Risk of surgical site infection and efficacy of antibiotic prophylaxis: a cohort study of appendectomy patients in Thailand

BACKGROUND: No data currently exist about use of antibiotics to prevent surgical site infections (SSI) among patients undergoing appendectomy in Thailand. We therefore examined risk factors, use, and efficacy of prophylactic antibiotics for surgical site infection SSI among patients with uncomplicated open appendectomy. METHODS: From July 1, 2003 to June 30, 2004 we conducted a prospective cohort study in eight hospitals in Thailand. We used the National Nosocomial Infection Surveillance (NNIS) system criteria to identify SSI associated with appendectomy. We used logistic regression analysis to obtain relative risk estimates for predictors of SSI. RESULTS: Among 2139 appendectomy patients, we identified 26 SSIs, yielding a SSI rate of 1.2 infections/100 operations. Ninety-two percent of all patients (95% CI, 91.0–93.3) received antibiotic prophylaxis. Metronidazole and gentamicin were the two most common antibiotic agents, with a combined single dose administered in 39% of cases. In 54% of cases, antibiotic prophylaxis was administered for one day. We found that a prolonged duration of operation was significantly associated with an increased SSI risk. Antibiotic prophylaxis was significantly associated with a decreased risk of SSI regardless of whether the antibiotic was administered preoperatively or intraoperatively. Compared with no antibiotic prophylaxis, SSI relative risks for combined single-dose of metronidazole and gentamicin, one-day prophylaxis, and multiple-day antibiotic prophylaxis were 0.28 (0.09–0.90), 0.30 (0.11–0.88) and 0.32 (0.10–0.98), respectively. CONCLUSION: Single-dose combination of metronidazole and gentamicin seems sufficient to reduce SSIs in uncomplicated appendicitis patients despite whether the antibiotic was administered preoperatively or intraoperatively

Dialysis-associated peritonitis in children

Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection

Colo-Pro: a pilot randomised controlled trial to compare standard bolus-dosed cefuroxime prophylaxis to bolus-continuous infusion–dosed cefuroxime prophylaxis for the prevention of infections after colorectal surgery

Standard bolus-dosed antibiotic prophylaxis may not inhibit growth of antibiotic resistant colonic bacteria, a cause of SSIs after colorectal surgery. An alternative strategy is continuous administration of antibiotic throughout surgery, maintaining concentrations of antibiotics that inhibit growth of resistant bacteria. This study is a pilot comparing bolus-continuous infusion with bolus-dosed cefuroxime prophylaxis in colorectal surgery. This is a pilot randomised controlled trial in which participants received cefuroxime bolus-infusion (intervention arm) targeting free serum cefuroxime concentrations of 64 mg/L, or 1.5 g cefuroxime as a bolus dose four-hourly (standard arm). Patients in both arms received metronidazole (500 mg intravenously). Eligible participants were adults undergoing colorectal surgery expected to last for over 2 h. Results were analysed on an intention-to-treat basis. The study was successfully piloted, with 46% (90/196) of eligible patients recruited and 89% (80/90) of participants completing all components of the protocol. A trialled bolus-continuous dosing regimen was successful in maintaining free serum cefuroxime concentrations of 64 mg/L. No serious adverse reactions were identified. Rates of SSIs (superficial and deep SSIs) were lower in the intervention arm than the standard treatment arm (24% (10/42) vs. 30% (13/43)), as were infection within 30 days of operation (41% (17/43) vs 51% (22/43)) and urinary tract infections (2% (1/42) vs. 9% (4/43)). These infection rates can be used to power future clinical trials. This study demonstrates the feasibility of cefuroxime bolus-continuous infusion of antibiotic prophylaxis trials, and provides safety data for infusions targeting free serum cefuroxime concentrations of 64 mg/L. Trial registration: NCT02445859

Data from: Porosity and water vapor conductance of two Troodon formosus eggs an assessment of incubation strategy in a maniraptoran dinosaur

Using tangential thin sections, we examined variation in porosity and water vapor conductance across two eggs of Troodon formosus, a small (∼50 kg) theropod dinosaur from the North American Upper Cretaceous, testing two hypotheses of egg incubation: (1) full burial within sediments or vegetation and (2) partial burial with exposed upper egg portions. We divided and sampled the eggs in five zones, 1 through 5 from blunt top to more pointed bottom. A geometric model composed of a hemisphere, cone, and paraboloid was used to estimate total and zonal volumes and surface areas. The 138 × 67 mm idealized Troodon egg has a volume, surface area, and mass of 296.4 cm3, 239.23 cm2, and 314.2 g, respectively. Zonal surface areas and volumes highlight the strongly asymmetric and elongate form of the Troodon egg. Geometric modeling provides better estimates of volume and surface area where egg shape diverges markedly from that of a typical bird egg. Porosity varies significantly across both Troodon eggs, with zones 2 and 3 having the largest pores and a majority (70–78%) of total conductance, whereas zone 5 has very low conductance. Total water vapor conductance in the two eggs are 31.85 and 40.62 mg H2O day− Torr−, values 76% and 97% of those predicted for an avian egg of similar size. Low total conductance compares favorably to values in extant birds and non-avian reptiles that incubate in open nests, arguing against full burial incubation. Together with nesting site evidence, low conductance values favor partial burial and incubation by a Troodon adult. Asymmetric egg shape concentrates volume, surface area, and conductance near or at the point of subaerial exposure. Among non-avian dinosaurs, the eggs of Troodon and troodontids are most similar to those of modern birds in having an asymmetric shape, low porosity, no ornamentation, and three structural eggshell layers

Varricchio-Suppl Mat

Five tables on: 1) the gas conductance of an average Troodon egg from MOR 299 and 750, 2) the gas conductance of a weighted (by sample size) average Troodon egg from MOR 299 ad 750, 3) chi-square test results for for uniform pore distributions in MOR 299 and 750, 4) chi-square test results for pore distribution comparison of Troodon eggs MOR 750 and 299, and 5) chi-square test for uniform distribution for average Troodon egg

Study area map within the Otway Basin (grey box) off the coast of Victoria, Australia (inset).

<p>White dots indicate amber-bearing well locations including well names. Dark grey shading represents modern land; light grey represents continental crust.</p