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Results for “WOUND INFECTION”

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PubMed2005

Comparison of bariatric and non-bariatric elective operations in morbidly obese patients on the basis of wound infection.

BACKGROUND: Wound infection rates after various types of bariatric operations have been well described. The question of whether bariatric surgery increases wound infection rate compared with similar elective surgical procedures in obese patients has not been clearly answered. The purpose of this study was to investigate wound status of morbidly obese patients after elective general surgery. METHODS: A prospective evaluation was conducted of 141 morbidly obese patients undergoing bariatric (n=60) and non-bariatric elective general surgery operation of similar invasiveness (n=81) with the ASEPSIS wound surveillance method. RESULTS: Median age of patients undergoing non-bariatric elective surgery (51, 32-68) was significantly higher than patients exposed to bariatric surgery (39, 24-57). Patients undergoing bariatric surgery had higher BMIs (44.0, 35-52.5) compared to the others (38.4, 35-43). All patients enrolled in the study were followed for a 21-day period. At the 7th postoperative day, 9 patients in the bariatric surgery group developed infection (15%), whereas 13 patients (16%) in the non-bariatric surgery group suffered wound infection. Wound infection was still present in 2 patients (3.4%) in the bariatric surgery group and 3 patients (3.7%) in the non-bariatric surgery group at the 21st day. Risk factors for wound infection included history of coronary artery diseases, diabetes, chronic respiratory illness and malignant disease. CONCLUSION: Bariatric surgery does not cause an additional risk of postoperative wound infection in morbidly obese patients, compared to elective general surgical operations of the same invasiveness.

Adult↗
PubMed2006

A novel titanium wound chamber for the study of wound infections in pigs.

In the face of emerging multidrug-resistant microbes, reliable animal models are needed to study potential new therapies in infected wounds. To this end, we implanted screw-top titanium chambers subdermally in full-thickness wounds on both flanks (n = 6 per flank) of 2 Goettinger minipigs. After 1 wk, chambers were inoculated with Staphylococcus aureus, Pseudomonas aeruginosa, or vehicle only. Throughout the study, wound fluid was harvested for quantitative bacterial cultures to monitor infection. Animals were followed for 4 wk, after which tissue biopsies were taken for histologic analysis and quantitative bacterial counts. The implanted titanium chambers were well tolerated by the pigs throughout the study. After inoculation of the chambers, wound infection was established and maintained for 14 d. Despite infection, no systemic effects were noted. Cross-contamination was negligible, compared with the vehicle-only control. After tissue ingrowth, each chamber creates a closed system that allows harvest of exudate or application of substances without loss of material from the chamber. Because 12 chambers are implanted in each pig, researchers have the opportunity to compare multiple treatment options (for example, antibiotics, antimicrobial peptides, gene therapy) in the same animal, with no interindividual variation. We conclude that the use of titanium chambers in pigs provides a reliable and reproducible in vivo model to investigate wound healing, wound infection, and treatment options.

Animals↗
PubMed1975

Wound infections in renal transplant wounds: pathogenetic and prognostic factors.

The factors contributing to transplant wound infection, as well as those determining its outcome, have been reviewed in 27 transplant patients with wound infection. Unrelated cadaver kidneys, diabetes, urinary fistulas and wound hematomas are all factors predisposing to wound infection. Overall incidence of wound infection in this series was 6.1% (27/439). When infections secondary to known preventable causes (i.e. hematomas and fistulas) were excluded, the incidence of wound infection was only 1.6%. Furthermore, if diabetics and retransplanted patients were excluded, the incidence of wound infection in non-diabetic patients who had their first transplant was only 0.7%. Perinephric infections are much more serious and carry a worse prognosis than superficial infections. Overall mortality of wound infections was 40% (8/27), most deaths being caused by sepsis from deep infection. Only three patients (11%) healed their wounds and saved their kidneys, whereas the rest of the survivors (15/18) healed their wounds but lost their kidneys. It is emphasized that prevention of hematomas and urinary fistulas is the most important measure in the prevention of transplant wound infection.

Adolescent↗
PubMed1992

Wound infection after cholecystectomy. Correlation between bacteria in bile and wound infection after operation on the gallbladder for acute and chronic gallstone disease.

OBJECTIVE: To see if there was a difference in the wound infection rates after operation for acute and chronic cholecystitis, and to see if the presence of bacteria in the bile had any influence on those rates. DESIGN: Prospective open study. SETTING: University hospital. SUBJECTS: 213 Patients undergoing cholecystectomy for acute or chronic gallstone disease. MAIN OUTCOME MEASURES: Incidence of postoperative wound infection, and of bile cultures growing pathogenic organism. RESULTS: There was no difference in wound infection rates between patients operated on for acute and those operated on for chronic cholecystitis. The presence of bacteria in the bile did not seem to influence the wound infection rate in either group. CONCLUSIONS: Early cholecystectomy and appropriate antibiotic prophylaxis result in an acceptably low wound infection rate, and the growth of bacteria from bile is not predictive of the development of wound infection.

Acute Disease↗
PubMed1997

Muscle flap reconstruction of pediatric poststernotomy wound infections.

Sternal wound infections following pediatric open-heart procedures occur infrequently. Four of our last 600 consecutive pediatric open-heart median sternotomies (1991 to 1996) required muscle flap reconstruction for treatment of deeply infected sternotomy wounds. Risk factors included multiple sternotomies, previous superficial infection, and immunocompromised states. Two patients were closed with bilateral pectoralis muscle flaps. The 2 other patients were closed with vertical rectus abdominis muscle flaps; 1 including an attached skin paddle. While the pectoralis major muscle flap is the first flap of choice utilized in adult patients, in pediatric patients a different hierarchy of flap selection is often necessary. The chest wall often has multiple scars from previous procedures, limiting use of the pectoralis muscle. In small infants the pectoralis muscle can be thin and inadequate for large sternal defects. All patients achieved healed wounds. Muscle flap reconstruction of pediatric sternal wounds can be an effective one-stage treatment for deep sternal wound infections with sternal instability.

Adolescent↗
PubMed2006

Treatment of infected wounds with maggot therapy after replantation.

Postoperative wound infection is a rare, but major, complication of replantation. Failure to control infection can lead directly to vascular thrombosis and, in turn, to loss of the replanted extremity. The use of maggots for wound debridement has a long history and has been lately re-introduced for treatment of intractable wounds. In this report, the authors present the experience of successful debridement of a severely infected wound after forearm replantation, using maggot therapy. The results and mechanism of maggot therapy are discussed.

Adult↗
PubMed1976

The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago.

Over a 4-year period 40,923 operations and 44,716 surgical admissions were monitored for both community and hospital onset infections. One thousand eight hundred sixty-five patients had 1966 surgical wound infections and 2056 remote infections including 1652 hospital onset and 404 community onset infections. One thousand one hudnred forty-four patients with multiple infections averaged 40 days in the hospital contrasted with 24 days for 721 patients with a single wound infection. The total excess cost of hospitalization for these patients was $951,150. A statistically significant reduction occurred for urinary tract infections, lower respiratory infections and clean and contaminated surgical wound infections. It is suggested that these are all inter-related and a significant reduction in surgical wound infections can be achieved through control of infections at remote sites, particularly those associated with medical devices. The coagulase positive staphylococcus is still the most important single bacterial species in the primary etiology of surgical wound infections. When the gastrointestinal tract is entered or "supra" infecting organisms appear, gram negative bacteria and mixed gram negative and gram positive infections are dominant. Reduction in remote site infections occurring in surgical patients is necessary to reduce the incidence of surgical wound infections, suggest preventive and control measures, and document the effectiveness of such measures.

Adolescent↗
PubMedDate not supplied

Factors associated with risk of surgical wound infections.

Surgical wound infections are the most common hospital-acquired infections among patients who undergo inpatient surgery. Risk of infection is a function of both patient susceptibility and exposure. The authors studied all discharges in Pennsylvania from October 1, 2004, through September 30, 2005, in which a circulatory (n= 65 940), neurological (n= 6706), or orthopedic (n = 107 825) procedure was performed using data from the Pennsylvania Health Care Cost Containment Council. They estimated the impact of patient-specific factors on risk of infection and compared the ability of these factors to predict infections relative to hospital effects. Results suggested that for all 3 types of procedures, patient-specific factors were a significant determinant of risk of surgical wound infection. However, prediction of infection was improved by 23% to 33% when hospital fixed effects were included. Although patient-specific factors had a statistically significant association with risk of infections, much of the risk of surgical wound infections is determined by hospital factors.

Adult↗
PubMed1994

Wound infection in total joint arthroplasty: effect of extended wound surveillance on wound infection rates.

OBJECTIVE: To determine the effects of a wound monitoring program on infection rates after total joint arthroplasty. DESIGN: Case series, comparing postoperative wound infection rates before and after hospital discharge. SETTING: A university-affiliated tertiary-care hospital. PATIENTS: A group of 865 patients who underwent primary or revision total hip or knee arthroplasty between September 1989 and September 1991 followed by in-hospital and post-discharge wound monitoring was compared with a baseline group of 204 patients who had undergone an arthroplasty procedure and in-hospital wound monitoring between March and September 1988; only 38 of these patients were selected for post-discharge monitoring. INTERVENTIONS: In the study group, wounds were monitored every 48 to 72 hours to the time of patient discharge and at 30 days post-discharge. Monthly reports of surgeon-specific and overall infection rates were sent to each surgeon during both baseline and study periods. MAIN OUTCOME MEASURES: Presence or absence of surgical wound infection. RESULTS: The initial overall wound infection rate was 9.9%. This decreased to 3.8% in the study group, after the wound monitoring program had been in place for at least 18 months. Post-discharge monitoring accounted for the majority of wound infections diagnosed. CONCLUSIONS: A wound monitoring program may be an important tool in lowering wound infection rates associated with total joint arthroplasty. Post-discharge monitoring is important in determining true wound infection rates.

Alberta↗
PubMedDate not supplied

Effective and creative surveillance and reporting of surgical wound infections.

Surgical wound infections offer a major challenge to hospital infection control programs. Surgical procedures and host factors are independent variables which markedly influence the risk of infection. Frequently used categories of surgical procedures (clean, contaminated, and infected) are inadequate to identify the special risks and problems of individual procedures. In 1976, in conjunction with the practicing surgeons of a large, referral hospital, the Infections Control Committee instituted surveillance of selected clean surgical procedures and deep-versus-superficial wound infections. Major problems associated with the cleaning of sternal saws and the timing of the administration of prophylactic antibiotics have been detected by these methods. Conventional surveillance undoubtedly would have overlooked these problems. Effective surveillance and control of surgical wound infections requires a willingness to modify surveillance activities to meet the local needs, and a determination to include the operating surgeons in the planning of surveillance activities.

Hospital Bed Capacity, 500 and over↗
PubMed1976

Wound infections in general surgery. Wound contamination, rates of infection and some consequences.

Rates of wound infection have been studied in a clinic performing to an equal degree both clean surgery and potentially contaminated surgery. Included in the study were 2827 patients with 213 (7.5%) postoperative wound infections. The postoperative mortality was 2.1%. Primary illness and cardiovascular complications were the main causes of postoperative death, while infectious complications (pneumonia, peritonitis and wound infection) were associated with or caused 1/3 of all postoperative deaths. Positive cultures from the wound before closure and from the wound dressings, immediately after operation, were followed by an increased risk of wound infection compared to negative cultures. Rates of wound infection were significantly higher in potentially contaminated operations compared to clean operations. Gram negative bacteria dominated in isolates from infected wounds after the former type of surgery, while S. aureus was the most common bacteria in wound infections after clean surgery. The time interval between operation and the discovery of wound infection was in the mean 10 days for staphylococci, and 9 days for Gram negative bacteria. The average time of hospitalization for patients contracting postoperative wound infections was 9 days longer than that for non-infected patients, which means that 3.4% of all nursing days were lost owing to excess hospitalization of infected patients.

Aged↗
PubMed2002

Effect of lidocaine and epinephrine on Staphylococcus aureus in a guinea pig model of surgical wound infection.

Postoperative wound infection, most often with, is of ubiquitous concern in surgical practice, occurring in an average of 1.5 to 5 percent of all procedures. The antimicrobial properties of local anesthetics have been documented over the past 25 years by in vitro studies. This study evaluates the effects of lidocaine preparations on in an in vivo setting. In a wound infection model using live albino guinea pigs, inoculum was introduced for the reproducible bacterial colonization of clean surgical wounds. One of two sites on the dorsum of each animal was infiltrated with a commercial lidocaine preparation (with and without epinephrine) prior to inoculation with (10 cfu/ml). The other site, inoculated with without preinfiltration with lidocaine, served as the control. Cultures from the sites treated with lidocaine were then compared with cultures from the control sites. All control sites had a consistent presence >or=10 cfu/ml, the threshold for bacterial inhibition of wound healing. Infiltration of the wound with 2 ml of 2% lidocaine prior to inoculation was associated with an average decrease in bacterial count of >70 percent ( n= 19). On the other hand, the addition of epinephrine (1:100,000) to lidocaine was associated with a 20-fold in bacterial counts compared with control values ( n= 10). This is the first study to demonstrate inhibition of by a local anesthetic agent in an in vivo model of a surgical wound. This information suggests a possible role for local anesthetics in prophylaxis against surgical wound infection.

Anesthetics, Local↗
PubMed2003

Pectoralis muscle flap reconstruction of pediatric sternal wound infections.

Sternal wound infection (SWI) is a life-threatening complication in both the pediatric and adult population. The morbidity and mortality of SWIs have decreased with the use of muscle flap reconstruction of the chest wall. Although the pectoralis muscle flap is the most frequently used flap in adults for reconstruction after SWI, its use in children has not been well described. To review current experience with the use of the pectoralis muscle flap in a pediatric population, a retrospective review of 1,200 consecutive median sternotomies occurring at the Children's Hospital of Pittsburgh between 1992 and 1997 was performed. All cases of postoperative SWI were identified, and the operative management was performed by a single surgeon. Reconstruction was performed with the use of unilateral or bilateral pectoral muscle flap advancements. Sternal wound infections developed in nine patients (0.75% incidence). The mean duration from initial sternotomy to the time of presentation of deep SWI was 39.5 days. Eight patients underwent reconstruction using pectoralis muscle advancement flaps. Two patients (25%) were reconstructed with a unilateral pectoralis advancement flap, whereas six patients (75%) required bilateral advancement flaps. One patient was treated with conservative management. The average length of stay after reconstruction was 9 +/- 4 days. Duration of follow-up ranged from 3 to 42 months (mean: 16 +/- 12 months). All reconstructions ultimately resulted in well-healed wounds with satisfactory cosmesis. No developmental or functional deficits have been documented in follow-up visits. Sternal wound infection is a serious postoperative complication of median sternotomy. Aggressive operative management with the use of muscle flap reconstruction has helped to lower the morbidity and mortality of this infection. The successful use of pectoralis muscle flap advancement for functional and esthetic reconstruction of the chest wall in children is described.

Child↗
PubMed2004

Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients.

OBJECTIVE: To assess the level of agreement between common definitions of wound infection that might be used as performance indicators. DESIGN: Prospective observational study. SETTING: London teaching hospital group receiving emergency cases as well as tertiary referrals. PARTICIPANTS: 4773 surgical patients staying in hospital at least two nights. MAIN OUTCOME MEASURES: Numbers of wound infections based on purulent discharge alone, on the Centers for Disease Control (CDC) definition of wound infection, on the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition, and on the ASEPSIS scoring method. RESULTS: 5804 surgical wounds were assessed during 5028 separate hospital admissions. The mean percentage of wounds classified as infected differed substantially with different definitions: 19.2% with the CDC definition (95% confidence interval 18.1% to 20.4%), 14.6% (13.6% to 15.6%) with the NINSS version, 12.3% (11.4% to 13.2%) with pus alone, and 6.8% (6.1% to 7.5%) with an ASEPSIS score > 20. The agreement between definitions with respect to individual wounds was poor. Wounds with pus were automatically defined as infected with the CDC, NINSS, and pus alone definitions, but only 39% (283/714) of these had ASEPSIS scores > 20. CONCLUSIONS: Small changes made to the CDC definition or even in its interpretation, as with the NINSS version, caused major variation in estimated percentage of wound infection. Substantial numbers of wounds were differently classified across the grades of infection. A single definition used consistently can show changes in percentage wound infection over time at a single centre, but differences in interpretation prevent comparison between different centres.

Adult↗
PubMed2002

Nonpharmacological prevention of surgical wound infections.

Postoperative wound infection is a common and serious complication of surgery. This review will focus on 2 factors known to modulate perioperative immunity: maintenance of perioperative normothermia and provision of supplemental perioperative oxygen. Hypothermia causes numerous adverse outcomes, including morbid myocardial events, increased blood loss and transfusion requirement, postsurgical wound infections, and prolonged hospitalization. Perioperative normothermia should thus be maintained unless therapeutic hypothermia is specifically indicated. Supplemental perioperative oxygen (inspired fraction of 80% instead of 30%) significantly reduces postoperative nausea and vomiting, diminishes the decrease in phagocytosis and bacterial killing usually associated with anesthesia and surgery, and reduces the rate of postoperative wound infection among patients who undergo colon resection. Available data thus suggest that supplemental perioperative oxygen improves surgical outcome with little or no associated risk.

Body Temperature↗
PubMedDate not supplied

[Incidence and sensitivity to antibiotics of germs isolated from surgical wound infections].

We studied 119 bacterial strains isolated from postoperative infected wounds. All these strains were considered to be strains that derived from the same number of nosocomial infections, all the postoperative infections of the wounds being nosocomial infections. Regarding their frequency, we isolated the following strains: E. coli--68 strains (57%), S. aureus--37 strains (31%), Pseudomonas spp.--9 strains (8%) and Proteus spp.--5 strains (4%). We performed the bacteriological study of these strains and some correlations between them and the surgical diagnosis. In order to help the surgical therapy of the overinfected wounds, we tested the drug sensitivity of all these strains. The results regarding the drug sensitivity show that these strains have different types of resistance to antibiotics, the Pseudomonas strains being the most resistant. We noticed a continuous decrease of the sensitivity of the isolated strains to certain antimicrobial drugs, and this focuses the attention on the necessity of monitoring the antibiotic prescriptions in hospitals. Taking into account the results obtained after this study, we should reconsider the concept of nosocomial infections control through prevention activities, in order to reduce the incidence and to identify the potential causes that can lead to nosocomial infections.

Anti-Bacterial Agents↗
PubMed2024

Development of a clinical metagenomics workflow for the diagnosis of wound infections.

BACKGROUND: Wound infections are a common complication of injuries negatively impacting the patient's recovery, causing tissue damage, delaying wound healing, and possibly leading to the spread of the infection beyond the wound site. The current gold-standard diagnostic methods based on microbiological testing are not optimal for use in austere medical treatment facilities due to the need for large equipment and the turnaround time. Clinical metagenomics (CMg) has the potential to provide an alternative to current diagnostic tests enabling rapid, untargeted identification of the causative pathogen and the provision of additional clinically relevant information using equipment with a reduced logistical and operative burden. METHODS: This study presents the development and demonstration of a CMg workflow for wound swab samples. This workflow was applied to samples prospectively collected from patients with a suspected wound infection and the results were compared to routine microbiology and real-time quantitative polymerase chain reaction (qPCR). RESULTS: Wound swab samples were prepared for nanopore-based DNA sequencing in approximately 4 h and achieved sensitivity and specificity values of 83.82% and 66.64% respectively, when compared to routine microbiology testing and species-specific qPCR. CMg also enabled the provision of additional information including the identification of fungal species, anaerobic bacteria, antimicrobial resistance (AMR) genes and microbial species diversity. CONCLUSIONS: This study demonstrates that CMg has the potential to provide an alternative diagnostic method for wound infections suitable for use in austere medical treatment facilities. Future optimisation should focus on increased method automation and an improved understanding of the interpretation of CMg outputs, including robust reporting thresholds to confirm the presence of pathogen species and AMR gene identifications.

Humans↗
PubMedDate not supplied

A proactive approach to wound infection.

The management and treatment of infection is a complex and important area in tissue viability nursing. Andrew Kingsley discusses the value of microbiology to clinical practice and the importance of adopting a proactive approach to the management of infected wounds using an infection continuum and algorithm to help promote effective care.

Algorithms↗