Surgical infections最新文献

{"title":"Comparison of Multi-Drug Resistant Organisms Causing Early Ventilator-Associated Pneumonia in Three Geographically Distinct Trauma Intensive Care Units.","authors":"Joseph M Swanson, Peyton C Cole, Julie E Farrar, Kristina L Smith, Andrew J Kerwin, G Christopher Wood, Dina M Filiberto","doi":"10.1089/sur.2024.149","DOIUrl":"10.1089/sur.2024.149","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> It is unclear why differences in patient location change organisms causing ventilator-associated pneumonia (VAP). We investigated VAP organisms in three geographically separate trauma intensive care units (TICUs). <b><i>Patients and Methods:</i></b> A retrospective review of organisms causing VAP (bronchoalveolar lavage [BAL] performed ≤7 d after admission and growing ≥10⁵ cfu/mL) in three geographically separate TICUs was conducted. Patients were treated by similar multidisciplinary teams and protocolized pathways. The primary outcome was the incidence of multi-drug resistant (MDR) VAP. Secondary outcomes were the incidence of inappropriate empiric antimicrobial therapy (IEAT) and the determination of risk factors for MDR VAP. Chi-squared, Kruskal-Wallis, and multi-variable logistic regression analyses were used accordingly. <b><i>Results:</i></b> In total, 271 patients were included: 142 in TICU-1, 63 in TICU-2, and 66 in TICU-3. The incidence of MDR VAP was similar across TICUs at 33.8%, 47.6%, and 39.4%, respectively (p = 0.17). Gram-negative MDRs were more prevalent in TICU-1 (70.8%) versus TICU-2 (60.0%) or TICU-3 (26.9%) (p = 0.001). Gram-positive MDRs were identified more in TICU-3 (73.1%) versus TICU-2 (43.3%) or TICU-1 (35.4%). IEAT did not differ by unit overall but was significantly greater for MDR gram-positive organisms in TICU-3 (70.4%) versus TICU-2 (44.8%) or TICU-1 (37.5%) (p = 0.02) and highest for MDR gram-negative organisms in TICU-1 (64.6%) versus TICU-2 (62.1%) or TICU-3 (55.8%) (p = 0.02). Multi-variable regression analyses revealed antibiotic days before BAL and kidney replacement therapy (KRT) as significant predictors of MDR VAP. <b><i>Conclusions:</i></b> Different TICU locations did not influence the overall incidence of MDR VAP, but differences in MDR organisms were observed. IEAT rates for both gram-positive and gram-negative organisms in different units may necessitate changes in empiric therapy. Antibiotic days prior to the BAL and KRT significantly increased the odds of early MDR VAP.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"324-330"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011934","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":"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":"309-318"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","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":"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":"349-354"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","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":"Time to Percutaneous Drain Placement and Impact on Patient Outcomes.","authors":"Tien Pham, Jacob C O'Dell, Jocelyn E Hunter Rose, Aaron Rohr, Matthew Johnson, Andrew Dulek, Robert D Winfield, Stepheny D Berry, Jennifer L Hartwell, Scott A Turner, Erich Wessel, Stephen R Eaton, C Cameron McCoy, Christopher A Guidry","doi":"10.1089/sur.2024.231","DOIUrl":"10.1089/sur.2024.231","url":null,"abstract":"<p><p><b><i>Background:</i></b> Percutaneous drains are a commonly used method of source control for intra-abdominal infections. Increased time to source control has been shown to predict worse outcomes in patients with intra-abdominal infections, but it is unclear whether this relationship is valid when the source control method is percutaneous drainage. <b><i>Hypothesis:</i></b> We hypothesized that increased time from diagnostic imaging to drain placement would be associated with higher complication rates in a population of patients requiring percutaneous drainage for intra-abdominal, retroperitoneal, or pelvic infectious processes. <b><i>Methods:</i></b> We identified all adult patients who received a percutaneous drain placed by interventional radiology that had positive microbial drain culture results in the abdomen, retroperitoneum, or pelvis from 2020 to 2021 at the University of Kansas Medical Center. Demographics, comorbidities, and Sequential Organ Failure Assessment (SOFA) scores were collected. Multiple organ failure was defined as derangement of two or more organ systems with an SOFA ≥ 3. Standard univariate and logistic regression analyses were performed. <b><i>Results:</i></b> One hundred seventy patients were included, 94 of whom developed a complication (52%). Drain placement occurred at a median of 20.6 hours (inter-quartile range or IQR: 11.3-31.0 h) overall. Both uni-variable and logistic regression analyses demonstrate that time from imaging read to drain placement did not differ between the complication and non-complication groups. <b><i>Conclusion:</i></b> In this observational study, the time from diagnosis of intra-abdominal infection to percutaneous drain placement was not associated with increased complication rates even in the sickest patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"286-291"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597100","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":"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":"319-323"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","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":"Non-Operative Management of Cholecystitis in Pregnant Patients Remains Common.","authors":"Jessica L Weaver, Alan Smith, Todd W Costantini, Laura Haines","doi":"10.1089/sur.2024.209","DOIUrl":"10.1089/sur.2024.209","url":null,"abstract":"<p><p><b><i>Background:</i></b> Cholecystectomy is the recommended treatment for acute cholecystitis in pregnancy, leading to fewer pregnancy-related complications than non-operative management. However, past research demonstrated high rates of non-operative management despite these recommendations. Rates of cholecystostomy tube usage and outcomes in pregnancy are not well described. We hypothesized that rates of interventions for cholecystitis have increased over time. <b><i>Patients and Methods:</i></b> The National Readmissions Database was queried for all visits in the first three quarters of each year 2016 to 2019, which included a patient with an International Classification of Diseases-10 code for cholecystitis and pregnancy. These entries were then further investigated for demographics, gestation, rates of interventions at the index admission (cholecystectomy or cholecystostomy tube), 90-day readmissions, interventions at readmission, and pregnancy-related complications. <b><i>Results:</i></b> Annual rates of interventions for cholecystitis remained low over the study period (27.0%-34.9%). Of patients treated with non-operative management, 6.0% had cholecystectomy on readmission. Compared with the first trimester, interventions were more likely in the second trimester (p < 0.001) and less likely in the third trimester (p < 0.001). Length of stay was highest for cholecystostomy tube placement and lowest for patients who received non-operative management. <b><i>Conclusions:</i></b> Cholecystectomy rates in pregnancy remain low despite evidence that cholecystectomy is safe. Cholecystostomy appears to be a safe alternative but associated with a longer length of stay. Further study is needed to determine what barriers exist to adequate treatment of cholecystitis in pregnant patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"304-308"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011941","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":"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":"336-342"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","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":"Comparing Outcomes and Infection Risk in Medical, Surgical, and Trauma Intensive Care Patients with Alcohol Use Disorder.","authors":"Kristin P Colling, Alexandra K Kraft, Melissa L Harry","doi":"10.1089/sur.2024.044","DOIUrl":"10.1089/sur.2024.044","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Alcohol is the most frequently abused drug in the United States, and alcohol use disorder (AUD) is a common comorbidity in intensive care units (ICUs). <b><i>Patients and Methods:</i></b> We performed a retrospective chart review of patients admitted to an ICU between January 2017 and March 2019 at a tertiary hospital serving a large rural population. Patients with diagnoses of AUDs were included. Patients were excluded if they did not require ICU care. Patient demographics, hospital course, infection type, culture results, and mortality were evaluated. We compared medical, surgical, and trauma ICU patient outcomes and infections. <b><i>Results:</i></b> In total, 527 patients met inclusion and exclusion criteria. Trauma ICU patients had the least pre-existing comorbidities, and surgical ICU patients had the longest lengths of stay. There was no difference in in-hospital mortality between ICU groups; however, surgical and medical ICU patients had significantly greater rates of in-hospital mortality compared with trauma ICU patients. Infections were common across all ICU types, occurring in 40% of patients. There was no difference in infection rate between ICU types. In multi-variable analysis controlling for age, gender, liver failure, chronic kidney disease, thrombocytopenia, complications, and blood transfusions, infection remained an independent predictor of in-hospital mortality (adjusted odds ratio 3.3, 95% confidence interval 1.7-6.4). Septic shock occurred in 57% of infections and was associated with an increased risk of mortality (38% vs. 2%, p < 0.001). Pneumonia was the most common infection occurring in 28% of the cohort, followed by bacteremia (7%), skin/soft tissue infections (6%), urinary tract infection (5%), intra-abdominal infections (4%), and <i>C. difficile</i> (2%). <b><i>Conclusions:</i></b> AUDs in all types of ICU patients are associated with high rates of infections and high morbidity and mortality.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"292-303"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047954","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":"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":"343-348"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12172637/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial and Clinical Toxicity of Empiric Vancomycin for Intra-Abdominal Infections: A Cohort Study.","authors":"Laura M Ebbitt, Jeremy D VanHoose, Samantha Manci, Aric Schadler, Abigail Leonhard, Jitesh A Patel","doi":"10.1089/sur.2024.269","DOIUrl":"https://doi.org/10.1089/sur.2024.269","url":null,"abstract":"<p><p><b><i>Background:</i></b> Vancomycin for intra-abdominal infections (IAI) should be reserved for healthcare-acquired infections, history of multiple interventions, or methicillin-resistant <i>Staphylococcus aureus</i> (MRSA). The MRSA incidence is low; however, fear of missing MRSA leads to overutilization. <b><i>Methods:</i></b> This single-center retrospective cohort study evaluated the cost and risks of empiric vancomycin for IAI. The primary objective was to determine the incidence of MRSA-positive culture and surveillance testing. Secondary outcomes included acute kidney injury (AKI) incidence, progression to dialysis, direct costs of vancomycin overutilization, length of stay, and 30-day mortality. <b><i>Results:</i></b> A total of 1,045 patients with IAI were identified and 491 (47%) received at least one dose of vancomycin. Thirty patients (2.9%) grew MRSA. Of those who grew MRSA, 21 (70%) were MRSA positive on the surveillance multi-drug resistance (MDR) culture or by polymerase chain reaction during hospitalization. There were no deaths within the MRSA group. AKI developed in 351 (33.6%) patients during their hospitalization, with 49.6% occurring within 48 hours of vancomycin administration. Of the 65 patients (6.9%) who required dialysis, 27 patients (42%) received vancomycin. The cost of unnecessary doses equated to $21,655 and $188,643.84 for vancomycin levels. <b><i>Conclusion:</i></b> Given the low MRSA culture incidence, it is reasonable to avoid vancomycin as empiric treatment for those being admitted for IAI alone to reduce the risk of AKI and reduce healthcare costs. Vancomycin should be limited mainly to those with a positive MRSA culture with consideration of vancomycin in those at highest MRSA risk such as a history of MRSA or known MRSA colonization.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180179","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}