Risk factors for surgical site infection following colorectal resection: a multi-institutional study

Introduction

Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly affects patients undergoing colorectal surgery. This study examined a multi-institutional dataset to determine risk factors for SSI following colorectal resection.

Methods

Data on 386 patients who underwent colorectal resection in three institutions were accrued. Patients were identified using a prospective SSI database and hospital records. Data are presented as median (interquartile range), and logistic regression analysis was used to identify risk factors.

Results

Patients (21.5 %) developed a postoperative SSI. The median time to the development of SSI was 7 days (5–10). Of all infections, 67.5 % were superficial, 22.9 % were deep and 9.6 % were organ space. In univariate analysis, an ASA grade of II (RR 0.6, CI 0.3–0.9, P?=?0.019), having an elective procedure (RR 0.4, CI 0.2–0.6, P?<?0.001), using a laparoscopic approach (RR 0.5, CI 0.3–0.9, P?=?0.019), having a daytime procedure (RR 0.3, CI 0.1–0.7, P?=?0.006) and having a clean/contaminated wound (RR 0.4, CI 0.2–0.7, P?=?0.001) were associated with reduced risk of SSI. In multivariate analysis, an ASA grade of IV (RR 3.9, CI 1.1–13.7, P?=?0.034), a procedure duration over 3 h (RR 4.3, CI 2.3–8.2, P?<?0.001) and undergoing a panproctocolectomy (RR 6.5, CI 1.0–40.9, P?=?0.044) were independent risk factors for SSI. Those who developed an SSI had a longer duration of inpatient stay (22 days [16–31] vs 15 days [10–26], P?<?0.001).

Conclusions

Patients who develop an SSI have a longer duration of inpatient stay. Independent risk factors for SSI following colorectal resection include being ASA grade IV, having a procedure duration over 3 h, and undergoing a panproctocolectomy.

     

Resolution of Persistent COVID-19 After Convalescent Plasma in a Patient with B Cell Aplasia

Journal of Clinical Immunology -     

Clickable Poly(ethylene glycol)‐Microsphere‐Based Cell Scaffolds

Clickable poly(ethylene glycol) (PEG) derivatives are used with two sequential aqueous two‐phase systems to produce microsphere‐based scaffolds for cell encapsulation. In the first step, sodium sulfate causes phase separation of the clickable PEG precursors and is followed by rapid geleation to form microspheres in the absence of organic solvent or surfactant. The microspheres are washed and then deswollen in dextran solutions in the presence of cells, producing tightly packed scaffolds that can be easily handled while also maintaining porosity. Endothelial cells included during microsphere scaffold formation show high viability. The clickable PEG‐microsphere‐based cell scaffolds open up new avenues for manipulating scaffold architecture as compared with simple bulk hydrogels.

     

FISSURE SEALANT IN A NUTSHELL. EVIDENCE-BASED META-EVALUATION OF SEALANTS’ EFFECTIVENESS IN CARIES PREVENTION AND ARREST

ObjectiveThis meta-evaluation aimed to summarize all available evidence regarding different fissure sealants on occlusal caries prevention, arrest, retention rate, adverse effect, and cost-effectiveness; when compared with no intervention, other preventive or minimally-invasive procedures.Materials and MethodsThe systematic reviews and meta-analyses were identified via four electronic databases and manual searching. Two independent reviewers performed study selection, data extraction, quality assessment with AMSTAR-2.ResultsAmong the 366 records yielded, 38 systematic reviews were identified as eligible 24 of them included meta-analyses. Moderate evidence has supported the efficacies of resin-based sealants (RBS) in occlusal caries prevention, arrest and cost-effectiveness compared to no interventions. Low to very low certainty of evidence suggested similar effectiveness of glass-ionomer cements in caries prevention with RBS and more superior performance of resin infiltration in arresting non-cavitated occlusal lesions.ConclusionThis meta-evaluation supports the use of RBS on permanent molars to reduce occlusal caries occurrence, arrest lesion progression and alleviate oral health inequalities between individuals of different socioeconomic status. This meta-evaluation also advocates further research on glass-ionomer cements and resin infiltration with respect to their efficacies in caries prevention and arrest.     

Juvenile and adenomatous gastrointestinal polyposis

Summary This is the fourth report of a case showing an association between juvenile and adenomatous polyposis. Starting at age 14, this patient underwent multiple polypectomies and gastrointestinal resections over a 15-year period. Although initial biopsies were diagnosed as juvenile polyps, later biopsies showed both adenomatous polyps and large polypoid masses with a mixture of juvenile and adenomatous features. Several typical small hyperplastic polyps were also found in the stomach. This case contrasts with the previous three cases in that the gastrointestinal tract is more widely involved and in that there is an unusual marked hyperplasia of argentaffin-and argyrophil-positive cells. The case reported here strengthens the relation between adenomatous polyposis and juvenile polyposis.     

Pilot study of Sandostatin (octreotide) therapy of refractory HIV-associated diarrhea

Seventeen AIDS patients were enrolled in a prospective open-label dose-finding study of octreotide (Sandostatin) therapy for refractory diarrhea. Five were nonevaluable due to progression of AIDS symptomatology, and one was excluded because of lack of confirmation of HIV infection. Five of 11 evaluable patients responded to therapy (45%); two each at 50 g and 100 g, and one at 250 g thrice daily doses. A sixth patient demonstrated a moderate reduction in stool volume at 250 g thrice daily, which, although deemed clinically relevant, did not meet the criteria for response. On discontinuation of therapy, diarrhea recurred in all patients within 1–12 days, and responded to reinitiation of octreotide in those five patients who resumed treatment. Only one of the three patients with concurrent cryptosporidial infection responded to treatment. The drug was well tolerated, with mild symptomatology in three patients. Long-term treatment at a stable dose was effective in three of five treated patients for periods for seven months in one (moderate responder) and one year in two. One patient required dose increases to control symptoms, but after one year of treatment developed severe nausea following injections, which required dose cessation. One patient had partial control of his diarrhea for only three months despite two dose increases. These data suggest that octreotide may be of useful therapeutic value in HIV-associated diarrhea and that further studies are indicated.This study was supported by Sandoz Canada Inc.     

Influence of Cytokines on the Growth Kinetics and Immunophenotype of Daughter Cells Resulting From the First Division of Single CD34+Thy-1+lin- Cells

There is a need to determine whether culture conditions may existfor ex vivo expansion of hematopoeitic stem cells (HSC), which favorsolely proliferative self-renewal of HSC as opposed to proliferationwith differentiation. Using single cells, we studied the effects ofindividual and combinations of cytokines in serum-free medium on thekinetics of the first cell doubling and the resulting phenotype of eachof individual daughter cell. CD34⁺Thy-1⁺lincells were plated 1 cell per well in Terasaki plates inserum-free medium containing cytokines. Each well containing a singlecell was monitored daily over 7 days for maintenance, division, or death. When division occurred in an individual well, the phenotype ofthe daughter cells was determined by staining with anti-CD34 fluorescein isothiocyanate (FITC)- and phycoerythrin (PE)-conjugated lineage specific antibodies. The cumulative percent of wells with anundivided single cell, wells in which the cell had divided, and wellsin which the cell had died were scored. The number of doublets withconserved phenotype (CD34⁺lin) wascompared to those wells with one or more differentiated daughter cells(CD34⁺lin⁺). Over 7 days, cells cultured insingle factors showed that between 13% (interleukin-6 [IL-6]) and29% (thrombopoietin [TPO]) of the cells were undivided, between 13%(IL-1) and 35% (TPO) of the cells doubled, and between 35% (TPO) andgreater than 60% (IL-11, IL-1, or hepatocyte growth factor[HGF]) died. When combinations of cytokines were usedover 7 days, between 5% (FLT-3 ligand [FLT-3L], stemcell factor [SCF], IL-3, IL-6, granulocytecolony-stimulating factor [G-CSF],  nerve growth factor[NGF]) and 22% (FLT-3L + HGF) of the cellsremained undivided, between 15% (HGF, IL-1, IL-11, G-CSF) and 68%(SCF + TPO) of the cells had doubled and between 27% (FLT-3L + TPO) and 70% (HGF, IL-1, IL-11, G-CSF) died. The combination of FLT-3L + TPO induced the highest total percent (64.6%) of cells withconserved phenotype (percent conserved doublets + percent with 1 cellconserved), followed by SCF + TPO, (50%) and the combination ofFLT-3L, SCF, IL-3, IL-6, G-CSF, NGF (53%). These combinations alsoproduced the highest yield of cells with conserved phenotype after onedivision (FLT-3L + TPO  81 cells/100 initial cells, SCF + TPO  68 cells/100 initial cells) (P = .01). Observation of thetime of the initial cell division and phenotype of the daughter cellsallowed us to identify candidate combinations of cytokines that promotemaintenance of lin cells (TPO), or recruit the primitivecells to divide and undergo phenotypic self-renewal (FLT-3L + TPO,SCF + TPO).     

Rate of FKS Mutations among Consecutive Candida Isolates Causing Bloodstream Infection

Precise FKS mutation rates among Candida species are undefined because studies have not systematically screened consecutive, disease-causing isolates. The Sensititre YeastOne (SYO) assay measures echinocandin MICs against Candida with less variability than reference broth microdilution methods. However, clinical breakpoint MICs may overstate caspofungin nonsusceptibility compared to other agents. Our objectives were to determine Candida FKS mutation rates by studying consecutive bloodstream isolates and to determine if discrepant susceptibility results were associated with FKS mutations. FKS hot spots were sequenced in echinocandin-intermediate and -resistant isolates and those from patients with breakthrough candidemia or ≥3 days of prior echinocandin exposure. Overall, 453 isolates from 384 patients underwent susceptibility testing; 16% were echinocandin intermediate or resistant. Intermediate susceptibility rates were higher for Candida glabrata than for other species (P < 0.0001) and higher for caspofungin than for other agents (P < 0.0001). Resistance rates were similar between agents. FKS mutations were detected in 5% of sequenced isolates and 2% of isolates overall. Corresponding rates among C. glabrata isolates were 8% and 4%, respectively. Among Candida albicans isolates, rates were 5% and <1%, respectively. Mutations occurred exclusively with prior echinocandin exposure and were not detected in other species. Isolates with discrepant susceptibility results did not harbor FKS mutations. Mutation rates among isolates resistant to ≥2, 1, and 0 agents were 75%, 13%, and 0%, respectively. In conclusion, FKS mutations were uncommon among non-C. glabrata species, even with prior echinocandin exposure. Discrepancies in echinocandin susceptibility by SYO testing were not driven by mutations and likely reflect imprecise caspofungin clinical breakpoints.