scholarly journals Semiquantitative Staphylococcus aureus Nasal Colony Reduction in Elective Orthopedic Surgery Reduces Surgical Site Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s386-s386
Author(s):  
Lisa Saidel ◽  
Riki Yosipovich ◽  
Ronit Nativ ◽  
Orli Sagi ◽  
Orly Shimoni ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Knee Replacement ◽  
Spine Surgery ◽  
Nasal Swab ◽  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Study Cohort ◽  
Quantitative Measurements ◽  
Infection Complication

Background: Clean surgical procedures such as hip and knee replacement and spine surgery have a low infection complication rate; however, if infections occur, there is substantial morbidity and increased cost. Staphylococcus aureus causes 30% of surgical site infections (SSIs). S. aureus colonization increases the risk of developing SSI. Nasal povidone-iodine 5% application reduces the S. aureus colonization burden. Objective: We aimed to reduce SSIs by applying nasal povidone-iodine 5% prior to hip and knee replacement and spine surgery. Methods: Adult patients hospitalized for elective hip replacement, knee replacement, or spine surgeries from February 2018 through August 2019 comprised the study cohort. All patients received preoperative guidance in the outpatient clinic. On admission, the evening before surgery, a nasal swab for S. aureus colonization was performed, followed by povidone-iodine 5% application in both nostrils and body chlorhexidine gluconate 4% bathing. Application of these substances was repeated in the morning before surgery. Within 24 hours after surgery, an additional nasal swab for S. aureus colonization was taken. A 90-day follow-up for SSI was done. Data were compared with a similar 2016–2017 cohort without the preoperative measures. Results: In total, 186 patients were included: 85 underwent hip or knee replacement (age 69 ± 13.2 y, 66% men), and 101 spine surgery (age 55 ± 15.4 y, 52% men). At screening, 18.3% were colonized with methicillin-sensitive S. aureus and 1.6% colonized with methicillin-resistant S. aureus. Pre- and postsurgery data for the cohort appear in Table 1. The SSI rate per 100 patient days for hip and knee replacement and for spine surgery decreased from 0.29 and 4.0, respectively, in the 2016–2017 cohort to 0 and 0.99, respectively, in the present cohort. Conclusions: Nasal povidone-iodine 5% reduced the S. aureus colonization burden. The SSI rate in elective hip and knee replacement and spine surgery significantly decreased. We show that there is no need for S. aureus eradication presurgery; semiquantitative S. aureus nasal colony reduction should suffice in reducing SSIs. Further research is needed using quantitative measurements for S. aureus colonization.Funding: NoneDisclosures: None

No evident association of nasal carriage of Staphylococcus aureus or its small-colony variants with cotrimoxazole use or ANCA-associated vasculitis relapses

Rheumatology ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Boun Kim Tan ◽  
Yoann Crabol ◽  
Jason Tasse ◽  
Frédéric Laurent ◽  
Narimane Nekkab ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nasal Swab ◽  
Microscopic Polyangiitis ◽  
Nasal Carriage ◽  
Small Colony Variant ◽  
Anca Associated Vasculitis ◽  
Small Colony ◽  
Relapse Rates

AbstractObjectiveTo identify the role of Staphylococcus aureus (SA) or its intracellular small-colony variant phenotype (SCV) with co-trimoxazole (CTX) or ANCA-associated vasculitis (AAV) activity.MethodsAll consecutive AAV patients with granulomatosis with polyangiitis (GPA), eosinophilic GPA or microscopic polyangiitis, followed at the French National Vasculitis Referral Center (09/2012–05/2013), and hospitalized non-AAV controls, exclusively for SA/SCV carriage comparisons, were enrolled. All had bilateral anterior nasal swab cultures. Nasal SA or SCV carriage was determined and associations with relapse(s), BVAS, ANCA-positivity, anti-staphylococcal and immunosuppressant use, were analysed ⩾4 years post-inclusion.ResultsNasal SA carriage rates did not differ among AAVs (P = 0.53): GPA (24/80; 30%), EGPA (7/28; 25%) and microscopic polyangiitis (3/11; 27.3%); and the rate was less frequent in controls than in GPA patients not taking CTX (P = 0.04). AAV patients taking CTX prophylaxis had less nasal SA carriage (8.7% vs 36.2%; P = 0.02). Nasal SA carriage or CTX use did not modify relapse rates, BVAS or ANCA-positivity at inclusion or during follow-up. Nasal SCV carriage, found in 15/207 (7.2%) patients, was similar for GPA (10/24; 41.7%), microscopic polyangiitis (2/7; 28.6%) and eosinophilic GPA (2/3; 66.7%), but higher (P = 0.02) than controls (1/14; 7.1%). SCV carriage by AAV groups did not modify relapse rates or ANCA positivity at inclusion or during follow-up; a trend towards higher BVAS was observed only for anti-PR3 ANCA patients.ConclusionNasal SA or SCV carriage was comparable among AAVs but more frequent than in controls. Nasal SA or SCV carriage and CTX use did not modify AAV relapse rates.

The efficacy of intrawound vancomycin powder and povidone-iodine irrigation to prevent surgical site infections in complex instrumented spine surgery

2019 ◽  
Vol 19 (10) ◽  
pp. 1648-1656 ◽  
Author(s):  
Justin V.C. Lemans ◽  
F. Cumhur Öner ◽  
Sebastiaan P.J. Wijdicks ◽  
Miquel B. Ekkelenkamp ◽  
H. Charles Vogely ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Vancomycin Powder ◽  
Instrumented Spine Surgery

scholarly journals Efficacy of Skin and Nasal Povidone-Iodine Preparation against Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus and S. aureus within the Anterior Nares

2015 ◽  
Vol 59 (5) ◽  
pp. 2765-2773 ◽  
Author(s):  
Michele J. Anderson ◽  
Maren L. David ◽  
Matt Scholz ◽  
Sally J. Bull ◽  
Dan Morse ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Human Skin ◽  
Povidone Iodine ◽  
Human Subjects ◽  
Surgical Site Infections ◽  
Attractive Alternative ◽  
Methicillin Resistant ◽  
Content Type ◽  
Nasal Swabs ◽  
Mrsa Infection

ABSTRACTMupirocin decolonization of nasalStaphylococcus aureusprior to surgery decreases surgical-site infections; however, treatment requires 5 days, compliance is low, and resistance occurs. In 2010, 3M Company introduced povidone-iodine (PVP-I)-based skin and nasal antiseptic (Skin and Nasal Prep [SNP]). SNP has rapid, broad-spectrum antimicrobial activity. We tested SNP's efficacy using full-thickness tissue (porcine mucosal [PM] and human skin) explant models and human subjects. Prior to or following infection with methicillin-resistantStaphylococcus aureus(MRSA) (mupirocin sensitive and resistant), explants were treated with Betadine ophthalmic preparation (Bet), SNP, or mupirocin (Bactroban nasal ointment [BN]) or left untreated. One hour posttreatment, explants were washed with phosphate-buffered saline (PBS) plus 2% mucin. One, 6, or 12 h later, bacteria were recovered and enumerated. Alternatively, following baseline sampling, human subjects applied two consecutive applications of SNP or saline to their anterior nares. One, 6, and 12 h after application of the preparation (postprep), nasal swabs were obtained, andS. aureuswas enumerated. We observed that treatment of infected PM or human skin explants with SNP resulted in >2.0 log10CFU reduction in MRSA, regardless of mupirocin sensitivity, which was significantly different from the values for BN- and Bet-treated explants and untreated controls 1 h, 6 h, and 12 h after being washed with PBS plus mucin. Swabbing the anterior nares of human subjects with SNP significantly reduced residentS. aureuscompared to saline 1, 6, and 12 h postprep. Finally, pretreatment of PM explants with SNP, followed by a mucin rinse prior to infection, completely prevented MRSA infection. We conclude that SNP may be an attractive alternative for reducing the bioburden of anterior nares prior to surgery.

Impact of a Methicillin-Resistant Staphylococcus Aureus Active Surveillance Culture Protocol on Mupirocin Prescribing

2009 ◽  
Vol 44 (9) ◽  
pp. 781-784
Author(s):  
Marisel Segarra-Newnham ◽  
Kristin St. John
Keyword(s):  
Staphylococcus Aureus ◽  
Active Surveillance ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Inpatient Setting ◽  
Surveillance Culture ◽  
Methicillin Resistant ◽  
The Impact ◽  
Active Surveillance Culture

Background To identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA), an active surveillance culture (ASC) protocol has been in place since March 2007. Decolonization with mupirocin ointment is not recommended but may be attempted after a positive MRSA screen. Objective Assess the impact of an inpatient ASC protocol on prescribing of mupirocin nasal ointment for decolonization before and after protocol implementation. Methods A retrospective review of mupirocin inpatient prescribing and outpatient clinic requests from March 2006 through February 2007 (1 year before ASC implementation) and from March 2007 through February 2008 (1 year after ASC implementation) was conducted. Cultures for MRSA after decolonization were evaluated. Results During the 24 months reviewed, 38 inpatients received mupirocin (18 before and 20 after ASC). Only 14 patients (37%) had a follow-up nasal swab (5 before and 9 after ASC). Of these patients, 5 (36%) had a positive nasal swab after the initial decolonization attempt. Ten patients (26%) had at least 1 clinical culture positive for MRSA after the initial decolonization (7 before and 3 after ASC). Outpatient requests for mupirocin increased 2.5-fold after ASC implementation. Sixty percent of the requests were not appropriate. Conclusion After implementation of the ASC protocol, there was no change in mupirocin prescribing for decolonization in the inpatient setting. However, outpatient requests—most of which were not indicated—increased. Success of decolonization cannot be assessed because follow-up nasal screening was not universally performed.

Management and outcomes of isolated interhemispheric subdural hematomas associated with falx syndrome

2019 ◽  
Vol 131 (6) ◽  
pp. 1920-1925
Author(s):  
Daniel A. Tonetti ◽  
William J. Ares ◽  
David O. Okonkwo ◽  
Paul A. Gardner
Keyword(s):  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Study Cohort ◽  
Venous Infarction ◽  
Nonsurgical Management ◽  
Subdural Hematomas ◽  
Poor Outcomes ◽  
Contemporary Management

OBJECTIVELarge interhemispheric subdural hematomas (iSDHs) causing falx syndrome are rare; therefore, a paucity of data exists regarding the outcomes of contemporary management of iSDH. There is a general consensus among neurosurgeons that large iSDHs with neurological deficits represent a particular treatment challenge with generally poor outcomes. Thus, radiological and clinical outcomes of surgical and nonsurgical management for iSDH bear further study, which is the aim of this report.METHODSA prospectively collected, single-institution trauma database was searched for patients with isolated traumatic iSDH causing falx syndrome in the period from January 2008 to January 2018. Information on demographic and radiological characteristics, serial neurological examinations, clinical and radiological outcomes, and posttreatment complications was collected and tallied. The authors subsequently dichotomized patients by management strategy to evaluate clinical outcome and 30-day survival.RESULTSTwenty-five patients (0.4% of those with intracranial injuries, 0.05% of those with trauma) with iSDH and falx syndrome represented the study cohort. The average age was 73.4 years, and most patients (23 [92%] of 25) were taking anticoagulants or antiplatelet medications. Six patients were managed nonoperatively, and 19 patients underwent craniotomy for iSDH evacuation; of the latter patients, 17 (89.5%) had improvement in or resolution of motor deficits postoperatively. There were no instances of venous infarction, reaccumulation, or infection after evacuation. In total, 9 (36%) of the 25 patients died within 30 days, including 6 (32%) of the 19 who had undergone craniotomy and 3 (50%) of the 6 who had been managed nonoperatively. Patients who died within 30 days were significantly more likely to experience in-hospital neurological deterioration prior to surgery (83% vs 15%, p = 0.0095) and to be comatose prior to surgery (100% vs 23%, p = 0.0031). The median modified Rankin Scale score of surgical patients who survived hospitalization (13 patients) was 1 at a mean follow-up of 22.1 months.CONCLUSIONSiSDHs associated with falx syndrome can be evacuated safely and effectively, and prompt surgical evacuation prior to neurological deterioration can improve outcomes. In this study, craniotomy for iSDH evacuation proved to be a low-risk strategy that was associated with generally good outcomes, though appropriately selected patients may fare well without evacuation.

SKIN MELANOMA INCIDENCE IN WORKERS OCUPATIONALLY EXPOSED TO IONIZING RADIATION OVER A PROLONGED PERIOD

2019 ◽  
Vol 65 (3) ◽  
pp. 441-446
Author(s):  
Valentina Rybkina ◽  
Tamara Azizova ◽  
Yevgeniya Grigoreva
Keyword(s):  
Ionizing Radiation ◽  
Gamma Rays ◽  
Disease Risk ◽  
Incidence Rates ◽  
Study Cohort ◽  
Calendar Period ◽  
Skin Melanoma ◽  
Melanoma Incidence ◽  
Occupationally Exposed

Purpose of the study. The study is aimed to investigate skin melanoma incidence in workers occupationally exposed to radiation over a prolonged period. Materials and methods. Skin melanoma incidence was studied in a cohort of workers first employed at nuclear facility Mayak Production Association (PA) between 1948 and 1982 who had been followed up till 31.12.2013 (22,377 individuals). Mean cumulative doses from external gamma-rays over the whole follow-up period were 0.54±0.001 Sv in males and 0.44±0.002 Sv in females. Incident rates for skin melanoma were analyzed by sex, attained age, calendar period of diagnostics and radiation dose using worldwide standard and the direct standardization technique. Results. 60 skin melanoma cases (37 in males and 23 in females) were registered in the study cohort over the whole follow-up period. The standardized skin melanoma incident rate was 8.51±1.46 in males and 8.78±2.27 in females per 100000 workers revealing statistically higher rates compared to corresponding rates for general populations of the Russian Federation, Urals Federal District and Chelyabinsk region. Skin melanoma incidence was significantly increased in the period of 1994 - 2013 as compared to the period of 1974 - 1993. Skin melanoma incidence excess in females was greater than that for males. Skin melanoma incidence increment in females was mostly driven by modifications of disease occurrence risk while in males it was driven by a combined effect of age pattern modifications in the study cohort and increase of disease risk. Conclusions. Skin melanoma incidence rates in the cohort of workers occupationally exposed to ionizing radiation over a prolonged period were associated with sex and attained age workers and the calendar period of diagnostics. No significant association of skin melanoma incidence with dose from external gamma-rays was observed. A significantly increasing trend was observed for skin melanoma incidence by the end of the follow-up in both males and females.

scholarly journals Metabolic Syndrome Features and Excess Weight Were Inversely Associated with Nut Consumption after 1-Year Follow-Up in the PREDIMED-Plus Study

2020 ◽  
Vol 150 (12) ◽  
pp. 3161-3170
Author(s):  
Alicia Julibert ◽  
Maria del Mar Bibiloni ◽  
Laura Gallardo-Alfaro ◽  
Manuela Abbate ◽  
Miguel Á Martínez-González ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Energy Intake ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Virgin Olive Oil ◽  
Hdl Cholesterol ◽  
Excess Weight ◽  
Study Cohort

ABSTRACT Background High nut consumption has been previously associated with decreased prevalence of metabolic syndrome (MetS) regardless of race and dietary patterns. Objectives The aim of this study was to assess whether changes in nut consumption over a 1-y follow-up are associated with changes in features of MetS in a middle-aged and older Spanish population at high cardiovascular disease risk. Methods This prospective 1-y follow-up cohort study, conducted in the framework of the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial, included 5800 men and women (55–75 y old) with overweight/obesity [BMI (in kg/m2) ≥27 and <40] and MetS. Nut consumption (almonds, pistachios, walnuts, and other nuts) was assessed using data from a validated FFQ. The primary outcome was the change from baseline to 1 y in features of MetS [waist circumference (WC), glycemia, HDL cholesterol, triglyceride (TG), and systolic and diastolic blood pressure] and excess weight (body weight and BMI) according to tertiles of change in nut consumption. Secondary outcomes included changes in dietary and lifestyle characteristics. A generalized linear model was used to compare 1-y changes in features of MetS, weight, dietary intakes, and lifestyle characteristics across tertiles of change in nut consumption. Results As nut consumption increased, between each tertile there was a significant decrease in WC, TG, systolic blood pressure, weight, and BMI (P < 0.05), and a significant increase in HDL cholesterol (only in women, P = 0.044). The interaction effect between time and group was significant for total energy intake (P < 0.001), adherence to the Mediterranean diet (MedDiet) (P < 0.001), and nut consumption (P < 0.001). Across tertiles of increasing nut consumption there was a significant increase in extra virgin olive oil intake and adherence to the MedDiet; change in energy intake, on the other hand, was inversely related to consumption of nuts. Conclusions Features of MetS and excess weight were inversely associated with nut consumption after a 1-y follow-up in the PREDIMED-Plus study cohort. This trial was registered at isrctn.com as ISRCTN89898870.

scholarly journals Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

2021 ◽  
Vol 10 (15) ◽  
pp. 3375
Author(s):  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
Toshitaka Yoshii ◽  
Satoru Egawa ◽  
Takashi Hirai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cervical Spine ◽  
Postoperative Complications ◽  
Spine Surgery ◽  
Posterior Longitudinal Ligament ◽  
Lower Extremity Function ◽  
Cervical Spine Surgery ◽  
The Impact

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

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