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Surgical Wound Infection (surgical + wound_infection)
Selected AbstractsRISK FACTORS FOR SURGICAL WOUND INFECTION AND BACTERAEMIA FOLLOWING CORONARY ARTERY BYPASS SURGERYANZ JOURNAL OF SURGERY, Issue 1 2000Denis W. Spelman Background: There has been no consensus from previous studies of risk factors for surgical wound infections (SWI) and postoperative bacteraemia for patients undergoing coronary artery bypass graft (CABG) surgery. Methods: Data on 15 potential risk factors were prospectively collected on all patients undergoing CABG surgery during a 12-month period. Results: Of 693 patients, 62 developed 65 SWI using the Centres for Disease Control definition: 23 were sternal wound infections and 42 were arm or leg wound infections at the site of conduit harvest. There were 19 episodes of postoperative bacteraemia. Multivariate analysis revealed that: (i) diabetes, obesity and previous cardiovascular procedure were independent predictors of SWI; and (ii) obesity was an independent risk factor for postoperative bacteraemia. Conclusions: These findings suggest that improved diabetic control and pre-operative weight reduction may result in a decrease in the incidence of SWI. But further prospective studies need to be undertaken to examine (i) whether the increased SWI risk in diabetes occurs with both insulin- and non-insulin-requiring diabetes, and whether improved peri-operative diabetes control decreases SWI; and (ii) what degree of obesity confers a risk of SWI and postoperative bacteraemia, and whether pre-operative weight reduction, if a realistic strategy in this patient group, results in a decrease in SWI. [source] I PREVENT Bacterial Resistance.DERMATOLOGIC SURGERY, Issue 10 2009An Update on the Use of Antibiotics in Dermatologic Surgery BACKGROUND AND OBJECTIVES Prophylaxis may be given to prevent a surgical wound infection, infective endocarditis (IE), or infection of a prosthetic joint, but its use before cutaneous surgery is controversial. Our aim was to review the current literature and provide a mnemonic to assist providers in appropriately prescribing prophylactic antibiotics. METHODS AND MATERIALS We reviewed the current literature, including the new guidelines provided by the American Heart Association (AHA). RESULTS The new AHA guidelines recommend prophylaxis for patients with high risk of an adverse outcome from IE instead of high risk of developing IE. The American Academy of Orthopedic Surgeons and the American Dental Association also provide guidelines. Given the paucity of conclusive studies, prophylaxis against a surgical wound infection is based more on clinical judgment. CONCLUSION The mnemonic we propose, "I PREVENT," represents: Immunosuppressed patients; patients with a Prosthetic valve; some patients with a joint Replacement; a history of infective Endocarditis; a Valvulopathy in cardiac transplant recipients; Endocrine disorders such as uncontrolled diabetes mellitus; Neonatal disorders including unrepaired cyanotic heart disorders (CHDs), repaired CHD with prosthetic material, or repaired CHD with residual defects; and the Tetrad of antibiotics: amoxicillin, cephalexin, clindamycin, and ciprofloxacin. [source] Investigation of risk factors for surgical wound infection among teaching hospitals in TehranINTERNATIONAL WOUND JOURNAL, Issue 1 2006Article first published online: 5 APR 200 Evaluation des Facteurs de Risques D'Infection de la Plaie Chirurgicale dans un Hopital Universitaire de Teheran Cette etude prospective a été menée pour évaluer les facteurs de risqué et l'incidence d'infection du site opératoire de patients admis dans les unités chirurgicales de 5 hôpitaux affiliés à l'Université des Sciences Médicales Iranienne. Le recueil de données sur une carte de registre remplie par un personnel spécialement entraîné. 918 patients admis dans des unités chirurgicales, ont été suivis pendant les 30 jours post opératoires à la recherché d'une infection du 1er Avril 2003 au 30 Septembre 2003. Un total de 77 patients ont été identifies sur les 918 cas inclus dans cette etude, avec un taux d'infection résulant total de 8,4%. Le risqué d'infection de plaie chirurgicale augmentait avec l'âge au dessus de 60 ans (OR = 3,1; p < 0.0001), l'existence d'un diabète (OR = 4,9; p < 0,0001), le tabac (OR = 2,2; p < 0,0001), l'obésité(OR = 4,1; p < 0,0001), le drainage de la plaie (OR = 2,2;p < 0,0001). Il existait une différence statistique significative dans la durée de l'anesthésie (136 vs 177 minutes, p < 0,001) et longueur de l'acte opératoire (99 vs 140,5) entre les patients sans infection du site et ceux avec infection du site. En conclusion identifier les facteurs de risques d'infection du site post-opératoire peut aider les praticiens à améliore la prise en charge des patients et peut faire diminuer la mortalité et la morbidité et les coûts de soins des patients chirurgicaux. Evaluierung von Risikofaktoren für chirurgische Wundinfektionen in akademischen Lehrkrankenhäusern in Teheran Diese prospektive Studie diente der Untersuchung von Risikofaktoren sowie der Inzidienz von chirurgischen Wundinfektionen in 5 verschiedenen chirurgischen Einrichtungen im Iran, welche Unversitätskliniken angeschlossen sind. Die Daten wurden von geschultem Personal auf speziell angelegte Registerkarten übertragen. Im Zeitraum vom 1. April bis zum September 2003 wurden insgesamt 918 chirurgische Patienten aufgenommen und über einen postoperativen Zeitraum von 30 Tagen beobachtet. 77 der 918 registrierten Patienten erlitten eine Wundinfektion entsprechend einer Inzidenzrate von 8,4%. Das Risiko einer Wundinfektion korrelierte mit dem Alter (>60LJ), Diabetes mellitus, Nikotinabusus, Adipositas und dem Vorhandensein von Wunddrainagen. Es konnten signifikante Unterschiede bezüglich der Narkosedauer (131,6 vs. 177 Minuten, p < 0,001) sowie der Operationsdauer zwischen Patienten mit einer postoperativen Wundinfektion und solchen, bei denen im Verlauf keine Infektion auftraten, herausgestellt werden. Zusammenfassend sollte eine Berücksichtigung der hervorgehobenen Risikofaktoren dem Arzt eine bessere Patientenversorgung ermöglichen, Mobidität und Mortalität senken und Krankenhauskosten reduzieren. Indagine dei fattori di rischio per ferite chirurgiche infette in ospedali universitari di Tehran Questo studio prospettico è stato intrapreso per investigare i fattori di rischio e l'incidenza delle sedi di infezioni chirurgiche (SSI) in pazienti di reparti chirurgici di cinque ospedali affiliati alla scuola medica della università iraniana. I dati raccolti in un registro compilato da personale addestrato specificamente. 918 pazienti ammessi in reparti chirurgici, sono stati seguiti per 30 giorni post operazione per infezioni della sede chirurgica durante il periodo 1 aprile 2003 fino a 30 settembre 2003. Un totale di 77 pazienti sono stati identificati tra 918 casi inclusi nello studio, con un risultato generale di tasso di infezione della sede chirurgica di 8.4%. Il rischio di ferita chirurgica infetta aumentava in base all'età maggiore di 60 anni (OR = 3.9; p < 0.0001). diabete mellito (OR = 4.9; p < 0.0001), fumo (OR = 3.1; p < 0.0001), obesità(OR = 4.1; p < 0.0001) e essudato della ferita (OR = 2.2; p < 0.0001). erano presenti delle differenze statisticamente significative nella durata della anestesia (131.6 vs. 177 minuti, p < 0.001) e nella durata dell'intervento chirurgico (99 vs. 140.5) tra i pazienti senza SSI e quelli con SSI. In conclusione l'identificazione dei fattori di rischio per le SSI consentirà al medico di migliorare la cura dei pazienti e potrà ridurre la mortalità e la morbilità ed il costo ospedaliero dei pazienti con ferite chirurgiche. Investigación de los Factores de Riesgo de Infección de Heridas Quirúrgicas en Hospitales Docentes de Teherán Se realizó este estudio prospectivo para investigar los factores de riesgo y la incidencia de infección de zonas quirúrgicas en pacientes ingresados en salas quirúrgicas de cinco hospitales afiliados a la Universidad de Ciencias Médicas de Irán. Los datos fueron recogidos en una ficha de registro a cargo de personal especialmente formado. Se siguió a 918 pacientes ingresados en salas quirúrgicas durante 30 días de la fase postoperatoria, por infección de la zona quirúrgica, desde el 1 de abril de 2003 hasta el 30 de septiembre de 2003. Se identificó a un total de 77 pacientes entre los 918 casos incluidos en el estudio, con una tasa global de infecciones en la zona quirúrgica del 8,4%. El riesgo de infección de la herida quirúrgica aumentaba en función de edades superiores a 60 años (IP = 3,9; P < 0,0001), diabetes mellitus (IP = 4,9; P < 0,0001), tabaquismo (IP = 3,1; P < 0,0001), obesidad (IP = 4,1; P < 0,0001) y drenaje de la herida (IP = 2,2; P < 0,0001). Se observó una diferencia estadísticamente significativa en la duración de la anestesia (131,6 frente a 177 minutos; P < 0,001) y la duración de la operación (99 frente a 140,5) entre los pacientes con y sin infección en la zona quirúrgica. En conclusión, la identificación de los factores de riesgo de la infección en zonas quirúrgicas contribuirá a que los médicos mejoren la asistencia de los pacientes y posibilitará la reducción de la mortalidad y la morbilidad, así como los costes asistenciales hospitalarios de pacientes quirúrgicos. [source] Lower genital tract lesions requiring surgical intervention in girls: Perspective from a developing countryJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2009Sebastian O Ekenze Aim: To determine the spectrum, outcome of treatment and the challenges of managing surgical lesions of lower genital tract in girls in a low-resource setting. Method: Retrospective study of 87 girls aged 13-years and younger, with lower genital tract lesions managed between February 2002 and January 2007 at the University of Nigeria Teaching Hospital, Enugu, southeastern Nigeria. Clinical charts were reviewed to determine the types, management, outcome of treatment and management difficulties. Results: The median age at presentation was 1 year (range 2 days,13 years). Congenital lesions comprised 67.8% and acquired lesions 32.2%. The lesions included: masculinised external genitalia (24), vestibular fistula from anorectal malformation (23), post-circumcision labial fusion (12), post-circumcision vulval cyst (6), low vaginal malformations (6), labial adhesion (5), cloacal malformation (3), bifid clitoris (3) urethral prolapse (3), and acquired rectovaginal fistula (2). Seventy-eight (89.7%) had operative treatment. Procedure related complications occurred in 19 cases (24.4%) and consisted of surgical wound infection (13 cases), labial adhesion (4 cases) and urinary retention (2 cases). There was no mortality. Overall, 14 (16.1%) abandoned treatment at one stage or another. Challenges encountered in management were inadequate diagnostic facilities, poor multidisciplinary collaboration and poor patient follow up. Conclusion: There is a wide spectrum of lower genital lesion among girls in our setting. Treatment of these lesions may be challenging, but the outcome in most cases is good. High incidence of post-circumcision complications and poor treatment compliance may require more efforts at public enlightenment. [source] Laparoscopic surgery impairs tissue oxygen tension more than open surgeryBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2007E. Fleischmann Background: Wound infection remains a common and serious complication after colonic surgery. Although many colonic operations are performed laparoscopically, it remains unclear whether this has any impact on the incidence of wound infection. Subcutaneous tissue oxygenation is an excellent predictor of surgical wound infection. The impact of open and laparoscopic colonic surgery on tissue oxygenation was compared. Methods: Fifty-two patients undergoing elective open and laparoscopic left-sided colonic resections were evaluated in a prospective observational study. Anaesthesia management was standardized and intraoperative arterial partial pressure of oxygen was kept at 150 mmHg in both groups. Oxygen tension was measured in the subcutaneous tissue of the right upper arm. Results: At the start of surgery subcutaneous tissue oxygen tension (PsqO2) was similar in both groups (mean(s.d.) 65·8(17·2) and 63·7(23·6) mmHg for open and laparoscopic operations respectively; P = 0·714). Tissue oxygen remained stable in the open group, but dropped significantly in the laparoscopic group during the course of surgery (PsqO2 after operation 53·4(12·9) and 45·5(11·6) mmHg, respectively; P = 0·012). Conclusion: Laparoscopic colonic surgery significantly decreases PsqO2, an effect that occurs early in the course of surgery. As tissue oxygen tension is a predictor of wound infection, these results may explain why the risk of wound infection after laparoscopic surgery remains higher than expected. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | |||||||||||||||||||