Tag Archives: Surgical Wound Infection

Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis

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“Uncomplicated and complicated appendicitis are currently distinguished as 2 different disease entities that require different treatments. The role of antibiotic treatment as an alternative for surgery in simple or uncomplicated appendicitis has been studied in adults and, more recently, in children. Acute complicated appendicitis with necrosis or perforation of the appendix is treated by appendectomy and usually followed by additional antibiotic
treatment aimed at reducing postoperative infectious complications. Restriction and proper use of antibiotics are important for reducing and preventing harmful adverse effects to the patients and preventing antibiotic resistance. In American guidelines, an antibiotic length of 4 to 7 days is advised after complicated appendicitis. To our knowledge, few studies have
investigated the reduction of antibiotic administration after appendectomy and these were mostly performed in children. Restricting antibiotic duration to fewer than 5 days after surgery in complicated appendicitis is seldom done, fearing infectious complications. However, 3 days of antibiotic treatment has been observed to be feasible and safe in a retrospective cohort of adults with complicated appendicitis.”

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Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh)

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“Surgical site infection (SSI) is the most common complication of surgery around the world, and disproportionately affects patients in low income and middle income countries (LMICs). SSI is unpleasant and harmful for patients, increases the care burden on families and communities, and is very costly for patients and providers. As a result, SSI was highlighted as the highest research priority in surgery in a global co prioritisation exercise. The causes of SSI are multifactorial, and a so called magic bullet to prevent SSI is unlikely to exist. In modern surgical practice, very few interventions to reduce the incidence of SSI have
been shown to be effective when tested robustly.”

“The ChEETAh trial evaluated a change in behaviour across theatre teams to routinely change gloves and instruments at the time of abdominal wound closure. Compared with
previous studies, ChEETAh is large, pragmatic, rigorously conducted, and transparently reported. It also includes a diverse and representative range of patients operated on in
hospitals across middle-income and lower-income settings. The high adherence rate with the intervention shows that routine change of gloves and instruments is deliverable
around the world. ChEETah robustly shows that routine change of gloves and instruments before wound closure reduced surgical site infections in clean–contaminated, contaminated, and dirty surgery, which was consistent across several sensitivity analyses. That there was no evidence to suggest heterogeneity of effect across any of the prespecified subgroups suggests that the effect is consistent across a wide range of patients.”

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Evaluation of Surgical Site Infections by Wound ClassificationSystem Using the ACS-NSQIP

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“The wound classification system is an important predictor of postoperative outcomes. Recent studies have focused on elements such as preoperative risk factors and co-morbidities, operative time, prophylactic antibiotic use, and the American Society of Anesthesiology (ASA) physical status score, along with wound classification to predict postoperative surgical outcomes”

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Negative Pressure Wound Therapy Use to Decrease Surgical Nosocomial Events in Colorectal Resections

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“Surgical site infection (SSI) is one of the most common complications following open colon and rectal surgery. Significant morbidity—secondary to increased length of stay, delay in adjuvant treatments, and psychosocial effects—has been well established in the literature. Further, SSIs confer additional monetary costs to the healthcare system.6 Despite best practice recommendations including prophylactic antibiotics and aseptic technique, SSIs remain common in open colorectal surgery. Rates of SSI in the literature range between 15
and 30%. Increased use of laparoscopy in colorectal surgery has significantly impacted rates of SSI but the uptake of laparoscopy has not been complete as certain patients are not candidates and conversion to open is required in approximately 15% of cases.”

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Negative Pressure Wound Therapy for Surgical-site Infection

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“Despite improvement in infection control, SSIs remain a common cause of morbidity after abdominal surgery. SSI has been associated with an increased risk of reoperation, prolonged hospitalization, readmission, and higher costs. Recent retrospective studies have suggested that the use of negative pressure wound therapy can potentially prevent this complication.”

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Sensitive quantification of Clostridium perfringens

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‘Clostridium perfringens is one of the most widely dispersed opportunistic pathogens and is well known to produce a number of toxins to cause several forms of histotoxic and enteric diseases in humans and animals [2]. Based on the production of four major toxins i.e., alpha, beta, epsilon and iota, it is categorized into five toxin-types viz. A, B, C, D and E. While it is ambiguous why C. perfringens produces so many diverse toxins, it is well known that it uses chromosomally-encoded α-toxin (which has phospholipase C (plc) and sphingomyelinase activities with hemolytic, necrotic and lethal abilities) as a chief virulent factor and key mediator for most of C. perfringens-associated diseases.”

Standard curves representing the quantitative detection of reference strains of C. perfringens by Amp-qPCR assay. C. perfringens ATCC 13124T, ATCC 9856, ATCC 3624, ATCC 3626, ATCC 12917, ATCC 14809, ATCC 27324, and CS 052–1 were cultivated separately in Glu-mGAM. DNA fractions were extracted from the culture samples in the early stationary phase (24 h), and bacterial counts were determined microscopically with DAPI staining. 10-fold serial dilutions of DNA corresponding to the bacterial counts ranging from 100 to 105 bacterial cells were assessed by 16S rRNA gene-specific a, plc-specific b, and cpe-specific c Amp-qPCR assays. The Cq values obtained were plotted against the log10number of bacterial cells subjected to each reaction. Data are expressed as means and standard deviations of the results from 7 strains (ATCC 13124T, ATCC 9856, ATCC 3624, ATCC 3626, ATCC 12917, ATCC 14809, and ATCC 27324) in the 16S rRNA gene-specific and plc-specific primer sets, and 3 strains (ATCC 12917, ATCC 14809, and CS 052–1) in the cpe-specific primer set

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Bacterial Translocation in Abdominal Trauma and Postoperative Infections

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There is higher risk of BT in trauma patients, and it is associated with a significant increase of postoperative infections. An abdominal trauma index ≥10 was found to be associated with the development of BT. This is the first study describing BT among patients with abdominal trauma, where causality is confirmed at molecular level.

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