Exploring the surge current degradation of natural ester oil-based nanofluids.

The surge endurance of natural ester oil-based nanofluids against surge events is investigated experimentally. The focus of this work is the examination, through dielectric spectroscopy measurements, of the alteration of the real and imaginary parts of the complex relative permittivity of iron oxide nanofluids as a result of an accelerated degradation test employing a sequence of repetitive current impulses produced via a 12 kV/6 kA combination wave generator. The target is the exploration of a possible implementation of nanofluids as multipurpose liquids that act, in addition to insulation and coolants, as surge absorption media. Promising experimental results are discussed and compared with those of mineral oil that is widely used as a conventional insulating liquid in power transformers.

Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.

OBJECTIVES: We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds. METHODS: The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study. RESULTS: Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]). CONCLUSION: The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.

Surveillance of community outbreaks of respiratory tract infections based on house-call visits in the metropolitan area of Athens, Greece.

BACKGROUND: The traditional Serfling-type approach for influenza-like illness surveillance requires long historical time-series. We retrospectively evaluated the use of recent, short, historical time-series for recognizing the onset of community outbreaks of respiratory tract infections (RTIs). METHODS: The data used referred to the proportion of diagnoses for upper or lower RTIs to total diagnoses for house-call visits, performed by a private network of medical specialists (SOS Doctors) in the metropolitan area of Athens, Greece, between January 01, 2000 and October 12, 2008. The reference standard classification of the observations was obtained by generating epidemic thresholds after analyzing the full 9-year period. We evaluated two different alert generating methods [simple regression and cumulative sum (CUSUM), respectively], under a range of input parameters, using data for the previous running 4-6 week period. These methods were applied if the previous weeks contained non-aberrant observations. RESULTS: We found that the CUSUM model with a specific set of parameters performed marginally better than simple regression for both groups. The best results (sensitivity, specificity) for simple regression and CUSUM models for upper RTIs were (1.00, 0.82) and (0.94, 0.93) respectively. Corresponding results for lower RTIs were (1.00, 0.80) and (0.93, 0.91) respectively. CONCLUSIONS: Short-term data for house-call visits can be used rather reliably to identify respiratory tract outbreaks in the community using simple regression and CUSUM methods. Such surveillance models could be particularly useful when a large historical database is either unavailable or inaccurate and, thus, traditional methods are not optimal.

Gentamicin collagen sponges for the prevention of sternal wound infection: a meta-analysis of randomized controlled trials.

OBJECTIVE: The study objective was to determine whether the application of gentamicin collagen sponges reduces sternal wound infections in patients undergoing cardiac surgery. METHODS: A meta-analysis of randomized controlled trials was performed. RESULTS: Four randomized controlled trials were eligible for inclusion. By pooling data from 4 randomized controlled trials (4672 per-protocol patients), gentamicin collagen sponges reduced deep sternal wound infections (risk ratio, 0.62; 95% confidence interval, 0.39-0.97) and any sternal wound infections (risk ratio, 0.61; confidence interval, 0.39-0.98). In contrast, no benefit was demonstrated regarding superficial sternal wound infections (4 randomized controlled trials [4672 patients]; risk ratio, 0.65; 95% confidence interval, 0.34-1.25) and all-cause mortality (3 randomized controlled trials [3994 patients]; risk ratio, 0.90; 95% confidence interval, 0.57-1.42). On the basis of data from 2 randomized controlled trials (3410 patients), gentamicin collagen sponges also seemed to reduce surgically treated sternal wound infections (risk ratio, 0.59; 95% confidence interval, 0.41-0.86). The most commonly isolated pathogens were coagulase-negative Staphylococcus spp (43%) and Staphylococcus aureus (28%). CONCLUSIONS: Gentamicin collagen sponges seem to reduce the sternal wound infection rate in patients undergoing cardiac surgery. The statistical heterogeneity among the existing trials underlines the need for additional large, high-quality randomized controlled trials.

Adhesive strips for the closure of surgical incisional sites: a systematic review and meta-analysis.

BACKGROUND: The authors evaluated the available evidence regarding the use of adhesive strips for the management of surgical incisions and compared them with sutures and other closure materials. Study design. Systematic review and meta-analysis of randomized controlled trials (RCTs). RESULTS: Twelve RCTs studying 1317 incisions in 1023 patients were included. No difference was found regarding the development of infection (odds ratio [OR] = 0.47; 95% Confidence interval [CI] = 0.12-1.85), dehiscence (OR = 1.22; 95% CI = 0.32-4.64), and overall cosmetic result (standardized mean difference = 0.01; 95% CI = -0.19 to 0.20). Closure with strips resulted in significantly lower incidence of redness (OR = 0.57; 95% CI = 0.37-0.89). The available data on pain, need for resuturing, swelling, patient satisfaction, and closure time with the use of strips could not be synthesized; however, regarding the latter 2 outcomes, application of strips seemed favorable. There was significant heterogeneity among the studies. CONCLUSIONS: The findings suggest that adhesive strips may be an efficient closure material for certain small-length incisions. Further research is warranted on outcomes such as dehiscence and the need for resuturing.

Risk factors for mesh-related infections after hernia repair surgery: a meta-analysis of cohort studies.

Mesh infection, although infrequent, is a devastating complication of mesh hernioplasties. The aim of this study was to systematically review and synthesize the available evidence on risk factors for synthetic mesh infection after hernioplasty. A systematic search was performed in PubMed and Scopus databases. The extracted data were synthesized with the methodology of meta-analysis. We identified six eligible studies that reported on 2,418 mesh hernioplasties. The crude mesh infection rate was 5%. Statistically significant risk factors were smoking (risk ratio [RR] = 1.36 [95% confidence interval (CI): 1.07, 1.73]; 1,171 hernioplasties), American Society of Anesthesiologists (ASA) score ≥3 (RR = 1.40 [1.15, 1.70]; 1,682 hernioplasties), and emergency operation (RR = 2.46 [1.56, 3.91]; 1,561 hernioplasties). Also, mesh infections were significantly correlated with patient age (weighted mean difference [WMD] = 2.63 [0.22, 5.04]; 2,364 hernioplasties), ASA score (WMD = 0.23 [0.08, 0.38]; 1,682 hernioplasties), and the duration of the hernioplasty (WMD = 44.92 [25.66, 64.18]; 833 hernioplasties). A trend toward higher mesh infection rates was observed in obese patients (RR = 1.41 [0.94, 2.11]; 2,243 hernioplasties) and in patients operated on by a resident (in contrast to a consultant; RR = 1.18 [0.99, 1.40]; 982 hernioplasties). Mesh infections usually resulted in mesh removal, and common pathogens included Staphylococcus spp., Enterococcus spp., and gram-negative bacteria. Patient age, ASA score, smoking, and the duration and emergency setting of the operation were found to be associated with the development of synthetic mesh infection. The heterogeneity of the available evidence should be taken under consideration. Prospective studies with a meticulous follow-up are warranted to further investigate mesh-related infections.

Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials.

Surgical sutures are conventionally used in skin closure of surgical wounds. Alternative wound closure techniques include staples and adhesive strips. We aimed to evaluate sutures versus staples as methods of surgical wound closure by performing a meta-analysis. We searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials for randomized controlled trials that compared sutures with staples for surgical wound closure. Trials referring to orthopedic operations were excluded. Twenty studies (involving a total of 2111 patients) were included. Five studies referred to obstetrics/gynecological operations, seven to general surgery, four to emergency care treatment, three to head/neck operations, and one to vascular surgery. Regarding the time needed for wound closure, staples were superior to sutures; the mean difference observed between the sutures and staples groups was 5.56 minutes per wound (95% confidence intervals [CI], 0.05 to 11.07). Wound infections were significantly fewer in the staples group compared with the sutures group(s) (12 studies, 1529 patients; odds ratio, 2.06; 95% CI, 1.20 to 3.51). In five studies, the use of staples was associated with significantly more pain compared with sutures. The majority of studies with available relevant data reported nonsignificant differences regarding the cosmetic result and patient's satisfaction. Our findings suggest that staples are associated with fewer wound infections compared with sutures in the evaluated types of surgery. However, in a rather limited number of studies, the use of staples was associated with more pain. Further studies incorporating more objective methods for assessment cosmetic and patient satisfaction are required to clarify this issue.

Do psychological variables affect early surgical recovery?

BACKGROUND: Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery. METHODS: We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes. RESULTS: We identified 16 eligible studies, 15 of which reported a significant association between at least one psychological variable or intervention and an early postoperative outcome. However, most studies also reported psychological factors not influencing surgical recovery and there was significant heterogeneity across the studies. Overall, trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism, religiousness, anger control, low pain expectations, and external locus of control seemed to promote healing. Psychological interventions (guided relaxation, couple support visit, and psychiatric interview) also appeared to favor recovery. Psychological factors unrelated to surgical outcomes included loneliness, perceived social support, anger expression, and trait anger. CONCLUSION: Although the heterogeneity of the available evidence precludes any safe conclusions, psychological variables appear to be associated with early surgical recovery; this association could bear important implications for clinical practice. Large clinical trials and further analyses are needed to precisely evaluate the contribution of psychology in surgical recovery.

Biological mesh for abdominal wall hernia synthetic mesh multidrug-resistant Pseudomonas aeruginosa infection: report of a case.

The use of biological mesh for the treatment of synthetic mesh-related infections in patients who undergo ventral hernia repair has been considered over the past few years. Removal of the infected synthetic mesh, which may be required in such cases, can result in recurring herniation. Biological implants have thus been recently used for the reconstruction of the existing defect. We herein present the case of a patient who developed multidrug-resistant Pseudomonas aeruginosa synthetic mesh infection following hernia repair, which was managed by the removal of the material and the application of a biological mesh in the contaminated area.

Biological mesh in hernia repair, abdominal wall defects, and reconstruction and treatment of pelvic organ prolapse: a review of the clinical evidence.

The use of biological meshes seems to be an innovation that influences all surgical fields. The existing evidence indicates that biological meshes cannot only be applied on the area of hernia repair, but also on cases of abdominal reconstruction and pelvic organ prolapse treatment, especially in the presence of contaminated or potentially contaminated surgical fields. Low risks of graft rejection, complications, and infection seem to be the main advantages of biological meshes in comparison with the synthetic nonabsorbable ones. Nevertheless, the elevated costs suggest that biological mesh implantation should be evaluated in correlation to the needs of each clinical case.

Antimicrobial prophylaxis in surgery: an international survey.

BACKGROUND: We investigated current clinical practice of antimicrobial prophylaxis (AMP) in surgery. METHODS: Survey administration of AMP to patients without co-morbidity or allergy undergoing surgery, among surgeons indexed as corresponding authors for articles published in general surgery, orthopedics, gynecology, and cardiac surgery journals. RESULTS: A total of 1,068 surgeons answered (response rate 68%). Of these, 26.1% do not begin infusion of the first antimicrobial dose within 1 h of incision, as suggested by guidelines, and 27.2% continue administering AMP for two or more days after surgery, including 7.6% who continue for four to seven days, in contradiction to the guidelines. There were significant differences between Europe and North America in the selection of AMP regimens. Furthermore, 19% of Europeans order infusion of the first antimicrobial dose during the incision compared with 3.9% of North Americans; 74.2% of Europeans discontinue AMP within 24 h after surgery compared with 86% of North Americans. Finally, 31% of general surgeons in North America administer supplementary oral prophylaxis for colectomy compared with only 5% of European surgeons. CONCLUSIONS: The AMP strategies in day-to-day self-reported practice differ significantly. Uniform, evidence-based practice is warranted, especially in this era of increasing antimicrobial resistance.

Chronic bacterial and parasitic infections and cancer: a review.

BACKGROUND: A relatively underestimated facet of infectious diseases is the association of chronic bacterial and parasitic infections with cancer development. Therefore, we sought to evaluate the evidence regarding the association of such infections with the development of malignancy, excluding the overwhelming evidence of the association of Helicobacter pylori and cancer. METHODOLOGY: We searched Pubmed, Cochrane, and Scopus without time limits for relevant articles. RESULTS: There is evidence that some bacterial and parasitic infections are associated with cancer development. The level of evidence of this association varies from high to low; in any case, a long time interval is mandatory for the development of cancer. A high level of evidence exists for the association of Salmonella Typhi with gallbladder and hepatobiliary carcinoma; Opisthorchis viverrini and Clonorchis sinensis with cholangiocarcinoma; Schistosoma hematobium with bladder cancer; chronic osteomyelitis with squamous cell carcinoma of the skin; and hidradenitis suppurativa with squamous cell carcinoma of the skin. In contrast, the level of evidence regarding the association of Chlamydia spp. with cancer is low. Mycobacterium tuberculosis is associated with lung cancer, albeit probably not etiopathogenetically. CONCLUSIONS: A considerable number of bacterial infections and parasitic infections are associated with the development of cancer. Further research into recognizing additional associations of bacterial and parasitic infections with cancer is mandatory.

Patients included in randomised controlled trials do not represent those seen in clinical practice: focus on antimicrobial agents.

Clinicians rely on the findings of randomised controlled trials (RCTs) to formulate clinical decisions regarding individual patients. We examined whether patients included in RCTs focusing on antimicrobial agents are representative of those encountered in real-life clinical situations. PubMed was searched for RCTs referring to the field of infectious diseases. Data regarding the exclusion criteria of the identified RCTs were extracted and critically evaluated. In total, 30 trials (17 referring to respiratory tract, 5 to skin and soft-tissue, 4 to intra-abdominal, 2 to gynaecological and 2 to bloodstream infections) were included in the study. All retrieved RCTs reported extensive exclusion criteria. After comparing in a qualitative manner (based on our clinical experience) the eligible patient population in the identified RCTs with the respective population that would be encountered in general practice, it was observed that the abovementioned patient populations differ considerably. In conclusion, RCTs in the field of infectious diseases use extensive and stringent exclusion criteria, a fact that may lead to considerable difference between the patient populations of RCTs and those viewed in clinical practice. The application of the findings of RCTs to the care of individual patients should be performed cautiously.

Daptomycin versus other antimicrobial agents for the treatment of skin and soft tissue infections: a meta-analysis.

BACKGROUND: Skin and soft tissue infections (SSTIs) are common in everyday clinical practice. Daptomycin has been shown to achieve very good concentrations in skin and soft tissues. OBJECTIVE: To compare the effectiveness and toxicity of daptomycin with that of other antimicrobials for the treatment of SSTIs. METHODS: PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles published up to March 2009. Comparative studies in which daptomycin was used in the intervention group were included in this meta-analysis. The primary outcome of interest was clinical success; secondary outcomes were microbiologic success, clinical success in subsets with complicated SSTIs (cSSTIs) or infections due to methicillin-resistant Staphylococcus aureus (MRSA), clinical success of daptomycin-versus vancomycin-treated patients, time to clinical cure, treatment-related adverse events, withdrawal from treatment due to toxicity, all-cause mortality, and development of resistance. RESULTS: Four studies were included in the analysis (3 were randomized controlled trials [RCTs]). Vancomycin and semisynthetic penicillins were used in the comparator arm. Three studies reported on patients with cSSTIs. The intention-to-treat (ITT) population was 1557 patients. No statistically significant difference between daptomycin and comparators was found regarding clinical success in clinically evaluable (OR 0.89; 95% CI 0.63 to 1.25 in the 3 RCTs and OR 1.34; 95% CI 0.38 to 4.66 with all 4 studies included), ITT, MRSA-infected patients, and those with cSSTIs. Two studies reported that significantly fewer patients with cSSTIs required prolonged treatment in the daptomycin arm and that clinical cure was faster than with comparators. No difference between the compared regimens was found in other outcomes. CONCLUSIONS: Daptomycin is effective and safe for the treatment of SSTIs. Studies evaluating the optimal duration of daptomycin therapy for cSSTIs, comparing daptomycin with new agents, and focusing on proven MRSA SSTIs will be helpful for the further evaluation of the drug.

Patients' perception of quality of pre-operative informed consent in athens, Greece: a pilot study.

BACKGROUND: We sought to perform a study to record and evaluate patients' views of the way surgeons communicate informed consent (IC) in Greece. METHODOLOGY/PRINCIPAL FINDINGS: A prospective pilot study was carried out in Athens from 9/2007 to 4/2008. The study sample was extracted from patients, operated by eight different surgeons, who volunteered to fill in a post-surgery self-report questionnaire on IC. A composite delivered information index and a patient-physician relationship index were constructed for the purposes of the analysis. In total, 77 patients (42 males) volunteered to respond to the questionnaire. The delivered information index scores ranged from 3 to 10, the mean score was 8, and the standard deviation (SD) was 1.9. All patients were aware of their underlying diagnosis and reason for surgery. However, a considerable proportion of the respondents (14.3%) achieved a score below or equal to 5. The patient-physician relationship scores ranged from 0 to 20, the mean score was 16 and the standard deviation (SD) was 4.3. The better the patient-physician relationship, the more information was finally delivered to the patient from the physician (Spearman's rank-order correlation coefficient was 0.4 and p<0.001). Delivered information index was significantly higher among participants who comprehended the right to informed consent, compared to participants who did not (p<0.001), and among participants who were given information regarding other possible therapeutic options (p = 0.001). 43% of the respondents answered that less than 10 minutes were spent on the consent process, 58.4% of patients stated that they had not been informed about other possible therapeutic choices and 28.6% did not really comprehend their legal rights to IC. CONCLUSIONS: Despite the inherent limitations and the small sample size that do not permit to draw any firm conclusions, results indicate that a successful IC process may be associated with specific elements such as the patient-physician relationship, the time spent by the physician to inform the patient, a participant's comprehension of the right to IC and the provision of information regarding other possible therapeutic options.

Informed consent: how much and what do patients understand?

OBJECTIVE: We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research. METHODS: We conducted a systematic search of PubMed (1961-2006) to identify relevant articles. RESULTS: We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research. CONCLUSIONS: Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.

Seasonality of mortality: the September phenomenon in Mediterranean countries.

BACKGROUND: Seasonal increases in the mortality rate have been associated with excessively cold or hot weather. We evaluated monthly patterns of mortality in selected countries. METHODS: We analyzed all-cause mortality statistics from 5 European Mediterranean countries (Cyprus, France, Greece, Italy, Spain), Sweden, North America (United States and Canada), Australia, New Zealand and Japan. We extracted and tabulated data on monthly all-cause mortality in the general population from the earliest to the latest year that records were available. RESULTS: We identified relevant data for a period of 2-57 years in each country. In the Mediterranean countries, the lowest average daily mortality was observed in September (all countries, 125/168 [74%] years). The fewest deaths were in August in Sweden (14/20 [70%] years) and North America (32/50 [64%] years). The fewest deaths in Japan occurred in July (2/2 [100%] years). In the southern hemisphere, the lowest mortality in Australia occurred in March (7/10 [70%] years) and in February for New Zealand (cumulative over 24 years). INTERPRETATION: Mortality in the general population declines in the late summer to early fall months in the countries evaluated. Environmental parameters may partly account for these associations, and further research is needed on the contribution of additional factors such as summer vacations.

Do changes in antimicrobial resistance necessitate reconsideration of surgical antimicrobial prophylaxis strategies?

BACKGROUND: The potential need for re-evaluation of guidelines on surgical antimicrobial prophylaxis (AMP) in an era of advancing antimicrobial resistance is a matter of a considerable controversy. METHOD: Review of the pertinent literature. RESULTS: Over the last decade, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has increased significantly, as illustrated by several surveillance studies. The blending of community acquisition and long-term carriage may increase the probability of unrecognized MRSA carriers being admitted to the hospital. Thus, MRSA is considered a major epidemiological threat in most parts of the world, exerting pressure for reconsideration of the guidelines for surgical AMP. The use of a glycopeptide as first-choice prophylaxis in major procedures such as cardiac surgery generally is not recommended but is not ruled out. Current recommendations are based on trials performed almost a decade ago at the latest and do not reflect the contemporary epidemiology of resistance. A few recent studies suggested that vancomycin in combination with gentamicin and rifampicin reduces the incidence of surgical site infections significantly in high-risk patients. These developments led some surgeons and infectious diseases clinicians to consider advanced antimicrobial coverage in surgical AMP. On the other hand, other clinicians are rightfully skeptical about extensive administration of glycopeptides or other agents beyond first- or second-generation cephalosporins because of the risk of further emergence and dissemination of antimicrobial resistance. CONCLUSION: Properly designed randomized trials are needed urgently to determine whether standard perioperative AMP should be reconsidered in settings with changing etiology of surgical infections.

Comparison of adverse events between oral and intravenous formulations of antimicrobial agents: a systematic review of the evidence from randomized trials.

BACKGROUND: Some clinicians may favor a strategy of early switch to oral antimicrobial therapy for patients responding to initial intravenous therapy. An important relevant consideration refers to the comparative safety and tolerability between oral and intravenous antimicrobial therapy. LITERATURE SEARCH/STUDY SELECTION: We sought to evaluate the above-mentioned issue by performing a systematic review of randomized studies comparing the occurrence of adverse events between oral and intravenous antimicrobial therapy with the same agents. FINDINGS: Ten relevant studies (five randomized controlled trials, three randomized cross-over studies, and two randomized, placebo-controlled, parallel-design studies) were included. Seven of the studies evaluated antibacterials (fluoroquinolones in four, and telithromycin, amoxicillin-clavulanic acid, and linezolid in one study each, respectively), whereas two studies evaluated ganciclovir, and one evaluated isavuconazole. No difference was observed in the rate of total adverse events between oral and intravenous administration of the same antimicrobial agents in any of the included studies that reported specific relevant data. Injection site reactions were noted more frequently with intravenous treatment in one study. No serious drug-related adverse events were reported, while study withdrawals due to adverse events did not considerably differ between the compared groups in any of the included studies. CONCLUSION: There are only limited comparative data regarding the adverse events associated with the administration of the same antimicrobial agents by the oral and intravenous route. Our review indicates that the adverse event profile of oral and intravenous antimicrobial therapy does not differ considerably; however, this issue requires validation by further studies.

Meta-analysis on surgical infections.

Meta-analysis on surgical infections may be a useful tool that can provide more accurate outcome estimates than other conventional types of studies. Published meta-analyses in surgical infections tend to focus mainly on the use of antimicrobial prophylaxis and on the comparison of different procedures or techniques for the treatment of surgical infections. The majority concern surgical infections in abdominal surgery. However, mortality is reported as primary outcome in few meta-analyses. Meta-analyses focusing exclusively on surgical infections, reporting data on mortality as a primary outcome, and comparing different antibiotic regimens for the treatment of surgical infections should be conducted.