Groin dissections in skin cancer: Effect of a change in prophylactic antibiotic protocol.

OBJECTIVES: To determine whether groin dissection surgical site infection (SSI) incidence changed with shorter post-operative antibiotic prophylaxis. BACKGROUND: Post-operative prophylaxis changed due to antimicrobial stewardship, from regular oral antibiotics until drain removal, to three intravenous doses. Both groups had a single intravenous dose at induction. METHODS: A prospective database of groin dissections for metastatic skin cancer was retrospectively reviewed for SSI according to Public Health England criteria. Eighty groin dissections in 79 consecutive patients were included: 40 had oral antibiotics until drain removal [mean 26±7 (range 19-36) days] and 39 had three post-operative intravenous doses. RESULTS: Longer prophylaxis was associated with lower SSI incidence [10 (25%) versus 21 (54%), odds ratio (OR) 3.50, 95% confidence interval (CI) 1.34-9.08, p = 0.009], fewer deep infections [5 (13%) versus 16 (41%), OR 4.89, 95% CI 1.57-15.13, p = 0.004], fewer readmissions for infection [5 (13%) versus 15 (38%), OR 4.38, 95% CI 1.40-13.65, p = 0.008], but similar seroma incidence [18 (45%) versus 16 (41%), OR 0.85, 95% CI 0.35-2.07, p = 0.72] and wound dehiscence [7 (18%) versus 5 (13%), OR 0.69, 95% CI 0.20-2.40, p = 0.56]. BMI ≥30 (n = 21) was associated with SSI, occurring in 13 of 21 (62%) (OR 3.859, 95% CI 1.34-11.10, p = 0.01). Median infection onset was 22 days (IQR 12-27) versus 17 (IQR 13-22), (p = 0.53). Multiple organisms were cultured in 21 of 31 (68%) patients with positive microbiological samples. CONCLUSIONS: SSI rates doubled with shorter prophylaxis; deep infections and readmissions for infection tripled. Obesity was independently associated with infection. Seroma and wound dehiscence incidence were unchanged. Infections mainly occurred in the third week after surgery and were polymicrobial.

Implementing an early childhood developmental screening and surveillance program in primary care settings: lessons learned from a project in Illinois.

Enhancing Developmentally Oriented Primary Care (EDOPC) is a project with a goal to increase the financing and delivery of preventive developmental services for children birth to age 3 years in the state of Illinois. Primary care providers have more opportunities to screen and observe infants and toddlers than any other professional, because they see them up to 13 times in the first 3 years of life for well-child visits. The project focused on using a 1-hour, on-site training for primary care providers and their entire office staff as the method of increasing knowledge, focusing on intent to change practice and implementation of routine early childhood developmental screening. Although many primary care providers routinely use only developmental surveillance in their practices, clinical practice guidelines recommend routine use of standardized developmental screening, using validated developmental screening tools. This article includes lessons learned and recommendations based on clinical practice guidelines and experiences of the team members during implementation of the EDOPC project. Primary care providers are critical to this process because children with developmental disorders have the best long-term outcomes and opportunities for improved family functioning with early detection, diagnosis, and treatment.

Amending greenroof soil with biochar to affect runoff water quantity and quality.

Numbers of greenroofs in urban areas continue to grow internationally; so designing greenroof soil to reduce the amount of nutrients in the stormwater runoff from these roofs is becoming essential. This study evaluated changes in extensive greenroof water discharge quality and quantity after adding biochar, a soil amendment promoted for its ability to retain nutrients in soils and increase soil fertility. Prototype greenroof trays with and without biochar were planted with sedum or ryegrass, with barren soil trays used as controls. The greenroof trays were subjected to two sequential 7.4cm/h rainfall events using a rain simulator. Runoff from the rain events was collected and evaluated. Trays containing 7% biochar showed increased water retention and significant decreases in discharge of total nitrogen, total phosphorus, nitrate, phosphate, and organic carbon. The addition of biochar to greenroof soil improves both runoff water quality and retention.

Role of outer surface protein D in the Borrelia burgdorferi life cycle.

Borrelia burgdorferi preferentially induces selected genes in mice or ticks, and studies suggest that ospD is down-regulated in response to host-specific signals. We now directly show that ospD expression is generally elevated within Ixodes scapularis compared with mice. We then assessed the importance of OspD throughout the spirochete life cycle by generating OspD-deficient B. burgdorferi and examining the mutant in the murine model of tick-transmitted Lyme borreliosis. The lack of OspD did not influence B. burgdorferi infectivity in mice or the acquisition of spirochetes by I. scapularis. OspD adhered to tick gut extracts in vitro, and the OspD-deficient B. burgdorferi strain had a threefold decrease in colonization of the tick gut in vivo. This decrease, however, did not alter subsequent spirochete transmission during a second blood meal. These data suggest that B. burgdorferi can compensate for the lack of OspD in both ticks and mice and that OspD may have a nonessential, secondary, role in B. burgdorferi persistence within I. scapularis.

Outer surface protein B is critical for Borrelia burgdorferi adherence and survival within Ixodes ticks.

Survival of Borrelia burgdorferi in ticks and mammals is facilitated, at least in part, by the selective expression of lipoproteins. Outer surface protein (Osp) A participates in spirochete adherence to the tick gut. As ospB is expressed on a bicistronic operon with ospA, we have now investigated the role of OspB by generating an OspB-deficient B. burgdorferi and examining its phenotype throughout the spirochete life cycle. Similar to wild-type isolates, the OspB-deficient B. burgdorferi were able to readily infect and persist in mice. OspB-deficient B. burgdorferi were capable of migrating to the feeding ticks but had an impaired ability to adhere to the tick gut and survive within the vector. Furthermore, the OspB-deficient B. burgdorferi bound poorly to tick gut extracts. The complementation of the OspB-deficient spirochete in trans, with a wild-type copy of ospB gene, restored its ability to bind tick gut. Taken together, these data suggest that OspB has an important role within Ixodes scapularis and that B. burgdorferi relies upon multiple genes to efficiently persist in ticks.

Borrelia burgdorferi lacking BBK32, a fibronectin-binding protein, retains full pathogenicity.

BBK32, a fibronectin-binding protein of Borrelia burgdorferi, is one of many surface lipoproteins that are differentially expressed by the Lyme disease spirochete at various stages of its life cycle. The level of BBK32 expression in B. burgdorferi is highest during infection of the mammalian host and lowest in flat ticks. This temporal expression profile, along with its fibronectin-binding activity, strongly suggests that BBK32 may play an important role in Lyme pathogenesis in the host. To test this hypothesis, we constructed an isogenic BBK32 deletion mutant from wild-type B. burgdorferi B31 by replacing the BBK32 gene with a kanamycin resistance cassette through homologous recombination. We examined both the wild-type strain and the BBK32 deletion mutant extensively in the experimental mouse-tick model of the Borrelia life cycle. Our data indicated that B. burgdorferi lacking BBK32 retained full pathogenicity in mice, regardless of whether mice were infected artificially by syringe inoculation or naturally by tick bite. The loss of BBK32 expression in the mutant had no adverse effect on spirochete acquisition (mouse-to-tick) and transmission (tick-to-mouse) processes. These results suggest that additional B. burgdorferi proteins can complement the function of BBK32, fibronectin binding or otherwise, during the natural spirochete life cycle.