Surgical infections最新文献

Background: Staphylococcus epidermidis, a commensal skin pathogen, is a key pathogen in surgical site infections (SSIs). This study characterized clinical isolates obtained from an abdominal operation to guide decolonization therapy.

Methods: In total, 146 S. epidermidis isolates obtained from pre-operative skin swabs of patients undergoing gynecological procedures were analyzed. PCR was performed to detect mecA, efflux pump genes (qacA/B, smr, etc.), and biofilm-associated genes (icaA-D, aap). Methicillin-resistant S. epidermidis (MRSE) isolates were typed by multi-locus sequence typing. Broth microdilution was used to assess susceptibility to benzalkonium chloride (BAC) and chlorhexidine digluconate (CHG). Biofilm formation was measured in the presence or absence of sub-inhibitory antiseptic exposure.

Results: Of the isolates, 49.3% were MRSE, and 63.0% and 29.5% carried qacA/B and smr, respectively. MRSE showed higher minimum inhibitory concentration (MIC₅₀) values for both antiseptics. qac-positive strains exhibited significantly increased BAC MIC₅₀ (1 vs. 0.25 µg/mL; p < 0.001). Biofilm-forming isolates (16.4%) had three-fold higher BAC MIC₅₀ (p < 0.01). Sub-MIC exposure to BAC/CHG induced biofilm formation in prior non-producers (p < 0.05); among these, 81.3% were qac-positive, and 62.5% were MRSE.

Conclusions: The high prevalence of MRSE and efflux genes contributed to antiseptic tolerance. Sub-inhibitory antiseptic concentrations may enhance biofilm formation in resistant strains, underscoring the need for optimized decolonization tactics to prevent SSI.

Introduction: Facial fractures account for over 400,000 emergency department visits annually in the United States. They are managed operatively, non-operatively, or via observation with diet and activity modification. Regardless of management, antibiotic agents are commonly prescribed. The Surgical Infection Society (SIS) published the 2020 guidelines limiting antibiotic agent use to the peri-operative period.

Methodology: We performed a retrospective chart review to evaluate antibiotic agent prescribing practices for patients with isolated facial fractures at an academic level-one trauma center. We assessed potential antibiotic agent days saved by adhering to SIS guidelines. Patients 18 and older presenting to the trauma service with a facial fracture from January 2019 to August 2024 were identified from the trauma registry. Patients with clear antibiotic agent indications (e.g., open fractures) were excluded. Descriptive and chi-square analyses were used.

Results: The number of potentially saved antibiotic agent days was 495. Of 119 patients, 89.1% received antibiotic agents, 57.6% at least twice. A total of 80.2% of antibiotic agents given were against SIS recommendations. The antibiotic agent administration rate for mandibular fractures was 97%. Operative management accounted for 93.2% of cases. Antibiotic agent use did not significantly differ between operative and non-operative management (p = 0.18) or between open and closed operative cases (p = 0.99). In operative cases, appropriate peri-operative antibiotic agents were used 89.9% of the time, with 47.5% pre-operative and 63.6% post-operative non-guideline use. Segmented logistic regression showed no statistically significant reduction in non-guideline antibiotic agent use after the guidelines were published. The 30-day post-operative surgical site infection rate was 3.4%, with no significant difference between guideline and non-guideline use.

Conclusion: There is substantial discordance between real-world antibiotic agent prescribing practices and SIS guideline recommendations for facial fractures. Quantifying excess non-guideline antibiotic agent use highlights an important opportunity for antimicrobial agent stewardship and provides a foundation for future quality improvement initiatives.

Purpose: Breast operations have a surgical site infection rate of <1.5%, a figure that increases to 3% after implant-based reconstructions. We aimed to assess whether contamination occurred before implant insertion and could be related to post-operative infections.

Patients and methods: The reconstruction team prepared the surgical field using a betadine solution and standard draping. After the surgical procedures, the antiseptic was re-applied around the incision, the surgical field re-draped, and the gloves changed before implant insertion. Immediately before the betadine application and re-draping, swab cultures were collected from the peri-areolar regions and margins of the exposed field. Any signs of infection were checked during the 2-year follow-up.

Results: A total of 164 cases were included; of these 13 showed positive swab cultures (12 of Staphylococcus epidermidis, and one of Bacillus species). Among them, only one patient developed a post-operative infection necessitating the insertion of a Hemovac drain at 42 days after a surgical procedure. Among the 151 patients with negative swab culture results, 10 patients received a diagnosis of post-operative infections; follow-up cultures primarily identified S. aureus (three methicillin-sensitive cases, four methicillin-resistant cases), whereas two were culture-negative.

Conclusion: Residual contamination may persist despite the initial surgical site sterilization. The re-application of antiseptics and re-draping immediately before implant insertion may help reduce post-operative infections and should be considered an adjunct to comprehensive peri-operative protocols. Some infections may be more closely related to post-operative management than pre-implant field contamination, underscoring the need for meticulous post-operative care. Definitive causal relationships should be tested using rigorously designed and adequately powered studies.

Background: Necrotizing soft tissue infections (NSTIs) are life-threatening surgical emergencies characterized by rapid tissue destruction, systemic toxicity, and high mortality. Early recognition and aggressive treatment are critical.

Case presentation: A previously healthy 28-year-old male presented with one week of right shoulder and chest wall pain. Initially diagnosed with muscle strains via MRI, he re-presented to the emergency department five days later with hypotension. Blood cultures grew Streptococcus pyogenes, and imaging revealed extensive soft tissue involvement. Emergent fasciotomy and serial debridement revealed NSTI extending from the right shoulder to the scrotum and contralateral shoulder. Despite broad-spectrum antibiotics, debridements, continuous renal replacement therapy, and vasopressors, the patient developed multi-organ failure and died within 24 h of ICU admission.

Conclusion: This case highlights the aggressive nature of NSTIs, the importance of early diagnosis, a non-classical presentation, and the potential for rapid progression to multi-organ failure and death even in young, previously healthy individuals.

Aims: This study aims to identify epidemiological, microbiological, and laboratory characteristics of cerebrospinal fluid (CSF) shunt infections in children and evaluate associated risk factors.

Patients and methods: Patients aged 0-18 years who underwent ventricular shunt placement at Gazi University Faculty of Medicine Hospital between January 1, 2010, and December 31, 2022, were retrospectively reviewed.

Results: A total of 201 shunt procedures performed in 176 patients were analyzed, with infection occurring in 32 cases (15.9%). Infection rates were higher in subgaleal shunts (60%) than ventriculoperitoneal shunts (15.2%) (p = 0.018). Shunt infections developed in 31.7% of procedures involving at least one risk factor, compared with 5.7% of procedures without identified risk factors (p < 0.001). Preterm infants (<37 wks) had a higher infection rate (49%) than those born ≥37 weeks (14.5%) (p < 0.001). Gram-positive microorganisms accounted for 56.3% of infections, most commonly Staphylococcus sp., whereas Pseudomonas aeruginosa and Klebsiella species were the most frequent gram-negative pathogens (each 12.5%). Patients with gram-negative meningitis had a significantly higher intensive care unit admission rate than those with gram-positive meningitis (p = 0.021). In multivariate analysis, subgaleal shunt placement was associated with increased odds of shunt infection (OR: 12.13; CI: 1.36-107.69) (p = 0.025). In regression analysis, preterm birth was independently associated with an increased risk of shunt infection (OR: 6.12; CI: 2.02-18.56).

Conclusions: Shunt infection rates and microbial patterns align with existing literature. Preterm birth emerged as a major risk factor for shunt infection, whereas subgaleal shunt placement appeared to be a potential risk factor that warrants cautious interpretation and further validation. The increased severity of gram-negative infections underscores the need for stringent monitoring and preventive strategies in high-risk populations.

Background: Emergency surgery (ES) is associated with a significantly higher risk of perioperative complications, including infectious, compared with elective surgery. This study aimed to identify the impact of time to surgical procedure and operative duration on infectious complications after ES.

Patients and methods: The 2013-2017 American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify all ES patients ≥18 years using the variable "Emergency." Delayed surgical procedure was defined as >12 h and prolonged surgical procedure as >2 h. Multivariable logistic regression adjusting for age, comorbidities, and surgical approach was used to investigate the impact of delayed and prolonged surgical procedure on postoperative infection, defined as the presence of sepsis, septic shock, surgical site infection (i.e., superficial, deep incisional, and organ space), pneumonia, and urinary tract infection. Sensitivity analyses were performed to examine the same relationship in emergency general surgery (EGS), identified with Current Procedural Terminology codes, and three subsets of EGS patients: exploratory laparotomy, cholecystectomy, and appendectomy.

Results: Out of 4,299,148 patients, 264,213 were included, of which 24,921 (9.4%) had postoperative infections. Patients with infectious complications were more likely to have comorbidities (e.g., obesity, diabetes), an open surgical approach, delayed surgical procedure (50.4% vs. 39.4%, p < 0.001), and prolonged surgical procedure (31.6% vs. 14.3%, p < 0.001). On multivariable analyses, delayed surgical procedure was significantly associated with a 14% higher risk of postoperative infection (adjusted odds ratios [aOR] 1.14; 95% confidence interval [CI] 1.1-1.18), and prolonged surgical procedure was significantly associated with twice the risk (aOR: 1.99; CI: 1.91-2.08). Similarly, delayed and prolonged surgical procedure were significantly associated with infectious complications in the subset of EGS patients (aOR: 1.16; CI: 1.11-1.22, aOR: 1.91; CI: 1.82-2.02, respectively). When examining the 3 sensitivity subsets of patients, prolonged surgical procedure was significantly associated with infectious complications in all cohorts (aOR: 1.45; CI: 1.28-1.64 in exploratory laparotomy, aOR: 1.93; CI: 1.52-2.46 in cholecystectomy, aOR: 2.06; CI: 1.69-2.53 in appendectomy), whereas delayed surgical procedure was significantly associated with infectious complications only in exploratory laparotomy (aOR: 1.23; CI: 1.13-1.33).

Conclusions: Delayed and prolonged surgical procedure are independently associated with increased risk of infectious complications in ES patients, including those undergoing EGS procedures. These findings highlight the importance of early and efficient surgical interventions in ES.

Surgical site infections (SSIs) and other infectious complications remain a major cause of preventable morbidity across Latin America. SSI prevalence in elective clean and clean-contaminated procedures in Latin America is substantial, and rates may increase further when post-discharge surveillance is incorporated. The XXXVII Panamerican Congress of Trauma, Critical Care, and Emergency Surgery, held in Cuenca, Ecuador, convened over 800 clinicians and researchers and featured a dedicated session focused on infectious complications in trauma and burn care. We present a focused narrative synthesis of five highlighted studies addressing infection prevention, diagnosis, and management in burn care, trauma, and emergency general surgery across the Americas. Collectively, these studies reflect the continental efforts to advance surgical infection science in the Americas and reinforce priorities for standardized SSI and intra-abdominal infection surveillance, including post-discharge follow-up, consistent reporting, and multi-center collaboration to accelerate translation of evidence into practice.

Background: Ventricular reservoir infections and cerebrospinal fluid (CSF) shunt infections are diagnosed when bacteria are recovered from microbiological cultures of CSF samples from these devices. We applied high throughput sequencing (HTS) to understand the course of changes in ventricular reservoir and shunt infection microbiota.

Objectives: Evaluate the utility of monitoring microbiota in CSF (1) from ventricular reservoirs to detect development of an infection and (2) during treatment of CSF shunt infections to assess treatment response.

Methods: Study populations included (1) neonates with temporizing ventricular reservoirs who developed reservoir infection and (2) children undergoing treatment for conventional culture-confirmed CSF shunt infection. The V4 region of the 16S ribosomal RNA gene was amplified and sequenced. Comparison of taxonomic results of HTS with standard microbiological culture results (when available) was described for each CSF sample. A robust HTS signal was defined by a microbial load of ≥1e5 microbial genome equivalents/mL.

Results: In none of the five ventricular reservoir infection cases was there a robust HTS signal for the responsible bacteria immediately prior to infection. In six of the seven CSF shunt infection cases, there was a robust HTS signal for the genus of the responsible bacteria in the sample at the time of positive CSF culture. The proportion of sequences from the genus associated with the responsible bacteria decreased during infection treatment.

Conclusions: These pilot data suggest limited utility in using HTS for surveillance for ventricular reservoir infections, as they emerge abruptly. In CSF shunt infection, HTS demonstrates a return to heterogeneous microbiota when bacterial cultures become negative.

Background: Endovascular graft infections can be devastating, with endovascular aortic aneurysm repair graft infections being the most reported. However, peripheral endovascular grafts are placed more frequently with fewer reports of infection.

Case presentation: We review an infected left superficial femoral artery (SFA) endovascular graft leading to degradation of the vessel. A 69-year-old patient with bilateral chronic limb ischemia underwent staged bilateral endovascular intervention. He presented one year later with an expanding left groin hematoma. Exploration revealed degradation of the left SFA. He underwent graft excision and bypass reconstruction.

Conclusions: Infections of peripheral stent grafts are likely underreported and should be considered when treating peripheral endovascular-related complications.