Surgical site infections and their prevention

Schweizer, Marin L.; Herwaldt, Loreen A.

doi:10.1097/qco.0b013e32835532f7

Cited by 13 publications

(7 citation statements)

References 54 publications

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“…Primary surgical site infections were the first and third most common source of infection-related readmission and similarly demonstrate the need for greater attention to processes of care. Relatively simple measures such as appropriate timing and dosing of antibiotics, attention to skin preparation, discontinuation of antibiotics after 24 hours, and hand washing have been demonstrated to reduce surgical site infections [18]. Unfortunately, previous studies have demonstrated that compliance with the aforementioned bundling strategies and process of care performance measures is poor [19].…”

Section: Commentmentioning

confidence: 99%

Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

Iribarne¹,

Chang²,

Alexander³

et al. 2014

The Annals of Thoracic Surgery

108

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Background Readmissions are a common problem in cardiac surgery. The goal of this study was to examine the frequency, timing, and associated risk factors for readmission after cardiac surgery. Methods 5,158 adult cardiac surgery patients (5,059 included in analysis) were prospectively enrolled in a 10center cohort study to assess risk factors for infection following cardiac surgery. Data were also collected on all-cause readmissions occurring within 65 days after surgery. Major outcomes included readmission rate stratified by procedure type, cause of readmission, length of readmission stay, and discharge disposition after readmission. Multivariable Cox regression was used to determine risk factors for time to first readmission. Results The overall rate of readmission was 18.7% (number of readmissions=945). When stratified by the most common procedure type, readmission rates were: isolated CABG (14.9%, n=248), isolated valve (18.3%, n=337), CABG + valve (25.0%, n=169). The three most common causes of first readmission within 30 days were: infection (17.1%, n=115), arrhythmia (17.1%, n=115), and volume overload (13.5%, n=91). More first readmissions occurred within 30 days (80.6%, n=672) than after 30 days (19.4%, n=162), and 50% of patients were readmitted within 22 days from index surgery. The median length of stay during the first readmission was 5 days. 15.8% (n=128) of readmitted patients were discharged to a location other than home. Baseline patient characteristics associated with readmission included: female gender, diabetes mellitus on medication, COPD, elevated creatinine, lower hemoglobin, and longer surgery time. In addition, the more complex surgical procedures were associated with increased risk of readmission compared to the CABG group. Conclusions Nearly 1 out of 5 patients who undergo cardiac surgery require readmission, an outcome with significant health and economic implications. Management practices to avert in-hospital infections, reduce post-operative arrhythmias, and avoid volume overload offer important targets for quality improvement.

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Section: Commentmentioning

confidence: 99%

Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

Iribarne¹,

Chang²,

Alexander³

et al. 2014

The Annals of Thoracic Surgery

108

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“…This depends on many factors such as an anatomy region, surgical approach, general condition of the patients, comorbidities and others. The most frequently isolated microorganisms of surgical site infection are: S. aureus, coagulase-negative staphylococci, Enterococcus spp., Gram-negative bacilli of the family Enterobacteriaceae (E. coli) or P. aeruginosa (Dierzanowska, 2008;Percival et al, 2012;Kim and Steinberg, 2012;Walter et al, 2012;Schweizer and Herwaldt, 2012).…”

Section: Discussionmentioning

confidence: 99%

In vitro studies of antibacterial and antifungal wound dressings comprising H2TiO3 and SiO2 nanoparticles

Krokowicz¹,

Tomczak²,

Bobkiewicz³

et al. 2015

Pol J Microbiol

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A b s t r a c tThe incidence rate of the infected and complex wound is established at approximately 40 000/1 million of the world's adult population. The aim of this study was to assess the efficiency of three novel types of wound dressings comprising sodium chloride, metatitanic acid and silicon dioxide nanoparticles. The study design was to prove their antimicrobial properties against the microorganisms most commonly causing wound infections. The study evaluated the antimicrobial effect of tested dressings on referenced strains of bacteria (ATCC collection, Argenta, Poland) and strains of fungi species (our own collection of fungi cultured from patients). The dressings were tested with both bacterial and fungal strains on solid media (Mueller-Hinton, Sobouraud, bioMerieux, France) in the standard method. The results confirmed the inhibition of growth of bacteria and revealed zones of inhibition for Escherichia coli, Staphylococcus aureus and Enterococcus faecalis. Significant zones of inhibition were established for Staphylococcus aureus and for fungi species of the Candida sp. These results would be crucial due to the fact of the low availability of antifungal therapeutics for both systemic and topical usage. Moreover, the current standard of antifungal treatment is associated with high costs and high toxicity in general. The preliminary results are very promising but further studies are necessary. Based on the obtained results, the tested dressings may contribute to the development of the surgical armamentarium of complex wound management in the near future.

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“…Administration of intranasal mupirocin to intensive care unit patients and to those undergoing surgery can reduce SSIs, be cost effective, and improve patient outcomes [19]- [24]. Prevention of even 20% of HAIs can save 5.7 -6.8 billion US dollars [8].…”

Section: Discussionmentioning

confidence: 99%

<i>In Vitro</i> Activities of Mupirocin, Tigecycline, Ceftaroline, Vancomycin, Linezolid and Daptomycin in Clinical Isolates of Methicillin-Resistant <i>Staphylococcus aureus</i> by E-Test Methodology

Chadha¹,

Mariano²,

LaBombardi³

et al. 2015

OJMM

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Introduction: In 2013, the Center for Disease Control (CDC) designated methicillin-resistant Staphylococcus aureus (MRSA) as a serious threat. In addition to its intrinsic virulence, MRSA has become resistant to numerous antibacterial agents. In many instances, mupirocin is used empirically to decolonize patients harboring MRSA to decrease the possibility of progression to disease. In vitro susceptibility information is critical to identify patients who would benefit from use of mupirocin for decolonization and treatment of infections caused by MRSA. Methods: One-hundred and sixty-three recent MRSA single patient clinical isolates were collected from the Clinical Microbiology Laboratory. In-vitro susceptibility testing was performed using E-test methodology for tigecycline, ceftaroline, daptomycin, vancomycin, linezolid, and mupirocin. Results: Of the 163 MRSA isolates tested, >99% demonstrated susceptibility to tigecycline, ceftaroline, daptomycin, vancomycin, and linezolid. Seventy (43%) had vancomycin MICs ≥ 1.5 µg/ml, twenty-four isolates (15%) were resistant to mupirocin, and three appeared to express mupirocin hetero-resistance. Conclusion: While antibiotic susceptibility to mupirocin is not routinely performed in clinical microbiology laboratories, the level of resistance to mupirocin identified in this surveillance study suggests that susceptibility testing should be added to routine MRSA panels.

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Surgical site infections and their prevention

Cited by 13 publications

References 54 publications

Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

In vitro studies of antibacterial and antifungal wound dressings comprising H2TiO3 and SiO2 nanoparticles

<i>In Vitro</i> Activities of Mupirocin, Tigecycline, Ceftaroline, Vancomycin, Linezolid and Daptomycin in Clinical Isolates of Methicillin-Resistant <i>Staphylococcus aureus</i> by E-Test Methodology

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Surgical site infections and their prevention

Cited by 13 publications

References 54 publications

Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

In vitro studies of antibacterial and antifungal wound dressings comprising H2TiO3 and SiO2 nanoparticles

&lt;i&gt;In Vitro&lt;/i&gt; Activities of Mupirocin, Tigecycline, Ceftaroline, Vancomycin, Linezolid and Daptomycin in Clinical Isolates of Methicillin-Resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; by E-Test Methodology

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<i>In Vitro</i> Activities of Mupirocin, Tigecycline, Ceftaroline, Vancomycin, Linezolid and Daptomycin in Clinical Isolates of Methicillin-Resistant <i>Staphylococcus aureus</i> by E-Test Methodology