Browsing by Subject "surgical site infection"

Now showing 1 - 3 of 3
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    Is surgical antibiotic prophylaxis necessary for pediatric orchiopexy?
    (Elsevier, 2018) Rensing, Adam J.; Whittam, Benjamin M.; Chan, Katherine H.; Cain, Mark P.; Carroll, Aaron E.; Bennett, William E., Jr.; Urology, School of Medicine
    Introduction Surgeons frequently use surgical antibiotic prophylaxis (SAP), despite limited evidence to support its efficacy. Potential adverse events associated with antibiotic use include allergic reaction (including anaphylaxis), Clostridium difficile infection, and selecting for resistant bacteria. Surgical site infections (SSI) are very rare in patients undergoing clean pediatric urologic procedures. Current guidelines are unclear about the efficacy of surgical antibiotic prophylaxis for prevention of SSI in the pediatric population. Objective It was hypothesized that children who received SAP prior to orchiopexy would have no reduction in surgical site infection (SSI) risk but an increased risk of antibiotic-associated adverse events. Methods A retrospective cohort study was conducted of all males aged between 30 days and 18 years who underwent an orchiopexy (ICD-9 CM 62.5) in an ambulatory or observation setting from 2004 to 2015 using the Pediatric Health Information System database. Inpatients and those with concomitant procedures were excluded. Chi-squared or Fisher's exact tests were used to determine the association between SAP and allergic reaction (defined as a charge for epinephrine or ICD-9 diagnosis code for allergic reaction on the date of surgery) and any of the following within 30 days: SSI, hospital readmission or any repeat hospital encounter. Mixed effects logistic regression was performed, controlling for age, race, and insurance, and clustering of similar practice patterns by hospital. Results A total of 71,767 patients were included: median age was 4.6 years, 61.4% were white, and 49.3% had public insurance; 33.5% received SAP. Of these participants, 996/71,767 (1.4%) had a perioperative allergic reaction and <0.1% were diagnosed with an SSI. On mixed effects logistic regression, those who received SAP had 1.2 times the odds of a perioperative allergic reaction compared with those who did not receive SAP ( P = 0.005). Surgical antibiotic prophylaxis was not associated with decreased rates of SSI, lower hospital readmission, nor a lower chance of a repeat encounter within 30 days. Conclusions In patients undergoing orchiopexy, it was found that SAP did not reduce the risk of postoperative SSI, readmissions, or hospital visits. Patients who received SAP had significantly increased odds of perioperative allergic reaction. This demonstrated that the risks of SAP outweigh the benefits in children undergoing orchiopexy.
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    Prophylactic negative pressure wound therapy at cesarean: Are we there yet?
    (Wiley, 2018) Tuuli, Methodius; Medicine, School of Medicine
    Prophylactic negative pressure wound therapy (NPWT) has emerged as a promising intervention in patients at high risk for surgical site infection (SSI). One such group is obese gravidae, a growing population worldwide who are at high risk for both cesarean delivery and SSI. Although the precise mechanism by which NPWT aids incisional wound healing is unclear, experimental evidence suggests that it reduces bacterial contamination, edema, and exudate, increases microvascular blood flow, promotes formation of granulation tissue and reduces lateral tensile and shear stress. Data on NPWT after cesarean have hitherto been limited to retrospective cohort and small pilot randomized trials (RCT). Whereas some studies demonstrated benefit in reducing SSI and other wound complications, they were limited by small sample sizes, selection bias and confounding.
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    A review of post-caesarean infectious morbidity: how to prevent and treat
    (Taylor & Francis, 2018) Pierson, Rebecca C.; Scott, Nicole P.; Briscoe, Kristin E.; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Post-caesarean infectious complications result in significant maternal morbidity and mortality as well as increased readmissions and increased health care cost worldwide. This review provides a discussion of several risk factors that have been identified which predispose women to post-surgical infection. We also provide an overview of strategies for infection prevention including antibiotics, surgical techniques and negative pressure wound therapy. Criteria for diagnosis of wound infection are provided, as well as appropriate treatment regimens. Given the impact of maternal post caesarean infection, it is important for women’s health care providers to understand how to prevent these infections, as well as recognise and treat them.