Impact of High-Intensity Ultrasound on Strength of Surgical Mesh when Treating Biofilm Infections

The use of cavitation-based ultrasound histotripsy to treat infections on surgical mesh has shown great potential. However, any impact of the therapy on the mesh must be assessed before the therapy can be applied in the clinic. The goal of this study was to determine if the cavitation-based therapy would reduce the strength of the mesh thus compromising the functionality of the mesh. First, S. aureus biofilms were grown on surgical mesh samples and exposed to high-intensity ultrasound pulses. For each exposure, the effectiveness of the therapy was confirmed by counting the number of colony forming units (CFUs) on the mesh. Most of the exposed meshes had no CFUs with an average reduction of 5.4-log10 relative to the sham exposures. To quantify the impact of the exposure on mesh strength, the force required to tear the mesh and the maximum mesh expansion before damage were quantified for control, sham, and exposed mesh samples. There was no statistical difference between the exposed and sham/control mesh samples in terms of ultimate tensile strength and corresponding mesh expansion. The only statistical difference was with respect to mesh orientation relative to the applied load. The tensile strength increased by 1.36 N while the expansion was reduced by 1.33 mm between the different mesh orientations

GPTArticleExtractor: An Automated Workflow for Magnetic Material Database Construction

A comprehensive database of magnetic materials is valuable for researching the properties of magnetic materials and discovering new ones. This article introduces a novel workflow that leverages large language models for extracting key information from scientific literature. From 22,120 articles in the Journal of Magnetism and Magnetic Materials, a database containing 2,035 magnetic materials was automatically generated, with ferromagnetic materials constituting 76% of the total. Each entry in the database includes the material's chemical compounds, as well as related structures (space group, crystal structure) and magnetic temperatures (Curie, N'eel, and other transitional temperatures). To ensure data accuracy, we meticulously compared each entry in the database against the original literature, verifying the precision and reliability of each entry

National Cohort Study of Preoperative Bacteriuria, Surgical Prophylaxis, and Postoperative Outcomes

Abstract Background: Despite recommendations against screening urine for bacteriuria prior to non-urological surgery, it is still a common practice. If the urine culture (Ucx) is positive, clinicians often feel compelled to give targeted therapy or expand the peri-operative prophylaxis (PPX) regimen to cover the urinary organism. Large multicenter studies are lacking. We aimed to evaluate rates and results of preoperative urine screening and postoperative outcomes among a national cohort of surgical patients. Methods: All patients who underwent cardiac, orthopedic implant, or vascular surgery within the national VA health care system during the period from 10/1/08–9/30/13 and had the PPX regimen manually validated were included. Rates of positive Ucx and wound cultures during the 90-day post-operative period were compared between patients with and without pre-operative bacteriuria. Among patients with a positive pre-op urine culture the association between activity of surgical PPX and positive post-op cultures was evaluated. Results: N = 78,810 surgeries were evaluated (21,889 cardiac, 46,565 orthopedic implant, 10,356 vascular). A pre-op Ucx was performed in 26% (Fig); of these, 6.6% were positive and 852 (63%) received PPX active against the uropathogen. Positive pre-op Ucx was associated with higher rates of positive post-op Ucx and wound cultures (Fig). Among patients who received active PPX, post-op Ucx was positive in 46% compared with 39% who received inactive PPX. The rate of post-op wound cultures was not different between patients who received active (25%) vs. inactive (24%) PPX. The pre-op and post-op organisms were the same in 117/221 (52.9%) Ucx and 17/104 (16.3%) wound cultures, respectively. PPX activity did not affect the match rate. Conclusion: This is the largest, multicenter study demonstrating no difference in post-op urine and wound cultures in patients receiving active vs. inactive surgical PPX for pre-op bacteriuria. Prevalence of bacteriuria was similar to other surgical populations. Limitations include predominantly male population and need for further characterization of pre-op antibiotic therapy and UTI and SSI outcomes. Disclosures All authors: No reported disclosures

C. difficile Screening for Colonization among Surgical Ward Admissions Is Feasible and Useful

Abstract Background: Identification of patients colonized with C. difficile (CDcol) upon admission and initiation of precautions has been shown to decrease hospital-acquired C. difficileinfection (HA-CDI) in a recent study. We implemented a quality improvement program screening new admissions to a surgical service and evaluated risk factors and outcomes associated with CDcol. Methods: Prospective cohort of all patients admitted to the surgical wards including ICU over a 6 month period 10/16–4/17. Upon admission, a perirectal swab was sent for C diff PCR. Patients with positive screens were placed on contact precautions. CDcol patients were not treated. Testing for CDI was done as usual practice only in patients with diarrhea. Main outcome was prevalence of CDcol and relationship to HA-CDI. Results: Of 708 surgical admissions, 585 (82.6%) patients were screened, 543 were eligible based on first admission; 19 (3.5%) were colonized. Recent surgical hospitalization (OR 13.2, 95% CI 3.4;52.1) and prior CDI (OR 19.5, 95% CI 2.9;127.7) were independent risk factors for CDcol. Antibiotic and PPI use were not associated. Of those with CDcol, 7 developed CDI (36.8%) compared with 5/524 (0.9%) screen negative patients (adj OR 60, 95% CI 12.6;286). CDcol combined with a prior h/o CDI allowed for detection of 8/12 (75%) cases of HA-CDI compared with 3/12 (25%) if only prior history was available. HA-CDI rates on surgical wards after one month post-implementation were 9.3/10,000 bed days of care compared with 12.2 in 2016 and 12.8 in 2015. No delays in bed flow were identified. Conclusion: Admission CDcol prevalence was low in our surgical VA population but was strongly associated with development of HA-CDI. Prior CDI was the strongest risk factor for CDcol and HA-CDI. Knowledge of prior CDI and CDcol status identified 75% of patients who developed CDI, 3 times more than knowledge of prior CDI alone. In certain settings, CDcol screening could improve detection and early isolation of potential CDiff spreaders. Implementation required significant support from administration, nursing and the laboratory, and was successful based on screening percentage without impact on bed flow. Impact on facility CDI rates remains to be fully demonstrated. Disclosures All authors: No reported disclosures

Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms

Background The Accreditation Council for Graduate Medical Education (ACGME) implemented duty hour regulations for residents in 2003 and again in 2011. While previous studies showed no systematic impacts in the first 2 years post-reform, the impact on mortality in subsequent years has not been examined. OBJECTIVE To determine whether duty hour regulations were associated with changes in mortality among Medicare patients in hospitals of different teaching intensity after the first 2 years post-reform. DESIGN Observational study using interrupted time series analysis with data from July 1, 2000 to June 30, 2008. Logistic regression was used to examine the change in mortality for patients in more versus less teaching-intensive hospitals before (2000–2003) and after (2003–2008) duty hour reform, adjusting for patient comorbidities, time trends, and hospital site. PATIENTS Medicare patients (n  = 13,678,956) admitted to short-term acute care non-federal hospitals with principal diagnoses of acute myocardial infarction (AMI), gastrointestinal bleeding, or congestive heart failure (CHF); or a diagnosis-related group (DRG) classification of general, orthopedic, or vascular surgery. MAIN MEASURE All-location mortality within 30 days of hospital admission. KEY RESULTS In medical and surgical patients, there were no consistent changes in the odds of mortality at more vs. less teaching intensive hospitals in post-reform years 1–3. However, there were significant relative improvements in mortality for medical patients in the fourth and fifth years post-reform: Post4 (OR 0.88, 95 % CI [0.93–0.94]); Post5 (OR 0.87, [0.82–0.92]) and for surgical patients in the fifth year post-reform: Post5 (OR 0.91, [0.85–0.96]). CONCLUSIONS Duty hour reform was associated with no significant change in mortality in the early years after implementation, and with a trend toward improved mortality among medical patients in the fourth and fifth years. It is unclear whether improvements in outcomes long after implementation can be attributed to the reform, but concerns about worsening outcomes seem unfounded

Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons

Despite concerns that duty hour reform might adversely affect the performance of new surgeons, this national study found no impact on patient outcomes, including 30-day mortality rates, failure-to-rescue, length of stay, and use of intensive care units. These findings should allay fears that reduced work hours during residency would produce surgeons less prepared for practice than their more experienced colleagues

Knowledge, awareness, and attitude towards infection prevention and management among surgeons: identifying the surgeon champion

Abstract Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.https://deepblue.lib.umich.edu/bitstream/2027.42/145433/1/13017_2018_Article_198.pd

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.Peer reviewe