Septic abdominal gossypiboma: A life threatening surgical site infection

2017 ◽  
Author(s):  
Carlos Augusto Gomes ◽  
Fausto Catena ◽  
Cleber Soares Junior ◽  
Massimo Sartelli ◽  
Salomone Di Saverio ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Venous Catheter ◽  
Clinical History ◽  
Site Infection ◽  
Female Age ◽  
Operative Removal ◽  
Triggered Reaction ◽  
Tract Perforation ◽  
Life Threatening ◽  
First Time

Gossypiboma is an uncommon surgical iatrogenic complication due to the retention of textile material inside natural cavities, especially in abdomen. An important aspect of gossypiboma is linked to the kind of inflammatory-triggered reaction: aseptic or pyogenic. In pyogenic reactions, granulomas and pus appear as a response to contaminated material left in the abdomen. Most patients are symptomatic, and clinical history and physical examination combined with computed tomography are essential to establish the diagnosis. The complication has similar pathophysiology from intra-abdominal abscess, however, has worse clinical course, poor prognosis and needs operative removal. Therefore, the gossypiboma deserves special attention and should be considered as a severe surgical site infection involving organs and/or spaces. Prevention is the key point to control the complication and is based on a systematic and systematized conference of such materials at the end of an operation. The purpose of this paper is to show for the first time all pathophysiologic steps of pyogenic gossypiboma. Moreover, to remind the risk factors associated to fungal infection (female, age, acute care unit stay, upper intestinal tract perforation, prolonged broad spectrum antibacterial therapy, parenteral nutrition and central venous catheter placement). At the same time, highlight that early antifungal therapy (Candida glabrata), should be kept in mind and should not be neglected as these was the agent involved in this patient’s death. Finally, alert the surgeons about this severe surgical site infection, which may lead to litigation.

scholarly journals Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England

2019 ◽  
Vol 101 (7) ◽  
pp. 463-471
Author(s):  
JLC Wong ◽  
CWY Ho ◽  
G Scott ◽  
JT Machin ◽  
TWR Briggs ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
National Survey ◽  
Financial Burden ◽  
Surgical Site Infections ◽  
Paediatric Surgery ◽  
Site Infection ◽  
Infection Rates ◽  
Infection Surveillance ◽  
Surgical Units ◽  
First Time

Introduction Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. Methods A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. Results Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. Conclusion The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.

Deep Wound Infection in Pediatrics after Open Cardiac Surgery

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Ayman Abd-Elhakeem Shoeb ◽  
Ashraf Abd-Elhameed El-Midany ◽  
Waleed Ismail Kamel Ibrahiem ◽  
Waleed Abd-Allah Abd-Elrazzak Atiea
Keyword(s):  
Health Care ◽  
Cardiac Surgery ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Wound Infection ◽  
Resistant Bacteria ◽  
Site Infection ◽  
Sternal Closure ◽  
Delayed Sternal Closure ◽  
Life Threatening

Abstract Surgical site infection (SSI) is a serious complication requiring prolonged hospitalization, intravenous antibiotics, wound care and dressings resulting in increased cost and resistant bacteria. In pediatric cardiac surgery, Median sternotomy is the most frequently used incision for the correction of congenital anomalies. Sternal wound infections (SWIs) are well described complications of cardiac surgery and can occur in 3% to 8% of children. Furthermore, the mortality rate can increase 2-fold after SSIs. Also, SSIs are associated with an increased length of hospital stay, readmissions, and higher health care expenditures. Mediastinitis is a retrosternal wound infection frequently associated with a macroscopically sternal osteomyelitis. Mediastinitis is uncomfortable for patients, is poorly accepted by parents, leads to a prolonged hospital stay repeated surgery and prolonged antibiotic therapy. Mediastinitis are costly for patients, providers, and health-care institutions. In A recent survey among congenital heart programs, the incidence of mediastinitis has been reported to occur in 0.2–1.4%. Gram-positive cocci are the most common pathogen. Gram negative organisms are increasingly recognized, especially in neonates, and are related to delayed sternal closure. Fungal organisms are not infrequently found. Mediastinitis generally presents 2–3 weeks after cardiac surgery. Child often appear irritable, tired, and febrile. The incision is erythematous and painful. Wound separation and purulent drainage from the incision are frequent. Some but not all will also have sternal instability or dehiscence. Associated bacteremia is not uncommon, present in up to 40% of patients. Postoperative mediastinitis is a life-threatening infection and increase health expenditure. Young age, malnutrition, hypothermia, hyperglycemia, longer duration of surgery, long time of delayed sternal closure, postoperative low cardiac output and long ICU stay were a risk factor of mediastinitis. Stick to1999 CDC's Guideline for prevention of surgical site infection and their update in 2017 especially proper timing of antibiotic prophylaxis and post-operative blood glucose management is important in prevention of these life-threatening complication. procalcitonin can be useful biologic marker of infection. Management of mediastinitis consist of debridement and culture-based antibiotics. Primary closure over mediastinal drain or high vacuum drain gave good result, less time consuming, more economic and more cosmetic. Vacuum assisted closure gave excellent result, but more time consuming, less economic and delayed closure is necessary. Larger studies are needed to compare both techniques in effectiveness and coast benefit.

scholarly journals Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

2015 ◽  
Vol 36 (12) ◽  
pp. 1431-1436 ◽  
Author(s):  
Kristen V. Dicks ◽  
Arthur W. Baker ◽  
Michael J. Durkin ◽  
Deverick J. Anderson ◽  
Rebekah W. Moehring ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Regression Models ◽  
Site Infection ◽  
Operative Duration ◽  
Binomial Regression ◽  
Hip And Knee Arthroplasty ◽  
American Society ◽  
Hip Arthroplasties ◽  
First Time

OBJECTIVETo determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties.DESIGNRetrospective cohort studySETTINGA total of 43 community hospitals located in the southeastern United States.PATIENTSAdults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012.METHODSLog-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age.RESULTSA total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P<.01).CONCLUSIONSShort operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.Infect. Control Hosp. Epidemiol. 2015;36(12):1431–1436

scholarly journals The role of antimicrobial sutures in preventing surgical site infection

2017 ◽  
Vol 99 (6) ◽  
pp. 439-443 ◽  
Author(s):  
D Leaper ◽  
P Wilson ◽  
O Assadian ◽  
C Edmiston ◽  
M Kiernan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Perioperative Period ◽  
Infection Prevention And Control ◽  
Site Infection ◽  
Skin Preparation ◽  
Life Threatening ◽  
Level I ◽  
The Uk ◽  
Healthcare Associated ◽  
And Control

INTRODUCTION Healthcare associated infections (HCAIs) are falling following widespread and enforced introduction of guidelines, particularly those that have addressed antibiotic resistant pathogens such as methicillin resistant Staphylococcus aureus or emergent pathogens such as Clostridium difficile, but no such decline has been seen in the incidence of surgical site infection (SSI), either in the UK, the EU or the US. SSI is one of the HCAIs, which are all avoidable complications of a surgical patient’s pathway through both nosocomial and community care. METHODS This report is based on a meeting held at The Royal College of Surgeons of England on 21 July 2016. Using PubMed, members of the panel reviewed the current use of antiseptics and antimicrobial sutures in their specialties to prevent SSI. FINDINGS The group agreed that wider use of antiseptics in surgical practice may help in reducing reliance on antibiotics in infection prevention and control, especially in the perioperative period of open elective colorectal, hepatobiliary and cardiac operative procedures. The wider use of antiseptics includes preoperative showering, promotion of hand hygiene, (including the appropriate use of surgical gloves), preoperative skin preparation (including management of hair removal), antimicrobial sutures and the management of dehisced surgical wounds after infection. The meeting placed emphasis on the level I evidence that supports the use of antimicrobial sutures, particularly in surgical procedures after which the SSI rate is high (colorectal and hepatobiliary surgery) or when a SSI can be life threatening even when the rate of SSI is low (cardiac surgery).

Risk Factors for Surgical Site Infection in Children

2006 ◽  
Vol 27 (7) ◽  
pp. 709-715 ◽  
Author(s):  
Juan Francisco Casanova ◽  
Rafael Herruzo ◽  
Jesús Díez
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Pediatric Patients ◽  
Risk Index ◽  
Venous Catheter ◽  
University Hospital ◽  
Site Infection ◽  
Convenience Sample ◽  
Peripheral Venous Catheter ◽  
Duration Of Surgery

Objectives.To assess the appropriateness of using the indices developed by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) project to determine risk factors for surgical site infection (SSI) in children and, if not appropriate, to explore the factors related to SSI in children so these factors could be used in a risk index for pediatric patients.Design.Cohort study during more than 4 years.Setting.La Paz University Hospital, a national reference center that serves Health Area 5 of Madrid, Spain, which has approximately 500,000 inhabitants.Patients.Convenience sample consisting of the 3,646 children admitted for surgery who had a postsurgical stay of more than 2 days.Results.A model with 8 predictive factors (degree of surgical contamination; duration of surgery; type of surgery; use of a peripheral venous catheter, central venous catheter, or urinary catheter; number of diagnoses; and SSI exposition time) was created. Its relation to the SSI rate was better than that of the SENIC or NNIS indices. Its sensitivity, specificity, and area under the receiver–operating characteristic curve were higher than that of the SENIC index.Conclusions.The model that we created seems to be more adequate for predicting SSI and evaluating pediatric patients' intrinsic risk than the SENIC and NNIS indices.

Sign in / Sign up

Export Citation Format

Share Document