Antibioticoprofilaxia em cirurgia adominal: quando recomendar? Posicionamento do Colégio Brasileiro de Cirurgia Digestiva / Antibiotic prophylaxis for abdominal surgery: when to recommend? brazilian college of digestive surgery position paper

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.

The ımportance of ınflammatory parameters ın predıctıng deep sternal wound ınfectıons after open heart surgery

SUMMARY OBJECTIVE: The aim of this study was to investigate the relationship between the development of deep sternal wound infection after open heart surgery and inflammatory parameters obtained from routine biochemical tests. METHODS: A total of 280 patients who underwent cardiac surgery with median sternotomy between January 2015 and January 2020 were examined retrospectively. Patients who developed deep sternal wound infection were identified as "Group 1," and those who did not develop deep sternal wound infection were identified as "Group 2." RESULTS: There were 70 patients with a mean age of 61.6±9.9 years in Group 1 and 210 patients with a mean age of 62.7±9.8 years in Group 2. As a result of the analysis, it was found that the presence of concomitant chronic obstructive pulmonary disease, concomitant diabetes mellitus, blood and blood product transfusion, postoperative 2nd day C-reactive protein, postoperative 1st day neutrophil-to-lymphocyte ratio, and delta neutrophil-to-lymphocyte ratio was found as independent predictive factors of postoperative deep sternal wound infection development (p=0.043, p=0.012, p=0.029, p=0.009, p=0.002, and p<0.001; respectively). As a predictor of deep sternal wound infections development, postoperative 1st day neutrophil-to-lymphocyte ratio cutoff value was 11.2 (area under the curve [AUC] 0.598; p=0.014; 60% sensitivity, and 65.2% specificity), and delta neutrophil-to-lymphocyte ratio cutoff value was 9.6 (AUC 0.716; p<0.001; 57.1% sensitivity, and 73.8% specificity). CONCLUSIONS: Deep sternal wound infection development can be predicted with inflammatory parameters such as neutrophil-to-lymphocyte ratio and C-reactive protein that are obtained from cheap and easily available routine biochemical tests.

MBL PRODUCING P.PENNERI - A MAJOR THREAT TO THE HOSPITAL

Introduction: Proteus spp. has been the signi?cant cause of wound infections as they commonly colonize the wound. Simultaneously multiple drug resistance mechanisms also pose a therapeutic challenge. P.penneri is commonly misidenti?ed as P.mirabilis which is multidrug resistant. The current study was Aim and objectives: conducted to determine the prevalence of MBLs in P.penneri among wound infections at a tertiary care hospital from Western Maharashtra. Specimens collected from wounds of OPD and IPD patients were examined by standard Material and Methods: bacteriological methods. All Proteus isolates were subjected to Antimicrobial susceptibility and MBL production test as per CLSI guidelines. Total 1826 wound samples were screened over the period of May 2017 to July 2018. Overall Results: prevalence of Proteus spp. was 7.12%, P.mirabilis being the commonest. Among all isolates 53.68% and 37.04% of P.mirabilis and P.vulgaris were ESBL producers, respectively. The rate for MBL production was 11.58% and 0% for P.mirabilis and P.vulgaris, respectively. On the contrary 75% of P.penneri isolates were ESBL producers and 12.5% were MBL producers. Discussion and conclusion: Emergence of ESBL and MBL producers is of special concern as Proteus spp. is intrinsically resistant to tigecycline and colistin. Identi?cation of P.penneri from clinical specimens is necessary, due to its multidrug resistance which makes clinical treatment extremely dif?cult. This will limit its control and eradication especially from wound infections as they are common colonizers. Therefore isolation of such beta lactamases producing P.penneri shall be considered as an alarming sign to control the spread of this superbug.

Incidencia y factores asociados a sepsis en victimas quemadas internadas en un hospital brasileño / Incidence and factors associated with sepsis in burned victims admitted to a Brazilian hospital

OBJETIVO: Conocer la incidencia de sepsis y los factores asociados en las víctimas de quemaduras. MÉTODO: Estudio retrospectivo, en que el diagnóstico de sepsis fue confirmado por los criterios de definición de sepsis de la Asociación Americana de Quemaduras. Se investigó la asociación entre sepsis y las características del paciente, las quemaduras y el tiempo de hospitalización. RESULTADOS: La incidencia de sepsis fue 14,5% (n=27) de los pacientes y 77,7% (n=21) evolucionaron para alta hospitalaria. La incidencia de sepsis fue asociada con el porcentaje de superficie corporal quemada mayor que 10% (p<0,001) y una estadía hospitalaria mayor que 10 días (p<0,001). La mortalidad fue mayor en pacientes con sepsis (p=0,002). Hubo un cambio en la frecuencia de prescripción de antimicrobianos con el diagnóstico de sepsis, algunos foram prescritos solamente antes (ciprofloxacina, cefalotina, ceftriaxona, amoxicilina y gentamicina) y otros solamente durante el episodio de sepsis (tigeciclina, piperacilina y tazobactam, fluconazol y linezolida). CONCLUSIÓN: La incidencia de sepsis fue baja y está asociada con muerte. Se identifico que, el porcentaje de superficie corporal quemada y la duración de la estadía hospitalaria, están significativamente asociados con la incidencia de sepsis. La sepsis cambió el perfil del uso de antimicrobianos.

OBJECTIVE: To assess the incidence of sepsis and factors associated with casualties of burns. METHODS: This is a retrospective study, in which the diagnosis of sepsis was confirmed by the criteria for definition of sepsis of the American Association of Burns. If we investigate the association between sepsis and patient characteristics, burns and hospitalization time. RESULTS: The incidence of sepsis was 14.5% (n=27) of patients and 77.7% (n=21) evolved to hospital discharge. The incidence of sepsis was associated with a body surface area percentage greater than 10% (p<0.001) and a greater state than 10 days (p <0.001). Mortality was higher in patients with sepsis (p=0.002). There was the change of antimicrobial profile. Same medicines was used only before the diagnosis (ciprofloxacin, cephalothin, ceftriaxone, amoxicillin and gentamicin) and other only after the sepsis diagnosis (tigecycline, piperacillin and tazobactam, fluconazol and linezolida). CONCLUSION: The incidence of sepsis is low and is associated with the disease. It has been found that the percentage of body surface burned and the length of hospital stay is significantly associated with the incidence of sepsis. The sepsis causes the change of antimicrobial use profile.

Analysis on the effect of two methods in different degrees deep sternal wound infection after undergoing cardiac surgery / 中华胸心血管外科杂志

Objective:To analysis the effect of two methods of transposition of pectoralis major in different degrees deep sternal wound infection(DSWI) after undergoing cardiac surgery.Methods:128 patients with DSWI after cardiac surgery were treated, 72 were mild, and 56 were severe. 66 cases of pectoralis major muscle flap docking method(medial muscle flap docking group) and 62 cases of lateral pectoralis major muscle flap turnover method(lateral muscle flap turnover group) were implemented respectively. Drainage tube indwelling time, reoperation rate, incidence of lung infection, long-term thoracic stability and other aspects were observed to compared the treatment effect.Results:In the mild patients, the medial muscle flap docking group and the lateral muscle flap turnover group were compared( P<0.05). The postoperative hospital stay [(14.2±4.7)days vs.(17.1±3.9)days], drainage tube retention time[(6.2±1.7)h vs.(9.1±2.9)h], and reoperation rate(2.4% vs. 6.7%), the incidence of lung infection(14.3% vs. 23.3%), long-term thoracic stability[73.8%(31/42)vs.43.3%(13/30)]. In the severe patients, the medial muscle flap docking group and the lateral muscle flap turnover group were compared. The postoperative hospital stay[(24.2±7.2)days vs.(20.1±3.5)days], drainage tube retention time[(20.2±6.6)h vs.(13.2±3.1)h], reoperation rate(20.8% vs.12.5%), incidence of pulmonary infection(41.7% vs. 31.3%), long-term thoracic stability[25.0%(6/24)vs.68.8%(22/32)]. The differences of the indicators in each group were significant , P<0.05. In the mild group, each index of the pectoralis major medial muscle flap docking method was superior to the lateral muscle flap turnover method, but the treatment results of the two methods in the severe group were opposite. Conclusion:Patients with mild deep DSWI treated with medial pectoralis major muscle flap docking and suture have less hospital stay, less reoperation rate, less complications and better treatment effect than reverse lateral pectoralis major muscle flap turnover. But the two treatments in the severe DSWI have the opposite effect.

Scalpel versus diathermy skin incision: a randomised clinical trial

Background: Scalpel skin incision produces a clean, incised wound with minimal tissue destruction. Cutting diathermy also produces an incised wound that heals as well as the one that is created by cold scalpel but with an added advantage of achieving quick hemostasis and saving operative time. The main thing of the present study is to verify and compare the usefulness of diathermy skin incision vs. scalpel skin incision in general surgical patients.Methods: The study was conducted in Medical College and Hospital, in 60 patients randomly selected for diathermy and scalpel incision, between 14-65 years age group, between January 2011-June 2012. Post operative pain, seroma, hematoma, discharge were observed and results were analyzed and compared for the two groups using Mann-Whitney U Test.Results: Diathermy group, with incision related time of 6.20±0.97 sec/cm, was significantly quicker (p=0.003) than scalpel incision, with incision time of 6.76±0.84 sec/cm. Postoperative pain scores, recorded daily over five days, showed insignificant difference between the two groups.Conclusions: We demonstrate that the diathermy provides efficient cutting of skin, with no superior wound-healing profile, comparable to that of the traditional scalpel blade.

Prevención y tratamiento de las infecciones del sitio operatorio en neurocirugía. Estado del arte / Prevention and treatment of surgical site infections in neurosurgery: state of the art

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.

A Prospective Study on Role of Prophylactic Antibiotics and Incidence of Postoperative Wound Infection in Surgery IPD

Introduction:- In the advancement of surgery, post-operative wound infection has been the greatest obstacle from down the centuries. For safe surgery, Lister introduced antiseptic methods. The initiation of antibiotics did raise the hope of a permanent solution to post-operative infection but later it has become the nightmare of the surgeon. Methodology:- Two groups were included in this study. Each group had 200 cases. This study conducted by department of Surgery in Ananta Institute of Medical Sciences and Research Centre, Rajsamand. The duration of the study over a period of one and half year. Result:- In our study, two groups were included, each group has 200 cases. In group A we had found 7% cases infected out of 200 cases, while in Group B had 34% infected cases out of total number of cases. Out of all cases we were found maximum infected cases from 41-50 ages in both groups. Conclusion:- This study conclude that, to prevent surgical-site infections, it is essential for the surgeons to take appropriate steps to avoid local microbial factors.

New technique of pectoral muscle flap reconstruction for 23 patients with deep sternal wound infections / 中国胸心血管外科临床杂志

@#Objective    To study the effect of deep sternal wound infections（DSWIs）treated by the techniques of pectoral major muscular(PM) turnover and non-suture remain after the wound restitution. Method    We retrospectively analyzed the clinical data of 23 patients with DSWIs in our hospital between June 2016 and December 2016. There were 13 males and 10 females at age of 4-73(54.5±19.5) years. There were 8 patients with concomitant diabetes mellitus and 1 patient with chronic obstructive pulmonary disease(COPD) and brain infarction. Eigteen patients were of type Ⅱ, 5 patients of type Ⅲ according to Pairolero’ classification in the DSWIs. Five patients were with remaining abscess cavity in the mediastinum by thoracic compute tomography(CT). Under general anesthesia the DSWIs debrided thoroughly. The PM elevated from the anterior pectoralis major fascia off subcutaneous tissue to lateral to anterior axillary line, the PM cutted off, then made to the muscle flap, turnover PM flap filled and fixed to sternal wound by lighten tensile suture, the subcutaneous tissue and skin sutured by cutting full-thickness. Results    The sternal reconstruction after debridement of the sternal wound was used by bilateral PM flap in the 17 patients, unilateral PM in 6 patients. There were 21(91.3%) patients in stage Ⅰ healing, 2 patients deferment healing of local cut skin without reoperation. There were 22 patients with non-paradoxical breathing during the postoperation. One death resulted from multiple-organ failure of the concomitant disease. The average of hospital day was 10.6 days. The wound healing was good by chest CT at 1 month after the operation. Conclusion    The sternal forming by the technique of the PM flap turnover, without remain of fremde stoffe in wound for DSWIs is distinctive method, evident effect.

A prospective study of wound infection among post‑discharge patients at a level 1 trauma centre of India.

Background and Aim: To study the rate of wound infections in the post‑discharged patient population and to assess the usefulness of post‑discharge surveillance. Methods: A prospective surveillance of all the post‑discharged trauma patients was done during a period of 6 months. Discharge instructions were given to all the patients regarding identification of the signs and symptoms of wound infections. They were telephonically followed up after a week to enquire about the wound condition and followed up in the outpatient department (OPD). Microbiology culture samples of those showing any signs and symptoms of infections were sent and their antimicrobial therapy, any change in the treatment schedule and the length of their hospital stay were noted. Factors such as wound class, type of surgeries and readmissions were noted. Results: A total of 281 postdischarge patients were enrolled, of which 101 were completely followed up for wound infections. Males were predominant (89%). Of the 101 patients, 42 (41.6%) patients wound showed infection during the intense follow‑up in the OPD. However, 59 patients (59/101, 58.4%) showed wound swab culture positivity before discharge. These 42 patients developed signs and symptoms of infection post‑discharge; 23 (22.7%) of them had change of antibiotic therapy during the follow‑up period due to culture positivity. Acinetobacter sp., Staphylococcus aureus and Klebsiella pneumoniae were the predominant organisms isolated in the study. A total of 45 patients (44.5%) had to be readmitted due to wound site infections. Conclusions: Wound infections are common after discharge among trauma patients highlighting the importance of active surveillance and participation of patients.

Inhibition of Coriaria Sinica Maxim’ s extract on burn wound infections with common three kinds of resistant bacteria / 中国药理学通报

Aim To explore the inhibition of Sinica Maxim′s extract( CSME) on resistant infections of burn wounds,such as the methicillin-resistant staphylococcus aureus ( MRSA ) , resistant pseudomonas aeruginosa (RPA) and resistant escherichia coli(RECO). Meth-ods The resistant strains were cultured by MH agar plates. After resistance genes of quality control strains were extracted and appraised, such as mecA, mexB, merA, qacE△1-sull, tnpU/A and mexB, etc, and then,some projects of CSME were detected,such as the antibacterial spectrum, the minimum inhibitory con-centration(MIC), different concentrations of sensitive rate and inhibition curves, etc. Finally, these results were compared with the inhibitory effects of some anti-biotics to determine the sensitivity rates of CSME. Re-sults The MIC of CSME was 62. 5 ,125 ,250 g · L-1 respectively on the MESA, RPA and RECO. The inhi-bition rates of CSME appeared concentration-dependent on these three kinds of resistant bacteria,and the inhi-bition rates of the multi-concentration CSME on RECO were significantly lower than on MRSA and RPA ( P<0. 05). While in MIC,the resistance rates of MRSA on carbenicillin, cefazolin, erythromycin were significant-ly higher than those of CSME(P<0. 05); The inhibi-tion zones of CSME were significantly smaller than those of ceftriaxone, cefepime, imipenem, but greater than those of other antibiotics( P<0. 05 ); The inhibi-tion zones of CSME on RPA were significantly smaller than those of carbenicillin, and greater than those of other antibiotics ( P <0. 05 ) . The inhibition zones of CSME on RECO were significantly smaller than those of ceftriaxone,cefepime,imipenem,ciprofloxacin,nitro-furazone,and greater than those of other antibiotics ( P<0. 05 ) . Conclusions CSME has a significant inhi-bition on burn wound infection with these three kinds of resistant bacteria,such as MRSA,RPA and RECO. It is prompted that CSME could become one of the effective drugs to control burn wound infections with multi-re-sistant strains.

Does Minimally Invasive Spine Surgery Minimize Surgical Site Infections?

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.

Bacterial distribution and resistance in orthopedic patients with wound infections in 2014 / 国际检验医学杂志

Objective To investigate the bacterial distribution and resistance in orthopedic patients with wound infections in the hospital in 2014 .Methods The bacteria identification and the antimicrobial susceptibility test were conducted by VITEK‐2 compact automatic system .Results A total of 864 pathogenic strains were collected ,with Gram‐positive bacteria 451 strains (52 .2% ) , Gram‐negative bacteria 398 strains(46 .1% ) .The first major pathogens of Gram‐positive bacteria were Staphylococcus aureus(n=233 ,27% );The top three pathogens of Gram‐negative bacteria were Pseudomonas aeruginosa(n=94 ,10 .9% ) ,Enterobacter cloacae (n=63 ,7 .3% ) ,Acinetobacter baumannii(n=58 ,6 .7% ) .All the Staphylococcus aureus isolates were susceptible to vancomycin , tigecycline ,nitrofuratoin ,quinupristin/dalfopristin ,linezolid .The resistant rates of Acinetobacter baumannii were higher than 50%to multiple antibiotics .Conclusion Staphylococcus aureus were predominant pathogens in orthopedic patients with wound infec‐tions in our hospital .Meantime ,Pseudomonas aeruginosa and Enterobacter cloacae were the prime pathogens in the Gram‐negative bacteria .The drug‐resistance situation is still severe ,and more effective measures should be taken to control the dissemination and growth of resistant strains .

Postoperative Wounds and their Antimicrobial Sensitivity Pattern (Hospital-Based Surveillance of Aerobic Bacteria).

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.

Adherencia a antibioterapia prequirúrgica en intervenciones torácicas y abdominales en el Hospital Universitario San Jorge, de Pereira / Adherence to prophylactic antibiotic therapy of thoraco-abdominal interventions in Hospital Universitario San Jorge, Pereira / Obediência à antibioticoterapia pré-cirúrgica em intervenções torácicas e abdominais no Hospital Universitário San Jorge, de Pereira

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.

An overview of medicinal plants as wound healers.

Wound healing is an integrated cellular and biochemical process of restoring normal structure functions of damaged tissue. Healing is a natural phenomenon by which body itself overcome the damaged to the tissue but the rate of healing is very slow and chance of microbial infection is high. Improvement in healing process can be accomplish either shorten the time required for healing or to minimize the undesired consequences. India has a rich tradition of plant-based knowledge on healthcare system. Several herbs and medicinal plants proved to be a wound healers were identified and formulated for treatment and management of wounds. Various herbal products have been used in management and treatment of wounds over the years. The present review attempt to highlight some herbs and medicinal plants proved to be scientifically used for the treatment of cuts and wounds as a wound healer.

S-plasty for pilonidal disease: modified primary closure reducing tension / 대한외과학회지

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.

Contaminación microbiológica y actividad antimicrobiana del azúcar de caña cristalizado sobre algunos agentes de interés médico en Costa Rica

Microbiological contamination and antimicrobial activity of cristalised cane sugar on some medically important microorganisms in Costa Rica. Unrefined cristalised cane sugar, obtained after the filtration and evaporation of sugar cane juice, is a nutritional product of traditional consumption in Costa Rica and other Neotropical countries. It has been used in the topic treatment of infected wounds, with satisfactory results even with some antibiotic-ressistant bacteria. We studied the microbiological quality of 50 commercial samples. The analyses included total aerobic and anaerobic bacteria plate count; aerobic and anaerobic spore count; mold and yeast count; total and fecal coliforms; and presence of Clostridium botulinum. The antimicrobial effect was tested for Staphylococcus aureus (ATCC 25923), S. epidermidis (UCR 2902), Pseudomonas aeruginosa (ATCC 9027), Escherichia coli (ATCC 25922), Salmonella enteritidis (ATCC 13076), Listeria monocytogenes (ATCC 19116) and Aspergillus niger (Asni 06). Most of the samples (76 %) presented counts lower than 100 CFU/g especially for sporulated forms (90 % lower than 20 CFU/g), the mold and yeast count was higher (38 % higher than 102 CFU/g), demonstrating the importance of these microorganisms in the spoilage of the product; 76 % of the samples presented fecal contamination; C. botulinum was not isolated with the methodology employed. No inhibitory effect was observed for A. niger, but all samples han an inhibitory effect over the other species, especially for P. aeruginosa and S. aureus. Rev. Biol. Trop. 56 (2): 431-437. Epub 2008 June 30.

La tapa de dulce o panela es un producto alimenticio de consumo tradicional, típico de países neotropicales, obtenido de la filtración y evaporación del jugo de la caña de azúcar. Además de su uso clásico como endulzante, en Costa Rica y otras partes del mundo se ha utilizado para el tratamiento tópico y empírico de heridas infectadas, con resultados satisfactorios, aún en infecciones por bacterias resistentes a diversos antibióticos. A fin de valorar el riesgo o beneficio de esta práctica, se evaluó la calidad microbiológica de 50 muestras de tapa de dulce de producción nacional obtenidas en trapiches, mercados y supermercados. Se realizaron recuentos bacterianos aerobios y anaerobios, de bacterias esporuladas y no esporuladas y de hongos y levaduras, se determinó el número de coliformes totales y fecales, la presencia de Clostridium botulinum y se evaluó el efecto antimicrobiano de este producto sobre algunos patógenos: Staphylococcus aureus (ATCC 25923), S. epidermidis (UCR 2902), Pseudomonas aeruginosa (ATCC 9027), Escherichia coli (ATCC25922), Salmonella enteritidis (ATCC 13076), Listeria monocytogenes (ATCC 19116) y Aspergillus niger (Asni 06). La mayoría de las muestras (76%) presentaron recuentos bacterianos menores de 100 UFC/g, especialmente de esporulados (90% menos de 20 UFC/g), y recuentos de hongos y levaduras elevados (20% mayores a 100 UFC/g). Un alto porcentaje de las muestras presentó contaminación fecal (76%, NMP/g desde 3 hasta 460). No se logró aislar C. botulinum en ninguna de las muestras. Todas las muestras del producto concentrado desarrollaron halo de inhibición sobre los cultivos, principalmente sobre P. aeruginosa y S. aureus; pero no se observó ningún tipo de inhibición sobre A. niger.

Efficacy of Cefazolin vs. Cefuroxime in Preventioning Cesarean Section Wound Infection / 中国药房

OBJECTIVE:To compare the efficacy of cefazolin and cefuroxime prevention of perioperative cesarean section wound infection. METHODS:291 cases of elective cesarean section surgery,according to the use of medicines are divided into group A(n=140)and group B(n=151),were retrospectively analyzed. Patients in group A,preoperative 30 min intravenous infusion of cefazolin 2.0 g;after surgery,2.0 g ivgtt,q12 h,continue to use 2～5 days. Patients in group B,preoperative 30 min intravenous infusion of cefuroxime 2.0 g;after surgery,2.0 g ivgtt,q12 h,continue to use 2～5 days. Comparison of the clinical effect of 2 groups patients. RESULTS:WBC,N%,Hb,complications,body temperature,wound healing had no statistical difference in postoperative between 2 groups. All patients were not the emergence of drug adverse reactions. CONCLUSION:cefazolin and cefuroxime has the same efficacy of prevention of cesarean section wound infection.

Infecção do sítio cirúrgico em pacientes submetidos à cirurgia do aparelho digestivo: uma proposta de predição de risco / Surgical site infections in patients submitted into surgery of digestive system: a proposal of risk prediction

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.