Surgical infections
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Surgical infections · Jun 2014
Review Meta AnalysisMeta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence.
A systematic literature review (SLR) and meta-analysis of surgical site infections (SSIs) after surgical incision closure with triclosan-coated sutures (TS) compared with non-antibacterial coated sutures (NTS) published previously by the authors suggested that fewer SSIs occurred in the TS study arm. However, the results were vulnerable to the removal of one key randomized controlled trial (RCT) because of insufficient data. Furthermore, recently published RCTs highlighted the need for an update of the SLR to challenge the robustness of results. ⋯ The two additional peer-reviewed double-blind RCTs of this update confirmed the predominant effect found in the authors' previous meta-analysis and established the robustness of conclusions that were lacking previously. This SLR and meta-analysis showed that the use of triclosan antimicrobial sutures reduced the incidence of SSI after clean, clean-contaminated, and contaminated surgery. The two additional peer-reviewed double blind RCTs reinforced the evidence level of this SLR (CEBM level 1a).
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Surgical infections · Jun 2014
Meta AnalysisGentamicin/collagen sponge use may reduce the risk of surgical site infections for patients undergoing cardiac operations: a meta-analysis.
A meta-analysis of all published randomized controlled trials of the effectiveness of gentamicin/collagen sponges for preventing surgical site infections (SSIs). ⋯ Use of gentamicin/collagen sponges was associated with a reduced risk of SSI following cardiac operations but not following colorectal procedures.
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Surgical infections · Jun 2014
Comparative StudyIdentifying risk factors for surgical site complications after laparoscopic ventral hernia repair: evaluation of the Ventral Hernia Working Group grading system.
In 2010, the Ventral Hernia Working Group (VHWG) published a grading system to assess the risk of surgical site complications in patients undergoing ventral hernia repair. This study evaluated the predictive value of the VHWG classification for the surgical outcomes of laparoscopic ventral hernia repair (LVHR) and identified independent factors associated with surgical site infection (SSI) and surgical site occurrence (SSO). ⋯ The VHWG classification was unable to predict SSI and SSO and may not be applicable in LVHR. This study identified independent factors associated with SSI and SSO in LVHR. Although further study is warranted to validate these results, the factors presented may be a useful tool to stratify patient risk of SSI and SSO with LVHR.
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Surgical infections · Jun 2014
Tumor necrosis factor-β Nco1 polymorphism and susceptibility to sepsis following major elective surgery.
Post-operative sepsis remains a substantial cause of morbidity and mortality. In injured patients, that a polymorphism of the gene for tumor necrosis factor-β (TNF-β) has been related to the development of sepsis. Genetic factors may also have a role in etio-pathogenesis of sepsis following surgery. We investigated the relationship of the polymorphism of the gene for TNF-β and the serum concentration of TNF-α to the development of sepsis after elective major surgery. ⋯ The development of sepsis was associated with a greater capacity to produce TNF-α after surgery. The Nco1 polymorphism of the TNF-β gene was associated with the development of post-operative sepsis with an increased serum concentration of TNF-α. In patients without post-operative sepsis, polymorphism of the TNF-β gene was not related to different levels of TNF-α production. This indicates an association between polymorphism of the TNF-β gene and post-operative sepsis, suggesting the TNFB2/B2 genotype as a high-risk factor for the development of sepsis after elective surgery.
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Surgical infections · Jun 2014
Risk factors for surgical site infection in emergency colorectal surgery: a retrospective analysis.
Since 2005, we have been conducting prospective surgical site infection (SSI) surveillance and infection control according to the U.S. Centers for Disease Control and Prevention guidelines for patients who undergo gastrointestinal surgery at our institution. Surgical site infection occurs with greater frequency in emergency than in elective surgery because of factors such as ill-conceived preoperative preparation and "dirty" operations. A large number of studies have been reported on risk factors for SSI in elective colorectal surgery; however, there are few papers on such factors in emergency colorectal surgery. The aim of this study was to identify risk factors for incisional SSI in emergency colorectal surgery. ⋯ The risk factors for incisional SSI in emergency colorectal surgery were incision contamination and obesity. Moreover, the incidence of incisional SSI among the incision class IV operations increased significantly with increasing extents of contamination. As a tactic for management of dirty abdominal wounds, we suggest that primary skin closure is suitable in cases of perforation of a prepared colon or colon perforation with localized contamination. On the other hand, in cases of colon perforation with generalized contamination, delayed primary skin closure or leaving an incision open to heal by secondary intention should be considered.