ABSTRACT
BACKGROUND: Hepatitis C virus (HCV) infection is thought to be associated with immune dysfunction. We hypothesized that HCV status would be associated with increased infectious complications in the surgical intensive care unit (SICU). METHODS: All patients admitted to our SICU between 2008 and 2012 were included. We evaluated 90-day mortality and infectious complications in the SICU. Multivariate logistic regression was performed to identify predictors of infectious complications and 90-day mortality. RESULTS: A total of 1,941 patients were included. The HCV-positive group had a higher overall incidence of infectious complications (25% vs 18%), particularly ventilator-associated pneumonia (VAP) and bacteremia. The increased incidences of VAP and bacteremia persisted when cirrhotic patients were excluded. Prolonged intubation (Odds Ratio [OR] = 2.1), abdominal surgery (OR = 1.6), and model for end-stage liver disease ≥ 15 (OR = 1.4) were independent predictors of SICU infectious complications. CONCLUSIONS: The HCV-positive group had an increased incidence of infectious complications in the SICU, particularly VAP and bacteremia. This effect persisted when cirrhotic patients were excluded.
Subject(s)
Cross Infection/epidemiology , Hepatitis C, Chronic/complications , Hospital Mortality , Intensive Care Units , Postoperative Complications/immunology , Adult , Aged , Bacteremia/diagnosis , Bacteremia/epidemiology , Bacteremia/immunology , Cause of Death , Critical Care , Cross Infection/physiopathology , Databases, Factual , Female , Follow-Up Studies , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/immunology , Humans , Immunocompromised Host , Logistic Models , Male , Middle Aged , Multivariate Analysis , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Retrospective Studies , Risk Assessment , Survival Rate , United StatesABSTRACT
We compared bedside polymerase chain reaction to culture for identifying Staphylococcus aureus in patients about to undergo surgery with hardware implantation. Patients were screened for S. aureus carrier status at the preoperative clinic and on the day of surgery. The sensitivity, specificity, positive and negative predictive values, and accuracy were calculated.
Subject(s)
Carrier State , Cross Infection , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Prosthesis Implantation , Staphylococcal Infections , Staphylococcus aureus/isolation & purification , Surgical Wound Infection , Carrier State/diagnosis , Carrier State/microbiology , Cross Infection/microbiology , Cross Infection/prevention & control , Humans , Infection Control/methods , Polymerase Chain Reaction/methods , Predictive Value of Tests , Preoperative Care/methods , Prosthesis Implantation/adverse effects , Prosthesis Implantation/methods , Sensitivity and Specificity , Staphylococcal Infections/microbiology , Staphylococcal Infections/prevention & control , Surgical Wound Infection/microbiology , Surgical Wound Infection/prevention & controlABSTRACT
IMPORTANCE: Surgical site infections (SSIs), commonly caused by methicillin-resistant Staphylococcus aureus (MRSA), are associated with significant morbidity and mortality, specifically when hardware is implanted in the patient. Previously, we have demonstrated that a preoperative decontamination protocol using chlorhexidine gluconate washcloths and intranasal antiseptic ointment is effective in eradicating MRSA in the nose and on the skin of patients. OBJECTIVE: To examine the effect of a decontamination protocol on SSIs in patients undergoing elective orthopedic surgery with hardware implantation. DESIGN, SETTING, AND PARTICIPANTS: A prospective database of patients undergoing elective orthopedic surgery with hardware implantation at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, was analyzed from October 1, 2012, to December 31, 2013. Cohort groups before and after the intervention were compared. INTERVENTIONS: Starting in May 2013, during their preoperative visit, all of the patients watched an educational video about MRSA decontamination and were given chlorhexidine washcloths and oral rinse and nasal povidone-iodine solution to be used the night before and the morning of scheduled surgery. MAIN OUTCOMES AND MEASURES: Thirty-day SSI rates were collected according to the definitions of the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance. Data on demographics, comorbidities such as chronic obstructive pulmonary disease and coronary artery disease, tobacco use, alcohol use, and body mass index were also collected. Univariate analysis was performed between the 2 groups of patients. Multivariate analysis was used to identify independent predictors of SSI. RESULTS: A total of 709 patients were analyzed (344 controls and 365 patients who were decolonized). Both groups were well matched with no significant differences in age, body mass index, sex, or comorbidities. All of the patients (100%) completed the MRSA decontamination protocol. The SSI rate in the intervention group was significantly lower (1.1%; 4 of 365 patients developed an SSI) than the SSI rate in the control group (3.8%; 13 of 344 patients developed an SSI) (P = .02). Multivariate logistic regression identified MRSA decontamination as an independent predictor of not developing an SSI (adjusted odds ratio, 0.24 [95% CI, 0.08-0.77]; P = .02). CONCLUSIONS AND RELEVANCE: Our study demonstrates that preoperative MRSA decontamination with chlorhexidine washcloths and oral rinse and intranasal povidone-iodine decreased the SSI rate by more than 50% among patients undergoing elective orthopedic surgery with hardware implantation. Universal decontamination using this low-cost protocol may be considered as an additional prevention strategy for SSIs in patients undergoing orthopedic surgery with hardware implantation and warrants further study.
Subject(s)
Clinical Protocols/standards , Decontamination/methods , Elective Surgical Procedures/adverse effects , Orthopedic Procedures/adverse effects , Preoperative Care/methods , Prostheses and Implants , Surgical Wound Infection/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Morbidity/trends , Orthopedic Procedures/methods , Prospective Studies , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Texas/epidemiologyABSTRACT
BACKGROUND: Bartonella henselae, Bartonella quintana, and Bartonella bacilliformis are responsible for the majority of cases of bartonellosis in humans. These species have various unique epidemiologic characteristics, clinical manifestations, and treatment approaches. The objective of this study was to summarize the evidence on the treatment for the three most common species of Bartonella in humans. METHODS: We searched electronic databases through August 2011 for randomized controlled trials and observational studies designed to evaluate the efficacy and safety of the regimens used to treat diseases produced by B. henselae, B. quintana, and B. bacilliformis. Study selection and appraisal were done in duplicate. RESULTS: We found two randomized and seven non-randomized studies at high risk of bias. For cat scratch disease, antibiotics did not significantly affect the cure rate or time to achieve cure. In chronic bacteremia, gentamicin and doxycycline significantly increased the resolution rate. The recommended treatment was not better than other regimens for infectious endocarditis and bacillary angiomatosis. CONCLUSIONS: Current clinical practice for the treatment of bartonellosis relies mostly on expert opinion and antimicrobial susceptibility data. Randomized controlled trials are needed in the field to compare different treatment options.
