Evaluating the effect of gentamicin-clindamycin lavage on post-operational pain and infection through laparoscopic colectomy surgery / Avaliação do efeito da lavagem com gentamicina-clindamicina sobre a dor e a infecção após colectomia laparoscópica

Abstract Introduction Peritoneal antibiotic or normal saline lavage is seen to be beneficial in order to reduce the pain or infection risk through laparoscopic surgeries. It can also be applied for laparoscopic colectomy surgeries. In this study, we have compared the effects of antibiotic solution lavage (gentamycin-clindamycin) with normal saline lavage in patients undergoing laparoscopic colectomy surgery. Method In this double-blind Randomized Controlled Trial (RCT), 40 patients undergoing laparoscopic colectomy surgery were divided into antibiotic and normal saline lavage groups (20 patients in each group). Post-operational pain, need for painkiller, white blood cells count, C-reactive protein level, duration of hospitalization and wound infection were compared in 30 days between the groups. Results Antibiotic lavage group had significantly less pain than the normal saline group (p < 0.05) through 3, 6, 12 and 24 h after surgery. C-reactive protein level, white blood cells count, painkiller use, and hospitalization duration were significantly lower in antibiotic group. However, there was no difference regarding wound or intra-abdominal infection between the both groups. Conclusion Using gentamicin-clindamycin peritonea lavage helps patients undergoing laparoscopic colectomy surgery in pain reduction, need for painkillers and hospitalization duration.

Resumo Introdução A lavagem peritoneal com antibiótico ou com soro fisiológico normal é benéfica para reduzir o risco de dor ou de infecção durante cirurgias laparoscópicas, além de poder ser aplicada também em colectomias laparoscópicas. Neste estudo, comparamos os efeitos da lavagem com solução antibiótica (gentamicina-clindamicina) e da lavagem com solução salina normal em pacientes submetidos à colectomia laparoscópica. Método Neste Ensaio Clínico Randomizado (ECR), controlado e duplo-cego, 40 pacientes submetidos à colectomia laparoscópica foram divididos em dois grupos (20 pacientes em cada grupo) para receberem antibiótico ou solução salina normal. Dor pós-operatória, necessidade de analgésico, contagem de leucócitos, nível de proteína C-reativa, tempo de internação e infecção da ferida foram comparados entre os grupos em 30 dias. Resultados De forma significativa, o Grupo Antibiótico apresentou menos dor que o Grupo Salina Normal (p < 0,05) em 3, 6, 12 e 24 horas após a cirurgia. O nível de proteína C-reativa, a contagem de leucócitos, o uso de analgésicos e o tempo de internação foram significativamente menores no Grupo Antibiótico. Porém, não houve diferença em relação à infecção da ferida ou intra-abdominal entre os dois grupos. Conclusão O uso da lavagem peritoneal com gentamicina-clindamicina ajuda a reduzir a dor, a necessidade de analgésicos e o tempo de internação de pacientes submetidos à colectomia laparoscópica.

Silvoflurano tópico en infección superficial por SARM tras artroplastia de rodilla: caso clínico / Topical sevoflurane for superficial MRSA infection after knee arthroplasty: case report

Intentar el tratamiento retentivo de material protésico ante heridas quirúrgicas infectadas por gérmenes resistentes es objeto de debate, especialmente cuando el agente causal es un Staphylococcus aureus resistente a meticilina (SARM). Una paciente diabética y con obesidad tipo I sufrió infección de la herida quirúrgica tras artroplastia de rodilla que no evolucionó bien con antibioterapia empírica y terapia hiperosmolar. Se planificó una reintervención que fue demorada por motivos extramédicos (falta de terapia de presión negativa para cubrir la herida postoperatoria, pues se preveía no poder realizar cierre primario). Mientras se conseguía este material, y tras obtener el consentimiento de la paciente, se iniciaron irrigaciones de la herida con sevoflurano tópico off-label, pues ese fármaco ha mostrado capacidad antimicrobiana. La evolución clínica fue excelente desde el inicio a pesar de que en el cultivo se aisló un SARM resistente a la antibioterapia empírica, por lo que se desestimó la reintervención y se continuó con sevoflurano tópico junto a la antibioterapia dirigida por antibiograma, lográndose la curación completa de la herida tras 6 semanas. Durante ese tiempo, la paciente no experimentó ningún efecto adverso atribuible al sevoflurano. El sevoflurano tópico aparece como una valiosa nueva opción terapéutica ante heridas postoperatorias infectadas, especialmente cuando los gérmenes causantes son resistentes a los antibióticos convencionales.

It is challenging to try a retentive treatment of prosthetic material superinfected by resistant microorganisms, especially when the causative agent is a methicillin-resistant Staphylococcus aureus (MRSA). A diabetic, obese female patient suffered from a postoperative wound infection after a knee arthroplasty. Initial treatment with antibiotics and hyperosmolar therapy failed and clinical evolution was no good. Surgery was scheduled, but it was delayed due to nonmedical reasons (lack of negative-pressure therapy to cover the wound since primary wound closure was anticipated to be very improbable to perform). While waiting for this therapy, off-label irrigations with topical sevoflurane were started after obtaining written consent, since this drug has exhibited antimicrobial properties. Clinical evolution turned out to be excellent since the very beginning, even though a MRSA resistant to the antibiotics empirically administered was isolated. Thus, surgery was discarded, and culture-guided antibiotic therapy was added to topical sevoflurane, which was followed by a complete healing of the wound after 6 weeks. Sevoflurane treatment was well tolerated as the patient reported no adverse effects. Therefore, treating postsurgical wounds with topical sevoflurane appears as a valuable new alternative, especially when infections are caused by microorganisms resistant to conventional antibiotics.

Caracteristicas de los pacientes pediatricos en postoperatorios de apendicectomia. Servicio de clínica quirurgica, Hospital Pediatrico Dr. Avelino L. Castelan, periodo 2016-2017 / Characteristics of pediatric patients in postopers of apendicectomy. Surgical clinic service, pediatric Hospital. Dr Avelino L. Castelan, between 2016-2017

El objetivo fue describir las caracteristicas de los pacientes pediatricos de 7 a 12 años en el post-operatorio inmediato de apendicectomia, con infección en el sitio quirurgico, en el Servicio de clinica quirurgica del Hospital pediatrico Dr. Avelino L. Castelan de la ciudad de Resistencia, Chaco, en el periodo de octubre de 2016 a mayo de 2017. Material y metodo: estudio transversal, observacional y descriptivo en pacientes pediatricos post operados de apendicectomia con infeccion en el sitio quirurgico. Para la recoleccion de datos se diseño un formulario que contiene las variables de caracterizacion, la informacion fue recolectada de las historias clinicas. Para el analisis estadistico se utilizo el programa excel. Resultados: la frecuencia de infeccion del sitio quirurgico fue del 50% (IC al 95% entre 38,41 y 61,58%), fue mas frecuente en el sexo masculino el 62,5% el tipo de infeccion fue 50% de infeccion profunda y fue mas frecuente en los niños. Conclusion: la frecuencia de ISQ de los pacientes pediatricos operados de apendicectomia es alta, es mas frecuente en el sexo masculino y en estos, el tipo de infeccion que prevalecio fue la infeccion profunda. La estancia hospitalaria fue prolongada, en la mayoria de los casos se utilizo para el tratamiento el metronidazol y gentamicina, en combinacion con otros antibioticos menos frecuentes...

Infecciones asociadas a diálisis peritoneal en el paciente pediátrico: diagnóstico y tratamiento / Peritoneal dialysis-related infections in pediatric patients: diagnosis and treatment review

Resumen Las infecciones asociadas a diálisis peritoneal (DP), corresponden a la principal complicación de los pacientes pediátricos en esta terapia de reemplazo renal, disminuyendo la sobrevida de la membrana peritoneal y empeorando el pronóstico del paciente. El reconocimiento precoz y un tratamiento oportuno de éstas son fundamentales para preservar esta modalidad dialítica. Se presenta una revisión actualizada de la literatura científica, con el fin de entregar recomendaciones reproducibles en los distintos centros pediátricos que realizan diálisis peritoneal crónica en niños.

Peritoneal dialysis-related infections are the main complication in pediatric patients undergoing this renal replacement therapy, associating a high rate of morbidity, generating also a decreasing survival of the peritoneal membrane and worsening the patient outcome. We describe the recommended diagnostic and therapeutic modalities to treat dialysis-related in children.

Clinical Trial Comparing Efficacy and Safety of Ornidazole 1% and Povidone Iodine 5% Fixed Dose Combination Ointment with Povidone Iodine 5% Formulation and Ornidazole 1% Formulation for Prevention or Treatment of Surgical Wounds.

Aim: This trial is undertaken to evaluate the efficacy and safety of this FDC ointment for post-surgical patient management. This multi-centre, prospective, randomized, comparative, open-labeled, three-arm parallel group study involving 180 patients was conducted in patients with surgical wound. The trial was conducted at 2 centres and had 90 patients completed at each center. Methods: Patients were in randomized in three groups, to receive either the study formulation of Ornidazole 1% - Povidone iodine 5% FDC ointment (Group I ) or Povidone iodine 5% Ointment (Group II) or Ornidazole 1% Ointment (Group III). These ointments were applied for post surgical wound care. Dressing was done twice daily till the discharge of patients (Day 5-7). Patients were asked to use respective ointment for wound dressings after discharge. The patients were assessed for clinical wound improvement by using the Bates Jensen Wound Assessment Tool (BWATS). General and systemic examination was done at every visit of the patient. Results: Reduction in wound size was significant in all three groups from day 1 onwards. In group I exudates amount improved significantly from day 5 as compared to day 3, in Group II and Group III the improvement was from Day 8 onwards as compared to day 5. Peripheral tissue edema and Peripheral Tissue Induration improved in Group I and as compared to baseline. Epithelialization was statistically better in Group I and Group II from day 1 compared to baseline and in Group III it improved from day 5. No adverse event were seen in any of the groups. Conclusion: We concluded that the combination was better as compared to each individual drug in prevention of wound infection and promoting wound healing.

Post-operative sinus formation due to Mycobacterium abscessus: A case report.

Summary: Mycobacterium abscessus is ubiquitously found rapidly growing mycobacteria. Although it is an uncommon pathogen, it has been known to cause cutaneous infection following inoculation, minor trauma or surgery. This communication reports an immuno-competent patient developing multiple sinuses due to Mycobacterium abscessus in the post- operative period.

Port Site Infection in Laparoscopic Surgeries.

Background/Aims: As the surgeries undertaken by laparoscope are increasing, complications are also increasing. In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments which might be a potential source of infection if not properly sterilized. Our study explains port site infection, its diagnosis and management with review of literature. Setting and Design: This study was carried out in a tertiary care setting and was an outcome study. Material and Methods: All five patients in the study were operated (April 2008-2010) elsewhere and came to us for management of non healing sinuses. Result: Amongst operated cases of laparoscopic cholecystectomy one healed by irrigation with superoxide, two cases healed with sinus exploration and wound debridement while one case required extensive wound debridement requiring temporary mesh repair of the abdominal wall with removal of the mesh (due to persistence of sinus) six months later following complete healing, no residual hernia. One operated case of laparoscopic incisional hernia repair with laparoscopic Cholecystectomy healed after removal of mesh with sinus exploration. Conclusion: The present study is an attempt to make surgeons aware about the complications which occur due to improper sterilisation of laparoscopic instruments ending into increased morbidity of patients.

Profilaxia com antimicrobianos para cirurgia colorretal / Antimicrobial prophylaxis for colorectal surgery

Introdução: Estudos mostram que a administração profilática de antibióticos antes da cirurgia colorretal previne a infecção da ferida cirúrgica no pós-operatório. No entanto, o antibiótico mais efetivo, a duração mais adequada do tratamento e a melhor via de administração permanecem indeterminados. Objetivos: Estabelecer a eficácia da profilaxia antimicrobiana para a prevenção de infecção da ferida cirúrgica em pacientes submetidos à cirurgia colorretal. 1. Determinar se profilaxia antimicrobiana reduz o risco de infecção da ferida cirúrgica; 2. Determinar as bactérias-alvo (aeróbias e/ou anaeróbias); 3. Determinar o melhor tempo e duração da administração de antibióticos; 4. Determinar a via mais eficaz de administração de antibióticos (intravenosa, oral ou ambas); 5. Determinar se qualquer antibiótico é claramente mais eficaz do que o padrão ouro atualmente recomendado. Métodos: Revisão sistemática Cochrane, na qual foram realizadas buscas nas bases de dados Cochrane Central Register of Controlled Trials (CENTRAL), Medline e Embase. Foram incluídos ensaios clínicos randomizados sobre o uso profilático de antibióticos em cirurgia colorretal eletiva e de emergência, e que incluíram infecção da ferida cirúrgica como desfecho.

Resultados: Esta revisão sistemática incluiu 182 ensaios (30.880 participantes), e 50 diferentes antibióticos, incluindo 17 cefalosporinas. Muitos estudos tiveram múltiplas variáveis que diferenciavam os dois grupos comparados e por isso não foi possível com pará-los com outros estudos que testaram apenas um antibiótico e que tiveram uma única variável diferenciando os dois grupos. A metanálise demonstrou uma diferença estatisticamente significativa na frequência de infecção da ferida cirúrgica no pós-operatório quando antibióticos profiláticos foram comparados com placebo ou nenhum tratamento (risco relativo, RR: 0,30; intervalo de confiança, IC de 95%: 0,22-0,41). Não houve diferença estatisticamente significativa ao comparar a duração de curto e longo prazo da profilaxia (RR 1,06, IC 95% 0,89-1,27); ou dose única versus doses múltiplas de antibióticos (RR 1,17, IC 95% 0,67-2,05). Coberturas adicionais para aeróbios ou anaeróbios mostraram melhora estatisticamente significativa na taxa de infecção da ferida cirúrgica (RR 0,41, IC 95% 0,23-0,71 e RR 0,55, IC 95% 0,35-0,85, respectivamente). Do mesmo modo, profilaxia oral combinada com intravenosa mostrou melhora estatisticamente significativa na taxa de infecção da ferida cirúrgica quando comparado com a administração intravenosa isolada (RR 0,55, IC 95% 0,41-0,74) ou oral isolada (RR 0,34, IC 95% 0,13-0,87). Esquemas considerados como padrão-ouro não foram menos efetivos que qualquer outra escolha de antibiótico. Conclusões: Antibióticos cobrindo bactérias aeróbias e anaeróbias devem ser administrados por via oral e por via intravenosa antes da cirurgia colorretal. Antibióticos administrados neste esquema reduzem o risco de infecção da ferida cirúrgica no pós-operatório em pelo menos 75%. São necessárias mais pesquisas para estabelecer o momento ideal para iniciar a profilaxia, a duração e a frequência de efeitos adversos em longo prazo, tais como a colite pseudomembranosa por Clostridium difficile.

Profilaxis antimicrobiana en ortopedia: reporte de 93 pacientes / Antimicrobial prophylaxis in orthopedics: report of 93 patients

La infección post-quirúrgica es una complicación con un alto costo social y económico, que puede llegar en ocasiones a la muerte del paciente, de allí la importancia de prevenir y tratar a tiempo esta enfermedad. Objetivo: evaluar el comportamiento y los resultados de la terapia antimicrobiana profiláctica en un número de pacientes atendidos en un grupo básico de trabajo. Método: se realizó un estudio observacional descriptivo con 93 pacientes a los que se les aplicó terapia antimicrobiana profiláctica en el Hospital Universitario Manuel Ascunce Domenech desde diciembre de 2009 a julio de 2010. Resultados: el promedio de edades fue de 43,5 años. La relación sexo masculino- femenino fue de 2 a 1,4. El método fue aplicado mayoritariamente en 28 pacientes con fracturas cerradas a los que se realizó fijación interna. La cefazolina fue el antimicrobiano más utilizado en el 70,9 por ciento de los pacientes. Treinta y cinco pacientes presentaron uno o más factores de riesgo estrechamente relacionados con la infección, de ellos uno desarrollo infección post-quirúrgica. Las reacciones adversas fueron encontradas en el 4,3 por ciento de los enfermos.Conclusiones: la terapia antimicrobiana profiláctica es efectiva en la prevención de infección post-quirúrgica

Postoperative infection is a complication with a high social and economic cost which may reach sometimes the death of the patient, therefore the importance of preventing and treating this disease in time. Objective: to evaluate behavior and results of the prophylactic antimicrobial therapy in patients treated in a basic working group. Method: a descriptive observational study was conducted with 93 patients who were applied prophylactic antimicrobial therapy in the University Hospital Manuel Ascunce Domenech from December 2009 to July 2010. Results: the average age was 43,5 years. A relationship between the sexes was about 2 to 1,4. The method was applied mostly in 28 patients with closed fractures which internal fixation was made. The cefazolin was the most used in 70,9 percent of patients.Thirty-five patients showed one or more risk factors closely associated with infection, of them one suffered postoperative infection. Adverse reactions were found in 4.3 percent of patients. Conclusions: prophylactic antimicrobial therapy is effective in the prevention of postoperative infection

Incidence and Risk Factors of Ventriculoperitoneal Shunt Infections in Children: A Study of 333 Consecutive Shunts in 6 Years

The major aims of this study were to estimate the infection rate and recognize the risk factor for ventriculoperitoneal (VP) shunt infections in children. To analyze shunt infection rate and identify risk factors, a retrospective cohort analysis of 333 consecutive VP shunt series was performed at Seoul National University Children's Hospital in Korea between January 2005 and February 2011. Overall, 35 shunts (10.5%) were infected, which represented an infection rate of 0.075 infection cases per shunt per year. VP shunt infection occurred at a median of 1 month (range, 6 days to 8 months) after insertion. An independent risk factor for shunt infection was undergoing an operation before the first year of life (relative risk 2.31; 95% confidence interval, 1.19-4.48). The most common causative microorganism was coagulase-negative staphylococci in 16 (45.7%) followed by Staphylococcus aureus in 8 (22.9%). Methicillin resistance rate was 83.3% among coagulase-negative staphylococci and S. aureus. In this study, cerebrospinal fluid shunt infection rate was 10.5%. Infection was frequently caused by methicillin-resistant coagulase-negative staphylococci and S. aureus within two months after shunt surgery. Vancomycin may be considered as the preoperative prophylaxis for shunt surgery in a situation where methicillin resistance rate is very high.

L-alanyl-glutamine pretreatment attenuates acute inflammatory response in children submitted to palatoplasty / Pré-tratamento com L-alanil-glutamina atenua a resposta inflamatória aguda em crianças submetidas à palatoplastia

PURPOSE: To evaluate the effects of L-alanyl-glutamine (L-Ala-Gln) pretreatment on oxidative stress, glycemic control and inflammatory response in children submitted to palatoplasty. METHODS: Thirty male children scheduled for routine palatoplasty, age range 2-10 years, were randomly assigned to 2 groups (n=15): Group A (saline, control) and Group B (L-Ala-Gln). Group A received normal saline 100 ml, delivered intravenously by infusion pump over 3 hours preceding surgical procedure. Group B was treated with L-Ala-Gln, 20 percent solution (0.5g/Kg), adding saline to complete 100ml. Peripheral venous blood samples were collected at 5 different time-points: T1- at the beginning of the study, 3 h prior to the surgical procedure; T2- at the end of the infusion (before the surgical procedure), T3- at the end of the surgical procedure, T4- 6 h postoperative and T5- 12 h postoperative. Parameters analyzed included glutathione (GSH), thiobarbituric acid reactive substances (TBARS), glucose, insulin, C-reactive protein (CRP) and interleukin-6 (IL-6). RESULTS: No statistically significant differences were found between groups comparing glucose, insulin, TBARS, GSH and IL-6 levels. However, glucose levels increased (P <0.001) in T4 and T5 as compared to baseline (T1) in control group as opposed to L-Ala-Gln group. IL-6 increased in both groups during the postoperative period, indicating an increased inflammatory response. L-Ala-Gln pretreatment did not suppress the increase of IL-6, but reduced the increase of postoperative CRP levels (T5, p <0.01). CONCLUSION: Pretreatment with L-Ala-Gln in children submitted to palatoplasty attenuates the inflammatory response in early post-operative period and promoted a better glycemic control.

OBJETIVO: Avaliar os efeitos do pré-tratamento com L-alanil-glutamina (L-Ala-Gln) sobre o estresse oxidativo, o controle glicêmico e a resposta inflamatória em crianças submetidas à palatoplastia. MÉTODOS: Trinta crianças do sexo masculino, agendadas para palatoplastia, faixa etária 2-10 anos, foram distribuídas aleatoriamente em dois grupos (n = 15): Grupo A (salina, controle) e Grupo B (L-Ala-Gln). O grupo A recebeu solução salina 0,9 por cento 100 ml, administrado por via intravenosa utilizando uma bomba de infusão durante 3 horas anteriores ao procedimento cirúrgico. O grupo B foi tratado com L-Ala-Gln, solução a 20 por cento (0,5 g/kg), acrescentando soro fisiológico até completar 100 ml. Amostras de sangue venoso periférico foram coletadas em cinco momentos diferentes: T1 (3 h antes do procedimento cirúrgico); T2 (no final da perfusão), T3 (no final do procedimento cirúrgico), no pós-operatório, após 6 h (T-4) e 12 h (T5). Os parâmetros analisados foram a glutationa (GSH), ácido tiobarbitúrico (TBARS), glicose, insulina, proteína C-reativa (PCR) e interleucina-6 (IL-6). RESULTADOS: Não houve diferença significante entre os grupos comparando as concentrações de glicose, insulina, TBARS, GSH e IL-6. No entanto, os níveis de glicose aumentaram em T4 e T5, comparado ao basal (T1) (P <0,001) e a IL-6 aumentou em ambos os grupos durante o período pós-operatório, sinalizando o aumento da resposta inflamatória. O pré-tratamento com L-Ala-Gln não suprimiu o aumento de IL-6, mas reduziu o aumento pós-operatório de PCR (T5, p<0,01). CONCLUSÃO: O pré-tratamento com L-Ala-Gln em crianças submetidas à palatoplastia atenua a resposta inflamatória no período pós-operatório imediato, promovendo um melhor controle glicêmico.

Factores asociados a infecciones nosocomiales en sitio quirúrgico para craneotomía / Factors associated with nosocomial surgical-site infections for craniotomy in Mexico City hospitals

Introducción: La infección nosocomial en sitio quirúrgico (INSQ) en craneotomía puede ocasionar la muerte o discapacidad que modifica la calidad de vida, por lo que se requiere encontrar factores que puedan ser utilizados para incluir en los índices de control. Por ello es necesario identificar factores asociados a esta infección y obtener el riesgo de infección atribuible y comparar su capacidad predictiva con el índice del NNISS (Sistema de Vigilancia Nacional de Infecciones Nosocomiales de Estados Unidos). Material y métodos: Se realizó un estudio de casos y controles durante dos años, en pacientes con craneotomía en hospitales del Instituto Mexicano del Seguro Social. Los pacientes cumplieron los criterios de los Centros de Control de Enfermedades de Atlanta para INSQ. Resultados: Se practicaron 737 craneotomías durante el estudio, 41 pacientes presentaron INSQ. Factores intrínsecos asociados: presencia de enfermedades crónicas (OR = 2.18) y craneotomía debida a causas no traumáticas (OR = 1.87); factores extrínsecos: turno vespertino (OR = 2.6) y la práctica de otra cirugía en el mismo sitio quirúrgico (OR = 5.2). Estos factores conformaron los índices de factores intrínsecos y extrínsecos. Con factores extrínseco se presentó 1.7 veces más riesgo en comparación con los factores intrínsecos, así como mayor área bajo la curva ROC (0.731). El riesgo con el índice NNISS con un factor fue de 1.5 y con dos a tres factores, de 4.7. Conclusiones: En esta población en estudio, los pacientes sometidos a una craneotomía tuvieron mayor asociación a INSQ con los factores extrínsecos.

BACKGROUND: Nosocomial surgical-site infection (NSSI) after craniotomy is responsible for an increase in deaths and/or disabilities that affect quality of life. It is necessary to identify factors to be included in an index for their control. The aim of this study was to a) identify intrinsic and extrinsic factors associated with NSSI after craniotomy and b) obtain the infection risk attributed to both intrinsic and extrinsic factors as well as to compare their predictive capability with the NNISS (National Nosocomial Infection Surveillance System) index. METHODS: A case-control study was conducted during a 2-year period in patients who underwent craniotomy in hospitals affiliated with the Instituto Mexicano del Seguro Social. Patients were selected according to the Centers for Disease Control and Prevention criteria for NSSI. RESULTS: During the study period 737 craniotomies were performed, 41 of which presented with NSSI. Intrinsic factors associated with NSSI were the presence of chronic diseases (OR = 2.18) and craniotomy due to nontraumatic causes (OR = 1.87), whereas extrinsic factors were procedures performed during the late shift (OR = 2.6) and another surgery at the same surgical site (OR = 5.2). These factors comprised the index with intrinsic and extrinsic factors. Extrinsic factors were 1.7 times higher than intrinsic factors, in addition to having a larger area under the ROC curve (0.731). The risk obtained with the NNISS index for patients who had one factor was 1.5, whereas that for patients who had two or three factors was 4.7. CONCLUSIONS: In the studied population, patients who underwent a craniotomy with extrinsic factors showed a higher association with NSSI.

Informe preliminar sobre sutura primaria en heridas de colon izquierdo / Primary suture in left colon wounds: Preliminary report

INTRODUCCIÓN. Es importante evaluar críticamente el tratamiento de las heridas del colon izquierdo tratadas por laparotomía urgente. El presente artículo buscó presentar un informe preliminar del resultado y la evolución de los pacientes tratados con sutura o resección y anastomosis primaria de heridas de colon izquierdo, atendidos en el Hospital Universitario de Maabar (Yemen). Se ofrece también una somera revisión de la literatura. MÉTODOS. Entre mayo de 2006 y enero de 2008 fueron operados 5 pacientes con herida penetrante de abdomen, producidas por arma de fuego y arma blanca, las cuales afectaron al colon izquierdo (hubo 3 pacientes con más de una lesión). Se realizó un estudio retrospectivo descriptivo de estos 5 pacientes. RESULTADOS. La edad promedio fue de 25 años. Hubo 3 lesionados por arma blanca y 2 por arma de fuego. A todos se les realizó sutura o resección y anastomosis primaria. Se encontraron 8 lesiones asociadas, mayormente en el intestino delgado. Tres pacientes fueron clasificados en el grupo II y 2 en el grupo III de la escala CIS-Flint. En la escala AAST, hubo 3 pacientes en el grado III y 2 en el grado V. Estos últimos recibieron heridas por arma de fuego y presentaron mayor número de lesiones asociadas. CONCLUSIONES. Las heridas del colon izquierdo, independientemente del número de estas y de los factores de riesgo y otras lesiones asociadas, pueden ser tratadas de manera segura con reparación primaria(AU)

INTRODUCTION: It is important to critically assess the treatment of left colon wounds treated by urgent laparotomy. In present paper we tried to present a preliminary report of results and course of patients treated with suture o resection and primary anastomosis of left colon wounds, seen in University Hospital of Maabar (Yemen). A brief revision of literature is presented. METHODS: Between May, 2006 and January, 2008 5, patients were operated on from an abdomen penetrating wound caused by firearm and by blade, which affected the left colon (there were 3 patients with more than a lesion). We made a descriptive and retrospective study in these 5 patients. RESULTS: Average age was of 25 years. There were 3 injured persons by blade, and 2 by firearm. In all of them we applied suture or resection and primary anastomosis. We found 8 associated lesions, mainly in small intestine. According to CIS-Flint scale three patients were classified in group II and two in group III. In AAST scale, there were 3 patients in grade III and 3 in grade V. These last ones had wounds by firearm and also a great number of associated lesions. CONCLUSIONS: Wounds of left colon, independently of its number and of risk factors, and other associated lesions, may be treated in a safe way using primary repair(AU)

Impacto de la profilaxis antibiótica perioperatoria en el Servicio de Ortopedia y Traumatología / Perioperative antibiotic prophylaxis in the Orthopedics and Traumatology Service: Its significance

El desarrollo de estrategias de trabajo y protocolos de profilaxis antibiótica perioperatoria tienen la finalidad de disminuir las infecciones posquirúrgicas. Una evaluación farmacoeconómica de 3 opciones terapéuticas para la profilaxis antibiótica perioperatoria realizada en el Servicio de Ortopedia en el 2001, ocasionó un cambio en la política de antimicrobianos y la aplicación de un protocolo de actuación. Conocer el impacto de la profilaxis antibiótica perioperatoria en el Servicio de Ortopedia y Traumatología del Instituto Superior de Medicina Militar Dr Luis Díaz Soto durante el período 2000-2006. Se realizó un estudio longitudinal, retrospectivo y descriptivo, que tomó como referencia el diseño de los estudios de utilización de medicamentos, de tipo esquema terapéutico y consecuencias prácticas. El cumplimiento del protocolo se valoró mediante el perfil farmacológico individual. La evolución del consumo, gasto en antibióticos y los comportamientos de la infección posoperatoria, la resistencia bacteriana y mapa microbiológico se realizaron mediante el análisis de la tendencia. El cumplimiento del protocolo fue adecuado en el 90,8 por ciento de los pacientes. Las principales violaciones se relacionaron con la duración del tratamiento. Se observó incremento del consumo de cefazolina (de 0,10 DDD en el 2000 a 0,71 DDD en el 2006); en el resto de los antibióticos la tendencia fue al descenso. Hubo un incremento de los gastos por cefazolina (3 536 pesos en el 2006) y una disminución de los restantes. El gasto en el 2000 fue de 56 004 pesos y en el 2006 de 41 942 pesos. La tendencia de la tasa de infección del sitio quirúrgico mostró un descenso en todas las localizaciones. Mientras que la resistencia bacteriana en el 2000 fue de un 56 por ciento y disminuyó en el 2006 a un 48 por ciento. El impacto de la implementación del protocolo de profilaxis antibiótica perioperatoria fue positivo, al lograrse un elevado acatamiento. El cumplimiento adecuado...

The aim of the development of work strategies and perioperative antibiotic prophylaxis protocols is to decrease postsurgical infections. A pharmaco-economic assessment of three therapeutical options for above mentioned prophylaxis in Orthopedic Service during 2001 changed the antimicrobial policy, and the application of a performance protocol. To know the impact of perioperative antibiotic prophylaxis in Orthopedic and Traumatology Service of Dr Luis Díaz Soto Higher Institute of Military Medicine during 2000-2006. We performed a cross-sectional, retrospective and descriptive study based on design of drugs use study with a therapeutical scheme and practical consequences. Protocol fulfillment was assessed by individual pharmacologic profile. Consumption evolution, antibiotic expense, and postoperative infection behaviors, bacterial resistance, and microbiological map were assessed by means of the trend analysis. Protocol fulfillment was appropriate in 90, 8 percent of patients. Main violations were related to treatment length. There was an increment in Cefazolin consumption (from 0,10 DDD in 2000 to 0,71 DDD in 2006); in the remainder antibiotics, trend decreased. There was an expense increment by Cefazolin ($ 3 536, and 2006 of $ 41 942). Trend of infection rate in surgical site showed a decrease in all the localizations, whereas the bacterial resistance in 2000 was of a 56 percent, and decreased in 2006 to a 48 percent. Impact of application of perioperative prophylaxis protocol was positive, achieving a high level of fulfillment. The proper fulfillment of antibiotic prophylaxis standard with Cefazolin allowed a decreasing trend in antibiotic consumptions and expenses. Infection in surgical site and the bacterial resistance showed the same decreasing trend and a positive correlation.

Antibiotic prophylaxis and incisional surgical site infection following colorectal cancer surgery: an analysis of 330 cases.

OBJECTIVE: To evaluate the rate of incisional surgical site infection (SSI) following colorectal cancer surgery in a university hospital and to determine whether duration of prophylactic antibiotic administration can affect the development of this complication. MATERIAL AND METHOD: The medical records of 330 patients with colorectal cancer undergoing elective oncological resection between 2003 and 2006 at Siriraj Hospital were reviewed. Patients were divided into two groups according to the duration of antibiotic administration; group A: prophylactic antibiotics were discontinued within 24 hours after surgery and group B: antibiotics administration was extended beyond 24 hours after surgery. Data including rate of incisional SSI were analyzed. RESULTS: There were 180 males and 150 females, with a mean age of 63 years. There were 126 patients (38%) in group A and 204 patients (62%) in group B. There was no statistical difference in patient characteristics and tumor-related variables between the two groups, except tumor location. Overall rate of incisional SSI was 14.5%. The rate of incisional SSI was not statistically different between the two groups (group A 11.1% vs. group B 16.7%, p = 0.22). Patients with incisional SSI had a significantly longer hospital stay than patients without incisional SSI (15.9 vs. 8.3 days, p < 0.001). CONCLUSION: This present study found the overall rate of incisional SSI following colorectal surgery to be 14.5%. There was no significant difference in the rate of this complication between the two groups. Thus, surgeons should be encouraged to use a shorter duration of antibiotics to prevent the emergence of antibiotic-resistant bacterial infection and reduce hospital expenditure.

The Efficacy of Postoperative Prophylactic Antibiotics in Orthognathic Surgery: A Prospective Study in Le Fort I Osteotomy and Bilateral Intraoral Vertical Ramus Osteotomy

PURPOSE: This study examined the efficacy of the postoperative prophylactic antibiotics used in orthognathic surgery. The prevalence of surgical site infections (SSIs) was determined according to the use of postoperative prophylactic antibiotics. PATIENTS AND METHODS: Fifty-six patients were divided into 2 groups. Each patient intravenously received 1.0 g of a third-generation cephalosporin (Cefpiramide) 30 minutes before surgery. Among them, 28 patients in the control group received 1.0 g Cefpiramide twice daily until the third day after surgery. The postoperative wounds were examined regularly for the presence of infectious signs. RESULTS: There was no significant difference in the incidence of postoperative wound infections between patients who had received postoperative prophylactic antibiotic administration and those who had not (p = 0.639). CONCLUSION: Prolonged prophylactic antibiotic use after orthognathic surgery may not be necessary, provided that there are no other significant factors for wound infections.

A rare case of mucormycosis of median sternotomy wound caused by Rhizopus arrhizus.

We describe a case of mucormycosis of median sternotomy wound caused by Rhizopus arrhizus . The patient, a known diabetic and a case of coronary artery disease underwent coronary artery bypass surgery. In the postoperative period, patient developed infection of the median sternotomy wound, from which R. arrhizus was isolated on culture. Patient succumbed in spite of being treated with surgical debridement and amphotericin B. To the best of our knowledge, this is the first reported case of mucormycosis of median sternotomy wound from India.

Profilaxis antibiótica en Cirugía Ortopédica y Traumatológíca: Hospital Militar de Matanzas, año 2006 / Antibiotic prophylaxis in orthopedic and traumatic surgery: Military Hospital of Matanzas, year 2006

Se realizó un estudio descriptivo longitudinal retrospectivo sobre la incidencia de sepsis postquirúrgica de la herida en pacientes intervenidos quirúrgicamente en el servicio de Ortopedia y Traumatología del Hospital Militar Dr. Mario Muñoz Monroy de Matanzas, durante el 1er. semestre del año 2006 y en los cuales se utilizaron dosis preoperatorias inmediatas y transoperatorias de Cefazolina con fines profilácticos, con el objetivo de conocer la eficacia de su uso y su relación con determinadas características clínico-epidemiológicas del acto quirúrgico. Para ello se revisaron las historias clínicas de todos los pacientes intervenidos en ese período, obteniéndose una tasa de infección de 3,8, lo cual se relacionó de forma proporcional con el tiempo quirúrgico, el grado de contaminación de la herida quirúrgica y la gravedad de la intervención quirúrgica, y defendiéndose como efectivo el uso del antibiótico según lo protocolizado en el servicio...

We carried out a retrospective, longitudinal, descriptive study on the incidence of the postsurgery sepsis of the wound in patients operated at the Orthopedic and Traumatic service of the Military Hospital “Dr. Mario Muñoz Monroy” of Matanzas, during the first semester of 2006, with whom there were used presurgery and transsurgery doses of Cefazoline with prophylactic purposes to know the efficacy of its use and its relation with some clinico-epidemiologic characteristics of the surgery. For that we reviewed the records of all the patients operated during the period, and found a 3,8, proportionally related with the surgical time, the contamination level of the surgical wound and the seriousness of the surgery, showing the antibiotic use effective as it was registered in the protocols of the service.

Seleção e uso de antibióticos em infecções intra-abdominais / Selection and use of anti-infective agents for intra-abdominal infections

RACIONAL: Infecções intra-abdominais são comuns e apresentam elevada morbidade e mortalidade e os agentes infecciosos responsáveis por tais afecções são geralmente os da flora gastrointestinal, em especial a E. coli e Bacteroides fragilis. OBJETIVO: Apresentar uma revisão da seleção e uso de antibióticos em infecções intra-abdominais. CONCLUSÕES: O uso adequado de antibióticos é fundamental para o controle mais rápido da infecção e reduzir a possibilidade de falha no tratamento. A terapia antimicrobiana é iniciada na suspeita de infecção intra-abdominal e os agentes antibióticos selecionados são utilizados de acordo com os germes mais prováveis de serem encontrados no local da infecção. Além disso, eficácia, custo, segurança e comodidade posológica são considerados para uma seleção mais apropriada. Diferentes esquemas são utilizados em infecções intra-abdominais comunitárias e hospitalares devido à flora mais resistente destas últimas.

BACKGROUND: Intra-abdominal infections are common and are associated with elevated morbidity and mortality. The microorganisms that cause intra-abdominal infections are usually from the gastrointestinal flora, mainly E. coli and Bacteroides fragilis. AIM: To present a review of the selection and use of antibiotics in intra-abdominal infections. CONCLUSIONS: Appropriate use of antibiotics is essential to control infection and to reduce treatment failure. Antibiotics are initiated whenever intra-abdominal infection is suspected and the antimicrobial agents are selected based on the most common microorganisms involved. In addition, efficacy, cost, safety, and posologic regimen are considered for an appropriated selection. Antibiotic regimen is different whether the infection is acquired in the community or at hospital due to the more resistant flora in the latter.