Surgical infections最新文献

{"title":"<i>Clostridium difficile</i> Bacteremia in an Elderly Patient with Multiple Comorbidities: A Case Report.","authors":"Binwei Wu, Xiaoying Song, Yu Liu, Xu Zheng","doi":"10.1089/sur.2024.223","DOIUrl":"10.1089/sur.2024.223","url":null,"abstract":"<p><p><i>Clostridium difficile</i> (<i>C. difficile</i>) stands as a primary cause of health-care-associated colitis in adults; however, extraintestinal manifestations of <i>C. difficile</i>, particularly bacteremia, are exceptionally rare. In this report, we document a case of an elderly male with multiple comorbidities who presented with an acute onset of fever. Diagnostic testing revealed the presence of concurrent bacteremia involving <i>C. difficile</i> and <i>Klebsiella pneumonia</i>. The multilocus sequence typing analysis identified this <i>C. difficile</i> strain as ST81. After receiving a combination treatment of vancomycin and biapenem, the patient successfully recovered and was subsequently discharged. This case report elucidates the clinical presentation and treatment strategies for <i>C. difficile</i> ST81 bacteremia, underscoring the critical need for heightened monitoring of extraintestinal infections in high-risk patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"112-115"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740524","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":"Outcomes of the Subsequent Periprosthetic Joint Infection Revisions after a Failed Debridement, Antibiotics and Implant Retention: A Multicentric Study of 197 Patients.","authors":"Álvaro Auñón, Martí Bernaus, Margarita Veloso, Lluis Font-Vizcarra, Jaime Esteban, Monica Mijangos, Nerea Hernández, Ainara Achaerandio, José Baeza, Francisco Argüelles, Roger Rojas, Joel Sánchez, Alejandra Martínez-Roselló, Montserrat Monfort, Javier Martínez, Alejandro Corredor, José María Lamo de Espinosa, Juan Castellanos, Juan Carlos Martínez Pastor, Alfonso Alías, Laia Boadas, Ernesto Muñoz-Mahamud, Marta Sabater","doi":"10.1089/sur.2024.047","DOIUrl":"10.1089/sur.2024.047","url":null,"abstract":"<p><p><b><i>Background:</i></b> The impact of prior unsuccessful debridement, antibiotics, and implant retention (DAIR) procedures on subsequent revisions is uncertain, with conflicting evidence. Despite 85% consensus against the second DAIR procedure following the 2018 International Consensus Meeting, a 2020 study reported high success rates for the aforementioned second DAIR procedure. <b><i>Methods:</i></b> We conducted a multicenter observational study reviewing data from patients with failed DAIR procedures between 2005 and 2021. Patients diagnosed with acute periprosthetic joint infection of the hip or knee were included, following ICM criteria. Failure was defined as uncontrolled infection leading to additional surgeries, prosthesis removal, infection-related mortality, or suppressive antibiotic therapy. Demographic, surgical, and microbiological variables were recorded. <b><i>Results:</i></b> Among 197 patients from 10 institutions with failed DAIR procedures were included: 88 (44.7%) received a second DAIR, 21 (10.7%) underwent one-stage revision, and 77 (39.1%) underwent two-stage revision. One-stage revision success rate was 76.2%, with no identified predictors of failure. Two-stage revision success rate was 79.3%; factors associated with failure included polymicrobial infections (p = 0.025) and revision procedures (p = 0.049). Second DAIR success rate was 54.5%; factors associated with failure included non-specialized surgical teams in the first DAIR (p = 0.034), non-exchange of mobile components (p = 0.0038), polymicrobial infections (p = 0.043), and antibiotic resistance (p = 0.035). Excluding patients with these risk factors increased the success rate to 83.3%. <b><i>Conclusions:</i></b> Second DAIR's overall success rate was 54.5%, significantly increasing to 83.3% when excluding patients with identified risk factors. These findings suggest considering second DAIR in carefully selected patients without these risk factors. Our study found success rates of 76.2% and 79.3% for one- and two-stage revisions, respectively, aligning closely with published data.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"57-62"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751702","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":"Too Hot to Handle: Investigating Seasonal Variations in Surgical Site Infections after Colorectal Surgery.","authors":"Chen Chia Wang, Kevin Sun, Hanjoo Lee, Shannon McChesney, Timothy Geiger, Joel Bradley, Aimal Khan","doi":"10.1089/sur.2024.298","DOIUrl":"https://doi.org/10.1089/sur.2024.298","url":null,"abstract":"<p><p><b><i>Background:</i></b> Surgical site infections (SSIs) increase morbidity and cost following colorectal surgery. Seasonal variabilities in SSI were shown in orthopedic and neurological operations but not yet investigated in colorectal surgery. <b><i>Objective:</i></b> We studied the seasonal trends of SSI in colorectal operations and hypothesized that warmer weather increases the risk of SSI. <b><i>Design:</i></b> This was a retrospective cohort study. <b><i>Settings:</i></b> Patients were identified from the National Surgical Quality Improvement Program and assigned to the warm (April to September) or cold cohort (October to March). <b><i>Patients:</i></b> All patients undergoing colorectal surgery between 2006 and 2021 without significant additional procedures were included. <b><i>Main Outcome Measures:</i></b> Our primary aim was to identify the difference in SSI rates between cohorts, whereas secondary aims included further characterization of the onset and type of SSI, as well as identifying the incidence of reoperation because of SSI. <b><i>Results:</i></b> The final study population included 306,984 patients, with 155,137 (50.5%) in the cold cohort and 151,847 (49.5%) in the warm cohort. The warm cohort had higher odds of overall SSI (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.02-1.07), with higher rates of superficial SSIs (OR: 1.08, 95% CI: 1.04-1.12) and comparable rates of deep incisional (OR: 1.02, 95% CI: 0.93-1.11) and organ space SSI (OR: 1.01, 95% CI: 0.97-1.05). SSIs occurred post-discharge more often in the warm cohort (57.1% vs. 55.9%, p = 0.048). Patients in the warm cohort also had higher odds of reoperation (OR: 1.39, 95% CI: 1.15-1.67). <b><i>Limitations:</i></b> This study has limitations inherent in retrospective research and the use of a national-level database, such as missing data and differences in reporting standards from each participating center. <b><i>Conclusions:</i></b> Our study showed that patients undergoing colorectal surgery during warm weather months were at higher risk of superficial SSI and reoperation because of infection than those in colder weather.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504337","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":"Antibiogram Surveillance to Determine Appropriate Initial Empiric Antibiotic Therapy for Ventilator-Associated Pneumonia.","authors":"Andrew J Kerwin, G Christopher Wood, Saskya Byerly, Dina M Filiberto, Julie E Farrar, Joseph M Swanson, Maegan L Rogers, Martin A Croce","doi":"10.1089/sur.2024.256","DOIUrl":"https://doi.org/10.1089/sur.2024.256","url":null,"abstract":"<p><p><b><i>Background:</i></b> Our protocolized empiric antibiotic therapy for early (≤7 d) ventilator-associated pneumonia (VAP) and late (>7 d) VAP based on our local antibiogram leads to inappropriate empiric antibiotic therapy (IEAT) approximately 15% of the time. We reviewed our trauma intensive care unit (TICU) antibiogram to determine if sensitivity patterns were changing and warranted protocol adjustments. We hypothesized there would be no change in IEAT over time. <b><i>Patients and Methods:</i></b> TICU patients with VAP (bronchoalveolar lavage culture ≥100,000 CFU/mL) between 2017 and 2022 were reviewed. We reviewed the pathogens and sensitivity patterns to identify the IEAT percentage, and we reviewed changes in the rate of antimicrobial days per 1,000 days present for 2018-2022. <b><i>Results:</i></b> We noted an increase in IEAT beginning in 2017. In early VAP, the increase in IEAT was because of an increase in identification of gram-negative bacteria isolates (7%-24%), specifically an increase in <i>Pseudomonas</i> (3%-10%) and a decrease in <i>Streptococcus sp.</i> (32%-23%) and <i>Haemophilus influenzae</i> (20%-17%). In late VAP, the increase in IEAT was largely because of an increase in identification of <i>Stenotrophomonas</i> (3%-5%) and <i>Acinetobacter</i> (4%-10%). Antimicrobial use changed as pathogens and sensitivity changed. There were increases in rates per 1,000 days for cefazolin (11.9%), vancomycin (22.8%), cefepime (33.1%), and meropenem (424.7%), whereas there were decreases in rates per 1,000 days for ampicillin/sulbactam (-4.5%) and piperacillin/tazobactam (-9.5%). <b><i>Conclusions:</i></b> The change in organisms identified and the increase in IEAT highlight the importance of continuous antibiogram monitoring.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484054","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":"Impact of Drain Removal Timing and Prophylactic Antibiotic Agents on Surgical Site Infections in Head and Neck Reconstruction.","authors":"Haruyuki Hirayama, Katsuhiro Ishida, Keita Kishi, Hiroki Kodama, Masaki Nukami, Taisuke Akutsu, Soichiro Fukuzato, Takeshi Miyawaki","doi":"10.1089/sur.2024.214","DOIUrl":"https://doi.org/10.1089/sur.2024.214","url":null,"abstract":"<p><p><b><i>Background:</i></b> Regarding drain removal timing in head and neck reconstruction, each institution applies its criteria, and a clear consensus has not been established. This pre-post study aims to identify risk factors for surgical site infection (SSI) after reconstructive surgical procedure for head and neck cancer, specifically examining the influence of drain removal timing. <b><i>Patients and Methods:</i></b> A cohort of 220 patients undergoing reconstructive surgical procedure was analyzed. Patients had closed suction drains removed on post-operative day (POD) 2 or POD3. The primary endpoint was SSI incidence within 30 days after operation. Secondary endpoints included the incidence of hematoma and lymphorrhea within 30 days after operation and drain tip culture results. Statistical analyses were performed using Fisher exact test and logistic regression models. <b><i>Results:</i></b> SSIs occurred in 14.5% of patients, with no significant difference between the POD2 (14.6%) and POD3 (14.5%) groups. No substantial differences were found for hematoma and lymphorrhea. The positive rate of drain tip cultures was significantly greater in the POD3 group (38.2%) compared with the POD2 group (18.0%). Multi-variable analysis showed no correlation between SSI and POD3 drain removal (odds ratio [OR], 0.728; p = 0.471). However, significant SSI risk factors included oral cavity lesions (OR, 3.510; p = 0.003) and ampicillin prophylaxis (OR, 5.266; p < 0.001). <b><i>Conclusions:</i></b> Oral cavity lesions and ampicillin prophylaxis were substantial SSI risk factors in reconstructive surgical procedure for head and neck cancer. However, drain removal timing did not significantly affect SSI incidence or other complications. Considering benefits such as shorter hospital stays and less chance of retrograde bacterial invasion, removing drains on POD2 is preferable compared with removal on POD3. Further research is needed to refine prophylactic protocols and enhance patient outcomes.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484056","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":"Antibiotics and Surgically Treated Acute Appendicitis, When, Where, and Why?","authors":"Andrew Hendrix, Alexander Kammien, Adrian A Maung, Bishwajit Battacharya, Kimberly A Davis, Kevin M Schuster","doi":"10.1089/sur.2024.264","DOIUrl":"https://doi.org/10.1089/sur.2024.264","url":null,"abstract":"<p><p><b><i>Background:</i></b> Antibiotics within an hour of incision reduce the incidence of surgical site infection (SSI) in clean-contaminated abdominal surgery. However, patients undergoing emergency surgery for an intra-abdominal infectious process often receive treatment antibiotics and may not benefit from additional pre-incisional antibiotics (POA). We hypothesized that POA would not lead to a reduction in the occurrence of SSIs following emergency appendectomy. <b><i>Patients and Methods:</i></b> All patients at a single institution undergoing emergency appendectomies for acute appendicitis from 2013 to 2020 were included. Age, gender, perforation, body mass index (BMI), Elixhauser comorbidity index (ECI), surgical approach, emergency department antibiotics (EDA), EDA administration time, and pre-operative antibiotics were abstracted. Primary outcomes were superficial/deep and organ-space SSIs. Bi-variable logistic regression models assessed the independent impact of each tactic. Multi-variable models compared those receiving pre-incisional cefazolin with those receiving no POA. <b><i>Results:</i></b> Patients (n = 1380) had a mean age (standard deviation) of 39.5 (17.0) years, and 48.6% were female. Age, gender, perforated appendicitis, EDA, ECI, and BMI all were predictive of infection. POA were not predictive of SSI (p = 0.632). After adjustment for age, gender, perforation, EDA, EDA administration timing, ECI, and BMI, only perforation (odds ratio [OR]: 17.08, 95% confidence interval [CI] = 6.97-51.43) and male gender (OR: 2.75, 95% CI = 1.29-6.43) were associated with organ-space infection, whereas pre-incisional cefazolin was not (OR: 0.83, 95% CI = 0.38-1.97). Emergency department broad-spectrum antibiotics were associated with a lower incidence of superficial/deep infection (OR: 0.06, 95% CI = 0.00-0.68); however, pre-incisional cefazolin was not (OR: 0.71, 95% CI = 0.08-15.34). <b><i>Conclusion:</i></b> For patients undergoing emergency appendectomies who have received broad-spectrum antibiotic treatment, additional pre-incisional cefazolin does not reduce the incidence of superficial/deep or organ-space SSI.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459506","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":"A Study of Risk Factors for Surgical Site Infections and Direct Economic Losses in Clean Orthopedic Surgery.","authors":"Qiuxia Zuo, Hua Li, Baoji Dong, Yuan Zhou, Kexin Zhao, Ping Tian","doi":"10.1089/sur.2024.257","DOIUrl":"https://doi.org/10.1089/sur.2024.257","url":null,"abstract":"<p><p><b><i>Background:</i></b> Surgical site infection (SSI) is a serious complication after clean orthopedic surgery. <b><i>Patients and Methods:</i></b> We retrospectively gathered data on 18,140 patients who underwent clean incision orthopedic operations at two institutions between January 2023 and April 2024. The study included 87 patients with SSIs in the case group and 80 matched controls without SSIs. Age, diabetes mellitus, and intra-operative blood transfusions were all examined using uni-variable and conditional multi-variable logistic regression to detect risk and independent risk factors for SSI. Differences in hospital charges and length of stay were also investigated. <b><i>Results:</i></b> Among the 18,140 surveyed patients, 87 developed SSIs, yielding an infection rate of 0.48%. Significant risk factors for SSI included hypertension (31.3% vs. 15.0%, p = 0.015), more than two surgical procedures (28.8% vs. 8.8%, p = 0.001), and durations of indwelling urinary catheters (p ＜ 0.001) and drains (p = 0.003). Independent risk factors included age ≥60 years [odds ratio (OR): 36.011, p = 0.025], more than two surgical procedures (OR: 7.001, p = 0.034), and durations of indwelling urinary catheters (OR: 2.164, p = 0.033) and drains (OR: 1.426, p = 0.004). The median hospitalization cost was $5,289.3 for patients with SSIs compared with $3,653.9 for those without infections. The cost difference was statistically significant (Z = -3.409, p = 0.001), with an additional median expense of $1,366.5 attributed to SSIs. Patients in the infection group were hospitalized for a median of 30 days, compared with 15 days in the non-infected group, a statistically significant difference (Z = -7.32, p < 0.001), resulting in 17 additional days of hospitalization. The total direct economic loss attributed to 80 SSI cases across both hospitals amounted to $162,415.8. <b><i>Conclusion:</i></b> The study identifies multiple risk factors for SSIs following orthopedic clean surgical procedures. Hospital-related departments should aim to mitigate these risks to decrease the incidence of SSIs and reduce the financial burden on patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399857","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":"Direct Peritoneal Resuscitation in Critically Ill Patients with an Open Abdomen is Associated with Increased Risk of Intraperitoneal Fungal Infections.","authors":"Cassandra A Cairns, James Martinson, Lindsay O'Meara, Roumen M Vesselinov, Jose J Diaz, Mira Ghneim","doi":"10.1089/sur.2024.128","DOIUrl":"https://doi.org/10.1089/sur.2024.128","url":null,"abstract":"<p><p><b><i>Background:</i></b> Damage control laparotomy (DCL) is a well-established tool to stabilize critically ill surgical patients. Direct peritoneal resuscitation (DPR), whereby the open abdomen is continuously irrigated with glucose-based hypertonic dialysate, is a valuable adjunct that improves abdominal closure rates and decreases wound complications. Infectious implications of its use remain underexplored. <b><i>Objective:</i></b> To assess the impact of DPR on the incidence intra-abdominal fungal infections (AFIs) in critically ill surgical patients. <b><i>Methods:</i></b> A retrospective chart review was performed of trauma and emergency general surgery patients undergoing DCL with and without DPR at our level 1 trauma center. The effect of DPR on the primary outcomes was assessed using two-stage logistic regression models. Classification and Regression Tree (CART) models were used to evaluate the leading factors contributing to the primary outcome. <b><i>Results:</i></b> A total of 169 patients were included in the study, 44% of which underwent DPR. Overall, patients who underwent DPR received a more frequent diagnosis of AFIs (28% vs. 13%, p = 0.012). After multi-variable adjustment, patients undergoing post-operative DPR had significantly higher odds of developing AFI (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 1.3-18.5). In hybrid-logit CART models, DPR was again identified as being associated with an increased likelihood of developing AFI (OR = 2.4, 95% CI: 1.0-6.0). <b><i>Conclusion:</i></b> In this cohort, DPR patients had significantly higher chances of developing AFIs. This supports the need for further investigation into the clinical implications of AFIs in critically ill surgical patients and the need to develop risk mitigating strategies.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392113","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":"Ventilator-Associated Pneumonia Predicts Severe Cognitive Disability in Severe Traumatic Brain Injury.","authors":"Shruthi Srinivas, Kelly Nahum, Christopher Gilliam, William Brigode, Stephanie Doris, Tanya Egodage, Michelle Kincaid, Anna Liveris, Katherine McBride, Kaushik Mukherjee, Philip Edmundson, Liz Penaloza-Villalobos, Jacob W Roden-Foreman, Joy Song, Johanna Stecher, Anthony Tigano, Brett Tracy","doi":"10.1089/sur.2024.208","DOIUrl":"https://doi.org/10.1089/sur.2024.208","url":null,"abstract":"<p><p><b><i>Background:</i></b> Ventilator-associated pneumonia (VAP) is linked to poor outcomes in patients with severe traumatic brain injury (TBI), yet its effect on cognitive disability is unknown. We hypothesized that there would be an association between severe cognitive disability and VAP in this patient population. <b><i>Methods:</i></b> We performed a post hoc analysis of a prospective, multi-center, observational study of adults with a severe, blunt TBI from 2020 to 2023. Patients were grouped by whether they developed VAP. Our primary outcome was severe cognitive disability, defined as a disability rating scale (DRS) score >13 at discharge (or 28 days post-injury if not discharged). <b><i>Results:</i></b> There were 309 patients in the cohort; 31.7% (<i>n</i> = 98) developed VAP. The VAP group had greater incidences of diffuse axonal injury (37.3% vs. 22.3%, p = 0.004), neurosurgical interventions (63.3 vs. 38.4%, p < 0.001), and tracheostomies (72.5% vs. 28.9%, p < 0.001). Patients with VAP had a longer duration of mechanical ventilation (13 d vs. 3 d, p < 0.001). Among patients with VAP, median time to diagnosis was 7 days (4-12), time to tracheostomy was 10 days (7-16), and time between the two events was 4 days (2-11). Greater proportions of cognitive disability (64.3% vs. 19.9%, p < 0.001) and worse median DRS scores (8 vs. 2, p < 0.001) occurred in the VAP group. On multi-variable regression analysis, VAP was an independent risk factor for severe cognitive disability (adjusted odds ratio [aOR]: 4.2, 95% CI: 2.2-7.8). <b><i>Conclusion:</i></b> Ventilator-associated pneumonia is common among patients with a severe TBI and is a risk factor for severe cognitive disability. Adherence to VAP prevention techniques may help mitigate cognitive impairment in this population.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080995","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":"30-Day Readmissions and the Need for Emergency Surgery Following Non-Operative Management of Perforated Diverticulitis.","authors":"Joshua Gazzetta, Alyssa Fesmire, Rita Orjionwe, Leo Andrew Benedict, Sean Nix","doi":"10.1089/sur.2024.101","DOIUrl":"10.1089/sur.2024.101","url":null,"abstract":"<p><p><b><i>Background:</i></b> Limited data are available on the evaluation and outcomes of patients with perforated diverticulitis who were treated without surgery. <b><i>Aims:</i></b> This retrospective review was aimed at investigating the 30-day non-elective re-admission rates for patients hospitalized with perforated diverticular disease who were treated without surgery, rates of patients requiring surgery on re-admission, and the independent predictors of re-admission. <b><i>Methods:</i></b> A total of 143,546 patients from the National Readmission Database, between 2016 and 2020, who were admitted with perforated diverticulitis and treated non-operatively were reviewed. Re-admitted patients were compared with those not re-admitted. Comparisons for continuous and categoric variables were made using the student t-test and chi-squared test, respectively. A logistic regression model was used to determine independent factors associated with re-admission. All analyses were done with SAS 9.4; p values <0.05 identified significance. <b><i>Results:</i></b> Among patients with perforated diverticulitis who were treated non-operatively, 17,868 (12.4%) were re-admitted within 30 days and 4,924 (27.6%) of patients re-admitted required surgical intervention. The greatest independent predictors of re-admission include patient insurance status, index length of stay, undergoing a drainage procedure, and patient disposition. Comorbidities predicting re-admission include renal failure, chronic pulmonary disease, diabetes mellitus, fluid and electrolyte disorders, and hypertension. Hospital total charges were greater at the index admission for patients requiring re-admission. <b><i>Conclusion:</i></b> Non-operative management of perforated diverticulitis is safe for many patients, but the risks for re-admission and subsequent need for emergency surgery require special consideration.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"1-5"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142508386","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}