[Utility of topical vancomycin application in the prevention of surgical site infection of the lumbosacral spine]. / Utilidad de la aplicación de vancomicina tópica en la prevención de infección de sitio quirúrgico de la columna lumbosacra.

INTRODUCTION: surgical site infections (SSI) remain a significant cause of morbidity and mortality and one of the most representative causes of nosocomial infections. The use of intrawound vancomycin in lumbar spine surgery is a potential prophylactic measure against SSI; however, evidence regarding its efficacy is contradictory. Our study was designed to research if intrawound vancomycin significantly prevents SSI in lumbar spine surgery. MATERIAL AND METHODS: this is a randomized, double-blinded, controlled clinical trial; 233 patients who underwent lumbar spine surgery, were randomly assigned to a group in which intrawound vancomycin was instilled in the incision before closure (109), or to a control group (114). The main outcome is the presence of SSI; we determined its prevalence and searched for difference between groups for association between SSI and independent variables. RESULTS: global SSI prevalence was 1.8%, in the experimental group was 0.9%, in the control group was 2.6%. There was no significant difference between these values, p = 0.622. The relative risk of SSI in the experimental group was 0.35 (95% CI 0.037-3.30), that of the control group was 2.87 (95% CI 0.30-27.16). The number needed to treat is 58.3. We did not find a significant association between the independent variables studied and the appearance of SSI. CONCLUSIONS: we did not find a significant difference in the prevalence of SSI between groups nor a significant association between SSI and independent variables.

INTRODUCCIÓN: las infecciones postoperatorias del sitio quirúrgico son una importante causa de morbimortalidad y una de las formas más comunes de infecciones nosocomiales. La aplicación de vancomicina al terminar una intervención de columna lumbar es una potencial práctica profiláctica de infecciones del sitio quirúrgico (ISQ). La evidencia que sostiene su uso es controversial. Nuestro estudio investiga si la aplicación de vancomicina disminuye en forma significativa la prevalencia de ISQ. MATERIAL Y MÉTODOS: ensayo clínico aleatorizado, controlado, cegado; 223 pacientes intervenidos de la columna lumbar fueron aleatoriamente asignados a un grupo experimental de 109 pacientes en quienes se colocó vancomicina y a un grupo control de 114 pacientes que no recibió vancomicina. El principal desenlace del estudio es la aparición de ISQ; se estudió la prevalencia de ISQ en ambos grupos y se buscó si existe diferencia significativa. Se analizó la existencia de factores predictores de ISQ. RESULTADOS: la prevalencia global de infección fue 1.8%; en el grupo experimenta 0.09% y en el grupo control 2.6%. No hubo diferencia significativa entre estas cifras, p = 0.622. El riesgo relativo de ISQ en el grupo experimental fue 0.35 (IC95% 0.037-3.30), el del grupo control fue 2.87 (IC95% 0.30-27.16). El número necesario para tratar es 58.3. No encontramos asociación significativa entre las variables independientes estudiadas y la aparición de ISQ. CONCLUSIONES: no encontramos evidencia suficiente de que la aplicación de vancomicina disminuya significativamente la prevalencia de ISQ ni asociación significativa de ISQ con las variables independientes estudiadas.

Lipase and Protease Production Ability of Multi-drug Resistant Bacteria Worsens the Outcomes of Wound Infections.

BACKGROUND: Surgical site infections are one of the major clinical problems in surgical departments that cost hundreds of millions of dollars to healthcare systems around the world. AIM: The study aimed to address the pressing issue of surgical site infections, which pose significant clinical and financial burdens on healthcare systems globally. Recognizing the substantial costs incurred due to these infections, the research has focused on understanding the role of lipase and protease production by multi-drug resistant bacteria isolated from surgical wounds in the development of post-surgical wound infections. METHODS: For these purposes, 153 pus specimens were collected from patients with severe post-surgical wound infections having prolonged hospital stays. The specimens were inoculated on appropriate culture media. Gram staining and biochemical tests were used for the identification of bacterial growth on suitable culture media after 24 hours of incubation. The isolated pathogens were then applied for lipase and protease, key enzymes that could contribute to wound development, on tributyrin and skimmed milk agar, respectively. Following the CSLI guidelines, the Kirby-Bauer disc diffusion method was used to assess antibiotic susceptibility patterns. The results revealed that a significant proportion of the samples (127 out of 153) showed bacterial growth of Gram-negative (n = 66) and Gram-positive (n = 61) bacteria. In total, isolated 37 subjects were declared MDR due to their resistance to three or more than three antimicrobial agents. The most prevalent bacteria were Staphylococcus aureus (29.13%), followed by S. epidermidis (18.89%), Klebsiella pneumoniae (18.89%), Escherichia coli (14.96%), Pseudomonas aeruginosa (10.23%), and Proteus mirabilis (7.87%). Moreover, a considerable number of these bacteria exhibited lipase and protease activity with 70 bacterial strains as lipase positive on tributyrin agar, whereas 74 bacteria showed protease activity on skimmed milk agar with P. aeruginosa as the highest lipase (69.23%) and protease (76.92%) producer, followed by S. aureus (lipase 62.16% and protease 70.27%). RESULTS: The antimicrobial resistance was evaluated among enzyme producers and non-producers and it was found that the lipase and protease-producing bacteria revealed higher resistance to selected antibiotics than non-producers. Notably, fosfomycin and carbapenem were identified as effective antibiotics against the isolated bacterial strains. However, gram-positive bacteria displayed high resistance to lincomycin and clindamycin, while gram-negative bacteria were more resistant to cefuroxime and gentamicin. CONCLUSION: In conclusion, the findings suggest that lipases and proteases produced by bacteria could contribute to drug resistance and act as virulence factors in the development of surgical site infections. Understanding the role of these enzymes may inform strategies for preventing and managing post-surgical wound infections more effectively.

The Impact of the COVID-19 Pandemic in Postoperative Neurosurgical Infections at a Reference Center in México.

The COVID-19 pandemic has had a major global impact on the treatment of hospitalized surgical patients. Our study retrospectively evaluates the impact of the COVID-19 pandemic at a neurosurgical reference center in Mexico City. We compared the number of neurosurgeries, the rate and type of postoperative infections, the causative microorganisms and in-hospital mortality rates in a 4-year period, from the pre-pandemic year 2019 until 2022. A total of 4150 neurosurgical procedures were registered. In 2020 the total number of surgeries was reduced by 36% compared to 2019 OR = 0.689 (95% CI 0.566-0.834) p ≤ 0.001, transnasal/trans sphenoidal pituitary resections decreased by 53%, and spinal surgeries by 52%. The rate of neurosurgical infections increased from 3.5% in 2019 to 5.6% in 2020 (p = 0.002). Regarding the microorganisms that caused infections, gram positive cocci accounted for 43.5% of isolates, Klebsiella spp. and Pseudomonas spp. caused one third of the infections. No significant differences were found for in-hospital mortality nor patterns of resistance to antibiotics. The number of surgeries increased in the last two years, although the infection rate has returned to pre-pandemic levels. We observed a lower impact from subsequent waves of COVID-19 and despite an increase in the number of surgeries, the surgeries have not amounted to the full pre-pandemic levels.

Compliance with Antibiotic Prophylaxis in Obstetric and Gynecological Surgeries in Two Peruvian Hospitals.

INTRODUCTION: Surgical site infections (SSI) can be as high in gynecology and obstetrics surgeries compared to other areas. Antimicrobial prophylaxis is an effective tool in the prevention of SSIs; however, it is often not adequately administered, so this study aimed to understand the compliance and factors associated with the use of the clinical practice guidelines for antibiotic prophylaxis in gynecological surgeries in two hospitals in the city of Huanuco, Peru. METHODS: An analytical cross-sectional study of all gynecologic surgeries performed during 2019 was performed. Compliance was determined based on the antibiotic chosen, dose, administration time, redosing, and prophylaxis duration. Age, hospital of origin, presence of comorbidities, surgery performed, as well as its duration, types of surgery, and anesthesia were considered as related factors. RESULTS: We collected 529 medical records of patients undergoing gynecological surgery with a median age of 33 years. The prophylactic antibiotic was correctly indicated in 55.5% of cases, and the dose was correct in 31.2%. Total compliance with the five variables evaluated was only 3.9%. Cefazolin was the most commonly used antibiotic. CONCLUSION: Low compliance with the institutional clinical practice guidelines for antibiotic prophylaxis was identified, showing that antimicrobial prophylaxis in the hospitals studied was inadequate.

Cierre primario diferido en pacientes laparotomizados de emergencia con índice SENIC ≥ 3 puntos / Deferred primary closure in emergency laparotomized patients with SENIC index ≥ 3 points

Las infecciones del sitio operatorio representan un desafío en el entorno hospitalario. El cierre primario diferido ha surgido como técnica para prevenirlas. Esta investigación busca explorar los beneficios del cierre primario diferido en la reducción de infecciones, estancia hospitalaria y costos, mejorando los resultados clínicos en cirugías abdominales. Objetivos. Evaluar el cierre primario diferido en pacientes laparotomizados de emergencia que acuden Hospital Universitario de Mérida ­Venezuela, con índice SENIC ≥ 3 puntos. Métodos. Se llevó a cabo un estudio experimental prospectivo para evaluar los efectos del cierre primario diferido en comparación con el cierre primario en laparotomías exploradoras. La muestra consistió en 160 pacientes. Se analizaron la presencia de infecciones, la duración de la estancia hospitalaria y la evolución temporal de las infecciones como desenlaces del estudio. Resultados. Se encontró que el cierre primario diferido redujo la presencia de infecciones en comparación con el cierre primario. La limpieza trans-operatoria y el diagnóstico de abdomen agudo quirúrgico infeccioso fueron factores beneficiosos. La antibioticoterapia continua en el postoperatorio también fue más efectiva. Se observó una disminución del riesgo de infección en el grupo experimental en un 37% en comparación con el grupo de control. Conclusiones. El cierre primario diferido de la herida reduce significativamente la probabilidad de infección del sitio operatorio en cirugías abdominales con heridas contaminadas. Es una técnica beneficiosa para pacientes con abdomen agudo quirúrgico infeccioso. Además, el cierre primario diferido resulta rentable al disminuir tanto la incidencia de ISO como la duración de la estancia hospitalaria

Surgical site infections pose a challenge in the hospital setting. Delayed primary closure has emerged as a technique to prevent such infections. This research aims to explore the benefits of delayed primary closure in reducing infections, hospital stay, and costs, thus improving clinical outcomes in abdominal surgeries. Objectives. To evaluate delayed primary closure in emergency laparotomized patients with SENIC index ≥ 3 points at the University Hospital of Mérida, Venezuela. Methods. A prospective experimental study was conducted to assess the effects of delayed primary closure compared to primary closure in exploratory laparotomies. The sample consisted of 160 patients. The presence of infections, duration of hospital stay, and temporal evolution of infections were analyzed as study outcomes. Results. Delayed primary closure was found to reduce the presence of infections compared to primary closure. Transoperative cleaning and the diagnosis of infectious surgical acute abdomen were beneficial factors. Continuous postoperative antibiotic therapy was also more effective. A 37% reduction in the risk of infection was observed in the experimental group compared to the control group. Conclusions. Delayed primary closure significantly reduces the probability of surgical site infection in abdominal surgeries with contaminated wounds. It is a beneficial technique for patients with infectious surgical acute abdomen. Additionally, delayed primary closure proves cost-effective by reducing both the incidence of surgical site infections and the duration of hospital stay(AU)

Infecciones del sitio quirúrgico en un hospital de enseñanza. Estudio observacional / Surgical site infections in a teaching hospital. Observacional study

Objetivo: determinar el número de pacientes que desarrollaron una infección postquirúrgica, posibles agentes etiológicos y complicaciones.Métodos : se realizó un estudio retrospectivo observacional que incluye a todos los supervivientes de las cirugías electivas y de emergencia de los servicios de Cirugía I, II y III del Hospital Universitario de Caracas durante el año 2019. Los datos fueron recopilados a través de la revisión de historias médicas. 48 historias cumplieron los criterios de inclusión, en estas se analizaron distintas variables como: días de hospitalización, síntomas, resultados de laboratorio, cultivos microbiológicos y tratamientos. A partir de estas se elaboraron tablas de frecuencia y análisis bivariado (Chi-cuadrado de Pearson) con el programa IBM SPSS Statistics 26.Resultados : la prevalencia de las infecciones postoperatorias fue de 4,69% CI 95% = (2,79-7,16%) en los servicios de Cirugía (I, II y III) del hospital durante el año 2019, la mayoría ocurrieron tras cirugías de emergencia (87,50%) tales como: apendicectomías (45,83%) y colecistectomías (10,41%). Solo al 22,91% de estos pacientes se les realizó cultivo microbiológico donde se encontró:E. coli (10,50%), Enterococcus sp. y Klebsiella pneumoniae (6,24%), Morganella morganii (2,1%) y Streptococcus pneumoniae (2,1%). Conclusión : las infecciones del sitio quirúrgico siguen siendo una de las principales causas de morbi-mortalidad y aumento de la estadía hospitalaria en los servicios de cirugía, son de diversa etiología bacteriana y están mayormente asociadas a cirugías abdominales, de emergencia(AU)

Objective: to determine the number of patients that developed a surgical site infection (SSI), possible etiologic agents and complications.Methods : an observational and retrospective study that includes every patient that underwent and survived a surgical procedure at the general surgery I, II and III services at the University Hospital of Caracas between January and December 2019. The study data were collected through the review of the medical records. 48 medical records that met the inclusion criteria and different variables were analyzed, including: days of hospitalization, symptoms, laboratory results, microbiological cultures and treatments. From those variables, frequency tables and bivariate analysis (Pearson's Chi-Square) were created with the IBM SPSS Statistics 26 program.Results : the SSI prevalence was 4,69% CI 95%= (2,79-7,16%) including the three surgery services (I, II and III) at the University Hospital of Caracas during 2019. Most of these occurred after emergency surgeries (87,50%) among which stand out: appendectomy (45,83%) and cholecystectomies (10,41%). Microbiological cultures were performed only in 22,91% of these patients and the following bacteria were isolated:E. coli (10,50%), Enterococcus sp. plus Klebsiella pneumoniae (6,24%), Morganella morganii (2,1%) and Streptococcus pneumoniae (2,1%). Conclusion : Surgical Site Infection (SSI) continues to be one of the main causes of morbimortality and increased hospital stay in surgical services in the hospital. These infections have a diverse bacterial etiology and are mostly associated with abdominal or emergency surgeries(AU)

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

BACKGROUND: Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. METHODS: A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. RESULTS: The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. CONCLUSIONS: Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

Impacto del uso de anillos y uñas esmaltadas en la calidad de la higiene de manos en el personal de salud / Impact of the use of rings and nail polish on hand hygiene quality in healthcare workers

Resumen Introducción: Las infecciones asociadas a la atención de salud son un problema frecuente en el ambiente hospitalario. La higiene de manos es la medida más efectiva para su prevención. El uso de ciertos accesorios en las manos podría disminuir su efectividad y favorecer la transmisión horizontal de agentes infecciosos. Objetivo: Revisar los estudios publicados que evalúan el impacto del uso de anillos y uñas esmaltadas en la calidad de la higiene de manos en trabajadores de la salud. Métodos: Búsqueda no sistemática en base de datos PUBMED/MEDLINE (1978-2018) de estudios en los cuales se mide la calidad de la higiene de manos o lavado quirúrgico, mediante cultivos cuantitativos o tinciones fluorescentes. Resultados: Uso de anillos: Trece de 51 artículos cumplían los criterios de inclusión. Siete fueron realizados en unidades clínicas, y en todos ellos éste se asoció a menor calidad de la higiene de manos (la mayoría de baja calidad). Contrariamente, en tres de cuatro estudios primarios realizados en pabellón (de baja calidad), su uso no impactó en la calidad del lavado quirúrgico. Igualmente, dos revisiones sistemáticas obtuvieron similares conclusiones. Uñas esmaltadas: siete de 54 artículos fueron incluidos. En cuatro hubo resultados discordantes (la mayoría de baja calidad). En un estudio controlado se observó reducción en la calidad del lavado quirúrgico sólo cuando el esmalte estaba dañado. El esmalte gel se asoció a menor calidad de la higiene de manos en dos estudios experimentales. Conclusiones: No existe evidencia de calidad suficiente para asociar el uso de estos accesorios con reducción en la calidad de la higiene de manos. Tampoco queda demostrada su inocuidad. En base a la evidencia disponible (la mayoría de baja calidad), se observó un impacto negativo del uso de anillos en unidades clínicas y también de uñas con esmalte dañado en pabellones quirúrgicos. Se requieren estudios de mejor calidad para abordar estos relevantes tópicos.

Abstract Background: Health-care-associated infections are a frequent problem in hospital environments. Hand hygiene is the most effective measure to prevent outbreaks. The use of certain accessories could decrease its effectiveness, facilitating horizontal transmission of pathogens. Objective: Analyze the evidence that assess the impact of the use of rings and nail polish on hand hygiene quality in healthcare workers. Methods: Non-systematic search in PUBMED/MEDLINE database (1978-2018) of studies in which the quality of hand hygiene or surgical washing is measured, using quantitative cultures or fluorescent stains. Results: Wearing rings: 13 studies met the inclusion criteria. Seven were carried out in general wards. In all of them the use of rings was associated with lower quality of hand hygiene (the majority of low quality). Contrarily, in 3 of 4 primary studies carried out in the operating rooms (of low quality), their use did not affect the quality of surgical washing. Similarly, two systematic reviews obtained similar conclusions. Nail polish: 7 of 54 studies met the inclusion criteria. In four of them there were discordant results (the majority of low quality). One RCT showed a reduction in the quality of surgical washing only when the nail polish was damaged. Gel nail polish was associated with lower quality in two experimental studies. Conclusions: There is insufficient evidence to associate the use of these accessories with the reduction in the quality of hand hygiene. Its safety was not proven neither. Based on the available evidence (the majority of low quality), a negative impact of the use of rings in clinical units and also of damaged nail polish in operating rooms was observed. Better quality studies are required to address these relevant issues.

Impact of weather on the risk of surgical site infections in a tropical area.

We studied the impact of average daily temperature and relative humidity on the risk of surgical site infections in 36,429 surgeries performed in a hospital in inner Brazil. Adjusted Poisson regression models found an association between surgical site infections and temperature (rate ratio [RR], 1.013; 95% confidence interval [CI], 1.001-1.025). The effect was concentrated on clean wound procedures and was greater over the 75th (RR, 1.109; 95% CI, 1.015-1.212) and 90th (RR, 1.196; 95% CI, 1.055-1.355) percentiles of daily temperature.

Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance. .