scholarly journals Diagnostic value of routine chest tube tip culture in surgery for noninfectious lung disease

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Martijn van Schelt ◽  
Kevin Jenniskens ◽  
Rob J. Rentenaar ◽  
Inez Bronsveld
Keyword(s):  
Surgical Site Infection ◽  
Lung Disease ◽  
Predictive Value ◽  
Chest Tube ◽  
Diagnostic Performance ◽  
Postoperative Infection ◽  
Diagnostic Value ◽  
Site Infection ◽  
Postoperative Infections ◽  
Routine Chest

Abstract Background Evaluation of the diagnostic value of routine chest tube tip culture for detection of postoperative infection after surgery for noninfectious lung disease. Methods Included subjects were patients who underwent lung surgery between January 1st 2013 and January 1st 2018 in University Medical Centre Utrecht and of whom a chest tube tip was cultured. Postoperative outcomes included pneumonia, surgical site infection, and empyema within 30 days after surgery. Univariable analysis for diagnostic accuracy of chest tube tip culture results predicting these postoperative outcomes was performed, as well as multivariable analysis using penalized firth logistic regression. Results Patients developed one or more postoperative infections in 42 out of 210 (20%) lung surgeries. Pneumonia, surgical site infection, and empyema were found in 36 (17%), 8 (4%), and 2 (1%) cases respectively. Chest tube tip culture had a sensitivity of 31%, a specificity of 83%, a positive predictive value of 32%, and a negative predictive value of 83% for postoperative infections. In the subgroup of patients who did not have evidence of postoperative infection at the time of chest tube removal, the drain tip culture’s positive and negative predictive value changed to 18% and 92% respectively. Adding additional variables to chest tube tip culture in a prediction model resulting in only limited improvement in diagnostic performance. Conclusions We found insufficient diagnostic performance to support the practice of routine chest tube tip culture after surgery for noninfectious lung disease. Therefore, routine chest tube tip culture is not advisable and should be omitted to unburden the healthcare process and prevent low value care together with extra costs.

Prevention of Postoperative Infection

2017 ◽  
Author(s):  
Rindi Uhlich ◽  
Parker Hu ◽  
Patrick L Bosarge
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Key Words ◽  
Perioperative Care ◽  
Postoperative Infection ◽  
Site Infection ◽  
Preoperative Preparation ◽  
Postoperative Infections ◽  
Regulatory Bodies ◽  
Rapid Pace

Surgical site infection remains a preeminent focus of perioperative care given its huge potential to impact outcomes, length of stay, and mortality. Numerous governmental and regulatory bodies have developed recommendations to limit the incidence of surgical site infection. These recommendations continue to evolve at a rapid pace, with all aspects of perioperative care sharing ongoing scrutiny. Implementation of these strategies should remain the focus of all providers to limit the incidence of postoperative infections and optimize outcomes. This review contains 4 figures, 14 tables, and 109 references. Key words: antibiotic, complication, infection, preoperative, preparation, postoperative, scrub, surgical site infection

scholarly journals Probiotics Used for Postoperative Infections in Patients Undergoing Colorectal Cancer Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Chongxiang Chen ◽  
Tianmeng Wen ◽  
Qingyu Zhao
Keyword(s):  
Colorectal Cancer ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Surgical Site Infection ◽  
Postoperative Infection ◽  
Meta Analysis ◽  
Site Infection ◽  
Postoperative Infections ◽  
Colorectal Cancer Surgery

Objective. The objective of this study was to conduct a systematic review and meta-analysis about probiotics to improve postoperative infections in patients undergoing colorectal cancer surgery. Methods. The PubMed and the Web of Science were used to search for appropriate randomized clinical trials (RCTs) comparing probiotics with placebo for the patients undergoing colorectal cancer surgery. The RevMan 5.3 was performed for meta-analysis to evaluate the postoperative infection, including the total infection, surgical site infection, central line infection, pneumonia, urinary tract infection, septicemia, and postoperative leakage. Results. Our meta-analysis included 6 studies involving a total of 803 patients. For the incidence of total postoperative infection (odd ratios (OR) 0.31, 95% confidence interval (CI) 0.15–0.64, I2=0%), surgical site infection (OR 0.62, 95% CI 0.39–0.99, I2=11%), central line infection (OR 0.61, 95% CI 0.15–2.45, I2=65%), pneumonia (OR 0.36, 95% CI 0.18–0.71, I2=0%), urinary tract infection (OR 0.26, 95% CI 0.11–0.60, I2=26%), septicemia (OR 0.28, 95% CI 0.17–0.49, I2=10%), postoperative leakage (OR 0.45, 95% CI 0.06–3.27, I2=68%), the results showed that the incidences of infections were significantly lower in the probiotics group than the placebo group. Conclusions. Probiotics is beneficial to prevent postoperative infections (including total postoperative infection, surgical site infection, pneumonia, urinary tract infection, and septicemia) in patients with colorectal cancer.

Prevention of Postoperative Infection

2017 ◽  
Author(s):  
Rindi Uhlich ◽  
Parker Hu ◽  
Patrick L Bosarge
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Key Words ◽  
Perioperative Care ◽  
Postoperative Infection ◽  
Site Infection ◽  
Preoperative Preparation ◽  
Postoperative Infections ◽  
Regulatory Bodies ◽  
Rapid Pace

Surgical site infection remains a preeminent focus of perioperative care given its huge potential to impact outcomes, length of stay, and mortality. Numerous governmental and regulatory bodies have developed recommendations to limit the incidence of surgical site infection. These recommendations continue to evolve at a rapid pace, with all aspects of perioperative care sharing ongoing scrutiny. Implementation of these strategies should remain the focus of all providers to limit the incidence of postoperative infections and optimize outcomes. This review contains 4 figures, 14 tables, and 109 references. Key words: antibiotic, complication, infection, preoperative, preparation, postoperative, scrub, surgical site infection

scholarly journals The A2B trial, antibiotic prophylaxis for excision-graft surgery in burn patients: a multicenter randomized double-blind study

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
François Dépret ◽  
◽  
Boris Farny ◽  
Mathieu Jeanne ◽  
Kada Klouche ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Controlled Study ◽  
Control Group ◽  
Placebo Control ◽  
Double Blind Study ◽  
Burn Patients ◽  
Site Infection ◽  
Postoperative Sepsis ◽  
Postoperative Infections

Abstract Background The indication for antibiotic prophylaxis in burn patients remains highly controversial, with no consensus having been reached. The objective of antibiotic prophylaxis is to reduce the risk of postoperative local and systemic infections. Burn surgery is associated with a high incidence of bacteremia, postoperative infections, and sepsis. However, antibiotic prophylaxis exposes patients to the risk of selecting drug-resistant pathogens as well as to the adverse effects of antibiotics (i.e., Clostridium difficile colitis). The lack of data precludes any strong international recommendations regarding perioperative prophylaxis using systemic antibiotics in this setting. The goal of this project is therefore to determine whether perioperative systemic antibiotic prophylaxis can reduce the incidence of postoperative infections in burn patients. Methods The A2B trial is a multicenter (10 centers), prospective, randomized, double-blinded, placebo-controlled study. The trial will involve the recruitment of 506 adult burn patients with a total body surface area (TBSA) burn of between 5 and 40% and requiring at least one excision-graft surgery for deep burn injury. Participants will be randomized to receive antibiotic prophylaxis (antibiotic prophylaxis group) or a placebo (control group) 30 min before the incision of the first two surgeries. The primary outcome will be the occurrence of postoperative infections defined as postoperative sepsis and/or surgical site infection and/or graft lysis requiring a new graft within 7 days after surgery. Secondary outcomes will include mortality at day 90 postrandomization, skin graft lysis requiring a new graft procedure, postoperative bacteremia (within 48 h of surgery), postoperative sepsis, postoperative surgical site infection, number of hospitalizations until complete healing (> 95% TBSA), number of hospitalization days living without antibiotic therapy at day 28 and day 90, and multiresistant bacterial colonization or infection at day 28 and day 90. Discussion The trial aims to provide evidence on the efficacy and safety of antibiotic prophylaxis for excision-graft surgery in burn patients. Trial registration ClinicalTrials.gov NCT04292054. Registered on 2 March 2020

Outcome following removal of TPLO implants with surgical site infection

2013 ◽  
Vol 26 (04) ◽  
pp. 260-265 ◽  
Author(s):  
B. Beale ◽  
R. Murtaugh ◽  
J. Swiderski-Hazlett ◽  
M. Unis ◽  
R. Savicky
Keyword(s):  
Surgical Site Infection ◽  
Surgical Procedures ◽  
Medical Management ◽  
Postoperative Infection ◽  
Tibial Plateau ◽  
Clinical Signs ◽  
Implant Removal ◽  
Site Infection ◽  
New Generation ◽  
Postoperative Infection Rate

SummaryObjective To evaluate the outcome of surgical site infection (SSI) associated with tibial plateau levelling osteotomy (TPLO) implants following treatment by medical management alone or implant removal with or without the administration of antibiotic medication.Animals Ninety dogs (104 TPLO surgical procedures).Methods Records of dogs that had undergone TPLO implant removal due to SSI were reviewed. Outcome following treatment with antibiotic medications without implant removal, and treatment with implant removal with and without the administration of antibiotic medications was evaluated.Results Treatment of SSI with antibiotic medication alone failed in 88.9% (64/72) of the dogs. The clinical signs of SSI resolved in 94.9% (74/78) of the dogs treated with implant removal (with and without the administration of antibiotic medication postimplant removal). The effect of administration of antibiotic medication on outcome of treatment of the SSI by implant removal was not significant. The rate of SSI associated with the Synthes implant was higher than with the Slocum implant, but not the New Generation implant.Conclusion Implant removal with or without the administration of antibiotic medication post-implant removal for treatment of TPLO SSI provided superior outcome compared to treatment with antibiotic medications without implant removal.Clinical significance Implant removal should be considered for TPLO SSI that have not responded to appropriate medical management. Further investigation of the various TPLO implants and their effects on postoperative infection rate is warranted.

Validation of Surgical Site Infection Surveillance in The Netherlands

2007 ◽  
Vol 28 (1) ◽  
pp. 36-41 ◽  
Author(s):  
J. Manniën ◽  
A. E. van der Zeeuw ◽  
J. C. Wille ◽  
S. van den Hof
Keyword(s):  
Surgical Site Infection ◽  
Predictive Value ◽  
Medical Records ◽  
Surveillance System ◽  
Structured Interview ◽  
Surveillance Data ◽  
National Nosocomial Infection Surveillance ◽  
Site Infection ◽  
Infection Surveillance

Objectives.To describe how continuous validation of data on surgical site infection (SSI) is being performed in the Dutch National Nosocomial Infection Surveillance System (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), to assess the quality and accuracy of the PREZIES data, and to present the corresponding outcomes of the assessment.Design.Mandatory, 1-day on-site validation visit to participating hospitals every 3 years. The process of surveillance, including the quality of the method of data collection, is validated by means of a structured interview. The use of SSI criteria is validated by review of medical records, with the judgment of the validation team as the criterion standard.Setting.Hospitals participating in PREZIES.Results.During 1999-2004, the validation team visited 40 hospitals and reviewed 859 medical charts. There was no deviation between reports of SSI by infection control professionals and findings by the PREZIES validation team at 30 hospitals and 1 deviation in each of 10 hospitals; the positive predictive value was 0.97, and the negative predictive value was 0.99. The validation team often gave advice to the hospital, aimed at perfecting the process of surveillance. On 2 occasions, data were removed from the PREZIES database after the validation visit revealed deviations from the SSI surveillance protocol that could have resulted in nonrepresentative SSI rate data.Conclusions.PREZIES is confident that the assembled Dutch SSI surveillance data are reliable and robust and are sufficiently accurate to be used as a reference for interhospital comparison. PREZIES will continue performing on-site validation visits, to improve the process of surveillance and ensure the reliability of the surveillance data.

scholarly journals The value of S-Detect in improving the diagnostic performance of radiologists for the differential diagnosis of thyroid nodules

2020 ◽  
Vol 22 (4) ◽  
pp. 415
Author(s):  
Qi Wei ◽  
Shu-E Zeng ◽  
Li-Ping Wang ◽  
Yu-Jing Yan ◽  
Ting Wang ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Diagnostic Value ◽  
Ultrasound Images ◽  
Experienced Radiologist ◽  
Before And After ◽  
Sensitivity Specificity

Aims: To compare the diagnostic value of S-Detect (a computer aided diagnosis system using deep learning) in differentiating thyroid nodules in radiologists with different experience and to assess if S-Detect can improve the diagnostic performance of radiologists.Materials and methods: Between February 2018 and October 2019, 204 thyroid nodules in 181 patients were included. An experienced radiologist performed ultrasound for thyroid nodules and obtained the result of S-Detect. Four radiologists with different experience on thyroid ultrasound (Radiologist 1, 2, 3, 4 with 1, 4, 9, 20 years, respectively) analyzed the conventional ultrasound images of each thyroid nodule and made a diagnosis of “benign” or “malignant” based on the TI-RADS category. After referring to S-Detect results, they re-evaluated the diagnoses. The diagnostic performance of radiologists was analyzed before and after referring to the results of S-Detect.Results: The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of S-Detect were 77.0, 91.3, 65.2, 68.3 and 90.1%, respectively. In comparison with the less experienced radiologists (radiologist 1 and 2), S-Detect had a higher area under receiver operating characteristic curve (AUC), accuracy and specificity (p <0.05). In comparison with the most experienced radiologist, the diagnostic accuracy and AUC were lower (p<0.05). In the less experienced radiologists, the diagnostic accuracy, specificity and AUC were significantly improved when combined with S-Detect (p<0.05), but not for experienced radiologists (radiologist 3 and 4) (p>0.05).Conclusions: S-Detect may become an additional diagnostic method for the diagnosis of thyroid nodules and improve the diagnostic performance of less experienced radiologists. 

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