World Journal of Surgical Infection最新文献

{"title":"Adhesive small-bowel obstruction: Conservative versus surgical management?","authors":"Shikuan Li, Yunlong Li","doi":"10.4103/wjsi.wjsi_3_23","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_3_23","url":null,"abstract":"Bowel obstruction is a common emergency requiring acute medical care. Small-bowel obstruction (SBO) accounts for 80% of all mechanical bowel obstruction, and adhesive SBO is the most common cause of SBO. Computed tomography imaging in patients with abdominopelvic surgery history is useful to diagnose adhesive SBO (ASBO), to exclude other causes of SBO, and to identify patients who need emergency surgeries which usually are closed-loop obstruction, strangulated obstruction, or perforation. For uncomplicated ASBO, the timing when surgery has always existed controversy. Studies revealed that prolonged nonoperative management is associated with increased morbidity. On the other hand, operative management of ASBO may decrease the risk of recurrence. During the conservative management for patients who do not need emergency surgeries, gastrografin challenge may accelerate relief from obstruction and avoid unnecessary surgery, or promote surgical decision-making and avoid delayed surgery. In addition, early postoperative SBO (EPSBO) with adhesive or inflammatory causes and unresectable malignant bowel obstruction should be identified and avoided surgery, although these patients have past abdominopelvic surgery history.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114948484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trocar-assisted percutaneous abscess drainage: A better way to treat intra-abdominal abscess","authors":"Chang Lai, J. Tao, Zhirong Cheng, Changli Lu, Changhui Ji, L. Kai, Lianmin Guan, Zhi-Lan Jiang","doi":"10.4103/wjsi.wjsi_4_23","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_4_23","url":null,"abstract":"Objective: This study aimed to introduce trocar-assisted percutaneous abscess drainage (TA-PAD) and compare it to the Seldinger puncture with pigtail drain (SPD) in the clinical treatment of intra-abdominal abscess. Materials and Methods: The clinical data of 23 patients with abdominal abscess treated with TA-PAD from 2017 to 2019 were retrospectively analyzed. Moreover, 18 patients with abdominal abscess treated with SPD from 2014 to 2016 were taken as the control. The therapeutic effects were compared between the two groups. Results: No death or surgery-related complications were observed in either group. There were significant differences between the two groups in the drainage rate of open surgery, the complete healing time of abscess, the time of inflammation relief, the recurrence rate of abscess, and the hospitalization cost (P < 0. 05). There was no significant difference in the duration of antibiotic use between the two groups (P > 0. 05). Conclusions: TA-PAD can optimize the treatment of abdominal abscesses with significantly lower surgical drainage rates, shorter hospital stays, lower recurrence rates, and lower hospital costs.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"23 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131109182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical officers as the key stakeholders in district level hospitals in Kenya","authors":"Chandler Hinson, A. Wanyoro, Amos Oburu, Joseph Solomkin","doi":"10.4103/wjsi.wjsi_6_23","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_6_23","url":null,"abstract":"Background: A core component of the World Health Organization (WHO) infection prevention and control (IPC) recommends that staffing levels be adequate for the patient workload. The lack of health-care workers in low- and middle-income countries (LMICs), particularly in sub-Saharan Africa is well documented; one way to alleviate the burden of surgical infections without a large commitment of resources is to better train and educate existing facility staff. The study aimed to understand the current allocation of the surgical workload in district level hospitals in Kenya to create targeted task-shifting and education programs. Methods: We developed a cross-sectional survey on IPC practices, adapted from the WHO Guideline on Core Components for IPC and the WHO Emergency and Essential Surgical Care Situational Analysis Tool, for use in district level facilities in LMICs. The survey components included IPC guidelines, surveillance, workload and environment, hospital characteristics, clinical workforce, obstetrical outcomes, and perioperative care practices. In a pilot feasibility trial of the survey tool, data were collected from 27 district level hospitals in Kenya from March to May 2019. These facilities were selected in part based on their capacity to provide comprehensive maternal and obstetric care, including cesarean operations, as cesareans make up the majority of surgeries in the regions and are associated with high surgical site infection rates. Results: The facilities included in the survey pilot serve an estimated population of 3,615,166. The average number of annual admissions was 7801 (Range: 1190–25,783). Thirteen of the 27 total facilities (48.1%) had no certified surgeons, six facilities had one certified surgeon (22.2%), and eight facilities employed two or more certified surgeons. In contrast, almost all facilities (n = 25; range: 2–15) employed medical officers who performed cesarean operations. The number of nurses in surgical and obstetricians and gynecologists wards ranged from 4 to 101, with an average of 27 years. Conclusion: Dedicating specialized training and education to medical officers and engaging them as key stakeholders is the key to creating practical and sustainable change when it comes to safe surgical provision of surgical and obstetric care within Kenya.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128967425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporary arterial shunting following a complete transection of femoral artery in a resource-limited setting","authors":"Raisa R Gao, LemfukaA Dieudonne, JNutai Kolleh","doi":"10.4103/wjsi.wjsi_5_23","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_5_23","url":null,"abstract":"The aim of a surgeon managing vascular trauma in an extremity is to save the life, limb, and function of the patient. The use of temporary intravascular shunting has been shown to be a successful damage control strategy in patients who present with hemodynamic instability. We present the first reported case of a penetrating arterial injury of the lower limb causing a large defect that was successfully treated with temporary intravascular shunting before definitive repair in the country of Liberia. In a low-resource setting such as ours, the surgeon often opts to amputate limbs with vascular injuries that are not believed to be candidates for primary repair. Using a pediatric feeding tube with good postoperative results, we demonstrated that temporary arterial shunting in damage control situations before definitive repair was not only feasible but also cost-effective and ultimately resulted in the preservation of the patient's limb.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114645599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolation of Gemella morbillorum from bile following laparoscopic cholecystectomy","authors":"H. Bonatti, H. Chatrath","doi":"10.4103/wjsi.wjsi_11_22","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_11_22","url":null,"abstract":"","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"141 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127327052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic and therapeutic procedures of small bowel perforation: A retrospective monocentric cohort study","authors":"Zhenlu Li, Shikuan Li, Changliang Wu, Zhen Liu, Yeying Zhao, J. Luan, Shuishan Miao, Peige Wang","doi":"10.4103/wjsi.wjsi_8_23","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_8_23","url":null,"abstract":"Background: Free perforation of the small bowel often has a rapid onset, and if left it untreated, can seriously affect a patient's prognosis. Therefore, in order to fully understand the etiology, diagnosis, and treatment of small bowel perforation (SBP), a classification of SBPs or treatment recommendations should be performed. Subjects and Methods: A retrospective, monocentric analysis of patients with SBPs was performed for the period of 2018–2022. Results: Over a 5-year period, 65 cases of SBP were documented. Perforation's localization was duodenal, jejunal, ileal, and undocumented. Eight etiologies were differentiated: obstructive (16.9%), ischemic (7.7%), diverticula-related (9.2%), inflammatory (9.2%), malignant (12.4%), traumatic (7.7%), foreign body (3.1%), and idiopathic (33.8%) perforations. Surgery combined with antibiotics was the most commonly used treatment (97.6%). The mortality rate was 6.2%, with a high rate for patients with ischemic and malignant perforations. Discussion: We have established the mature diagnostic and therapeutic treatment. Furthermore, it was found that the shorter the time between admission and operation, the better the prognosis, the better quality of life, with 12.3% ostomy rate. Conclusion: We have presented a comprehensive analysis of 65 patients treated for SBP over a 5year period, suggested a classification system of SBP according to the etiology, and described diagnostic and therapeutic steps for treatment.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124041508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adapting infection prevention and control assessment tools for use in low- and middle-income countries","authors":"Chandler Hinson, A. Wanyoro, Amos Oburu, Joseph Solomkin","doi":"10.4103/wjsi.wjsi_7_23","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_7_23","url":null,"abstract":"Background: There are many existing infection prevention and control (IPC) tools developed and validated by large organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention. These tools are generally created with little input from professionals working in low-income regions and are tested in high-income countries and/or high-level facilities in low- and middle-income countries (LMICs). Recent publications have highlighted both the disproportionate burden of surgical site infections (SSIs) in LMICs and the very limited data on surgical conditions and practices in these regions. There is a need and a desire for quality improvement in SSI/IPC/patient safety in low-level facilities in LMIC. Therefore, a logical starting point would be to adapt available tools for use in resource-limited facilities, with a strong focus on input and enthusiastic participation from local health-care workers and leadership. Our goal was to assess IPC capacity of facilities by analyzing health-care-associated infection (HAI) surveillance, hospital workforce and infrastructure, environmental cleaning, and surgical operative practices. Methods: We created an adapted survey using components from the WHO's Guideline on Core Components for IPC and Essential Surgical Care Situational Analysis Tool that addressed IPC program support, HAI surveillance, surgical preparation practices, and infrastructural support. Purposive sampling was used to identify 23 health facilities across 7 counties in Kenya. We chose to use cesarean section as a bellwether procedure because it is a high-volume procedure in LMIC. Permission to conduct the survey was solicited from facility leadership prior to the beginning of the survey. Two surveyors visited each facility to complete the adapted assessment framework. Results: All facilities had an IPC program and 22 (95.6%) reported that their program was supported by facility leadership and a professional IPC team. However, only 10 (43.5%) facilities reported a specific IPC budget. Eight (34.8%) facilities had on-site and 8 (34.8%) had off-site microbiological laboratory. Twelve (52.2%) conducted HAI surveillance, and out of those that conducted HAI surveillance, 11 (91.7%) monitored specifically for SSIs. Most had adequate and reliable water (95.6%) and power (91.3%). Fifteen (65.2%) allowed bed-sharing and 6 (26.1%) placed beds in hallways or areas other than rooms. Over 75% of facilities did not follow the WHO-recommended preoperative practices on bathing, hair removal, and skin preparation. Conclusions: This survey was a time and resource-efficient way of collecting the data needed to understand the variables associated with surgery, SSI, and IPC in low-level facilities. Clear targets for surgical practice improvement were identified, and the workforce and infrastructure data will be used to design effective and sustainable solutions.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132963186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colonic anastomotic fistula treated by endoscopic over-the-scope clip with fibrin glue","authors":"Jinpeng Zhang, Y. Teng, Ruixia Tian, Huajian Ren","doi":"10.4103/wjsi.wjsi_2_23","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_2_23","url":null,"abstract":"Enterocutaneous fistula is a severe complication of gastrointestinal surgery, often associated with abdominal infection, bleeding, malnutrition, and multiple organ dysfunction. Among the early stages of enterocutaneous fistula, the active promotion of spontaneous healing of enterocutaneous fistula is crucial for the treatment of enterocutaneous fistula. Herein, we present a case of enterocutaneous fistula occurring in a 55-year-old Chinese male patient. The patient was operated on by sigmoid diverticulum perforation and underwent partial sigmoid resection and colostomy. Four months later and stoma reversal was done, after which the incision went through repeat infection. He presented to the outpatient department with a sinus tract within the median abdominal incision and pus in abdominal drainage. He was then diagnosed with a colonic anastomotic fistula after computer tomography and fistulography. The successful closure of the fistula confirmed by colonogram was achieved within 2 weeks by the treatment of over-the-scope clip (OTSC) combined with fibrin glue. Our case shows that the approaches of OTSC and fibrin glue are expected to be a promising and novel strategy for treating enterocutaneous fistulas.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123736534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A counterculture movement: Characterizing the prognostic utility of obtaining wound cultures for incisional surgical site infections","authors":"G. McLaren, Jesse Chou, Robert G Sawyer","doi":"10.4103/wjsi.wjsi_16_22","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_16_22","url":null,"abstract":"Background: Surgical site infections (SSIs) account for 15% of all healthcare-associated infections, yet, the utility of cultures remains controversial. We hypothesized that obtaining cultures would not affect outcomes from incisional SSI. Methods: All incisional SSI from general surgery patients treated as inpatients at a single institution between 1997 and 2017 were included. Patient variables were compared by Student's t-test and Chi-square analysis. Predictors of in-hospital mortality, duration of therapy, and hospital length of stay, including the acquisition of wound cultures, were determined by multivariate (MV) logistic regression analysis. Results: In total, 2054 SSIs were identified: 1077 (52.4%) with cultures and 977 (47.6%) without. Obtaining cultures were associated with higher severity of illness/Acute Physiology and Chronic Health Evaluation (APACHE-II) score (12.4 ± 0.2 vs. 8.8 ± 0.2; P < 0.0001) and multiple comorbidities, as well as a longer antimicrobial course (13.8 ± 0.3 days vs. 9.1 ± 0.2 days; P < 0.0001), length of stay (17.4 ± 0.8 days vs. 9.7 ± 0.5 days; P < 0.0001), and mortality (8.6% vs. 4.2%; P < 0.0001). Factors independently predicting mortality included age in years (odds ratio [OR] 1.03 [95% confidence interval [CI] 1.02–1.05], P < 0.0001), APACHE-II (OR 1.17 [95% CI 1.14–1.21], P < 0.0001), days from operation to diagnosis (OR 1.01 [95% CI 1.01–1.02], P < 0.0001), and diagnosis of SSI after discharge (OR 4.98 [95% CI 2.18–11.35], P < 0.0001). Obtaining cultures (OR 1.04 [95% CI 0.65–1.64], P = 0.88) were not associated with mortality. Acquisition of cultures was independently associated with longer antimicrobial duration and length of stay. Conclusion: Routinely obtaining cultures from infected surgical incisions does not change the overall outcome and should be reserved for special circumstances, such as critical illness.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127808316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the prognostic utility of isolating yeast in surgical site infections and subsequent use of antifungal therapies","authors":"Jesse Chou, G. Mclaren, A. Cheng, Robert G Sawyer","doi":"10.4103/wjsi.wjsi_13_22","DOIUrl":"https://doi.org/10.4103/wjsi.wjsi_13_22","url":null,"abstract":"Background: Whether the isolation of yeast from surgical site infections (SSIs) affects outcomes is unclear. We hypothesized that for SSI, yeasts are nonpathogenic and that neither the isolation of yeast nor the use of antifungal agents affects outcomes. Methods: Incisional SSIs from general surgery patients at a single institution between 1997 and 2017 with positive cultures were analyzed, categorized by the presence of yeast. Demographics and in-hospital mortality were compared by Student's t-test and Chi-square analysis. Independent predictors of isolation of yeast and in-hospital mortality were determined by multivariate logistic regression analysis (MV). Results: In total, 977 infections with positive cultures were identified: 190 (19.4%) with yeast and 787 (80.6%) without. By univariate analysis, cultures positive for yeast were associated with a higher severity of illness/APACHE II score (15.6 ± 0.5 versus 11.6 ± 0.2; P < 0.0001), diagnosis in the ICU (83/190, 43.6% versus 154/787, 19.5%; P < 0.0001), age (55.2 ± 1.1 versus 52.4 ± 0.5; P = 0.015), and female sex (105/190, 55.3% versus 362/787, 46.0%; P = 0.027). Independent predictors of isolation of yeast included sex, APACHE II Score, and diagnosis after discharge from index procedure, and for mortality, age, APACHE II, diagnosis after discharge, and receiving antifungal treatment. Isolation of yeast was not associated with mortality (P = 0.12). For fungal SSI, antifungal treatment was not associated with decreased mortality. Conclusion: Isolation of yeast from incisional SSI is not associated with mortality, and the use of antifungal agent is associated with higher mortality. Routine fungal cultures of SSI are not warranted.","PeriodicalId":278234,"journal":{"name":"World Journal of Surgical Infection","volume":"423 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116011861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}