Diagnosis and Management of Surgical Site Infections: Narrative Review

Infection of the wound after surgery is a regular occurrence. Wound infection is a complicated process that involves a molecular interplay between numerous biological processes. Wound infections are associated with a high rate of morbidity and mortality. Surgical site infections are a common surgical complication that affects approximately 3%-6% of all surgical procedures according to different studies. Surgical site infections (SSIs) cause negative consequences in patients, such as prolonged hospitalization and mortality. Each incision causes wound contamination, however there are established techniques to reduce the incidence of SSI. Improved adherence to evidence-based preventative strategies such as adequate antibiotic prophylaxis, in particular, can help to reduce the rate of SSI. The sort of procedure used determines the correct diagnosis of SSI. Early detection, on the other hand, is critical for good management of all surgical operations. Consistent antibiotic therapy, wound drainage, and, if necessary, vigorous wound debridement are all part of the treatment for SSI. Following that, wound management is determined by the location and nature of the infection. This study aims to: Diagnosis and Management of Surgical Site Infections. In this review we will be looking at surgical site infections epidemiology, etiology, diagnosis and management.

Efficacy of Norway Spruce Ointments and Bacterial and Fungal Alterations in the Treatment of Castration Wounds in Piglets

This study aimed to evaluate the efficacy of Norway spruce ointments on wound healing of castration wounds in piglets. This study included 95 male pigs randomly divided into five treatment groups: Norway spruce balm (Vulpuran), Norway spruce resin (Abilar), pork lard (ointment base of Vulpuran), no treatment (negative control) and antibiotic blue spray (Cyclo spray, positive control). Wound healing parameters (such as healing time, wound size, reddening of wound edges and surrounding, swelling, secretion and wound contamination), microbiological status and the haptoglobin level as an inflammation parameter were investigated. In the Norway spruce groups, some positive effects on wound healing parameters were found. In the first 6 days of treatment, Abilar or Vulpuran showed the smallest means of wound areas, and at the end of the study (day 15 + 17), the highest rates of completely closed wounds compared to the other groups. Vulpuran treatment led to significantly lower wound secretion (p = 0.003) and wound contamination (p = 0.015) than the untreated control did. Furthermore, the microbiological status was determined using MALDI-TOF-MS and partial 16S rRNA gene sequencing at different days of treatment. A comparison of the five treatment groups on day 3 revealed that Norway spruce led to the lowest rate of wounds colonised with fungi, mainly classified into genus Candida, (Abilar 77%, Vulpuran 70%) in comparison with blue spray (89%), lard (100%) and untreated control (100%). Fungi could only be detected in one of the 13 samples treated with Vulpuran on day 8, which nearly reached significance (p = 0.055).

Physicochemical Investigations of Hydrogels Containing Gold Nanoparticles Designed for Biomedical Use

Currently, many investigations are being performed to develop dressing materials with a positive effect on the wound healingprocess. In general, innovative dressings should ensure wound exudate absorption, constitute an external barrier limiting thepossibility of wound contamination and, importantly, also provide therapeutic properties. This work is focused on obtainingmaterials with potential use as dressings for treatment of difficult-to-heal wounds. The synthesis methodology of acrylic hydrogelsmodified with selected modifiers, i.e. arabic gum, nanogold, bee pollen and chamomile extract, was developed. Next, thesorption properties of the materials were determined as well as their behavior during the incubation in fluids imitating theenvironment of the human body. Additionally, the impact of such an incubation on their structure was evaluated by FT-IR spectroscopy.It was proved that the modifiers affected the sorption properties of hydrogels, i.e. samples with additives showed evenapprox. 2.5-fold lower swelling ability. In turn, incubation of hydrogels in simulated body fluids did not cause any rapid changesin pH, which may indicate the biocompatibility of the tested materials with the tested fluids. Thus, it may be concluded that thedeveloped materials show great application potential for biomedical purposes and may be subjected to more advanced studiessuch as cytotoxicity assessments towards selected cell lines.

The Role of the Gastrointestinal Tract in Toxigenic Clostridium tetani Infection: A Case-Control Study

Tetanus arises from wound contamination with Clostridium tetani, but approximately one fifth of patients have no discernable entry wound. Clostridium tetani is culturable from animal feces, suggesting the gastrointestinal tract could be an endogenous reservoir or direct-entry portal, but human data are lacking. In this study of 101 Vietnamese adults with tetanus and 29 hospitalized control subjects, admission stool samples were cultured for C. tetani. Anti-tetanus toxin antibodies were measured by ELISA. Clostridium tetani toxigenicity was evaluated using polymerase chain reaction and sequencing. Toxigenic C. tetani was cultured from stool samples in 50 of 100 (50%) tetanus cases and 12 of 28 (42.9%) control subjects (P = 0.50), and stool samples of 44 of 85 (52.4%) tetanus cases with clinically identified wounds compared with 6 of 15 (47.6%) patients without clinically identified wounds (P = 0.28). Nine of 12 (75%) control subjects with toxigenic C. tetani in their stool samples lacked protective antibody concentrations. These findings fail to show evidence of an association between gastrointestinal C. tetani and tetanus infection, but emphasize the importance of increasing vaccination coverage.

A PROSPECTIVE CLINICO- BACTERIOLOGICAL STUDY OF SURGICAL SITE INFECTION AT PBM HOSITAL

Background: This study aims at determining the risk factors and incidence of surgical site infections. Methods: The material for the present study was obtained from patient’s undergone surgery in Department of General Surgery, SPMC and PBM Hospital, Bikaner, Rajasthan from 1st Jan 2019 to 31th December, 2019. Surgical site were considered to be infected according to the definition by NNIS. The wounds were classified according to the wound contamination class system proposed by U.S. National Research Council. Results: A study of 400 operated cases was carried out of which 39 were diagnosed to be having surgical site infection as per the CDC criteria. Thus the incidence of SSI in this study is 9.75%. Conclusion: Incidence of surgical site infection was more in emergency surgery case as compare to elective. Keywords: SSI, Emergency, Elective

Treating Facial Cuts to a Near Scar Less Outcome in Children

Background: Facial Lacerations constitute an important reason for children (< 18 years) to visit emergency room. While bleeding and pain are the associated acute problems, the long term outcome in terms of a cosmetically acceptable scar is a matter of significant parental concern. The aim of the research is to study the profile of facial lacerations in children and to assess the outcome of repair. Materials and Methods: A retrospective review of children who underwent facial laceration repair between January 2018 and December 2020 was done. The deep ones underwent sutured repair in layers reinforced withtissue adhesive in operation room under intra-venous anesthesia and superficial ones in emergency room with only tissue adhesive following usual wound treatment protocol. Demographics, surgical details and outcomes were studied. All the repaired cuts were followed up at 1 year retrospectively and the cosmetic outcome was evaluated using modified stony brooke scoring system. Results: A total of 40 patients (24 males, 16 females) underwent facial laceration repair at a mean age of 4.7 years (range 1-13 years). Seventeen were deep and 23 were superficial cuts. Only1child in the superficial group with gross wound contamination at presentation developed wound infection. No dissatisfaction was reported in the deep group while parents of 4 children in the superficial group reported dissatisfaction with the final scar. Conclusion: While surface cuts can be treated with irrigations and tissue adhesive in the emergency room, the deeper cuts require layered repair aided by tissue adhesive for optimum scar outcome.

Multicomponent coating in purulent wound healing: A randomised controlled experimental study

Background. Purulent wound healing is a pressing surgical challenge relevant in 30−35% of patient cases. To the more, wound infectious agents elaborate resistance to available drugs warranting the development of new drug combinations exserting a multidirectional effect on the wound process.Objective. Using a purulent wound model to experimentally evaluate the efficiency of a new multicomponent wound coating comprised of polyethylene oxide and carboxymethylcellulose sodium-immobilised dioxidine, methyluracil, metronidazole and lidocaine hydrochloride in comparison with a legal approved wound coating drug preparation of beeswax and propolis-based dioxidine ointment.Methods. The antimicrobial activity range (disk-diffusion method) and local anaesthetic effect (Rainier’s method) of the developed wound coating have been assessed. The healing process was studied in a purulent wound model with 72 Wistar rats divided between two equal groups. The following methods were applied: visual wound inspection (wound cleansing time, absence of wound-surrounding tissue oedema, granulation and epithelisation), planimetric parameter estimation (wound area, healing rate, wound area reduction ratio), wound contamination and pH measurement, wound section cell morphometry (granulocyte, macrophage, lymphocyte and fibroblast counts, cell index estimation). Daily dressings were applied for 15 days.Results. The developed wound coating exhibited high efficiency against Gram-positive and Gram-negative bacteria in the zone of inhibition tests. Its local anaesthetic effect was significantly superior to the approved drug by the duration of action. The wound area reduction was 94.2 (93.7; 94.8)% in the experimental group and 86 (84.2; 88.8)% in the control (differences statistically significant) already on day 10. A maximal healing rate in both groups was registered in phase 1 of the wound process being 1.4 times higher in experiment compared to the control. The wound contamination was significantly lower in experiment vs. control on day 8 (p = 0.0075). Wound pH negatively correlated with the fibroblast count and positively — with the contamination level.Conclusion. The study demonstrates high efficiency of the developed wound coating against infectious agents and its positive healing impact via reducing phase 1 and stimulating proliferation in phase 2 of the wound process.

Comparison of Local and Systemic DTPA Treatment Efficacy According to Actinide Physicochemical Properties Following Lung or Wound Contamination in the Rat

Purpose: In cases of occupational accidents in nuclear facilities or subsequent to terrorist activities, the most likely routes of internal contamination with alpha-particle emitting actinides, such as plutonium (Pu) and americium (Am), are by inhalation or following wounding. Following contamination, actinide transfer to the circulation and subsequent deposition in skeleton and liver depends primarily on the physicochemical nature of the compound. The treatment remit following internal contamination is to decrease actinide retention and in consequence potential health risks, both at the contamination site and in systemic retention organs as well as to promote elimination. The only approved drug for decorporation of Pu and Am is the metal chelator diethylenetriaminepentaacetic acid (DTPA). However, a limited efficacy of DTPA has been reported following contamination with insoluble actinides, irrespective of the contamination route. The objectives of this work are to evaluate the efficacy of prompt local and/or systemic DTPA treatment regimens following lung or wound contamination by actinides with differing solubility. The conclusions are drawn from retrospective analysis of experimental studies carried out over 10 years.Materials and Methods: Rat lungs or wounds were contaminated either with poorly soluble Mixed OXide (U, Pu O2) or more soluble forms of Pu (nitrate or citrate). DTPA treatment was administered promptly after contamination, locally to lungs by insufflation of a powder or inhalation of aerosolized solution or by injection directly into the wound site. Intravenous injections of DTPA were given either once or repeated in combination with the local treatment. Doses ranged from 1 to 30 µmol/kg. Animals were euthanized from day 7–21 and alpha activity levels were measured in urine, lungs, wound, bone and liver for determination of decorporation efficacy.Results: Different experiments confirmed that whatever the route of contamination, most of the activity is retained at the entry site after insoluble MOX contamination as compared with contamination with more soluble forms which results in very low activities reaching the systemic compartment and subsequent retention in bone and liver. Several DTPA treatment regimens were evaluated that had no significant effect on either lung or wound levels compared with untreated animals. In contrast, in all cases systemic retention (skeleton and liver) was reduced and urinary excretion were enhanced irrespective of the contamination route or DTPA treatment regimen.Conclusion: The present study demonstrates that despite limitation of retention in systemic organs, different DTPA protocols were ineffective in removing insoluble actinides deposited in lungs or wound site. For moderately soluble actinides, local or intravenous DTPA treatment reduced activity levels both at contamination and at systemic sites.