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1.
JAMA ; 323(6): 519-526, 2020 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-32044942

RESUMEN

Importance: Following surgery to treat major trauma-related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting. Objective: To assess outcomes in patients who have incisions resulting from surgery for lower limb fractures related to major trauma and were treated with either incisional negative pressure wound therapy or standard wound dressing. Design, Setting, and Participants: A randomized clinical trial conducted at 24 trauma hospitals representing the UK Major Trauma Network that included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from July 7, 2016, through April 17, 2018, with follow-up to December 11, 2018. Interventions: Incisional negative pressure wound therapy (n = 785), which involved a specialized dressing used to create negative pressure over the wound, vs standard wound dressing not involving negative pressure (n = 763). Main Outcomes and Measures: The primary outcome measure was deep surgical site infection at 30 days diagnosed according to the criteria from the US Centers for Disease Control and Prevention. A preplanned secondary analysis of the primary outcome was performed at 90 days. The secondary outcomes were patient-reported disability (Disability Rating Index), health-related quality of life (EuroQol 5-level EQ-5D), surgical scar assessment (Patient and Observer Scar Assessment Scale), and chronic pain (Douleur Neuropathique Questionnaire) at 3 and 6 months, as well as other local wound healing complications at 30 days. Results: Among 1548 participants who were randomized (mean [SD] age, 49.8 [20.3] years; 561 [36%] were aged ≤40 years; 583 [38%] women; and 881 [57%] had multiple injuries), 1519 (98%) had data available for the primary outcome. At 30 days, deep surgical site infection occurred in 5.84% (45 of 770 patients) of the incisional negative pressure wound therapy group and in 6.68% (50 of 749 patients) of the standard wound dressing group (odds ratio, 0.87 [95% CI, 0.57 to 1.33]; absolute risk difference, -0.77% [95% CI, -3.19% to 1.66%]; P = .52). There was no significant difference in the deep surgical site infection rate at 90 days (11.4% [72 of 629 patients] in the incisional negative pressure wound therapy group vs 13.2% [78 of 590 patients] in the standard wound dressing group; odds ratio, 0.84 [95% CI, 0.59 to 1.19]; absolute risk difference, -1.76% [95% CI, -5.41% to 1.90%]; P = .32). For the 5 prespecified secondary outcomes reported, there were no significant differences at any time point. Conclusions and Relevance: Among patients who underwent surgery for major trauma-related lower limb fractures, use of incisional negative pressure wound therapy, compared with standard wound dressing, resulted in no significant difference in the rate of deep surgical site infection. The findings do not support the use of incisional negative pressure wound therapy in this setting, although the event rate at 30 days was lower than expected. Trial Registration: isrctn.org Identifier: ISRCTN12702354.


Asunto(s)
Vendajes , Fijación Interna de Fracturas , Fracturas Abiertas/cirugía , Extremidad Inferior/lesiones , Terapia de Presión Negativa para Heridas , Infección de la Herida Quirúrgica/prevención & control , Adolescente , Adulto , Femenino , Fijación Interna de Fracturas/efectos adversos , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Infección de la Herida Quirúrgica/epidemiología
2.
J Cardiothorac Surg ; 15(1): 5, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915020

RESUMEN

BACKGROUND: The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients' risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons. METHODS: A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden. RESULTS: Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, "no-touch" by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres. CONCLUSIONS: In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.


Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Clorhexidina/uso terapéutico , Vena Safena/trasplante , Recolección de Tejidos y Órganos/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Puente de Arteria Coronaria , Estudios Transversales , Humanos , Enfermería de Quirófano/métodos , Atención Perioperativa/métodos , Pautas de la Práctica en Medicina , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Encuestas y Cuestionarios , Técnicas de Sutura , Suturas , Suecia , Recolección de Tejidos y Órganos/efectos adversos , Procedimientos Quirúrgicos Vasculares/efectos adversos
3.
J Hosp Infect ; 104(3): 321-327, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31931045

RESUMEN

BACKGROUND: Surveillance systems for surgical site infections (SSIs), as a measure of patient safety, help health institutions devise strategies to reduce or prevent them. No surveillance systems exist to monitor SSIs in Ghana. AIM: To establish a system for monitoring trends and detecting outbreaks in order to create awareness of and control SSIs. METHODS: An active 30-day surveillance was undertaken at the general surgical unit of the Korle Bu Teaching Hospital, from July 1st, 2017 to December 31st, 2018 to identify SSI. It involved a daily inpatient surveillance of patients who had had a surgical procedure, followed by post-discharge surveillance by means of a healthcare personnel-based survey and a patient-based telephone survey. We supplied quarterly feedback of results to surgeons. FINDINGS: Among the 3267 patients included, 331 were identified with an SSI, a 10% incidence risk. Patients who acquired an SSI experienced increased morbidity including nine extra days in hospital and an adjusted relative mortality risk of 2.3 (95% confidence interval: 1.3 - 4.1; P=0.006) compared to patients without SSI. Forty-nine per cent (161/331) of SSIs were diagnosed post discharge using the healthcare personnel-based survey. The patient-based telephone survey contributed 12 additional cases. SSI incidence risk decreased from 12.8% to 7.5% during the study period. CONCLUSION: Post-discharge surveillance is feasible using existing healthcare personnel, and the results highlight the high risk and burden of SSIs in Ghana. A surveillance system with feedback for monitoring SSIs may contribute to reducing SSIs; however, firm conclusions regarding the impact need longer observation time.


Asunto(s)
Infección Hospitalaria/epidemiología , Seguridad del Paciente , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Adulto , Anciano , Niño , Estudios de Cohortes , Femenino , Ghana , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Estudios Prospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/prevención & control , Adulto Joven
4.
J Surg Res ; 246: 560-567, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31668604

RESUMEN

BACKGROUND: The objective of this study was to assess whether a zinc-impregnated polypropylene mesh (ZnMesh) has better antibacterial properties in a contaminated environment compared with a regular polypropylene mesh. MATERIALS AND METHODS: Thirty-eight Wistar Han rats underwent cecal ligation and puncture to induce peritonitis 24 h before implantation of an intraperitoneal ZnMesh or a regular polypropylene mesh. Primary outcome was the number of colony forming units (CFU) per sample (mesh and abdominal wall). Secondary outcomes were macroscopic (incorporation of mesh, abscesses, and adhesions on mesh surface) and histological (inflammatory cell reaction, mesh-specific parameters, and collagen deposition) parameters. All outcomes were evaluated after 30 and 90 d. RESULTS: After 30 d, no significant difference in CFU per sample was present between the ZnMesh and control groups. After 90 d, a lower number of CFU per sample was present in the ZnMesh group compared with the control group (trypticase soy agar with 5% sheep blood: 0 log10 CFU/sample IQR: 0-1.40 versus 1.58 log10 CFU/sample IQR: 0-4.30, P = 0.012; MacConkey: 0 log10 CFU/sample IQR: 0-2.65 versus 1.18 log10 CFU/sample IQR: 0-4.04, P = 0.438). After 90 d, the percentage of adhesions on mesh surface was significantly higher in the ZnMesh group (95% IQR: 60%-100% versus 50% IQR: 23%-75%, P = 0.029). No differences were seen in other macroscopic outcomes or histology. CONCLUSIONS: A significantly lower number of CFU per sample was found in the ZnMesh group after 90 d. After 30 d, no statistically significant differences in CFU per sample were seen. This result suggests that the ZnMesh group has better antibacterial properties in a contaminated environment. However, this is at the cost of a significantly higher percentage of adhesions.


Asunto(s)
Hernia Ventral/prevención & control , Peritonitis/cirugía , Mallas Quirúrgicas , Infección de la Herida Quirúrgica/prevención & control , Adherencias Tisulares/epidemiología , Zinc/administración & dosificación , Pared Abdominal/cirugía , Animales , Bacterias/aislamiento & purificación , Recuento de Colonia Microbiana/estadística & datos numéricos , Modelos Animales de Enfermedad , Humanos , Masculino , Ensayo de Materiales , Peritonitis/complicaciones , Peritonitis/microbiología , Polipropilenos , Ratas , Ratas Wistar , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/microbiología , Adherencias Tisulares/etiología , Cicatrización de Heridas
5.
Vasc Endovascular Surg ; 54(2): 147-161, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31736431

RESUMEN

INTRODUCTION: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. METHODS: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. RESULTS: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. CONCLUSIONS: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.


Asunto(s)
Antibacterianos/administración & dosificación , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular/efectos adversos , Portadores de Fármacos , Infecciones Relacionadas con Prótesis/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Antibacterianos/efectos adversos , Humanos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Factores de Riesgo , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/microbiología , Resultado del Tratamiento
6.
J Surg Res ; 246: 100-105, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31563829

RESUMEN

BACKGROUND: Surgical site infection (SSI) is an established quality indicator and predictor for adverse patient outcomes. Multiple strategies have been established to reduce SSI; however, optimum protocol remains unclear. The aim of the study was to assess the impact of established protocol on SSI after colon surgery. METHODS: We established a colon SSI bundle in 2017, which includes a chlorhexidine prescrub followed by chloraPrep, betadine wound wash, antibiotic infused irrigation, use of closure tray, and incision coverage with silver impregnated dressing. Retrospective analysis of a 2-y (2016-2017) prospectively collected before and after analysis of all patients undergoing elective colon surgery was performed. Patients were divided into two groups: preprotocol (PP: year 2016) and postprotocol (PoP: year 2017). Patients in the two groups were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication of procedure, and procedure type. Outcome measures were SSI, hospital length of stay, and readmission rate. RESULTS: A total of 328 patients were analyzed, and after propensity matching, 94 patients (PP:47 and PoP:47) were included. The mean age was 63.7 ± 16.4 y, 43.6% male, and 44.6% of procedures were performed laparoscopically. There was no difference in demographics, comorbidities, and procedure details between two groups. PoP patients had significantly lower superficial (odds ratio: 0.91 [0.74-0.98]; P = 0.045) and deep SSI (odds ratio:0.97 [0.65-0.99]; P = 0.048) than PP patients. PoP patient had shorter length of stay (P = 0.049) and trend toward lower readmission rate (P = 0.098) compared with PP patients and an 85% reduction in the Centers for Medicare and Medicaid Services standardized infection rate. CONCLUSIONS: Protocol-driven patient care improves patient outcomes. SSI bundle reduced SSI in patient undergoing colon surgery. Establishing national SSI bundles will help standardize care and help optimize patient outcomes.


Asunto(s)
Protocolos Clínicos , Colon/cirugía , Procedimientos Quirúrgicos Electivos/efectos adversos , Cuidados Preoperatorios/métodos , Infección de la Herida Quirúrgica/prevención & control , Anciano , Antibacterianos/administración & dosificación , Antiinfecciosos Locales/administración & dosificación , Profilaxis Antibiótica/métodos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Estudios Retrospectivos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento , Estados Unidos
7.
Ann R Coll Surg Engl ; 102(2): 133-140, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31508999

RESUMEN

INTRODUCTION: Surgical site infections cause considerable postoperative morbidity and mortality. The aim of this study was to determine the effect on surgical site infection rates following introduction of a departmental oral antibiotic bowel preparation protocol. METHODS: A prospective single-centre study was performed for elective colorectal resections between May 2016-April 2018; with a control group with mechanical bowel preparation and treatment group with oral antibiotic bowel preparation (neomycin and metronidazole) and mechanical bowel preparation. The primary outcome of surgical site infection and secondary outcomes of anastomotic leak, length of stay and mortality rate were analysed using Fisher's exact test and independent samples t-tests. A cost-effectiveness analysis was also performed. RESULTS: A total of 311 patients were included; 156 in the mechanical bowel preparation group and 155 in the mechanical bowel preparation plus oral antibiotic bowel preparation group. The study included 180 (57.9%) men and 131 (42.1%) women with a mean age of 68 years. There was a significant reduction in surgical site infection rates (mechanical bowel preparation 16.0% vs mechanical bowel preparation plus oral antibiotic bowel preparation 4.5%; P = 0.001) and mean length of stay (mechanical bowel preparation 10.2 days vs mechanical bowel preparation plus oral antibiotic bowel preparation 8.2 days; P = 0.012). There was also a reduction in anastomotic leak and mortality rates. Subgroup analyses demonstrated significantly reduced surgical site infection rates in laparoscopic resections (P = 0.008). There was an estimated cost saving of £239.13 per patient and £37,065 for our institution over a one-year period. CONCLUSION: Oral antibiotic bowel preparation is a feasible and cost-effective intervention shown to significantly reduce the rates of surgical site infection and length of stay in elective colorectal surgery.


Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Enfermedades del Colon/cirugía , Enfermedades del Recto/cirugía , Infección de la Herida Quirúrgica/prevención & control , Administración Oral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica/economía , Enfermedades del Colon/economía , Análisis Costo-Beneficio , Procedimientos Quirúrgicos Electivos/economía , Inglaterra , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedades del Recto/economía , Infección de la Herida Quirúrgica/economía , Adulto Joven
8.
World Neurosurg ; 133: e303-e307, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31520754

RESUMEN

OBJECTIVE: To explore the safety and efficacy of hydrogen peroxide H2O2 in controlling blood loss and surgical site infection (SSI) after multisegmental lumbar spine surgery. METHODS: A total of 2626 patients who had undergone multisegmental lumbar spinal surgery from January 2015 to January 2018 were included in the present study. Stratified by the use of H2O2 irrigation, they were divided into 2 groups: the control group (n = 1345) and the experimental group (n = 1281). The demographic parameters, laboratory examination results, and surgery-related information (e.g., operative time, number of operated levels, intraoperative blood loss, postoperative drainage, postoperative SSI, extubation time), and perioperative complications were recorded. RESULTS: No significant differences were seen regarding the demographic parameters, laboratory examination results, comorbidities, and surgery-related information. The extubation time and postoperative drainage collection were lower in the experimental group (3.6 ± 0.5 vs. 4.1 ± 0.6 days, P = 0.402; 251.8 ± 67.5 vs. 291.8 ± 71.3 mL, P = 0.013). In the control group, the rate of SSI was 2.4% (32 of 1345) and included 17 superficial wound infections and 15 deep wound infections. In the experimental group, the SSI rate was 1.4% (18 of 1281; 15 with a superficial wound infection and 3 with a deep wound infection). Staphylococcus aureus was the most common organism, especially in the experimental group (66.7% vs. 50%). No statistically significant difference was found between the 2 groups in the perioperative complications, including hematencephalon, deep vein thrombosis, pulmonary embolism, and myocardial infarction (P > 0.05). Pneumocephalus was not observed in either group. CONCLUSION: The application of H2O2 in posterior lumbar interbody fusion can reduce the blood loss and incidence of SSI after surgery and was quite beneficial for controlling the increasing number of vancomycin-resistant bacteria.


Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Hemostasis Quirúrgica/métodos , Peróxido de Hidrógeno/uso terapéutico , Vértebras Lumbares/cirugía , Fusión Vertebral , Infección de la Herida Quirúrgica/prevención & control , Anciano , Antibacterianos/uso terapéutico , Antiinfecciosos Locales/administración & dosificación , Profilaxis Antibiótica , Estudios de Casos y Controles , Femenino , Humanos , Peróxido de Hidrógeno/administración & dosificación , Masculino , Persona de Mediana Edad , Premedicación , Estudios Retrospectivos , Infecciones Estafilocócicas/prevención & control , Irrigación Terapéutica
9.
Br J Anaesth ; 124(1): 110-120, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31767144

RESUMEN

BACKGROUND: We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. METHODS: We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. RESULTS: We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59-1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48-1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups. CONCLUSIONS: An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. CLINICAL TRIAL REGISTRATION: NCT02776046.


Asunto(s)
Oxígeno/uso terapéutico , Respiración Artificial/métodos , Infección de la Herida Quirúrgica/prevención & control , Abdomen/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Oxihemoglobinas/análisis , Oxihemoglobinas/metabolismo , Atención Perioperativa , Respiración con Presión Positiva , Medicina de Precisión , Atelectasia Pulmonar/epidemiología , Atelectasia Pulmonar/etiología , Resultado del Tratamiento
10.
J Urol ; 203(2): 351-356, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31441676

RESUMEN

PURPOSE: The primary rationale for antimicrobial prophylaxis (AP) is to decrease the incidence of surgical site infection (SSI) and other preventable periprocedural infections, with the secondary goal of reducing antibiotic overuse. This Best Practice Statement (BPS) updates the prior American Urological Association (AUA) BPS and creates a comprehensive and user-friendly reference for clinicians caring for adult patients who are undergoing urologic procedures. MATERIALS AND METHODS: Recommendations are based on a review of English language peer-reviewed literature from 2006 through October 2018 and were made by consensus by a multidisciplinary panel. The search parameters included timing, re-dosing, and duration of AP across urologic procedures where there was the possibility of SSI. Excluded from the search were the management of infections outside the genitourinary (GU) tract and pediatric procedures. RESULTS: Single-dose AP is recommended for most urologic cases and antimicrobials should only be used when medically necessary, for the shortest duration possible, and not beyond case completion. Surgeons are the most accurate discerners of an SSI, and should use standard definitions to make better calculations of patient risk. The risk classification developed is dependent on the likelihood of developing SSI, and not the associated consequences of SSI. CONCLUSIONS: The AUA developed a multi-disciplinary BPS to guide clinicians on the proper usage of AP across urologic procedures and wound classifications. It is recommended that the lowest dose of antimicrobials be administered to decrease the risk of infection and to minimize the risk of drug-resistant organisms.


Asunto(s)
Profilaxis Antibiótica/normas , Infecciones Bacterianas/prevención & control , Micosis/prevención & control , Cuidados Preoperatorios/normas , Infección de la Herida Quirúrgica/prevención & control , Procedimientos Quirúrgicos Urológicos , Humanos , Procedimientos Quirúrgicos Urológicos/clasificación
11.
J Surg Res ; 246: 506-511, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31679799

RESUMEN

BACKGROUND: The studies that established historical rates of surgical infection after cholecystectomy predate the modern era of laparoscopy and routine prophylactic antibiotics. Newer studies have reported a much lower incidence of infections in "low-risk" elective, outpatient, laparoscopic cholecystectomies. We investigated the current rate of postoperative infections in these cases within a large, U.S. METHODS: We retrospectively reviewed elective laparoscopic cholecystectomies from the 2016-2017 American College of Surgeons National Surgical Quality Improvement Program database. Our primary outcome was postoperative surgical site infection; secondary was Clostridium difficile infection. Logistic models evaluated the associations of patient and operation characteristics with these outcomes. RESULTS: Surgical infection occurred in 1.0% of cases (293/30,579). Cdifficile infection occurred in 0.1% (31 cases). In our adjusted multivariable models, other/unknown race/ethnicity, diabetes, hypertension, smoking, American Society of Anesthesiologists >2, operative minutes, and wound class 4 were associated with a significantly higher odds of surgical infection; no covariates were significantly associated with Cdifficile infection. CONCLUSIONS: In the setting of modern U.S. surgical practice, the incidence of infection after elective laparoscopic cholecystectomy is very low, on par with clean cases. Our study identified several patient characteristics that were strongly associated with surgical infection. Many of these are not included as risk factors in current guidelines for antibiotic prophylaxis and may help to identify those at higher risk for this rare complication.


Asunto(s)
Profilaxis Antibiótica/normas , Colecistectomía Laparoscópica/efectos adversos , Infecciones por Clostridium/epidemiología , Procedimientos Quirúrgicos Electivos/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Adulto , Antibacterianos/uso terapéutico , Infecciones por Clostridium/etiología , Infecciones por Clostridium/prevención & control , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Estados Unidos/epidemiología
12.
J Hosp Infect ; 104(3): 305-308, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31877337

RESUMEN

BACKGROUND: The role of laminar flow (LAF) is contradictory with several studies failing to replicate risk reduction. The 2016 World Health Organization guidelines identified this lack of good comparative studies. AIM: To analyse the use of LAF and the incidence of prosthetic joint infections (PJIs) in Asian patients undergoing total knee replacement (TKR). METHODS: Patients who underwent standard cemented posterior-stabilized TKR from 2004 to 2014 were reviewed from a prospectively collected single-surgeon database. Revision, traumatic and/or inflammatory cases were excluded. The type of airflow used was identified. The technique and surgical protocol for all procedures were similar. Tourniquets and inserted drains were routinely used. Patellar resurfacing was not performed. Patients were followed up at the outpatient clinics at regular intervals up to two years. At each visit, the patient was assessed for the occurrence of PJI. FINDINGS: Of the 1028 procedures, 453 (44.1%) were performed in an LAF operating theatre (OT) whereas 575 (55.9%) were performed in a non-LAF OT. There were no significant differences between the two groups in terms of age, gender, or side of procedure. The overall incidence of PJI was 0.6% (N = 6). Three (50%) occurred in an LAF OT whereas three (50%) occurred in a non-LAF OT. This was not statistically significant. CONCLUSION: Laminar flow systems are costly to procure and maintain. With modern aseptic techniques, patient optimization, and use of prophylactic antibiotics, laminar flow does not appear to further reduce risk of PJI in Asian patients after TKR.


Asunto(s)
Microbiología del Aire , Artroplastia de Reemplazo de Rodilla/efectos adversos , Control de Infecciones/métodos , Infecciones Relacionadas con Prótesis/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Anciano , Movimientos del Aire , Ambiente Controlado , Femenino , Humanos , Masculino , Ventilación/instrumentación
14.
Ann Otol Rhinol Laryngol ; 129(1): 5-11, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31390881

RESUMEN

OBJECTIVES: Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. METHODS: Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. RESULTS: Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. CONCLUSIONS: Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.


Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Cavidad Nasal/microbiología , Tabique Nasal/cirugía , Procedimientos Quírurgicos Nasales/métodos , Férulas (Fijadores)/microbiología , Infección de la Herida Quirúrgica/prevención & control , Adolescente , Adulto , Anciano , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Cefalexina/uso terapéutico , Técnicas de Cultivo , Farmacorresistencia Bacteriana , Farmacorresistencia Bacteriana Múltiple , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus/aislamiento & purificación , Infección de la Herida Quirúrgica/epidemiología , Adulto Joven
15.
Medicine (Baltimore) ; 98(49): e18068, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804314

RESUMEN

BACKGROUND: Surgical-site infections after primary total joint arthroplasty (TJA) are a significant issue. Antibiotic-impregnated bone cement (AIBC) has been widely used for the treatment of infected joints, but routine use of AIBC in primary TJA remains controversial. In this systematic review, we evaluated the efficacy of AIBC in reducing surgical-site infections after primary TJA. METHODS: We systematically searched Pubmed, EMbase, Cochrane Library, CMB, CNKI, and WanFang Data for studies (published until June 1, 2019) evaluating AIBC use in reducing infection rates. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Meta-analysis was performed using Review Manager 5.3 software. The registration number is CRD42017078341 in PROSPERO. RESULTS: In total, 10 studies were included, resulting in a sample size of 13,909 arthroplasty cases. The overall pooled data demonstrated that, compared with systemic antibiotics, AIBC was more effective in decreasing deep infection rates (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.14-0.89, P = .030), although there were higher superficial infection rates with AIBC (OR = 1.53, 95% CI = 1.11-2.11, P = .010). Compared to systemic antibiotics alone, AIBC with systemic antibiotics significantly decreased deep infection rates (OR = 0.55, 95% CI = 0.41-0.75, P = .0001) but there was no difference in superficial infection rates (OR = 1.43, 95% CI = 0.81-2.54, P = .220). In the subgroup analysis, both randomized controlled trials and cohort studies had reduced deep infection rates after primary TJA (OR = 0.61, 95% CI = 0.37-0.99, P = .050 and OR = 0.49, 95% CI = 0.34-0.70, P = .0001, respectively). AIBC decreased deep infection rates in both total hip and knee arthroplasty (OR = 0.25, 95% CI = 0.12-0.52, P = .0002 and OR = 0.62, 95% CI = 0.45-0.87, P = .005, respectively). Deep infection rates were significantly decreased by AIBC with gentamicin (OR = 0.31, 95% CI = 0.20-0.49, P < .00001) but unaffected by AIBC with cefuroxime (OR = 0.35, 95% CI = 0.10-1.20, P = .100). Deep infection rates in the AIBC and control groups were similar when laminar airflow was applied to the operating room (OR = 0.90, 95% CI = 0.60-1.35, P = .620); however, without laminar airflow, the efficacy of AIBC in decreasing deep infection rates was significantly higher than that of control group (OR = 0.21, 95% CI = 0.08-0.59, P = .003). CONCLUSIONS: AIBC may significantly decrease deep infection rates after primary total hip and knee arthroplasty, with or without systemic antibiotics.


Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Cementos para Huesos/química , Infecciones Relacionadas con Prótesis/prevención & control , Administración Oral , Antibacterianos/uso terapéutico , Humanos , Oportunidad Relativa , Infección de la Herida Quirúrgica/prevención & control
16.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 494-502, Oct.-Dec. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1041352

RESUMEN

ABSTRACT Objective: To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy. Data source: Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected. Data collection and analysis: Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time. Conclusions: There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.


RESUMO Objetivo: Analisar o uso de antibióticos em crianças e adolescentes no perioperatório de apendicectomia. Fonte de dados: Realizou-se uma revisão integrativa, nas bases de dados MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Cochrane e no portal PubMed, sem limite de tempo. As palavras-chave utilizadas foram: apendicite, criança, adolescente e antibacterianos com booleano AND. Os artigos incluídos foram publicados nos idiomas português, inglês ou espanhol e cujos participantes tivessem idade inferior a 18 anos. Os artigos de revisão e diretrizes foram excluídos. A qualidade da evidência foi analisada, e foram selecionados 24 artigos. Síntese dos dados: Sobre os estudos selecionados, sete foram ensaios clínicos randomizados (nível de evidência II), oito coortes (nível III), sete observacionais retrospectivos (nível V) e duas análises documentais históricas (nível IV). Os estudos abordaram antibióticos usados na apendicite aguda em suas formas não complicada e complicada. Os antibióticos iniciados no pré-operatório evidenciaram diminuição nas taxas de infecção da ferida cirúrgica. Os esquemas de primeira linha (empíricos) foram testados em relação à sensibilidade dos microrganismos nas culturas de material peritoneal, no entanto os resultados foram controversos. Sugeriram-se antibióticos de amplo espectro em alguns estudos por apresentar boa cobertura, no entanto em outros eles não foram recomendados, pelo risco de desenvolver resistência bacteriana. O menor tempo de administração e a mudança mais precoce para a via oral reduziram o tempo de internação. Conclusões: Existe um grande número de protocolos clínicos com antibióticos diversos, no entanto não existe padronização em relação ao tipo de antibiótico, tempo de uso nem via.


Asunto(s)
Humanos , Niño , Adolescente , Apendicectomía , Apendicitis/cirugía , Infección de la Herida Quirúrgica/prevención & control , Cuidados Preoperatorios/métodos , Profilaxis Antibiótica/métodos , Antibacterianos/uso terapéutico , Esquema de Medicación , Resultado del Tratamiento
17.
Rev Chilena Infectol ; 36(3): 265-273, 2019 Jun.
Artículo en Español | MEDLINE | ID: mdl-31859744

RESUMEN

INTRODUCTION: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. OBJECTIVE: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. MATERIAL AND METHOD: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. RESULTS: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". CONCLUSION: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Modelos Biológicos , Infección de la Herida Quirúrgica/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/psicología , Transfusión Sanguínea , Depresión/complicaciones , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1188-1195, 2019 Dec 25.
Artículo en Chino | MEDLINE | ID: mdl-31874537

RESUMEN

Objective: To compare the efficacy of purse-string skin closure (PSC) and linear skin closure (LSC) in stoma reversal. Methods: Randomized controlled trials (RCT) comparing the use of PSC and LSC during stoma reversal were searched from Embase, PubMed, Web of Science, CNKI net, Wanfang database, VIP Chinese Science and Technology Journal Database. Literature inclusion criteria: (1) randomized controlled trials about comparing PSC and LSC in stoma reversal published publicly; only including English literature; (2) patients undergoing stoma (ileostomy or colostomy) reversal without limitation of age, sex and ethnicity; (3) PSC group receiving the suture of the dermis layer of the skin by purse-string suture, and forming a pore channel in the center of the skin after tightening and knotting, in order to achieve the purpose of secondary healing; the LSC group receiving the suture of the skin with conventional simple interrupted suture; (4) the enrolled literatures needed to include at least one of the following outcome indicators: the primary outcome was the incidence of SSI; the secondary outcome included the operation time, incisional hernia, hospital stay and patient satisfaction. Literature exclusion criteria: (1) duplicate published studies, incomplete studies, reviews, case reports, unpublished literature, retrospective studies, non-RCT. The search time ended on November 15, 2018. The basic information and important outcome indicators of the included articles were extracted. The Cochrane bias risk assessment tool was used to evaluate the quality of the selected literatures. Patient satisfaction was assessed using the following scales: (1) the patient and observer scar assessment scale (POSAS); (2) the body image questionnaire (BIQ); (3) Likert scale; (4) short form 36 (SF-36), version 2; (5) visual analog scale (VAS). Meta-analysis was performed using Review manager 5.3 software provided by the Cochrane Collaboration. Results: A total of 9 randomized controlled trials were included, involving 806 patients with 411 cases in the PSC group and 395 cases in the LSC group. Baseline data such as age, gender, body mass index (BMI), underlying disease, and anesthesia grading were not significantly different between the two groups (all P>0.05). The quality of these nine randomized controlled trials was high. Because the evaluation methods for these studies are not uniform, it is impossible to conduct a meta-analysis of patient satisfaction. However, from the summary results of various studies, the postoperative satisfaction of the purse-string suture group was better than that of the linear suture group. The meta-analysis showed that there was significant difference in postoperative SSI incidence between the PSC group and the LSC group [OR=0.14, 95%CI: 0.08-0.24, P<0.00001], while there were no significant differences in incidence of incisional hernia [OR=0.66, 95%CI: 0.24-1.82, P=0.42], operation time [MD=0.61, 95%CI: -3.17-4.38, P=0.75], and hospital stay [MD=-0.26, 95%CI: -0.82-0.30, P=0.37]. Conclusions: PSC can be used for closure of the wound following stoma reversal. Compared with LSC, PSC can significantly reduce the incidence of SSI, and increase patients' satisfaction.


Asunto(s)
Anastomosis Quirúrgica/métodos , Estomas Quirúrgicos , Infección de la Herida Quirúrgica/prevención & control , Técnicas de Sutura , Colostomía , Humanos , Ileostomía , Ensayos Clínicos Controlados Aleatorios como Asunto , Procedimientos Quirúrgicos Reconstructivos , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento
19.
Am Surg ; 85(11): 1228-1233, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31775964

RESUMEN

SSIs after ventral hernia repair (VHR) represent a significant complication. The impact of postoperative prophylactic antibiotics on the SSI rates after VHRs is unclear. A systematic review of PubMed and Web of Science databases from inception through March 2016 investigating the effect of postoperative prophylactic antibiotics after VHRs was performed. Strict inclusion and exclusion criteria were implemented, and the methodological quality of the included studies was assessed. After systematic independent assessment of 216 citations, four studies, involving 344 patients, met the inclusion criteria. Among the included studies, 164 patients received >24 hours of postoperative prophylactic antibiotics, whereas 180 patients were controls. The overall incidence of SSI among patients receiving postoperative antibiotics was 14.6 per cent (95% confidence interval [CI], 9.9 to 20.9) which compares favorably with the control group: 35.5 per cent (95% CI, 28.9 to 42.7) (odds ratio: 0.3, 95% CI: 0.2 to 0.5, P < 0.01). Among patient's receiving postoperative antibiotics, the pooled average duration of postoperative antibiotic treatment was 6.2 ± 0.4 days. Based on the available evidence, the use of postoperative prophylactic antibiotics seems to be associated with lower SSI rates after VHRs. Future prospective randomized controlled trials should be conducted to further confirm the efficacy of this prophylactic intervention.


Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica , Hernia Ventral/cirugía , Infección de la Herida Quirúrgica/prevención & control , Índice de Masa Corporal , Intervalos de Confianza , Humanos , Incidencia , Persona de Mediana Edad , Tempo Operativo , Cuidados Posoperatorios , Infección de la Herida Quirúrgica/epidemiología
20.
Braz J Cardiovasc Surg ; 34(5): 588-595, 2019 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-31719010

RESUMEN

OBJECTIVE: To evaluate the efficacy of triclosan-coated suture for the reduction of infection in saphenectomy wounds of patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 508 patients who underwent saphenectomy in CABG surgery were included in a prospective, randomized, double-blind trial from February/2011 to June/2014. Patients were randomized into the triclosan-coated suture group (n= 251) and the conventional non-antibiotic suture group (n=257). Demographic (gender and age), clinical (body mass index, diabetes, and use of analgesics), and intraoperative (cardiopulmonary bypass and cross-clamp times) variables and those related to the saphenectomy wound (pain, dehiscence, erythema, infection, necrosis, and hyperthermia) were measured and analyzed. RESULTS: Of the 508 patients who underwent saphenectomy, 69.9% were males and 40.2% were diabetic. Thirty-three (6.5%) patients presented infection: 13 (5.3%) with triclosan and 20 (7.9%) with conventional suture (P=0.281). Among diabetic patients (n=204), triclosan suture was used in 45.1% with four cases of infection; conventional suture was used in 54.9% of them, with 11 cases of infection. Most patients (94.3%) underwent on-pump CABG. Wound pain was observed in 9.9% of patients with triclosan-coated suture and in 17.9% with conventional suture (P=0.011). Wound hyperthermia was found in 1.6% of patients with triclosan-coated suture and in 5.4% of those with conventional suture (P=0.028). CONCLUSION: Triclosan-coated suture shows lower infection rate in saphenectomy of patients undergoing CABG, although the differences were not statistically significant. Pain and wound hyperthermia were less frequent in patients with triclosan-coated sutures compared with conventional sutures.


Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Puente de Arteria Coronaria/métodos , Poliglactina 910/uso terapéutico , Vena Safena/cirugía , Infección de la Herida Quirúrgica/prevención & control , Técnicas de Sutura , Triclosán/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Puente de Arteria Coronaria/efectos adversos , Complicaciones de la Diabetes , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del Tratamiento
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