Surgical infections最新文献

{"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}

{"title":"<i>Letter:</i> Outcomes of the Subsequent Periprosthetic Joint Infection Revisions after a Failed Debridement, Antibiotics, and Implant Retention: A Multicentric Study of 197 Patients.","authors":"Xiangji Liu, Hao Wu","doi":"10.1089/sur.2025.004","DOIUrl":"10.1089/sur.2025.004","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"451-452"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650886","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":"Closed Incisional Negative Pressure Wound Therapy is Cost-Effective at Reducing Superficial Surgical Site Infections.","authors":"Lauren T Kerivan, Katherine A Vilain, Terra M Hill, Christopher A Guidry","doi":"10.1089/sur.2024.286","DOIUrl":"10.1089/sur.2024.286","url":null,"abstract":"<p><p><b><i>Background:</i></b> Surgical site infections (SSIs) have a significant health economic burden, accounting for more than US $3.3 billion in costs, and lead to increased microbial resistance, prolonged hospital stays, elevated 30-day mortality rates, greater incidences of reoperation, and decreased quality of life. Recently, evidence has emerged suggesting that prophylactic closed incision negative pressure wound therapy (ciNPWT) may substantially reduce the risk of post-operative wound complications, specifically SSIs. This study aimed to evaluate whether ciNPWT is cost-effective compared with routine incision care for the prevention of superficial SSIs. <b><i>Hypothesis:</i></b> We hypothesized that ciNPWT is cost-effective compared with routine incision care for the prevention of superficial SSIs. <b><i>Methods:</i></b> A cost-effectiveness decision analytic model was created comparing the use and non-use of ciNPWT. Superficial SSI probabilities, cost of care for patients with and without post-operative infection, and quality of life Short Form (SF)-36 survey data were obtained from a literature review. Cost of ciNPWT was obtained from health administrative data. A decision tree was constructed using TreeAge Software Pro Version 2020 (TreeAge Software, Inc., Williamstown, MA). Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness and reliability of the model. <b><i>Results:</i></b> One-way sensitivity analysis with a willingness-to-pay threshold of $5,000 demonstrated that above a baseline infection rate of approximately 6.4%, ciNPWT is cost-effective at reducing superficial SSI. Probabilistic sensitivity analysis indicated that even with uncertainty present in the parameters analyzed, the majority of simulations (95.4%) favored ciNPWT as the more effective tactic. <b><i>Conclusions:</i></b> Despite the added device cost, ciNPWT is cost-effective for superficial SSI prevention across a variety of surgical infection risk profiles.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"413-419"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664609","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, Najiha Farooqi, Janice Lester, Phil Barie, Jared Huston","doi":"10.1089/sur.2025.011","DOIUrl":"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":"441-450"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","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":"Predictive Value of Stone Management According to Size-Hardness (SMASH) Score for Post-Operative Fever after Ureteroscopy.","authors":"Rıdvan Kayar, Kemal Kayar, Emrah Özsoy, İlker Artuk, Samet Demir, Emre Tokuc, Metin Öztürk","doi":"10.1177/10962964251365523","DOIUrl":"https://doi.org/10.1177/10962964251365523","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Post-operative fever (POF) is a common infectious complication following ureteroscopy (URS). Early identification of high-risk patients may help reduce morbidity and optimize peri-operative management. This study aimed to evaluate the predictive value of the Stone Management According to Size-Hardness (SMASH) score-a composite index based on stone size and density-for forecasting POF after URS. <b><i>Patients and Methods:</i></b> We retrospectively analyzed 143 patients who underwent semi-rigid and flexible URS for unilateral ureteral stones between January 2023 and January 2025. Demographic, radiological, and operative parameters were recorded, including SMASH score, Hounsfield unit (HU), stone size and location, operative time, and hydronephrosis. POF was defined as a body temperature ≥38.3°C with a positive urine culture. Comparative and receiver operating characteristic curve analyses were performed to assess predictors of POF. <b><i>Results:</i></b> POF occurred in 17 patients (11.9%). The febrile group had significantly higher SMASH scores (median: 8.08 vs. 5.09, p = 0.001), HU values (720 vs. 626, p = 0.006), and longer operative times (41 vs. 34 min, p = 0.001). Proximal stone location was also more common in the febrile group (p = 0.001). No significant differences were observed in age, gender, comorbidities, or hydronephrosis. <b><i>Conclusions:</i></b> Elevated SMASH scores, longer operative time, and proximal stone location were independently associated with POF after URS. The SMASH score may serve as a useful tool for pre-operative risk stratification, allowing for enhanced peri-operative precautions in high-risk patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754358","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}