Surgical infections最新文献

{"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":"https://doi.org/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":"0"},"PeriodicalIF":1.4,"publicationDate":"2025-03-24","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":"Choice of Machine Learning Models Is Important to Predict Post-Operative Infections in Surgical Patients.","authors":"Addison Heffernan, Reetam Ganguli, Isaac Sears, Andrew H Stephen, Daithi S Heffernan","doi":"10.1089/sur.2024.288","DOIUrl":"https://doi.org/10.1089/sur.2024.288","url":null,"abstract":"<p><p><b><i>Background:</i></b> Surgical quality datasets are critical to decision-making tools including surgical infection (SI). Machine learning models (MLMs), a branch of artificial intelligence (AI), are increasingly being ingrained within surgical decision-making algorithms. However, given the unique and distinct functioning of individual models, not all models may be suitable for acutely ill surgical patients. <b><i>Patients and Methods:</i></b> This is a 5-year retrospective review of National Surgical Quality Improvement Program (NSQIP) patients who underwent an operation. The data were reviewed for demographics, medical comorbidities, rates, and sites of infection. To generate the MLMs, data were imported into <i>Python</i>, and four common MLMs, extreme gradient boosting, K-nearest neighbor (KNN), random forest, and logistic regression, as well as two novel models (flexible discriminant analysis and generalized additive model) and ensemble modeling, were generated to predict post-operative SIs. Outputs included area under the receiver-operating characteristic curve (AUC ROC) including recall curves. <b><i>Results:</i></b> Overall, 624,625 urgent and emergent NSQIP patients were included. The overall infection rate was 8.6%. Patients who sustained a post-operative infection were older, more likely geriatric, male, diabetic, had chronic obstructive pulmonary disease, were smokers, and were less likely White race. With respect to MLMs, all four MLMs had reasonable accuracy. However, a hierarchy of MLMs was noted with predictive abilities (XGB AUC = 0.85 and logistic regression = 0.82), wherein KNN has the lowest performance (AUC = 0.62). With respect to the ability to detect an infection, precision recall of XGB performed well (AUC = 0.73), whereas KNN performed poorly (AUC = 0.16). <b><i>Conclusions:</i></b> MLMs are not created nor function similarly. We identified differences with MLMs to predict post-operative infections in surgical patients. Before MLMs are incorporated into surgical decision making, it is critical that surgeons are at the fore of understanding the role and functioning of MLMs.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ceftaroline + Rifampin Versus Vancomycin + Rifampin in the Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i> Meningitis in an Experimental Rabbit Model.","authors":"Damla Akdag, Tuncer Turhan, Elif Bolat, Gamze Sanlıdag-Isbilen, Canberk Tomruk, Furkan Isbilen, Yigit Uyanikgil, Sohret Aydemir, Tansu Yamazhan, Husnu Pullukcu, Bilgin Arda, Meltem Tasbakan, Berke Gokkilic, Ekin Kartal, Dilsah Baskol Elik, Hilal Sipahi, Sercan Ulusoy, Oguz Resat Sipahi","doi":"10.1089/sur.2024.069","DOIUrl":"https://doi.org/10.1089/sur.2024.069","url":null,"abstract":"<p><p><b><i>Background/Aim:</i></b> To compare the effectiveness ceftaroline-rifampicin (CR) and vancomycin-rifampicin (VR), against methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) in a rabbit meningitis model, to compare the effects on brain tissues in terms of inflammation and apoptosis and to test the antibiotics via in vitro time-kill and synergy tests. <b><i>Method:</i></b> Meningitis was induced using MRSA strain ATCC 43300. After 28 hours, the rabbits were split into three groups: control, VR, and CR. A CSF culture was taken at the start (<i>T</i>₀) and end of treatment (EOT)-the 24th hour of treatment. At EOT, the animals' brain tissues were examined for inflammation and apoptosis. The study strain was tested for a 24-hour time kill assay. <b><i>Results:</i></b> At the EOT, statistically significant differences were observed between the treatment groups in terms of reducing the cerebrospinal fluid (CSF) bacterial count, achieving partial or complete treatment response, and exhibiting lower levels of neuronal apoptosis compared with the control group. However, there was no significant difference in all three parameters and in survival between the two treatment groups. The CR group exhibited a noticeable decrease in inflammation than the control group, but no significant difference was found between the control group versus VR and VR versus CR group. Rifampicin did not improve antibacterial efficacy in the in vitro time-kill assay. <b><i>Conclusion:</i></b> The CR arm showed better complete response and inflammation, but both treatments were similar in other parameters. CR combination was found as effective as VR combination for treating MRSA meningitis.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic and Etiologic Characteristics of Urinary Tract Infections in Patients with Cervical Cancer Undergoing Radical Operation with Indwelling Ureteral Stents.","authors":"Chengwen Jin, Hualei Bu, Jiangdong Xiang, Chengjuan Jin","doi":"10.1089/sur.2024.129","DOIUrl":"https://doi.org/10.1089/sur.2024.129","url":null,"abstract":"<p><p><b><i>Background:</i></b> The objective of this study was to investigate the clinicopathologic and etiologic characteristics of urinary tract infections in patients with cervical cancer who had undergone radical operation with ureteral stent insertion. <b><i>Patients and Methods:</i></b> We conducted a retrospective analysis on the medical records of 24 patients who underwent radical operation for cervical cancer with indwelling ureteral stents at Shanghai General Hospital between April 2019 and December 2022. <b><i>Results:</i></b> A total of 15 patients experienced urinary tract infections, resulting in an infection rate of 62.5%. Although postoperative adjuvant chemotherapy might have been a potential risk factor for urinary tract infections, the difference was not statistically significant (p = 0.074). A total of 30 pathogen strains were isolated, with <i>Escherichia coli</i> being the most prevalent. Notably, two strains of carbapenem-resistant <i>Enterobacteriaceae</i> were identified. The majority of patients (70.83%) had ureteral stents in place for 3-12 months. As the duration of stent insertion exceeded 2 months, we noted a decrease in antibiotic sensitivity against the same pathogen. Furthermore, fungal infections became more prevalent when the stent placement duration surpassed 4 months. <b><i>Conclusions:</i></b> The incidence of urinary tract infection is exceptionally high in patients with locally advanced cervical cancer and who have undergone radical operation with ureteral stent insertion. <i>E. coli</i> strains exhibited relative resistance to penicillins and cephalosporins. With prolonged stent placement, there was a notable diminution in antibiotic sensitivity against the same pathogen, and the microbial profile shifted from bacteria to fungi. This study provides valuable insights for the determination of the optimal timing for stent removal or replacement and for the selection of effective antibiotics to treat urinary tract infections for patients with indwelling ureteral stents, so as to ultimately prevent severe infections and mitigate disease burden.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664584","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":"https://doi.org/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":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-19","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":"Hyperbaric Oxygen Therapy for Necrotizing Soft Tissue Infections: A Retrospective Cohort Analysis of Clinical Outcomes.","authors":"Akira Shishido, Gregory Schrank, Alexander Vostal, Megan Uehling, Ravi Tripathi, Sai Chintalapati, Lauren Conway, Nikki Kus, Laura DiChiacchio, Marc Kai, Joseph A Kufera, Ronald Rabinowitz","doi":"10.1089/sur.2024.285","DOIUrl":"https://doi.org/10.1089/sur.2024.285","url":null,"abstract":"<p><p><b><i>Background:</i></b> Hyperbaric oxygen therapy (HBOT) is an adjunctive therapy for necrotizing soft tissue infections (NSTIs) that remains controversial due to lack of quality clinical evidence. This retrospective cohort examines the impact of HBOT on clinical outcomes from NSTI at a single center where evaluation for HBOT is standard of care. <b><i>Methods:</i></b> The COVID-19 pandemic disrupted HBOT service and NSTI cases went without HBOT treatment, allowing for a comparison of treatment groups. The clinical outcomes of 253 patients with NSTI that were evaluated for HBOT were compared; 143 (56.3%) received HBOT and 110 (43.3%) did not. <b><i>Results:</i></b> Baseline characteristics were similar except for surface area of the wounds and distribution on the extremities. More patients in the non-HBOT group died within 90 days of admission than those in the HBOT group (5.8% vs. 15.4%, p = 0.015). Further, patients with large wounds (≥450 cm²) and those with high APACHE II scores (≥18) who underwent HBOT had significantly lower risk of death than patients who did not (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.02-0.72). <b><i>Conclusion:</i></b> Our study shows that there was a mortality benefit in patients with NSTI that was more significant in patients with large wounds and higher APACHE II scores.</p>","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Letter to the Editor:</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":"https://doi.org/10.1089/sur.2025.004","url":null,"abstract":"","PeriodicalId":22109,"journal":{"name":"Surgical infections","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-12","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-10","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":"https://doi.org/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":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-10","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}