Analysis of the incidence of surgical site infections after open reposition of long bone fractures and closed fracture settings in a 7-year follow-up in an orthopedic and trauma ward in southern Poland.

INTRODUCTION: Surgical Site Infection (SSI) is the most common clinical form of Healthcare-Associated Infections (HAI) in orthopedic and trauma wards. MATERIAL AND METHOD: A retrospective study was conducted at the Department of Orthopedics and Trauma Surgery in Tarnów in 2012-2018. 3 155 patients treated for bone fractures were analyzed, including 1961 Open Reduction of Fracture (FX) and 1 194 Closed Reduction of Fracture with Internal Fixation (CR) surgeries. The study was conducted in accordance with the methodology recommended by the Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). The aim of the study was to assess the incidence of SSI in patients undergoing the FX and CR procedures. RESULTS: 28 SSIs were identified in the examined ward; 16 SSI cases related to the FX procedure and 12 cases related to CR. The incidence for FX was 0.8% and for CR 1%. In patients with diagnosed SSI, the stay in the ward was longer (p <0.001) than in patients without SSI. In FX operations, the standardized risk index (SIR) did not exceed the value of one. Staphylococcus aureus was the most common organism isolated from materials from patients with SSI. CONCLUSIONS: In the examined period, the median age of women was higher than that of men, which may indicate a higher incidence of fractures in women. Patients with diagnosed SSI had a longer stay in the ward than patients without SSI. The incidence of SSI in FX and CR has been reduced compared to previous studies in the same ward.

Long-Term Antibiotic Prophylaxis in Urology and High Incidence of Clostridioides difficile Infections in Surgical Adult Patients.

Clostridioides difficile infections are the main cause of antibiotic-related diarrhea. Most of them come in the form of healthcare-associated Clostridioides difficile infections (HA-CDI). The aim of the study was to analyze HA-CDI epidemiology and the relationship between antibiotic consumption and CDI epidemiology at St Luke's Provincial Hospital in Tarnow, Poland. In 2012-2018, surveillance of CDI was carried out in adult surgical wards at St Luke's Provincial Hospital. The data were collected in accordance with the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC), and the ATC/DDD system (Anatomical Therapeutic Chemical Classification System) of the World Health Organization. In total, in the study period, 51 cases of CDI involved CA-CDI (24.5%) and 147 were HA-CDIs (75.5%). The most CA-CDIs were found in the general surgery (32.6%) and urology (17.0%) wards. CA-CDI incidence was 0.7/1000 patients and for HA-CDI it was 2/1000 patients (4.4/10,000 patientdays (pds)). The highest HA-CDI incidence was in the neurosurgical departments (18/10,000 pds) and oncological surgery (8.4/10,000) pds. There was a significant positive correlation between CA-CDI and HA-CDI (correlation of 0.943, p < 0.001) and between the number of patients hospitalized and HA-CDI (correlation of 0.865, p = 0.012). The total antibiotic consumption amounted to 0.7 DDD/10,000 pds; it was the highest in the urology ward (0.84/10,000 pds) and 49.5% of the antibiotics were fluoroquinolones (0.41/10,000 pds). On the basis of regression coefficients, a positive correlation was demonstrated between the use of fluoroquinolones and the HA-CDI incidence rate. Both a high percentage of CDI cases and a high intake of antibiotics were recorded in the urology department. About half of all antibiotics were fluoroquinolones.

Epidemiology of Surgical Site Infections Considering the NHSN Standardized Infection Ratio in Hip and Knee Arthroplasties.

Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. MATERIAL AND METHODS: The study was conducted in 2012-2018 in a Trauma and Orthopedics Ward in Tarnów according to the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). RESULTS: The surveillance comprised 2340 surgery patients, including: 1756 Hip Arthroplasties (HPRO) and 584 Knee Arthroplasties (KPRO). In the group of patients under study, 37 cases of SSI were detected, including: 26 cases of SSI after HPRO and 11 cases in KPRO. The average incidence of SSI amounted to 1.6% (1.5% HPRO and 1.9% KPRO) and in-hospital incidence density rates were 1.23 and 1.53 per 1000 patient-days, respectively. Median age of surgical patients in both HPRO and KPRO was 70 years. Women were undergoing arthroplasty surgery more often than men, HPRO (p < 0.05) and KPRO (p < 0.001). Patients with SSI stayed in the ward longer (SSI-HPRO, p < 0.001) (SSI-KPRO p < 0.01). In KPRO operations, the incidence of SSI was higher than expected, calculated according to the Standardized Infection Ratio (SIR). The most common etiologic agents isolated from SSIs in both HPRO and KPRO were coagulase-negative staphylococci. CONCLUSIONS: Establishing a thorough surveillance of hospital-acquired infections that takes into consideration epidemiological indicators is indispensable to properly assess the epidemiological situation in the ward. The optimal solution is to carry out long-term and multi-center surveillance in the framework of a uniform program, however, even results of single-center studies provide valuable data indicating challenges and needs in improving patient safety.

Comparison of Radiographic Outcomes of Surgical Treatment in Patients with Distal Radial Fractures.

BACKGROUND: Unstable and comminuted distal radial fractures require surgical treatment by percutaneous insertion of Kirschner wires, open reduction, and fixation with a non-locking or locking plate or with an external device. Choosing a surgical method that produces "better" outcomes may help select the most efficient treatment method. MATERIAL AND METHODS: The study group included 100 patients after surgical treatment by closed reduction and simple fixation with Kirschner wires and by open reduction and LCP locking plate fixation. Radiographic assessment was based on images obtained before the surgery, immediately after fracture reduction, and at 6 weeks, 6 months, and 12 months after the procedure. RESULTS: A comparison of the volar tilt angle in patients after fixation with Kirschner wires and LCP plates did not show any statistically significant differences before the surgery or at 6 weeks. A difference in the outcomes was found at 6 and 12 months and it turned out to be highly statistically significant. A comparison of the inclination angle and radial height in patients after Kirschner wire and LCP plate fixation showed statistically significant differences at 6 weeks, 6 months, and 12 months. A comparison of the radiographic outcomes using the Sarmiento classification in patients after Kirschner wire and LCP plate fixation revealed statistically significant differences at all follow-up time points. CONCLUSIONS: 1. The radiographic parameters were superior in patients treated by open reduction and LCP plate fixation. 2. The difference was seen with regard to all the parameters studied.

[The use of SPACER in the surgical treatment of periendoprosthetic hip infections--own experience]. / Zastosowanie "Spacera gotowego" w leczeniu infekcji okoloprotezowych stawu biodrowego--doswiadczenie wlasne.

The work presents the results of the treatment of 6 patients with periendoprosthetic hip infection with the use of the spacer in the Orthopaetic-Traumatic Ward between 01. 09. 2010 and 31. 12. 2013. Each case of infection was treated in two stages. In the first stage, the primary endoprothesis and inflammatory site were removed, and SPACER was implanted. In the second stage, after subsidence of clinical and laboratory symptoms of infection, the surgery was performed involving exchange of the SPACER to a revisory endoprothesis . All the patients were administered Vancomicine intravenously from the day of surgery until the results of bacterial culture were obtained. Then the antibiotic was given intravenously according to the antibiogram for 10 days; in case of negative culture, the therapy with Vancmicinewas continued for 10 days. This was followed by the administration of an oral antibiotic according to antibiogram for 6 weeks, and in case of negative culture, Biseptol 2 x 960 mg was given also for 6 weeks. The second stage of the procedure was carried out between the third and sixth month after the first surgery. In 5 patients inflammatory condition subsided, and a functional result was assessed by the patients as good. In one case inflammation did not heal and the patient remains with "hanging hip"; the result of the treatment was assessed as bad.

Surgical site infections in patients of orthopedic - trauma unit in district hospital in 2008-2012.

THE PURPOSE OF THE STUDY: The purpose of this study was to evaluate the prevalence and structure of surgical site infections in the Department of Orthopaedis - Trauma Unit in Regional Hospital. St. Luke in Tarnow in 2008-2012. MATERIALS AND METHODS: Data analysis included 7189 patients operated in 2008-2012. The data collection and analysis used standard statistical tools and definitions for nosocomial infections issued by the U.S. Centers for Disease Control and Prevention (CDC). RESULTS: In the study group it was 91 cases of SSI (surgical site infection), including 35 patients (38%) with post-operative open reduction of long bone fracture (FX), 16 (18%) with reduction of closed fractures (CR), 15 patients (16%) undergoing hip endoprosthesis (HPRO), 13 (14%) with open reduction surgery of small bones (OR-OTHER), 4 (4%) after knee endoprosthesis surgery (KPRO), and 8 (9%), after treatments of other infections (OTHER). The latter have not been taken into account in the further analysis due to the small number and variety of surgical procedures. The incidence of SSI was for: FX from 2.6 (2008) to 4.1 (2011); CR from 1.2 (2012) 4.8 (2008), HPRO from 0.7 (2012) to 1.3 (2009 r.), OR-OTHER from 0 (2009) to 4.5 (2010); KPRO from 0 (2010-2012) to 2.1 (2009). Among the etiological factors isolated from clinical materials derived from patients diagnosed with infections dominated Gram-positive bacteria, especially Staphylococcus-aureus: HPRO-40%, KPRO-75% FX-46%, OR-OTHER-62%, CR-63%, OTHER -38%. Strains resistant to methicillin (MRSA) were not reported. CONCLUSION: Prevention measures implemented in many areas of the potential impact on risk factors for SSI, has helped to achieve in 2012, the lowest rate of infection for all the analyzed procedures in the last 5 years. Conducting targeted surveillance of surgical site infection keeps morbidity associated with SSI at an acceptably low level and allows for precise planning of the preventive measures in this area.

[Problems with treatment of trochanteric femur fractures at elderly patients]. / Problemy w leczeniu zlaman kretarzowych kosci udowej u osób w wieku podeszlym.

Authors analyzed patients complications with trochanteric fractures of femur treated in Department Orthopedic and Casualty of St. Lukas Hospital in Tarnów from 01.01.2008 to 31.12.2009 in this study. During this period were treated 167 patients. In most of cases operative treatment such as: Dynamic Hip Screw fixation, Gamma nailing, Ender's method and angle plate with screws were used. Prosthetic replacement was also used and 9 patients weren't operated because of coexisting pathological states. Basing on a done analyze of clinical material it was pronounced that independently from used surgical procedure regional and general complications are being occurred.