Bryan Lich’s Post

This study evaluates nosocomial infections in pediatric patients post-cardiac surgery, analyzing data from the National Center for Cardiovascular Diseases in China. Out of 4776 patients, the nosocomial infection rate was 2.1%, with multidrug-resistant organisms (MDROs) found in 36 patients. Pneumonia and sepsis were the most common infections, with pneumonia showing an incidence density of 7. #MultidrugResistantOrganisms #NosocomialInfections #PediatricCardiacSurgery #SurgicalOutcomes

🔬 Essential Review on PJI Treatment! 🔬 Explore this Review "Antimicrobial treatment of patients with a #periprosthetic joint infection: basic principles" by Wouter Rottier, Jessica Seidelman, and Marjan Wouthuyzen-Bakker. Congratulation that this paper has already garnered1️⃣1️⃣citations! 🌟 Key Highlights: ✅Understanding antibiotic tolerance due to #biofilm formation ✅The role of biofilm-active #antibiotics from in vitro and in vivo perspectives ✅Clinical evidence on the effectiveness of #rifampicin and fluoroquinolones ✅Optimal treatment duration and the timing of switching to oral therapy 📚 Read the full review here: https://lnkd.in/gacEYWP7 #Orthopedics #PJI #MedicalResearch #Arthroplasty #Antibiotics #Biofilm #SSI #JointInfection

🦠 Unexpected Cause of Hospital infections 🦠 We traditionally think that patients get infected by superbugs while staying in the hospital. A new study genetic data found that bacteria causing these infections come from previously harmless bacteria that patients already had on their bodies before they even entered the hospital. Bacteria living innocuously on our own bodies when we are healthy and are most often responsible for these superbug infections when we are sick at the hospital . For example, 86% of the bacteria causing infections after spine surgery were genetically matched to bacteria a patient carried before surgery. Nearly 60% of infections were also resistant to the preventive antibiotic administered during surgery. A shift toward more individualized approaches to the patient’s microbes may be the future of hospital infection prevention. 📰 Long D, Bryson-Cahn C, Waalkes A, et al. Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery. Science Translational Med. 2024, Apr 10, Vol 16, 742. #Studies #HospitalCare

The aim of this systematic review and meta-analysis is to explore the effect of topical vancomycin powder (VP) in surgical site infection (SSI) prevention and adverse events after joint arthroplasty and to provide a specific theoretical basis for clinical treatment. The review process was conducted according to the PRISMA guidelines. Two independent researchers meticulously screened the literature based on predefined inclusion and exclusion criteria, evaluated the quality of the selected studies, and extracted relevant data. Data analysis was conducted using RevMan 5.4 software. This meta-analysis included 24 studies encompassing a total of 34 811 patients. The pooled analysis showed that the topical administration of VP significantly reduced the incidence of SSI. Subgroup analyses by doses, type of joint (hip and knee), and type of surgery (primary and revision) confirmed that vancomycin consistently lowered SSI rates. Moreover, the incidence of SSI caused by gram-negative germs and gram-positive germs decreased following the use of VP, although the reduction was not significant for infections caused by MRSA. However, the use of VP was associated with a significant increase in sterile complications at the incision site and delayed incision healing. The topical application of VP is effective in reducing the incidence of infections following joint arthroplasty. Despite an increased risk of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision-making. However, it should not be discarded due to side effects. Read more on 📄 Efficacy and safety of vancomycin for local application in the prevention of surgical site infection after joint arthroplasty: a systematic review and meta-analysis https://bit.ly/3YnrXpP ✒️ Chengxin Xie, Liwei Zhang, Dehua Zhang, Lingjian Tao, Yong Zhao, and Hua Luo #arthroplasty #jointarthroplasty #infection #vancomycin #surgicalsiteinfection #hip #knee #OpenReviews #orthopedics #orthopaedics #surgery #openaccess

🦠 Unexpected Cause of Hospital infections 🦠 We traditionally think that patients get infected by superbugs while staying in the hospital. A new study genetic data found that bacteria causing these infections come from previously harmless bacteria that patients already had on their bodies before they even entered the hospital. Bacteria living innocuously on our own bodies when we are healthy and are most often responsible for these superbug infections when we are sick at the hospital . For example, 86% of the bacteria causing infections after spine surgery were genetically matched to bacteria a patient carried before surgery. Nearly 60% of infections were also resistant to the preventive antibiotic administered during surgery. A shift toward more individualized approaches to the patient’s microbes may be the future of hospital infection prevention. 📰 Long D, Bryson-Cahn C, Waalkes A, et al. Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery. Science Translational Med. 2024, Apr 10, Vol 16, 742. #Studies #HospitalCare

For many decades, patients recovering from wound closure have been instructed not to bathe. Although studies have shown that earlier postoperative bathing does not increase the risk of wound infection, it remains rare in practice for patients to be allowed earlier postoperative bathing. We performed this meta-analysis to determine how earlier bathing affected rates of wound infection, other complications, and patient satisfaction. This systematic review conforms to PRISMA guidelines. The PubMed, EMBASE, Medline, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from their inception dates to December 31, 2022. We estimated pooled values for the efficacy of trial of earlier bathing versus delayed bathing using the odds ratio and their associated 95% CI, and we used the I 2 statistic to assess heterogeneity between studies contributing to these estimates. Of the 1813 articles identified by our search, 11 randomized controlled trials including 2964 patients were eligible for inclusion. The incidence of wound infection did not differ significantly between the earlier bathing and delayed bathing groups, nor did rates of other wound complications such as redness and swelling, or wound dehiscence. However, the incidence of hematoma in the delayed bathing group was higher than in the earlier bathing group. Reported patient satisfaction was significantly higher in the earlier bathing group. The medical community, health authorities, and government should create and disseminate clinical practice guidelines to guide patients to evidence-based beneficial treatment. Read more on 📄 Does earlier bathing increase the risk of surgical site infection? A meta-analysis of 11 randomized controlled trials https://bit.ly/4cbFy7f ✒️ Yu Ren, Hui Yu, Zhangfu Wang, Wenjun Pan, Lin Chen, and Hua Luo #OpenReviews #surgicalsiteinfection #infection #wound #woundcomplication #postoperative #bathing #orthopedics #orthopaedics #surgery #orthopedicsurgery #orthopaedicsurgery #openaccess #openaccessjournal

BACKGROUND Previous studies on nonoperative management (NOM) of acute appendicitis (AA) indicated comparable outcomes to surgery, but the effect of COVID-19 infection on appendicitis outcomes remains unknown. Thus, we evaluate appendicitis outcomes during the COVID-19 pandemic to determine the effect of COVID-19 infection status and treatment modality. We hypothesized that active COVID-19 patients would have worse outcomes than COVID-negative patients, but that outcomes would not differ between recovered COVID-19 and COVID-negative patients. Moreover, we hypothesized that outcomes would not differ between nonoperative and operative management groups, regardless of COVID-19 status. METHODS We queried the National COVID Cohort Collaborative from 2020 to 2023 to identify adults with AA who underwent operative or NOM. COVID-19 status was denoted as follows: COVID-negative, COVID-active, or COVID-recovered. Intention to treat was used for NOM. Propensity score–balanced analysis was performed to compare outcomes within COVID groups, as well as within treatment modalities. RESULTS A total of 37,868 patients were included: 34,866 COVID-negative, 2,540 COVID-active, and 460 COVID-recovered. COVID-active and recovered less often underwent operative management. Unadjusted, there was no difference in mortality between COVID groups for operative management. There was no difference in rate of failure of NOM between COVID groups. Adjusted analysis indicated, compared with operative, NOM carried higher odds of mortality and readmission for COVID-negative and COVID-active patients. CONCLUSION This study demonstrates higher odds of mortality among NOM of appendicitis and near equivalent outcomes for operative management regardless of COVID-19 status. We conclude that NOM of appendicitis is associated with worse outcomes for COVID-active and COVID-negative patients. In addition, we conclude that a positive COVID test or recent COVID-19 illness alone should not preclude a patient from appendectomy for AA. Surgeon clinical judgment of a patient's physiology and surgical risk should, of course, inform the decision to proceed to the operating room. In The Journal of Trauma and Acute Care Surgery #JOTACS #CirUrgT Elisa Reitano Emiliano Ledo Paula Ferrada. MD, FACS, FCCM, MAMSE Carlos Yánez Shankarnath S Stefano PB Cioffi Dimitris Damaskos

NIH reports that Hospital Acquired Infections (HAIs) in the US are close to 700,000, with 49,000 caused by Surgical Site Infections (SSIs), mainly from wound class IV procedures like colorectal surgeries. While OR suites' environmental conditions and patients' health are key factors, the type of surgery and surgeon's approach can play a crucial role in SSIs. Health care facilities follow guidelines, yet SSIs can occur. The CDC, in collaboration with the American College of Surgeons, developed the "Surgical Wound Classification System" to create consistent parameters for reporting. This system categorizes surgical wounds and can be accessed on the CDC website. In cases like a ruptured appendix that can include a colorectal surgery, SSIs are not unusual due to pre-existing contamination or current infection despite prophylactic antibiotic use. Analyzing the surgeon's operative note and infection status at the time of surgery is crucial to determine if the Standard of Care was breached during the procedure or at another time during the patient's inpatient stay. This scenario represents a class IV Dirty/Infected surgical wound. Would your approach differ if the client faced an SSI after total joint arthroplasty, a class I Clean procedure with no prior contamination? Researching the operative notes and infection status is vital in both instances to assess cases thoroughly. Which other medical records might you review to "make your case"?

#surgery #appendicitis #infectioncontrol #children https://lnkd.in/gd6N8gVM Key Points Question In #children with nonperforated #appendicitis with gangrenous, suppurative, or exudative findings, is continuation of postoperative #antibiotics associated with a reduction in surgical site infection risk and resource use? Findings In this multicenter cohort study of 958 children from 16 hospitals using complementary hospital and patient-level analyses, no association was found between postoperative antibiotic use and postoperative risk of surgical site infection, abdominal imaging, or hospital revisits. Meaning Use of postoperative antibiotics did not improve outcomes in children with nonperforated appendicitis with gangrenous, suppurative, or exudative findings.

2.Title: “Post-Cardiovascular Surgery Complications: Investigating Fever, Chest Pain, and Leukocytosis after Triple Bypass Surgery – Diagnostic Research and Infection Management” Potential Causes of Post-CABG Infections: Infections following CABG surgery are not uncommon and can stem from several sources, including surgical site infections, sternal wound infections, endocarditis, or mediastinitis. The presence of fever, chest pain, and high WBC counts after two months warrants the investigation of these complications. 1. Surgical Site Infection (SSI): Infections at the incision site are a known risk after CABG, particularly in patients with comorbidities like diabetes or obesity. SSIs may be superficial or deep, extending into the sternum and chest cavity. Symptoms include localized redness, swelling, discharge, and tenderness. 2. Sternal Wound Infection (SWI): A more serious form of infection, SWI, may result from the disruption of the sternum during surgery. These infections can lead to osteomyelitis (bone infection) if not treated promptly. Fever, pain at the wound site, and elevated WBC counts are common indicators. 3. Mediastinitis: Mediastinitis is a deep infection of the mediastinum (the space between the lungs) that may occur after CABG. This is a life-threatening condition that requires immediate medical intervention. It typically presents with systemic symptoms such as fever, chest pain, and high WBC counts. 4. Endocarditis: Endocarditis, an infection of the heart valves or inner lining of the heart chambers, can occur post-surgery due to bacterial contamination. This can cause fever, malaise, heart murmurs, and systemic embolic events. It can be diagnosed through blood cultures and echocardiography. Courtesy to Dr. Natasha Alterman ,Cardiologist,Auckland City Hospital,USA