Surgical infections最新文献

{"title":"Fever in the Trauma Bay: A Marker for Greater Risk of Adverse Outcomes.","authors":"Samir M Fakhry, Yan Shen, Gina M Berg, James R Dunne, Parker Hu, Darrell L Hunt, Mark G McKenney, Nicholas W Sheets, R Joseph Sliter, Matthew M Carrick, Jeneva M Garland, Alessandro Orlando","doi":"10.1089/sur.2024.184","DOIUrl":"https://doi.org/10.1089/sur.2024.184","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Previous work identified a sub-group of trauma patients at risk for bacteremia who presented with signs of infection, including fever. A majority were older adult falls who had early onset bacteremia. <b><i>Hypothesis:</i></b> Fever in the trauma bay is associated with a greater risk of adverse outcomes and identifies patients who might benefit from early initiation of interventions for sepsis. <b><i>Methods:</i></b> Trauma patients ≥18 years, drawn from a system-wide electronic medical record (EMR) (2017-2020), were included. Fever+ patients (temperature >38°C) were compared with Fever- patients (36°C-38°C). Multi-variable logistic regressions assessed the association of fever status with outcomes. The interaction between fever, age, and outcomes was assessed. <b><i>Results:</i></b> A total of 140,647 patients were included from 89 centers. Eight hundred ninety (0.6%) were Fever+ and had worse unadjusted outcomes. After adjustment, Fever+ patients had significantly greater mortality (adjusted odds ratios [aOR], 95% confidence interval: 1.05 [1.04-1.07]), intensive care unit use (1.08 [1.04-1.11]), and ventilator use (1.11 [1.09-1.13]). Fever+ status was associated with a significantly larger aOR of severe sepsis in older versus younger patients (≥65 y: 1.12 [1.11-1.13]; <65 y: 1.04 [1.03-1.05]). Fever+ status was also associated with a significantly larger aOR of bacteremia in older versus younger patients (≥65 y: 1.09 [1.08-1.10]; <65 y: 1.04 [1.03-1.05]). <b><i>Implications:</i></b> Although uncommon, fever at presentation is an ominous sign for trauma patients and portends significantly greater risks for bacteremia, sepsis, and mortality. These risks increase with age. These findings suggest older adults who present with fever warrant early aggressive intervention and may sustain injury as a consequence of debility from systemic infection.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Finegoldia magna:</i> An Infrequent Guest in Orthopedic Infections.","authors":"Santiago Gabardo, Cristina Ortega-Portas, Jaime Esteban, Antonio Blanco-García, Álvaro Auñón","doi":"10.1089/sur.2024.134","DOIUrl":"https://doi.org/10.1089/sur.2024.134","url":null,"abstract":"<p><p><b><i>Background:</i></b> <i>Finegoldia magna</i> is a species of anaerobic gram-positive coccus considered part of human microbiota. It has been described as a cause of skin and soft tissue infections, but it is not a common cause of operation-related infections. <b><i>Objectives:</i></b> Describe the characteristics, treatment, and results of musculoskeletal infection by <i>F. magna</i> treated in our center. <b><i>Methods:</i></b> We performed a descriptive, retrospective observational study. Clinical records of all musculoskeletal surgical infections treated in our department between 2012 and 2022 were reviewed. We selected the patients with a positive culture for <i>F. magna</i>. Risk factors for infection, patient's medical records, previous operation performed, time from surgical procedure to infection, susceptibility tests, antibiotic and surgical treatment for the infection, and recovery rate were registered for the analysis. <b><i>Results:</i></b> Twenty patients have positive cultures for <i>F. magna</i>, representing 15.5% of the anaerobic infections. Eleven of them were arthroplasties, three fracture synthesis, two foot operations, two spinal operations, and two soft tissue operations. All patients underwent operation and antibiotic treatment. The most commonly used antibiotic scheme was amoxicillin followed by amoxicillin-rifampicin. Eighty percent of the patients achieved a complete clinical recovery with a mean of 2.1 surgical procedures. Patients with polymicrobial infections required twice the number of operations (p = 0.047) and exhibited a failure rate of 36% compared with 0% for monomicrobial cases (p = 0.043). <b><i>Conclusions:</i></b> Orthopedic infections caused by <i>F. magna</i> are infrequent, but they usually have good outcomes. Polymicrobial infection with <i>F. magna</i> exhibits poorer clinical results and requires a greater number of operations compared with monomicrobial ones.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ascending-to-Descending Aortic Bypass of a Thoracic Stent Graft Infection with a Rare Pathogen.","authors":"Tsung-Han Cheng, Yu-Ting Cheng, Sung-Yu Chu, Chih-Chun Lee, Shao-Wei Chen","doi":"10.1089/sur.2024.227","DOIUrl":"https://doi.org/10.1089/sur.2024.227","url":null,"abstract":"<p><p><b><i>Background:</i></b> Stent graft infection (SGI) caused by <i>Burkholderia cepacia</i> complex is rare. The usage of ascending-to-descending aortic bypass (ADAB) in such situations has not yet been fully discussed. <b><i>Methods:</i></b> Case report and literature review. <b><i>Results:</i></b> We describe a case of SGI caused by <i>B. cepacia</i> complex after multiple surgical interventions because of an injury from a fall. The successful management encompassed thoracic endovascular aortic repair, antibiotic agents, device removal, and ADAB. <b><i>Conclusion:</i></b> Our report highlights the ADAB technique in addressing the progression of infection after multiple minimally invasive thoracic procedures for emergent thoracic trauma. The ADAB technique could be considered a viable option in certain clinical scenarios in SGI.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Letter to the Editor:</i> Hydatid Cyst of the Liver Mimicking Cutaneous Abscess in a 5-Year-Old Child.","authors":"Mohamed Zouari, Manel Belhajmansour, Emna Krichen, Asma Issaoui, Najoua Ben Kraiem, Mahdi Ben Dhaou, Riadh Mhiri","doi":"10.1089/sur.2024.293","DOIUrl":"https://doi.org/10.1089/sur.2024.293","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Cause of Chest Wall Abscess: <i>Salmonella</i> Enterica Infection Based on Metagenomics Next-Generation Sequencing Diagnosis.","authors":"Yueying Zeng, Xue You, Chunfang You","doi":"10.1089/sur.2024.316","DOIUrl":"https://doi.org/10.1089/sur.2024.316","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2023 Semmelweis Lecture: Sepsis Is a Myth.","authors":"Robert G Sawyer","doi":"10.1089/sur.2023.380","DOIUrl":"https://doi.org/10.1089/sur.2023.380","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"U-Type-Shaped Curves Across Economics, Biology, and Infection.","authors":"John C Alverdy","doi":"10.1089/sur.2024.211","DOIUrl":"https://doi.org/10.1089/sur.2024.211","url":null,"abstract":"<p><p>Major threats to the economic future of several nations include climate change, infectious pandemics, and drug-resistant bacteria. The rise and fall of each of these behaviors seems to conform to a U-shaped or inverted U-shaped curve. In academic medicine, stakeholders in the field (infection control personnel, epidemiologists, and vaccinologists) will argue that infectious outbreaks can be prevented by surveillance programs and the development of new drugs (antibiotics, vaccines, etc.). The promise of vaccines, antibiotics, genetic manipulations, air filtration, agriculture control measures, etc., is that with next-generation technology, effective countermeasures can be rapidly deployed to combat any emerging threat to our ecosystem and hence our economy. In this piece, we advance the idea that Laffer curves and their U-type-shaped ancestors share interconnectedness across multiple domains of science including biology, economics, infectious disease, and ecology. U-type-shaped curves and their sibling, the inverted U-curve, conform to the general principle of hormesis, a biphasic response where there is a measured benefit at lower exposures to a phenomenon yet harm when exposure is excessive (i.e., low-dose stimulation and high-dose inhibition).</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stop-It Randomized Clinical Trial (RCT) for Intra-Abdominal Infection (IAI) Revisited: Multivariate Analyses To Identify Treatment Effects 4 Days Antibiotic Agents Versus Resolution Signs/Symptoms + 2 Days and Drivers of Outcomes.","authors":"Nicholas P Zanghi, Nicole Stouffer, Gus J Slotman","doi":"10.1089/sur.2024.277","DOIUrl":"https://doi.org/10.1089/sur.2024.277","url":null,"abstract":"<p><p><b><i>Background</i></b>: The STOP-IT randomized clinical trial (RCT) pioneered limiting antibiotic agents in intra-abdominal infection (IAI) with adequate surgical source control, but NIH funding ended before an adequate power sample size was enrolled to determine equivalence between STOP-IT study regimens: four days of antibiotic agents (4-days) after source control versus antibiotic agents until resolution of signs and symptoms of IAI plus two days (standard of care [SOC]). The objective of this investigation was to identify possible significant treatment effects 4-days versus SOC, and independent variables defining and predicting outcomes. <b><i>Methods</i></b>: De-identified data from 518 STOP-IT subjects were analyzed retrospectively in two groups: 4-days (n = 258) and SOC (n = 260), and separately as one group (n = 518). Statistics: multivariate regression analysis, chi-squared, and simple Cohen kappa coefficient. <b><i>Results</i></b>: No pre-randomization variable predicted protocol FAILURE (surgical site infection, recurrent IAI, or death at 30 d) in 4-day subjects. APACHE II predicted SOC FAILURE, but no cut point determined treatment effect (AUC = 0.608). Both observations implied that FAILURE may not reflect patient outcomes. Additionally, Cohen kappa for FAILURE and hospitalization at 7, 14, and 21 days was weak (0.1154, 0.2084, and 0.1969, respectively) with high numbers of discordant values. Pre-randomization variables associated with hospitalization/discharge at days 7, 14, and 21: extra-abdominal infection 1 (p < 0.0001), APACHE II score (p < 0.0001), age (p = 0.006), and WBC maximum (p < 0.05). However, all of these pre-randomization variables did not predict FAILURE, except APACHE II. <b><i>Conclusions</i></b>: Poor Cohen kappa coefficients indicate STOP-IT FAILURE agreed only weakly with hospital/discharge at 7, 14, or 21 days, and is not a valid reliable endpoint in IAI or for determining success or failure of any treatment. Pre-randomization extra-abdominal infection, APACHE II score, age, and WBC maximum strongly predicted hospitalization, but only APACHE II predicted failure. The study should use the appropriate sample size calculation when doing an equivalence on the basis of the Two One-Sided Test design. RCTs in IAI need prospectively validated clinically reliable endpoints that align with known patient outcomes that determine success.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Aerosol Inhalation of Colistin Sulfate for the Treatment of Carbapenem-Resistant <i>Klebsiella pneumoniae</i> Infection in the Peri-Operative Period of Liver Transplantation: A Single-Center Retrospective Study.","authors":"Xiangyan Liu, Jianfang Lu, Zhuoyi Wang, Li Zhuang, Guoping Jiang, Tian Shen, Jincheng Ma, Shusen Zheng","doi":"10.1089/sur.2024.216","DOIUrl":"https://doi.org/10.1089/sur.2024.216","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study intended to evaluate the clinical efficacy and safety of colistin sulfate aerosol inhalation in combination with ceftazidime-avibactam for the treatment of pulmonary carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) infection during the peri-operative period of liver transplantation. <b><i>Materials and Methods:</i></b> A retrospective analysis was designed to investigate 52 patients who developed pulmonary CRKP infection after liver transplantation between December 1, 2019, and November 30, 2022. On the basis of whether they received colistin sulfate aerosol inhalation, the patients were divided into the treatment group (<i>n</i> = 29) and the control group (<i>n</i> = 23). The baseline information, infection status, CRKP enzyme type, inflammatory markers, liver and kidney function, and prognosis were compared and analyzed. <b><i>Results:</i></b> There were no significant differences in patient characteristics, infection status, and drug resistance enzyme type between the treatment group (treated with colistin sulfate aerosol inhalation and ceftazidime and avibactam sodium for injection) and the control group (treated with ceftazidime and avibactam sodium for injection alone). Colistin sulfate aerosol inhalation treatment reduced concentrations of inflammatory markers, with post-treatment white blood cell count, procalcitonin, and C-reactive protein significantly lower than pre-treatment levels (p < 0.05). Except for C-reactive protein at 14 days (p = 0.032), the two groups had no significant differences in other indicators. There were no significant differences in alanine aminotransferase, aspartate aminotransferase, total bilirubin, and glomerular filtration rate after treatment, indicating no discernible alteration in liver and kidney function. In addition, the treatment group took a significantly shorter time to normalize body temperature compared with the control group (p = 0.025), but there were no significant differences in the cure with no colonization rate and all-cause mortality rate between the two groups. <b><i>Conclusions:</i></b> The combination of colistin sulfate aerosol inhalation and ceftazidime and avibactam sodium for injection is effective in treating pulmonary CRKP infection during the peri-operative period of liver transplantation. It does not impose an additional burden on liver and kidney function, providing a new treatment option for this type of infection.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomics in Human Septic Shock: State of the Art.","authors":"Fabiano Pinheiro da Silva","doi":"10.1089/sur.2024.161","DOIUrl":"https://doi.org/10.1089/sur.2024.161","url":null,"abstract":"<p><p><b><i>Background:</i></b> Septic shock is a complex syndrome characterized by signs of intense systemic inflammation and a profound dysregulation of the immune response. Large-scale gene expression analysis is a valuable tool in this scenario because sepsis affects various cellular components and signaling pathways. <b><i>Results:</i></b> In this article, we provide an overview of the transcriptomic studies that investigated human sepsis from 2007 to 2024, highlighting their major contributions. <b><i>Conclusions:</i></b> The field, however, still faces substantial limitations and several challenges. To advance further, we believe that standardization of sample collection and data analysis, preservation of cell and tissue architecture, and integration with other omics techniques are crucial for a broader understanding of this lethal disease.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}