Category Archives: Infectious Diseases

Timing of elective surgery and risk assessment after SARS-CoV-2 infection

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“Patients who develop symptoms of SARS-CoV-2 infection within 7 weeks of planned surgery, including on the day of surgery, should be screened for SARS-CoV-2. Elective surgery should not usually be undertaken within 2 weeks of diagnosis of SARS-CoV-2 infection. For patients who have recovered from SARS-CoV-2 infection and who are low risk or having low-risk surgery, most elective surgery can proceed 2 weeks following a SARS-CoV-2 positive test. For patients who are not low risk or having anything other than low-risk surgery between 2 and 7 weeks following infection, an individual risk assessment must be performed. This should consider: patient factors (age; comorbid and functional status); infection factors (severity; ongoing symptoms; vaccination); and surgical factors (clinical priority; risk of disease progression; grade of surgery).”

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Article of interest: Role of antibiotic prophylaxis for the prevention of intravascular catheter-related infection

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Carratalà J. Role of antibiotic prophylaxis for the prevention of intravascular catheter-related infection. Clin Microbiol Infect. 2001;7 Suppl 4:83-90. Free full-text.

“A plausible explanation for the failure to reduce catheter-related bacteremia with this prophylactic approach probably lies in the mechanism by which catheter-related infection occurs. Thus, it is known that in long-term central venous catheters, bacteria are more likely to be introduced during and following catheter hub manipulation than via spread from the skin insertion site or from tunnel infection. On the other hand, the systemic administration of prophylactic glycopeptides may lead to the emergence of resistant organisms, and Centers for Disease Control and Prevention guidelines recommend against its use [55]. Therefore, the use of systemic glycopeptides to prevent intravascular catheter-related infections is not recommended.” (p. 85)

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Early diagnosis and risk factors of necrotizing soft tissue infection

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Fernando SM, Tran A, Cheng W, et al. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019 Jan;269(1):58-65. doi: 10.1097/SLA.0000000000002774. Full-text for Emory users.

Conclusion: “Our systematic review found that individual physical examination signs (fever, hemorrhagic bullae, and hypotension) were poorly sensitive for diagnosis of NSTI. CT had superior sensitivity and specificity to plain radiography in diagnosing NSTI, but may not be readily available in all centers, and may not be suitable for unstable patients. Finally, the LRINEC score was poorly sensitive for diagnosis of NSTI, suggesting that a low score is not sufficient to rule out the diagnosis.”

See also:

Abu El Hawa AA, Dekker PK, et al. Early Diagnosis and Surgical Management of Necrotizing Fasciitis of the Lower Extremities: Risk Factors for Mortality and Amputation. Adv Wound Care (New Rochelle). 2022 May;11(5):217-225.

Harasawa T, et al. Accurate and quick predictor of necrotizing soft tissue infection: Usefulness of the LRINEC score and NSTI assessment score. J Infect Chemother. 2020 Apr;26(4):331-334.

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Article of interest: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2021

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Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021 Nov 1;49(11): e1063-e1143.

Full-text for Emory users.

Methods: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

Results: The Surviving Sepsis Guideline panel provided 93 statements on early management and resuscitation of patients with sepsis or septic shock. Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions.

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ISPD peritonitis guideline recommendations: 2022 update on prevention & treatment

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Li PK, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int. 2022 Mar;42(2):110-153. Free full-text.

Abstract: The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year.

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Postoperative complications of patients during the COVID-19 pandemic.

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Deng JZ, et al. The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States. Ann Surg. 2022 Feb 1;275(2): 242-246.

Results: Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06-10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22-5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35-5.53), and sepsis (aOR, 3.67; 95% CI: 2.18-6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20-4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients.

Conclusions: Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.

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Klebsiella pneumoniae liver abscess

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Jun JB. Klebsiella pneumoniae Liver Abscess. Infect Chemother. 2018 Sep;50(3):210-218. doi: 10.3947/ic.2018.50.3.210.

Abstract: Since the mid 1980s, the prevalence of liver abscess caused by hypervirulent Klebsiella pneumoniae strain has increased in Asia, particularly in Taiwan and Korea. This strain is mostly K1 or K2 serotype, and has hypercapsular and hypermucoid phenotypes. Most infections are community acquired, and patients rarely have a hepatobiliary disease prior to infection. Clinical manifestations are characterized by fever and high C-reactive protein, and metastatic infections, such as septic emboli in the lung and endophthalmitis and meningitis are frequently observed. Antibiotic resistance is rare. Antibiotic treatment and abscess drainage are needed, and early diagnosis and treatment of endophthalmitis is also important.

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