Surgical infections最新文献

{"title":"Urinary Catheter Utility in Laparoscopic Appendectomy: Risk Benefit Analysis of Post-Operative Urinary Tract Complications.","authors":"Charoo Piplani, Jennifer E Geller, Sorasicha Nithikasem, George A Hung, Amanda L Teichman, Philip S Barie, Mayur Narayan, Rachel L Choron","doi":"10.1089/sur.2024.196","DOIUrl":"10.1089/sur.2024.196","url":null,"abstract":"<p><p><b><i>Background:</i></b> Catheter-associated urinary tract infections (CAUTIs) account for 1 million nosocomial infections annually and 75% of all hospital-acquired UTIs. A risk factor for CAUTI is prolonged urinary catheterization (UC); therefore, transitory UC during laparoscopic appendectomy (LA), a common practice justified to avoid iatrogenic bladder injury, is believed to be safe. However, data on the incidence of post-operative UC-related complications, including CAUTI, following LA or their avoidance are limited. <b><i>Hypothesis:</i></b> Patients who underwent UC for LA developed more post-operative UTIs than patients without UC (noUC), without effect on the incidence of bladder injury. <b><i>Patients and Methods:</i></b> Retrospective analysis of patients ≥21 years who underwent LA (2016-2023) at an academic hospital. The primary outcome was post-operative UTI in UC versus noUC patients, defined as symptoms or urinalysis findings compatible with UTI within 21 days from LA. Secondary outcomes included bladder injury, catheter-related complications, time until UTI diagnosis, and antibiotic exposure. Statistics: Mann-Whitney U and Fisher exact tests; p < 0.05. <b><i>Results:</i></b> Among 981 LA, there were 678 UC and 303 noUC. A majority was male (56%) and young [38 years, inter-quartile range (IQR) 28-50]. Duration of catheterization was 102 min (IQR 85-123), whereas duration of the procedure was 58 min (IQR 44-80). There were more catheter-related complications in the UC versus noUC group (10 [1.5%] vs. 0; p = 0.04). The incidence of UTI was 0.5%, with five cases (0.7%) after UC and zero for noUC (p = 0.34). UTIs were detected at 11 post-operative days (IQR 6-17) and treated with antibiotic agents for 5 days (IQR 5-13). Four UC patients had urinary retention (two required re-catheterization and discharge with an indwelling catheter). One UC urinary \"retainer\" developed a post-operative UTI and required hospital re-admission. There was no urinary retention in the noUC group. There were no bladder injuries. <b><i>Conclusions:</i></b> The incidence of UTI was low following LA; bladder injuries were non-existent. UC-related complications were greater among UC patients, but there was neither urinary retention and post-operative catheterization nor bladder injury in the noUC group; we suggest the omission of UC for LA.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"249-254"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883024","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":"Triple Versus Double Antibiotic Therapy in Children Undergoing Laparoscopic Appendicectomy for Complicated Appendicitis: A Case-Control Study.","authors":"Kai-Zheong Lim, Ramesh M Nataraja, Maurizio Pacilli","doi":"10.1089/sur.2024.322","DOIUrl":"https://doi.org/10.1089/sur.2024.322","url":null,"abstract":"<p><p><b><i>Background and Objectives:</i></b> Historically, a triple-antibiotic (TA) regimen (ampicillin, gentamicin, metronidazole) has been used for children with complicated appendicitis (CA) at our institution. We implemented a double-antibiotic (DA) regimen (ceftriaxone, metronidazole) in November 2018. The aim of this study was to compare the post-operative outcomes between the two groups. <b><i>Patients and Methods:</i></b> Clinical and laboratory data were collected from the medical records of children who underwent laparoscopic appendicectomy (LA) for CA between November 2017 and 2019. Data, reported as number of cases (%) and median with interquartile range or 95% confidence interval (CI), were analyzed with Fisher exact test and Mann-Whitney U test; p values <0.05 were considered significant. <b><i>Results:</i></b> One hundred and ninety-seven patients were identified; 99 treated with the TA regimen and 98 with the DA regimen. The groups had similar demographics. Post-operative complications were similar between the two groups: intra-abdominal abscess (IAA) 12 (12.1%) in TA versus 10 (10.2%) in DA (p = 0.82); surgical site infections 1 (1.0%) in TA versus 2 (2.2%) in DA (p = 0.62). Time to defervescence in the first 5 post-operative days was substantially longer in the TA group: 72 (95% CI 72-96) versus 48 (95% CI 48-72) hours (p = 0.003). Among patients without post-operative IAA, the DA group had a shorter post-operative hospital stay (5 [5-6] vs. 5.5 [5-6] days; p = 0.04). The cost of DA regimen was substantially lower (p < 0.0001). <b><i>Conclusions:</i></b> The DA regimen provided better post-operative temperature control and a quicker overall recovery, without increasing the incidence of IAA and surgical site infection in children following LA for CA.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015256","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 Patterns and Virulence Gene Profiles of <i>Klebsiella pneumoniae</i> Isolated from Surgical Site Infections in Iran.","authors":"Fatemeh Zeynali Kelishomi, Samira Amereh, Fatemeh Ghayyaz, Raana Kazemzadeh Anari, Susan Khanjani, Farhad Nikkhahi","doi":"10.1089/sur.2024.268","DOIUrl":"https://doi.org/10.1089/sur.2024.268","url":null,"abstract":"<p><p><b><i>Background:</i></b> The prevalence of <i>Klebsiella pneumoniae</i> in surgical site infections (SSIs) has increased recently. This study aimed to evaluate the antimicrobial resistance patterns and biofilm formation capacity of <i>K. pneumoniae</i> strains isolated from SSIs. <b><i>Methods:</i></b> A total of 63 <i>K. pneumoniae</i> isolates were obtained from patients with SSIs. Antimicrobial susceptibility testing was determined using the Kirby-Bauer method. Molecular analyses were performed to confirm the presence of virulence and antibiotic resistance genes. Biofilm formation was determined using a semiquantified microtiter plate assay, and optical density measurements were used to classify the isolates into weak, moderate, and strong biofilm producers. Biofilm structure was observed using field-emission scanning electron microscopy. Statistical analyses were performed using SPSS software version 16 (SPSS Inc., Chicago, IL, USA), and data were analyzed and presented in terms of frequency and percentage. <b><i>Results:</i></b> The frequencies of <i>fimH</i>, <i>mrkD</i>, <i>mrkA</i>, <i>wcaG</i>, and <i>magA</i> were 98.4%, 96.8%, 77.7%, 61.9%, and 7.9%, respectively. The highest rates of antibiotic resistance were observed for cefazolin, cefuroxime, and piperacillin/tazobactam and 98.4% of the isolates were resistant to at least one antibiotic agent. The most prevalent resistance genes were <i>bla</i>_SHV (42.8%), <i>bla</i>_CTX-M (31.7%), <i>bla</i>_TEM (28.5%), and <i>bla</i>_OXA48 (22.2%). All the tested isolates were able to produce biofilms, and 76.2% were classified as strong biofilm producers. <b><i>Conclusions:</i></b> <i>Klebsiella pneumoniae</i> is one of the common pathogens in SSIs, and due to its antibiotic resistance and the presence of multiple virulence factors, proper controlling strategies need to be carried out.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047287","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":"Highlights from the 37th Annual Meeting of the Japanese Society of Surgical Infection.","authors":"Robert G Sawyer, Sean M A Sawyer","doi":"10.1089/sur.2025.045","DOIUrl":"https://doi.org/10.1089/sur.2025.045","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050059","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":"Surgical Infection Society Guidelines for Use of Antimicrobial Agent-Coated Suture to Reduce the Risk of Surgical Site Infection after Abdominal Operation.","authors":"Joseph D Forrester, Anu Seshadri, Nimitt Patel, Najhi Farooqi, Janice Lester, Phil Barie, Jared Huston","doi":"10.1089/sur.2025.011","DOIUrl":"https://doi.org/10.1089/sur.2025.011","url":null,"abstract":"<p><p><b><i>Background:</i></b> Abdominal operation is common as are surgical site infections (SSIs). Triclosan (polychlorophenoxyphenol) is an antimicrobial antiseptic used in a variety of consumer products, including suture. The Surgical Infection Society's Therapeutics and Guidelines Committee convened to perform a systematic review and develop pragmatic recommendations for use of triclosan-coated suture in prevention of SSI after an abdominal surgical procedure. <b><i>Methods:</i></b> A research librarian designed and performed searches of three bibliographic databases: PubMed, Embase, and Web of Science. Methodology for this practice management guideline conformed to Reporting Items for practice Guidelines in HealThcare Working Group standards. Covidence was used for study selection and quality and certainty of published evidence was evaluated using GRADE. The clinical question assessed was: \"For adult patients undergoing abdominal surgery, does triclosan-coated suture vs. non-triclosan-coated suture reduce the risk of post-operative SSI?\" <b><i>Results:</i></b> A total of 3,616 studies were identified, with 30 studies involving 97,807 patients informing the clinical question response. Among included studies, 13 (43%) were randomized controlled trials (RCTs) and 17 (57%) were meta-analyses. Seventeen (57%) studies comprising 67,445 (69%) patients demonstrated reduction in SSI, with 13 (43%) studies comprising 30,362 (31%) patients demonstrating no benefit. Estimated cumulative adjusted absolute risk reduction associated with triclosan-coated sutures, among studies demonstrating benefit, was 3.2% (standard deviation ±6.2%). Overall quality of evidence was high. We recommend triclosan-coated suture for incision closure after an abdominal operation to reduce risk of SSI <i>(Grade 1A)</i>. <b><i>Conclusions:</i></b> Higher-level evidence suggests a small but significant benefit for triclosan-coated suture in reducing SSI risk following an abdominal surgical procedure.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027016","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":"Tanshinone IIA Improves Intestinal Barrier Integrity in Septic Rats.","authors":"Lvzhao Liao, Yiying Xiao, Xi Xing, Xi Wang, Jianming Zhou, Wenjing Li, Sixu Pan, Nafei Xu, Ronglin Jiang","doi":"10.1089/sur.2025.012","DOIUrl":"https://doi.org/10.1089/sur.2025.012","url":null,"abstract":"<p><p><b><i>Aims:</i></b> The present work aimed to examine impact of tanshinone IIA on intestinal barrier in sepsis and to explore the underpinning mechanisms. <b><i>Materials and Methods:</i></b> Sepsis induction in Sprague-Dawley (SD) rats was conducted via cecal ligation and puncture (CLP), with subsequent intraperitoneal injection of tanshinone IIA. Intestinal permeability was examined 12 h post-operation using the fluorescein isothiocyanate dextran method. Blood and distal ileum tissue samples were collected for Enzyme-Linked Immunosorbent Assay (ELISA) analysis of oxidative stress and inflammatory markers. Histopathologic examination was performed using hematoxylin and eosin staining and the Terminal deoxynucleotidyl transferase dUTP Nick-End Labeling (TUNEL) assay. Immunofluorescence and immunoblot were performed for protein detection. In vitro, Caco-2 cells were administered lipopolysaccharide (LPS) followed by tanshinone IIA treatment, and pregnane X receptor (PXR) and cytochrome P450-3A4 (CYP3A4) protein levels were assessed. <b><i>Results:</i></b> In sepsis model rats, tanshinone IIA dose-dependently reversed the increased intestinal permeability, bacterial shift rate, ileum Chiu's score, apoptosis level of ileal mucosa, the elevated serum and ileal Malondialdehyde (MDA), Interleukin-1 beta (IL-1β), and Tumor Necrosis Factor-alpha (TNF-α) amounts, and the enhanced ileal expression levels of Proto-oncogene c-Fos (<i>c-Fos</i>) and tryptase proteins. In addition, tanshinone IIA restored the decreased serum and ileal Superoxide Dismutase (SOD) levels and reversed the reduced ileal expression levels of claudin-1, Junctional Adhesion Molecule (JAM), occludin, and ZO-1. In vitro, tanshinone IIA restored PXR and CYP3A4 levels following LPS stimulation. <b><i>Conclusion:</i></b> Tanshinone IIA exerts a protective effect in murine CLP-induced sepsis. The underlying mechanism may involve activation of the PXR-CYP3A4 pathway in murine intestinal epithelial cells.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052635","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":"Splenectomy for the Treatment of Splenomegaly in People Living with HIV: An Uncommon Complication.","authors":"Pablo Gomes-da Silva de Rosenzweig, Oscar Mario Delgado-Casillas, Juan Carlos Vázquez-Minero, Ricardo Stanley Vega-Barrientos","doi":"10.1089/sur.2025.003","DOIUrl":"https://doi.org/10.1089/sur.2025.003","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The objective of this study was to describe the clinical and microbiologic characteristics of adult patients with HIV infection and splenomegaly treated with splenectomy. <b><i>Methods:</i></b> We conducted a retrospective study, including patients with the diagnosis of HIV and splenomegaly treated with splenectomy between 2005 and 2023. <b><i>Results:</i></b> We included 20 patients with a mean age of 36 years (±2), with a predominance of males (n = 18). Some patients had more than one condition associated with splenomegaly. The following were considered as the indication for splenectomy: Splenic abscesses in 13 (65%), refractory thrombocytopenia in 9 (45%), symptomatic splenomegaly in 5 (25%), and splenic lymphoma in 1 (5%). After operation, spleen samples were sent for microbiology culture, displaying the invasion of bacteria in 11 (55%), fungi in 8 (40%), and viruses in 8 (40%). When evaluating the indications for splenectomy between groups, splenic abscesses were more present in those patients without active treatment (83% vs. 38%, p = 0.035), whereas symptomatic splenomegaly presented more frequently in those with active antiretroviral therapy (ART; 63% vs. 0%, p = 0.004). <b><i>Conclusions:</i></b> The cornerstone of treatment for patients with splenomegaly should initially focus on adherence to ART and addressing the underlying cause. However, when the condition is refractory splenectomy may be indicated.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039801","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":"Lactate Levels and Their Relation to Surgical Site Infections in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.","authors":"İsa Caner Aydın, Ahmet Orhan Sunar, Serkan Ademoğlu, Ömer Özduman, Uğur Duman, Selçuk Gülmez, Mustafa Duman, Erdal Polat","doi":"10.1089/sur.2025.006","DOIUrl":"https://doi.org/10.1089/sur.2025.006","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Peritoneal carcinomatosis (PC) patients undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) face a high risk of morbidity. Surgical site infections (SSIs) are among the main contributors to this issue. This relation is influenced not only by the effects of major surgical resections but also by the hemodynamic changes induced by HIPEC. Although elevated lactate levels (LL) have been associated with greater complication rates in CRS-HIPEC patients, their direct association with the development of SSIs has not been thoroughly investigated. <b><i>Methods:</i></b> Patients who underwent CRS + HIPEC were retrospectively reviewed. Pre-operative demographic data, hemodynamic parameters and records, transfusion records, and all post-operative follow-up and treatment records were analyzed. Patients were categorized into SSI+ and SSI-. Factors contributing to SSI development were examined using regression analysis. <b><i>Results:</i></b> A total of 110 patients who underwent CRS + HIPEC between January 2018 and December 2021 were included in the study. LL obtained at intensive care unit (ICU) admission were greater in patients who developed SSIs (p = 0.020). Cutoff point for ICU admission LL in diagnosing SSI was ≥6 mmol/L (area under the curve: 0.640 [0.526-0.753], p = 0.020). SSI development (23% vs. 50%, p = 0.003) was more prevalent in patients with lactate values ≥6 mmol/L. In multi-variable analysis, LL ≥6 mmol/L (odds ratio [OR]: 4.614, p = 0.005) and clean-contaminated wounds (OR: 27.677, p = 0.002) were related with increased SSI development. <b><i>Conclusion:</i></b> In patients with PC, LL of 6 mmol/L or greater during the ICU stay have been associated with SSI development. For this high-risk patient subgroup, a readily available peri-operative parameter such as lactate may guide prophylactic antibiotic selection. However, despite its high specificity, the low sensitivity of our findings should be carefully considered before clinical decision-making. Further studies analyzing larger, more homogeneous cohorts are needed to better clarify the relation between LL, SSI development, and prophylactic antibiotic use.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050061","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":"What Are the Optimal Irrigating Wound Vacuum Parameters When Using Bacteriophage Therapeutics?","authors":"Nazary Nebeluk, Daria Van Tyne, Kapil Saharia, James B Doub","doi":"10.1089/sur.2025.029","DOIUrl":"https://doi.org/10.1089/sur.2025.029","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Bacteriophages are promising adjuvant anti-biofilm agents. Yet novel ways to repeatedly administer bacteriophages in vivo are needed. One technique utilizes irrigating wound vacuum systems. However, the proper parameters to use with bacteriophages are poorly defined. Therefore, the objective of this study was to elucidate proper bacteriophage irrigating vacuum parameters. <b><i>Methods:</i></b> Individual <i>Pseudomonas aeruginosa</i> and <i>Staphylococcus aureus</i> clinical isolates were allowed to form biofilms in microwell plates and then exposed to repeated irrigations with saline or with bacteriophages over 8 hours. The repeated irrigations corresponded to theoretical different dwell times of the irrigating vacuum system. Residual biofilm mass was compared among groups by staining with crystal violet and measuring optical density. <b><i>Results:</i></b> As the number of saline irrigations increased, there was less biofilm burden, and this was substantially less than growth controls (p < 0.05). When compared with saline, bacteriophages substantially reduced biofilms except for the <i>P. aeruginosa</i> bacteriophage at dwell times of 20 minutes. Furthermore, bacteriophages caused no observable colony forming units per milliliter for all dwell times except 20-minute dwell times, and this was statistically significant (p < 0.05) when compared with saline infusions. <b><i>Conclusions:</i></b> Frequent irrigation with shorter dwell times facilitates biofilm disruption and reduces bacterial burden. However, if dwell times are too short, bacteriophages may not have sufficient time to hydrolyze biofilm and to infect and kill bacteria. On the basis of our model, we propose a minimum of 1 hour dwell time but appreciate that more translational research is needed to refine these approaches.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023735","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":"Liver Transplantation Is Associated with Vancomycin-Resistant <i>Enterococcus</i> Bacteremia at an Academic Medical Center in Loma Linda, California, 2016-2023.","authors":"Eugene W Liu, Hala Nashed, James M Pappas","doi":"10.1089/sur.2024.312","DOIUrl":"10.1089/sur.2024.312","url":null,"abstract":"<p><p><b><i>Background:</i></b> Loma Linda University Medical Center has had rates of hospital-onset vancomycin-resistant <i>Enterococcus</i> blood stream infections (HO VRE BSIs) above the statewide rate among major teaching hospitals in California. We sought to identify factors associated with this high rate. <b><i>Methods:</i></b> We conducted retrospective case-control studies, first comparing cases of HO VRE BSI with controls with HO vancomycin sensitive <i>Enterococcus</i> BSI. HO BSI was defined as a positive blood culture specimen collected ≥72 h after hospital admission. Inpatients were identified from microbiology records 2016-2023. For each hospitalization complicated by HO BSI, we compared gender, age, prior history of VRE, and specific admission diagnoses. In secondary analysis, we compared liver transplant recipients 2016-2024 with/without HO VRE BSI by the same variables and also by severity of illness, prior biliary interventions, and inpatient antibiotics received within 180 days before transplant. <b><i>Result:</i></b> Among 137 cases and 139 controls, age (odds ratio [OR] 1.03; 95% confidence interval [CI] = 1.01-1.04), history of VRE in the past year (13.98; 4.10-47.64), and liver transplant recipient status (3.96; 1.25-12.52) were independently associated with increased odds of HO VRE BSI. Among liver transplant recipients, receipt of piperacillin/tazobactam (1.11; 1.03-1.20) was independently associated with increased odds of HO VRE BSI. <b><i>Conclusion:</i></b> The association of HO VRE BSI with liver transplant could explain the higher rate of HO VRE BSI in our institution. These results, in combination with secondary analysis on liver transplant patients, suggest VRE infection control should focus on liver transplant populations and antibiotic stewardship with broad-spectrum antibiotics.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023734","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}