Surgical site infections

Surgical site infections (SSIs) lead to adverse patient outcomes, including prolonged hospitalization and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSIs. In particular, improved adherence to evidence-based preventative measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSIs.     

Guide to the elimination of orthopedic surgery surgical site infections: an executive summary of the Association for Professionals in Infection Control and Epidemiology elimination guide

This article is an executive summary of the APIC Guide to the Elimination of Orthopedic Surgical Site Infections. Infection preventionists, care providers, and perioperative personnel are encouraged to obtain the original, full length APIC Elimination Guide for more thorough coverage on strategies to prevent surgical site infections in orthopedic surgery.     

Relationship between perioperative glycemic control and postoperative infections

Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection （POI）, which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. These leukocyte deficiencies are the cause of infection and improve with tight glycemic control, which leads to fewer POIs in critically ill surgical patients. Tight glycemic control, such as intensive insulin therapy, has a risk of hypoglycemia. In addition, the optimal targeted blood glucose range to reduce POI remains unknown. Since 2006, we have investigated tight perioperative blood glucose control using a closed-loop artificial endocrine pancreas system, to reduce POI and to avoid hypoglycemia. In this Topic Highlight, we review the relationship between perioperative glycemic control and POI, including the use of the artificial pancreas.     

Original Article--Surgical site infections following pediatric cardiac surgery in a tertiary care hospital: Rate and risk factors

BackgroundSurgical site infections [SSIs] are the second most common type of healthcare-associated infections and leading cause of postoperative morbidity and mortality in pediatric cardiac surgery. This study aims to determine the rate of, risk factors for, and most common pathogen associated with the development of SSIs after pediatric cardiac surgery.MethodsPatients aged ≤14 years who underwent cardiac surgery at our tertiary care hospital between January 2010 and December 2015 were retrospectively reviewed.ResultsThe SSI rate was 7.8% among the 1510 pediatric patients reviewed. Catheter-associated urinary tract infection [CAUTI] [odds ratio [OR] 5.7; 95% confidence interval [CI] 2.3–13.8; P < 0.001], ventilator-associated pneumonia [VAP] [OR 3.2; 95% CI 1.4–7.2; P = 0.005], longer postoperative stay [≥25 days] [OR 4.1; 95% CI 2.1–8.1; P < 0.001], and a risk adjustment in congenital heart surgery [RACHS-1] score of ≥2 [OR 2.4; 95% CI 1.2–5.6; P = 0.034] were identified as risk factors for SSIs. Staphylococcus aureus was the most common pathogen [32.2%].ConclusionsSSI risk factors were longer postoperative stay, CAUTI, VAP, and RACHS-1 score of ≥2. Identification and confirmation of risk factors in this study is important in order to reduce the rate of SSIs following cardiac surgery.     

2006-2010年江苏省土源性线虫病监测点调查结果分析

目的 分析江苏省土源性线虫病监测点2006-2010年土源性线虫感染率及变化情况.方法 2006-2010年在江苏省宿迁市沭阳县胡集镇华集村设立国家土源性线虫病监测点,同时在全省其他地区设立省、市级监测点83个.每年秋季收集3岁以上的常住居民(1000人以上)粪便,采用改良加藤厚涂片法粪检肠道蠕虫卵.在沭阳县监测点,随机选择送检的10户家庭,采集其居所附近的菜地、厕所周边、庭院和厨房等4种环境类型的土壤各1份,用改良饱和硝酸钠漂浮法检测蛔虫卵污染情况;对参检的3～12周岁儿童用透明胶纸肛拭法加检蛲虫卵.在其他监测点,抽查幼儿园儿童和小学低年级学生,用透明胶纸肛拭法检查蛲虫卵.结果 沭阳县监测点居民土源性线虫感染率和儿童蛲虫感染率均呈下降趋势,从2006年的1.81％(19/1049)和4.72％ (5/106)分别下降至2010年的1.23％(13/1061)和0(0/90),分别下降32.04％和100％;其他监测点居民土源性线虫和儿童蛲虫感染率也呈下降趋势,2006年分别为2.61％ (2547/97405)和2.42％(3187/131 965),2010年分别为0.84％(900/107 233)和0.95％(1015/106 959),分别下降67.82％和60.74％.所有感染者均为轻度感染;检测50户家庭不同环境类型的土壤200份,未发现蛔虫卵.结论 2006-2010年江苏省人群土源性线虫和儿童蛲虫感染率呈下降趋势,处于较低流行水平.     

Incidence of surgical site infection after craniotomy: comparison between three months and twelve months of epidemiological surveillance

Objective: To determine the incidence of surgical site infection in patients undergoing craniotomy and to compare 12-month and 3-month post-discharge surveillance periods in terms of their impact on the incidence of surgical site infection in those patients.Methods: This was a retrospective cohort study involving 173 adult patients submitted to “clean” craniotomy, with or without implants, during the six-month period, at a university hospital in the city of São Paulo, Brazil. All the patients were evaluated in the pre-, trans- and postoperative periods and were followed for 12 months to analyze the development of surgical site infections.Results: Of the 173 patients undergoing craniotomy during the study period, 20 developed an surgical site infection during the first, and 12 months after discharge, the overall incidence of surgical site infection therefore being 11.56%, compared with a 1-month incidence of 8.67% and a 3-month incidence of 10.98%. Among the 106 patients who received implants, the 1-, 3-, and 12-month incidence of surgical site infection was 7.54% (n?=?8), 8.49% (n?=?9), and 9.43% (n?=?10), respectively. Among the 67 patients who did not receive implants, the 1-, 3-, and 12-month incidence of surgical site infection was 10.44% (n?=?7), 14.92% (n?=?10), and 14.92% (n?=?10), respectively.Conclusion: The incidence of surgical site infection after craniotomy is high. Reducing the duration of the post-discharge surveillance period from 12 months to 3 months did not cause significant losses in the numbers of surgical site infection identified or a substantial decrease in their incidence.