Surgical infections最新文献

{"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":"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":"428-434"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","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":"Ceftaroline + Rifampin Versus Vancomycin + Rifampin in the Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i> Meningitis in an Experimental Rabbit Model.","authors":"Damla Akdag, Tuncer Turhan, Elif Bolat, Gamze Sanlıdag-Isbilen, Canberk Tomruk, Furkan Isbilen, Yigit Uyanikgil, Sohret Aydemir, Tansu Yamazhan, Husnu Pullukcu, Bilgin Arda, Meltem Tasbakan, Berke Gokkilic, Ekin Kartal, Dilsah Baskol Elik, Hilal Sipahi, Sercan Ulusoy, Oguz Resat Sipahi","doi":"10.1089/sur.2024.069","DOIUrl":"10.1089/sur.2024.069","url":null,"abstract":"<p><p><b><i>Background/Aim:</i></b> To compare the effectiveness ceftaroline-rifampicin (CR) and vancomycin-rifampicin (VR), against methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) in a rabbit meningitis model, to compare the effects on brain tissues in terms of inflammation and apoptosis and to test the antibiotics via in vitro time-kill and synergy tests. <b><i>Method:</i></b> Meningitis was induced using MRSA strain ATCC 43300. After 28 hours, the rabbits were split into three groups: control, VR, and CR. A CSF culture was taken at the start (<i>T</i>₀) and end of treatment (EOT)-the 24th hour of treatment. At EOT, the animals' brain tissues were examined for inflammation and apoptosis. The study strain was tested for a 24-hour time kill assay. <b><i>Results:</i></b> At the EOT, statistically significant differences were observed between the treatment groups in terms of reducing the cerebrospinal fluid (CSF) bacterial count, achieving partial or complete treatment response, and exhibiting lower levels of neuronal apoptosis compared with the control group. However, there was no significant difference in all three parameters and in survival between the two treatment groups. The CR group exhibited a noticeable decrease in inflammation than the control group, but no significant difference was found between the control group versus VR and VR versus CR group. Rifampicin did not improve antibacterial efficacy in the in vitro time-kill assay. <b><i>Conclusion:</i></b> The CR arm showed better complete response and inflammation, but both treatments were similar in other parameters. CR combination was found as effective as VR combination for treating MRSA meningitis.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"395-404"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658321","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":"Experience with Infections Caused by <i>Tissierella praeacuta</i>: An Emerging Anaerobic Surgical Pathogen.","authors":"Hugo J R Bonatti, Sridhar Gona, Aaron George","doi":"10.1089/sur.2024.023","DOIUrl":"10.1089/sur.2024.023","url":null,"abstract":"<p><p><b><i>Background:</i></b> <i>Tissierella praeacuta</i> (TP), previously known as <i>Clostridium hastiforme</i>, is a rare and potentially underreported pathogen. TP may cause a variety of infections, including the potential as an important pathogen of intra-abdominal infections (IAIs). Still little data on this anaerobic gram-positive rod are available. <b><i>Patients and Methods:</i></b> The institutional database was searched for TP infections during a 4-year period. Isolation and identification of the pathogen were done according to standard guidelines, including those for anaerobic culture. <b><i>Results:</i></b> A total of 21 patients, including 11 males and 10 females, with a median age of 63.8 (range 35.8-90) years with infections because of TP (24 isolates) were identified. There were eight IAIs, 12 soft tissue infections, and 1 pleural empyema; two patients had bacteremia. In 19 cases, microscopy was done revealing white blood cells in 79%, gram-positive cocci in 53%, gram-negative rods in 47%, and gram-positive rods in 32%. Final cultures grew TP monoculture in 38%; in 62%, TP was part of a mixed flora. Twenty-four co-pathogens were identified, including gram-positive cocci (13), gram-negative rods (9), and gram-positive rods (2). Treatment consisted of antibiotic agents, including beta-lactams, clindamycin, or metronidazole, and surgery or interventional drainage for the majority of cases. Outcomes were generally favorable with 19 of the 21 patients surviving. <b><i>Conclusions:</i></b> This is a first large series of infections because of the emerging pathogen TP from a rural area. TP mainly causes purulent infections requiring surgical intervention. The series emphasizes the importance of anaerobic cultures in surgical specimens.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"365-370"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011205","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":"Hyperbaric Oxygen Therapy for Necrotizing Soft Tissue Infections: A Retrospective Cohort Analysis of Clinical Outcomes.","authors":"Akira Shishido, Gregory Schrank, Alexander Vostal, Megan Uehling, Ravi Tripathi, Sai Chintalapati, Lauren Conway, Nikki Kus, Laura DiChiacchio, Marc Kai, Joseph A Kufera, Ronald Rabinowitz","doi":"10.1089/sur.2024.285","DOIUrl":"10.1089/sur.2024.285","url":null,"abstract":"<p><p><b><i>Background:</i></b> Hyperbaric oxygen therapy (HBOT) is an adjunctive therapy for necrotizing soft tissue infections (NSTIs) that remains controversial due to lack of quality clinical evidence. This retrospective cohort examines the impact of HBOT on clinical outcomes from NSTI at a single center where evaluation for HBOT is standard of care. <b><i>Methods:</i></b> The COVID-19 pandemic disrupted HBOT service and NSTI cases went without HBOT treatment, allowing for a comparison of treatment groups. The clinical outcomes of 253 patients with NSTI that were evaluated for HBOT were compared; 143 (56.3%) received HBOT and 110 (43.3%) did not. <b><i>Results:</i></b> Baseline characteristics were similar except for surface area of the wounds and distribution on the extremities. More patients in the non-HBOT group died within 90 days of admission than those in the HBOT group (5.8% vs. 15.4%, p = 0.015). Further, patients with large wounds (≥450 cm²) and those with high APACHE II scores (≥18) who underwent HBOT had significantly lower risk of death than patients who did not (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.02-0.72). <b><i>Conclusion:</i></b> Our study shows that there was a mortality benefit in patients with NSTI that was more significant in patients with large wounds and higher APACHE II scores.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"384-389"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650889","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":"Pneumonia and Dysphagia after Cervical Spine Trauma.","authors":"Andrew H Tran, Kaitlin A Ritter, Vanessa P Ho, Christopher W Towe, Jeffrey A Claridge, Laura Kreiner","doi":"10.1089/sur.2024.150","DOIUrl":"10.1089/sur.2024.150","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> In patients with cervical spine trauma (CST) or cervical spinal cord injury (C-SCI), literature reports the incidence of dysphagia at 17% and 30%, respectively. It remains unclear whether diagnosing dysphagia during an index admission (IA) would help prevent subsequent pneumonia or whether it would simply reflect a risk for future pneumonia. We hypothesized that IA dysphagia would be associated with greater future pneumonia-related readmission. <b><i>Methods:</i></b> We identified patients with CST or C-SCI from the Nationwide Readmissions Database. Readmissions within 90 days of discharge were identified, and logistic regression identified factors associated with 90-day readmission and pneumonia. Factors included age, C-SCI, pneumonia at IA, dysphagia at IA, comorbidity count, ISS, index discharge destination, and payer type. <b><i>Results:</i></b> Of 27,752 patients with CST, 23.6% had C-SCI (median age 58; median ISS 16). A total of 9% of all patients with CST had dysphagia (13% for C-SCI). In total, 11.9% of IA survivors were readmitted within 90 days and 16.8% had a diagnosis of pneumonia. In adjusted logistic regression, dysphagia at IA was not associated with readmission or pneumonia. Pneumonia, C-SCI, and tracheostomy at IA were associated with pneumonia at readmission. <b><i>Conclusion:</i></b> The incidence of IA dysphagia for patients with CST in this study was low, suggesting under-diagnosis. Pneumonia was common at both IA and readmission for patients with CST and C-SCI. Pneumonia at IA, tracheostomy, and C-SCI were strong predictors of pneumonia at readmission. Due to the discordant dysphagia rates, protocolized screening for dysphagia during IA may be key to understanding pneumonia-related readmission.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"420-427"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587129","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":"Microbial Pathogen Spectrum in Anastomotic Leaks after Ivor-Lewis Esophagectomy.","authors":"Andreas Schneider, Seung-Hun Chon, Philipp Kasper, Wolfgang A Wetsch, Christiane J Bruns, Andreas Hohn","doi":"10.1089/sur.2024.300","DOIUrl":"10.1089/sur.2024.300","url":null,"abstract":"<p><p><b><i>Background:</i></b> Anastomotic leaks after esophagectomy cause significant morbidity and mortality. In addition to their early detection and prompt endoscopic or surgical management, providing adequate antimicrobial agents is a fundamental aspect of therapy. In this study, different types of microbiological samples were analyzed to provide insight into the microbial pathogen spectrum of anastomotic leaks after esophagectomy. <b><i>Methods:</i></b> We retrospectively reviewed patients who developed anastomotic leak after Ivor-Lewis esophagectomy at a German high-volume center between 2016 and 2018. Results of microbiological cultures from surgical samples, chest tube fluid, endoscopic aspirates, and blood cultures were analyzed to determine species and antimicrobial susceptibility. <b><i>Results:</i></b> Out of 513 consecutive patients undergoing esophagectomy, 74 developed an anastomotic leak. About 88%-100% of positive samples showed growth of gram-positive bacteria, mainly viridians streptococci but also enterococci. Gram-negative bacteria were found in 48%-82% of positive samples, mainly enterobacterales. Yeasts were found in 43%-64%. The prevalance of multidrug-resistant bacteria was low in our patient population. Expected failure of empiric antibiotic treatment was <10% for piperacillin-tazobactam, meropenem, and tigecycline (each combined with an echinocandin) but not for ampicillin-sulbactam, ceftriaxone plus metronidazole, moxifloxacin, or gentamicine plus clindamycin. <b><i>Conclusions:</i></b> There is a broad microbial pathogen spectrum in anastomotic leaks after esophagectomy. Implications for empiric antimicrobial treatment arise from enterobacterales, enterococci, and yeasts.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"371-377"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587128","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":"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":"405-412"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","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":"Is There Always a Need to Perform Urine Culture before <i>Bacillus</i> Calmette-Guérin Instillation for Bladder Cancer?","authors":"Ali Bourgi, Omar Ghanem, Camille Brocail, Franck Bruyère","doi":"10.1089/sur.2024.119","DOIUrl":"10.1089/sur.2024.119","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> There are no unanimous recommendations between urology societies regarding the performance of a urine culture before <i>Bacillus</i> Calmette<b>-</b>Guérin (BCG) instillations. The management of a positive urine culture before each instillation depends on the choice of the urologist. The objective of our study was to collect urine cultures performed before instillations and to study their impact on the risk of associated urinary tract infection (UTI) and on the risk of recurrence of bladder tumors. <b><i>Patients and Methods:</i></b> A retrospective analysis of induction BCG files (six instillations per cycle) associated or not with maintenance BCG (three instillations per cycle) was performed between January 2022 and January 2023. A urine culture was systematically carried out a few days before each instillation. In the event of a positive urine culture, the choice of treatment depended on the referring urologist. Demographic data, tumor characteristics, risk factors for UTI, and bacteriological data (date of urine culture, leukocyturia, hematuria, polymicrobial, sterile, and antibiotic therapy given) were collected. <b><i>Results:</i></b> Eighty patients were included, all with non-muscle-infiltrating bladder tumors. A total of 812 urine cultures were studied, of which 88 were positive. Among all positive urine cultures, 42 did not receive antibiotics, and yet no febrile UTI was detected. A serious infectious event was reported in two patients including one death, and no risk factor for the occurrence of a positive urine culture could be identified. Bladder tumor recurrence was identified in 17 patients, 3 of whom had positive urine culture treated with antibiotics. <b><i>Conclusions:</i></b> Performing urine culture before BCG instillation does not seem necessary. Antibiotic therapy for a positive urine culture could expose to a higher risk of recurrence.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"390-394"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701494","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":"Competing Interests: Vancomycin Use in Trauma Patients is Similar During Methicillin-Resistant <i>Staphylococcus aureus</i> Nasal Swab Based De-Escalation and Universal Mupirocin Decolonization Protocols.","authors":"Elizabeth D Krebs, Shayan Rakhit, Jennifer R Beavers, Leanne Atchison, Robel T Beyene","doi":"10.1089/sur.2024.280","DOIUrl":"10.1089/sur.2024.280","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Protocols for vancomycin de-escalation often rely on nasal swab testing for methicillin-resistant <i>Staphylococcus aureus</i> (MRSA). However, in settings of hospital-wide universal MRSA decolonization with nasal mupirocin, these swabs may be unreliable, hindering de-escalation protocols. This study investigated vancomycin use and MRSA infection in trauma patients managed under each of these separate protocols. <b><i>Methods:</i></b> This retrospective review compared patients admitted to a Level 1 trauma center during a time-period of MRSA swab-based vancomycin de-escalation (\"de-esc\") with those admitted during a subsequent period of universal decolonization (and thus \"no de-esc\"). The primary outcome was total days of vancomycin per patient receiving vancomycin. Additional outcomes included a proportion of patients receiving a short course of vancomycin (<3 d), overall vancomycin rates, and in-hospital MRSA infections. <b><i>Results:</i></b> A total of 5,678 patients were evaluated, with 2,891 admitted during the \"de-esc\" period and 2,787 admitted during universal decolonization (\"no de-esc\"). There was no difference in the proportion of patients receiving vancomycin during the \"de-esc\" versus \"no de-esc\" protocols (7.2% [n = 208] vs. 6.5% [n = 181], p = 0.3). Among these patients, there was also no difference in either total days of vancomycin (5.3 d vs. 5.9 d, p = 0.3) or proportion receiving a short vancomycin course (33% vs. 29%, p = 0.5). There were 56 total patients with MRSA infections, with no difference between the two time periods (1.1% vs. 0.7%, p = 0.07). <b><i>Conclusion:</i></b> Despite concerns that a hospital-wide MRSA universal decolonization policy would hinder nasal swab-based vancomycin de-escalation, both vancomycin use and MRSA infection rates remained the same during the two time periods.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"435-440"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784445","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 a Multiplex PCR Assay for Rapid Diagnosis and Antibiotic Utilization in Trauma Intensive Care Unit Patients with Ventilator-Acquired Pneumonia.","authors":"Gregory R Stettler, Danielle M Detelich, Joshua S Chait, Alexandra R Monetti, Elizabeth L Palavecino, James R Beardsley, Preston R Miller, Andrew M Nunn","doi":"10.1089/sur.2024.290","DOIUrl":"10.1089/sur.2024.290","url":null,"abstract":"<p><p><b><i>Background:</i></b> Ventilator-associated pneumonia (VAP) is a frequent complication in injured patients. Multiplex polymerase chain reaction (PCR) facilitates rapid identification of many respiratory pathogens prior to formal culture results. Our objective was to evaluate the effect of multiplex PCR implementation in a trauma intensive care unit (TICU) on antibiotic utilization and de-escalation. <b><i>Patients and Methods:</i></b> Injured adult patients admitted to the TICU with quantitative respiratory cultures were included. Patients were dichotomized into two groups, before (PRE) or after (POST) implementation of the pneumonia (PNA) panel. The PRE cohort included all patients meeting study criteria from January to June 2021, and the POST cohort included all patients meeting study criteria from January to June 2022, Patients were excluded if there was any documented infection requiring antibiotics other than a respiratory source. <b><i>Results:</i></b> During the study period, 60 patients met criteria for inclusion, 30 PRE and 30 POST. Diagnosis of VAP was confirmed in 43.3% PRE and 50% POST patients. The time to antibiotic change was substantially shorter in the POST group (23 h vs. 61 h, p < 0.001). In the POST cohort, 83% of initial antibiotic regimens were eligible for change on the basis of PNA panel. Of these, 88% were changed in a median time of 15.4 h. In all patients, total days of antibiotic therapy (DOT) were not different (9 vs. 10, p = 0.207); however, vancomycin DOT was less in the POST group (2 d vs. 3 d, p ≤ 0.001). In those patients diagnosed with VAP, the total antibiotic (10 vs. 12 d p = 0.008), vancomycin (2 vs. 3 d p = 0.003), and cefepime DOT (3 vs. 4 d 0.029) were substantially less in the POST group. <b><i>Conclusions:</i></b> Utilization of multiplex PCR in addition to bacterial culture substantially reduced time to achieve targeted antibiotic therapy in suspected pneumonia. Furthermore, it reduced the number of days of vancomycin therapy.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"378-383"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617335","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}