Antibiotic Prophylaxis for Surgical Site Infection in General Surgery: Oncological Treatments and HIPEC

The procedure of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a combined surgical and oncological treatment for peritoneal carcinomatosis of various origins. Antibiotic prophylaxis is usually center-related and should be discussed together with the infectious disease specialist, taking into account the advanced oncologic condition of the patient, the complexity of surgery—often requiring multiorgan resections—and the risk of post-HIPEC neutropenia. The incidence of surgical site infection (SSI) after CRS and HIPEC ranges between 11 and 46%. These patients are also at high risk of postoperative abdominal infections and septic complications, and a bacterial translocation during HIPEC has been hypothesized. Many authors have proposed aggressive screening protocols and a high intra and postoperative alert, in order to minimize and promptly identify all possible infectious complications following CRS and HIPEC.

SARS-CoV-2 Positivity in a Combat Sports Bubble

ObjectiveThe objective of this report is to describe a SARS-CoV-2 protocol and subsequent positivity rate for athletes and staff participating in combat sports events.BackgroundCombat sports are among the most challenging to protect against the transmission of communicable diseases. Sports neurologists are often called on to take a leadership role in the safe management of these events. Our team was asked to provide a plan for pre-fight SARS-CoV-2 testing during the recent pandemic. As a result, we were able to successfully host 28 major combat sports events at a single venue with minimal exposure for staff and participants.Design/MethodsAthletes and staff were tested for the SARS-CoV-2 virus with a PCR method. Samples were obtained via nasal swab upon arrival at the host hotel. All participants were then quarantined until the results were available. Those with negative tests were allowed to resume training in isolated pods. All participants were retested within 72 hours of the event. Those who were positive were quarantined off site for up to 2 weeks. Consultation was provided with an infectious disease specialist via telemedicine.ResultsA total of 8,135 tests were performed from July 1, 2020 until April 30, 2021 for the purpose of maintaining a safe venue. A total of 1,649 subjects were tested. There were 42 positive tests that resulted in an overall SARS-CoV-2 positivity rate of 0.516% for these events.ConclusionsOur sports neurology team was able to design and implement an effective plan to protect combat sports athletes and staff during the SARS-CoV-2 pandemic. This allowed the safe continuation of 28 events. This protocol design can be implemented when dealing with future outbreaks of communicable diseases.

Development, reliability and validity of infectious disease specialist Nurse’s Core competence scale

Aim This study aims to develop an instrument to measure infectious disease specialist nurses’ core competence and examining the scale’s validity and reliability. Background With the increase of infectious diseases, more and more attention has been paid to infectious disease nursing care. The core competence of the infectious disease specialist nurses is directly related to the quality of nursing work. In previous researches, infectious disease specialist nurses’ core competence was measured by the tools developed for general nurses instead of specialized tools, which made it difficult to clarify the core competence of nurses in infectious diseases department. Methods Preliminary items were developed through literature review, theoretical research, qualitative interview and Delphi method. The confirmed 47 items were applied in the two rounds of data collection. Evaluation data on 516 infectious disease specialist nurses’ core competence in the first round were utilized to preliminarily evaluate and explore the scale’s constrution, while evaluation data on 497 infectious disease specialist nurses’ core competence in the second round were utilized to do reliability analysis and validity analysis. In this study, factor analysis, Cronbach’s α, Pearson correlation coefficients were all adopted. Results The final scale is composed of 34 items and 5 factors, and adopted the 5-point scoring method. The factors are Professional Development Abilities, Infection Prevention and Control Abilities, Nursing Abilities for Infectious Diseases, Professionalism and Humanistic Accomplishment, and Responsiveness to Emergency Infectious Diseases. The explanatory variance of the five factors was 75.569%. The reliability and validity of the scale is well validated. The internal consistency, split-half reliability and test-retest reliability were 0.806, 0.966 and 0.831 respectively. The scale has good structural validity and content validity. The content validity was 0.869. Discrimination analysis showed that there were significant differences in the scores of core competence and its five dimensions among infectious disease specialist nurses of different ages, working years in infectious diseases, titles, educational background, marital status and wages (all P < 0.05). Conclusions The proposed scale takes on high reliability and validity, and is suitable for assessing the infectious disease specialist nurses’ core competence. Relevance to clinical practice This scale provides a reference for clinical assessment of infectious disease nursing.

A rare case as different cause of retropharyngeal and spinal epidural abscess: spondylodiscitis

Background Retropharyngeal abscess (RPA) is a life-threatening, dangerous condition and uncommon in adults. The coexistence of RPA, cervical spinal epidural abscess (CSEA), and spondylodiscitis is extremely rare. Case presentation We present a case with a retropharyngeal and epidural abscess caused by spondylodiscitis. A 61-year-old man was referred to our clinic with the complaints of sore throat, limitation in neck range of motion, numbness, and weakness in the left arm and the left ear for one month. The airway was not obstructed. Neurological deficits were detected in his left arm. Cervical computed tomography revealed a 50 × 30 × 15 mm retropharyngeal abscess. Cervical magnetic resonance imaging showed abscess, C5–6 spondylodiscitis and epidural abscess, and myelopathic signal changes in the C3–7 spinal cord. The abscess was drained, and C5–6 discectomy was performed. The patient was discharged with cervical collar and antibiotics. Conclusions Multidisciplinary approach that consists of otolaryngologist, neurosurgeon, and infectious disease specialist is needed to avoid complications and any delay.

Enterococcus faecalis bloodstream infection: does infectious disease specialist consultation make a difference?

Purpose To evaluate the relationship between mortality or relapse of bloodstream infection (BSI) due to Enterococcus faecalis and infectious diseases specialist consultation (IDC) and other factors potentially associated with outcomes. Methods In a tertiary-care center, consecutive adult patients with E. faecalis BSI between January 1, 2016 and January 31, 2019, were prospectively followed. The management of E. faecalis BSI was evaluated in terms of adherence to evidence-based quality-of-care indicators (QCIs). IDC and other factors potentially associated with 90-day-mortality or relapse of E. faecalis BSI were analyzed by multivariate logistic regression. Results A total of 151 patients with a median age of 68 years were studied. IDC was performed in 38% of patients with E. faecalis BSI. 30 cases of endocarditis (20%) were diagnosed. All-cause in-hospital mortality was 23%, 90-day mortality was 37%, and 90-day relapsing E. faecalis BSI was 8%. IDC was significantly associated with better adherence to 5 QCIs. Factors significantly associated with 90-day mortality or relapsing EfB in multivariate analysis were severe sepsis or septic shock at onset (HR 4.32, CI 2.36e7.88) and deep-seated focus of infection (superficial focus HR 0.33, CI 0.14e0.76). Conclusion Enterococcus faecalis bacteremia is associated with a high mortality. IDC contributed to improved diagnostic and therapeutic management.

Development, Reliability and Validity of Infectious Disease Specialist Nurse’s Core Competence Scale

Aim: This study aimsto develop an instrument to measure infectious disease specialist nurses’ core competence and examining the scale’s validity and reliability.Background: With the increase of infectious diseases, more and more attention has been paid to infectious disease nursing care. The core competence of the infectious disease specialist nurses is directly related to the quality of nursing work. In previous researches, infectious disease specialist nurses’ core competence was measured bythe tools developed for general nursesinstead of specialized tools, which made it difficult to clarify the core competence of nurses in infectious diseases department.Methods: Preliminary items were developed through literature review, theoretical research, qualitative interview and Delphi method. The confirmed 47 items were applied in the two rounds of data collection. Evaluation data on 516 infectious disease specialist nurses’ core competence in the first round were utilized to preliminarily evaluate and explore the scale’s constrution, whileevaluation data on 497 infectious disease specialist nurses’ core competence in the second round were utilized to doreliability analysis and validity analysis. In this study, factor analysis, Cronbach's a, Pearson correlation coefficients were all adopted.Results: The final scaleis composed of 34 items and 5 factors, and adoptedthe 5-point scoring method. The factors areProfessional Development Abilities, Infection Prevention and Control Abilities, Nursing Abilities for Infectious Diseases, Professionalism and Humanistic Accomplishment, and Responsiveness to Emergency Infectious Diseases.The explanatory variance of the five factors was 75.569%. The reliability and validity of the scale is well validated.The internal consistency, split-half reliability and test-retest reliability were 0.806, 0.966 and 0.831 respectively.The scale has good structural validity and content validity. The content validity was 0.869. Discrimination analysisshowed that there were significant differences in the scores of core competence and its five dimensions among infectious disease specialist nurses of different ages, working years in infectious diseases, titles, educational background, marital status and wages (all P< 0.05).Conclusions:The proposed scale takes on high reliability and validity,and is suitable for assessing the infectious disease specialist nurses’ core competence.Relevance to clinical practice: This scale provides a reference for clinical assessment of infectious disease nursing.

To the organization of measles stations

The purpose of our message is to fix the attention of a pediatrician and an infectious disease specialist on the need to organize measles stations. The functioning of the stations will not only ensure the preservation of the lives of children, the bottom and will give a certain economic effect it will not tear away the working mother from production; hence, it is clear that doctors need to widely familiarize the public with the purpose and task of measles stations.

Successful treatment with secnidazole for trichomoniasis in the setting of metronidazole hypersensitivity

Limited effective treatment options currently exist for trichomoniasis management among patients with metronidazole hypersensitivity. We report a patient with a documented history of metronidazole hypersensitivity who initially was treated with nitazoxanide but demonstrated clinical and microbiological failure. Secnidazole was subsequently used for treatment, which resulted in clinical and microbiological cure without observation of cross-reactivity. Secnidazole may represent a potential treatment option for trichomoniasis in patients with metronidazole hypersensitivity after consultation with an infectious disease specialist.