at 3-Tesla for 38 commonly used cosmetics. MATERIALS AND METHODS: Thirty-eight cosmetics (16, nail polishes; 5, eyeliners; 3, mascaras; 10, eye shadows; 1, lip gloss; 1, body lotion; 1, body glitter, and 1, hair loss concealer) underwent evaluation for MRI artifacts at 3-Tesla. The cosmetics were applied a copper-sulfate-filled, phantom and initially assessed using a "screening" gradient echo (GRE) pulse sequence. Of the 38 different cosmetics, 14 (37%) exhibited artifacts. For these 14 cosmetics, additional characterization of artifacts was performed using a GRE pulse sequence. A qualitative scale was applied to characterize the artifact size. RESULTS: Artifacts were observed, as follows: 2, nail polishes; 5, eyeliners; 3, mascaras; 3, eye shadows; 1, hair loss concealer. Artifact size ranged from small (eye shadow) to very large (hair loss concealer) and tended to be associated with the presence of iron oxide or other metal-based ingredient. CONCLUSIONS: Commonly used cosmetics caused artifacts that may create issues if the area of interest is the same as where the cosmetic was applied or if its presence was unknown, thus, potentially causing it to be construed as pathology. Therefore, these findings have important implications for patients referred for MRI examinations.

An in vitro assessment of MRI issues at 3-Tesla for antimicrobial, silver-containing wound dressings.

Although no reports of adverse events have been published to date, the presence of metallic dressing ingredients may present an magnetic resonance imaging (MRI) safety concern for patients using silver-containing wound dressings. The purpose of this in vitro study was to test magnetic field interactions (ie, translational attraction and torque), heating, artifacts, and conductivity (ie, electrical resistance) when using MRI at 3-Tesla for two (nonborder and border) silver-containing wound dressings. The results indicated the dressings displayed no magnetic field interactions (deflection angle 0˚; no torque), and in each case, MRI-related heating effects were at the same levels as the background temperature increases (ie, <1.8˚C). The dressings created extremely subtle artifacts (one-for-one relationship) on the MR images. With regard to the conductivity assessments, the average resistance values were 20 kOhm and 1.1 kOhm, respectively, for the nonborder and border wound dressings, which were acceptable levels. The findings show the two silver-containing wound dressings tested will not pose hazards or risks to patients and, thus, are considered "MR safe" according to the current labeling terminology used for medical products, and each dressing may be left in place when a patient undergoes an MRI examination. To date, only a hydrofiber silver-containing dressing has been tested for MRI safety. Because of potential variances in material characteristics, MRI test results are specific to the dressings tested and cannot be applied to other products. Future studies to define the level of silver concentration in dressings that may pose a hazard for performing an MRI are warranted.