Surgical infections最新文献

{"title":"Ventilator-Associated Pneumonia Predicts Severe Cognitive Disability in Severe Traumatic Brain Injury.","authors":"Shruthi Srinivas, Kelly Nahum, Christopher Gilliam, William Brigode, Stephanie Doris, Tanya Egodage, Michelle Kincaid, Anna Liveris, Katherine McBride, Kaushik Mukherjee, Philip Edmundson, Liz Penaloza-Villalobos, Jacob W Roden-Foreman, Joy Song, Johanna Stecher, Anthony Tigano, Brett Tracy","doi":"10.1089/sur.2024.208","DOIUrl":"10.1089/sur.2024.208","url":null,"abstract":"<p><p><b><i>Background:</i></b> Ventilator-associated pneumonia (VAP) is linked to poor outcomes in patients with severe traumatic brain injury (TBI), yet its effect on cognitive disability is unknown. We hypothesized that there would be an association between severe cognitive disability and VAP in this patient population. <b><i>Methods:</i></b> We performed a post hoc analysis of a prospective, multi-center, observational study of adults with a severe, blunt TBI from 2020 to 2023. Patients were grouped by whether they developed VAP. Our primary outcome was severe cognitive disability, defined as a disability rating scale (DRS) score >13 at discharge (or 28 days post-injury if not discharged). <b><i>Results:</i></b> There were 309 patients in the cohort; 31.7% (<i>n</i> = 98) developed VAP. The VAP group had greater incidences of diffuse axonal injury (37.3% vs. 22.3%, p = 0.004), neurosurgical interventions (63.3 vs. 38.4%, p < 0.001), and tracheostomies (72.5% vs. 28.9%, p < 0.001). Patients with VAP had a longer duration of mechanical ventilation (13 d vs. 3 d, p < 0.001). Among patients with VAP, median time to diagnosis was 7 days (4-12), time to tracheostomy was 10 days (7-16), and time between the two events was 4 days (2-11). Greater proportions of cognitive disability (64.3% vs. 19.9%, p < 0.001) and worse median DRS scores (8 vs. 2, p < 0.001) occurred in the VAP group. On multi-variable regression analysis, VAP was an independent risk factor for severe cognitive disability (adjusted odds ratio [aOR]: 4.2, 95% CI: 2.2-7.8). <b><i>Conclusion:</i></b> Ventilator-associated pneumonia is common among patients with a severe TBI and is a risk factor for severe cognitive disability. Adherence to VAP prevention techniques may help mitigate cognitive impairment in this population.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"279-285"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080995","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":"Deep Surgical Site Infection with Epidural Abscess Following Anterior Cervical Discectomy and Fusion: A Case Report and Incidence Analysis in Sweden.","authors":"Ryo Fujita, Ioannis Georgopoulos, Pavlos Vlachogiannis, Katrin Ivars, Paul Gerdhem, Anna MacDowall","doi":"10.1089/sur.2025.013","DOIUrl":"10.1089/sur.2025.013","url":null,"abstract":"<p><p><b><i>Background:</i></b> Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with a low complication rate. Although dysphagia and recurrent laryngeal nerve paralysis are well-documented, deep surgical site infections (SSIs) are rare (0.03%-0.3%). This report presents a rare case of deep SSI with an epidural abscess post-ACDF and analyzes the incidence of SSI in Sweden using Swespine data. <b><i>Case Presentation:</i></b> A 55-year-old female developed cervicothoracic pain and bilateral arm pain three weeks after C6/7 ACDF. Imaging confirmed deep SSI with an epidural abscess. Despite antibiotic agents, reoperation was required 37 days post-operatively, involving C7 corpectomy and titanium reconstruction. Cultures identified oral flora, suggesting hematogenous spread from untreated dental caries. Swespine data showed a 0.05% incidence of deep SSI among 9,382 cases. <b><i>Conclusions:</i></b> Deep SSI following ACDF is an exceptionally rare but serious complication. Cervicothoracic pain may indicate SSI, and pre-operative dental care is advisable to reduce infection risk.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"359-363"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658267","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> Physics-Biology-Chemistry Model: A New Clinical Proposal for Intra-Abdominal Infections.","authors":"Fengping Zhang, Xurui Zhang, Chang Liu, Jingyao Zhang","doi":"10.1089/sur.2024.305","DOIUrl":"10.1089/sur.2024.305","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"355-356"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059420","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":"Extended Post-Operative Antibiotic Usage Does Not Reduce Surgical Site Infections after Spinal Surgery.","authors":"Sade Olatunbosun, Brian L Hollenbeck","doi":"10.1089/sur.2024.258","DOIUrl":"10.1089/sur.2024.258","url":null,"abstract":"<p><p><b><i>Background:</i></b> Currently there is not a clear basis of evidence for post-operative antibiotic duration in spine surgery. A better understanding of risk factors and proper dosing for antibiotics will help improve outcomes and further define appropriate antibiotic use. <b><i>Patients and Methods:</i></b> A single-center retrospective cohort study of all patients undergoing spinal fusions and/or decompressions between January 1, 2018, and July 1, 2023 was performed. Patient demographic data and surgical information were collected. The exposure variable assessed was the duration of post-operative antibiotic administration. The primary outcome was incidence of surgical site infections (SSI). Uni-variable and multi-variable analysis were used to determine risk factors for infection. <b><i>Results:</i></b> A total of 5,656 procedures were performed by 25 different orthopedic spine- or neurosurgery-trained surgeons. The incidence of SSI was similar between the ≤24 h of antibiotic group and the >24 h antibiotic group, 0.50% and 0.45%, respectively (p = 0.769). In multi-variable analysis, only a body mass index (BMI) over 30 was associated with increased risk for SSI (odds ratio 2.54 [1.12, 5.74]). <b><i>Conclusion:</i></b> We observed no significant difference in the incidence of SSI among patients who were administered ≤24 h of post-operative antibiotics compared with those who we administered >24 h post-operative antibiotics. A BMI ≥30 was a risk factor for SSI in both uni-variable and multi-variable analysis.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"331-335"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011939","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> Rectal Adenocarcinoma in Children: An Uncommon Cause of Perforation and Sepsis.","authors":"Mohamed Zouari, Manel Belhajmansour, Rami Zouari, Wiem Rhaiem, Najoua Ben Kraiem, Mahdi Ben Dhaou, Riadh Mhiri","doi":"10.1089/sur.2025.005","DOIUrl":"10.1089/sur.2025.005","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"357-358"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587127","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":"Comparison of Multi-Drug Resistant Organisms Causing Early Ventilator-Associated Pneumonia in Three Geographically Distinct Trauma Intensive Care Units.","authors":"Joseph M Swanson, Peyton C Cole, Julie E Farrar, Kristina L Smith, Andrew J Kerwin, G Christopher Wood, Dina M Filiberto","doi":"10.1089/sur.2024.149","DOIUrl":"10.1089/sur.2024.149","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> It is unclear why differences in patient location change organisms causing ventilator-associated pneumonia (VAP). We investigated VAP organisms in three geographically separate trauma intensive care units (TICUs). <b><i>Patients and Methods:</i></b> A retrospective review of organisms causing VAP (bronchoalveolar lavage [BAL] performed ≤7 d after admission and growing ≥10⁵ cfu/mL) in three geographically separate TICUs was conducted. Patients were treated by similar multidisciplinary teams and protocolized pathways. The primary outcome was the incidence of multi-drug resistant (MDR) VAP. Secondary outcomes were the incidence of inappropriate empiric antimicrobial therapy (IEAT) and the determination of risk factors for MDR VAP. Chi-squared, Kruskal-Wallis, and multi-variable logistic regression analyses were used accordingly. <b><i>Results:</i></b> In total, 271 patients were included: 142 in TICU-1, 63 in TICU-2, and 66 in TICU-3. The incidence of MDR VAP was similar across TICUs at 33.8%, 47.6%, and 39.4%, respectively (p = 0.17). Gram-negative MDRs were more prevalent in TICU-1 (70.8%) versus TICU-2 (60.0%) or TICU-3 (26.9%) (p = 0.001). Gram-positive MDRs were identified more in TICU-3 (73.1%) versus TICU-2 (43.3%) or TICU-1 (35.4%). IEAT did not differ by unit overall but was significantly greater for MDR gram-positive organisms in TICU-3 (70.4%) versus TICU-2 (44.8%) or TICU-1 (37.5%) (p = 0.02) and highest for MDR gram-negative organisms in TICU-1 (64.6%) versus TICU-2 (62.1%) or TICU-3 (55.8%) (p = 0.02). Multi-variable regression analyses revealed antibiotic days before BAL and kidney replacement therapy (KRT) as significant predictors of MDR VAP. <b><i>Conclusions:</i></b> Different TICU locations did not influence the overall incidence of MDR VAP, but differences in MDR organisms were observed. IEAT rates for both gram-positive and gram-negative organisms in different units may necessitate changes in empiric therapy. Antibiotic days prior to the BAL and KRT significantly increased the odds of early MDR VAP.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"324-330"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Drain Removal Timing and Prophylactic Antibiotic Agents on Surgical Site Infections in Head and Neck Reconstruction.","authors":"Haruyuki Hirayama, Katsuhiro Ishida, Keita Kishi, Hiroki Kodama, Masaki Nukami, Taisuke Akutsu, Soichiro Fukuzato, Takeshi Miyawaki","doi":"10.1089/sur.2024.214","DOIUrl":"10.1089/sur.2024.214","url":null,"abstract":"<p><p><b><i>Background:</i></b> Regarding drain removal timing in head and neck reconstruction, each institution applies its criteria, and a clear consensus has not been established. This pre-post study aims to identify risk factors for surgical site infection (SSI) after reconstructive surgical procedure for head and neck cancer, specifically examining the influence of drain removal timing. <b><i>Patients and Methods:</i></b> A cohort of 220 patients undergoing reconstructive surgical procedure was analyzed. Patients had closed suction drains removed on post-operative day (POD) 2 or POD3. The primary endpoint was SSI incidence within 30 days after operation. Secondary endpoints included the incidence of hematoma and lymphorrhea within 30 days after operation and drain tip culture results. Statistical analyses were performed using Fisher exact test and logistic regression models. <b><i>Results:</i></b> SSIs occurred in 14.5% of patients, with no significant difference between the POD2 (14.6%) and POD3 (14.5%) groups. No substantial differences were found for hematoma and lymphorrhea. The positive rate of drain tip cultures was significantly greater in the POD3 group (38.2%) compared with the POD2 group (18.0%). Multi-variable analysis showed no correlation between SSI and POD3 drain removal (odds ratio [OR], 0.728; p = 0.471). However, significant SSI risk factors included oral cavity lesions (OR, 3.510; p = 0.003) and ampicillin prophylaxis (OR, 5.266; p < 0.001). <b><i>Conclusions:</i></b> Oral cavity lesions and ampicillin prophylaxis were substantial SSI risk factors in reconstructive surgical procedure for head and neck cancer. However, drain removal timing did not significantly affect SSI incidence or other complications. Considering benefits such as shorter hospital stays and less chance of retrograde bacterial invasion, removing drains on POD2 is preferable compared with removal on POD3. Further research is needed to refine prophylactic protocols and enhance patient outcomes.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"309-318"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotics and Surgically Treated Acute Appendicitis, When, Where, and Why?","authors":"Andrew Hendrix, Alexander Kammien, Adrian A Maung, Bishwajit Battacharya, Kimberly A Davis, Kevin M Schuster","doi":"10.1089/sur.2024.264","DOIUrl":"10.1089/sur.2024.264","url":null,"abstract":"<p><p><b><i>Background:</i></b> Antibiotics within an hour of incision reduce the incidence of surgical site infection (SSI) in clean-contaminated abdominal surgery. However, patients undergoing emergency surgery for an intra-abdominal infectious process often receive treatment antibiotics and may not benefit from additional pre-incisional antibiotics (POA). We hypothesized that POA would not lead to a reduction in the occurrence of SSIs following emergency appendectomy. <b><i>Patients and Methods:</i></b> All patients at a single institution undergoing emergency appendectomies for acute appendicitis from 2013 to 2020 were included. Age, gender, perforation, body mass index (BMI), Elixhauser comorbidity index (ECI), surgical approach, emergency department antibiotics (EDA), EDA administration time, and pre-operative antibiotics were abstracted. Primary outcomes were superficial/deep and organ-space SSIs. Bi-variable logistic regression models assessed the independent impact of each tactic. Multi-variable models compared those receiving pre-incisional cefazolin with those receiving no POA. <b><i>Results:</i></b> Patients (n = 1380) had a mean age (standard deviation) of 39.5 (17.0) years, and 48.6% were female. Age, gender, perforated appendicitis, EDA, ECI, and BMI all were predictive of infection. POA were not predictive of SSI (p = 0.632). After adjustment for age, gender, perforation, EDA, EDA administration timing, ECI, and BMI, only perforation (odds ratio [OR]: 17.08, 95% confidence interval [CI] = 6.97-51.43) and male gender (OR: 2.75, 95% CI = 1.29-6.43) were associated with organ-space infection, whereas pre-incisional cefazolin was not (OR: 0.83, 95% CI = 0.38-1.97). Emergency department broad-spectrum antibiotics were associated with a lower incidence of superficial/deep infection (OR: 0.06, 95% CI = 0.00-0.68); however, pre-incisional cefazolin was not (OR: 0.71, 95% CI = 0.08-15.34). <b><i>Conclusion:</i></b> For patients undergoing emergency appendectomies who have received broad-spectrum antibiotic treatment, additional pre-incisional cefazolin does not reduce the incidence of superficial/deep or organ-space SSI.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"349-354"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Percutaneous Drain Placement and Impact on Patient Outcomes.","authors":"Tien Pham, Jacob C O'Dell, Jocelyn E Hunter Rose, Aaron Rohr, Matthew Johnson, Andrew Dulek, Robert D Winfield, Stepheny D Berry, Jennifer L Hartwell, Scott A Turner, Erich Wessel, Stephen R Eaton, C Cameron McCoy, Christopher A Guidry","doi":"10.1089/sur.2024.231","DOIUrl":"10.1089/sur.2024.231","url":null,"abstract":"<p><p><b><i>Background:</i></b> Percutaneous drains are a commonly used method of source control for intra-abdominal infections. Increased time to source control has been shown to predict worse outcomes in patients with intra-abdominal infections, but it is unclear whether this relationship is valid when the source control method is percutaneous drainage. <b><i>Hypothesis:</i></b> We hypothesized that increased time from diagnostic imaging to drain placement would be associated with higher complication rates in a population of patients requiring percutaneous drainage for intra-abdominal, retroperitoneal, or pelvic infectious processes. <b><i>Methods:</i></b> We identified all adult patients who received a percutaneous drain placed by interventional radiology that had positive microbial drain culture results in the abdomen, retroperitoneum, or pelvis from 2020 to 2021 at the University of Kansas Medical Center. Demographics, comorbidities, and Sequential Organ Failure Assessment (SOFA) scores were collected. Multiple organ failure was defined as derangement of two or more organ systems with an SOFA ≥ 3. Standard univariate and logistic regression analyses were performed. <b><i>Results:</i></b> One hundred seventy patients were included, 94 of whom developed a complication (52%). Drain placement occurred at a median of 20.6 hours (inter-quartile range or IQR: 11.3-31.0 h) overall. Both uni-variable and logistic regression analyses demonstrate that time from imaging read to drain placement did not differ between the complication and non-complication groups. <b><i>Conclusion:</i></b> In this observational study, the time from diagnosis of intra-abdominal infection to percutaneous drain placement was not associated with increased complication rates even in the sickest patients.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"286-291"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Finegoldia magna:</i> An Infrequent Guest in Orthopedic Infections.","authors":"Santiago Gabardo, Cristina Ortega-Portas, Jaime Esteban, Antonio Blanco-García, Álvaro Auñón","doi":"10.1089/sur.2024.134","DOIUrl":"10.1089/sur.2024.134","url":null,"abstract":"<p><p><b><i>Background:</i></b> <i>Finegoldia magna</i> is a species of anaerobic gram-positive coccus considered part of human microbiota. It has been described as a cause of skin and soft tissue infections, but it is not a common cause of operation-related infections. <b><i>Objectives:</i></b> Describe the characteristics, treatment, and results of musculoskeletal infection by <i>F. magna</i> treated in our center. <b><i>Methods:</i></b> We performed a descriptive, retrospective observational study. Clinical records of all musculoskeletal surgical infections treated in our department between 2012 and 2022 were reviewed. We selected the patients with a positive culture for <i>F. magna</i>. Risk factors for infection, patient's medical records, previous operation performed, time from surgical procedure to infection, susceptibility tests, antibiotic and surgical treatment for the infection, and recovery rate were registered for the analysis. <b><i>Results:</i></b> Twenty patients have positive cultures for <i>F. magna</i>, representing 15.5% of the anaerobic infections. Eleven of them were arthroplasties, three fracture synthesis, two foot operations, two spinal operations, and two soft tissue operations. All patients underwent operation and antibiotic treatment. The most commonly used antibiotic scheme was amoxicillin followed by amoxicillin-rifampicin. Eighty percent of the patients achieved a complete clinical recovery with a mean of 2.1 surgical procedures. Patients with polymicrobial infections required twice the number of operations (p = 0.047) and exhibited a failure rate of 36% compared with 0% for monomicrobial cases (p = 0.043). <b><i>Conclusions:</i></b> Orthopedic infections caused by <i>F. magna</i> are infrequent, but they usually have good outcomes. Polymicrobial infection with <i>F. magna</i> exhibits poorer clinical results and requires a greater number of operations compared with monomicrobial ones.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"319-323"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}