Prevention of Postoperative Infection

DeckerMed Surgery ◽

10.2310/surg.2016 ◽

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

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Prevention of Postoperative Infection

10.2310/vasc.2016 ◽

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

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

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01713-6 ◽

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.

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Probiotics Used for Postoperative Infections in Patients Undergoing Colorectal Cancer Surgery

BioMed Research International ◽

10.1155/2020/5734718 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

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.

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Allograft versus autograft in cervical and lumbar spinal fusions: an examination of operative time, length of stay, surgical site infection, and blood transfusions

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.16.03847-9 ◽

2018 ◽

Vol 63 (1) ◽

Author(s):

Meghan E. Murphy ◽

Brandon A. Mccutcheon ◽

Jennifer Grauberger ◽

Daniel Shepherd ◽

Patrick R. Maloney ◽

...

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Operative Time ◽

Blood Transfusions ◽

Site Infection ◽

Time Length ◽

Spinal Fusions ◽

Lumbar Spinal

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Patients with Risk Factors for Complications Do Not Require Longer Antimicrobial Therapy for Complicated Intra-Abdominal Infection

The American Surgeon ◽

10.1177/000313481608200951 ◽

2016 ◽

Vol 82 (9) ◽

pp. 860-866 ◽

Cited By ~ 6

Author(s):

Rishi Rattan ◽

Casey J. Allen ◽

Robert G. Sawyer ◽

John Mazuski ◽

Therese M. Duane ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Surgical Site Infection ◽

Chronic Health Evaluation ◽

Health Evaluation ◽

Site Infection ◽

Chronic Health ◽

Abdominal Infection ◽

Short Course ◽

Intra Abdominal Infection

A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site infection, recurrent intra-abdominal infection, extra-abdominal infection, and Clostridium difficile infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-abdominal infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intraabdominal infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.

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

Trials ◽

10.1186/s13063-020-04894-y ◽

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

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The association between preoperative length of stay and surgical site infection after lower extremity bypass for chronic limb-threatening ischemia

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.08.037 ◽

2020 ◽

Cited By ~ 1

Author(s):

Luke M. Stewart ◽

Emily L. Spangler ◽

Danielle C. Sutzko ◽

Benjamin J. Pearce ◽

Graeme E. McFarland ◽

...

Keyword(s):

Length Of Stay ◽

Lower Extremity ◽

Surgical Site Infection ◽

Site Infection

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1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1110 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S449-S449

Author(s):

Túlio Alves Jeangregório Rodrigues ◽

Guilherme Fernandes de Oliveira ◽

Júlia G C Dias ◽

Laís Souza Campos ◽

Letícia Rodrigues ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Exploratory Laparotomy ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Hospital Death ◽

Site Infection ◽

The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

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Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.11.peds16455 ◽

2017 ◽

Vol 19 (4) ◽

pp. 421-427 ◽

Cited By ~ 5

Author(s):

Brandon A. Sherrod ◽

Brandon G. Rocque

Keyword(s):

Length Of Stay ◽

Surgical Site Infection ◽

Pediatric Patients ◽

Pediatric Neurosurgery ◽

Neurosurgical Procedures ◽

Site Infection ◽

Improvement Program ◽

Superficial Infection ◽

Index Procedure ◽

Postoperative Length

OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program–Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within 30 days after surgery. CONCLUSIONS Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure.

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