Incidence of surgical site infection after craniotomy: comparison between three months and twelve months of epidemiological surveillance

ABSTRACT Objective: To determine the incidence of surgical site infection in patients undergoing craniotomy and to compare 12-month and 3-month post-discharge surveillance periods in terms of their impact on the incidence of surgical site infection in those patients. Methods: This was a retrospective cohort study involving 173 adult patients submitted to "clean" craniotomy, with or without implants, during the six-month period, at a university hospital in the city of São Paulo, Brazil. All the patients were evaluated in the pre-, trans- and postoperative periods and were followed for 12 months to analyze the development of surgical site infections. Results: Of the 173 patients undergoing craniotomy during the study period, 20 developed an surgical site infection during the first, and 12 months after discharge, the overall incidence of surgical site infection therefore being 11.56%, compared with a 1-month incidence of 8.67% and a 3-month incidence of 10.98%. Among the 106 patients who received implants, the 1-, 3-, and 12-month incidence of surgical site infection was 7.54% (n= 8), 8.49% (n= 9), and 9.43% (n= 10), respectively. Among the 67 patients who did not receive implants, the 1-, 3-, and 12-month incidence of surgical site infection was 10.44% (n= 7), 14.92% (n= 10), and 14.92% (n= 10), respectively. Conclusion: The incidence of surgical site infection after craniotomy is high. Reducing the duration of the post-discharge surveillance period from 12 months to 3 months did not cause significant losses in the numbers of surgical site infection identified or a substantial decrease in their incidence.

Prevalence and antibiogram of methicillin resistant Staphylococcus aureus isolated from medical device-related infections; a retrospective study in Lahore, Pakistan

Abstract INTRODUCTION: With the advancement of medicine and surgery, various types of medical devices have become part of treatment strategies. METHODS: Identification and antimicrobial sensitivity testing were done according to CLSI guidelines following standard microbiological practices. RESULTS: Urinary catheter infections (31%) were most frequent followed by central venous catheter (18%) and orthopedic implants (15%). Methicillin resistant Staphylococcus aureus (MRSA) was a major cause of device-related infection after Escherichia coli (21%); other pathogens were Klebsiella pneumoniae (14%), Pseudomonas spp. (10%), Acinetobacter spp. (8%) and Candida species (7%). None of MRSA was resistant to vancomycin (MIC ≥16µg/mL). Resistance rates were 98% and 97% for ofloxacin and ciprofloxacin, respectively. CONCLUSIONS Escherichia coli and MRSA are major pathogens of medical device-related infections.

Estudio retrospectivo de la endocarditis infecciosa en diferentes grupos de riesgo / Infective endocarditis in an internal medicine ward

Background: Due to the increasing number of intravenous drug users, subjects with immune deficiencies or with prosthetic valves, infective endocarditis (IE) continues to be prevalent and to have a high mortality. Aim: To review all cases of infective endocarditis diagnosed in an Internal Medicine Service. Material and methods: Retrospective review of medical records of all patients with infective endocarditis, hospitalized in an Internal Medicine ward, between 1989 and 2003. Dukes criteria were used to define definitive, possible and less probable cases of IE. Results: Eighty seven patients with definite IE were identified (66 males, age range 19-84 years), with a mean incidence of 5.3 per 1000 hospitalizations. IE in intravenous drugs users was usually caused by Staphylococcus aureus and presented high risk of embolism (RR: 3,21). Subjects aged over 70 years had a relative risk of mortality of 5.5. Hospital acquired IE was associated with advanced age and IV catheters appeared as the only predisposing factor. Patients with prosthetic valves were also older, their main complication was abscess formation and their mortality was higher. Conclusions: A closer approach to differential conditions of patients, according to age, intravenous drug use or the presence of prosthetic valves, is necessary