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":"https://doi.org/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":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-27","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":"Influencing Factors of Urinary Tract Stones Complicated by Urinary Tract Infections and the Construction of a Column Chart Prediction Model.","authors":"Li Cai, Xiaofen Wu, Xin Lian, Qing Zhou","doi":"10.1089/sur.2024.212","DOIUrl":"https://doi.org/10.1089/sur.2024.212","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To analyze the influencing factors of urinary tract stones complicated by urinary tract infections and construct a column chart prediction model. <b><i>Patients and Methods:</i></b> From July 2020 to October 2023, 345 patients with urinary tract stones admitted to our hospital were collected as the training set, they were separated into an infection group of 51 cases and a non-infection group of 294 cases on the basis of the presence or absence of concurrent urinary tract infections; 192 patients with urinary tract stones were used as the testing set and were divided into an infection group of 26 cases and a non-infection group of 166 cases on the basis of the presence or absence of concurrent urinary tract infections. Data such as gender, age, and procalcitonin (PCT) were recorded. Multi-variable logistic regression analysis was applied to screen predictive factors, R4.0.2 software was applied to construct a column chart model, the calibration curve and Receiver Operating Characteristic (ROC) curve were applied to evaluate the discrimination and calibration of the column chart model; decision curve analysis curve was applied to evaluate the predictive performance of column chart models. <b><i>Results:</i></b> The proportions of female, diabetes mellitus, indwelling time of urinary catheter ≥7 days, the PCT, and urine pH in the infected group were greater than those in the non-infected group (p < 0.05). Female, diabetes mellitus, catheter retention time ≥7 days, high PCT, and high urine pH were independent risk factors for urinary calculi complicated with urinary tract infection (p < 0.05). Training set: C-index was 0.913, Area Under Curve (AUC) was 0.943 [95% Confidence Interval (CI) = 0.912-0.973], sensitivity was 86.36%, and specificity was 89.81%, testing set: C-index was 0.905, AUC was 0.959 (95% CI = 0.928-0.989), sensitivity was 84.65%, and specificity was 95.84%, indicating good discriminability of the line graph model; Hosmer-Lemeshow test showed <i>χ</i>² = 2.843, 2.894, p = 0.944, 0.941, the calibration curve approached the ideal curve, and the line graph model had good calibration. When the risk threshold for urinary tract stones complicated by urinary tract infections was between 0.08 and 0.86, this column chart model provided clinical net benefits. <b><i>Conclusion:</i></b> The column chart prediction model for urinary tract stones complicated by urinary tract infections constructed in this study has high predictive efficiency and clinical practical value, and can provide reference for medical staff.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740546","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":"Molecular Identification of OXA Carbapenemase-Encoding Genes in <i>Acinetobacter baumannii</i> Isolated from Patients in Critical Care in Egypt.","authors":"Nahla Y Sahlol, Nermin M K Mohamed, Khaled Z El-Baghdady, Iman M A El-Kholy, Gihan M Fahmy, Mai A Sahbal, Hagar L Mowafy","doi":"10.1089/sur.2024.210","DOIUrl":"https://doi.org/10.1089/sur.2024.210","url":null,"abstract":"<p><p><b><i>Background:</i></b> The emergence of carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) in hospitals, particularly within critical care units, has garnered substantial global concern. CRAB commonly arises from the degradation by various ß-lactamases. <b><i>Objective</i></b>: We aimed to assess OXA-type carbapenemases in clinical isolates of <i>A. baumannii</i> obtained from an Egyptian tertiary care facility. <b><i>Patients and Methods:</i></b> This study examined 25 distinct <i>A. baumannii</i> strains collected from various clinical samples of patients in intensive care unit. Bacterial identification was conducted utilizing both traditional methods and the Vitek2 system. Antibiotic resistance profiles were assessed according to the European Committee on Antimicrobial Susceptibility Testing standards using the Vitek2 Compact automated system. Additionally, multiplex real-time polymerase chain reaction was used to identify the presence of blaOXA23, blaOXA24, blaOXA51, and blaOXA58 carbapenemase genes. Colistin susceptibility was assessed utilizing the broth microdilution method. <b><i>Results:</i></b> Carbapenem resistance was identified in 100% of the studied isolates. The blaOXA51 gene was detected in all <i>A. baumannii</i> strains. The gene blaOXA23 was identified in 22 strains (88%), whereas blaOXA24 and blaOXA58 were present in 15 strains (60%). All isolates, except one, co-harbored two or more OXA encoding genes. Colistin resistance was detected in 4 of 25 strains (16%). <b><i>Conclusion:</i></b> Our findings demonstrate the widespread distribution of CRAB isolates that co-harbor multiple carbapenemase-encoding genes. Molecular epidemiological studies and the surveillance of antibiotic resistance profiles may aid in identifying and tracing the origins of resistant bacteria, thereby limiting their spread.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739651","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":"Predictive Factors for Fertility of Daughter Cysts in Hepatic Cystic Echinococcosis and Insights into the Origin of Daughter Cysts.","authors":"Aymen Trigui, Nahed Khemakhem, Sami Fendri, Mohammad Saad Saumtally, Rahma Daoud, Amira Akrout, Jihen Trabelsi, Rafik Mzali, Fatma Cheikhrouhou, Salma Ketata, Chadli Dziri, Ali Ayadi, Foued Frikha, Nizar Kardoun, Salah Boujelbene","doi":"10.1089/sur.2024.007","DOIUrl":"https://doi.org/10.1089/sur.2024.007","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The cycle of <i>Echinococcus granulosus</i> and its developmental potential has always been a subject of debate. While the origin of protoscoleces was well defined, the origin of daughter cysts (DC) was still a contentious topic, and several hypotheses have been proposed. The aim of this work was to study the fertility of DC and its predictive factors in order to determine its origin. <b><i>Patients and Methods:</i></b> This was a prospective pilot study including hepatic echinococcal cysts containing DC operated in the Department of General and Visceral Surgery of Habib Bourguiba University Hospital, Sfax, during a 22-month period. A parasitological study of the DC including the determination of their fertility was done. <b><i>Results:</i></b> A total of 248 DC collected from 27 multi-vesicular cysts from 21 patients were included in our study. The fertility rate of the DC was 64.5%. Free hooks were present in 130 DC (52.4%) and in only 11(12%) of infertile DC. In a multi-variable analysis, only World Health Organization-Informal Working Groups on Echinococcosis classification type CE2, bilious cyst fluid, number of DC per cyst, cyst size, and DC diameter were factors associated with DC fertility (p < 0.05). Out of 88 infertile DC, 77 (87.5%) were devoid of any hooks. <b><i>Conclusion:</i></b> Our findings suggest that most of the analyzed DC were fertile, with fertility associated with factors such as cyst size, DC size, CE2 type, and number of DC/cysts. The absence of hooks in infertile DC questions prevailing theories of their origin.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740146","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":"The Predictive Value of Heparin-Binding Protein in Total Joint Arthroplasty Prosthesis Infections.","authors":"Dongsheng Guo, Dahui Shen, Yuefu Dong","doi":"10.1089/sur.2024.122","DOIUrl":"https://doi.org/10.1089/sur.2024.122","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study aims to explore the predictive value of heparin-binding protein (HBP) in diagnosing prosthesis infections after total joint arthroplasty (TJA), in order to provide a new biomarker for early identification and management of prosthetic joint infections (PJI) post-TJA. <b><i>Methods:</i></b> A retrospective analysis of data from 168 patients who underwent TJA revision at Lianyungang First People's Hospital from October 2020 to March 2024 was conducted. The participants were divided into an infection group (38 cases) and a non-infection group (94 cases). Inclusion criteria included all patients undergoing joint prosthesis revision who had preoperative HBP levels measured. Primary assessment parameters included HBP, C-reactive protein (CRP), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR). Univariate analysis and multivariate regression analysis were used to evaluate the correlation of these factors with PJI, and the performance of HBP in predicting PJI was analyzed using the receiver operating characteristic (ROC) curve. <b><i>Results:</i></b> There were significant statistical differences in HBP, CRP, WBC, and ESR between the infection and non-infection groups (p < 0.05). Multivariate regression analysis showed that HBP is an independent predictive factor for the risk of PJI. The area under the ROC curve was 0.856, indicating that HBP has good predictive performance. The optimal cutoff value for HBP was 51.3, with a sensitivity of 69.2% and a specificity of 89.5%. <b><i>Conclusion:</i></b> The study found that HBP levels are significantly associated with the occurrence of PJI following TJA, serving as an effective independent predictive factor for PJI risk. HBP has high predictive value and can be considered an important biomarker for predicting PJI post-TJA in clinical settings, aiding in the early identification and management of PJI, thereby improving patient treatment outcomes and quality of life.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740255","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":"Genetically Predicted Body Composition and Risk of Surgical Site Infection: A Mendelian Randomization Study.","authors":"Jinru Yang, Fen Zhang, Hui Xue, Nuo Chen, Yonghua Yao, Kun Li, Ying Wang","doi":"10.1089/sur.2024.133","DOIUrl":"https://doi.org/10.1089/sur.2024.133","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study employed uni-variable and multi-variable Mendelian randomization (MVMR) analyses, utilizing publicly available genome-wide association study (GWAS) data, to assess the causal relationship between body composition measures such as body mass index (BMI), waist circumference (WC), and the occurrence of surgical site infection (SSI). <b><i>Patients and Methods:</i></b> GWAS summary statistical data were obtained for BMI, WC, and SSI from the MRC Integrated Epidemiology Unit (MRC-IEU) database, inverse variance weighted (IVW) method was used as the main analysis, and supplement sensitivity analysis (including heterogeneity test, pleiotropy analysis, leave-one-out analysis, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO)) was used to check the robustness of the results. <b><i>Results:</i></b> The MR analysis showed that the increase in BMI and WC predicted by genes had a substantial causal effect on the incidence of SSI (IVW: odds ratio [OR] = 1.003, 95% confidence interval [CI] = 1.002-1.004, p < 0.001; IVW: OR = 1.003, 95% CI = 1.002-1.005, p < 0.001), respectively, and the MVMR analysis showed that after jointly incorporating smoking and alcohol parameters, the impact of BMI and WC on SSI remained substantial (OR = 1.003, 95% CI = 1.002-1.004, p < 0.001; OR = 1.004, 95% CI = 1.002-1.005, p < 0.001). <b><i>Conclusion:</i></b> We further support the causal relationship between increased body composition including BMI and WC and the occurrence of SSI, highlighting the importance of SSI prevention in patients with obesity. Further research is required to mitigate the occurrence of surgical incisions in patients with obesity in the future.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628687","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 an Acute Care Surgery Clinical Pathway on Patient Outcomes in Acute Appendicitis.","authors":"Naima Islam, Garima Thakkar, Celeste Ferguson, Kevin Kennedy, Nicholas Bennett, Tolulope Oyetunji, Alyssa Fesmire, Josh Gazzetta, Dennis Arce, Tammy Neblock-Beirne, Sean Nix, Leo Andrew O Benedict","doi":"10.1089/sur.2024.100","DOIUrl":"10.1089/sur.2024.100","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> Acute care surgery (ACS) encompasses surgical critical care, emergency general surgery, and the surgical management of trauma. Following ACS implementation at our institution, we developed a perioperative clinical pathway for acute appendicitis (AA) to improve efficiency and standardize post-operative care. The purpose of our study is to assess patient outcomes utilizing our ACS clinical pathway for patients with AA. <b><i>Methods:</i></b> This is a retrospective cohort study involving patients admitted to our tertiary care facility with AA who underwent appendectomy. Patients were classified by pre-implementation (January 1, 2016-July 31, 2018) and post-implementation (August 1, 2018-December 31, 2020) of our ACS clinical pathway. The primary outcome was hospital length of stay (LOS). Statistical analysis was performed using SAS with a p-value <0.05 determined as significant. <b><i>Results:</i></b> Of the 492 patients included, 225 were in the pre- and 267 were in the post-implementation cohorts. Hospital LOS was substantially decreased in the post-implementation cohort (31.2 vs. 50.4 h, p < 0.001). The post-implementation group had a substantial decrease in computed tomography (CT) to operating room (OR) start time (6.81 vs. 11.4 h, p < 0.001), CT to antibiotic agents' administration (2.20 vs. 3.37 h, p < 0.001), inpatient opioid utilization (125 morphine equivalents [ME] vs. 172 ME, p < 0.001), and discharge antibiotic agents' prescription rates (23.6% vs. 30.7%, p = 0.077). Recovery unit discharges (20 vs. 9%, p < 0.001) were increased in the post-implementation cohort. <b><i>Conclusion:</i></b> Our ACS clinical pathway for AA resulted in earlier surgical intervention, enhanced opioid and antimicrobial stewardship, and gains in surgical care efficiencies.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590670","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":"Different Clinical Characteristics of Right-Sided Versus Left-Sided Colonic Diverticular Complications: A Four-Year Retrospective Study in a Chinese Population.","authors":"Qi Gao, Jia-Yuan Peng, Yue-Qing Bai, Xiao-Er Wei, Zhong-Nan Li","doi":"10.1089/sur.2024.132","DOIUrl":"10.1089/sur.2024.132","url":null,"abstract":"<p><p><b><i>Aim:</i></b> To determine whether right-sided and left-sided colonic diverticular complications have different clinical manifestations and treatment outcomes. <b><i>Methods:</i></b> Patients diagnosed with diverticulitis or diverticular hemorrhage from January 2019 to December 2023 were retrieved. Patients were assigned into the right-sided group and the left-sided group according to the colon affected by diverticular complications. For each patient, age, gender, body mass index (BMI), lifestyle, clinical presentation, and concomitant medication were recorded. Clinical characteristics and treatment outcomes were compared with between the two groups. <b><i>Results:</i></b> A total of 123 patients were included in this study, 89 in the right-sided group and 34 in the left-sided group. Patients in the right-sided group presented a significantly lower mean age (43.33 vs. 66.35 yrs old, p < 0.0001) and a smaller proportion of patients with BMI above 25 (10.11% vs. 24.76%, p = 0.02). Left-sided group diverticulitis had a significantly higher proportion of Hinchey III to IV (29.41% vs. 1.12%, p = 0.0001) and rate of intensified conservative treatment (30.77% vs. 2.38%, p = 0.0003). Patients in the left-sided group had a higher rate of crowding of diverticula (diverticular number counted >20) (35.29% vs. 1.12%, p < 0.01). Two patients in the right-sided group and eight in the left received laparotomy because of diverticulitis. All three cases of hemorrhage were in the right-sided group. <b><i>Conclusion:</i></b> Compared with the left, right-sided diverticulosis is characterized by a younger age, less-virulent diverticulitis, and potentially higher hemorrhagic propensity. Different mechanisms between the groups may exist to mediate the onset and development of diverticulosis and its complications.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590669","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":"Antimicrobial Resistance Trends and Epidemiological Characteristics of Isolates from Intra-Abdominal Infections in China: A 6-Year Retrospective Study (2017-2022).","authors":"Meilin Wu, Yong Chen, Jiayang Li, Zhitao Zhou, Lei Wu, Wenqi Wu, Jiajie Wang, Sai Tian, Xiuwen Wu, Tao Zheng, Jianan Ren","doi":"10.1089/sur.2024.140","DOIUrl":"https://doi.org/10.1089/sur.2024.140","url":null,"abstract":"<p><p><b><i>Background:</i></b> Antimicrobial resistance represents a continuing threat to the health of patients with intra-abdominal infections (IAIs). This study aimed to provide clinicians with guidance to optimize antibiotic therapy. <b><i>Methods:</i></b> The clinical data and antibiotic susceptibility results of pathogens from patients with IAIs from 2017 to 2022 were retrospectively collected. The 6-year period was segmented into two stages, namely, the early (2017-2020) and recent stages (2021-2022). The distribution and antibiotic resistance of pathogens were compared between the stages. <b><i>Results:</i></b> In total, 5,795 pathogens were isolated from 2,283 patients diagnosed with IAIs. Gram-negative bacteria, Gram-positive bacteria, and fungi accounted for 71.0%, 21.4%, and 7.5% of the isolates, respectively. <i>Klebsiella pneumoniae</i> (1,037, 17.9%) was the primary isolate. The proportion of extended-spectrum β-lactamase-producing <i>Enterobacteriaceae</i> was 89.8% (2,028/2,259), with extended-spectrum β-lactamase-producing <i>Escherichia coli</i> and <i>K. pneumoniae</i> accounting for 27.4% and 43.2%, respectively, of all such isolates. The carbapenem resistance rates of <i>E. coli</i> and <i>K. pneumoniae</i> were 17.1% and 75.9%, respectively. Compared with that in the early stage, the imipenem resistance rate of <i>E. coli</i> was significantly higher in the recent stage (13.8% vs. 25.1%, p < 0.001). Among Gram-positive bacteria, 88 strains of vancomycin-resistant <i>Enterococcus</i> were detected, giving a resistance rate of 10.3%, and the detection rate of methicillin-resistant <i>Staphylococcus aureus</i> was 65.7%. <b><i>Conclusions:</i></b> <i>Enterobacteriales</i> and non-fermentative bacteria from IAIs remain highly resistant to carbapenems. The epidemiological characteristics and antibiotic resistance profiles of pathogens in various regions should be closely monitored to mitigate the appearance of drug-resistant bacteria in clinical settings.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628720","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":"Beyond CDC-Defined Surgical Site Infection: Factors Associated with Antibiotic Prescription After Breast Operation.","authors":"Corey K Gentle, Moustafa Moussally, Jenny H Chang, Hanna Hong, Kelly Walker, Kelly Nimylowycz, Sayf Al-Deen Said, Zahraa Al-Hilli","doi":"10.1089/sur.2024.145","DOIUrl":"https://doi.org/10.1089/sur.2024.145","url":null,"abstract":"<p><p><b><i>Background:</i></b> Most studies on surgical site infections (SSIs) use the US Centers for Disease Control and Prevention (CDC) guidelines, which excludes inflammation or cellulitis without fever. The aim of this study was to evaluate antibiotic prescription trends in the post-operative period among patients undergoing breast operation. We explore the outcomes of patients receiving antibiotic agents outside of the CDC-defined SSI. <b><i>Patients and Methods:</i></b> A retrospective review of patients undergoing breast operation from January 2021 to May 2021 was conducted. Solely reconstructive and cosmetic cases were excluded. The primary outcome was the prevalence of antibiotic prescription in the absence of CDC-defined SSI, excluding routine prophylactic antibiotic agents, with analysis of associated factors. <b><i>Results:</i></b> A total of 754 breast surgical procedures were included. Seventy-seven patients (10.2%) were prescribed outpatient antibiotic agents. CDC-defined SSI occurred in 5.3% (n = 40), mostly involving tissue expander/implant-based reconstruction (47.5%, n = 19). However, 37 (4.9%) did not progress to meet the CDC criteria for SSI. Patients prescribed outpatient antibiotic agents without CDC-defined SSI did not have increased rates of diabetes mellitus, obesity, or current smoking. These patients were more likely to have a surgical drain (48.6% vs. 28.4%, p = 0.02), plastic surgery involvement (32.4% vs. 18.0%, p = 0.048), and a post-operative seroma (32.4% vs. 8.1%, p < 0.001) and or or cellulitis (18.9% vs. 0%, p < 0.001). <b><i>Conclusion:</i></b> Patients are prescribed antibiotic agents after breast operation based on clinical judgment for indications other than CDC-defined SSI. Post-operative wound morbidity including seroma and cellulitis could be contributing to these antibiotic prescriptions. Further study is needed to determine whether providers are preemptively treating SSIs appropriately or over-treating non-infectious wound complications.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590608","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}