Surgical infections
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Surgical infections · May 2019
Sweet and Sour: Impact of Early Glycemic Control on Outcomes in Necrotizing Soft-Tissue Infections.
Background: Necrotizing soft-tissue infection (NSTI) is a devastating disease associated with high rates of morbidity and mortality. Hyperglycemia is associated with poor wound healing; however, there are no studies evaluating glycemic control outcomes in patients with NSTI. The objective of this study was to examine disease progression and death in patients with NSTI who achieved early glycemic control (EGC) compared with patients that did not. Methods: A retrospective chart review of patients with NSTI was conducted between November 2011 and August 2017. ⋯ There was no significant difference in the primary outcome (83.3%% versus 84.3%; p > 0.99) or incidence of hypoglycemia (14.8% versus 23.5%; p = 0.32). Patients with EGC were more likely to return home after discharge (44.4% versus 23.5%; p = 0.039). Conclusion: Overall, there was no difference in composite clinical outcomes between patients with EGC and those without, although more patients who achieved EGC were discharged home. Patients with DM were less likely to achieve EGC.
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Surgical infections · Apr 2019
Case ReportsSpontaneous Hepatic Hemorrhage Caused by Emphysematous Cholecystitis: A Case Report and Literature Review.
Emphysematous cholecystitis and spontaneous hepatic hemorrhage are uncommon and serious conditions with non-specific presentations that can lead to a poor clinical outcome. We report a case of spontaneous hepatic hemorrhage of emphysematous cholecystitis. A 49-year-old male presented to the emergency department with fever, chills, right upper quadrant pain, vomiting, and diarrhea of four days' duration. He had a history of diabetes mellitus, hypertension, and uarthritis. Computed tomography (CT) revealed an enlarged gallbladder with intra-luminal, intra-mural, and peri-cholecystic air; subcapsular high-density fluid collection; and an intra-hepatic mass with gas and liquid in the right lobe of the liver. After receiving prompt administration of appropriate antibiotic agents, drainage, and an alternative operation the patient recovered well. ⋯ Emphysematous cholecystitis is potentially fatal because of its serious complications. It needs to be diagnosed promptly, not only based on the effervescent gallbladder sign but also on the inflammatory presentations. Furthermore, for patients with spontaneous hepatic hemorrhage, attention should be paid to the underlying cause. Treatment should be individualized to improve diagnosis and cure as early as possible, thereby improving prognosis.
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Surgical infections · Apr 2019
Impact of Intra-Operative Adverse Events on the Risk of Surgical Site Infection in Abdominal Surgery.
Intra-operative adverse events (iAEs) recently were shown to correlate independently with an increased risk of post-operative death, morbidity, re-admissions, and length of hospital stay. We sought to understand further the impact of iAEs on surgical site infections (SSIs) in abdominal surgical procedures and delineate which patient populations are most affected. We hypothesized that all patients with iAEs have an increased risk for SSI, especially those with pre-existing risk factors for SSI. ⋯ The iAEs are associated independently with increased SSIs, particularly in patients with less pre-existing risk factors for SSI. Preventing iAEs or mitigating their impact, once they occur, may help decrease the rate of SSIs.
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Surgical infections · Jan 2019
Emergency Surgery Score Accurately Predicts the Risk of Post-Operative Infection in Emergency General Surgery.
The Emergency Surgery Score (ESS) was validated recently as an accurate and user-friendly post-operative mortality risk calculator specific for Emergency General Surgery (EGS). ESS is calculated by adding one to three integer points for each of 22 pre-operative variables (demographics, co-morbidities, and pre-operative laboratory values); increasing scores accurately and gradually predict higher mortality rates. We sought to evaluate whether ESS can predict the occurrence of post-operative infectious complications in EGS patients. ⋯ The ESS accurately predicts the occurrence of post-operative infectious complications in EGS patients and could be used for pre-operative clinical decision-making as well as quality benchmarking of infection rates in EGS.
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Surgical infections · Nov 2018
ReviewAntiseptic Irrigation as an Effective Interventional Strategy for Reducing the Risk of Surgical Site Infections.
A surgical site infection (SSI) can occur at several anatomic sites related to a surgical procedure: Superficial or deep incisional or organ/space. The SSIs are the leading cause of health-care-associated infection (HAI) in industrialized Western nations. Patients in whom an SSI develops require longer hospitalization, incur significantly greater treatment costs and reduction in quality of life, and after selective surgical procedures experience higher mortality rates. ⋯ In an era of antibiotic stewardship, with a widespread prevalence of bacterial resistance to multiple antibiotic agents, there has emerged an interest in using intra-operative antiseptic irrigation to reduce microbial contamination in the surgical site before closure and possibly reduce the need for antibiotic agents. This approach has gained added appeal in an era of biomedical device implantation, especially with the recognition that most, if not all, device-related infections are associated with biofilm formation. This review focuses on the limited, evidence-based rationale for the use of antiseptic agents as an effective risk reduction strategy for prevention of SSIs.