Development of the Bacterial Spectrum and Antimicrobial Resistance in Surgical Site Infections of Trauma Patients

2020 ◽  
Vol 21 (8) ◽  
pp. 684-693 ◽  
Author(s):  
Rico Eisner ◽  
Norman Lippmann ◽  
Christoph Josten ◽  
Arne C. Rodloff ◽  
Daniel Behrendt
Keyword(s):  
Antimicrobial Resistance ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Bacterial Spectrum

Antimicrobial Resistance Nosocomial Strains of Enterobacter spp. in Ukrainian surgical Hospitals: results of multicenter study

2018 ◽  
Vol 2 (4) ◽  
pp. 39-45
Author(s):  
A.G. Salmanov ◽  
O.M. Verner
Keyword(s):  
Antimicrobial Resistance ◽  
Multicenter Study ◽  
Antimicrobial Susceptibility ◽  
National Level ◽  
Surgical Site Infections ◽  
Hospital Record ◽  
Antimicrobial Susceptibility Test ◽  
Local Data ◽  
Epidemiologic Surveillance ◽  
Medical Institutions

Objective. To determine activity of antimicrobials against Enterobacter spp. isolated from patients hospitalized to surgical departments in different Ukrainian hospitals. Materials and methods. A total of 3991 Enterobacter spp. isolated from patients with surgical site infections in 24 surgical hospitals in 17 Ukrainian regions. The identification and antimicrobial susceptibility of Enterobacter spp. were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results. The most potent antimicrobials were imipenem, meropenem, cefixime and amikacinum. The high rates of resistance were found to penicillin (46,2%), ampicillin/sulbactam (42,9%), gentamicin (40,4%), ceftazidime (39,4%), ampicillin (38,2%), and cefuroxime (36,3%). Conclusions. (1) Resistance of nosocomial strains of Enterobacter spp. at in patient medical institutions, that are subject to research, is a serious therapeutic and epidemiologic issue. Imipenem, meropenem, cefixime and amikacinum have been the most active to nosocomial strains of Enterobacter spp. (2) Taking into account resent changes and resistance levels of nosocomial strains of Enterobacter spp., which take place in various regions, constant monitoring over resistance to antimicrobials at every in patient medical institution is required. Also, hospital record sheets of antibiotics should be elaborated based upon the local data received. (3) Antibiotics utilization policy in each surgical in patient institution should be determined based in accordance with the local data on resistance to antimicrobials. (4) System of epidemiologic surveillance over antimicrobial resistance should be established on the local, regional, and national level.

scholarly journals Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

2020 ◽  
Vol 41 (S1) ◽  
pp. s397-s398
Author(s):  
Ayush Lohiya ◽  
Samarth Mittal ◽  
Vivek Trikha ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
...  
Keyword(s):  
Surveillance System ◽  
Trauma Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Care Hospital ◽  
Middle Income ◽  
Predominant Pathogen ◽  
Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

Diabetes Mellitus Influencing the Bacterial Species in Surgical Site Infections of Orthopedic Trauma Patients

2021 ◽  
Vol 30 (1) ◽  
Author(s):  
Rico Angeli ◽  
Norman Lippmann ◽  
Arne C. Rodloff ◽  
Johannes K. M. Fakler ◽  
Daniel Behrendt
Keyword(s):  
Diabetes Mellitus ◽  
Bacterial Species ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Orthopedic Trauma

Anastomotic Outcomes in Military Exploratory Laparotomies in the Modern Combat Era

2022 ◽  
pp. 000313482110502
Author(s):  
Patrick F. Walker ◽  
Joseph D. Bozzay ◽  
David W. Schechtman ◽  
Faraz Shaikh ◽  
Laveta Stewart ◽  
...  
Keyword(s):  
Medical Center ◽  
Damage Control ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Intestinal Anastomoses ◽  
Military Hospitals ◽  
Anastomotic Failure ◽  
Significant Difference ◽  
Regional Medical Center ◽  
Outcome Differences

Background Intestinal anastomoses in military settings are performed in severely injured patients who often undergo damage control laparotomy in austere environments. We describe anastomotic outcomes of patients from recent wars. Methods Military personnel with combat-related intra-abdominal injuries (June 2009-December 2014) requiring laparotomy with resection and anastomosis were analyzed. Patients were evacuated from Iraq or Afghanistan to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals. Results Among 341 patients who underwent 1053 laparotomies, 87 (25.5%) required ≥1 anastomosis. Stapled anastomosis only was performed in 57.5% of patients, while hand-sewn only was performed in 14.9%, and 9.2% had both stapled and hand-sewn techniques (type unknown for 18.4%). Anastomotic failure occurred in 15% of patients. Those with anastomotic failure required more anastomoses (median 2 anastomoses, interquartile range [IQR] 1-3 vs. 1 anastomosis, IQR 1-2, P = .03) and more total laparotomies (median 5 laparotomies, IQR 3-12 vs. 3, IQR 2-4, P = .01). There were no leaks in patients that had only hand-sewn anastomoses, though a significant difference was not seen with those who had stapled anastomoses. While there was an increasing trend regarding surgical site infections (SSIs) with anastomotic failure after excluding superficial SSIs, it was not significant. There was no difference in mortality. Discussion Military trauma patients have a similar anastomotic failure rate to civilian trauma patients. Patients with anastomotic failure were more likely to have had more anastomoses and more total laparotomies. No definitive conclusions can be drawn about anastomotic outcome differences between hand-sewn and stapled techniques.

scholarly journals The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

2020 ◽  
Vol 9 (12) ◽  
pp. 4006
Author(s):  
Thomas Lustenberger ◽  
Simon Lars Meier ◽  
René Danilo Verboket ◽  
Philipp Störmann ◽  
Maren Janko ◽  
...  
Keyword(s):  
Complication Rate ◽  
Surgical Outcomes ◽  
Surgical Complications ◽  
Situational Awareness ◽  
Surgical Complication ◽  
Surgical Site Infections ◽  
Care Bundle ◽  
Trauma Patients ◽  
Complication Rates ◽  
Time Period

Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.

scholarly journals Retrospective analysis of antimicrobial resistance and bacterial spectrum of infection in Gabon, Central Africa

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Abraham S Alabi ◽  
Lisa Frielinghaus ◽  
Harry Kaba ◽  
Katrin Kösters ◽  
Michaëla A M Huson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Retrospective Analysis ◽  
Central Africa ◽  
Bacterial Spectrum

scholarly journals Implementing a Combined Infection Prevention and Control with Antimicrobial Stewardship Joint Program to Prevent Caesarean Section Surgical Site Infections and Antimicrobial Resistance: a Tanzanian Tertiary Hospital Experience

2020 ◽  
Author(s):  
Elisa Gentilotti ◽  
Pasquale De Nardo ◽  
Boniface Nguhuni ◽  
Alessandro Piscini ◽  
Caroline Damian ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Caesarean Section ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Surgical Site Infections ◽  
Tertiary Hospital ◽  
Infection Prevention And Control ◽  
Post Intervention ◽  
Combined Infection ◽  
And Control

Abstract Background. Surgical site infections are a leading cause of morbidity and mortality after caesarean section, especially in Low and Middle Income Countries. We hypothesized that a combined infection prevention and control with antimicrobial stewardship joint program would decrease the rate of post- caesarean section surgical site infections at the Obstetrics & Gynaecology Department of a Tanzanian tertiary hospital. Methods. The intervention included: 1. formal and on-job trainings on infection prevention and control; 2. evidence-based education on antimicrobial resistance and good antimicrobial prescribing practice. A second survey was performed to determine the impact of the intervention. The primary outcome of the study was post-caesarean section surgical site infections prevalence and secondary outcome the determinant factors of surgical site infections before/after the intervention and overall. The microbiological characteristics and patterns of antimicrobial resistance were ascertained.Results. Total 464 and 573 women were surveyed before and after the intervention, respectively. After the intervention, the antibiotic prophylaxis was administered to a significantly higher number of patients (98% vs 2%, p<0.001), caesarean sections were performed by more qualified operators (40% vs 28%, p=0.001), with higher rates of Pfannenstiel skin incisions (29% vs 18%, p<0.001) and of absorbable continuous intradermic sutures (30% vs 19%, p<0.001). The total number of post-caesarean section surgical site infections was 225 (48%) in the pre-intervention and 95 (17%) in the post intervention group (p<0.001). A low prevalence of gram-positive isolates and of methicillin-resistant Staphylococus aureus was detected in the post-intervention survey. Conclusions. Further researches are needed to better understand the potential of a hospital-based multidisciplinary approach to surgical site infections and antimicrobial resistance prevention in resource-constrained settings.

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