Surgical infections最新文献

{"title":"Comparing Outcomes and Infection Risk in Medical, Surgical, and Trauma Intensive Care Patients with Alcohol Use Disorder.","authors":"Kristin P Colling, Alexandra K Kraft, Melissa L Harry","doi":"10.1089/sur.2024.044","DOIUrl":"10.1089/sur.2024.044","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Alcohol is the most frequently abused drug in the United States, and alcohol use disorder (AUD) is a common comorbidity in intensive care units (ICUs). <b><i>Patients and Methods:</i></b> We performed a retrospective chart review of patients admitted to an ICU between January 2017 and March 2019 at a tertiary hospital serving a large rural population. Patients with diagnoses of AUDs were included. Patients were excluded if they did not require ICU care. Patient demographics, hospital course, infection type, culture results, and mortality were evaluated. We compared medical, surgical, and trauma ICU patient outcomes and infections. <b><i>Results:</i></b> In total, 527 patients met inclusion and exclusion criteria. Trauma ICU patients had the least pre-existing comorbidities, and surgical ICU patients had the longest lengths of stay. There was no difference in in-hospital mortality between ICU groups; however, surgical and medical ICU patients had significantly greater rates of in-hospital mortality compared with trauma ICU patients. Infections were common across all ICU types, occurring in 40% of patients. There was no difference in infection rate between ICU types. In multi-variable analysis controlling for age, gender, liver failure, chronic kidney disease, thrombocytopenia, complications, and blood transfusions, infection remained an independent predictor of in-hospital mortality (adjusted odds ratio 3.3, 95% confidence interval 1.7-6.4). Septic shock occurred in 57% of infections and was associated with an increased risk of mortality (38% vs. 2%, p < 0.001). Pneumonia was the most common infection occurring in 28% of the cohort, followed by bacteremia (7%), skin/soft tissue infections (6%), urinary tract infection (5%), intra-abdominal infections (4%), and <i>C. difficile</i> (2%). <b><i>Conclusions:</i></b> AUDs in all types of ICU patients are associated with high rates of infections and high morbidity and mortality.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"292-303"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047954","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":"Direct Peritoneal Resuscitation in Critically Ill Patients with an Open Abdomen is Associated with Increased Risk of Intraperitoneal Fungal Infections.","authors":"Cassandra A Cairns, James Martinson, Lindsay O'Meara, Roumen M Vesselinov, Jose J Diaz, Mira Ghneim","doi":"10.1089/sur.2024.128","DOIUrl":"10.1089/sur.2024.128","url":null,"abstract":"<p><p><b><i>Background:</i></b> Damage control laparotomy (DCL) is a well-established tool to stabilize critically ill surgical patients. Direct peritoneal resuscitation (DPR), whereby the open abdomen is continuously irrigated with glucose-based hypertonic dialysate, is a valuable adjunct that improves abdominal closure rates and decreases wound complications. Infectious implications of its use remain underexplored. <b><i>Objective:</i></b> To assess the impact of DPR on the incidence intra-abdominal fungal infections (AFIs) in critically ill surgical patients. <b><i>Methods:</i></b> A retrospective chart review was performed of trauma and emergency general surgery patients undergoing DCL with and without DPR at our level 1 trauma center. The effect of DPR on the primary outcomes was assessed using two-stage logistic regression models. Classification and Regression Tree (CART) models were used to evaluate the leading factors contributing to the primary outcome. <b><i>Results:</i></b> A total of 169 patients were included in the study, 44% of which underwent DPR. Overall, patients who underwent DPR received a more frequent diagnosis of AFIs (28% vs. 13%, p = 0.012). After multi-variable adjustment, patients undergoing post-operative DPR had significantly higher odds of developing AFI (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 1.3-18.5). In hybrid-logit CART models, DPR was again identified as being associated with an increased likelihood of developing AFI (OR = 2.4, 95% CI: 1.0-6.0). <b><i>Conclusion:</i></b> In this cohort, DPR patients had significantly higher chances of developing AFIs. This supports the need for further investigation into the clinical implications of AFIs in critically ill surgical patients and the need to develop risk mitigating strategies.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"343-348"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12172637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392113","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":"Financial and Clinical Toxicity of Empiric Vancomycin for Intra-Abdominal Infections: A Cohort Study.","authors":"Laura M Ebbitt, Jeremy D VanHoose, Samantha Manci, Aric Schadler, Abigail Leonhard, Jitesh A Patel","doi":"10.1089/sur.2024.269","DOIUrl":"https://doi.org/10.1089/sur.2024.269","url":null,"abstract":"<p><p><b><i>Background:</i></b> Vancomycin for intra-abdominal infections (IAI) should be reserved for healthcare-acquired infections, history of multiple interventions, or methicillin-resistant <i>Staphylococcus aureus</i> (MRSA). The MRSA incidence is low; however, fear of missing MRSA leads to overutilization. <b><i>Methods:</i></b> This single-center retrospective cohort study evaluated the cost and risks of empiric vancomycin for IAI. The primary objective was to determine the incidence of MRSA-positive culture and surveillance testing. Secondary outcomes included acute kidney injury (AKI) incidence, progression to dialysis, direct costs of vancomycin overutilization, length of stay, and 30-day mortality. <b><i>Results:</i></b> A total of 1,045 patients with IAI were identified and 491 (47%) received at least one dose of vancomycin. Thirty patients (2.9%) grew MRSA. Of those who grew MRSA, 21 (70%) were MRSA positive on the surveillance multi-drug resistance (MDR) culture or by polymerase chain reaction during hospitalization. There were no deaths within the MRSA group. AKI developed in 351 (33.6%) patients during their hospitalization, with 49.6% occurring within 48 hours of vancomycin administration. Of the 65 patients (6.9%) who required dialysis, 27 patients (42%) received vancomycin. The cost of unnecessary doses equated to $21,655 and $188,643.84 for vancomycin levels. <b><i>Conclusion:</i></b> Given the low MRSA culture incidence, it is reasonable to avoid vancomycin as empiric treatment for those being admitted for IAI alone to reduce the risk of AKI and reduce healthcare costs. Vancomycin should be limited mainly to those with a positive MRSA culture with consideration of vancomycin in those at highest MRSA risk such as a history of MRSA or known MRSA colonization.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180179","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":"Nomogram for Predicting Post-Operative Pulmonary Infection in Patients with Traumatic Intra-Cranial Hematoma.","authors":"Jian-Rong Yu, Hai Hu, Hong Luo, Zhi Yang, Jun-Tao Tan, Qin Zhuang","doi":"10.1089/sur.2025.054","DOIUrl":"https://doi.org/10.1089/sur.2025.054","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study sought to determine key risk factors for post-operative pulmonary infections (PPIs) in traumatic intra-cranial hematoma (TICH) patients and to develop a nomogram for evaluating infection risk. <b><i>Methods:</i></b> A retrospective analysis was performed on TICH patients at a single-center hospital between October 2014 and September 2023. Key risk factors for PPI were identified using multi-variable logistic regression analysis, which were subsequently incorporated into a nomogram. Internal validation of the model was performed to assess its reliability and accuracy. <b><i>Results:</i></b> This study included 252 TICH patients, identifying significant risk factors for PPI such as age ≥60 years (odds ratio [OR]: 3.45, 95% confidence interval [CI]: 1.89-6.78, p < 0.001), smoking history (OR: 2.95, 95% CI: 1.56-5.24, p < 0.001), Glasgow Coma Scale [GCS] score <8 (OR: 4.10, 95% CI: 2.22-8.35, p < 0.001), mechanical ventilation for more than 3 days (OR: 6.25, 95% CI: 3.35-11.75, p < 0.001), and chest injury (OR: 4.75, 95% CI: 2.49-9.16, p < 0.001). A predictive nomogram based on these factors demonstrated good discriminative power upon internal validation. <b><i>Conclusion:</i></b> Age, smoking history, GCS score, duration of mechanical ventilation, and chest injury are independent risk factors for PPI in TICH patients. The developed nomogram is a valuable tool for clinicians in predicting infection risk and guiding post-operative management.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143644","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":"Negative Nasal Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) Polymerase Chain Reaction Rules Out Future MRSA Infections in Severely Injured Trauma Patients.","authors":"Gregory R Stettler, Kaely Miller, Kristen A Rebo, Seth Garner, Andrew M Nunn","doi":"10.1089/sur.2024.284","DOIUrl":"https://doi.org/10.1089/sur.2024.284","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Studies have shown that methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) polymerase chain reaction (PCR) swabs aid in de-escalating and decreasing the duration of antibiotic use in respiratory infections. However, the utility of MRSA PCR swabs is unknown for severely injured trauma patients. The aim of this study is to determine if negative MRSA PCR nasal swabs are associated with future MRSA infections in trauma patients admitted to the intensive care unit (ICU). <b><i>Methods:</i></b> Trauma patients admitted to the ICU that had a nasal MRSA PCR from July 2022 to March 2024 were evaluated. Demographics, as well as complication rates (including myocardial infarction, stroke, venous thromboembolism, acute respiratory distress syndrome, acute kidney injury), number and site of cultures obtained, days from MRSA PCR to culture, and positivity of a MRSA infection in those cultures, were evaluated. <b><i>Results:</i></b> In the study period, 65 severely injured patients were identified with an infection and nasal MRSA PCR. Most patients were male (74%), suffered a blunt mechanism (85%), and had a 28-day mortality rate of 36.9%. The median injury severity score was 26. Of the 65 injured patients, 7 (10.8%) had a positive MRSA PCR. There were 142 cultures obtained. No patient that had a negative PCR had a positive MRSA infection. The performance characteristics of a MRSA PCR swab included sensitivity (100%), specificity (92%), positive predictive value (29%), and negative predictive value (NPV, 100%). <b><i>Conclusion:</i></b> The incidence of MRSA-positive infections in trauma patients is low with a negative MRSA PCR swab, NPV of 100%. On the basis of these findings, there should be consideration of withholding empiric MRSA coverage in trauma ICU patients with a negative MRSA PCR. This may aid in reducing unnecessary antibiotic initiation and healthcare costs. Larger studies are needed to validate these findings and help delineate patients for which empiric MRSA coverage can be withheld.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111860","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":"Prevention of Surgical Site Infection after Spine Operation with Care Bundle.","authors":"Masakazu Toi, Keishi Maruo, Fumihiro Arizumi, Kazuya Kishima, Mitsuhiro Nishizawa, Marika G Rosenfeld, Toshiya Tachibana","doi":"10.1089/sur.2025.007","DOIUrl":"https://doi.org/10.1089/sur.2025.007","url":null,"abstract":"<p><p><b><i>Background:</i></b> A Care Bundle is proposed to prevent surgical site infections (SSIs). This study investigated SSI incidence and risk factors at our hospital, developed an SSI prevention Care Bundle, and tested its efficacy. <b><i>Methods:</i></b> A retrospective review of 1,117 patients who underwent spinal surgical procedure under general anesthesia (January 2016-July 2023) was conducted. A total of 764 patients (mean age 69.7 y, 58.0% female) were included. SSI was diagnosed as per U.S. Centers for Disease Control and Prevention's guidelines. Risk factors evaluated included patient factors, operation-related factors, season, and Care Bundle implementation (introduced in April 2019). The Care Bundle included chlorhexidine gluconate bathing, skin disinfection, high-performance air purifier, glove changes, iodine-impregnated drapes, prophylactic antibiotic agents, and pre-operative sponge brushing. <b><i>Results:</i></b> SSI incidence was 2.6% (0.7% superficial, 1.9% deep), decreasing from 4.6% pre-Care Bundle to 1.0% post-implementation. Risk factors included smoking (p = 0.003), diabetes mellitus (p = 0.025), instrumentation (p = 0.039), posterior cervical operation (p = 0.049), and warm season (p = 0.024). Logistic regression identified Care Bundle implementation (odds ratio [OR] 0.27, p = 0.013), instrumentation (OR 3.59, p = 0.038), and warm season (OR 3.63, p = 0.025) as independent factors. <b><i>Conclusion:</i></b> The Care Bundle effectively reduced SSI. Certain factors such as instrumentation and surgical procedures during warm seasons were associated with greater SSI rates.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094970","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 Multi-Center Observational Study: Empiric Anti-Fungal Coverage after Non-Colonic Gastrointestinal Perforation.","authors":"Andrea M Gochi, Wardah Rafaqat, Vahe Panossian, Mira Ghneim, Seema Anandalwar, Dias Argandykov, Cynthia J Susai, Nathan J Alcasid, Geoffrey A Anderson, Alexander J Ordoobadi, Erik J Teicher, David P Blake, Brendin R Beaulieu-Jones, Sabrina E Sanchez, Christopher A Guidry, Pedro Teixeira, Jonathan Meizoso, Brianna L Collie, Sarah McWilliam, Patrick McGonagill, Nicole Nitschke, Tara Kortlever, Colette Galet, Lillian A Nefcy, Jeffrey L Johnson, Michael P DeWane, Joseph Cuschieri, Amber Himmler, Jennifer Rickard, Jonathan Gipson, April E Mendoza","doi":"10.1089/sur.2024.306","DOIUrl":"https://doi.org/10.1089/sur.2024.306","url":null,"abstract":"<p><p><b><i>Background:</i></b> Empiric anti-fungals are frequently administered in patients with non-colonic gastrointestinal (GI) perforations, but there is limited evidence of their benefit. We hypothesized that empiric anti-fungals would offer no clinical benefit compared with a standard course of antimicrobial therapy. <b><i>Methods:</i></b> This multi-center prospective cohort study included patients ≥18 years old undergoing operative management for non-colonic GI perforations across 15 centers between August 2021 and January 2024. The primary outcome was organ-space surgical site infection (SSI). We performed propensity score matching to adjust for confounders and a backward stepwise regression model to identify predictors of an organ-space SSI. A subgroup analysis of spontaneous upper GI perforations was performed as well. <b><i>Results:</i></b> A total of 192 patients were included; 138 (71.88%) received empiric anti-fungal therapy, and 17.7% developed an organ-space SSI. Before matching, empiric anti-fungal use was frequent in critically ill patients although not associated with organ-space SSI. After matching, there were no differences in organ-space SSI (17.5% vs. 17.5%, p = 0.99). In multi-variable regression, American Society of Anesthesiologists physical status classification system (ASA) category 3 increased the risk of organ-space SSI (odds ratio [OR] 2.49, p = 0.04), whereas perioperative proton-pump inhibitor (PPI) use was protective (OR 0.15, p = 0.004). In the subgroup analysis (N = 150), empiric anti-fungal therapy did not reduce infection risk. Pre-operative shock increased the risk of organ-space SSI (OR 2.83, p = 0.04), whereas PPI use remained protective (OR 0.15, p = 0.01). <b><i>Conclusion:</i></b> Empiric anti-fungal use was not associated with reduced organ-space SSI, even after adjusting for confounders. Given the lack of benefit, we caution against the use of routine empiric anti-fungal therapy in non-colonic GI perforations.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050063","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 Stewardship Impact on the Treatment of Intra-abdominal Infections in the Surgical Intensive Care Unit.","authors":"Meghan E Peterson, Jade Flynn, Michael C Smith, Kelli Rumbaugh","doi":"10.1089/sur.2024.304","DOIUrl":"https://doi.org/10.1089/sur.2024.304","url":null,"abstract":"<p><p><b><i>Background:</i></b> Broad-spectrum antibiotic agents are utilized for complicated intra-abdominal infection (cIAI); however, the need for empiric methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) coverage is not clear as the incidence of MRSA cIAI is rare. <b><i>Patients and Methods:</i></b> A single-center, retrospective, pre- and post-cohort study of adults admitted to the surgical intensive care unit (SICU) with cIAI between March 1, 2021, to May 1, 2023, was conducted. Historically, the SICU utilized vancomycin for all cIAI; however, in April 2022, the preferred regimen was changed to either piperacillin-tazobactam with vancomycin added for patients with MRSA risk factors or for <i>Enterococcus</i> spp. coverage in cefepime- or levofloxacin-based regimens for penicillin-allergic patients. The primary outcome was number of vancomycin days of therapy (DOT) per 1,000 patient days. Categoric and continuous variables were analyzed with chi-square and Fisher exact tests. <b><i>Results:</i></b> A total of 142 SICU encounters were included, 64 in the pre-cohort and 78 in the post-cohort. There was no difference in median vancomycin DOT per 1,000 patient days (14 days [interquartile range or IQR 5-21]; 16 days [IQR 8-17] p = 0.522) between the pre- and post-cohort. There was a significant reduction in the number of patients given vancomycin after the protocol change (90.6%; 76.9%, p = 0.042). A significant increase in piperacillin-tazobactam exposure was also observed (48.4%; 82.1%, p < 0.001) in the post-cohort aligning with our institutional practice change. <b><i>Conclusions:</i></b> In critically ill surgical patients with cIAI, the implementation of an antimicrobial stewardship guideline did not reduce vancomycin DOT per 1,000 patient days, however, it did result in a significant reduction in vancomycin exposure.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023733","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":"Nosocomial Infections in Trauma Patients Receiving Extracorporeal Membrane Oxygenation.","authors":"Larisa Shagabayeva, Luciana Tito Bustillos, Jessica M Delamater, Michael D Cobler-Lichter, Nicole B Lyons, Brianna L Collie, Oswald Perkins, Megan Laurendeau, Edward B Lineen, Valerie Hart, Jonathan P Meizoso, Tiago Machuca, Nicholas Namias, Kenneth G Proctor, Brandon M Parker","doi":"10.1089/sur.2024.190","DOIUrl":"https://doi.org/10.1089/sur.2024.190","url":null,"abstract":"<p><p><b><i>Background:</i></b> The risk of infections in acute trauma patients receiving extracorporeal membrane oxygenation (ECMO) has not been well defined, but this population is among the sickest in the hospital. This study characterizes the blood and respiratory pathogens in trauma patients receiving ECMO and tests the hypothesis that trauma patients receiving ECMO pose a unique risk for nosocomial infections. <b><i>Methods:</i></b> All trauma patients (n = 50) who required ECMO at a level 1 trauma center between July 2014 and September 2023 were retrospectively reviewed. Blood and respiratory samples were examined for pathogens. Burn injuries were excluded from this study. <b><i>Results:</i></b> Most were male (88%) and sustained blunt injuries (60%), of which the most common mechanism was motor vehicle collision (37%). The median intensive care unit (ICU) length of stay was 26 days (interquartile range [IQR]: 12-54), median ventilator days was 22 (IQR: 9-51), and median length of ECMO treatment was eight days (IQR: 4-18). The most common ECMO type was veno-venous (80%). Blood stream and/or respiratory infections were detected in 22 (44%) patients. The most common was respiratory infection (70.2%). Gram-negative pathogens were most common in both blood stream (53.3%) and respiratory infections (75%). Among the blood stream pathogens, 20% were multi-drug resistant. Among the respiratory pathogens, 41.7% were multi-drug resistant. The median number of days from ECMO cannulation to blood stream infection was 10 days (IQR: 4-16) and the median number of days to respiratory infection was seven days (IQR: 3-11). Mortality was 22.7% (n = 5) among patients who had a respiratory and/or blood stream infection and 60% (n = 17) in ECMO patients who had no infection (p = 0.007). <b><i>Conclusion:</i></b> Almost half of trauma patients receiving ECMO had nosocomial infections, which is comparable with the infection rate of trauma patients in the ICU not on ECMO. Larger studies are needed to further assess infection risk in these patients and provide guidelines to mitigate this risk.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039147","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":"Efficacy and Safety of Aerosol Inhalation of Colistin Sulfate for the Treatment of Carbapenem-Resistant <i>Klebsiella pneumoniae</i> Infection in the Peri-Operative Period of Liver Transplantation: A Single-Center Retrospective Study.","authors":"Xiangyan Liu, Jianfang Lu, Zhuoyi Wang, Li Zhuang, Guoping Jiang, Tian Shen, Jincheng Ma, Shusen Zheng","doi":"10.1089/sur.2024.216","DOIUrl":"10.1089/sur.2024.216","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study intended to evaluate the clinical efficacy and safety of colistin sulfate aerosol inhalation in combination with ceftazidime-avibactam for the treatment of pulmonary carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) infection during the peri-operative period of liver transplantation. <b><i>Materials and Methods:</i></b> A retrospective analysis was designed to investigate 52 patients who developed pulmonary CRKP infection after liver transplantation between December 1, 2019, and November 30, 2022. On the basis of whether they received colistin sulfate aerosol inhalation, the patients were divided into the treatment group (<i>n</i> = 29) and the control group (<i>n</i> = 23). The baseline information, infection status, CRKP enzyme type, inflammatory markers, liver and kidney function, and prognosis were compared and analyzed. <b><i>Results:</i></b> There were no significant differences in patient characteristics, infection status, and drug resistance enzyme type between the treatment group (treated with colistin sulfate aerosol inhalation and ceftazidime and avibactam sodium for injection) and the control group (treated with ceftazidime and avibactam sodium for injection alone). Colistin sulfate aerosol inhalation treatment reduced concentrations of inflammatory markers, with post-treatment white blood cell count, procalcitonin, and C-reactive protein significantly lower than pre-treatment levels (p < 0.05). Except for C-reactive protein at 14 days (p = 0.032), the two groups had no significant differences in other indicators. There were no significant differences in alanine aminotransferase, aspartate aminotransferase, total bilirubin, and glomerular filtration rate after treatment, indicating no discernible alteration in liver and kidney function. In addition, the treatment group took a significantly shorter time to normalize body temperature compared with the control group (p = 0.025), but there were no significant differences in the cure with no colonization rate and all-cause mortality rate between the two groups. <b><i>Conclusions:</i></b> The combination of colistin sulfate aerosol inhalation and ceftazidime and avibactam sodium for injection is effective in treating pulmonary CRKP infection during the peri-operative period of liver transplantation. It does not impose an additional burden on liver and kidney function, providing a new treatment option for this type of infection.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":"224-231"},"PeriodicalIF":1.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898159","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}