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Surgical Infections

Bhavani Manivannan, Deepak Gowda, Pradeep Bulagonda, Abhishek Rao, Sai Suguna Raman, Shanmuga Vadivoo Natarajan
BACKGROUND: We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. METHOD: A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded...
February 26, 2018: Surgical Infections
Thomas A Heafner, Clayton Lewis, Graham Baluh, Michael Clemens, Brandon Propper, Zachary M Arthurs
BACKGROUND: Despite improved peri-operative care, prosthetic graft infections continue to cause substantial morbidity and mortality. Contemporary graft infection models have tested a conduit's infectability using varying concentrations without standardization. Using a static assay in vitro model, we sought to evaluate the impact of inoculation concentration on vascular conduit attachment. METHODS: The 2-hour and 24-hour attachment of Staphylococcus aureus TCH1516 and Pseudomonas aeruginosa PA01-UW were determined on polytetrafluoroethylene (PTFE), Dacron® , nitinol, cobalt chromium, and Viabahn® (W...
February 21, 2018: Surgical Infections
Juyuan Liu, Na Li, Jinjuan Hao, Yanming Li, Anlei Liu, Yinghong Wu, Meng Cai
BACKGROUND: Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial healthcare costs, with increased morbidity and mortality. To investigate the effects of the antibiotic stewardship program on prevention and control of SSI during clean surgery, we investigated this situation in our institution. PATIENTS AND METHODS: We performed a quasi-experimental study to compare the effect before and after the antibiotic stewardship program intervention...
February 20, 2018: Surgical Infections
Locke Uppendahl, Caitlin Chiles, Stephanie Shields, Fanglong Dong, Elizabeth Kraft, Jennifer Duong, James Delmore
BACKGROUND: The purpose of this study was to establish compliance with guidelines published by the American College of Obstetricians and Gynecologists (ACOG) regarding prophylactic antibiotic use in gynecologic surgery at our institution, and define areas of improvement to promote antibiotic stewardship. PATIENTS AND METHODS: This was a retrospective cohort study at a single, large tertiary care and teaching hospital in Kansas. Patients who underwent inpatient or outpatient gynecologic surgery during 2013 were included...
February 16, 2018: Surgical Infections
Keisuke Nakase, Hanae Fukushima, Tomoko Yukawa, Hidemasa Nakaminami, Takeshi Fujii, Norihisa Noguchi
BACKGROUND: The skin bacterium Propionibacterium acnes has been reported to be responsible for surgical site infections (SSIs). Skin disinfection before surgery therefore is of the utmost importance in the prevention of SSIs caused by skin bacteria. METHODS: We assessed the susceptibility of clinical isolates of two skin bacteria, P. acnes and Staphylococcus epidermidis, to disinfectants. RESULTS: The range of chlorhexidine digluconate (CHG) minimum inhibitory concentrations (MICs) for P...
February 15, 2018: Surgical Infections
Montserrat Juvany, Carlos Hoyuela, Miguel Trias, Fernando Carvajal, Jordi Ardid, Antoni Martrat
BACKGROUND: Although incisional hernia repair is classified as a clean surgery, it still has a high incidence of surgical site infection (SSI) (0.7%-26.6%). The presence of an SSI could increase early recurrence rates after incisional hernia repair. PATIENTS AND METHODS: Patients undergoing elective incisional hernia repair with no bowel contamination between January and December 2015 were assessed prospectively. Demographic and surgical data, local post-operative complications, and one-year recurrence rates in patients with and without SSI were compared...
February 13, 2018: Surgical Infections
Christopher B Horn, Adrian A Coleoglou Centeno, Jarot J Guerra, John E Mazuski, Grant V Bochicchio, Isaiah R Turnbull
BACKGROUND: Previous studies have suggested that percutaneous drainage and interval appendectomy is an effective treatment for appendicitis with associated abscess. Few studies to date have analyzed risk factors for failed drain management. We hypothesized that older patients with more co-morbidities would be at higher risk for failing conservative treatment. METHODS: The 2010-2014 editions of the National Inpatient Sample (NIS) were queried for patients with diagnoses of peri-appendiceal abscesses...
February 12, 2018: Surgical Infections
Erasmo Spaziani, Annalisa Di Filippo, Simone Orelli, Flavia Fiorini, Martina Spaziani, Orlando Tintisona, Angelo Torcasio, Alessandro De Cesare, Marcello Picchio
BACKGROUND: Skin preparation with antiseptic agents is commonly recommended for incisional site cleansing before surgery. We present the result of a prospective case series submitted to a scheduled pre-operative antiseptic procedure combining chlorhexidine gluconate and povidone-iodine before elective laparoscopic cholecystectomy. PATIENTS AND METHODS: Consecutive patients underwent pre-operative standardized cleansing of the operation site combining chlorhexidine gluconate and povidone-iodine...
February 9, 2018: Surgical Infections
Stephanie N Pilieci, Saad Y Salim, Daithi S Heffernan, Kamal M F Itani, Rachel G Khadaroo
BACKGROUND: Video education has many advantages over traditional education including efficiency, convenience, and individualized learning. Learning sterile surgical technique (SST) is imperative for medical students, because proper technique helps prevent surgical site infections (SSIs). We hypothesize that video education is at least as effective as traditional skill demonstration in teaching first-year medical students SST. METHODS: A video series was created to demonstrate SST ( https://www...
February 6, 2018: Surgical Infections
Anthony J Lewis, Matthew R Rosengart
BACKGROUND: Considerable research effort has focused on the development of novel therapies for the treatment of sepsis, yet after decades of clinical trials, few significant advances have been achieved. This limitation persists despite a wealth of data yielded by basic science that has expanded our knowledge of the biology of this disease exponentially. METHOD: Review of the English-language literature. RESULTS: Translational researchers may address the resultant gap between the basic science laboratory and clinical research worlds...
February 2, 2018: Surgical Infections
Bryanna M Emr, Alicia M Alcamo, Joseph A Carcillo, Rajesh K Aneja, Kevin P Mollen
BACKGROUND: Although there are some commonalities between pediatric and adult sepsis, there are important differences in pathophysiology, clinical presentation, and therapeutic approaches. The recognition and diagnosis of sepsis is a significant challenge in pediatric patients as vital sign aberrations and examination findings are often subtle as compared to those observed in adults. Gaps in knowledge that have been studied in depth in adult sepsis are still being investigated in pediatric patients such as best practices in ventilation, invasive monitoring, and resuscitation...
February 2, 2018: Surgical Infections
Philip S Barie
BACKGROUND: Discussion of outcomes of surgical sepsis is no longer straightforward. Definitions of sepsis have changed recently and updated data are scant. Surgical patient populations are often heterogeneous; the patient population being considered must be described with precision. Traditional 30-d operative mortality may not be the most relevant outcome to consider. What should change or be the emphasis going forward? METHODS: Review and synthesis of pertinent English-language literature...
February 2, 2018: Surgical Infections
John C Alverdy
BACKGROUND: Surgical metabolism has been a founding field of investigation in surgery without which the boundaries of critical care, trauma, and surgical oncology could not have advanced. Traditionally, understanding the shifts in electrolytes, carbohydrates, fats, and amino acids that could explain the rapidly evolving proteolysis after catabolic stress and tumor growth has been a major focus of research that led to our current approach to maintaining homeostasis over the course of major surgical intervention and injury...
February 2, 2018: Surgical Infections
Xinli Li, William Nylander, Tracy Smith, Soonhee Han, William Gunnar
BACKGROUND: Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population...
February 1, 2018: Surgical Infections
Arezoo Rajaee, Rebecca Barnett, William G Cheadle
The sepsis syndrome is a systemic host inflammatory response accompanied by organ dysfunction in response to invading microbial pathogens. The host recognizes both danger and pathogens through its pattern recognition receptors on immune cells. These receptors bind to pathogen- (PAMP) and danger- (DAMP) associated molecular patterns derived from microbes and host tissues, respectively. These processes set in motion a cascade of events in host cells and tissue, which activate multiple cytokines that serve as activators of the host inflammatory response as well as eventually lead to resolution of the response if the host recovers...
January 24, 2018: Surgical Infections
Sarah Moore, Brian Weiss, Jose L Pascual, Lewis J Kaplan
Sepsis and septic shock are each commonly accompanied by acute respiratory failure and the need for invasive as well as non-invasive ventilation throughout a patient's intensive care unit course. We explore the underpinnings of acute respiratory failure of pulmonary as well as non-pulmonary origin in the context of invasive and non-invasive management approaches. Both pharmacologic and non-pharmacologic adjuncts to ventilatory and oxygenation support are highlighted as well. Finally, rescue modalities are positioned within the intensivist's armamentarium for global care of support of the critically ill or injured patient with sepsis or septic shock...
January 23, 2018: Surgical Infections
Markus T Ziesmann, John C Marshall
BACKGROUND: Sepsis as a process has been recognized since the time of the Ancient Greeks. The concept has evolved recently to reflect a disease process of a severe, systemic response to infection. Acute, life-threatening but potentially reversible organ dysfunction is its hallmark, and unresolving organ dysfunction is the dominant cause of death in critical illness. Its evolution, persistence, and resolution reflect a complex interplay of factors originating in the initial inciting insult, the innate immune and metabolic response of the host, and the beneficial and harmful consequences of intensive care unit (ICU) supportive care...
January 23, 2018: Surgical Infections
Sara E Parli, Grishma Trivedi, Alison Woodworth, Phillip K Chang
BACKGROUND: Procalcitonin (PCT) is a serum biomarker currently suggested by the Surviving Sepsis Campaign to aid in determination of the appropriate duration of therapy in sepsis patients. We review the use of procalcitonin in patients after trauma or acute care surgery. METHOD: A MEDLINE search via PubMed was performed using the combination of "procalcitonin" and "humans" and "injuries, trauma," "wounds and injuries," or "wounds." Studies of burn patients, children, other biomarkers, and non-acute care surgery were excluded...
January 22, 2018: Surgical Infections
Asher Weisberg, Pauline Park, Jill R Cherry-Bukowiec
The use of early goal-directed therapy (EGDT) for the management of severe sepsis and septic shock, a practice put forth by Dr. Rivers et al. in 2001, ushered in a new era of targeted sepsis therapy. After its publication, several further studies helped validate the protocolized approach to sepsis management, ultimately leading to its incorporation into the Surviving Sepsis Campaign guidelines. Since that time, however, a trio of large multi-center randomized controlled trials have taken place to evaluate the efficacy of EGDT when compared with usual care and have demonstrated that strict adherence to the entirety of the original EGDT protocol is unnecessary for improved outcomes...
January 22, 2018: Surgical Infections
Jason M Samuels, Hunter B Moore, Ernest E Moore
BACKGROUND: Disseminated intravascular coagulation (DIC) remains a challenging complication of infection with inadequate treatment and significant morbidity and mortality rates. METHODS: Review of the English-language literature. RESULTS: Disseminated intravascular coagulation arises from the immune system's response to microbial invasion, as well as the byproducts of cell death that result from severe sepsis. This response triggers the coagulation system through an interconnected network of cellular and molecular signals, which developed originally as an evolutionary mechanism intended to isolate micro-organisms via fibrin mesh formation...
January 18, 2018: Surgical Infections
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