BACKGROUND:Extended post antibiotics do not reduce infectious complications after traumatic facial injuries or elective clean-contaminated head and neck operation. However, the optimal duration of antibiotic prophylaxis following operative repair of traumatic neck aerodigestive injuries remains uncertain. This study compared outcomes between perioperative (≤24 hours) and extended (>24 hours) antibiotic prophylaxis and hypothesized that extended prophylaxis would not reduce local infectious complications. METHODS:Using a Level I and II university-based trauma system registry, patients undergoing operative repair of traumatic neck aerodigestive injuries (oropharynx, hypopharynx, larynx, esophagus, and trachea) were identified over an 8-year period (2017-2024). Demographics, injury characteristics, management strategies, and antibiotic use were collected. Patients were stratified by antibiotic prophylaxis duration (perioperative vs. extended). The primary outcome was local infectious complications. Secondary outcomes included leak, stenosis, reintervention, length of stay, and mortality. RESULTS:Sixty-five patients with operative penetrating or blunt neck aerodigestive injuries were identified: 35 received perioperative antibiotics and 30 received an extended course. Most injuries were penetrating (93.8%). Extended antibiotics were prescribed more frequently in older patients (40.5 vs. 29 years, p < 0.01), while injury characteristics and adjunctive management strategies were otherwise similar. Local infectious complication rates did not differ significantly between the perioperative and extended antibiotic groups (5.7% vs. 20%, p = 0.13). Rates of leak, stenosis, reintervention, length of stay, and mortality were also similar. No patient, injury, or management factor was associated with local infectious complications. CONCLUSIONS:Extended post antibiotic prophylaxis was not associated with lower infection rates or improved clinical outcomes following operative repair of traumatic neck aerodigestive injuries. Prospective multicenter studies are needed to validate these findings and refine antibiotic protocols for these injuries.
BACKGROUND:Surgical site infection (SSI) is a common complication after open appendectomy. The effectiveness of intra-operative antibiotic irrigation compared with saline irrigation remains uncertain. To evaluate the efficacy and safety of antibiotic irrigation versus saline irrigation during open appendectomy. METHODS:We conducted a systematic review and random-effects meta-analysis of randomized controlled trials comparing antibiotic irrigation with saline irrigation in patients undergoing open appendectomy. The literature search identified 40 records; after duplicate removal and title/abstract screening, 15 articles underwent full-text review, and five randomized controlled trials (RCTs) were included. Risk of bias was assessed using the ROB-2 tool. RESULTS:Five RCTs involving 1,080 patients were included (533 antibiotic irrigation; 547 saline), conducted in Saudi Arabia, Egypt, Iran, Iraq, and Nepal. The weighted mean age was 28.20 years, and most participants were male (54.4% vs. 57.5% in intervention and control groups). The mean follow-up was 1.1 months. All trials were rated low risk of bias. SSI occurred in 4.8% (26/533) of patients receiving antibiotic irrigation versus 8.9% (49/547) receiving saline. Antibiotic irrigation significantly reduced SSI risk (RR 0.60, 95% CI: 0.36 to 0.99; p = 0.05) with minimal heterogeneity (I2 = 6.87%). Leave-one-out analyses suggested fragility, with significance not consistently maintained when individual studies were omitted. Trial sequential analysis crossed the conventional boundary but not the monitoring boundary, and the required information size was not reached, indicating inconclusive evidence. Doi plot analysis showed minor asymmetry (LFK index -1.90). No significant differences were observed for abdominal abscess, post-operative ileus, length of stay, or operative duration. CONCLUSIONS:Antibiotic irrigation may reduce SSI after open appendectomy, but the evidence is fragile and remains insufficient by TSA. Future research should focus on minimally invasive appendectomy, with open-surgery studies reserved for settings where it remains common.
BACKGROUND:Sternal infection after lung transplantation is uncommon but life-threatening; late-onset cases may be difficult to diagnose when signs are subtle. CASE:A 38-year-old female developed methicillin-susceptible Staphylococcus aureus sternal infection with bacteremia 7 months after bilateral lung transplantation. Computed tomography (CT) showed a localized abscess around the sternal wires. MANAGEMENT:CT and intraoperative findings confirmed that infection was confined to extrathoracic peri-sternal tissues without communication with the thoracic cavity. This guided debridement, drainage, wire removal, antimicrobial therapy, and negative-pressure wound therapy (NPWT) with instillation and dwell time followed by standard NPWT. OUTCOME:After infection control and adequate granulation, delayed primary closure was performed 60 days after debridement without flap reconstruction. She was discharged on day 77, without recurrence, 8 months after closure. CONCLUSIONS:Careful assessment of infection extent may help identify patients with localized infection suitable for staged management, permitting delayed primary closure without flap reconstruction.
BACKGROUND:Mesh infections after laparoscopic inguinal hernia repair are rare, particularly those caused by Mycobacterium abscessus, a multi-drug-resistant nontuberculous mycobacterium. CASE PRESENTATION:We describe two cases of M. abscessus infection following total extraperitoneal inguinal hernia repairs. Both patients developed delayed groin pain and fluid collections. Cultures confirmed M. abscessus, requiring mesh explanation and prolonged multi-drug antibiotic therapy. Despite complications, both achieved infection resolution after approximately 12 months. DISCUSSION:Investigation suggested contamination of laparoscopic instrument sheaths as the infection source, prompting changes in sterilization protocols. The pathogen's biofilm formation and resistance to sterilization contributed to persistence. CONCLUSION:Early recognition, mesh removal, and multi-disciplinary care are essential for successful management of M. abscessus mesh infections. Strict adherence to sterilization protocols is critical in preventing such rare but serious complications.
INTRODUCTION:Antimicrobial agent resistance caused by excessive antibiotic agent use is a critical global concern. Antibiotic agent time-outs (ATO) are recommended stewardship tools; however, their benefits after emergency abdominal operations are unproven. We evaluated whether incorporating an ATO in routine post-operative rounds could shorten the antibiotic treatment course without compromising patient outcomes. METHODS:This single-center, retrospective study included adults (aged ≥18 y) who underwent emergency operation for intra-abdominal infection at the Kyoto Medical Center between January 2017 and December 2018. From January 1, 2018, surgeons conducted daily ATOs, reassessing the indication, spectrum, and planned duration of each antimicrobial agent regimen. Segmented regression analysis was performed to compare pre- and post-intervention trends. RESULTS:During the 24-month study period, 226 patients were screened, and 93 met the inclusion criteria (44 pre-intervention and 49 post-intervention). The mean duration of post-operative antibiotic agent therapy decreased from 6.7 to 5.8 days, whereas that of meropenem exposure reduced from 0.7 to 0.1 days. Interrupted time-series analysis showed an immediate 3.9-day-level decrease following ATO implementation (95% confidence interval: -8.4 to 0.6; p = 0.09). Surgical site infection rate, number of overall complications, and median length of hospital stay remained unchanged. CONCLUSION:Surgeon-led ATOs integrated into daily rounds were associated with a shorter post-operative antimicrobial agent duration after an emergency abdominal procedure, although the reduction did not reach statistical significance. Clinical outcomes, including post-operative complications and length of stay, were not worsened. This pragmatic, low-resource intervention aligns with the goals of surgical antimicrobial agent stewardship and warrants consideration for broader implementation.
BACKGROUND:Infections involving the aorta are particularly complex, posing unique diagnostic and therapeutic challenges. Aortic infections (AIs) are associated with considerable morbidity and mortality and incur significant healthcare costs. This narrative review examines the current literature and offers guidance on primary and post-operative AIs. METHODS:We conducted a search using electronic databases (PubMed, Medline, Scopus, and Cochrane) with a Boolean approach using selected keywords of aorta and infection, aortitis, aortic graft infection, infected aortic aneurysm, and mycotic aneurysm. RESULTS:AIs are among the most feared complications in vascular surgery. Gram-positive bacteria, such as Staphylococcus aureus, are responsible for about 80% of AIs. These microorganisms produce toxins capable of leading to anastomotic disruption. The common use of broad-spectrum antibiotic agents has resulted in an increasing prevalence of multi-drug-resistant organisms, making the management of AIs even more complex. Clinical presentation is often non-specific, ranging from mild symptoms, such as abdominal pain, malaise, and fever, to sepsis and hemorrhagic shock due to anastomotic rupture. Management of patients with an infected aorta includes antimicrobial therapy and surgical source control, which may include washout and aneurysm repair if a primary aortic infection or graft removal if a post-operative infection. Collaboration with intensive care unit and ID consultation improved long-term outcomes. CONCLUSIONS:AIs are among the most complicated and challenging surgical problems and are potentially life-threatening and require a multi-disciplinary approach to reduce its prevalence and improve clinical outcomes.
BACKGROUND:Surgical site infection (SSI) after pancreaticoduodenectomy (PD) remains a major cause of post-operative morbidity. Various risk factors for SSI have been identified. This study aimed to investigate the relationship between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, a novel inflammatory biomarker, and SSI following PD. METHODS:The outcomes of patients who underwent PD between January 2017 and December 2022 were retrospectively analyzed. Patients who underwent laparoscopic surgery, received neoadjuvant therapy for borderline or locally advanced tumors, had metastatic disease, or presented with evident infections requiring treatment at the time of surgery were excluded. Demographic data, post-operative outcomes, and the presence of SSI were recorded. The CALLY index and other potential risk factors for SSI were evaluated. RESULTS:The cutoff value for the CALLY index was determined as 5. Patients with a CALLY index <5 had a significantly higher incidence of SSI (p < 0.001). Multi-variate analysis demonstrated risk factors for SSI included CALLY index, elevated pre-operative CRP level, post-operative pancreatic fistula, and pre-operative biliary drainage (p = 0.021, p = 0.003, p < 0.001, and p = 0.037, respectively). Multi-variate analysis demonstrated that the CALLY index was a strong independent predictor of SSI (odds ratio = 5.195; 95% confidence interval: 2.430-11.107). CONCLUSIONS:The CALLY index is an independent risk factor for SSI after PD. This index reflects inflammation, immune status, and nutritional condition and represents a simple, non-invasive, and easily calculable predictive tool.
BACKGROUND:This retrospective analysis investigated the role of serum IL-6 and IL-10 in distinguishing among pathological types of acute appendicitis and in preoperatively predicting perforation. METHODS:The data from 376 patients were categorized into three groups on the basis of the definitive postoperative histopathological diagnosis: acute simple appendicitis (SIA), acute suppurative appendicitis (SA), and acute gangrenous appendicitis (GA). According to whether acute appendicitis is accompanied by perforation, the subjects are further stratified into two groups: non-perforated and perforated. RESULTS:A statistically significant difference in IL-6 levels was observed among the groups (SIA vs. SA, p < 0.0001; SIA vs. GA, p < 0.0001; SA vs. GA, p < 0.0001). The IL-6 independently predicted a types of appendicitis pathology [SIA vs. SA: odds ratio (OR) 1.059, 95% confidence interval (CI) (1.039-1.079), p < 0.0001; SIA vs. GA: OR 1.080, 95% confidence interval (CI) (1.049-1.113), p < 0.0001; SA vs. GA: OR 1.000, 95% confidence interval (CI) (1.000-1.000), p = 0.05]. The optimum cut-off for the initial IL-6 was 23.54 [area under the curve (AUC) 0.8512, SIA vs. SA)], 39.36 (AUC 0.9844, SIA vs. GA), and 90.88 (AUC 0.8433, SA vs. GA). The IL-6 was significantly higher in the perforated group than in the non-perforated group (29.86 vs. 453.50, p < 0.001). The IL-6 independently predicted acute perforated appendicitis in multi-variable logistic regression analysis [OR 1.000, 95% confidence interval (CI) (1.000-1.000), p < 0.042]. The optimum cut-off for acute perforated appendicitis was 331.3 (AUC 0.8074). The diagnostic performance of IL-10 in differentiating acute appendicitis pathology types was fair (AUC 0.7322 for SIA vs. SA; 0.92263 for SIA vs. GA; 0.7738 for SA vs. GA) but consistently lower than IL-6, and its predictive value for acute perforated appendicitis remained limited (AUC 0.7875), further underscoring the superior discriminative capacity of IL-6. CONCLUSIONS:Preoperative evaluation of IL-6 and IL-10 can be useful in distinguishing pathological subtypes of acute appendicitis and predicting associated perforation.
BACKGROUND:Postoperative abdominopelvic abscesses are primarily managed with antimicrobial therapy and percutaneous drainage. A subset of abscesses is unamenable to drainage due to small size or technical inaccessibility and is therefore managed conservatively with antimicrobial therapy alone. Clinical outcomes and factors of treatment failure with antimicrobial therapy alone for postoperative non-drainable abscesses remain poorly defined. METHODS:A retrospective cohort study included adult surgical patients at a tertiary hospital with abdominopelvic abscesses diagnosed within 30 days postoperatively and deemed non-drainable. All patients received systemic antimicrobials and were followed for 60 days. The primary outcome was therapy success. Other outcomes included clinical response, rehospitalization, and exploration of risk factors for antimicrobial therapy failure. RESULTS:The study included 69 patients. Abscesses were considered non-drainable because of inaccessible location (n = 47, 68.1%) or small size (n = 22, 31.9%). The median duration of antimicrobial therapy was 18 days, including 12 days of inpatient treatment. At 60 days from antimicrobials initiation, 53 patients (76.8%) achieved therapy success. The median time to clinical response was 8 days. Among patients with follow-up imaging, most demonstrated abscess resolution or reduction in size. Independent predictors of treatment failure were pelvic abscess location (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.5-30.3) and postoperative corticosteroid exposure (OR, 11.9; 95% CI: 1.1-129.7). A longer interval between procedure and abscess diagnosis was inversely associated with failure (OR, 0.8 per day; 95% CI, 0.7-0.9). CONCLUSION:When postoperative abdominopelvic abscesses are deemed not amenable to drainage, antimicrobial therapy with close clinical follow-up was associated with favorable outcomes.
Background: Peristomal infection (PI) is the most frequent complication following percutaneous gastrostomy, and the increase of multi-drug-resistant (MDR) bacteria poses a therapeutic challenge. We evaluated whether targeted antimicrobial agent prophylaxis (TAP), on the basis of pre-procedure rectal screening, reduces the incidence of MDR PIs compared with standard prophylaxis. Methods: We conducted a single-center, single-arm, open-label trial, comparing a prospective cohort (July 2021-July 2022) receiving TAP based on MDR screening results with a retrospective cohort (June 2020-June 2021) that received standard prophylaxis. A total of 118 patients were included, 60 in the intervention group and 58 in the historical cohort. TAP patients underwent a pre-procedure screening tactic, using nasal, axillary, inguinal, pharyngo-tonsillar, and rectal swabs. Patients with positive cultures received prophylaxis with an antibiotic agent active against the isolated bacteria, along with coverage for methicillin-sensitive Staphylococcus aureus. Patients with negative cultures received standard prophylaxis with amoxicillin-clavulanate. Both regimens were administered as a single dose one hour before the procedure. Results: MDR colonization was detected in 36.4% of screened patients. The 30-day PI incidence was comparable in both cohorts [20.7% (12/58) in the historical cohort vs. 16.7% (10/60) in the intervention group; p = 0.64]. Among TAP patients who developed PI, 7/10 had negative MDR screening, 3/10 had infections caused by pathogens different from those identified in screening, and 2/10 developed infections with the same MDR bacteria despite appropriate prophylaxis. Conclusions: In patients undergoing percutaneous gastrostomy, TAP based on MDR colonization status did not reduce the incidence of PIs or MDR etiology compared with standard prophylaxis. Our findings question the role of colonization-guided prophylaxis in percutaneous gastrostomy and underscore the need for alternative preventive tactics in surgical site infection control.
BACKGROUND:To assess the association between antibiotic use, for any indication, within 30 days prior to thyroidectomy and the incidence of surgical site infections (SSIs) using a large global electronic medical records database. METHODS:A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Adults who underwent thyroidectomy were stratified into two groups: those who received antibiotics within 30 days prior to the surgical procedure and those who did not. Propensity score matching (PSM) was employed to adjust for demographic and clinical variables. The primary outcome was the development of SSIs up to 90 days following the surgical procedure. Secondary outcomes included wound dehiscence, emergency department (ED) visits, and the use of post-operative antibiotics. RESULTS:After 1:1 PSM, each cohort consisted of 3,518 patients. At 30 days following thyroidectomy, patients who received antibiotics prior to the surgical procedure exhibited significantly higher risks of SSI (risk ratio [RR] 1.75, 95% confidence interval [CI]: 1.136-2.695), wound dehiscence (RR 2.571, 95% CI: 1.389-4.759), ED visits (RR 1.367, 95% CI: 1.126-1.661), and post-operative antibiotic use (RR 4.205, 95% CI: 3.702-4.775) compared to patients without pre-operative antibiotic exposure. These elevated risks were also observed at 60 and 90 days post-surgical procedure. CONCLUSION:Exposure to pre-surgical antibiotics, for any reason, is associated with post-thyroidectomy complications for at least 90 days. This finding should be considered in the decision-making process regarding the timing of the surgical procedure, particularly for elective, non-urgent procedures such as thyroidectomy.
BACKGROUND:Candidemia is a serious complication after gastrointestinal (GI) perforation and/or ischemia, yet most evidence pools candidemia with intra-abdominal candidiasis (IAC). We sought candidemia-specific risk factors after GI perforation and/or ischemia and evaluated associated outcomes. METHODS:We conducted a single-center, retrospective matched case-control study of adults undergoing emergency surgical procedure for GI perforation and/or ischemia and admitted to a surgical intensive care unit. Cases with candidemia during index admission were matched 4:1 to controls by age, Charlson Comorbidity Index, and surgical procedure year. Conditional logistic regression assessed pre-specified risk factors, and exploratory outcomes included mortality, length of stay, and days on invasive ventilation. RESULTS:Twenty-four cases were matched to 99 controls. Factors identified to be independently associated with candidemia include the presence of IAC (adjusted OR [aOR]: 5.51, 95% CI: 1.61, 18.89; p = 0.007), upper GI injury (aOR: 4.28, 95% CI: 1.52-12.08; p = 0.006), and diffuse intra-abdominal contamination, compared with contained/none (aOR: 3.21, 95% CI: 1.06-9.74; p = 0.040). Among candidemia cases, species distribution was Candida albicans 41.7%, C. glabrata 33.3%, C. parapsilosis 12.5%, with single cases of C. tropicalis, C. krusei, and C. dubliniensis. Candidemia was associated with a longer hospital length of stay (+13.97 d; 95% CI: 0.90-27.04; p = 0.036), without significant differences in ICU stay, duration of invasive ventilation, or mortality. CONCLUSIONS:After GI perforation and/or ischemia, the risk of candidemia is highest in patients with upper GI injury and diffuse contamination, independent of IAC. These readily identifiable operative features may guide targeted surveillance and selective early antifungal strategies. Prospective validation is warranted.
BACKGROUND:Differentiating spinal tuberculosis (STB) from pyogenic spinal infection (PSI) remains a critical diagnostic challenge, and misdiagnosis can lead to inappropriate treatment, prolonged morbidity, and poor clinical outcome. OBJECTIVE:This study aims to develop a convenient, practical model on the basis of routinely available clinical data to accurately differentiate between STB and PSI. PATIENTS AND METHODS:We retrospectively reviewed 211 patients (59 STB, 152 PSI) with pathological confirmation in our hospital's orthopedic department, collecting general data (age, gender, BMI, tuberculosis history), laboratory indices (T-SPOT.TB, white blood cell, NP, C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], hemoglobin, etc.), and imaging findings (intervertebral disc destruction [IDD], vertebral body destruction [VBD], sclerotic bone and sequestrum formation [SBSF], intraspinal abscess [ITA], injection abscess). Univariate and multivariate regressions identified independent factors to construct a nomogram, whose performance was assessed via receiver operating characteristic curves, calibration curves, and decision curve analysis. RESULTS:Univariate analysis revealed that the T-SPOT.TB, CRP, ESR, albumin, albumin-to-globulin ratio, IDD, VBD, SBSF, and ITA were statistically significant. Multifactorial logistic regression analysis revealed that the T-SPOT. TB, CRP, ESR, and albumin were strongly associated with STB. The nomogram model was established via R software on the basis of risk factors. The area under the receiver operating characteristic of the subjects in the modeling group was 0.770. According to the nomogram model, the predicted value of the calibration curve was consistent with the actual value. CONCLUSION:This nomogram provides a reliable, simple, economical, practical tool for differentiating STB from PSI. By enabling accurate and timely distinction between these two infectious entities, the model facilitates the development of targeted and more effective treatment strategies.
BACKGROUND:Modified radical mastoidectomy (MRM) is a common surgical procedure in otology. However, postoperative surgical site infection (SSI) will lengthen hospital stay, raise healthcare expenses, and even lead to the death of patients. At present, there is relatively little research on the risk factors of SSI after MRM, especially the lack of an established risk prediction model. PATIENTS AND METHODS:Patients who underwent MRM at Jining NO.1 People's Hospital from 2020 to 2024 were selected. Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors for SSI after MRM. On the basis of these factors, a Nomogram prediction model was constructed. The predictive value of the model was evaluated by constructing receiver operating characteristic (ROC) curve, calibration curve, and decision curve. RESULTS:A total of 278 MRM patients met the inclusion criteria, 19 (6.83%) had developed SSI, and 259 (93.17%) had not. Multivariate logistic regression analysis confirmed diabetes, hypoproteinemia, neutrophil-to-lymphocyte ratio, antibiotic prophylaxis administered 0.5-1 h preoperatively, and operative time as independent factors (all p <0.05). The prediction model demonstrated excellent discriminative ability. Area under the curve of the ROC curve was 0.856, validated by Hosmer-Lemeshow testing (χ2 = 6.265, p = 0.618), calibration curve, and decision curve analysis. These findings highlight the model's robust accuracy and clinical utility in stratifying the risk of SSI after MRM. CONCLUSIONS:The Nomogram prediction model constructed based on logistic regression can effectively predict the risk of SSI after MRM, which is helpful for early clinical intervention and reducing the occurrence of nosocomial infection.
PURPOSE:Pyelonephritis is quite common in patients with urolithiasis. This condition not only complicates the management of urolithiasis but also makes the treatment of associated urinary tract infections more challenging. The aim of this study is to identify the risk factors for pyelonephritis in patients with urolithiasis. MATERIALS AND METHODS:A total of 8,273 patients with urolithiasis were retrospectively screened (2016-2025). From this cohort, 302 patients who developed pyelonephritis and 302 age- and gender-matched controls without pyelonephritis were randomly selected, forming a matched case-control study population. Demographic and clinical variables, including age, gender, stone size and location, number of stones, comorbidities, prior urinary operation, presence of a double-J ureteral stent, and urinary tract obstruction, were analyzed as potential risk factors. RESULTS:Pyelonephritis developed in 302 patients (53.3% female). Hydronephrosis was the strongest independent risk factor, increasing risk nearly ninefold. Other significant risk factors included hypertension, diabetes mellitus, chronic kidney disease, malignant disease, immunosuppression, larger stone burden, multiple and bilateral stones, ureteral stent presence, and prior urinary operation. Each 1-mm increase in stone size was associated with a 2.3% increase in the risk of developing pyelonephritis. Bacteremia was detected in 66 patients, and urine cultures were positive in 229 patients. Escherichia coli was the most common pathogen, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. CONCLUSIONS:Hydronephrosis, ureteral stent presence, a history of open or laparoscopic intervention, hypertension, and higher stone burden were independently associated with the development of pyelonephritis in patients with urolithiasis. Gram-negative bacilli were the most frequently isolated pathogens. Identification of these risk factors may support earlier recognition of high-risk patients and guide preventive and therapeutic decision-making. Prospective multi-center studies are needed to confirm these findings.
