A case-control study of risk factors for wound infection in a colorectal unit

INTRODUCTION Postoperative wound infections have been responsible for increasing morbidity and are associated with an increased use of hospital resources. Previous studies have identified several risk factors. However, most studies are outdated, and few relate to the era of enhanced recovery and laparoscopic surgery. This study investigated the association between patient and operative factors and the development of postoperative wound infections in colorectal surgery. METHODS Patients with documented wound infections or dehiscences were identified from a database of elective and emergency colorectal surgery. Patients with wound infections were matched by operation type to a control group of colorectal patients. Differences in patient and operative factors between case and control group were analysed using conditional logistic regression. RESULTS A total of 56 patients with wound infection were identified from 647 operations (8.6%). Fifty-seven per cent were emergency operations and eighty-eight per cent were performed as open surgery or as laparoscopic surgery converted to open. Forty per cent of patients had high ASA (American Society of Anesthesiologists) grades (3 or 4). Multivariate logistical regression showed that obese patients and those having open surgery had the highest risk of infections. The median postoperative hospital stay for patients with wound infections was twice as long as for those patients without wound infections. CONCLUSIONS Open surgery and obesity are independent risk factor for wound infections. An increase in laparoscopically performed operations and new strategies for managing wounds in obese patients may help to reduce the rate of wound infection

Challenges in the management of chronic wound infections.

ABSTRACT Objectives Chronic wound infections may delay the healing process and are responsible for a significant burden on healthcare systems. Since inappropriate management may commonly occur in the care of these patients, this review aims to provide a practical guide underlining actions to avoid in the management of chronic wound infections. Methods We performed a systematic review of the literature available in PubMed in the last 10 years, identifying studies regarding the management of patients with chronic wound infections. A panel of experts discussed the potential malpractices in this area. A list of 'Don'ts', including the main actions to be avoided, was drawn up using the 'Choosing Wisely' methodology. Results In this review, we proposed a list of actions to avoid for optimal management of patients with chronic wound infections. Adequate wound bed preparation and wound antisepsis should be combined, as the absence of one of them leads to delayed healing and a higher risk of wound complications. Moreover, avoiding inappropriate use of systemic antibiotics is an important point because of the risk of selection of multidrug-resistant organisms as well as antibiotic-related adverse events. Conclusion A multidisciplinary team of experts in different fields (surgeon, infectious disease expert, microbiologist, pharmacologist, geriatrician) is required for the optimal management of chronic wound infections. Implementation of this approach may be useful to improve the management of patients with chronic wound infections

Draft Genome Sequences of Two Vibrio parahaemolyticus Strains Associated with Gastroenteritis after Raw Seafood Ingestion in Colorado.

Vibrio parahaemolyticus is a Gram-negative pathogen associated with gastrointestinal and wound infections after exposure to raw seafood or contaminated waters. We report here the whole-genome sequences of two stool isolates (CDC-AM50933 and CDC-AM43539) from patients in Colorado presenting with gastroenteritis after ingesting raw seafood

Outbreak of Aeromonas hydrophila wound infections association with mud football

On 16 February 2002, a total of 26 people presented to the emergency department of the local hospital in the rural town of Collie in southwest Western Australia with many infected scratches and pustules distributed over their bodies. All of the patients had participated in a “mud football” competition the previous day, in which there had been 100 participants. One patient required removal of an infected thumbnail, and another required surgical debridement of an infected toe. Aeromonas hydrophila was isolated from all 3 patients from whom swab specimens were obtained. To prepare the mud football fields, a paddock was irrigated with water that was pumped from an adjacent river during the 1-month period before the competition. A. hydrophila was subsequently isolated from a water sample obtained from the river. This is the first published report of an outbreak of A. hydrophila wound infections associated with exposure to mud.Hassan Vally, Amanda Whittle, Scott Cameron, Gary K. Dowse and Tony Watso

Bacteriological profile of wound infections and antimicrobial resistance in selected gram-negative bacteria

Background: Managing wound infections is a challenging task. Understanding their resistance pattern is an essential step at reducing its burden in hospital settings. Objective: To determine the bacteriological diversity of wound infections and the antimicrobial resistance exhibited by a selected Gram-negative bacterium in the Aljouf region of Saudi Arabia. Methods: The study retrospectively analysed the antibiograms of wound infections from hospitalized patients for the year 2019. The European Centre for Disease Control guidelines were adopted for the classification of resistant bacteria. Multidrug-, extensive drug-, and carbapenem-resistant isolates are presented as frequencies and percentages. Results: A total of 295 non-duplicate wound swab antibiograms were retrieved, 64.4% (190) and 35.6% (105) isolates were Gram-negative and Gram-positive bacterial infections respectively. Predominant pathogens included Staphylococcus species 21.0% (62), E. coli 16.3% (48) and K. pneumoniae 13.5% (40). 148 (77.9%), 42 (22.1%) and 43 (22.6%) of the Gram-negative isolates were multidrug-, extensively drug- and carbapenem-resistant. The antibiotic resistance exhibited by gram-negative bacteria was 43.4% (234/539), 59.1% (224/379) and 53.7% (101/188) towards carbapenems, 3rd - and 4th – generation cephalosporins. Conclusions: The majority of wound infections are caused by multidrug-, extensively drug- and carbapenem-resistant Gram-negative bacteria. Further studies should focus on the molecular basis of this resistance. Keywords: Wound infections; hospital; Gram-negative bacteria; antibiograms; multidrug-resistance; E. coli

BACTERIOLOGICAL STUDY OF POST-OPERATIVE WOUND INFECTIONS AND THEIR ANTIBIOGRAMS IN A TERTIARY CARE TEACHING HOSPITAL

Background: Surgical site infections (SSI) are frequently occurring in postoperative complications. The present study is undertaken to isolate and determine the frequency of distribution of pathogens in post-operative wound infections and the antimicrobial susceptibility pattern of the causative organisms. Methods: This cross-sectional, prospective study was carried out over a period of one year. 250 pus samples from cases of surgical site infections were processed for gram staining, culture, biochemical identification tests, and antimicrobial susceptibility testing. Results: Out of 250 patients of post-operative wound infections, 48 are cultured positive, among which 21 were gram-positive, and 27 were gram-negative. Staphylococcus aureus emerged as the commonest etiological agent 17 (35.42%) followed by Pseudomonas aeruginosa 14 (29.17%), E.coli 6 (12.5%). Amikacin (72.9%) was found to be the most effective antibiotic, and Multidrug resistance was observed with staphylococcus aureus (79.16%) and pseudomonas aeruginosa (83.3%). Conclusions: Staphylococcus aureus is the commonest etiological agent for Postoperative wound infections. Antibiotic susceptibility pattern of various isolates helps in proper selection of antibiotics and in this study, it was found that Amikacin was the most effective antibiotic against postoperative wound infections. &nbsp

Antibacterial smart hydrogels: New hope for infectious wound management

Millions of people die annually due to uncured wound infections. Healthcare systems incur high costs to treat wound infections. Tt is predicted to become more challenging due to the rise of multidrug-resistant conditions. During the last decades, smart antibacterial hydrogels could attract attention as a promising solution, especially for skin wound infections. These antibacterial hydrogels are termed 'smart' due to their response to specific physical and chemical environmental stimuli. To deliver different drugs to particular sites in a controlled manner, various types of crosslinking strategies are used in the manufacturing process. Smart hydrogels are designed to provide antimicrobial agents to the infected sites or are built from polymers with inherent disinfectant properties. This paper aims to critically review recent pre-clinical and clinical advances in using smart hydrogels against skin wound infections and propose the next best thing for future trends. For this purpose, an introduction to skin wound healing and disease is presented and intelligent hydrogels responding to different stimuli are introduced. Finally, the most promising investigations are discussed in their related sections. These studies can pave the way for producing new biomaterials with clinical applications

BACTERIOLOGICAL STUDY OF POST-OPERATIVE WOUND INFECTIONS AND THEIR ANTIBIOGRAMS IN A TERTIARY CARE TEACHING HOSPITAL

Background: Surgical site infections (SSI) are frequently occurring in postoperative complications. The present study is undertaken to isolate and determine the frequency of distribution of pathogens in post-operative wound infections and the antimicrobial susceptibility pattern of the causative organisms. Methods: This cross-sectional, prospective study was carried out over a period of one year. 250 pus samples from cases of surgical site infections were processed for gram staining, culture, biochemical identification tests, and antimicrobial susceptibility testing. Results: Out of 250 patients of post-operative wound infections, 48 are cultured positive, among which 21 were gram-positive, and 27 were gram-negative. Staphylococcus aureus emerged as the commonest etiological agent 17 (35.42%) followed by Pseudomonas aeruginosa 14 (29.17%), E.coli 6 (12.5%). Amikacin (72.9%) was found to be the most effective antibiotic, and Multidrug resistance was observed with staphylococcus aureus (79.16%) and pseudomonas aeruginosa (83.3%). Conclusions: Staphylococcus aureus is the commonest etiological agent for Postoperative wound infections. Antibiotic susceptibility pattern of various isolates helps in proper selection of antibiotics and in this study, it was found that Amikacin was the most effective antibiotic against postoperative wound infections. &nbsp

Prevention of perioperative wound infections

Surgical site infection (SSI) is the commonest hospital acquired infection that occurs in early postoperative period in surgical patients and accounts for 38% of infections in surgical patients and 31.1% of all infections in trauma patients. Ifs frequency increase parallels increase in number of risk factors. Prevention of peri-operative infection necessitates management directed at optimizing of patient factors like smoking, nutritional factors, immune-suppression, obesity and cardiovascular status. Use of principles like antibiotic prophylaxis, aseptic theatre conditions, respect of soft tissues during operation, local therapy and other modern patient safety practices is mandatory. Antibiotic prophylaxis should be started early pre-operatively at least 30-60 minutes before incision and antibiotic level exceeding minimal inhibitory concentration for infecting organism or before inflation of a tourniquet if applicable to closure of wound. Aiming at short preoperative stay in hospital, and pre-washing of the area concerned before cleaning with antiseptic are also imperative in reducing SSI. Preoperative skin preparation is an important element in prevention of infection, but removes only up to 80% of skin flora. Standard surgical antisepsis is an accepted method and involves scrubbing with antiseptic solutions. Chlorhexidine gluconate compared with povodine iodine showed a prolonged reduction in skin contamination and with less toxicity and skin irritation. Aqueous surgical hand scrubs are equivalent to traditional scrubs with regard to reduction of skin contamination, with higher surgeons protocol compliancy compared to traditional scrubs. The use of laminar flow and ultra-violet light in theatre is associated with decreased rates of postoperative skin infections and contamination. Respect of soft tissues during surgery through decrease in excessive use of diathermy, contusions and excessive tension is advised. Wound closure without tension and no dead space is encouraged. Issues of wound drainage have not been shown to reduce rates of infection. When used, closed suction drainage is better than open drain. SSI is a common complication and it is in the interest of the surgeon and the patient that it is prevented as it can be associated with morbidity, mortality and increased resource utilization. This article will deal with peri-operative management of the orthopaedic patient using evidence based benefits to the current practices available from recent updates, reviews and prospective randomized control trials, and some retrospective studies

Effects of Antibiotics Administration on the Incidence of Wound Infection in Percutaneous Dilatational Tracheostomy

The effect of antibiotics during the perioperative period of percutaneous dilatational tracheostomy (PDT) is still controversial. A total of 297 patients who underwent the PDT procedure were divided into 2 groups:those administered antibiotics perioperatively and those not administered antibiotics. Wound infections were noted in 7 cases (incidence rate, 2.36%) and no death was recorded. Of the 69 patients without antibiotics, 5 developed wound infections (incidence rate, 7.25%), while only 2 of the 228 patients with antibiotics developed wound infections (incidence rate, 0.88%) (p＝0.002;risk ratio, 8.82;95% confidence interval, 1.67-46.6). Of the 7 cases of wound infection, 5 cases occurred during the early period after PDT (within 7 days). Collectively, the present results suggest that prophylactic administration of antibiotics may prevent the incidence of PDT-induced wound infection, especially in the early phase after the PDT procedures. The need for antibiotics in PDT should be reconsidered