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Rev. bras. cir. cardiovasc ; 36(4): 565-570, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1347146


Abstract This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of São Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.

Humans , Cardiac Surgical Procedures/adverse effects , Mediastinitis/etiology , Schools, Medical , Sternum/surgery , Surgical Wound Infection/etiology , Treatment Outcome , Debridement , Sternotomy/adverse effects
Rev. bras. cir. cardiovasc ; 36(4): 500-505, July-Aug. 2021. tab
Article in English | LILACS | ID: biblio-1347154


Abstract Introduction: Use of bilateral internal thoracic artery (BITA) as graft in coronary artery bypass grafting (CABG) is controversial because it is related to higher in-hospital mortality, incidence of sternal wound-related infection, and an increase in surgical time. The primary objective of this study is to evaluate in-hospital mortality and mortality within 30 days from discharge. The secondary objective is to evaluate the occurrence of deep sternal wound infection in a 90-day follow-up. Methods: This is a retrospective review of the medical records of 152 patients undergoing elective CABG with the use of BITA and cardiopulmonary bypass (CPB). These patients were divided into two groups, diabetics and non-diabetics. Patients with acute myocardial infarction and concomitant valvular disease were not included in the sample. Results: Preoperative characteristics did not show significant differences between the groups, which allowed a comparative analysis. The variables electrocardiography time and aortic clamping time were higher in the diabetic group, with a significant statistical difference (P<0.0001). In-hospital mortality occurred in three patients, and there was no mortality up to 30 days in both groups. There was no significant difference in the primary end point between groups (P=0.56). Deep sternal wound infection was present in only one patient and showed no significant difference in the secondary outcome between groups (P=0.40). Conclusion: We did not observe a higher mortality and occurrence of deep sternal wound infection with the use of BITA in diabetic patients compared to non-diabetics, even with greater CPB and aortic clamping times in diabetics.

Coronary Artery Disease/surgery , Diabetes Mellitus , Mammary Arteries , Surgical Wound Infection/etiology , Retrospective Studies , Risk Factors , Treatment Outcome , Myocardial Revascularization
Article in Chinese | WPRIM | ID: wpr-887872


Objective To investigate the incidence of surgical site infection(SSI)following conversion from laparoscopic to open cholecystectomy and to analyze the related risk factors. Methods The clinical data of 179 patients who had experienced conversion from laparoscopic to open cholecystectomy in Peking Union Medical College Hospital from January 2014 to August 2019 were analyzed retrospectively.Univariate and multivariate logistic regression analyses were performed to evaluate the associations between clinical variables and SSI. Results The incidence of SSI was 19.0%(34/179)after conversion from laparoscopic to open cholecystectomy.The multivariable analysis demonstrated that preoperative endoscopic retrograde cholangiopancreatography(ERCP)(

Cholecystectomy , Humans , Laparoscopy , Retrospective Studies , Risk Factors , Surgical Wound Infection/etiology
Rev. cuba. ortop. traumatol ; 34(2): e273, jul.-dic. 2020. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1156599


RESUMEN Cronobacter sakazakii es una bacteria Gram negativa que pertenece a un grupo emergente de patógenos oportunistas de la familia de los Enterococos, que causa infecciones nosocomiales. Afecta típicamente a los recién nacidos de bajo peso; puede causar graves infecciones como meningitis, sepsis o enterocolitis necrotizante, potencialmente mortales, aunque la gran mayoría de las infecciones se producen en pacientes ancianos, en los que son mucho más leves. Se reporta el primer caso confirmado de infección de herida quirúrgica en España causada por C. sakazakii en un adulto inmunocompetente(AU)

ABSTRACT Cronobacter sakazakii is a Gram negative bacterium that belongs to an emerging group of opportunistic pathogens of the Enterococci family, which causes nosocomial infections. It typically affects low birth weight newborns. It can cause serious infections such as meningitis, sepsis, or life-threatening necrotizing enterocolitis, although the vast majority of infections occur in elderly patients, where they are much milder. We report the first confirmed case of surgical wound infection in Spain, caused by C. sakazakii in an immunocompetent adult(AU)

Humans , Male , Aged , Surgical Wound Infection/etiology , Enterobacteriaceae Infections/etiology , Fractures, Bone/surgery , Fibula/injuries , Open Fracture Reduction/adverse effects
Rev. chil. ortop. traumatol ; 61(3): 83-89, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1177638


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.

Humans , Female , Aged , Staphylococcal Infections/drug therapy , Surgical Wound Infection/drug therapy , Arthroplasty, Replacement, Knee/adverse effects , Sevoflurane/administration & dosage , Staphylococcal Infections/etiology , Surgical Wound Infection/etiology , Administration, Topical , Methicillin-Resistant Staphylococcus aureus , Anti-Bacterial Agents
Rev. bras. oftalmol ; 78(2): 86-90, mar.-abr. 2019. tab
Article in English | LILACS | ID: biblio-1003578


Abstract Purpose: This study aims to describe the incidence, clinical presentation, and evolution of endophthalmitis cases occurred at an ophthalmologic center in Brazil. Methods: This is a review of medical records of patients undergoing cataract surgery from 2008 to 2014. Clinical variables associated with the outcome of postoperative endophthalmitis were evaluated. Results: during the study period, 27,609 cataract surgeries were performed. It was identified 35 cases of endophthalmitis. The overall incidence of endophthalmitis was 0.13%, with an annual variation from 0.04% to 0.27%. The main signs and symptoms in patients with endophthalmitis were ocular pain and low visual acuity associated with conjunctival hyperemia and hypopyon. Gram-positive microorganisms were the most frequent etiological agents. All patients received an intra-vitreous injection of antibiotics as immediate treatment. The final visual acuity was equal to or worse than the ability to count the examiner's fingers in 57.1% of the patients. Evisceration or enucleation was required in 3 patients. Conclusion: The incidence of endophthalmitis and the majority of signs and symptoms found in this study were in agreement with literature in the field. Although the incidence rate is low, the loss of vision experienced by most patients with endophthalmitis after cataract surgery highlights the need for efforts to prevent infection and early diagnosis to avoid such complications.

Resumo Objetivo: Descrever a incidência, a apresentação clínica e a evolução dos casos de endoftalmites ocorridos em um centro oftalmológico no Brasil. Métodos: Trata-se de uma revisão de prontuários dos pacientes submetidos à cirurgia de catarata no período de 2008 a 2014. Foram avaliadas as variáveis clínicas associadas ao desfecho de endoftalmite pós-operatória. Resultados: durante o período do estudo, foram realizadas 27.609 cirurgias de catarata. Foram identificados 35 casos de endoftalmite. A incidência global de endoftalmite foi de 0,13%, com variação anual de 0,04% a 0,27%. Os principais sinais e sintomas em pacientes com endoftalmite foram dor ocular e baixa acuidade visual associado à hiperemia conjuntival e hipópio. Os microrganismos gram-positivos foram os agentes etiológicos mais frequentes. Todos os pacientes receberam uma injeção intravítreo de antibióticos como tratamento imediato. A acuidade visual final foi igual ou pior que a capacidade de contar os dedos do examinador em 57,1% dos pacientes. Evisceração ou enucleação foi necessário em 3 pacientes. Conclusão: A incidência de endoftalmite e a maioria dos sinais e sintomas encontrados neste estudo estão de acordo com os reportados na literatura. Embora a taxa de incidência seja baixa, a perda de visão experimentada pela maioria dos pacientes com endoftalmite após a cirurgia de catarata destaca a necessidade de esforços para medidas de prevenção de infecção e diagnóstico precoce para evitar tais complicações.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Cataract Extraction/adverse effects , Endophthalmitis/etiology , Endophthalmitis/epidemiology , Epidemiological Monitoring , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Surgical Wound Infection/epidemiology , Cataract Extraction/methods , Medical Records , Endophthalmitis/prevention & control , Epidemiology, Descriptive , Infection Control
Rev. argent. coloproctología ; 30(1): 27-37, mar. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1023695


Introducción: La ligadura con banda elástica es un procedimiento efectivo y de bajo costo, para el manejo de hemorroides grado I-III, que no requiere internación. Sus complicaciones, cuando presentes, son habitualmente leves. Aunque poco comunes, existen complicaciones graves asociadas a este procedimiento. El objetivo de este estudio es realizar una revisión de las complicaciones infecciosas pelvi-perineales de la ligadura con banda elástica, características comunes de presentación y alternativas de tratamiento en aquellos que sufren estas complicaciones. Descripción del caso: Se expone el caso de un hombre de 71 años de edad que presentó una sepsis pelviana severa posterior a la realización de una ligadura con banda elástica. A las 48 horas del procedimiento consulta por dolor perianal, dificultad miccional y fiebre. Se realiza el drenaje quirúrgico de ambas fosas isquiorrectales, luego de lo cual intercurre con shock séptico, realizándose una laparotomía, drenaje de retroperitoneo, colostomía sigmoidea. Posteriormente, debido al desarrollo de un síndrome compartimental abdominal, el abdomen se dejó abierto y contenido con una malla. Discusión: Se han descripto complicaciones sépticas posteriores a escleroterapia y crioterapia hemorroidal, ligadura con banda elástica, hemorroidectomia convencional y con sutura mecánica. Se exponen 20 casos de sepsis pelviana post-ligadura con banda elástica. La relación hombre:mujer fue de 3:1, con un amplio rango de edad (27-82 años). Sólo 2 tenían antecedentes de inmunosupresión. La progresión o la persistencia del dolor asociado a fiebre, dificultad miccional, edema perineal y/o genital fueron signos y síntomas comunes que se manifestaron dentro de los 14 días posteriores a la ligadura. Tal como en el caso aquí referido como en otros ya publicados, la realización de imágenes ayudó al diagnóstico y a la planificación quirúrgica. Todos recibieron antibioticoterapia de amplio espectro y 13 requirieron además cirugía. El espectro de tratamientos quirúrgicos fue desde el drenaje incisional hasta la amputación rectal. Ante la progresión del cuadro séptico, la realización de una ostomía fue la conducta más usual. Cinco pacientes requirieron más de una cirugía, y 8 fallecieron. Conclusión: Es importante conocer las complicaciones infecciosas mayores y su presentación clínica, para realizar un diagnóstico y tratamiento precoz de las mismas, con el fin de disminuir su elevada morbilidad o mortalidad. (AU)

Background: Rubber band ligation is an effective, low-cost procedure for grade I-III hemorrhoids, and does not require hospitalization. Its complications, when present, are usually mild. Although rare, there are serious complications associated with this procedure. The purpose of this review was to identify common presenting features and treatment alternatives in those who suffer pelviperineal infectious complications after rubber band ligation. Case Report: The present case is that of a 71-year-old man who presented severe pelvic sepsis after rubber band ligation. He complained of perianal pain, voiding difficulties and fever 48 hours after the procedure. Surgical drainage of both ischiorectal fossae was carried out. He developed septic shock. Laparotomy, retroperitoneal drainage and sigmoid loop colostomy were performed. In a subsequent operation due to abdominal compartment syndrome, the abdomen was left open and contained with a mesh. Discussion: Septic complications have been described after sclerotherapy, cryotherapy, rubber band ligation, conventional hemorrhoidectomy and stapled haemorrhoidopexy. We describe 20 cases of pelvic sepsis after rubber band ligation. The male: female ratio was 3: 1, with a wide age range (27- 82 years). Only 2 had a history of immunosuppression. The progression or persistence of pain associated with fever, voiding difficulties, perineal and / or genital edema were common signs and symptoms that appeared within 14 days after rubber band ligation. In the case here referred to as in others already published, imaging studies helped the diagnosis and surgical planning. All received broad spectrum antibiotic therapy and 13 required surgery. The spectrum of surgical treatments ranged from incisional drainage to rectal amputation. In view of the progression of the septic condition, performing an ostomy was the most usual conduct. Five patients required more than one surgery, and 8 died. Conclusion: It is important to acknowledge the major infectious complications and their clinical presentation, to help with an early diagnosis and treatment, in order to reduce their high morbidity and mortality. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Surgical Wound Infection/etiology , Sepsis/etiology , Hemorrhoids/surgery , Ligation/adverse effects , Ligation/methods , Rectal Diseases/surgery , Rectal Diseases/therapy , Reoperation , Surgical Wound Infection/therapy , Sepsis/therapy , Ligation/instrumentation , Anti-Bacterial Agents/therapeutic use
Rev. bras. cir. cardiovasc ; 34(1): 1-7, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985248


Abstract Objective: To analyze data related to surgical treatment in patients with congenital heart defects (CHD) and Down syndrome (DS) based on information from International Quality Improvement Collaborative Database for Congenital Heart Disease (IQIC). Methods: Between July 1, 2010 and December 31, 2017, 139 patients with CHD and DS underwent surgery at Hospital de Base and Hospital da Criança e Maternidade de São José do Rio Preto (FUNFARME)/Faculdade de Medicina de São José do Rio Preto - SP (FAMERP). A quantitative, observational and cross-sectional study was performed in which the pre, intra and postoperative data were analyzed in an IQIC database. The data included gender, age, prematurity, weight, preoperative procedures, diagnosis, associated cardiac and non-cardiac anomalies, Risk Adjustment for Congenital Heart Surgery (RACHS-1), type of surgery, cardiopulmonary bypass (CPB), perfusion time, aortic clamping time and CPB temperature, bacterial sepsis, surgical site infection and other infections, length of stay in intensive care unit (ICU), length of hospital stay and in-hospital mortality. Results: The most prevalent procedures were complete atrioventricular septal defect repair (58 - 39.45%), followed by closure of ventricular septal defect (36 - 24.49%). The RACHS-1 categories 1, 2, 3 and 4 were distributed as 22 (15%); 49 (33.3%); 72 (49%) and 4 (2.7%), respectively. There were no procedures classified as categories 5 or 6. Bacterial sepsis occurred in 10.2% of cases, surgical site infection in 6.1%, other infections in 14.3%. The median length of ICU stay was 5 days and the median length of hospital stay was 11 days. In-hospital mortality was 6.8%. Conclusion: Surgical treatment in patients with CHD and DS usually does not require highly complex surgical procedures, but are affected by infectious complications, resulting in a longer ICU and hospital length of stay with considerable mortality.

Humans , Male , Female , Infant, Newborn , Infant , Down Syndrome/complications , Down Syndrome/mortality , Heart Defects, Congenital/surgery , Postoperative Complications/mortality , Surgical Wound Infection/etiology , Surgical Wound Infection/mortality , Infant, Premature , Cross-Sectional Studies , Risk Factors , Treatment Outcome , Hospital Mortality , Sepsis/microbiology , Sepsis/mortality , Risk Assessment , Quality Improvement , Heart Defects, Congenital/complications , Heart Defects, Congenital/mortality , Intensive Care Units , Length of Stay
Rev. Soc. Bras. Med. Trop ; 52: e20190039, 2019. tab
Article in English | LILACS | ID: biblio-1041600


Abstract INTRODUCTION: The growing incidence of post-surgical atypical mycobacteriosis (PSAM) may be related to the increased use of low- and medium-complexity video-assisted surgery. METHODS: Between April 2007 and June 2009, 125 patients were referred from the State Health Department of Rio de Janeiro for the treatment of confirmed, probable, or suspected PSAM. RESULTS: Laparoscopic cholecystectomy was the most frequent surgical procedure (48.8%) among patients. Clarithromycin, ethambutol, and terizidone were used to treat 113 patients for a mean duration of 226 days. CONCLUSIONS: Despite the need for multidrug therapy and long treatment duration, most included patients adhered to treatment and experienced cure without relapse.

Humans , Male , Female , Postoperative Complications/etiology , Surgical Wound Infection/etiology , Video-Assisted Surgery/adverse effects , Postoperative Complications/epidemiology , Surgical Wound Infection/epidemiology , Brazil/epidemiology , Clarithromycin/therapeutic use , Drug Therapy, Combination , Ethambutol/therapeutic use , Middle Aged , Mycobacterium Infections, Nontuberculous
Rev. Col. Bras. Cir ; 46(4): e2252, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1020370


RESUMO Objetivo: apresentar uma análise descritiva dos resultados de um pacote de cuidados aplicado em pacientes obesos submetidos à cirurgia bariátrica, no que diz respeito ao controle de infecção. Métodos: um pacote de cuidados foi estruturado, visando a conter as taxas de infecção de sítio cirúrgico (ISC) em pacientes submetidos à cirurgia bariátrica. O pacote incluiu interrupção de tabagismo, banho com clorexidina 4% duas horas antes da cirurgia, cefazolina 2g em bolus na indução anestésica associada à administração da mesma droga com dose de 1g em infusão contínua, tricotomia apropriada, controle glicêmico, oxigênio suplementar, normotermia, controle da dor com morfina intrarraquidiana e remoção do curativo estéril 48 horas após a cirurgia. Todos os pacientes foram seguidos por 30 dias. Resultados: entre os 1.596 pacientes incluídos, 334 (20,9%) foram submetidos à cirurgia aberta e 1.262 (79,1%) à cirurgia videolaparoscópica. As taxas de ISC foram de 0,5% no grupo submetido à cirurgia laparoscópica e de 3% nos submetidos à cirurgia aberta. A incidência geral de ISC foi de 1%. Infecções intra-abdominal, do trato respiratório e do trato urinário ocorreram em 0,9%, 1,1% e 1,5% da amostra, respectivamente. Faixas mais elevadas de índice de massa corporal foram associadas a maiores incidências de ISC (p=0,001). Entre os pacientes com diabetes, 2,2% desenvolveram ISC, enquanto a taxa de infecção entre os não diabéticos foi de apenas 0,6%. Conclusão: o pacote de cuidados instituído, estruturado por estratégias centrais baseadas em evidências, associadas à medidas secundárias, foi capaz de manter baixas taxas de ISC após cirurgia bariátrica.

ABSTRACT Objective: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. Methods: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. Results: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. Conclusion: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.

Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Surgical Wound Infection/prevention & control , Perioperative Care/methods , Bariatric Surgery , Bariatric Surgery/adverse effects , Patient Care Bundles , Surgical Wound Infection/etiology , Surgical Wound Infection/epidemiology , Brazil/epidemiology , Body Mass Index , Incidence , Prospective Studies , Risk Factors , Diabetes Mellitus, Type 2/complications , Middle Aged , Obesity/surgery
Rev. chil. infectol ; 35(2): 123-132, abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959421


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.

Humans , Child, Preschool , Child , Surgical Wound Infection/diagnosis , Surgical Wound Infection/drug therapy , Peritoneal Dialysis/adverse effects , Catheter-Related Infections/diagnosis , Catheter-Related Infections/drug therapy , Anti-Infective Agents/therapeutic use , Surgical Wound Infection/classification , Surgical Wound Infection/etiology , Severity of Illness Index , Risk Factors , Catheter-Related Infections/etiology , Anti-Infective Agents/classification
Hosp. Aeronáut. Cent ; 13(2): 84-88, 2018. tabl
Article in Spanish | LILACS, BINACIS | ID: biblio-1021137


Introducción: La histerectomía es uno de los procedimientos quirúrgicos que con más frecuencia se realiza en Ginecología. La frecuencia de aparición de absceso de cúpula varía desde un 0,7% a un 14%. La infección generalmente es polimicrobiana y los gérmenes implicados son los de la flora vaginal y endocervical de la mujer sana. En el Hospital Aeronáutico Central, desde el año 2007, además de la profilaxis intraoperatoria con cefalosporinas de primera generación, se realiza en las 12 horas previas a la cirugía programada, profilaxis con óvulos vaginales polivalentes. Objetivos: Evaluar la disminución de la incidencia de absceso de cúpula vaginal post cirugía ginecológica, que implique la manipulación de la vagina, con administración pre-quirúrgica de óvulos vaginales polivalentes. Material y Método: Estudio observacional, descriptivo y retrospectivo. Se incluyeron 220 pacientes que se les realizaron 220 histerectomías totales: 202 por vía abdominal, 5 laparoscópicas y 13 vaginales. Se realizó profilaxis intraoperatoria con cefalosporinas de 1º generación. Se les administró por vía vaginal un óvulo polivalente compuesto por: metronidazol 300 mg, miconazol nitrato 100 mg, neomicina sulfato 48,8 mg, polimixina b sulfato 4,4 mg, centella asiática 15 mg y excipientes. Se evaluó la aparición de absceso de cúpula vaginal en los 6 meses posteriores a la cirugía. Resultados: Se hallaron complicaciones post quirúrgicas en 10 pacientes (4.5%): 4 pacientes (1,8%) con infección del tracto urinario, 3 pacientes (1,4%) con infección de herida quirúrgica, 1 paciente (0,4%) con fístula vesico-vaginal, 1 paciente con Tromboembolismo pulmonar, 1 paciente con granuloma de cúpula vaginal y 1 paciente con absceso de cúpula vaginal. Esta paciente no recibió el óvulo vaginal polivalente. Conclusión: De los datos obtenidos de las 220 pacientes analizadas, y teniendo en cuenta la bibliografía consultada, podemos concluir que las pacientes que son sometidas a histerectomías totales con técnica de cúpula vaginal cerrada y que reciben como profilaxis preoperatoria un óvulo vaginal polivalente, presentan menor incidencia de complicaciones post operatorias, principalmente a nivel de la cúpula vaginal, y en particular abscesos de cúpula.

Introduction: Hysterectomy is one of the surgical procedures most frecuently performed in gynecology. Vault abscess frequency of appearance varies from 0.7% to 14%. The infection is usually polymicrobial and involved germs are those from vaginal and endocervical flora of the healthy woman. In the Hospital Aeronáutico Central, since 2007, in addition to intraoperative prophylaxis with first-generation cephalosporins, prophylaxis with polyvalent vaginal ovules is performed within 12 hours prior to scheduled surgery. Objectives: Evaluate the decrease in the incidence of vaginal vault abscess after gynecological surgery, involving the manipulation of the vagina, with pre-surgical administration of polyvalent vaginal ovules. Material and Method: Observational, descriptive and retrospective. 220 patients who underwent 220 total hysterectomies were included: 202 abdominal via, 5 laparoscopic and 13 vaginal. Intraoperative prophylaxis was performed with 1st generation cephalosporins. They were administered through vaginal via with Polyvalent ovule composed of: metronidazole 300 mg, miconazole nitrate 100 mg, neomycin sulfate 48.8 mg, polymyxin b sulfate 4.4 mg, gotu kola 15 mg and excipients. The appearance of vaginal dome abscess was evaluated in the 6 months following surgery. Results: Post-surgical complications were found in 10 patients (4.5%): 4 patients (1.8%) with urinary tract infection, 3 patients (1.4%) with surgical wound infection, 1 patient (0.4%) ) with vesico-vaginal fistula, 1 patient with pulmonary thromboembolism, 1 patient with vaginal vault granuloma and 1 patient with abscess of vaginal vault. This patient did not receive the polyvalent vaginal ovum. Conclusion: Data obtained from the 220 patients analyzed, and taking into account the bibliography consulted, we can conclude that patients who undergo total hysterectomies with a closed vaginal vault technique who receive a polyvalent vaginal ovum as a preoperative prophylaxis, present a lower incidence of post-operative complications, mainly at the level of the vaginal vault, and in particular dome abscesses

Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Antibiotic Prophylaxis/trends , Hysterectomy, Vaginal/adverse effects , Surgical Wound Infection/etiology , Thromboembolism/etiology , Endometrial Neoplasms/complications , Pelvic Organ Prolapse/complications , Reproductive Tract Infections/etiology , Menorrhagia/complications
An. bras. dermatol ; 92(4): 474-477, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-887001


Abstract: Background: Surgical sutures, wound tension, additional skin incisions and other factors may result in recurrence of tumor-like scar. Objective: To investigate the role of wound natural healing therapy in tumor-like hypertrophic scar. Methods: In this study, tumor-like hypertrophic scars of 47 cases were excised completely and the residual wounds were treated with natural healing. The short-term and long-term effects of treatment were evaluated. Results: All cases were successfully cured by natural healing therapy. The healing time of the maximum wound (80mm × 20mm) and the minimal wound (5mm× 5mm) was 25 days and 7 days respectively. The size of new skin scars ranged from 3mm to 11 mm. Clinical followed-up was performed in 34 cases for 36 months. Among them, no recurrence happened in 31 cases and new scar size ranged from 2mm to 8mm, while local recurrence happened in 3 cases whose scar size were less than 5 mm. Study Limitations: The cure rate of the therapy was 91.2%. Conclusion: The wound natural healing therapy is effective in treating tumor-like hypertrophic scar, which can prevent recurrence and has good cosmetic results.

Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Wound Healing/physiology , Cicatrix, Hypertrophic/surgery , Wound Closure Techniques , Postoperative Period , Recurrence , Surgical Wound Infection/etiology , Sutures/adverse effects , Suture Techniques/adverse effects , Treatment Outcome , Cicatrix, Hypertrophic/pathology , Cicatrix, Hypertrophic/prevention & control , Preoperative Period
Rev. bras. cir. cardiovasc ; 32(1): 1-7, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-843468


Abstract Objective: Deep sternal wound infection following coronary artery bypass grafting is a serious complication associated with significant morbidity and mortality. Despite the substantial impact of deep sternal wound infection, there is a lack of specific risk stratification tools to predict this complication after coronary artery bypass grafting. This study was undertaken to develop a specific prognostic scoring system for the development of deep sternal wound infection that could risk-stratify patients undergoing coronary artery bypass grafting and be applied right after the surgical procedure. Methods: Between March 2007 and August 2016, continuous, prospective surveillance data on deep sternal wound infection and a set of 27 variables of 1500 patients were collected. Using binary logistic regression analysis, we identified independent predictors of deep sternal wound infection. Initially we developed a predictive model in a subset of 500 patients. Dataset was expanded to other 1000 consecutive cases and a final model and risk score were derived. Calibration of the scores was performed using the Hosmer-Lemeshow test. Results: The model had area under Receiver Operating Characteristic (ROC) curve of 0.729 (0.821 for preliminary dataset). Baseline risk score incorporated independent predictors of deep sternal wound infection: obesity (P=0.046; OR 2.58; 95% CI 1.11-6.68), diabetes (P=0.046; OR 2.61; 95% CI 1.12-6.63), smoking (P=0.008; OR 2.10; 95% CI 1.12-4.67), pedicled internal thoracic artery (P=0.012; OR 5.11; 95% CI 1.42-18.40), and on-pump coronary artery bypass grafting (P=0.042; OR 2.20; 95% CI 1.13-5.81). A risk stratification system was, then, developed. Conclusion: This tool effectively predicts deep sternal wound infection risk at our center and may help with risk stratification in relation to public reporting and targeted prevention strategies in patients undergoing coronary artery bypass grafting.

Humans , Male , Female , Aged , Sternum , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Coronary Artery Bypass/adverse effects , Mammary Arteries , Brazil , Prospective Studies , Risk Factors , ROC Curve , Treatment Outcome , Hospitals
Rev. chil. cir ; 68(5): 390-393, oct. 2016.
Article in Spanish | LILACS | ID: lil-797350


Las infecciones de sitio operatorio son eventos adversos frecuentes en cirugía, su presencia determina una mayor morbimortalidad, además de estancia hospitalaria y costos económicos para los afectados. La obesidad constituye un factor de riesgo para dicha enfermedad por aspectos multifactoriales. Considerando la epidemia occidental del sobrepeso y la obesidad, así como la masificación de la cirugía bariátrica, es importante mantener conceptos actualizados. La obesidad determina un estado de respuesta inflamatorio sistémico basal, el cual puede ser descompensado por segundas injurias, dicha descompensación puede determinar en una mayor tasa de infecciones asociadas a la intervención quirúrgica. Existe evidencia que no logra demostrar significación estadística con relación a la presencia de diabetes o H. pylori como factor de riesgo. De forma complementaria, algunos paradigmas como la mayor tasa de infecciones pulmonares o la necesidad de uso de antibiótico-profilaxis en cirugía bariátrica se mantiene.

Surgical site infections are frequent adverse events in surgery, its presence determines increased morbidity and mortality plus hospital stay and economic costs for those affected. Obesity is a risk factor for this disease by multifactorial aspects. Considering the Western epidemic overweight and obesity, as well as the massification of bariatric surgery, it is important to keep updated concepts. Obesity determines a state of basal systemic inflammatory response, which can be decompensated by a second hit, this decompensation can determine a higher rate of infections associated to surgery. There is evidence that fails to demonstrate statistical significance in relation to the presence of diabetes or H. pylori infection as a risk factor. As a complement, some paradigms as the highest rate of lung infections or the need for antibiotic prophylaxis use in bariatric surgery remains.

Humans , Surgical Wound Infection/etiology , Diabetes Complications/complications , Bariatric Surgery/adverse effects , Obesity/complications , Surgical Wound Infection/prevention & control , Risk Factors , Antibiotic Prophylaxis , Obesity/surgery
Rev. méd. Chile ; 144(8): 1038-1043, ago. 2016. tab
Article in Spanish | LILACS | ID: biblio-830609


Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

Humans , Minor Surgical Procedures , Surgical Wound Infection/prevention & control , Asepsis/methods , Dermatologic Surgical Procedures , Anti-Bacterial Agents/therapeutic use , Surgical Wound Infection/etiology , Antisepsis/methods , Hand Disinfection/methods , Risk Factors , Sepsis/prevention & control
Rev. cuba. cir ; 55(2): 0-0, abr.-jun. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-791492


Introducción: las infecciones posoperatorias favorecen la ocurrencia de otras complicaciones, en ocasiones letales, razón por la que elevan los índices de morbilidad y mortalidad. Objetivo: identificar diferentes factores relacionados con la aparición de las infecciones posoperatorias que están asociados con la mortalidad por sus efectos. Métodos: se realizó un estudio descriptivo, de serie de casos, basado en 258 pacientes operados de forma urgente o electiva durante el trienio 2012-2014 en el Servicio de Cirugía General del Hospital Provincial Saturnino Lora de Santiago de Cuba. Estos pacientes presentaron infecciones posquirúrgicas, de los cuales 27 (10,5 por ciento) fallecieron. Resultados: la aparición de la infección posquirúrgica estuvo asociada a las intervenciones contaminadas en la cirugía urgente seguida por las limpias y limpias contaminadas para la electiva, así como la infección del sitio operatorio superficial y en otras localizaciones en ambos grupos. La mortalidad estuvo relacionada con la edad mayor de 60 años, el estado físico preoperatorio ASA ≥ III, la cirugía abdominal urgente, contaminada, el tiempo quirúrgico mayor de una hora y las reintervenciones. Conclusiones: en todos los fallecidos repercutieron los factores de predicción para la ocurrencia de infecciones posoperatorias y como consecuencia de la correlación de cada uno de ellos, se acrecentó el riesgo de morir(AU)

Introduction: postoperative infections cause other complications, sometimes lethal ones, a reason why they raise morbidity and mortality rates. Objective: to identify different factors related to the occurrence of postoperative infection and which, because of their effects, they are associated with mortality. Methods: a descriptive study of case series was carried out, based on 258 patients who had emergency or elective surgery in the Department of Surgery of Saturnino Lora Provincial Hospital of Santiago de Cuba (2012-2014). These patients had postoperative infections, and 27 of them (10.5 percent) died. Results: the occurrence of postoperative infection was associated with contaminated interventions in emergency surgery, followed by clean and clean-contaminated for the elective one, as well as surface surgical site infection and in other locations in both groups. Mortality was associated with age (over 60 years), preoperative fitness ASA≥III, contaminated emergency abdominal surgery, operating time longer than an hour and second interventions. Conclusions: In all the deceased patients there was a repercussion of predicting factors for the occurrence of postoperative infections and, as a result of the correlation of each of them, the risk of dying increased(AU)

Humans , Aged , Cross Infection/complications , Postoperative Complications/mortality , Risk Factors , Surgical Wound Infection/etiology , Case-Control Studies , Epidemiology, Descriptive
Rev. Esc. Enferm. USP ; 49(6): 1004-1011, Dec. 2015. graf
Article in Portuguese | LILACS, BDENF | ID: lil-767813


Abstract OBJECTIVE Characterizing readmissions from orthopedic surgical site infections. METHOD An integrative review of literature in the LILACS, IBECS, MEDLINE, Cochrane, SciELO and PUBMED databases, using the descriptors Patient readmission, Wound infection, Cross infection, Orthopedic procedures, Orthopedics. RESULTS 78 studies were identified and 10 publications were selected. Surgical site infections are the most common cause of unplanned orthopedic readmissions, representing long periods of hospitalization, new surgical procedures and high costs, and greater possibility of subsequent hospitalizations. Most significant predictors have indicated average length of hospitalization, need for intensive care, emergency status at admission, risk of death, age > 65 years, males and higher body mass index. CONCLUSION Readmission rates have increasingly become measures of quality and concerns about costs. New studies could involve issues related to indirect costs, specifically social and psychological costs.

Resumen OBJETIVO Caracterizar los reingresos por infección del sitio quirúrgico ortopédico. MÉTODO Revisión integradora de la literatura, en las bases de datos LILACS, IBECS, MEDLINE, Cochrane, SciELO y PUBMED, por medio de los descriptores Reingreso del paciente, Infección de la herida operatoria, Infección hospitalaria, Procedimientos ortopédicos, Ortopedia. RESULTADOS Fueron identificados 78 estudios y seleccionadas 10 publicaciones. La infección del sitio quirúrgico es la causa más frecuente entre los reingresos ortopédicos no planificados, que representan largas estancias hospitalarias, nuevas intervenciones quirúrgicas y costos elevados, además de mayor posibilidad de ingresos subsiguientes. Los factores predictivos más significativos señalaron tiempo de estancia media, necesidad de cuidados intensivos, status de urgencia en el ingreso, riesgo de muerte, edad > 65 años, sexo masculino y mayor índice de masa corpórea. CONCLUSIÓN Las tasas de reingreso se hacen cada vez más medidas de cualidad y preocupación con relación a los costos. Nuevos estudios podrían involucrar cuestiones relacionadas con costos indirectos, especialmente los sociales y psicológicos.

Resumo OBJETIVO Caracterizar as readmissões por infecção do sítio cirúrgico ortopédico. MÉTODO Revisão integrativa da literatura, nas bases de dados LILACS, IBECS, MEDLINE, Cochrane, SciELO e PUBMED, por meio dos descritores Readmissão do paciente, Infecção da ferida operatória, Infecção hospitalar, Procedimentos ortopédicos, Ortopedia. RESULTADOS Identificados 78 estudos e selecionadas 10 publicações. A infecção do sítio cirúrgico é a causa mais frequente entre as readmissões ortopédicas não planejadas, que representam longos períodos de internação, novas intervenções cirúrgicas e custos elevados, além de maior possibilidade de internações subsequentes. Fatores preditivos mais significantes apontaram tempo médio de internação, necessidade de cuidados intensivos,status de urgência na admissão, risco de morte, idade > 65 anos, sexo masculino e maior índice de massa corporal. CONCLUSÃO Taxas de readmissão tornam-se cada vez mais medidas de qualidade e preocupação em relação a custos. Novos estudos poderiam envolver questões relacionadas a custos indiretos, especificamente os sociais e psicológicos.

Humans , Orthopedic Procedures/adverse effects , Patient Readmission , Surgical Wound Infection/etiology , Surgical Wound Infection/therapy
Acta cir. bras ; 30(12): 844-851, Dec. 2015. tab
Article in English | LILACS | ID: lil-769503


ABSTRACT PURPOSE: To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS: A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS: The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION: The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.

Adult , Aged , Female , Humans , Male , Middle Aged , Drainage/methods , Herniorrhaphy/rehabilitation , Incisional Hernia/surgery , Seroma/etiology , Surgical Wound Infection/etiology , Drainage/adverse effects , Follow-Up Studies , Hernia, Ventral/surgery , Incisional Hernia/complications , Reoperation , Seroma , Surgical Mesh/adverse effects , Suture Techniques/adverse effects