Perioperative infections in congenital heart disease.

BACKGROUND: Perioperative infections have significant consequences for children with congenital heart disease (CHD), which can manifest as acute or chronic infection followed by poor growth and progressive cardiac failure. The consequences include delayed or higher-risk surgery, and increased postoperative morbidity and mortality. METHODS: A systematic search for studies evaluating the burden and interventions to reduce perioperative infections in children with CHD was undertaken using PubMed. RESULTS: Limited studies conducted in low- to middle-income countries demonstrated the large burden of perioperative infections among children with CHD. Most studies focussed on infections after surgery. Few studies evaluated strategies to prevent preoperative infection or the impact of infection on decision-making around the timing of surgery. Children with CHD have multiple risk factors for infections including delayed presentation, inadequate treatment of cardiac failure, and poor nutrition. CONCLUSIONS: The burden of perioperative infections is high among children with CHD, and studies evaluating the effectiveness of interventions to reduce these infections are lacking. As good nutrition, early corrective surgery, and measures to reduce nosocomial infection are likely to play a role, practical steps can be taken to make surgery safer.

Inpatient surgical site infection after shoulder arthroplasty.

BACKGROUND: Surgical site infection (SSI) after joint arthroplasty is associated with prolonged hospitalization, reoperation, inferior outcomes, and substantial resource utilization. As the number of shoulder replacements performed in the United States continues to rise, measuring the incidence of inpatient SSI after hemiarthroplasty (HSA) and total shoulder arthroplasty (TSA), and associated risk factors for infection is worthwhile. METHODS: Using the Nationwide Inpatient Sample (NIS), we reviewed 241,193 patients undergoing TSA or reverse TSA and 159,795 undergoing HSA between 2002 and 2011 and identified patients with an associated diagnosis of SSI during the admission. Demographic characteristics, preoperative diagnoses, further surgical procedures, associated comorbidities, and in-hospital events associated with SSI were sought in multivariable logistic regression analysis. RESULTS: An in-hospital SSI developed in 0.08% of patients undergoing TSA or reverse TSA and in 0.11% of patients undergoing HSA. Independent risk factors for inpatient SSI included TSA vs HSA (odds ratio [OR], 1.83), Medicaid insurance vs private insurance (OR, 3.93), diagnosis of fracture nonunion (OR, 5.76), avascular necrosis (OR 2.71), or proximal humeral fracture (OR, 2.62) vs primary osteoarthritis, comorbidities, in-hospital events (blood transfusion, pneumonia, and acute renal failure), and increased duration of hospital stay. CONCLUSIONS: The small percentage of SSI that occurs during the initial inpatient stay after shoulder arthroplasty is related to diagnoses other than primary osteoarthritis in more infirm patients with low-income government insurance (Medicaid). Patients considering shoulder arthroplasty can use this information to help decide between the potential improvement in comfort and function of the shoulder and the potential for major adverse events such as infection.

Impact of perioperative SARS-CoV-2 Omicron infection on postoperative complications in liver cancer hepatectomy: A single-center matched study.

OBJECTIVES: To explore the effects of perioperative SARS-CoV-2 Omicron infection on postoperative complications in patients with liver cancer. METHODS: A propensity-matched study was conducted, which included patients with primary liver cancer who underwent hepatectomy from September 01, 2022 to January 20, 2023. Patients who infected SARS-CoV-2 Omicron during the perioperative period (7 days before to 30 days after surgery) were matched 1:1 with noninfected patients. The primary outcomes, which were COVID-19-related major complications and liver resection-specific complications, were analyzed using multivariate logistic regression. RESULTS: A total of 243 patients were included, with 63 cases of perioperative infections, of which 62 were postoperative infections. The overall 30-day postoperative mortality rate was 1.6% (4/243). Compared to noninfected patients, those with perioperative infections showed no significant difference in the occurrence of adverse postoperative outcomes. However, they had a higher rate of 30-day readmission after surgery (11.1% vs 0%, P = 0.013). Perioperative SARS-CoV-2 infection was not associated with "major cardiorespiratory complications" or "liver resection-specific complications", but age, pre-existing comorbidities, and tumor type were related to these outcomes. CONCLUSION: Perioperative SARS-CoV-2 Omicron infection did not increase the incidence of postoperative complications in patients with liver cancer. However, those patients had a higher rate of 30-day readmission after surgery.

Epidemiology and prevention of surgical site infection in Japan.

Healthcare-associated infection control practices in Japan were not commonly acknowledged until mid-1980s, when an academic society focusing on infection control was founded and large academic hospitals began to establish infection control departments. In the late 1990s, the society established a nationwide surveillance system mainly focusing on surgical site infection (SSI). Coincidentally, the guideline for the prevention of SSI published by the US Centers for Disease Control and Prevention (CDC) was revised in 1999. It was translated into Japanese, and has been widely referenced in Japanese clinical practices. Since then, both epidemiological research and preventive practices in Japan have been developed. Overall SSI incidence was about 10% in the early 2000s, but fell to 7% by 2007, with a further reduction to 5% in 2020. A large SSI database cohort created through surveillance enabled us to conduct research regarding risk factors for SSI following various types of surgery. In mid-2010s, the revision of CDC's SSI prevention guideline and the new one by the World Health Organization were published. Novel evidence-based SSI prevention practices such as normal body temperature and antiseptic-impregnated sutures are recommended, and have been timely introduced into Japanese surgical practice. However, many of the practices and devices shown to be effective in preventing SSI are not approved for reimbursement by public healthcare insurance in Japan, which has so far prevented those measures from being widely used in Japanese healthcare.

Bilateral Three-Port Video-Assisted Thoracoscopic Thymectomy for Thymoma in Good's Syndrome With a History of Bacteremia.

A 62-year-old man presented with back pain, lower leg swelling, and fever and was referred to our hospital. Blood cultures identified Helicobacter fennelliae as the causative agent of bacteremia associated with pyogenic spondylitis and cellulitis. CT revealed a tumor in the upper anterior mediastinum, and blood tests showed low gamma globulin levels, raising the suspicion of Good's syndrome. Infection control was prioritized, and the patient received antibiotics for four weeks. After blood cultures returned negative, preoperative gamma globulin was administered to mitigate infection risk, and a total thymectomy was planned. A bilateral three-port thoracoscopic total thymectomy was performed, and the patient was observed as an outpatient without any postoperative infection recurrence. We present a case of Good's syndrome with a high infection risk, successfully managed with a minimally invasive bilateral three-port thoracoscopic total thymectomy and effective perioperative infection control.

Evidence-based guideline for the prevention and management of perioperative infection.

BACKGROUND: We have updated the guideline for preventing and managing perioperative infection in China, given the global issues with antimicrobial resistance and the need to optimize antimicrobial usage and improve hospital infection control levels. METHODS: We conducted a comprehensive evaluation of the evidence for prevention and management of perioperative infection, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Revisions were made to the guidelines in response to feedback from the experts. RESULTS: There were 17 questions prepared, for which 37 recommendations were made. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the meta-analysis results, recommendations were graded using the Delphi method to generate useful information. CONCLUSIONS: This guideline provides evidence to perioperative antimicrobial prophylaxis that increased the rational use of prophylactic antimicrobial use, with substantial improvement in the risk-benefit trade-off.

Bacterial contamination of water used as thermal transfer fluid in fluid-warming devices.

INTRODUCTION: Recent reports implicated heater-cooler units (HCUs), which are used for warming infusions, blood or in extracorporeal membrane oxygenation devices, as a possible origin of healthcare-associated infections (HAIs) with potentially pathogenic bacteria, such as non-tuberculous mycobacteria [1]. This represents a source of contamination in a usually sterile setting. AIM: To analyse water from infusion heating devices (IHDs) for bacterial contamination, and to determine if IHDs are a potential source in the transmission of HAIs. METHODS: Thermal transfer fluid (TTF; 300-500 mL) was collected from the reservoirs of 22 independent IHDs and processed on different selective and non-selective media for colony count and identification of bacteria. Strains of Mycobacterium spp. were analysed by whole-genome sequencing. RESULTS: Bacterial growth was observed in all 22 TTF samples after cultivation at 22 °C and 36 °C. Pseudomonas aeruginosa was the most frequent pathogen identified, present in 13.64% (3/22) of samples at >100 colony-forming units/100 mL. Colonization with Mycobacterium chimaera, Ralstonia pickettii and Ralstonia mannitolilytica was detectable in 9.09% (2/22) of samples. Primary sequencing of the detected M. chimaera suggests a close relationship with a M. chimaera strain detected in an outbreak in Switzerland which led to the death of two patients. DISCUSSION: Contamination of TTF represents a germ reservoir in a sensitive setting. Handling errors of IHDs may lead to the distribution of opportunistic or facultative bacterial pathogens, increasing the risk of transmission of nosocomial infections.

Risk factors of infection of totally implantable venous access port: A retrospective study.

BACKGROUND: Infection is the most frequent complication associated with the use of totally implantable venous access port (TIVAP). This retrospective study was conducted to determine the risk factors affecting TIVAP-related infection. METHODS: A total of 1406 patients implanted with TIVAP at our center were included in this retrospective study. Incidence of perioperative infection, patient characteristics and bacteriologic data were retrieved and analyzed. Univariable analyses and multiple logistic regression analyses were used to determine the risk factors. RESULTS: Overall, 72 (5.1%) patients had perioperative infection, and TIVAP was finally removed from 12 (0.85%) patients. There was significantly more hematologic malignancy in the infection group, compared to the non-infection group. Patients with chemotherapy and infection within 30 days before operation also had more infections. There were more inpatients in the infection group than in the non-infection group. The rate of hematoma was higher in the infected patients. Multivariate logistic analysis revealed that hematoma (OR 5.695, p < 0.001), preoperative hospital stay (⩾14d) (OR 2.945, p < 0.001), history of chemotherapy (OR 2.628, p = 0.002), history of infection (within 30 days) (OR 4.325, p < 0.001) were independent risk factor for infection. CONCLUSIONS: This study demonstrated that hematoma, preoperative hospital stay (⩾14d), history of chemotherapy and history of infection (within 30 days) are independent risk factor for all patients.

Wide-spectrum antibiotic prophylaxis guarantees optimal outcomes in drowned donor kidney transplantation.

BACKGROUND: Drowned victims possibly obtain various pathogens from drowning sites. Using drowned renal donors to expand the donor pool still lacks consensus due to the potential risk of disease transmission. RESEARCH DESIGN AND METHODS: This retrospective study enrolled 38 drowned donor renal recipients in a large clinical center from August 2012 to February 2021. A 1:2 matched cohort was generated with donor demographics, including age, gender, BMI, and ICU durations. Donor microbiological results, recipient perioperative infections, and early post-transplant and first-year clinical outcomes were analyzed. RESULTS: Compared to the control group, drowned donors had significantly increased positive fungal cultures (36.84% vs.13.15%, p = 0.039). Recipients in the drowned group had significantly higher rates of gram-negative bacteria (GNB) and multidrug-resistant GNB infections (23.68% vs.5.26%, 18.42% vs. 3.95%, both p < 0.05). Other colonization and infections were also numerically more frequent in the drowned group. Drowned donor recipients receiving inadequate antibiotic prophylaxis had more perioperative bloodstream infections, higher DGF incidences, and more first-year respiratory tract infections and recipient loss than those receiving adequate prophylaxis (all p < 0.05). Clinical outcomes were similar between the adequate group and the control group. CONCLUSIONS: Drowned donors could be suitable options under wide-spectrum and adequate antimicrobial prophylaxis.

Optimal Perioperative Antimicrobial Management Strategies of Kidney Transplant Recipients Guided by Metagenomic Next-Generation Sequencing of Deceased Donors' Microbiology Samples.

Background: There is no consensus on the optimal use of perioperative antibiotics prophylaxis after kidney transplantation, but there is a common trend to limit the duration of antibiotic use worldwide. Metagenomic next-generation sequencing (mNGS) has emerged as a novel technology for pathogen detection in clinical practice due to its noninvasive, rapid, precise and high susceptibility to detect infectious pathogens. However, data are lacking on whether mNGS analyses could be used to detect pathogens and guide anti-infection regimens in kidney transplant donors and recipients. Methods: We conducted a retrospective study to review all clinic data of mNGS and traditional laboratory methods (TMs) for pathogen detection in kidney transplant recipients and their corresponding deceased donors from August 1, 2021 to October 30, 2022 in our center. Results: A total of 57 donors and 112 of their corresponding recipients were included. The antimicrobial strategy mainly depended on mNGS results combined with traditional pathogen culture and clinical conditions. The percentages of positive pathogen detected by mNGS in blood, urine, bronchoalveolar lavage fluid (BALF) and preservation fluids (PFs) were 50.9% (29/57), 35.1% (20/57), 84.2% (48/57) and 54.4% (31/57) respectively, and were 24.6% (14/57), 15.8% (9/57), 57.9% (33/57) and 14.1% (8/57) respectively when using TMs. mNGS could detected all of pathogens which were detected by TMs. However, samples with negative TMs testing can be additionally detected as positive by mNGS (15/43 in blood, 11/48 in urine, 15/24 in BALF and 23/49 in PFs). Drug resistance genes were detected in 9 donors by mNGS,which were consistent with 6 donors by TMs. There was only one case of donor-derived infection in this study. Conclusion: This study showed that it is effective to combine mNGS with traditional pathogen detection methods and clinical features to develop optimal perioperative antimicrobial management strategies for deceased donor kidney transplantation.

[Value of procalcitonin in the diagnosis of perioperative infection in patients undergoing primary hip replacement].

OBJECTIVE: To analyze the value of procalcitonin (PCT) in the diagnosis of perioperative infection associated with implants in patients with primary hip arthroplasty. METHODS: A retrospective study was conducted on 150 patients who underwent primary hip arthroplasty from June 2018 to June 2020, including 86 males and 64 females, aged from 47 to 77 years old with an average of (57.04±7.43) years. All patients with primary hip arthroplasty were divided into infection group and non infection group according to whether there was infection after operation. Blood samples were collected from the elbow vein before operation (D0) and on the 4, 6, 8 days after operation(D4, D6 and D8) respectively to detect the serum PCT level and white blood cell count (WBC) level. RESULTS: Among 150 patients with primary hip arthroplasty, 34 patients with postoperative infection were in the infection group, and 116 patients without postoperative infection were in the noninfection group. In the infection group, there were 19 cases of superficial surgical site infection(55.88%, 19/34), 9 cases of urinary tract infection (26.47%, 9/34), and 6 cases of pneumonia(17.65%, 6/34). After bacterial culture in the infection group, there were 9 cases of Staphylococcus aureus, 3 cases of Escherichia coli, 3 cases of Staphylococcus epidermidis, 3 cases of Streptococcus constellation, 3 cases of Candida albicans, 6 cases of Klebsiella pneumoniae, 2 cases of Escherichia coli and Streptococcus agalactis, 3 cases of coagulase invisible staphylococcus and Burkholderia cepacia, 2 cases of Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa. There was no significant difference in PCT levels between two groups in D0(P=0.081), D4(P=0.069) and D6(P=0.093), but there was significant difference in D8(P=0.007). There was no significant difference in WBC between two groups at any time point(P>0.05). The results of receiver operating characteristic curve(ROC) showed that the AUC of PCT diagnosis was 0.978[95%CI(0.933, 1.022)] and that of WBC was 0.562[95%CI(0.398, 0.726)], PCT was an important predictor of infection after primary hip arthroplasty(AUC>0.9). When the critical value was 0.526 ng/ml, the sensitivity and specificity of PCT diagnosis are 36% and 100%, respectively, WBC was not a significant predictor of infection after primary hip arthroplasty (0.5

Metagenomic Next-Generation Sequencing Versus Traditional Laboratory Methods for the Diagnosis and Treatment of Infection in Liver Transplantation.

Background: Metagenomic next-generation sequencing (mNGS) has emerged as an effective method for the noninvasive and precise detection of infectious pathogens. However, data are lacking on whether mNGS analyses could be used for the diagnosis and treatment of infection during the perioperative period in patients undergoing liver transplantation (LT). Methods: From February 2018 to October 2018, we conducted an exploratory study using mNGS and traditional laboratory methods (TMs), including culture, serologic assays, and nucleic acid testing, for pathogen detection in 42 pairs of cadaveric liver donors and their corresponding recipients. Method performance in determining the presence of perioperative infection and guiding subsequent clinical decisions was compared between mNGS and TMs. Results: The percentage of liver donors with mNGS-positive pathogen results (64.3%, 27/42) was significantly higher than that using TMs (28.6%, 12/42; P<0.05). The percentage of co-infection detected by mNGS in liver donors was 23.8% (10/42) significantly higher than 0.0% (0/42) by TMs (P<0.01). Forty-three pathogens were detected using mNGS, while only 12 pathogens were identified using TMs. The results of the mNGS analyses were consistent with results of the TM analyses in 91.7% (11/12) of donor samples at the species level, while mNGS could be used to detect pathogens in 66.7% (20/30) of donors deemed pathogen-negative using TMs. Identical pathogens were detected in 6 cases of donors and recipients by mNGS, among which 4 cases were finally confirmed as donor-derived infections (DDIs). For TMs, identical pathogens were detected in only 2 cases. Furthermore, 8 recipients developed early symptoms of infection (<7 days) after LT; we adjusted the type of antibiotics and/or discontinued immunosuppressants according to the mNGS results. Of the 8 patients with infections, 7 recipients recovered, and 1 patient died of severe sepsis. Conclusions: Our preliminary results show that mNGS analyses can provide rapid and precise pathogen detection compared with TMs in a variety of clinical samples from patients undergoing LT. Combined with symptoms of clinical infection, mNGS showed superior advantages over TMs for the early identification and assistance in clinical decision-making for DDIs. mNGS results were critical for the management of perioperative infection in patients undergoing LT.

Diclofenac Resensitizes Methicillin-Resistant Staphylococcus aureus to ß-Lactams and Prevents Implant Infections.

Implant infections caused by methicillin-resistant Staphylococcus aureus (MRSA) can cause major complications during the perioperative period. Diclofenac, one of the most widely used nonsteroidal anti-inflammatory drugs, is often used to relieve pain and inflammation. In this study, it is found that high-dose diclofenac can inhibit the growth of MRSA, and does not easily induce drug-resistant mutations after continuous passage. However, low-doses diclofenac can resensitize bacteria to ß-lactams, which help to circumvent drug resistance and improve the antibacterial efficacy of conventional antibiotics. Further, low-dose diclofenac in combination with ß-lactams inhibit MRSA associated biofilm formation in implants. Transcriptomic and proteomic analyses indicate that diclofenac can reduce the expression of genes and proteins associated with ß-lactam resistance: mecA, mecR, and blaZ; peptidoglycan biosynthesis: murA, murC, femA, and femB; and biofilm formation: altE and fnbP. Murine implant infection models indicate that diclofenac combined with ß-lactams, can substantially alleviate MRSA infections in vivo. In addition, it is investigated that low dose diclofenac can inhibit MRSA antibiotic resistance via the mecA/blaZ pathway and related biofilms in implants. The synergistic effect of diclofenac and ß-lactams might have promising applications for preventing perioperative infection, considering its multitarget effects against MRSA.

[Impact of the COVID-19 pandemic on hepato-pancreato-biliary surgery and organ transplantation]. / Auswirkung der COVID-19-Pandemie auf die hepatopankreatobiliäre Chirurgie und die Organtransplantation.

BACKGROUND AND OBJECTIVE: Due to the coronavirus disease 2019 (COVID-19) pandemic extensive reorganization and limitation of resources within the healthcare system became inevitable. This review highlights the direct and indirect impact of the COVID-19 pandemic on the fields of hepato-pancreato-biliary (HPB) surgery and organ transplantation incorporating the current literature and expert opinions published by national and international societies. Trends in surgical numbers were analyzed via the Eurotransplant Statistics Report Library and an in-center evaluation of HPB surgical procedures. RESULTS: For the fields of HPB surgery and organ transplantation a drastic decrease of procedures performed during the first wave of the pandemic was broadly reported. Interestingly, a compensatory increase of procedures was mostly not observed during the following months resulting in a slight overall decrease for 2020 compared to 2019. Whether this trend was due to increased mortality because of postponed surgeries and altered treatment regimens cannot be ruled out at this time. A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is definitely associated with a complicated course, especially in the perioperative course and after transplantation. DISCUSSION: Due to the increased risk profile of the named patient groups, there is an increased risk for a severe COVID-19 course. This must be considered when weighing up the treatment alternatives, protection recommendations and prioritization for vaccinations.

High incidence of postoperative infections after pancreaticoduodenectomy: A need for perioperative anti-infectious strategies.

OBJECTIVES: Postoperative infections occur frequently after pancreaticoduodenectomy, especially in patients with bile colonization. Recommendations for perioperative anti-infectious treatment are lacking, and clinical practice is heterogenous. We have analyzed the effects of bile colonization and antibiotic prophylaxis on postoperative infection rates, types and therapeutic consequences. METHODS: Retrospective observational study in patients undergoing pancreaticoduodenectomy with intraoperative bile culture. Data on postoperative infections and non-infectious complications, bile cultures and antibiotic prophylaxis adequacy to biliary bacteria were collected. RESULTS: Among 129 patients, 53% had a positive bile culture and 23% had received appropriate antibiotic prophylaxis. Postoperative documented infection rate was over 40% in patients with or without bile colonization, but antibiotic therapy was more frequent in positive bile culture patients (77% vs. 57%, P=0,008). The median duration of antibiotic therapy was 11 days and included a broad-spectrum molecule in 42% of cases. Two-thirds of documented postoperative infections involved one or more bacteria isolated in bile cultures, which was associated with a higher complication rate. While bile culture yielded Gram-negative bacilli (57%) and Gram-positive cocci (43%), fungal microorganisms were scarce. Adequate preoperative antibiotic prophylaxis according to bile culture was not associated with reduced infectious or non-infectious complication rates. CONCLUSION: Patients undergoing pancreaticoduodenectomy experience a high rate of postoperative infections, often involving bacteria from perioperative bile culture when positive, with no preventive effect of an adequate preoperative antibiotic prophylaxis. Increased postoperative complications in patients with bile colonization may render necessary a perioperative antibiotic treatment targeting bile microorganisms. Further prospective studies are needed to improve the anti-infectious strategy in these patients.

Tuberculous peritonitis; The effectiveness of diagnostic laparoscopy and the perioperative infectious prevention: A case report.

BACKGROUND: Tuberculous peritonitis (TBP) is uncommon in Japan, and its diagnosis with conventional methods is time taking and requires a high clinical index of suspicion. Laparoscopy with peritoneal biopsy is a tool for rapid and accurate diagnosis of TBP. However, few cases have mentioned the infectious control and prevention during the perioperative period. This case is written following the SCARE scale for case report writing. CASE PRESENTATION: A 30-year-old man from Southeast Asia with a past medical history of pulmonary tuberculosis at 3-year-old admitted to our institution with abdominal pain and slight fever lasting for a week. With the elevation of inflammatory response and CA125, we conducted CT (Computed tomography). Not only ascites, panniculitis with peritoneal nodules, and the thickening of the omentum were found. Considering the possibility of malignancy and TBP, we performed a diagnostic laparoscopy. Slightly cloudy ascites, peritoneal and thickening omentum with white nodules were seen, and pathological diagnosis from the omentum during the operation raised the possibility of TBP due to its caseating granuloma and these findings allowed us to start the rapid treatment. CONCLUSION: We reported the effectiveness of diagnostic laparoscopy along with the aspect of perioperative prevention for TBP.

Value of procalcitonin for diagnosing perioperative pneumonia, urinary infections and superficial surgical site infections in patients undergoing primary hip and knee arthroplasty.

Serum procalcitonin (PCT) levels may be helpful for the diagnosis of infections during the perioperative period of arthroplasty. However, there is much debate in the literature regarding the appropriate cut-off value for different types of surgery and local bacterial infection. The present study aimed to evaluate serum PCT levels in patients undergoing arthroplasty and to determine the cut-off value that may represent perioperative pneumonia, urinary infections and superficial surgical site infections. The present retrospective study included a total of 500 patients treated between July 2014 and August 2015. The case group contained 25 patients with perioperative infections (pneumonia, urinary and superficial surgical site infections), and the control group contained 25 patients without any post-surgical complications. Serum levels of PCT and white blood cells (WBC) were measured pre-operatively (D0) and at post-operative D4, D6 and D8, and the sensitivity, specificity and predictive value of these parameters were assessed. Regarding the comparison of the mean PCT levels between the case and the control group, a significant difference was seen at D8 (P=0.007), while no significant differences were observed at D0 (P=0.010), D4 (P=0.069) and D6 (P=0.093). No statistically significant differences in WBC levels between groups were observed for (P>0.01). In the control group, the PCT levels at D4 (0.062±0.020 ng/ml) were 2-fold of the mean baseline value, followed by a decrease until D6 (0.051±0.019 ng/ml) and a return close to the normal range by D8 (0.032±0.015 ng/ml). The PCT levels in the case group had rapidly increased on D4 (0.510±1.208 ng/ml). In contrast to the control group, they continuously increased on D6 (0.527±1.360 ng/ml) and D8 (0.686±1.117 ng/ml). From a clinical point of view, infection events were indicated in these patients during post-operative follow-up. For PCT, the area under the receiver operating characteristic curve (AUC) was 0.978 [95% confidence interval (CI), 0.933-1.022], and for WBC, the AUC was 0.562 (95% CI, 0.398-0.0.726). Based on the above data, the PCT value was a significant predictor of infection (AUC>0.9). For PCT, the cut-off point of 0.0995 ng/ml was associated with a sensitivity of 96% and a specificity of 100%. However, WBC were not a significant predictor of infection (0.5

Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review.

Total hip (THA) and total knee arthroplasty (TKA) are widely used, successful procedures for symptomatic end stage arthritis of the hips or knees, but patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SPA) including ankylosing spondylitis (AS) and psoriatic arthritis (PSA) are at higher risk for adverse events after surgery. Utilization rates of THA and TKA remain high for patients with RA, and rates of arthroplasty have increased for patients with SLE and SPA. However, complications such as infection are increased for patients with SLE, RA, and SPA, most of whom are receiving potent immunosuppressant medications and glucocorticoids at the time of surgery. Patients with SLE and AS are also at increased risk for perioperative cardiac and venous thromboembolism (VTE), while RA patients do not have an increase in perioperative cardiac or VTE risk, despite an overall increase in VTE and cardiac disease. This narrative review will discuss the areas of heightened risk for patients with RA, SLE, and SPA, and the perioperative management strategies currently used to minimize the risks.

Perioperative hair removal: A review of best practice and a practice improvement opportunity.

The current practice of perioperative hair removal reflects research-driven changes designed to minimize the risk of surgical wound infection. An aspect of the practice which has received less scrutiny is the clean-up of the clipped hair. This process is critical. The loose fibers represent a potential infection risk because of the micro-organisms they can carry, but their clean-up can pose a logistical problem because of the time required to remove them. Research has demonstrated that the most commonly employed means of clean-up, the use of adhesive tape or sticky mitts, can be both ineffective and time-consuming in addition to posing an infection risk from cross-contamination. Recently published research evaluating surgical clippers fitted with a vacuum-assisted hair collection device highlights the potential for significant practice improvement in the perioperative hair removal clean-up process. These improvements include not only further mitigation of potential infection risk but also substantial OR time and cost savings.

Analysis of risk factors for perioperative infection of intracranial aneurysm interventional embolization for subarachnoid hemorrhage / 国际外科学杂志

Objective:To explore the risk factors of intracranial aneurysm interventional embolization for subarachnoid hemorrhage (SAH) perioperative infection.Methods:A retrospective analysis of the clinical data of 236 SAH patients who underwent aneurysm interventional embolization in the Department of Neurosurgery, Huangshan Shoukang Hospital from May 2018 to December 2019, and statistics of the surgical treatment effects and postoperative conditions of all patients, according to the perioperative Infective status in the early stage, the patients were divided into infected group ( n=44) and non-infected group ( n=192) according to the perioperative infection, and the clinical indicators of the patients were recorded, including age, gender, history of drinking, smoking history, history of diabetes, and whether there was any temporary blockade during the operation, aneurysm location, triacylglycerol, lipoprotein type, CT-Fisher classification, history of hypertension, aneurysm diameter, number, albumin, Hunt-Hess classification, Glasgow coma score (GCS) at admission, number of punctures. Measurement data were expressed as the mean ± standard deviation ( Mean± SD), comparison between groups was by t-test; count data comparison between groups was by Chi-square test. Logistic regression was used to analyze the risk factors of infection in SAH patients during perioperative period. Results:The treatment success rate of all SAH patients was 100%; the results of univariate analysis showed that the history of hypertension, aneurysm diameter, number, albumin, Hunt-Hess classification, GCS score at admission, and number of punctures were compared between infected group and non-infected group, the difference was statistically significant ( P<0.05); the results of multivariate Logistic regression analysis showed that history of hypertension, aneurysm diameter ≥8 mm, a large number of aneurysms, albumin ≤35.12 g/L, Hunt-Hess classification Grade Ⅲ to Ⅳ, GCS score> 5 points at admission, and number of punctures>2 times were risk factors for perioperative infection in SAH treated by interventional embolization of intracranial aneurysm; the total score of all factors in the nomogram prediction model was 314.84 points, the corresponding value was 14.96% of the perioperative infection rate of intracranial aneurysm interventional embolization for SAH. Conclusions:Interventional embolization of intracranial aneurysm for SAH can achieve good clinical results. However, history of hypertension, aneurysm diameter ≥ 8 mm, a large number of aneurysms, albumin ≤ 35.12 g/L, Hunt-Hess grade Ⅲ to Ⅳ, GCS score > 5 points at admission, number of punctures> 2 times are all independent risk factors leading to perioperative infection in patients, and clinical attention should be paid to and actively prevented.