Surgical Infections

Can We Predict Post-operative Sepsis after Neonatal Abdominal Surgery?
Zouari M, Belhajmansour M, Issaoui A, Jarboui O, Ben Kraiem N, Ben Dhaou M and Mhiri R
Risk of Infective Endocarditis in Patients with Spinal Surgical Site Infection and Bacteremia
Rodrigues S, Gille O, Collinet C, Jouhet V, Griffier R, Damade C, Bride J, Boishardy A, Ternacle J, Issa N, Amelot A and Bouyer B
Surgical site infection (SSI) is responsible for significant morbidity, prolonged hospital stays, and increased costs. Infectious endocarditis (IE) is a rare but serious complication of bacteremia, particularly that resulting from SSI. The VIRSTA score predicts the risk of IE and determines the priority of transthoracic echocardiography (TTE) in patients with bacteremia. The aim of the study was to (1) assess the performance of the VIRSTA score and (2) determine the usefulness of TTE in bacteremia related to spinal SSI. We carried out a retrospective study of consecutive patients with spinal SSI and bacteremia at two university hospitals in France (Bordeaux and Tours) from January 2009 to January 2023. We collected the patients' clinical and surgical characteristics at baseline, VIRSTA score items, TTE results, and medicosurgical management. The associations of these parameters with IE were assessed using the chi-square test and logistic regression models. Of 82 patients with spinal SSI and bacteremia, only 1 (1.21%) developed IE. Thirteen patients did not benefit from TTE during hospitalization and were considered free of IE after clinical follow-up. Diabetes mellitus (p < 0.04) and the presence of severe sepsis or septic shock (p < 0.03) were significantly associated with the presence of IE in this population. Incidence of IE in patients with spinal SSI and bacteremia is low. The VIRSTA score has high sensitivity but is not accurate for identifying patients at high risk for IE and systematic performance of TTE is complex and not useful in this setting. IV.
Impact of an Acute Care Surgery Clinical Pathway on Patient Outcomes in Acute Appendicitis
Islam N, Thakkar G, Ferguson C, Kennedy K, Bennett N, Oyetunji T, Fesmire A, Gazzetta J, Arce D, Neblock-Beirne T, Nix S and Benedict LAO
Acute care surgery (ACS) encompasses surgical critical care, emergency general surgery, and the surgical management of trauma. Following ACS implementation at our institution, we developed a perioperative clinical pathway for acute appendicitis (AA) to improve efficiency and standardize post-operative care. The purpose of our study is to assess patient outcomes utilizing our ACS clinical pathway for patients with AA. This is a retrospective cohort study involving patients admitted to our tertiary care facility with AA who underwent appendectomy. Patients were classified by pre-implementation (January 1, 2016-July 31, 2018) and post-implementation (August 1, 2018-December 31, 2020) of our ACS clinical pathway. The primary outcome was hospital length of stay (LOS). Statistical analysis was performed using SAS with a p-value <0.05 determined as significant. Of the 492 patients included, 225 were in the pre- and 267 were in the post-implementation cohorts. Hospital LOS was substantially decreased in the post-implementation cohort (31.2 vs. 50.4 h, p < 0.001). The post-implementation group had a substantial decrease in computed tomography (CT) to operating room (OR) start time (6.81 vs. 11.4 h, p < 0.001), CT to antibiotic agents' administration (2.20 vs. 3.37 h, p < 0.001), inpatient opioid utilization (125 morphine equivalents [ME] vs. 172 ME, p < 0.001), and discharge antibiotic agents' prescription rates (23.6% vs. 30.7%, p = 0.077). Recovery unit discharges (20 vs. 9%, p < 0.001) were increased in the post-implementation cohort. Our ACS clinical pathway for AA resulted in earlier surgical intervention, enhanced opioid and antimicrobial stewardship, and gains in surgical care efficiencies.
Beyond CDC-Defined Surgical Site Infection: Factors Associated with Antibiotic Prescription After Breast Operation
Gentle CK, Moussally M, Chang JH, Hong H, Walker K, Nimylowycz K, Said SA and Al-Hilli Z
Most studies on surgical site infections (SSIs) use the US Centers for Disease Control and Prevention (CDC) guidelines, which excludes inflammation or cellulitis without fever. The aim of this study was to evaluate antibiotic prescription trends in the post-operative period among patients undergoing breast operation. We explore the outcomes of patients receiving antibiotic agents outside of the CDC-defined SSI. A retrospective review of patients undergoing breast operation from January 2021 to May 2021 was conducted. Solely reconstructive and cosmetic cases were excluded. The primary outcome was the prevalence of antibiotic prescription in the absence of CDC-defined SSI, excluding routine prophylactic antibiotic agents, with analysis of associated factors. A total of 754 breast surgical procedures were included. Seventy-seven patients (10.2%) were prescribed outpatient antibiotic agents. CDC-defined SSI occurred in 5.3% (n = 40), mostly involving tissue expander/implant-based reconstruction (47.5%, n = 19). However, 37 (4.9%) did not progress to meet the CDC criteria for SSI. Patients prescribed outpatient antibiotic agents without CDC-defined SSI did not have increased rates of diabetes mellitus, obesity, or current smoking. These patients were more likely to have a surgical drain (48.6% vs. 28.4%, p = 0.02), plastic surgery involvement (32.4% vs. 18.0%, p = 0.048), and a post-operative seroma (32.4% vs. 8.1%, p < 0.001) and or or cellulitis (18.9% vs. 0%, p < 0.001). Patients are prescribed antibiotic agents after breast operation based on clinical judgment for indications other than CDC-defined SSI. Post-operative wound morbidity including seroma and cellulitis could be contributing to these antibiotic prescriptions. Further study is needed to determine whether providers are preemptively treating SSIs appropriately or over-treating non-infectious wound complications.
Antimicrobial Resistance Trends and Epidemiological Characteristics of Isolates from Intra-Abdominal Infections in China: A 6-Year Retrospective Study (2017-2022)
Wu M, Chen Y, Li J, Zhou Z, Wu L, Wu W, Wang J, Tian S, Wu X, Zheng T and Ren J
Antimicrobial resistance represents a continuing threat to the health of patients with intra-abdominal infections (IAIs). This study aimed to provide clinicians with guidance to optimize antibiotic therapy. The clinical data and antibiotic susceptibility results of pathogens from patients with IAIs from 2017 to 2022 were retrospectively collected. The 6-year period was segmented into two stages, namely, the early (2017-2020) and recent stages (2021-2022). The distribution and antibiotic resistance of pathogens were compared between the stages. In total, 5,795 pathogens were isolated from 2,283 patients diagnosed with IAIs. Gram-negative bacteria, Gram-positive bacteria, and fungi accounted for 71.0%, 21.4%, and 7.5% of the isolates, respectively. (1,037, 17.9%) was the primary isolate. The proportion of extended-spectrum β-lactamase-producing was 89.8% (2,028/2,259), with extended-spectrum β-lactamase-producing and accounting for 27.4% and 43.2%, respectively, of all such isolates. The carbapenem resistance rates of and were 17.1% and 75.9%, respectively. Compared with that in the early stage, the imipenem resistance rate of was significantly higher in the recent stage (13.8% vs. 25.1%, p < 0.001). Among Gram-positive bacteria, 88 strains of vancomycin-resistant were detected, giving a resistance rate of 10.3%, and the detection rate of methicillin-resistant was 65.7%. and non-fermentative bacteria from IAIs remain highly resistant to carbapenems. The epidemiological characteristics and antibiotic resistance profiles of pathogens in various regions should be closely monitored to mitigate the appearance of drug-resistant bacteria in clinical settings.
Bacteremia in an Elderly Patient with Multiple Comorbidities: A Case Report
Wu B, Song X, Liu Y and Zheng X
() stands as a primary cause of health-care-associated colitis in adults; however, extraintestinal manifestations of , particularly bacteremia, are exceptionally rare. In this report, we document a case of an elderly male with multiple comorbidities who presented with an acute onset of fever. Diagnostic testing revealed the presence of concurrent bacteremia involving and . The multilocus sequence typing analysis identified this strain as ST81. After receiving a combination treatment of vancomycin and biapenem, the patient successfully recovered and was subsequently discharged. This case report elucidates the clinical presentation and treatment strategies for ST81 bacteremia, underscoring the critical need for heightened monitoring of extraintestinal infections in high-risk patients.
Prevention of Early Ventriculoperitoneal Shunt Infection: A Long-Term Experience from Peking Union Medical College Hospital
Zhang X, Chen Y, Yin R, Chang J, Dong X, Xu H, Li P, Yang L, Liu X, Wei J and Wang R
Preventing the early shunt infection is critical for the success of ventriculoperitoneal shunt (VPS) operation. Our goal was to establish a standardized protocol to prevent early shunt infection. This was a single-center retrospective study. Patients who received the VPS in Peking Union Medical College Hospital (PUMCH) between August 2012 and June 2022 were enrolled. Data of patients were extracted from the PUMCH hydrocephalus database. An evidence-based protocol to prevent early shunt infection was established, implemented, and supervised strictly throughout the study period. A central nervous system (CNS) infection presented within 30 days after VPS was defined as early VPS infection. A total of 311 patients who received VPS were enrolled in this study. Under the strict execution of a standardized protocol including scalp pre-disinfection, "no touch" shunt technique, and an amikacin-soaked catheter, only 2 patients had early shunt infection. We established a standardized shunt infection prevention protocol and reported a low early infection rate. Our experience may be a clinical pearl for the surgical treatment of patients with hydrocephalus.
Migration of Fish Bone Foreign Bodies into Thyroid and Common Carotid Artery
Kuang R, Sun B, Wei Q, Deng J and Chen X
Molecular Identification of OXA Carbapenemase-Encoding Genes in Isolated from Patients in Critical Care in Egypt
Sahlol NY, Mohamed NMK, El-Baghdady KZ, El-Kholy IMA, Fahmy GM, Sahbal MA and Mowafy HL
The emergence of carbapenem-resistant (CRAB) in hospitals, particularly within critical care units, has garnered substantial global concern. CRAB commonly arises from the degradation by various ß-lactamases. : We aimed to assess OXA-type carbapenemases in clinical isolates of obtained from an Egyptian tertiary care facility. This study examined 25 distinct strains collected from various clinical samples of patients in intensive care unit. Bacterial identification was conducted utilizing both traditional methods and the Vitek2 system. Antibiotic resistance profiles were assessed according to the European Committee on Antimicrobial Susceptibility Testing standards using the Vitek2 Compact automated system. Additionally, multiplex real-time polymerase chain reaction was used to identify the presence of blaOXA23, blaOXA24, blaOXA51, and blaOXA58 carbapenemase genes. Colistin susceptibility was assessed utilizing the broth microdilution method. Carbapenem resistance was identified in 100% of the studied isolates. The blaOXA51 gene was detected in all strains. The gene blaOXA23 was identified in 22 strains (88%), whereas blaOXA24 and blaOXA58 were present in 15 strains (60%). All isolates, except one, co-harbored two or more OXA encoding genes. Colistin resistance was detected in 4 of 25 strains (16%). Our findings demonstrate the widespread distribution of CRAB isolates that co-harbor multiple carbapenemase-encoding genes. Molecular epidemiological studies and the surveillance of antibiotic resistance profiles may aid in identifying and tracing the origins of resistant bacteria, thereby limiting their spread.
Clinical Characteristics and Risk Factors of Surgical Site Infection in Patients with Open Abdomen with Fistula Undergoing the Abdominal Wall Reconstruction Utilizing Biological Mesh: A Single-Center Retrospective Study
Liu Y, Li S, Huang J, Teng Y, Wu L, Zhang J, Zhang X, Li X, Zhang Z, Hong Z, Ren H, Wu X and Ren J
This study aimed to evaluate the clinical characteristics and identify risk factors for surgical site infection (SSI) following abdominal wall reconstruction using biological mesh. A retrospective analysis was conducted on patients with open abdomen (OA) with fistula who underwent abdominal wall reconstruction with biological mesh at Jinling Hospital between January 2010 and August 2023. Patients were divided into SSI and non-SSI groups, and their perioperative data were compared to identify potential risk factors. The SSI rate following abdominal wall reconstruction was 23.71% (23/97) in patients with OA with fistula. Significant differences (p < 0.05) were found between the SSI and non-SSI groups in body mass index (BMI), BMI classification, nutritional risk index (NRI) classification, abdominal wall defect partition, pre-operative day one neutrophil count (NEUT), post-perative day one white blood cells (WBCs) and NEUT, post-operative day three WBCs and NEUT, post-operative day seven procalcitonin (PCT) and NEUT, length of hospitalization, and total hospitalization cost. Multifactorial analysis identified normal BMI (odds ratio [OR]: 0.151, 95% confidence interval [CI]: 0.041-0.551, p = 0.004) and high BMI (OR: 0.072, 95% CI: 0.010-0.546, p = 0.011) as protective factors against SSI and moderate NRI (OR: 4.054, 95% CI: 1.069-15.376, p = 0.004), severe NRI (OR: 18.233, 95% CI: 2.971-111.897, p = 0.002), and abdominal wall defect partition (OR: 4.032, 95% CI: 1.218-13.349, p = 0.022) as independent risk factors for SSI. Normal BMI and high BMI act as protective factors against SSI, whereas moderate NRI, severe NRI, and abdominal wall defect partition are independent risk factors for SSI. Nutritional management and surgical care should be emphasized to reduce SSI incidence in patients with OA with fistula undergoing abdominal wall reconstruction.
The Predictive Value of Heparin-Binding Protein in Total Joint Arthroplasty Prosthesis Infections
Guo D, Shen D and Dong Y
This study aims to explore the predictive value of heparin-binding protein (HBP) in diagnosing prosthesis infections after total joint arthroplasty (TJA), in order to provide a new biomarker for early identification and management of prosthetic joint infections (PJI) post-TJA. A retrospective analysis of data from 168 patients who underwent TJA revision at Lianyungang First People's Hospital from October 2020 to March 2024 was conducted. The participants were divided into an infection group (38 cases) and a non-infection group (94 cases). Inclusion criteria included all patients undergoing joint prosthesis revision who had preoperative HBP levels measured. Primary assessment parameters included HBP, C-reactive protein (CRP), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR). Univariate analysis and multivariate regression analysis were used to evaluate the correlation of these factors with PJI, and the performance of HBP in predicting PJI was analyzed using the receiver operating characteristic (ROC) curve. There were significant statistical differences in HBP, CRP, WBC, and ESR between the infection and non-infection groups (p < 0.05). Multivariate regression analysis showed that HBP is an independent predictive factor for the risk of PJI. The area under the ROC curve was 0.856, indicating that HBP has good predictive performance. The optimal cutoff value for HBP was 51.3, with a sensitivity of 69.2% and a specificity of 89.5%. The study found that HBP levels are significantly associated with the occurrence of PJI following TJA, serving as an effective independent predictive factor for PJI risk. HBP has high predictive value and can be considered an important biomarker for predicting PJI post-TJA in clinical settings, aiding in the early identification and management of PJI, thereby improving patient treatment outcomes and quality of life.
Influencing Factors of Urinary Tract Stones Complicated by Urinary Tract Infections and the Construction of a Column Chart Prediction Model
Cai L, Wu X, Lian X and Zhou Q
To analyze the influencing factors of urinary tract stones complicated by urinary tract infections and construct a column chart prediction model. From July 2020 to October 2023, 345 patients with urinary tract stones admitted to our hospital were collected as the training set, they were separated into an infection group of 51 cases and a non-infection group of 294 cases on the basis of the presence or absence of concurrent urinary tract infections; 192 patients with urinary tract stones were used as the testing set and were divided into an infection group of 26 cases and a non-infection group of 166 cases on the basis of the presence or absence of concurrent urinary tract infections. Data such as gender, age, and procalcitonin (PCT) were recorded. Multi-variable logistic regression analysis was applied to screen predictive factors, R4.0.2 software was applied to construct a column chart model, the calibration curve and Receiver Operating Characteristic (ROC) curve were applied to evaluate the discrimination and calibration of the column chart model; decision curve analysis curve was applied to evaluate the predictive performance of column chart models. The proportions of female, diabetes mellitus, indwelling time of urinary catheter ≥7 days, the PCT, and urine pH in the infected group were greater than those in the non-infected group (p < 0.05). Female, diabetes mellitus, catheter retention time ≥7 days, high PCT, and high urine pH were independent risk factors for urinary calculi complicated with urinary tract infection (p < 0.05). Training set: C-index was 0.913, Area Under Curve (AUC) was 0.943 [95% Confidence Interval (CI) = 0.912-0.973], sensitivity was 86.36%, and specificity was 89.81%, testing set: C-index was 0.905, AUC was 0.959 (95% CI = 0.928-0.989), sensitivity was 84.65%, and specificity was 95.84%, indicating good discriminability of the line graph model; Hosmer-Lemeshow test showed = 2.843, 2.894, p = 0.944, 0.941, the calibration curve approached the ideal curve, and the line graph model had good calibration. When the risk threshold for urinary tract stones complicated by urinary tract infections was between 0.08 and 0.86, this column chart model provided clinical net benefits. The column chart prediction model for urinary tract stones complicated by urinary tract infections constructed in this study has high predictive efficiency and clinical practical value, and can provide reference for medical staff.
Predictive Factors for Fertility of Daughter Cysts in Hepatic Cystic Echinococcosis and Insights into the Origin of Daughter Cysts
Trigui A, Khemakhem N, Fendri S, Saumtally MS, Daoud R, Akrout A, Trabelsi J, Mzali R, Cheikhrouhou F, Ketata S, Dziri C, Ayadi A, Frikha F, Kardoun N and Boujelbene S
The cycle of and its developmental potential has always been a subject of debate. While the origin of protoscoleces was well defined, the origin of daughter cysts (DC) was still a contentious topic, and several hypotheses have been proposed. The aim of this work was to study the fertility of DC and its predictive factors in order to determine its origin. This was a prospective pilot study including hepatic echinococcal cysts containing DC operated in the Department of General and Visceral Surgery of Habib Bourguiba University Hospital, Sfax, during a 22-month period. A parasitological study of the DC including the determination of their fertility was done. A total of 248 DC collected from 27 multi-vesicular cysts from 21 patients were included in our study. The fertility rate of the DC was 64.5%. Free hooks were present in 130 DC (52.4%) and in only 11(12%) of infertile DC. In a multi-variable analysis, only World Health Organization-Informal Working Groups on Echinococcosis classification type CE2, bilious cyst fluid, number of DC per cyst, cyst size, and DC diameter were factors associated with DC fertility (p < 0.05). Out of 88 infertile DC, 77 (87.5%) were devoid of any hooks. Our findings suggest that most of the analyzed DC were fertile, with fertility associated with factors such as cyst size, DC size, CE2 type, and number of DC/cysts. The absence of hooks in infertile DC questions prevailing theories of their origin.
Retroperitoneal Schwannoma with Infection: A Case Report
Si Y and Huang Y
Genetically Predicted Body Composition and Risk of Surgical Site Infection: A Mendelian Randomization Study
Yang J, Zhang F, Xue H, Chen N, Yao Y, Li K and Wang Y
This study employed uni-variable and multi-variable Mendelian randomization (MVMR) analyses, utilizing publicly available genome-wide association study (GWAS) data, to assess the causal relationship between body composition measures such as body mass index (BMI), waist circumference (WC), and the occurrence of surgical site infection (SSI). GWAS summary statistical data were obtained for BMI, WC, and SSI from the MRC Integrated Epidemiology Unit (MRC-IEU) database, inverse variance weighted (IVW) method was used as the main analysis, and supplement sensitivity analysis (including heterogeneity test, pleiotropy analysis, leave-one-out analysis, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO)) was used to check the robustness of the results. The MR analysis showed that the increase in BMI and WC predicted by genes had a substantial causal effect on the incidence of SSI (IVW: odds ratio [OR] = 1.003, 95% confidence interval [CI] = 1.002-1.004, p < 0.001; IVW: OR = 1.003, 95% CI = 1.002-1.005, p < 0.001), respectively, and the MVMR analysis showed that after jointly incorporating smoking and alcohol parameters, the impact of BMI and WC on SSI remained substantial (OR = 1.003, 95% CI = 1.002-1.004, p < 0.001; OR = 1.004, 95% CI = 1.002-1.005, p < 0.001). We further support the causal relationship between increased body composition including BMI and WC and the occurrence of SSI, highlighting the importance of SSI prevention in patients with obesity. Further research is required to mitigate the occurrence of surgical incisions in patients with obesity in the future.
Antibiotic Stewardship through Use of a Preferred Antibiotic Regimen is Associated with Decreased Organ Space Surgical Site Infections in Uncomplicated and Complicated Pediatric Appendicitis
Adams U, Kane N, Wilson W, Willis Z, Eakes AM, Dillon M, Akinkuotu AC, McLean SE, Charles AG and Phillips MR
There is a lack of consensus on the optimal antibiotic regimen for pediatric appendicitis, and conflicting data exist regarding the need for extended-spectrum use in this population. We implemented an antibiotic stewardship program with a standard, preferred antibiotic regimen for both uncomplicated and complicated appendicitis and hypothesized that clinical outcomes would be equivalent. This is a single-institution, retrospective study of pediatric patients (≤18 y) who underwent appendectomy for acute appendicitis between October 2015 and May 2022. We used institutional data from our stewardship program supplemented by manual chart review. Patients were assigned to pre- and post-pathway cohorts on the basis of appendectomy date. Patients were further stratified on the basis of whether they met criteria for complicated appendicitis on the basis of intra-operative findings. There were 752 patients that were included: 346 (46.0%) in the pre-pathway cohort and 406 (54.0%) in the post-pathway cohort. The pre-pathway cohort had a higher rate of complicated appendicitis (40.2 vs. 25.6%). However, pre- and post-pathway cohorts had similar rates of post-operative infections, readmissions, and reoperations. When separated by complicated operative findings, patients with uncomplicated appendicitis had a shorter length of stay post-pathway implementation (p < 0.001). After controlling for complicated operative findings and pertinent covariates, the preferred antibiotic regimen was independently associated with decreased odds of post-operative organ space surgical site infections (SSI) (adjusted odds ratio 0.22, 95% CI: 0.05-0.99). Antibiotic stewardship to increase the use of a standardized, preferred antibiotic regimen did not result in worse clinical outcomes. The preferred regimen was significantly associated with a decreased rate of organ space SSI, even when controlling for complicated operative findings. The mechanism of this finding requires additional study.
Different Clinical Characteristics of Right-Sided Versus Left-Sided Colonic Diverticular Complications: A Four-Year Retrospective Study in a Chinese Population
Gao Q, Peng JY, Bai YQ, Wei XE and Li ZN
To determine whether right-sided and left-sided colonic diverticular complications have different clinical manifestations and treatment outcomes. Patients diagnosed with diverticulitis or diverticular hemorrhage from January 2019 to December 2023 were retrieved. Patients were assigned into the right-sided group and the left-sided group according to the colon affected by diverticular complications. For each patient, age, gender, body mass index (BMI), lifestyle, clinical presentation, and concomitant medication were recorded. Clinical characteristics and treatment outcomes were compared with between the two groups. A total of 123 patients were included in this study, 89 in the right-sided group and 34 in the left-sided group. Patients in the right-sided group presented a significantly lower mean age (43.33 vs. 66.35 yrs old, p < 0.0001) and a smaller proportion of patients with BMI above 25 (10.11% vs. 24.76%, p = 0.02). Left-sided group diverticulitis had a significantly higher proportion of Hinchey III to IV (29.41% vs. 1.12%, p = 0.0001) and rate of intensified conservative treatment (30.77% vs. 2.38%, p = 0.0003). Patients in the left-sided group had a higher rate of crowding of diverticula (diverticular number counted >20) (35.29% vs. 1.12%, p < 0.01). Two patients in the right-sided group and eight in the left received laparotomy because of diverticulitis. All three cases of hemorrhage were in the right-sided group. Compared with the left, right-sided diverticulosis is characterized by a younger age, less-virulent diverticulitis, and potentially higher hemorrhagic propensity. Different mechanisms between the groups may exist to mediate the onset and development of diverticulosis and its complications.
Outcomes of the Subsequent Periprosthetic Joint Infection Revisions after a Failed Debridement, Antibiotics and Implant Retention: A Multicentric Study of 197 Patients
Auñón Á, Bernaus M, Veloso M, Font-Vizcarra L, Esteban J, Mijangos M, Hernández N, Achaerandio A, Baeza J, Argüelles F, Rojas R, Sánchez J, Martínez-Roselló A, Monfort M, Martínez J, Corredor A, de Espinosa JML, Castellanos J, Martínez Pastor JC, Alías A, Boadas L, Muñoz E and Sabater M
The impact of prior unsuccessful debridement, antibiotics, and implant retention (DAIR) procedures on subsequent revisions is uncertain, with conflicting evidence. Despite 85% consensus against the second DAIR procedure following the 2018 International Consensus Meeting, a 2020 study reported high success rates for the aforementioned second DAIR procedure. We conducted a multicenter observational study reviewing data from patients with failed DAIR procedures between 2005 and 2021. Patients diagnosed with acute periprosthetic joint infection of the hip or knee were included, following ICM criteria. Failure was defined as uncontrolled infection leading to additional surgeries, prosthesis removal, infection-related mortality, or suppressive antibiotic therapy. Demographic, surgical, and microbiological variables were recorded. Among 197 patients from 10 institutions with failed DAIR procedures were included: 88 (44.7%) received a second DAIR, 21 (10.7%) underwent one-stage revision, and 77 (39.1%) underwent two-stage revision. One-stage revision success rate was 76.2%, with no identified predictors of failure. Two-stage revision success rate was 79.3%; factors associated with failure included polymicrobial infections (p = 0.025) and revision procedures (p = 0.049). Second DAIR success rate was 54.5%; factors associated with failure included non-specialized surgical teams in the first DAIR (p = 0.034), non-exchange of mobile components (p = 0.0038), polymicrobial infections (p = 0.043), and antibiotic resistance (p = 0.035). Excluding patients with these risk factors increased the success rate to 83.3%. Second DAIR's overall success rate was 54.5%, significantly increasing to 83.3% when excluding patients with identified risk factors. These findings suggest considering second DAIR in carefully selected patients without these risk factors. Our study found success rates of 76.2% and 79.3% for one- and two-stage revisions, respectively, aligning closely with published data.
The Great Masquerader: Pulmonary Paragonimiasis
Sun B, Deng J, Kuang R and Zhou J
Construction of Survival Nomogram for Ventilator-Associated Pneumonia Patients: Based on MIMIC Database
Li J and Yan H
To construct and validate a predictive nomogram model for the survival of patients with ventilator-associated pneumonia (VAP) to enhance prediction of 28-day survival rate in critically ill patients with VAP. A total of 1,438 intensive care unit (ICU) patients with VAP were screened through Medical Information Mart for Intensive Care (MIMIC)-IV. On the basis of multi-variable Cox regression analysis data, nomogram performance in predicting survival status of patients with VAP at ICU admission for 7, 14, and 28 days was evaluated using the C-index and area under the curve (AUC). Calibration and decision curve analysis curves were generated to assess clinical value and effectiveness of model, and risk stratification was performed for patients with VAP. Through stepwise regression screening of uni-variable and multi-variable Cox regression models, independent prognostic factors for predicting nomogram were determined, including age, race, body temperature, Sequential Organ Failure Assessment score, anion gap, bicarbonate concentration, partial pressure of carbon dioxide, mean corpuscular hemoglobin, and liver disease. The model had C-index values of 0.748 and 0.628 in the train and test sets, respectively. The receiver operating characteristic curve showed that nomogram had better performance in predicting 28-day survival status in the train set (AUC = 0.74), whereas it decreased in the test set (AUC = 0.66). Calibration and decision curve analysis curve results suggested that nomogram had favorable predictive performance and clinical efficacy. Kaplan-Meier curves showed significant differences in survival between low, medium, and high-risk groups in the total set and training set (log-rank < 0.05), further validating the effectiveness of the model. The VAP patient admission ICU 7, 14, and 28-day survival prediction nomogram was constructed, contributing to risk stratification and decision-making for such patients. The model is expected to play a positive role in supporting personalized treatment and management of VAP.
Extended Prophylactic Antibiotics in Penetrating Neck Aerodigestive Injuries Are Not Associated with Improved Outcomes
Holliday TL, Byerly S, Evans C, Babowice JE, Lenart EK, Soule S, Kerwin AJ and Filiberto DM
Literature currently supports the limited use of prophylactic antibiotics within the trauma population. However, data supporting limited (≤24 h) or extended (>24 h) use in penetrating aerodigestive neck injuries is lacking. We sought to describe the role of prophylactic antibiotics in this population and hypothesized there was no reduction in complications for patients on extended prophylactic antibiotics. Using a single-center trauma registry, patients with penetrating aerodigestive neck injuries were identified over a 5-year period. Demographics, injuries, management, and prophylactic antibiotic utilization were collected. Patients were stratified by the utilization of extended prophylactic antibiotics. Outcomes included infection, leak, reinterventions, and mortality. Of 436 patients with penetrating neck injuries, 72 (17%) patients were identified with aerodigestive injuries. Forty-one (57%) patients received extended (>24 h) prophylactic antibiotics, whereas 31 (43%) received limited (≤24 h) prophylactic antibiotics. There was no difference in the patient demographics or injury severity score between the two groups. Extended prophylactic antibiotic use was associated with higher rates of infection (22% vs. 3%, p = 0.036) and leak (15% vs. 0%, p = 0.034) and no difference in reintervention (20% vs. 3%, p = 0.068) or mortality (10% vs. 13%, p = 0.719) compared with limited prophylactic antibiotics. Median duration of extended antibiotic use was 7 days. Operative intervention was equivalent across extended prophylactic antibiotics and limited antibiotics groups (59% vs. 58%, p = 0.968). There is insufficient evidence to support the extended (>24 h) use of prophylactic antibiotics in patients with penetrating neck aerodigestive injuries.