Factores que intervienen en la aparición de infecciones en heridas quirúrgicas de pacientes intervenidos en el hospital general milagro en el periodo de agosto 2020 a enero 2021 / Factors intervening in the appearance of infections in surgical wounds of patients operated at the milagro general hospital in the period from august 2020 to january 2021

El Ecuador mantiene una alta tasa de mortalidad derivada de las infecciones de heridas quirúrgicas, las post cesárea son las que se presentan comúnmente, donde las bacterias cada vez evolucionan mecanismos de resistencia a los antibióticos. Objetivo: analizar los factores que intervienen en la aparición de infección en herida quirúrgica. Materiales y Métodos: investigación tipo inductivo-deductiva al analizar variables cuantitativas; y la aplicación del razonamiento, con el que se obtuvieron generalizaciones del tema en estudio Resultados: Sexo el 35 % Mujeres y el 65% Varones, el 25 % tienen edad de 15 a 40 años, el 45 % tienen de 41 a 60 años, y el 30 % tienen de 61 años y más. Con respecto al nivel de educación, 50 % no tiene educación, 25% primaria, 15% secundaria y 10% superior, según la residencia el 75% vive en zona rural y 25 % en zona urbana. La mayoría de los procedimientos quirúrgicos involucrados en la complicación de infecciones de la herida fueron de emergencia en un 93,3%; mientras que las que se presentaron en electivas respondieron al 6,7%. Se observó que el 80% de las cirugías realizadas son clasificadas como cirugías limpias contaminadas, y un 20% cirugías contaminadas. Las mismas que tiene un alto riesgo de infectarse el SQ. Conclusiones: A pesar de que las acciones preventivas de preparación de piel y asepsia ­ antisepsia previa al acto quirúrgico se cumplen, las infecciones de la herida quirúrgica se siguen dando en una parte de pacientes intervenidos en el Hospital General Milagro(AU)

Ecuador maintains a high mortality rate derived from surgical wound infections, post-cesarean sections are the ones that commonly occur, where bacteria increasingly evolve mechanisms of resistance to antibiotics. Objective: to analyze the factors that intervene in the appearance of infection in surgical wounds. Materials and Methods: inductive-deductive type research when analyzing quantitative variables; and the application of reasoning, with which generalizations of the subject under study were obtained Results: Sex 35% Women and 65% Men, 25% are between 15 and 40 years old, 45% are between 41 and 60 years old, and 30% are 61 and older. Regarding the level of education, 50% have no education, 25% primary, 15% secondary and 10% higher, according to residence, 75% live in rural areas and 25% in urban areas. Most of the surgical procedures involved in the complication of wound infections were emergency in 93.3%; while those who attended electives responded to 6.7%. It was observed that 80% of the surgeries performed are classified as clean contaminated surgeries, and 20% contaminated surgeries. The same ones that have a high risk of becoming infected with SQ. Conclusions: Although the preventive actions of skin preparation and asepsis - antisepsis prior to the surgical act are fulfilled, infections of the surgical wound continue to occur in a part of patients operated on at the Hospital General Milagro(AU)

Topical application of lidocaine or bupivacaine in the healing of surgical wounds in dogs

Abstract Purpose: To analyze the anesthetic drugs interference with wound healing when used in the surgical bed. Methods: Macro and microscopic aspects of healing of surgical wounds were evaluated after instillation of topical anesthetics without vasoconstrictor or saline solution 0.9% as control in the transsurgical period. Thirty dogs, males and females were divided into two experimental groups. In both groups, two circular punch lesions of 6 mm diameter were performed in the abdomen. In group 1, lidocaine was instilled in one of the lesions and saline solution in the contralateral lesion. In group 2 the procedure was repeated with the use of bupivacaine. The macroscopic assessment of the lesions was performed on the first, third and tenth postoperative day. The excisional biopsy was performed on the tenth day and the samples were submitted for histopathological examination. Results: The macroscopic analysis had a significant difference between groups. Microscopic analysis was not significant between groups. Conclusions: The topical application of lidocaine and bupivacaine in the surgical wound is feasible and it does not influence skin healing. The benefit of such a practice, which has been the subject of other studies, seems to outweigh the risks.

Antibiotic resistance profiles of Acinetobacter baumannii isolates from surgical wound infections at Kamuzu Central Hospital in Malawi:a retrospective study

Background: Acinetobacter baumannii has emerged as one of the most significant pathogen due to its ability to develop antimicrobial resistance to a broad range of commonly available antibiotics. It represents a serious iatrogenic complication of modern healthcare, where patients acquire infections in healthcare facilities with limited treatment options, resulting in increased morbidity, mortality and health costs. Methods:  In this retrospective study, results of culture and antimicrobial susceptibility tests of samples collected from surgical wounds of patients from January to December 2017 were extracted from Laboratory information management system at Kamuzu Central Hospital (KCH) in Malawi.Results: This study ranks A. baumannii as the fourth common cause of surgical wound infections at KCH, with a prevalence of 12.3%. Other most prevalent isolates were: E. coli (25.9%), S. aureus (25.9%) and Proteus species (17.5%). All A. baumannii isolates were resistant to Amoxicillin/Clavulanate and Ceftriaxone; 96.4% were resistant to Ampicillin; 92.9% were resistant to Gentamycin, Ceftazidime and Sulphamethoxazole-trimethoprim; 89.3% were resistant to Ciprofloxacin; and 85.7% were resistant to Cefuroxime and Piperacillin/Tazobactam; while 17.9% were resistant to Meropenem. A total of 82% of the A. baumannii isolates were Multi-Drug Resistant (MDR), while 14% were Extremely Drug Resistant (XDR).Conclusion: The emergence of MDR and XDR A. baumannii at KCH calls for rational use of available antibiotics and regular monitoring of antimicrobial resistance patterns to prevent dissemination of current strains and emergence of new resistant strains.

Diagnóstico microbiológico. Su importancia en las infecciones quirúrgicas / The microbiological diagnosis. Its importance in surgical infections

Introducción: Se ha calculado una prevalencia total de infección de la herida quirúrgica del 5 al 10 por ciento. Objetivo: Resumir los principales elementos que definen el diagnóstico microbiológico y su importancia en las infecciones quirúrgicas, así como analizar aquellos factores que favorecen la proliferación microbiana en las heridas quirúrgicas. Planteamiento: En la actualidad la infección del sitio quirúrgico constituye la tercera infección nosocomial más habitual y la más importante entre los pacientes operados. El acercamiento a este tema se justifica plenamente si se toma en consideración la diversidad de intervenciones quirúrgicas que se realizan actualmente. Conclusiones: El diagnóstico microbiológico resulta fundamental, tanto para definir la fase de la infección como para identificar el microorganismo que afecta el resultado de la operación, ya que contribuye a establecer la sensibilidad a los antibióticos y a la elección adecuada del tratamiento(AU)

Introduction: Total prevalence of surgical site infection is calculated to from 5 to 10 percent of surgical interventions. Objective: To summarize the main elements defining the microbiological diagnosis and its importance in surgical infections, and analyze those factors that favor microbial proliferation in surgical wounds. Development: At present, surgical site infection is the third most recurrent nosocomial infection and the most important among operated patients. The approach to this topic is fully justified if the diversity of surgical interventions currently performed is taken into account. Conclusions: The microbiological diagnosis is fundamental both to define the infection phase and to identify the microorganism affecting the result of the surgical intervention, because it contributes to knowing the sensitivity to antibiotics and to select the treatment appropriately(AU)

Epidemiological Characteristics of Surgical Wound- Infections in Cancer Patients from Jalisciense Institute of Cancerology. México.

Background: The surgical wound infections (SWI) are common in hospitals, depending on the type of surgery and the presence of risk factors, cancer patients have a higher prevalence of infection, (immune-compromised state in which it is located). A low rate of infection is one parameter to measure the quality of surgical services. The aim of the present work was to determine the epidemiological characteristics of SWI in cancer patients in the Jaliscience institute of cancerology. Study Design: A descriptive, retrospective study. Methodology: 46 patients were studied with SWI. Centers of disease control and prevention criteria for surgical wound infection were considered. Information was obtained from the Jaliscience Institute of Cancerology epidemiological department, using the hospital network for epidemiological surveillance (HNES) format record´s, included microbiological results and clinical data. The statistical analysis were performed with the SPSS-20 program. Results: There were 2637 major surgeries from April 2008 thru December 2010. 46 had SWI. Frequency of service per 100 infected surgeries was: Gastroenterology 58.6%, Gynecology 32.6%, Urology 4.4, Head and Neck 2.2% and Traumatology 2.2%. Incidence by gender: men (1.1), women (0.83), with no significant difference. Average age of 51 years. The surgical-wound infected (SWI) were detected between 7.4±4.2 days. Average days stay 19 days. The results of microbiology cultures exhibited: Escherichia coli 53.3%, Pseudomonas aeruginosa 11.9%, Morganella morganii 4.8%, Enterococcus faecium 11.9%, Enterococcus faecalis 23.8%, Staphylococcus-coagulase-negative 7.1%, Streptococcus ß-hemolytic 4.8%. Conclusion: Surgical wound infection rates were similar to that reported in other countries and below the rates reported in oncology hospitals in México. It is important to note that a proper preventive approach and epidemiological surveillance are critical to avoid mortality of patients.

Empleo de la presión negativa en el tratamiento de heridas complicadas: Reporte de seis casos / Use of negative pressure for the treatment of complicated wounds: Report of six cases

Objetivo: Conocer la utilidad de un sistema de terapia basado en presión negativa tópica, aplicado en la herida quirúrgica complicada. Sede: Servicio de Cirugía General, hospital de tercer nivel de atención. Diseño: Estudio piloto, prospectivo, longitudinal y descriptivo. Análisis estadístico: Medidas de tendencia central. Pacientes y métodos: Se presentan seis pacientes postoperados, con herida quirúrgica abierta, complicada. Todos con infección demostrada por cultivo y con salida de material purulento, tres pacientes con abdomen abierto por sepsis abdominal, uno con lesión torácica postraumática, uno con muñón de amputación supracondílea infectado y el último paciente con herida quirúrgica complicada posterior a dermolipectomía; todos ellos con tratamientos previos sobre la herida quirúrgica antes de aplicar la presión negativa. Se incluyeron pacientes consecutivos que presentaban: herida complicada, infectada, con estancia hospitalaria prolongada, quienes no presentaban progreso con el tratamiento médico tradicional. Resultados: El tiempo de aplicación de la presión negativa para los seis pacientes estuvo entre 6 y 26 días, con evolución satisfactoria, obteniéndose la mejoría deseada de la herida quirúrgica y de la cavidad abdominal. En los tres pacientes con abdomen abierto y tratamiento previo con bolsa de Bogotá, se pudo cerrar la cavidad abdominal entre los 14 y los 26 días posteriores al tratamiento con presión negativa; en los otros tres pacientes, con lesiones más superficiales, el cierre de la herida se logró entre el sexto y el décimo cuarto día. En todos hubo seguimiento mayor a cinco meses, conservándose la herida cerrada, sin alteraciones. Conclusión: La terapia de presión negativa fue útil en el tratamiento de pacientes con heridas quirúrgicas complicadas y/o en el tratamiento de pacientes con abdomen abierto en sustitución de la bolsa de Bogotá. Del 100% de días de estancia hospitalaria, el 30% fue con terapia basado en presión negativa tópica.

Objective: To know the usefulness of a therapy system based on negative pressure topically applied on a complicated surgical wound. Setting: General Surgery Service, third level health care hospital. Design: Pilot study, prospective, longitudinal and descriptive. Statistical analysis: Central tendency measures. Patients and methods: We present six post-operated patients with open complicated surgical wounds. All with infection demonstrated by culture and output of purulent material: three patients with open abdomen due to abdominal sepsis, one with post-traumatic thoracic injury, one with an supracondyle infected stump, and the last with complicated surgical wound due to dermolipectomy, all of them with treatments of the surgical wound before applying negative pressure. We included consecutive patients coursing with complicated infected wounds, prolonged in-hospital stay, and who did not improve with traditional medical treatment. Results: The time of negative pressure application for the six patients ranged from 6 to 26 days, with satisfactory evolution, obtaining the expected improvement of the surgical wound and the abdominal cavity. In the three patients with open abdomen and previous treatment with Bogota pouch, the abdominal cavity could be closed between 14 and 26 days of negative pressure treatment; in the other three patients with more superficial wounds, closure of the wound was achieved between the 6th and 14th day. All patients were followed for more than 5 months, the wound remained closed and without any alterations. Conclusion: Negative pressure therapy was useful in the treatment of patients with complicated surgical wounds and/or treatment of open abdomen substituting the Bogota pouch. Of the 100% of in-hospital stay days, 30% corresponded to topically applied negative pressure therapy.

Manejo de heridas quirurgicas contaminadas y sucias con cuatro modalidades de tratamiento local / Management of contaminated and dirty surgical wounds with different local treatment modalities

En el periodo comprendido entre marzo y noviembre de 1986 se estudiaron en el Servicio de Cirugia General del Hospital Universitario San Vicente de Paul de Medellin, 216 pacientes de sexo masculino, con heridas quirurgicas potencialmente infectadas, clasificadas como sucias o contaminadas. Aleatoriamente se los distribuyo en cuatro grupos para propositos del tratamiento local, asi: grupo 1: solucion salina a presion (59 pacientes); grupo 2: iodo-povidona (51 pacientes); grupo 3: panela (57 pacientes) y grupo 4 : sin tratamiento local (49 pacientes). El indice de infeccion fue 18% en los 106 pacientes con heridas contaminadas y 25% en los 110 que tenian heridas sucias; en ninguno de los dos grupos hubo deferencias atribuibles a la modalidad de tratamiento local. Se encontro que en las siguientes circunstancias el indice de infeccion era significativamente menor: a) cuando el paciente recibia antibioticos tanto en el preoperatorio como en el postoperatorio; b) cuando el cultivo de la herida era negativo o el recuento de bacterias resultaba inferior a 10 a la 5 bacterias por gramo de tejido. La frecuencia de cultivos positivos fue significativamente menor en los pacientes tratados con solucion salina a presion que en los tratados con panela o dejados sin tratamiento; sin embargo, la frecuencia de evidencias de infeccion fue similar en los pacientes de los 4 grupos. En 95% de los pacientes con cultivos negativos se logro el cierre primario tardio de la herida; en comparacion, ello solo ocurrio en 56% de quienes tenian cultivo positivo con recuentos inferiores a...

Between March and November 1986 we studled 216 men with potentially infected surgical wounds (either contaminated or diny). For the purpose of local treatment they were allocated to one of 4 groups, namely: 1) pressure irrigation with saline solution; 2) lodo-povidone solution; 3) application of panela (unrefined brown sugar); 4) no local treatment. infection indexes were 18% and 25% in patients with contaminated and diny wounds respectively; no differences attributable to the local treatment procedure were found. infection index was significantly lower In the following circumstances: a) In patients that received antibiotics both before and after the operation; b) In those with culture results that were either negative or lower than 105 bacteria per gram of tissue.Frequency of positive wound cultures was significantly lower in patients with saline pressure irrigation as compared to those treated with panela or left without treatment. However, the frequency of clinical evidences of infection was similar In the 4 groups. In patients with negative cultures late primary closure was achieved in 95% of the cases; the corresponding figure for those with positive results (but under 105 bacteria per gram) was 56%. We conclude that pressure Irr1gatlon of the wound with saline solution is advantageous in relation to the other methods employed in this study.