A comparative study on antibiotics and no antibiotics in clean surgical cases

Background: Surgical wound infection is one of the most commonly occurring complications and its incidence has been lowest in clean surgical cases. Prophylactic antibiotics are routinely used in all surgical cases. But this is not indicated in clean surgical cases. Due to undue fear of infections, many practicing surgeons use antibiotics in clean surgical cases. Misuse of antimicrobials leads to drug toxicity, super infections, high health care cost and colonization of wards by highly resistant microbes. Objective of the study is to compare the frequencies of wound site infections in patients undergoing clean elective general surgery operations with no antibiotics and single dose prophylactic antibiotics.Methods: A comparative study of 100 patients undergoing elective clean surgeries at Victoria Hospital from November 2012 to October 2014 was undertaken. Data was collected by history taking, clinical examination, hematological and microbiological investigations and follow up.Results: Two cases in each group had post-operative infections noticed on the day 2 wound examination. All the four cases had culture positive with isolates being S. aureus in three and E. coli in single case.Conclusions: Post-operative wound infections noted in two cases in both the groups do not have any clinical and statistical significance; hence single dose of prophylactic antibiotics is not required in all the clean surgical cases. A simple size of large number is required in this area of research to conclude with statistical significance.

Fatores de riscos para mediastinite no pós-operatório de cirurgia cardíaca / Risk factors for mediastinitis in the post-operative period of heart surgery / Factores de riesgo para mediastinitis en el período postoperatorio de cirugía cardíaca

Objetivos: Identificar os fatores de risco pré e pós-operatórios relacionados ao desenvolvimento de mediastinite entre pacientes submetidos à cirurgia cardíaca em um hospital da cidade do Rio de Janeiro, caracterizar a população estudada e analisar a relação entre os fatores de risco e a incidência de mediastinite nos pacientes submetidos à cirurgia cardíaca. Método: Estudo descritivo, abordagem quantitativa, em que foram identificados os fatores de risco para mediastinite em pacientes que realizaram cirurgia cardíaca em um hospital do Rio de Janeiro. Resultados: Obteve-se um n de 192 pacientes, de maioria homens, na faixa etária de 50 a 69 anos e em sobrepeso. Diabetes mellitus e tabagismo foram as comorbidades mais frequentes, e CRVMC a cirurgia mais realizada, 4 pacientes apresentaram mediastinite. Conclusão: A identificação destes fatores contribui para elaboração de estratégias de prevenção para mediastinite, e na implementação de cuidados de enfermagem no pré e pós-operatório de cirurgias cardíacas

Objectives: To identify pre and postoperative risk factors related to the development of mediastinitis among patients submitted to cardiac surgery at a hospital in the city of Rio de Janeiro, to characterize the study population and to analyze the relationship between risk factors and the incidence of mediastinitis in patients undergoing cardiac surgery. Method: descriptive study, quantitative approach, in which the risk factors for mediastinitis were identified in patients who underwent cardiac surgery in a hospital in Rio de Janeiro. Results: a n of 192 patients, mostly males, aged 50 to 69 years and overweight were obtained. Diabetes mellitus and smoking were the most frequent comorbidities, and CRVMC the most performed surgery, 4 patients had mediastinitis. Conclusion: the identification of these factors contributes to the elaboration of prevention strategies for mediastinitis, and the implementation of nursing care in the pre and postoperative period of cardiac surgeries

Objetivos: Identificar los factores de riesgo pre y postoperatorios relacionados al desarrollo de mediastinitis entre pacientes sometidos a la cirugía cardiaca en un hospital de la ciudad de Río de Janeiro, caracterizar a la población estudiada y analizar la relación entre los factores de riesgo y la incidencia de mediastinitis en los pacientes sometidos a la cirugía cardiaca. Método: Estudio descriptivo, abordaje cuantitativo, en que se identificaron los factores de riesgo para la mediastinitis en pacientes que realizaron una intervención cardiaca en un hospital de Río de Janeiro. Resultados: Se obtuvo un n de 192 pacientes, de mayoría hombres, en el grupo de edad de 50 a 69 años y en sobrepeso. La diabetes mellitus y el tabaquismo fueron las comorbilidades más frecuentes, y CRVMC la cirugía más realizada, 4 pacientes presentaron mediastinitis. Conclusión: La identificación de estos factores contribuye a la elaboración de estrategias de prevención para la mediastinitis, y en la implementación de cuidados de enfermería en el pre y postoperatorio de cirugías cardíacas

Aspectos epidemiológicos das infecções de sítio cirúrgico em cirurgias ortopédicas com implante em um hospital de reabilitação

Este estudo é uma coorte histórica, com informações de 517 pacientes submetidos à cirurgia ortopédica com implante da Rede SARAH Hospitais de Reabilitação, unidade de Brasília, entre os meses de janeiro de 2010 a julho de 2015. Teve como objetivo geral analisar os aspectos epidemiológicos das infecções de sítio cirúrgico em cirurgias ortopédicas com implante. Como objetivos específicos, pretendeu-se estimar a incidência global da infecção, estimar a incidência de infecção por topografia, por tipo de cirurgia, segundo ASA e potencial de contaminação da ferida operatória, identificar possíveis fatores de risco para ocorrência da infecção, identificar os microrganismos responsáveis pela infecção e propor um modelo de predição de risco com as variáveis estudadas. Para alcançar os objetivos propostos, analisaram-se os dados descritivamente através de frequência simples e medidas de tendência central como média mediana e variabilidade desvio-padrão. Em seguida realizou-se modelo de regressão logística GEE para verificar os possíveis fatores de risco associados à infecção de sítio cirúrgico. A população foi caracterizada por pacientes do sexo feminino, com média de idade 58 anos e estar acima do peso corporal (IMC >25kg/m²). Foram diagnosticadas 22 ISC, com incidência global de 3,5% [IC95% 2,1-5,5]. As infecções superficiais foram as mais incidentes (1,4%) e dentre os procedimentos cirúrgicos, as artroplastias de quadril tiveram a taxa mais alta de infecção (4,2%). A incidência de infecção em pacientes classificados com ASA III e IV (6,9%) foi maior do que nos classificados com ASA I e II (2,6%) e a taxa de infecção foi maior em cirurgias classificadas como potencialmente contaminadas e contaminadas (15,6%), enquanto as cirurgias limpas cirurgias limpas a incidência foi de 2,6%. O S. aureus foi o microrganismo mais prevalente. . O modelo de ajustefinal definiu como fatores para infecções cirúrgicas ortopédicas com implante:...

This study is a historical cohort with information from 517 patients submitted to orthopedic surgery with implantation of the SARAH Network of Rehabilitation Hospitals, Brasília unit, from January 2010 to July 2015. Its general objective was to analyze the epidemiological aspects of infections of surgical site in orthopedic surgeries with implant. As a specific objective, it was intended to estimate the global incidence of infection, to estimate the incidence of infection by topography, by type of surgery, according to ASA and potential for wound infection, to identify possible risk factors for infection, to identify microorganisms Responsible for the infection and to propose a model of risk prediction with the studied variables. To reach the proposed objectives, data were analyzed descriptively through simple frequency and measures of central tendency as median mean and standard deviation variability. A GEE logistic regression model was then performed to verify the possible risk factors associated with surgical site infection. The population was characterized by female patients, with a mean age of 58 years and being overweight (BMI> 25kg / m²). Twenty-two ISCs were diagnosed, with a global incidence of 3.5% [95% CI 2.1-5.5]. The superficial infections were the most incidental (1.4%) and among the surgical procedures, hip arthroplasties had the highest rate of infection (4.2%). The incidence of infection in patients classified as ASA III and IV (6.9%) was higher than those classified as ASA I and II (2.6%) and the incidence of infection in clean surgeries was 2.6%. That in potentially contaminated and contaminated surgeries was 15.6%. S. aureus was the most prevalent microorganism. The final adjustment model defined as factors for implant orthopedic surgical infections:...

A Randomised Control Trial on the Use of Topical Methicillin in Reducing Post-Operative Ventriculoperitoneal Shunt Infection

Background: A double-blind randomised control study was conducted on all patients who were admitted or referred to the Department of Neurosurgery, Sultanah Aminah Hospital, Johor Bahru, with a diagnosis of hydrocephalus where a ventriculoperitoneal shunt was indicated. Methods: The period of study was from November 2005 to May 2007, and the follow-up period was 3 months after surgery. Randomisation was carried out in the operating room prior to the procedure. The scrub nurse selected a sealed envelope, which contained the assignment of each patient to 1 of 2 treatment groups: Group 1 patients were treated with topical methicillin, and Group 2 patients were not treated with topical methicillin. Prophylactic antibiotic, cefuroxime (25 mg/kg) was given intravenously at induction. Standard sterile operative technique was followed in preparing and draping the patients. Results: A total of 90 patients were recruited in the study, and 13 (14.4%) patients developed an infection within 3 months post-operation. Group 1 had a 8.9% risk of infection, and Group 2 had a 20% risk; however, there was no statistically significant post-operative ventriculoperitoneal shunt (VPS) infection reduction with the use of topical methicillin in VPS surgery (P = 0.230). Multivariate analysis showed that only duration of surgery had a significant influence on the incidence of postoperative VPS infection in the non-methicillin group (P = 0.02). The non-methicillin group had an 8 times greater risk of developing post-operative VPS infection than the methicillin group if surgery lasted longer than 1 hour. Conclusion: Topical methicillin had no significance in the reduction of post-operative VPS infection.