Browsing by Subject "Surgical"

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    Giant Actinomyces brain abscess in an immunocompetent child: A management strategy
    (Scientific Scholar, 2021-07-06) Chicoine, Nicole H.; Griffith-Linsley, Jackson; Goh, Joling; Manaloor, John J.; Raskin, Jeffrey S.; Neurological Surgery, School of Medicine
    Background: Intraparenchymal brain abscess is a collection of microbes caused by inoculation through direct extension or hematogenous spread. Although rare, intraparenchymal abscesses are potentially fatal and can be detected when patients are symptomatic due to local mass effect on adjacent neural tissue. Brain abscess treatment includes medical management with appropriate antibiotics alone or medical management in combination with surgical debridement. Treatment strategies depend on the size and location of disease, as well as the virulence of the microorganism. Similar to medical management strategies, surgical strategies among providers are not uniform, with variation in approaches from complete extirpation of the abscess, including the abscess wall, to minimally invasive stereotactic needle aspiration. In particular, for children, there are no guidelines for therapy. Case description: We report a case of giant Actinomycosis right frontal brain abscess in an immunocompetent child without risk factors. A review of the literature for the treatment of brain abscess caused very rarely by Actinomyces in children is performed. Conclusion: Successful treatment of brain access depends on organism and location. The even more uncommon giant intraparenchymal abscesses can be managed with minimal access and prolonged antibiosis, especially when slow-growing organisms are identified. Long-term follow-up should be employed to mitigate missed late failures.
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    Mortality Associated with Surgical Site Infections Following Cardiac Surgery: Insights from the International ID-IRI Study
    (Elsevier, 2025-01-08) Erdem, Hakan; Ankarali, Handan; Al-Tawfiq, Jaffar A.; Angamuthu, Kumar; Piljic, Dragan; Umihanic, Ajdin; Dayyab, Farouq; Karamanlioğlu, Dilek; Pekok, Abdullah Umut; Cagla-Sonmezer, Meliha; El-Kholy, Amani; Gad, Maha Ali; Velicki, Lazar; Akyildiz, Ozay; Altindis, Mustafa; Başkol-Elik, Dilşah; Erturk-Sengel, Buket; Kara, İbrahim; Kahraman, Umit; Özdemir, Mehmet; Caskurlu, Hulya; Cag, Yasemin; Al-Khalifa, Abdulwahab; Hakamifard, Atousa; Batinjan, Marina Kljaković-Gašpić; Tahir, Muhammad; Tukenmez-Tigen, Elif; Zajkowska, Joanna; ElKholy, Jehan; Gašparović, Hrvoje; Filiz, Mine; Gul, Ozlem; Tehrani, Hamed Azhdari; Doyuk-Kartal, Elif; Aybar-Bilir, Yesim; Kahraman, Hasip; Mikulić, Hrvoje; Dayan, Saim; Cascio, Antonio; Yurdakul, Eray Serdar; Colkesen, Fatma; Karahangil, Kadriye; Espinosa, Angel; Rahimi, Bilal Ahmad; Vangel, Zdraveski; Fasciana, Teresa; Giammanco, Anna; Medicine, School of Medicine
    Objectives: Surgical site infections (SSIs) after cardiac surgery increase morbidity and mortality rates. This multicenter study aimed to identify mortality risk factors associated with SSIs after heart surgery. Methods: Conducted from January to March 2023, this prospective study included 167 patients aged >16 years with post-heart surgery SSIs. The primary focus was the 30-day mortality. Univariate analysis and multivariate logistic regression utilizing the backward elimination method were used to establish the final model. Results: Several factors significantly correlated with mortality. These included urinary catheterization (odds ratio [OR] 14.197; 90% confidence interval [CI] 12.198-91.721]), emergent surgery (OR 8.470 [90% CI 2.028-35.379]), valvular replacement (OR 4.487 [90% CI 1.001-20.627]), higher quick Sequential Organ Failure Assessment scores (OR 3.147 [90% CI 1.450-6.827]), advanced age (OR 1.075 [90% CI 1.020-1.132]), and postoperative re-interventions within 30 days after SSI (OR 14.832 [90% CI 2.684-81.972]). No pathogens were isolated from the wound cultures of 53 (31.7%) patients. A total of 43.1% of SSIs (n = 72) were due to gram-positive microorganisms, whereas 27.5% of cases (n = 46) involved gram-negatives. Among the gram-positive bacteria, Staphylococci (n = 30, 17.9%) were the predominant microorganisms, whereas Klebsiella (n = 16, 9.6%), Escherichia coli (n = 9, 5.4%), and Pseudomonas aeruginosa (n = 7, 4.2%) were the most prevalent. Conclusions: To mitigate mortality after heart surgery, stringent infection control measures and effective surgical antisepsis are crucial, particularly, in the elderly. The clinical progression of the disease is reflected by the quick Sequential Organ Failure Assessment score and patient re-intervention, and effective treatment is another essential component of SSI management.