scholarly journals Antibacterial Envelope Use for the Prevention of Surgical Site Infection in Spinal Cord Stimulator Implantation Surgery: A Retrospective Review of 52 Cases

2021 ◽  
Vol Volume 14 ◽  
pp. 2249-2254
Author(s):  
Jonathan M Hagedorn ◽  
Nicholas Canzanello ◽  
Markus A Bendel ◽  
Thomas P Pittelkow ◽  
Tim J Lamer
Keyword(s):  
Spinal Cord ◽  
Surgical Site Infection ◽  
Retrospective Review ◽  
Site Infection ◽  
Spinal Cord Stimulator

Perioperative Antibiotic Selection and Surgical Site Infection in Elective Colon Surgery

2020 ◽  
Vol 86 (9) ◽  
pp. 1091-1093
Author(s):  
Madiha Aziz ◽  
Jack Beale ◽  
Brynn Sheehan ◽  
Nicholas Bandy ◽  
Michael Martyak
Keyword(s):  
Surgical Site Infection ◽  
Retrospective Review ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Colon Surgery ◽  
Site Infection ◽  
Inclusion Criteria ◽  
Antibiotic Selection ◽  
Elective Colon Surgery ◽  
Elective Colon

Objectives The highest rates of surgical site infections (SSIs) are associated with colorectal operations (up to 30%). A sentinel paper showed that the use of intravenous (IV) cefazolin and metronidazole was associated with decreased rates of SSI compared with cefoxitin (6% vs 13%). We reviewed the association of SSI with prophylactic antibiotic choice. We specifically investigated the regimens of ceftriaxone and metronidazole IV, cefoxitin IV, or ertapenem. Methods We conducted a retrospective review of 532 colon surgeries between 2016 and 2018. Inclusion criteria were patients 18-89 years of age undergoing elective colon surgery who received ceftriaxone/metronidazole, cefoxitin, or ertapenem for prophylaxis. All emergent cases were excluded. This resulted in 241 elective colon cases for review. The primary endpoint was to determine if the use of ceftriaxone/metronidazole decreased the rate of SSI. Results In total, there were 241 elective colon cases with 21 SSI. We compared SSI rates in the ceftriaxone/metronidazole group to those patients receiving either cefoxitin or ertapenem (4.5% vs 12.2%; P = .035). We then compared SSI in ceftriaxone/metronidazole to SSI in cefoxitin (4.5% vs 10%; P = .13). Finally, we compared SSI in the ceftriaxone/metronidazole group to SSI in the ertapenem group (4.5% vs 14%; P = .03). Comorbidities and underlying factors were similar across all antibiotic groups. Conclusion In our experience, the use of ceftriaxone/metronidazole is associated with a decreased SSI rate. Furthermore, ceftriaxone/metronidazole use is superior to the use of ertapenem, with a trend toward superiority over cefoxitin. Based on this study, we recommend ceftriaxone/metronidazole as antibiotic prophylaxis for elective colon surgery.

Clinical significance of positive cranial bone flap cultures and associated risk of surgical site infection after craniotomies or craniectomies

2011 ◽  
Vol 114 (6) ◽  
pp. 1746-1754 ◽  
Author(s):  
Hsiu-yin Chiang ◽  
Victoria M. Steelman ◽  
Jean M. Pottinger ◽  
Annette J. Schlueter ◽  
Daniel J. Diekema ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Surgical Site Infection ◽  
Potential Risk ◽  
Retrospective Review ◽  
Common Source ◽  
Site Infection ◽  
Increased Risk ◽  
Skin Flora ◽  
Potential Risk Factors

Object The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures—especially those contaminated with Propionibacterium acnes—to assess the risk of SSI after reimplanting (either during the initial operation or subsequently) bone flaps with positive cultures, and to identify risk factors for SSI following the initial craniotomies or craniectomies. Methods The authors conducted a retrospective review of cases in which patients underwent craniotomy/craniectomy procedures between January and October 2007 in the neurosurgery department at the University of Iowa Hospitals and Clinics. They also reviewed processes and procedures and did pulsed field gel electrophoresis of P. acnes isolates to look for a common source of contamination. They then conducted a prospective cohort study that included all patients who underwent craniotomy/craniectomy procedures between November 2007 and November 2008 and met the study criteria. For the cohort study, the authors obtained cultures from each patient's bone flap during the craniotomy/craniectomy procedures. Data about potential risk factors were collected by circulating nurses during the procedures or by a research assistant who reviewed medical records after the procedures. An infection preventionist independently identified SSIs through routine surveillance using the Centers for Disease Control and Prevention's definitions. Univariate and bivariate analyses were performed to determine the association between SSI and potential risk factors. Results The retrospective review did not identify specific breaks in aseptic technique or a common source of P. acnes. Three hundred seventy-three patients underwent 393 craniotomy/craniectomy procedures during the cohort study period, of which 377 procedures met the study criteria. Fifty percent of the bone flaps were contaminated by microorganisms, primarily skin flora such as P. acnes, coagulase-negative staphylococci, and Staphylococcus aureus. Reimplanting bone flaps that had positive culture results did not increase the risk of infection after the initial craniotomy/craniectomy procedures and the subsequent cranioplasty procedures (p = 0.80). Allowing the skin antiseptic to dry before the procedures (p = 0.04, OR 0.26) was associated with lower risk of SSIs. Female sex (p = 0.02, OR = 3.49) was associated with an increased risk of SSIs; Gliadel wafer implants (p = 0.001, OR = 8.38) were associated with an increased risk of SSIs after procedures to treat tumors. Conclusions Operative factors such as the way the skin is prepared before the incision rather than the skin flora contaminants on the bone flaps may play an important role in the pathogenesis of SSIs after craniotomy/craniectomy. Gliadel wafers significantly increased the risk of SSI after procedures to treat tumors.

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