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ABSTRACT BACKGROUND: Surgical antibiotic prophylaxis is an essential component of perioperative care. The use of prophylactic regimens of antibiotics is a well-established practice that is encouraged to be implemented in preoperative/perioperative protocols in order to prevent surgical site infections. AIMS: The aim of this study was to emphasize the crucial aspects of antibiotic prophylaxis in abdominal surgery. RESULTS: Antibiotic prophylaxis is defined as the administration of antibiotics before contamination occurs, given with the intention of preventing infection by achieving tissue levels of antibiotics above the minimum inhibitory concentration at the time of surgical incision. It is indicated for clean operations with prosthetic materials or in cases where severe consequences may arise in the event of an infection. It is also suitable for all clean-contaminated and contaminated operations. The spectrum of action is determined by the pathogens present at the surgical site. Ideally, a single intravenous bolus dose should be administered within 60 min before the surgical incision. An additional dose should be given in case of hemorrhage or prolonged surgery, according to the half-life of the drug. Factors such as the patient's weight, history of allergies, and the likelihood of colonization by resistant bacteria should be considered. Compliance with institutional protocols enhances the effectiveness of antibiotic use. CONCLUSION: Surgical antibiotic prophylaxis is associated with reduced rates of surgical site infection, hospital stay, and morbimortality.
RESUMO RACIONAL: A antibioticoprofilaxia é um componente importante dos cuidados perioperatórios. OBJETIVOS: Abordar os principais aspectos da antibioticoprofilaxia em cirurgia digestiva. RESULTADOS: Ela é definida como a redução da carga de bactérias no sítio operatório através da obtenção de níveis séricos de antibiótico acima da concentração inibitória mínima no momento da incisão cirúrgica. Está indicada em cirurgias limpas com próteses e nas quais a consequência de uma eventual infecção seja grave, bem como em todas as cirurgias limpas-contaminadas e contaminadas. O espectro de ação do antibiótico deve ser de acordo com a flora esperada no sítio cirúrgico e deve ser administrado 60 minutos antes da incisão, em bolus, por via endovenosa e preferencialmente em dose única. Nos casos de hemorragia importante ou cirurgias mais longas, uma nova dose pode ser administrada. O peso do paciente, a história de alergia a medicamentos e a possibilidade de colonização por bactérias multirresistentes devem ser levados em conta. A aderência a protocolos institucionais aumenta a chance de uso adequado da antibioticoprofilaxia. CONCLUSÕES: A antibioticoprofilaxia está associada à redução das taxas de infecção do sítio cirúrgico, tempo de internação e morbidade.
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RESUMEN El manejo adecuado de las infecciones del sitio operatorio (ISO) en neurocirugía es fundamental para la disminución de la carga de morbilidad y mortalidad en estos pacientes. La sospecha y confirmación diagnóstica asociadas al aislamiento microbiológico son esenciales para asegurar el tratamiento oportuno y el adecuado gerenciamiento de antibióticos. En esta revisión se presenta de forma resumida los puntos fundamentales para la prevención y el tratamiento de infecciones del sitio operatorio en neurocirugía y se incluye un apartado sobre el uso de antibióticos intratecales/intraventriculares.
SUMMARY The adequate management of surgical wound infections in neurosurgery is fundamental for reducing the burden of morbidity and mortality in these patients. The suspicion and diagnostic confirmation associated with microbiological isolation are essential to ensure timely treatment and proper management of antibiotics. Therefore, in this review we present, in a synthetic manner, the main points for the prevention and treatment of surgical site infections in neurosurgery, which includes a section on the use of intrathecal/intraventricular antibiotics.
Subject(s)
Humans , Surgical Wound Infection , Primary Prevention , NeurosurgeryABSTRACT
STUDY DESIGN: Retrospective review of prospectively collected data. PURPOSE: To evaluate the incidence of surgical site infections (SSIs) in minimally invasive spine surgery (MISS) in a cohort of patients and compare with available historical data on SSI in open spinal surgery cohorts, and to evaluate additional direct costs incurred due to SSI. OVERVIEW OF LITERATURE: SSI can lead to prolonged antibiotic therapy, extended hospitalization, repeated operations, and implant removal. Small incisions and minimal dissection intrinsic to MISS may minimize the risk of postoperative infections. However, there is a dearth of literature on infections after MISS and their additional direct financial implications. METHODS: All patients from January 2007 to January 2015 undergoing posterior spinal surgery with tubular retractor system and microscope in our institution were included. The procedures performed included tubular discectomies, tubular decompressions for spinal stenosis and minimal invasive transforaminal lumbar interbody fusion (TLIF). The incidence of postoperative SSI was calculated and compared to the range of cited SSI rates from published studies. Direct costs were calculated from medical billing for index cases and for patients with SSI. RESULTS: A total of 1,043 patients underwent 763 noninstrumented surgeries (discectomies, decompressions) and 280 instrumented (TLIF) procedures. The mean age was 52.2 years with male:female ratio of 1.08:1. Three infections were encountered with fusion surgeries (mean detection time, 7 days). All three required wound wash and debridement with one patient requiring unilateral implant removal. Additional direct cost due to infection was $2,678 per 100 MISS-TLIF. SSI increased hospital expenditure per patient 1.5-fold after instrumented MISS. CONCLUSIONS: Overall infection rate after MISS was 0.29%, with SSI rate of 0% in non-instrumented MISS and 1.07% with instrumented MISS. MISS can markedly reduce the SSI rate and can be an effective tool to minimize hospital costs.
Subject(s)
Humans , Cohort Studies , Debridement , Decompression , Diskectomy , Health Expenditures , Hospital Costs , Hospitalization , Incidence , Minimally Invasive Surgical Procedures , Prospective Studies , Retrospective Studies , Spinal Stenosis , Spine , Surgical Wound Infection , Wounds and InjuriesABSTRACT
Surgical site infections are an important cause of hospital-acquired infections among surgical patients and is the commonest troublesome reason for poor wound healing. They continue to be a major problem even in hospitals with the most modern facilities and standard protocols of preoperative preparation and antibiotic prophylaxis.
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Objetivos: determinar la adherencia al protocolo de antibioterapia prequirúrgica en pacientes sometidos a cirugías torácicas y abdominales del Hospital Universitario San Jorge, de Pereira. Materiales y métodos: estudio descriptivo observacional que recogió información de todos los pacientes intervenidos quirúrgicamente entre el 1 de abril y el 31 de junio de 2010. La información se tomó de historias clínicas considerando las variables edad, sexo, tipo de intervención quirúrgica, hora, día de la semana, antimicrobianos empleados comparados con los recomendados por las guías institucionales. El análisis se hizo mediante SPSS 19.0 para Windows. Resultados: se hicieron 211 cirugías, con predominio de hombres (52,6%) y edad promedio de 45,2 ± 19,9 años. La adherencia a guías de profilaxis antibiótica prequirúrgica fue de 44,5% de los procedimientos. Las variables sexo masculino (OR: 2,2; IC 95%: 1,220-4,063, p=0,009), cirugía de urgencias (OR: 2,1; IC 95%: 1,136-3,889, p=0,018) y fines de semana (OR: 2,3; IC 95%: 1,090-5,255, p=0,03) se asociaron de manera estadísticamente significativa con falta de adherencia. Conclusiones: se identificó una baja adherencia a las guías de antibioterapia prequirúrgica, asociada con cirugías de urgencia y de fines de semana. Se debe intervenir con educación y realimentación el equipo humano que trabaja en estas condiciones para mejorar el cumplimiento de las guías.
Objective: determine adherence to the protocol of antibiotic prophylaxis in patients undergoing surgery at Hospital Universitario San Jorge, Pereira. Materials and methods: observational descriptive study took information from all patients who underwent surgery between April 1 and June 31, 2010. The information was taken from medical records considering the variables age, gender, type of surgery, time, day of week, antimicrobial agents used compared with those recommended by institutional guidelines. The analysis was done using SPSS 19.0 for Windows. Results: there were 211 patients, with a predominance of men (52,6%) and average age of 45,2 ± 19,9 years. Adherence to guidelines pre-surgical prophylaxis was 44,5% of procedures. The variables male gender (OR 2,2; 95% CI 1,220 to 4,063, p=0,009), emergency surgery (OR 2,1; 95% CI 1,136 to 3,889, p=0,018) and weekends surgery (OR 2,3; 95% CI 1,090 to 5,255; p=0,03) were statistically significantly associated with nonadherence. Conclusion: it found low guideline for pre-surgical antibiotic adherence associated with emergency and weekends surgeries. Should intervene with education and feedback the team working in the emergency and surgery department to improve the level of compliance with guidelines.
Objetivos: determinar a adesão ou a obediência ao protocolo de antibioticoterapia pré-cirúrgica nos pacientes submetidos a cirurgias torácicas e abdominais do Hospital Universitário San Jorge, de Pereira. Metodologia: estudo descritivo de observação, que obteve informação de todos os pacientes que foram operados no período compreendido entre 1ro de abril e 31 de junho de 2010. A informação foi extraída das histórias clínicas, considerando as variáveis de idade, gênero, tipo de intervenção cirúrgica, hora, dia da semana, antimicrobianos utilizados comparados com os recomendados pelos guias institucionais. A análise foi realizada mediante SPSS 19.0 para Windows. Resultados: foram realizadas 211 cirurgias, com predomínio de homens (52,6%) com uma idade média entre 45,2 ± 19,9 anos. A obediência às guias de profilaxia antibiótica pré-cirúrgica foi de 44,5% dos procedimentos. As variáveis de gênero masculino (OR: 2,2; IC 95%: 1,220-4,063; p=0,009), cirurgias de urgências (OR: 2,1; IC 95%: 1,136-3,889, p=0,018) e fins de semana (OR: 2,3; IC 95%: 1,090-5,255, p=0,03) foram associadas de maneira estatisticamente significativa com a desobediência às guias. Conclusões: a identificação das variáveis associadas com a desobediência ás guias poderá ser usada para desenvolver intervenções que melhorem à obediência ás guias de prática médica, o que certamente, ocasionará um menor risco de infecção da ferida operatória e outras complicações.
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Humans , Anti-Bacterial Agents , Surgical Wound Infection , Practice Guideline , Medication AdherenceABSTRACT
PURPOSE: S-plasty for pilonidal disease reduces the tension on the midline by distributing it diagonally and flattening the natal cleft. The aim of this study was to evaluate the outcomes of S-plasty on simple midline primary closure and the clinical features of pilonidal patients in a low incidence country. METHODS: S-plasty was applied on 17 patients from July 2008 to October 2010. Data of these patients were collected with computerized prospective database forms during a perioperative period and via telephone interview for follow-up. Surgical site infection (SSI) was defined according to the Center for Disease Control guidelines. The severity of surgical site infection was graded. RESULTS: All patients were treated with primary S-plasty. Two patients (11.7%) developed low grade SSI. The average healing time after S-plasty was 18.1 days. No recurrences were observed. The mean follow-up period was 13.5 months (range, 6 to 33 months). CONCLUSION: We have shown that primary S-plasty for pilonidal disease is simple, and its surgical outcomes are compatible to the results of other surgical treatments. We present primary S-plasty as a feasible treatment option in a low incidence country.
Subject(s)
Humans , Follow-Up Studies , Incidence , Interviews as Topic , Perioperative Period , Pilonidal Sinus , Recurrence , Surgical Flaps , Surgical Wound Infection , Wound Closure Techniques , Wound HealingABSTRACT
Trata-se de um estudo de caráter epidemiológico, tipo coorte, prospectivo, realizado no Serviço de Cirurgia do Aparelho Digestivo (CAD), em dois hospitais gerais de ensino, da cidade de São Paulo. Teve por objetivo geral: desenvolver um índice preditivo de risco, para a infecção do sitio cirúrgico (ISC), em pacientes submetidos à cirurgia do aparelho digestivo e comparar sua capacidade preditiva com o índice de risco do National Nosocomial Infection Surveillance (NNIS). Os objetivos específicos foram: determinar a incidência de infecção do sítio cirúrgico intra-hospitalar e após a alta, avaliar os possíveis fatores de risco para ISC: idade, sexo, procedimento cirúrgico realizado, condição de realização da cirurgia, condição clínica do paciente (Sociedade Americana de Anestesiologia - ASA), obesidade (Índice de Massa Corpórea - IMC), presença de neoplasia, classificação da ferida operatória, duração do procedimento cirúrgico, uso de antibioticoterapia, permanência pré-operatória, gravidade da doença de base do paciente, uso de anestesia, cirurgia laparoscópica, além de validar o índice de risco NNIS e compará-lo com o modelo alternativo. Todos os pacientes submetidos a CAD, no período de agosto de 2001 a março de 2002 foram acompanhados, de acordo com os critérios estabelecidos pela metodologia NNIS, durante a internação e após a alta hospitalar, até o trigésimo dia da data da cirurgia, por retorno ambulatorial e contato telefônico. No período do estudo, obteve-se uma incidência global de ISC de 24,5%; foram notificadas 149 ISC, sendo 33 (22,1%) durante a internação e 116 (77,9%) após alta hospitalar. Considerando, apenas a incidência intra-hospitalar da ISC, esta foi apenas 5,4%. Em relação aos possíveis fatores de risco para ISC, estiveram associados à sua ocorrência na análise univariada: unidade, obesidade, risco cirurgia, duração ajustada, cirurgia laparoscópica, potencial de contaminação, anestesia e o ) uso de antibiótico. Todas estas variáveis mostraram-se estatisticamente significativas à ocorrência da ISC, p<0,05. Para a análise multivariada, pela regressão logística foram incluídas todas as variáveis que apresentaram um valor de p<0,20: unidade, obesidade, risco cirurgia, duração ajustada, cirurgia laparoscópica, potencial de contaminação, anestesia, uso de antibiótico, tipo de cirurgia. No entanto, perderam a significância estatística: unidade, anestesia, uso de antibiótico, tipo de cirurgia. Para construção do modelo alternativo, foram incluídas: obesidade, risco cirurgia, duração ajustada, cirurgia laparoscópica e potencial de contaminação. Na validação do Modelo NNIS, foi incluída a variável ASA, por ser parte constituinte do mesmo e pela sua importância epidemiológica. Após a construção do modelo na validação do índice de risco NNIS, verificou-se que o mesmo mostrou pouco preditivo à ocorrência da ISC, na amostra estudada, sendo avaliado em relação ao ajuste dos dados, pelo teste de adequação de Hosmer-Lemeshow e pelo poder de discriminação obtido pela curva ROC, [(0,652); 0,627; IC 95,0% 0,575 - 0,678]; modelo alternativo [(0.895); 0,753; IC 95,0% 0,708 - 0,799]. A validação do modelo alternativo não se constituiu objetivo deste estudo, mas foi verificada melhor área sob a curva e, portanto, melhor acurácia em relação ao Modelo NNIS. Os resultados deste estudo oferecem aos profissionais do controle de infecção hospitalar novas perspectivas para continuidade da busca de um índice de risco do paciente de cirurgia do aparelho digestivo e que apresente maior acurácia em relação ao atualmente adotado, considerando as peculiaridades dos procedimentos cirúrgicos realizados.
It was a prospective and epidemiologic study, type cohort, in the Surgery of digestive System (SDS) Service, accomplished at two teaching general hospitals, in São Paulo. The general objective of this study was: to develop a predictive risk index for the surgical site infection (SSI), in patients that went into surgery of digestive system, and to compare its capacity of prediction with the National Nosocomial Infection Surveillance (NNIS) Risk Index; and the specific objectives were: to determine the incidence of the surgical site infection in-hospital and after discharge; to evaluate the possible risk factors for SSI: age, sex, condition of surgery completion, patient's clinical condition (American Society Anesthesiology - ASA), obesity (Corporeal Mass Index - CMI), presence of neoplasia, classification of the surgical wound, duration of the surgical procedure, antibiotic therapy, preoperative permanence, and the severity of the base disease, anesthetic use, laparoscopy surgery; and also to validate the NNIS Risk Index and to evaluate the power prediction of the alternative model. All patients that went into the SDS, since august 2001 until march 2002, were accompanied, in concordance with the criterion established by NNIS methodology, during the stay in-hospital and after the discharge, until the thirtieth day after the surgery date, by ambulatory return and phone contact. In the period of study, it was obtained a SSI global incidence of 24,5%, 149 SSI were notified, being 33 (22,1%) during the stay, and 116 (77,9%) after discharge. Considering just the intra-hospitalar SSI incidence, it was only 5,4%. In relation to the possible risk factors for SSI, in the univariate analysis, there were associated to its occurrence: unit, obesity, surgery risk, adjusted duration, laparoscopy surgery and potential of contamination, anesthesia and antibiotic therapy. All these variables were statistically significant for the occurrence of SSI, p<0,05. For the multivariate analysis, through the logistic regression, were included all variables that presented a p<0,20: unit, obesity, surgery risk, adjusted duration, laparoscopy surgery, potential of contamination, anesthetizes and the antibiotic therapy, surgery type. However, the following variables lost statistical significance: unit, anesthesia, antibiotic therapy, surgery type. For the construction of the Alternative model were included: obesity, surgery risk, adjusted duration, laparoscopy surgery, and potential of contamination. In the NNIS model validation, the variable ASA was included, for being constituent part of NNIS, and for its epidemiologic importance. After the construction of the model, in the validation of the NNIS Risk Index, it was verified that this index showed little power prediction for the occurrence of SSI in the studied sample, evaluated in relation to the adjustment of the data, through the Hosmer-Lemeshow adaptation test and by the discrimination power obtained with the ROC curve [(0,652); 0,627; IC95% 0,575 - 0,678]; Alternative model [(0.895); 0,753; IC95% 0,708 - 0,799]. Although it didn't constitute an objective of this study to validate the Alternative model, it presented a better area under the ROC curve, and, therefore, better accuracy in comparison with the NNIS model. The results of this study provide for the professionals of nosocomial infection control new perspectives for continuing the search of a risk index for patients that went into the surgery of digestive system, looking for the one that presents larger accuracy, in comparison to the one now adopted, considering the peculiarities of the surgical procedures realized.