Surgical site infections (SSIs) are among the leading healthcare-associated infections worldwide, and S. aureus is the most prevalent cause. Antimicrobial resistance, dormant cells, and biofilm formation contribute to treatment failure in SSIs. Therefore, new therapeutic approaches are needed to fight SSIs. The bacteriocin AP7121 has previously shown in vitro bactericidal and anti-biofilm activity against multi-resistant S. aureus. This study aimed to advance on the characterization of the in vitro activity of AP7121 against dormant forms of methicillin-resistant S. aureus (MRSA) and its effect on the adherence of a biofilm-producing strain to sutures. Additionally, a preliminary murine model of SSIs was utilized to proceed toward the in vivo application of AP7121, comparing its antimicrobial potency with the commercial antibiotic Cefazolin. Initially, MRSA cultures were grown to the logarithmic growth phase and subsequently exposed to varying concentrations of AP7121. Viable bacterial counts were assessed at different times of incubation. AP7121 demonstrated a concentration-dependent effect on dormant cells of MRSA when using 8xMIC. The effect of AP7121 on the adherence of biofilm-producing S. aureus to suture surfaces was subsequently evaluated using scanning electron microscopy. AP7121 showed significant inhibitory effects on the adherence of S. aureus in suture threads. Finally, AP7121 demonstrated a significant in vivo bactericidal effect against S. aureus in SSI model. The reduction in viable bacterial counts compared to the control group exceeded 90 % for both Cefazolin and AP7121 treatments. These preliminary findings highlight AP7121 as a novel and promising antimicrobial peptide for potential applications in human and veterinary medicine.

Implementing evidence-based practice (EBP) is a complex process requiring healthcare providers to integrate evidence-based medicine (EBM) into clinical practice, ultimately improving clinical outcomes. This systematic review examined the sources of information for EBP, analyzed the extent of EBP implementation by healthcare providers, and explored the factors influencing EBP in Africa.

We identified articles published between January 1992 and March 2024 by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMbase, PubMed, and Scopus databases. The pooled effect sizes for the prevalence of EBP and odds ratios (ORs) were estimated using random- and fixed-effects models as appropriate. For the qualitative component of the study, we performed a thematic analysis and subsequently integrated and interpreted findings from both the quantitative and qualitative analyses.

Thirty-three studies were included in this review, involving 9722 healthcare providers: 60.3% nurses, 15.9% physicians, and 15.4% midwives. Our findings revealed a lack of detailed information on how healthcare providers utilized different forms of EBM to inform EBP and clinical outcomes in Africa. Self-reported EBP was 57.3% among nurses and 37.3% among physicians. Nigeria had the highest self-reported EBP (75.2%), whereas Egypt had the lowest (18.9%). Common sources of information reported for EBP were PubMed, UpToDate, the Cochrane Library, clinical guidelines, and training programs. Factors associated with EBP included knowledge of EBP (OR = 2.13, 95% confidence interval [CI]: 1.83-2.47), positive attitude toward EBP (OR = 1.95, 95% CI: 1.76-2.15), and having EBM training (OR = 3.08, 95% CI: 2.08-4.57), and a managerial role (OR = 2.16, 95% CI: 1.37-3.41). The availability of guidelines (OR = 1.88, 95% CI: 1.5-2.37) and internet access (OR = 1.90, 95% CI: 1.54-2.34) were also found to increase EBP. Our qualitative analysis identified common barriers to EBP, including a lack of support, resistance to change, poor communication, and failure to integrate EBP courses into the continuing education curricula.

This systematic review found limited information on the sources of EBM, how it was delivered, and its frequency of use in clinical practice. Thus, the correlation between EBM, EBP, and clinical outcomes was not fully transparent. Further studies are required to examine the medical conditions addressed within providers' scopes of practice, the types of evidence utilized, the frequency and consistency of EBP implementation, and its effect on enhancing patient outcomes.

Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO2) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.

Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80-100% perioperative FiO2 to prevent surgical site infection (SSI) versus 21-35% FiO2. This 12-month internal pilot assessed feasibility of hospital site opening, patient recruitment, intervention adherence, patient follow-up and safety. Patients were randomised in a 1:1:1:1 ratio to the four intervention group combinations and followed up for 30 days.

We recruited 927 patients from seven hospitals in India and South Africa over 12 months from November 2020. There were 907 adults (97.8%) and 20 children aged ten or over (2.2%): 89/927 (9.6%) patients died. Site opening reached 70% of our target (7/10) hospitals, and patient recruitment 107% (927/870). 917/927 (99%) patients in the mouthwash arm, and 840/927 (91%) patients in the oxygen arm received the allocated intervention. Lower adherence to the oxygen intervention related mainly to clinically necessary FiO2 increases in the 21-35% FiO2 arm. 30-day follow-up was completed appropriately for 924/927 (99%) patients. and was performed by a masked assessor for all patients. There were no reported safety events.

This pilot showed the feasibility and safety of a major phase III trial in post-operative infection prevention in LMICs.

ClinicalTrials.gov NCT04256798.

Surgical site infections (SSI) are a major concern due to their contributions to morbidity, economic loss, and death among individuals who underwent operations in healthcare institutions. To decrease this infection, various pharmacological and non-pharmacological interventions have been devised and implemented for major surgery patients. Pharmacological interventions include the provision of antibiotic prophylaxis and antiseptic agents, whereas non-pharmacological interventions encompass programmatic interventions such as protocols, policies, quality improvement initiatives, training, and education that are given at the institutional level. However, the effect of particularly non-pharmacological interventions on the reduction has not been comprehensively evaluated for over a decade. This systematic review attempts to synthesize a piece of evidence on the effect of non-pharmacological intervention in Sub-Saharan Africa on minimizing SSI and enhancing health outcomes.

Databases including MEDLINE, Google Scholar, Cochrane Library, AJOL, Hinari, search platforms, and open-access repositories were accessed. Two investigators conducted a literature selection process, and the quality of selected articles was assessed using a JBI quality evaluation checklist.

A total of 11 studies that met the inclusion criteria were analyzed. Three main intervention categories were identified, which focused on improving adherence to protocol, policy change or induction, and delivery of multimodal strategies. These interventions led to a reduction in SSI rates in varying degrees (15% to 95%). Multimodal interventions are the most widely implemented and comprehensive approaches that integrate multiple evidence-based practices, which have demonstrated a substantial reduction of SSI in different surgical populations. The rates of improvement with these interventions were influenced by intervention type, patient characteristics, surgical urgency, healthcare setting, follow-up time, and criteria for measuring the outcomes that may influence the SSI rates.

Interventions focusing on policy, protocol, and multimodal strategies can effectively reduce SSI rates, with the latter being the most effective. Patient and clinical characteristics, along with the healthcare setting, were influential factors affecting the interventions' impact on SSI. This systematic review is registered in PROSPERO, in the number CRD42024524963.

Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and Cochrane Library were searched for studies investigating antibiotic prophylaxis dosing in surgical patients with obesity. Outcomes of interest were pharmacokinetic parameters such as plasma and interstitial fluid concentrations, area under the concentration time curve in plasma and in interstitial fluid, and other pharmacokinetic measures. Thirty studies investigating cefazolin, cefoxitin, cefuroxime, piperacillin/tazobactam, meropenem, ertapenem, metronidazole, vancomycin, ciprofloxacin, and gentamicin were included in this analysis. Except for metronidazole, cefoxitin, and gentamicin, there is currently no evidence suggesting the need for dosing adjustments.

Post-injection endophthalmitis (PIE) is the most concerning complication that accompanies intravitreal injections. This review discusses the recent literature in endophthalmitis prophylaxis including types of antisepsis, the use of topical antibiotics, methods of anesthesia, masking, and office-based versus operating room-based injections.

Povidone iodine (PI) remains the gold standard for PIE prophylaxis. Chlorhexidine gluconate (CHG) is an alternative antiseptic agent utilized in other areas of medicine with similar broad spectrum antibacterial activity. Recent clinical trials have demonstrated that the rate of endophthalmitis is similar with CHG prophylaxis compared to PI prophylaxis while offering improved patient comfort at a similar cost. Routine use of topical antibiotics should be avoided as they do not appear to reduce endophthalmitis risk and may promote bacterial resistance. All methods of anesthesia appear to be acceptable. In-office injections are not associated with an increased rate of endophthalmitis compared to operating room injections.

The rate of post-injection endophthalmitis is extremely low due to a myriad of measures employed by retina specialists. Topical antisepsis is the most important tool to combat post-injection endophthalmitis. CHG is emerging as an alternative to PI due to its efficacy and enhanced patient comfort.

Surgical site infection (SSI) prevention "bundles" have been shown to reduce rates of SSI in adult colorectal surgery (CRS) patients. Our purpose was to investigate the association between selection and timing of preoperative antibiotics and incidence of SSI in pediatric CRS patients.

We performed a retrospective analysis of a prospectively collected cohort study spanning January 2019-December 2022 comparing the incidence of SSI in all pediatric CRS patients at a single institution before and after implementation of a surgical "bundle" focused on appropriate selection and timely administration of prophylactic antibiotics. Antibiotic selection and timing were each categorized compliant or noncompliant. SSIs were stratified into superficial, deep incisional, and organ space infections. The primary outcome was incidence of SSI within 30 d of operation. Logistic regression analysis was performed.

Full compliance was noted in 56% of cases in the prebundle cohort and 88% of cases in the postbundle cohort. SSI rates were decreased by 44%. A logistic regression model failed to identify antibiotic selection or timing as an independent predictor of SSI.

The implementation of this perioperative surgical bundle was associated with a reduction in superficial SSI in pediatric CRS patients. Notably, specific adherence to antibiotic selection and timing of administration alone were not found to be predictive for reduction in SSI rates. These findings may support the use of surgical bundles in SSI reduction in pediatric patients undergoing CRS.

Postoperative wound infections remain a significant challenge in gastrointestinal surgery, with substantial implications for prolonged hospital stays and healthcare costs. Immunonutrition with n-3 polyunsaturated fatty acids (PUFAs) offers potential preventive benefits through modulation of inflammatory responses. This study aimed to explore the impact of enteral nutritional enriched with n-3 PUFAs on wound infection in patients undergoing gastrointestinal surgery.

A thorough search was carried out, from databases to December 2023, across Cochrane Library, Embase, CNKI, Google Scholar, Wanfang, and PubMed on randomized controlled trials (RCTs) examining the impacts of enteral nutritional enriched with n-3 PUFAs for treatment of patients with gastrointestinal surgery. Two independent researchers conducted literature screening, data extraction, and quality assessments. The primary outcome measures were wound infection and complications. Statistical analysis was conducted in Stata 17.0 and RevMan 5.4 software.

Fifteen RCTs involving 1442 patients who underwent gastrointestinal surgery were included. The analysis revealed the application of enteral nutritional enriched with n-3 PUFAs markedly decreased the occurrence of complications (odds ratio [OR] = 0.56, 95 % confidence intervals [CI]: 0.44-0.71, P < 0.001) and wound infection (OR = 0.68, 95 %CI: 0.47-0.98, P = 0.04) in patients who underwent gastrointestinal surgery.

This study demonstrates that postoperative support with enteral nutritional enriched with n-3 PUFAs can effectively decrease the occurrence of wound infections and postoperative complications following gastrointestinal surgery. These findings suggest that n-3 PUFAs supplementation should be considered as a standard component of perioperative nutritional protocols to improve surgical outcomes in patients undergoing gastrointestinal procedures.

In this article, we have addressed the recent published article by Wang et al which examines risk factors associated with surgical site infections (SSIs) and evaluates the effectiveness of prophylactic antibiotics in their prevention. Wang et al identified several significant risk factors of SSIs, including age ≥ 60 years, diabetes mellitus, and surgical complications such as insufficient cystic duct stump closure, gallbladder perforation, empyema, and postoperative hematoma. Their findings suggest that prophylactic antibiotics can serve as a protective factor against SSIs. However, other reported risk factors and preventive strategies warrant consideration to further reduce the incidence of SSIs, lower healthcare costs, and enhance patient outcomes. Additionally, the judicious use of prophylactic antibiotics is crucial in light of the growing global challenge of antibiotic resistance caused by the misuse and overuse of antibiotics. Effective management strategies for prophylactic antibiotic use should be prioritized to balance infection control with the need to combat antimicrobial resistance.

Peripheral arterial disease (PAD) results from the narrowing of arteries. Aortic aneurysms - abnormal dilatations in artery walls - are a related concern. For severe cases, arterial reconstruction surgery is the treatment option. Surgical site infections (SSIs) are a feared and common complication of vascular surgery. These infections have a significant global healthcare impact. Evaluating the effectiveness of preventive measures is essential.

To assess the effects of pharmacological and non-pharmacological interventions, including antimicrobial therapy, antisepsis, and wound management, for the prevention of infection in people undergoing any open or hybrid aortic or aortoiliac peripheral arterial reconstruction.

The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform, LILACS, and ClinicalTrials.gov up to 11 November 2024.

We included all randomised controlled trials (RCTs) with a parallel (e.g. cluster or individual) or split-body design, and quasi-RCTs, which assessed any intervention to reduce or prevent infection following aortic or aortoiliac procedures for the treatment of aneurysm or PAD. There were no limitations regarding age and sex.

We used standard Cochrane methodological procedures. Two review authors independently extracted the data and assessed the risk of bias of the trials. A third review author resolved disagreements when necessary. We assessed the evidence certainty for key outcomes using GRADE.

We included 21 RCTs with 4952 participants. Fifteen studies were assessed as having a high risk of bias in at least one domain, and 19 studies had an unclear risk of bias in at least one domain. We analysed 10 different comparisons for eight different outcomes. The comparisons were antibiotic versus placebo or no treatment; short-duration antibiotics (≤ 24 hours) versus long-duration antibiotics (> 24 hours); different types of systemic antibiotics (one versus another); antibiotic-bonded implant versus standard implant; Dacron graft versus stretch polytetrafluoroethylene graft; prophylactic closed suction drainage versus undrained wound; individualised goal-directed therapy (IGDT) versus fluid therapy based on losses, standard haemodynamic parameters and arterial blood gas values (standard care); comprehensive geriatric assessment versus standard preoperative care; percutaneous versus open-access technique; and negative pressure wound therapy (NPWT) versus standard dressing. The primary outcomes were graft infection rate and SSI rate. The secondary outcomes included all-cause mortality, arterial reconstruction failure rate, re-intervention rate, amputation rate, pain resulting from the intervention, and adverse events resulting from the interventions to prevent infection. We did not assess all the outcomes across the different comparisons. The main findings are presented below. Antibiotic versus placebo or no treatment (five studies) Very low-certainty evidence from five included studies suggests that antibiotic prophylaxis reduces SSI (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.15 to 0.71; 5 studies, 583 participants; number needed to treat for an additional beneficial outcome (NNT) 9). With very low- to low-certainty evidence, there was little or no difference between the groups in the other assessed outcomes (graft infection rate, all-cause mortality, re-intervention rate, and amputation rate). We did not quantitatively assess other outcomes in this comparison. Short duration antibiotics (≤ 24 hours) versus long duration antibiotics (> 24 hours) (three studies) Very low-certainty evidence from three included studies suggests that there is little or no difference in graft infection rate (RR 2.74, 95% CI 0.11 to 65.59; 1 study, 88 participants) or SSI rate (RR 3.65, 95% CI 0.59 to 7.71; 1 study, 88 participants) between short- and long-duration antibiotic prophylaxis. We did not quantitatively assess other outcomes in this comparison. Different types of systemic antibiotics (one versus another) (seven studies) We grouped seven studies comparing one antibiotic to another into three subgroups that compared different classes of antibiotics amongst themselves. We found little or no difference between the groups analysed. Graft infection rate: beta-lactams versus cephalosporins (RR 0.36, 95% CI 0.02 to 8.71; 1 study, 88 participants; very low-certainty evidence); glycopeptides versus cephalosporins (RR 5.00, 95% CI 0.24 to 103.05; 1 study, 238 participants; low-certainty evidence); one cephalosporin versus another (RR not estimable, CI not estimable; 1 study; 69 participants; very low-certainty evidence); SSI rate: beta-lactams and cephalosporins (RR 0.27, 95% CI 0.03 to 2.53; 2 studies, 229 participants; very low-certainty evidence); glycopeptides versus cephalosporins (RR 2.17, 95% CI 0.65 to 7.23; 2 studies, 312 participants; very low-certainty evidence); and one cephalosporin versus another (RR 1.26, 95% CI 0.21 to 7.45; 3 studies, 625 participants; very low-certainty evidence). We could extract all-cause mortality data for the glycopeptide versus cephalosporin comparison; there was little or no difference between groups (RR 1.33, 95% CI 0.30 to 5.83; 1 study, 238 participants; low-certainty evidence). We did not quantitatively assess other outcomes in this comparison.

Very low-certainty evidence suggests that the use of prophylactic antibiotics may prevent SSIs in aortic or aortoiliac peripheral arterial reconstruction. We found no superiority amongst specific antibiotics or differences in extended antibiotic use (over 24 hours) compared with shorter use (up to 24 hours), with low-certainty evidence. For other interventions, very low- to moderate-certainty evidence showed little or no difference across various outcomes. We advise interpreting these conclusions with caution due to the limited number of events in all groups and comparisons.

The fibrous capsule around cardiac implantable electronic device (CIED) generators represents avascular tissue that could be colonized and provides the nidus for latent infection. The purpose of the study is to evaluate the effects of incision of the capsule floor at the lower and/or medial part at the time of generator replacement on the CIED infection and hematoma formation.

This observational study with retrospective analysis of prospectively collected data included patients who underwent CIED generator replacement between January 2013 and January 2024. A total of 1059 consecutive patients were compared according to the incision of the capsule floor at the lower and/or medial part: 448 patients without (group 1) and 611 patients with an incision on the capsule floor (group 2).

Fifteen patients with CIED infection after generator replacement were identified. There were no significant differences between the two groups, except for a higher percentage of patients with number of previous procedures on pocket ≥ 2 (35% vs. 19.6%, p < 0.001), and NOAC use (10.6% vs. 6.7%, p = 0.027) in group 2. There was a lower infection rate in group 2 compared to group 1 (0.7% vs. 2.5%, p = 0.014). In multivariate analysis, independent predictors of CIED infection after generator replacement were replacement without an incision of the capsule floor (OR 4.384, 95% CI [1.355-14.189]; p = 0.014), and age< 65 years (OR 3.259, 95% CI [1.133-9.378]; p = 0.028).

Generator replacement without incision of the capsule floor during generator replacement was associated with increased CIED infection risk. To minimize CIED infection risk, capsule floor incision could be considered during generator replacement.

The prevention of orthopedic infections is of critical importance to improve patient outcomes and reduce health care costs. Preventative strategies can be employed preoperatively, including mitigation of medical risk factors, methicillin-resistant Staphylococcus aureus decolonization, appropriate skin preparation, and optimizing perioperative antimicrobial prophylaxis; intraoperatively, including utilizing irrigation, topical antibiotics, infection control measures, and timely debridement/optimal surgical techniques; and postoperatively, including consideration of antibiotic duration after primary arthroplasty and reimplantation. This article provides an evidence-based discussion of these strategies while also highlighting areas where ongoing research may be beneficial.

Post-rhinoplasty pain control should use a multimodal regimen. Evidence suggests decreasing routine prescriptions of narcotics is reasonable for most individuals, and acetaminophen and nonsteroidal antiinflammatory drug combinations may be equivalent to as-needed opioids for postsurgical pain management. Preoperative pain counseling is important to set post-rhinoplasty pain expectations and reduce opioid use. A single intravenous dose of prophylactic antibiotics before incision is sufficient for most cases of functional rhinoplasty. Additional considerations are given to complex revision cases, use of allogenic grafts or implants, external osteotomies, or patients with immunosuppression or at risk of endocarditis.

To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management.

Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members. Modified US Preventive Services Task Force criteria were used to determine levels of evidence and certainty. Using a modified Delphi method, >50% agreement was needed to accept a recommendation for author review, and >75% agreement for a recommendation to be accepted. The ASRA Pain Medicine Board of Directors reviewed and approved the final guidelines.

After documenting the incidence and infectious complications associated with regional anesthesia and interventional pain procedures including implanted devices, we made recommendations regarding the role of the anesthesiologist and pain physician in infection control, preoperative patient risk factors and management, sterile technique, equipment use and maintenance, healthcare setting (office, hospital, operating room), surgical technique, postoperative risk reduction, and infection symptoms, diagnosis, and treatment. Consensus recommendations were based on risks associated with different settings and procedures, and keeping in mind each patient's unique characteristics.

The recommendations are intended to be multidisciplinary guidelines for clinical care and clinical decision-making in the regional anesthesia and chronic interventional pain practice. The issues addressed are constantly evolving, therefore, consistent updating will be required.

Surgical-site antisepsis is used to prevent surgical-site infections (SSIs). Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine, povidone-iodine, and olanexidine, in reducing the SSI rate, an optimal recommendation is still not established. The aim of this study was to evaluate the efficacy of aqueous olanexidine compared with chlorhexidine-alcohol as the optimal antiseptic for preventing SSI in clean-contaminated surgery.

This multicentre randomized trial for surgical skin antisepsis in clean-contaminated gastrointestinal and hepatobiliary-pancreatic surgeries in five hospitals evaluated the efficacy of olanexidine and chlorhexidine-alcohol. The primary endpoint was 30-day SSI. Secondary outcomes included the occurrence of SSI types, intervention-related toxicity, and reoperation caused by SSI.

Overall, 700 patients from five institutions underwent randomization; 347 received olanexidine and 345 received chlorhexidine-alcohol in the full analysis set. The 30-day SSI rate was 12.4% (43 of 347) in the olanexidine group and 13.6% (47 of 345) in the chlorhexidine-alcohol group (adjusted risk ratio (aRR) 0.911 (95% c.i. 0.625 to 1.327); P = 0.626). No significant differences were observed between the groups regarding the secondary outcomes, including the occurrence of superficial incisional SSI, deep incisional SSI, organ/space SSI, and reoperation caused by SSI. Overall adverse effects were seen in two patients (0.58%) in the olanexidine group and in three patients (0.87%) in the chlorhexidine-alcohol group (aRR 0.663 (95% c.i. 0.111 to 3.951)).

Olanexidine did not significantly reduce the occurrence of overall SSI compared with chlorhexidine-alcohol. Nevertheless, these findings provide valuable insights for developing novel surgical SSI management protocols.

UMIN 000049712 (University Hospital Medical Information Network Clinical Trials Registry).

Surgical site infections (SSIs) remain a significant cause of morbidity, prolonged hospital stays, and increased healthcare costs, particularly in low-resource settings such as Ethiopia. While SSIs are widely recognized as preventable, the burden of these infections remains high, especially in sub-Saharan Africa, where healthcare resources are limited, and surgical care may not consistently meet recommended standards. In Ethiopia, as in many similar settings, the lack of robust, context-specific predictive tools limits the ability of healthcare providers to proactively manage SSI risks. Current predictive models and nomograms for SSI risk are generally developed in high-resource settings and may not accurately capture the unique risk factors in Ethiopia. The aim of this study was Development and validation of nomogram for Surgical Site Infection Prediction Among General Surgery Patients in Amhara. A prospective follow-up study was conducted involving general surgery patients at referral hospitals in the Amhara region. Predictors of SSIs were identified through logistic regression analysis, and a nomogram was constructed based on these predictors. The model was internally validated using bootstrapping techniques to assess the accuracy and reliability of the risk estimates. Model performance was evaluated in terms of discrimination, measured by the area under the receiver operating characteristic (ROC) curve (AUC), and calibration, using calibration plots. The incidence of SSI was 39.6%. The key prognostic predictors of this model were: sex, age, diabetes mellitus (DM), wound classification, wound care, American Society of Anesthesiologists (ASA) score, residence, surgery duration, preoperative hospital stays, alcohol consumption, and prior surgical history. The model's discrimination power was 90.1% with 95% CI (87-93%) and its calibration is well fitted with 45 degrees. The bootstrapped model produced consistent β coefficients, supporting the stability and robustness of the model. The nomogram was developed with key predictors of SSI and demonstrated excellent discrimination ability, with an AUC of 0.87 (95% CI: 0.84-0.91). Calibration plots showed a strong agreement between predicted and observed probabilities, indicating the model is well-calibrated. The incidence of SSI was notably high. American Society of Anesthesiologists (ASA) score, sex, age, diabetes mellitus (DM), wound classification, wound care practices, patient residence, surgery duration, preoperative hospital stay, alcohol use, and history of previous surgeries were key prognostic predictors. The validated model had an excellent discrimination power with well fitted calibration. The developed nomogram accurately predicts the risk of SSIs among general surgery patients. It might serve as a practical tool for identifying high-risk patients, enabling healthcare providers to implement targeted preventive measures, improving patient outcomes and reducing the burden of SSIs in Ethiopian healthcare settings. Further external validation is recommended to confirm the model's applicability across different settings.

Background: Surgical site infections (SSIs) have a significant health economic burden, accounting for more than US $3.3 billion in costs, and lead to increased microbial resistance, prolonged hospital stays, elevated 30-day mortality rates, greater incidences of reoperation, and decreased quality of life. Recently, evidence has emerged suggesting that prophylactic closed incision negative pressure wound therapy (ciNPWT) may substantially reduce the risk of post-operative wound complications, specifically SSIs. This study aimed to evaluate whether ciNPWT is cost-effective compared with routine incision care for the prevention of superficial SSIs. Hypothesis: We hypothesized that ciNPWT is cost-effective compared with routine incision care for the prevention of superficial SSIs. Methods: A cost-effectiveness decision analytic model was created comparing the use and non-use of ciNPWT. Superficial SSI probabilities, cost of care for patients with and without post-operative infection, and quality of life Short Form (SF)-36 survey data were obtained from a literature review. Cost of ciNPWT was obtained from health administrative data. A decision tree was constructed using TreeAge Software Pro Version 2020 (TreeAge Software, Inc., Williamstown, MA). Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness and reliability of the model. Results: One-way sensitivity analysis with a willingness-to-pay threshold of $5,000 demonstrated that above a baseline infection rate of approximately 6.4%, ciNPWT is cost-effective at reducing superficial SSI. Probabilistic sensitivity analysis indicated that even with uncertainty present in the parameters analyzed, the majority of simulations (95.4%) favored ciNPWT as the more effective tactic. Conclusions: Despite the added device cost, ciNPWT is cost-effective for superficial SSI prevention across a variety of surgical infection risk profiles.

 Guidelines for systemic antibiotic prophylaxis (SAP) in arthroplasty surgery vary worldwide from repeated doses to only 1 preoperatively. We aimed to investigate, primarily whether 4 doses reduced the risk of PJI compared with 1 to 3 doses, and secondarily if there was a difference between types of antibiotics.

 Patients reported to the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register with primary total knee (TKA), total (THA) or hemi- (HA) hip arthroplasty between 2005 and 2023 were included. Cases with 1 to 4 doses of cefalotin (half-life = 45 minutes), cefazolin (90 minutes), cefuroxime (70 minutes), cloxacillin (30 minutes), or clindamycin (180 minutes) were assessed. Primary outcome was 1-year risk of reoperation (adjusted hazard rate ratio; aHRR) for PJI and was estimated by Cox regression analyses. Secondary outcomes were reoperation for PJI and reoperation for any cause with follow-up of up to 19 years. Non-inferiority analyses and propensity score matching with subsequent Kaplan-Meier analyses were performed with a predetermined non-inferiority margin of 15% (aHRR = 1.15).

 301,204 cases were included. Of these, 3,388 (1.1%) were reoperated on for PJI within 1 year. The 1-year incidence of reoperation for PJI was 98/9,760 (1.0%) for 1 dose of SAP, 109/10,956 (0.9%) for 2 doses, 178/18,948 (0.9 %) for 3 doses, and 3,003/261,540 (1.0%) for 4 doses. The 1-year risk (aHRR, 95% confidence interval [CI]) of reoperation for PJI was 1.0 (CI 0.8-1.2), 0.9 (CI 0.8-1.2), and 0.9 (CI 0.9-1.1) for 1, 2, and 3 doses, respectively, compared with 4 doses. The 1-year incidence of reoperation for PJI was 2,162/183,964 (1.2%) for cefalotin, 993/91,159 (1.1%) for cefazolin, 35/4,435 (0.8%) for cefuroxime, 85/9,022 (0.9%) for cloxacillin, and 113/12,624 (0.9%) for clindamycin. Compared with cefazolin, cloxacillin (1.2, CI 1.0-1.6) and cefalotin (1.4, CI 1.2-1.5) had a higher risk of reoperation for PJI, whereas cefuroxime (1.0, CI 0.7-1.4) and clindamycin (1.1, CI 0.9-1.3) had a similar risk.

 4 doses of SAP did not reduce the risk of PJI compared with 1 to 3 doses in primary arthroplasty as measured against PJI. Cefazolin, the 1st-generation cephalosporin with the longest half-life, showed the lowest risk of PJI.

There are few evidence-based guidelines for perioperative antibiotic management in neonates who undergo enteric operations. We sought to assess antibiotic administration practices in a large population of patients who underwent operations involving enteric anastomoses and evaluate the incidence of postoperative infection and other outcomes based on antibiotic approach.

The Pediatric Health Information Systems database was queried for patients who underwent repair of esophageal, duodenal or jejuno-ileal atresia in 2021. The type and number of consecutive days of perioperative antibiotics was determined and ICD-10 codes corresponding to infection were noted. The incidences of post operative infections (bacterial and fungal), antibiotic-resistant infections and anti-fungal medication administration were determined.

516 infants were identified. A wide variety of antibiotics were administered and 39 % of patients received more than one day of treatment. There were no differences in the incidence of postoperative infection between those who received more or less than one day of perioperative antibiotics for any of the operations assessed. The incidence of bacterial infection in patients treated with cefazolin or cefoxitin monotherapy was no different than that for all other regimens. There were no significant differences in the incidence of post-operative fungal infection based on antibiotic type or duration.

There was substantial variation in the duration and type of antibiotics administered after neonatal enteric operations. We identified a low incidence of infection with only one day of perioperative antibiotics and there was no evidence that longer treatment reduced infection risk. Cefazolin monotherapy was likewise associated with a low risk for perioperative infections.

Non-interventional observational database study.

To determine the effects of rapid (1 minute) and slow (10 minutes) intravenous (IV) injection of sodium penicillin on arterial blood pressure in anesthetized horses.

Prospective randomized clinical trial.

A group of 29 client-owned horses of various breeds, 1-20 years old, with body masses of 360-710 kg.

General anesthesia was induced with a variety of anesthetic protocols and maintained with isoflurane under mechanical ventilation, with hourly doses of IV lidocaine and an infusion of dexmedetomidine. Horses were administered IV intraoperative penicillin every 2 hours after the preoperative dose, reconstituted with 50 mL of saline (group small dilution, SD) and administered over 1 minute, or with 250 mL of saline (group large dilution, LD) administered over 10 minutes. Systolic, diastolic and mean arterial blood pressures (SAP, DAP, MAP), heart rate, end-tidal isoflurane and carbon dioxide, dobutamine rate and arterial electrolytes were recorded before and for 20 minutes after penicillin. Comparisons between and within groups were with two-way anova.

Dose and time to penicillin delivery during anesthesia were similar between groups. SAP decreased significantly by 4.8-9.6% (p < 0.0001-0.038), DAP by 12.7-25.4% (p = 0.0009-0.016) and MAP by 6.6-18.4% (p = 0.0009-0.028) from injection and for 15-20 minutes in group SD. In group LD, significant decreases in DAP (13.8-18.5%; p < 0.0001-0.005) and MAP (10.1-13.9%; p < 0.0001-0.003) occurred at 3-15 minutes, and DAP (p = 0.013 and 0.008) and MAP (p = 0.016 and 0.007) were higher than for group SD at 1 and 3 minutes. Dobutamine rate and other variables were similar between groups.

Arterial blood pressure decreased with both SD and LD in anesthetized horses, but to a lesser extent in the slower, more diluted LD group.

Objective: 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). Patients and Methods: 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. 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). Conclusion: 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.

Chitosan is a water-soluble polysaccharide with good adherence to negatively charged surfaces and reported antimicrobial and anti-inflammatory properties. Coating the surfaces of medical devices with chitosan is a promising strategy for harnessing these benefits. However, the surface properties of commercial polymers need to be altered to enable the bonding of thin chitosan films. In this study, the adhesion of chitosan onto plasma-treated polyvinyl chloride (PVC) and the metabolic activity of urothelial cells on chitosan-coated medical-grade PVC used for the synthesis of urinary catheters were evaluated. To improve the adhesion of chitosan onto the PVC catheters, PVC samples were made "super-hydrophilic". PVC substrates were briefly treated with a powerful hydrogen plasma and weakly ionised oxygen plasma afterglow to obtain a chlorine-free surface film, which was rich in oxygen functional groups, followed by incubation of the plasma-treated substrates in an aqueous solution of chitosan. Then, urothelial RT4 cells were seeded on the treated and untreated PVC substrates, and their metabolic activity, confluency, and cell morphology were examined. X-ray photoelectron spectroscopy was used to measure the nitrogen concentration, which corresponded to the chitosan concentration on the substrate. The results showed that the substrates were uniformly covered by a thin layer of chitosan only on plasma-treated surfaces and not on untreated surfaces. Moreover, the chitosan coating provided a stimulated environment for cell adhesion and growth. In conclusion, the chitosan-coated super-hydrophilic PVC substrate shows potential to improve the overall performance and safety of medical devices such as urinary catheters.

Incisional hernia remain an important complication after abdominal surgery. Repair often includes use of synthetic mesh, but certain risk factors for complication after mesh hernia repair have been described. Among these, immunosuppression due to co-existing conditions is hypothesized to increase postoperative complications, but data is scarce and contradicting. Therefore, the aim was to assess outcome after mesh hernia repair in immunosuppressed patients.

Patients with and without immunosuppression undergoing elective incisional hernia repair at our clinic between 2010 and 2019 were analyzed in this retrospective study. Pre-existing conditions, details of immunosuppression, postoperative course and outpatient follow-up for hernia recurrence were collected and impact of clinical variables on outcome was analyzed. Propensity score matching was performed for comparison of cohorts.

Immunosuppression was associated with increased postoperative complications in the overall cohort of 732 patients undergoing incisional ventral hernia repair in univariate but not multivariate analysis (p = 0.036 and p = 0.25, respectively). Overall postoperative complications did not differ between patients with immunosuppression compared to the matched collective. However, use of > 2 immune suppressive agents and immunosuppression history > 48 months showed significant impact on postoperative complications in univariate and multivariate analysis (p = 0.003/p = 0.023 and p = 0.018/p = 0.03, respectively). Age (< 60 years), duration of surgery (> 120 min), midline hernia according to EHS classification and number of immunosuppressive agents administered were identified as important risk factors for recurrence in immunocompromised patients (p = 0.045, p = 0.023, p = 0.012 and 0.049, respectively).

In this study, overall safety with desirable outcome of mesh implantation in immunosuppressed patients was documented. Furthermore, data suggested significant impact of number of immunosuppressive agents as a predicator of postoperative complications in this collective, possibly enabling risk stratification within this subgroup.

Surgical site infections (SSIs) represent one of the most prevalent and significant complications associated with surgical procedures, often leading to prolonged hospitalization and delayed patient recovery. While recent international consensus guidelines have proposed evidence-based strategies to mitigate SSIs, they fall short in addressing the efficient and interdisciplinary implementation of these measures within the operating theater. Consequently, further research is required to identify and evaluate optimal interdisciplinary organizational approaches for the prevention of SSIs.

This study aims to map the scope, diversity, and nature of research on interdisciplinary strategies aimed at reducing SSIs and to analyze the impact of interdisciplinary on the effectiveness of preventive interventions.

Using the Joanna Briggs Institute (JBI) methodology for scoping reviews, a comprehensive search will be conducted across databases including Embase (encompassing MEDLINE and PubMed-not-MEDLINE), CINAHL, and the Cochrane Library, supplemented by manual searches of reference lists from included papers. This review targets studies published between 2016 and 2024, aligning with the World Health Organization's 2016 SSI prevention guidelines, which introduced significant advancements in practice and remain the global benchmark. Only studies published in English or French will be considered. Around 5 reviewers independently distributed the included papers for detailed reading and data extraction, while the lead author concurrently and independently reviewed all papers. Inclusion criteria follow the Participants, Concept, and Context (PCC) framework, specifying that the eligible population comprises surgical teams. The primary concept of interest is interdisciplinary strategies aimed at preventing infection risk. The context focuses on adult surgical procedures within the operating room during turnover periods. Studies using experimental, quasi-experimental, preexperimental, observational, case-control, or cross-sectional designs will be included.

From the 1679 papers initially identified, 45 were selected for detailed analysis by 5 reviewers, with the selection process completed by November 2024.

Emerging interdisciplinary strategies demonstrate significant potential in reducing the incidence of SSIs. This initiative forms part of a broader global project focused on codeveloping standardized protocols for preoperative preparation within the operating room to mitigate SSI risks. The findings of this scoping review will serve as the foundation for a subsequent qualitative survey and a pre-post quasi-experimental quantitative study to evaluate the integration and effectiveness of these strategies in clinical practice. The review protocol will be formally registered in the Open Science Framework (OSF) in 2024.

DERR1-10.2196/67660.

Background: Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. A skin antiseptic solution is used to reduce the bacterial count and prevent PJI. There is no consensus in the literature on the application of antiseptic solutions. This study aims to compare the rate of infection between patients who received alcohol wash with Chloraprep to those who received povidone iodine wash with Chloraprep. Methods: A total of 607 patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a single institution between January 2009 and July 2023 were reviewed. Perioperative variables were collected. The infection rate was used as a primary outcome. An odds ratio was calculated to compare infection and complication rates between the groups. Results: For patients who underwent THA, no difference in the rate of complications (alcohol wash: n = 6, 4.5%; povidone wash: n = 5, 3.6%; OR: 0.796; 95% CI: 0.237-2.673) or infection (alcohol wash: n = 1, 0.7%; povidone wash: n = 2, 1.4%; OR: 1.942; 95% CI: 0.174-21.667) was found. No difference in the rate of complications (alcohol wash: n = 3, 1.9%; povidone wash: n = 2, 1.2%; OR: 0.635; 95% CI: 0.105-3.849) or infection (alcohol wash: n = 0; povidone wash: n = 1, 0.6%; OR: 0.994; 95% CI: 0.983-1.006) was found in patients who underwent TKA. Conclusions: Surgical site preparation using alcohol wash with chlorhexidine offers similar short-term benefits in preventing postoperative infection to a povidone iodine wash with chlorhexidine in primary total joint arthroplasty. The use of alcohol wash and chlorhexidine is effective, while reducing the preparation time.

The objective of this systematic review and meta-analysis is to assess and synthesize the global evidence on the level of nurses' knowledge and its determinants regarding the prevention of surgical site infections.

This systematic review and meta-analysis were conducted following strict methodological guidelines to ensure accuracy and reliability. Adhering to the 2020 PRISMA checklist, a systematic review and meta-analysis sought to establish the pooled proportion of nurse's knowledge and its determinants regarding surgical site infection prevention globally. MeSH terms and keywords were included in the search. Data extraction, quality assessment, and analysis followed established protocols. Heterogeneity and publication bias was assessed using STATA version 17.0.

A total of seventeen observational studies, with sample sizes ranging from 30 to 515 participants, were included in the final analysis in a global context. In this systematic review and meta-analysis, the pooled proportion of nurses with good knowledge of surgical site infection prevention is 62% (95% CI: 50-74%) when assessed using a dichotomous scale. However, when knowledge is measured using a three-point Likert scale, the pooled proportion of those with good knowledge drops to 46% (95% CI: 21-72%), with an additional 27% (95% CI: 16-38%) demonstrating fair or moderate knowledge.

This systematic review and meta-analysis is the first to synthesize data on nurses' knowledge of surgical site infection (SSI) prevention. The findings reveal poor knowledge levels, highlighting the need for targeted educational interventions globally. While the pooled odds ratio is not statistically significant, training, longer service years, and higher education improve SSI prevention knowledge by enhancing critical thinking, boosting confidence, and fostering adherence to evidence-based practices. Future research should focus on identifying factors influencing nurses' knowledge, particularly through longitudinal and interventional studies. Policymakers should incorporate international guidelines such as those recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) into nursing curricula, supported by robust assessment tools and educator training, to improve knowledge transfer and implementation of best practices.

Antibiotic overuse is driving a global rise in antibiotic resistance, highlighting the need for robust antimicrobial stewardship (AMS) initiatives to improve prescription practices. While antimicrobials are essential for treating sepsis and preventing surgical site infections (SSIs), they can inadvertently disrupt the gut microbiota, leading to postoperative complications. Treatment methods vary widely across nations due to differences in drug choice, dosage, and therapy duration, affecting antibiotic resistance rates, which can reach up to 51% in some countries. In Romania and the Republic of Moldova, healthcare practices for surgical antibiotic prophylaxis differ significantly despite similarities in genetics, culture, and diet. Romania's stricter healthcare regulations result in more standardized antibiotic protocols, whereas Moldova's limited healthcare funding leads to less consistent practices and greater variability in treatment outcomes.

This study presents the results of a prospective cross-border investigation involving 86 colorectal cancer patients from major oncological hospitals in Romania and Moldova. We analyzed fecal samples collected from patients before and 7 days post-antibiotic treatment, focusing on the V3-V4 region of the 16S rRNA gene.

Our findings indicate that inconsistent antibiotic prophylaxis policies-varying in type, dosage, or therapy duration-significantly impacted the gut microbiota and led to more frequent dysbiosis compared to stricter prophylactic antibiotic practices (single dose, single product, limited time).

We emphasize the need for standardized antibiotic prophylaxis protocols to minimize dysbiosis and its associated risks, promoting more effective antimicrobial use, particularly in low- and middle-income countries (LMICs).

The primary aim of this study was to compare differences, if any, in missed infection prevention and control (IPC) activities before and after the pandemic, along with the related predictors. The secondary aim was to identify relationships between missed IPC activities and unfinished nursing care.

A repeated cross-sectional design was conducted in 2019 (pre-pandemic, 184 nurses) and 2024 (post-pandemic, 240 nurses) in a large academic hospital following the Checklist for Reporting of Survey Studies guidelines. The Missed Nursing Care in Infection Prevention and Control Survey (MNC-IPC) (Part A: missed activities, Part B: reasons), the Unfinished Nursing Care Survey (UNCS), and professional data were collected homogeneously across both periods.

Self-reported missed IPC activities decreased from 2.15 out of 5 (95% confidence interval (CI), 2.05-2.25) to 1.51 (95% CI, 1.45-1.58) (P<0.0005), as did the related reasons, which decreased from 2.35 out of 4 (95% CI, 2.24-2.46) to 2.20 (95% CI, 2.11-2.30) (P=0.046). The total variance in the MNC-IPC overall scores was explained by 22.8% (pre-) and 20.7% (post-pandemic) by different predictors: system-level issues (estimated value 0.409, P=0.008) and nurses' intention to leave (0.107, P=0.023) in the pre-pandemic and by the number of patients admitted in the last shift (0.015, P=0.053), organizational issues (0.186, P<0.0005) and priority-setting issues (0.092, P=0.053) in the post-pandemic period. MNC-IPC and UNCS scores have reported significant correlations in both periods.

Missed IPC activities were less likely in the post-pandemic period possibly due to system efforts and lessons learned during the pandemic, which may have routinized IPC practices among nurses. Overall, predictors of missed IPC care changed after the pandemic, suggesting new patterns and the need for innovative interventions, particularly at the unit level and targeting younger nurses. The correlations between UNCS and MNC-IPC suggest that targeted improvements in one area are likely to yield positive outcomes in the other. However, despite their commonalities, these represent two distinct phenomena.

Incorporating infection prevention and control (IPC) is crucial for strengthening global surgery, particularly in low- and middle-income countries (LMICs). This review article highlights the critical role IPC plays in ensuring equitable and sustainable surgical care, aligning with the Sustainable Development Goals (SDG) 3 and 10, which aim to promote health and reduce inequalities. Surgical site infections (SSIs) and other healthcare-associated infections (HAIs) disproportionately affect LMICs, where IPC infrastructure is often underdeveloped. Without robust IPC measures, surgeries in these regions can result in higher morbidity, mortality, and healthcare costs, exacerbating disparities in healthcare access and outcomes. Despite global efforts, such as the World Health Organization (WHO) Guidelines on the Prevention of Surgical Site Infections, IPC integration in surgical practices remains inconsistent, particularly in resource-constrained settings. More widespread adoption and implementation are necessary. By embedding IPC within global surgery frameworks, health systems can improve surgical outcomes, reduce costs, and enhance the resilience of healthcare systems. Effective IPC reduces extended hospital stays, limits the spread of antimicrobial resistance, and increases trust in surgical services. Moreover, the cost savings from preventing SSIs are substantial, benefiting both healthcare systems and patients by reducing the need for prolonged care and antibiotic treatments. This review article calls for greater integration of IPC measures in global surgery initiatives to ensure that surgical interventions are both life-saving and equitable. Strengthening IPC is not optional but essential for achieving the broader goals of universal health coverage and improving public health outcomes globally.

Surgical antimicrobial prophylaxis (SAP) is an effective infection prevention strategy used to reduce postoperative surgical site infection. Inappropriate use of SAP is a concern in low-middle-income countries (LMICs) due to increased mortality risks, adverse reactions, re-admission rates and length of hospital stay. Antimicrobial Stewardship Programs (ASP) have been shown to be effective in improving the appropriate use of antibiotics including the use of SAP. The aim of this review was to evaluate the impact of ASP on the appropriate use of SAP and its implication on patient outcomes in LMICs.

The protocol for this review was registered in PROSPERO. Studies published between 1st January 2010 and 31st December 2023 were searched electronically from Medline, Central Cochrane Library, web of science, CINAHL and APA PsychInfo databases. Studies were included if they assessed the impact of ASP interventions on SAP use in low- and middle-income countries (LMICs). Studies were evaluated using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool for non-randomized and before and after studies as well as the Cochrane Risk of Bias 2 (ROB 2) tool for randomized studies. Findings were summarized in tables.

Twenty studies comprising of seventeen before-after studies, two interrupted time series, and one randomized controlled trial were included. Penicillins and cephalosporins were the most commonly used antibiotics for SAP. Most (50%) of the studies were conducted in Asia followed by Africa (45%). While 80% of the studies showed the impact of ASP on compliance to SAP guidelines, only 45% showed an impact on antibiotic utilization. Again, 50% and 60% showed an impact on reducing antibiotic costs and patient length of stay at hospitals respectively. Patient outcomes including rates of surgical site infections and mortality showed no significant change. The studies showed a high risk of bias mainly due to the choice of study designs.

ASP interventions in LMICs are effective in improving SAP guideline adherence, antibiotic utilization and their cost. Deliberate effort must be made to improve on the quality of future interventional studies in these settings to guide practice and encourage other LMICs to conduct such studies to assess the influence of different geographical contexts on SAP use.

Surgical site infection (SSI) is a common type of hospital-acquired infection and affects up to a third of patients following surgical procedures. It is associated with significant mortality and morbidity. In the United Kingdom alone, it is estimated to add another £30 million to the cost of adult cardiac surgery. Although generic guidance for SSI prevention exists, this is not specific to adult cardiac surgery. Furthermore, many of the risk factors for SSI are prevalent within the cardiac surgery population. Despite this, there is currently no standard of care for SSI prevention in adults undergoing cardiac surgery throughout the preoperative, intraoperative and postoperative periods of care, with variations in practice existing throughout from risk stratification, decontamination strategies and surveillance.

Primary objective: to assess the clinical effectiveness of pre-, intra-, and postoperative interventions in the prevention of cardiac SSI.

(i) to evaluate the effects of SSI prevention interventions on morbidity, mortality, and resource use; (ii) to evaluate the effects of SSI prevention care bundles on morbidity, mortality, and resource use.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid, from inception) and Embase (Ovid, from inception) on 31 May 2021.

gov and the WHO International Clinical Trials Registry Platform (ICTRP) were also searched for ongoing or unpublished trials on 21 May 2021. No language restrictions were imposed.

We included RCTs evaluating interventions to reduce SSI in adults (≥ 18 years of age) who have undergone any cardiac surgery.

We followed the methods as per our published Cochrane protocol. Our primary outcome was surgical site infection. Our secondary outcomes were all-cause mortality, reoperation for SSI, hospital length of stay, hospital readmissions for SSI, healthcare costs and cost-effectiveness, quality of life (QoL), and adverse effects. We used the GRADE approach to assess the certainty of evidence.

A total of 118 studies involving 51,854 participants were included. Twenty-two interventions to reduce SSI in adults undergoing cardiac surgery were identified. The risk of bias was judged to be high in the majority of studies. There was heterogeneity in the study populations and interventions; consequently, meta-analysis was not appropriate for many of the comparisons and these are presented as narrative summaries. We focused our reporting of findings on four comparisons deemed to be of great clinical relevance by all review authors. Decolonisation versus no decolonisation Pooled data from three studies (n = 1564) using preoperative topical oral/nasal decontamination in all patients demonstrated an uncertain direction of treatment effect in relation to total SSI (RR 0.98, 95% CI 0.70 to 1.36; I2 = 0%; very low-certainty evidence). A single study reported that decolonisation likely results in little to no difference in superficial SSI (RR 1.35, 95% CI 0.84 to 2.15; moderate-certainty evidence) and a reduction in deep SSI (RR 0.36, 95% CI 0.17 to 0.77; high-certainty evidence). The evidence on all-cause mortality from three studies (n = 1564) is very uncertain (RR 0.66, 95% CI 0.24 to 1.84; I2 = 49%; very low-certainty evidence). A single study (n = 954) demonstrated that decolonisation may result in little to no difference in hospital readmission for SSI (RR 0.80, 95% CI 0.44 to 1.45; low-certainty evidence). A single study (n = 954) reported one case of temporary discolouration of teeth in the decolonisation arm (low-certainty-evidence. Reoperation for SSI was not reported. Tight glucose control versus standard glucose control Pooled data from seven studies (n = 880) showed that tight glucose control may reduce total SSI, but the evidence is very uncertain (RR 0.41, 95% CI 0.19 to 0.85; I2 = 29%; numbers need to treat to benefit (NNTB) = 13; very-low certainty evidence). Pooled data from seven studies (n = 3334) showed tight glucose control may reduce all-cause mortality, but the evidence is very uncertain (RR 0.61, 95% CI 0.41 to 0.91; I2 = 0%; very low-certainty evidence). Based on four studies (n = 2793), there may be little to no difference in episodes of hypoglycaemia between tight control vs. standard control, but the evidence is very uncertain (RR 2.12, 95% CI 0.51 to 8.76; I2 = 72%; very low-certainty evidence). No studies reported superficial/deep SSI, reoperation for SSI, or hospital readmission for SSI. Negative pressure wound therapy (NPWT) versus standard dressings NPWT was assessed in two studies (n = 144) and it may reduce total SSI, but the evidence is very uncertain (RR 0.17, 95% CI 0.03 to 0.97; I2 = 0%; NNTB = 10; very low-certainty evidence). A single study (n = 80) reported reoperation for SSI. The relative effect could not be estimated. The certainty of evidence was judged to be very low. No studies reported superficial/deep SSI, all-cause mortality, hospital readmission for SSI, or adverse effects. Topical antimicrobials versus no topical antimicrobials Five studies (n = 5382) evaluated topical gentamicin sponge, which may reduce total SSI (RR 0.62, 95% CI 0.46 to 0.84; I2 = 48%; NNTB = 32), superficial SSI (RR 0.60, 95% CI 0.37 to 0.98; I2 = 69%), and deep SSI (RR 0.67, 95% CI 0.47 to 0.96; I2 = 5%; low-certainty evidence. Four studies (n = 4662) demonstrated that topical gentamicin sponge may result in little to no difference in all-cause mortality, but the evidence is very uncertain (RR 0.96, 95% CI 0.65 to 1.42; I2 = 0%; very low-certainty evidence). Reoperation for SSI, hospital readmission for SSI, and adverse effects were not reported in any included studies.

This review provides the broadest and most recent review of the current evidence base for interventions to reduce SSI in adults undergoing cardiac surgery. Twenty-one interventions were identified across the perioperative period. Evidence is of low to very low certainty primarily due to significant heterogeneity in how interventions were implemented and the definitions of SSI used. Knowledge gaps have been identified across a number of practices that should represent key areas for future research. Efforts to standardise SSI outcome reporting are warranted.

Whether skin disinfection of the surgical site using chlorhexidine-alcohol is superior to povidone-iodine-alcohol in reducing reoperation and surgical site infection rates after major cardiac surgery remains unclear.

CLEAN 2 was a multicenter, open-label, randomized, two-arm, assessor-blind, superiority trial conducted in eight French hospitals. We randomly assigned adult patients undergoing major heart or aortic surgery via sternotomy, with or without saphenous vein or radial artery harvesting, to have all surgical sites disinfected with either 2% chlorhexidine-alcohol or 5% povidone-iodine-alcohol. The primary outcome was any resternotomy by day 90 or any reoperation at the peripheral surgical site by day 30.

Of 3242 patients (1621 in the chlorhexidine-alcohol group [median age, 69 years; 1276 (78.7%) men] and 1621 in the povidone-iodine-alcohol group [median age, 69 years; 1247 (76.9%) men], the percentage required reoperation within 90 days was similar (7.7% [125/1621] in the chlorhexidine-alcohol group vs 7.5% [121/1621] in the povidone-iodine-alcohol group; risk difference, 0.25 [95% confidence interval (CI), - 1.58-2.07], P = 0.79). The incidence of surgical site infections at the sternum or peripheral sites was similar (4% [65/1621] in the chlorhexidine-alcohol group vs 3.3% [53/1621] in the povidone-iodine-alcohol group; risk difference, 0.74 [95% CI - 0.55-2.03], P = 0.26). Length of hospital stay, intensive care unit or hospital readmission, mortality and surgical site adverse events were similar between the two groups.

Among patients requiring sternotomy for major heart or aortic surgery, skin disinfection at the surgical site using chlorhexidine-alcohol was not superior to povidone-iodine-alcohol for reducing reoperation and surgical site infection rates.

The aim of this study was to investigate the effect of peri- and postoperative antimicrobial prophylaxis (AMP) on surgical site infection (SSI) in surgeries with elective antibiotic administration in a large university hospital with a high volume of people in the operating room. In this retrospective study, 1060 cats and dogs belonging to private owners were analysed for the occurrence of SSI over a period of almost 5 years, except during the COVID pandemic. Both the patient files were included, and the patient owners were contacted by questionnaire. The type of surgery, the use and type of AMP, as well as the occurrence, time, type and treatment of an SSI were documented. The overall SSI rate was 7.8 % (66/841). The use of an AMP did not lead to a significant reduction in risk in any of the surgeries analysed. Postoperative continuation of antibiotic prophylaxis showed no significant difference compared to perioperative prophylaxis alone. When interpreting the results, the retrospective nature of the study should be considered, as well as the fact that some of the results are based on a survey of patient owners.

Medical device companies and regulatory bodies rely on a nondestructive bacterial sampling technique specified by the American Society for Testing and Materials (ASTM E1173-15) to test preoperative skin preparations (PSPs). Despite the widespread use of PSPs, opportunistic skin-flora pathogens remain the most significant contributor to surgical site infections, suggesting that the ASTM testing standard may be underreporting true dermal bioburden. We hypothesized that ASTM E1173-15 may fail to capture deep skin-dwelling flora. To test this hypothesis, we applied ASTM E1173-15 and a full-thickness skin sampling technique, which we established previously through application to the backs of seven pigs (Yorkshire/Landrace hybrid) following a clinically used PSP (4% chlorhexidine gluconate). The results showed that samples quantified using the full-thickness skin method consistently cultured more bacteria than the ASTM standard, which principally targeted surface-dwelling bacteria. Following PSP, the ASTM standard yielded 1.05 ± 0.24 log10 CFU/cm2, while the full-thickness tissue method resulted in 3.24 ± 0.24 log10 CFU/cm2, more than a 2 log10 difference (p < 0.001). Immunofluorescence images corroborated the data, showing that Staphylococcus epidermidis was present in deep skin regions with or without PSP treatment. Outcomes suggested that a full-thickness sampling technique may better evaluate PSP technologies as it resolves bioburdens dwelling in deeper skin regions.

Surgical site infection (SSI) continues to be a common complication of surgery. The real benefit of using topical antibiotics for the prevention of SSI in abdominal hernia repair surgery is still unknown. This study aimed to evaluate the usefulness of topical gentamicin in SSI prophylaxis in incisional hernia repair with mesh. A randomized controlled trial was conducted in patients undergoing open incisional hernia repair. Patients were randomly assigned to one of two groups: in the gentamicin group, each layer of the abdominal wall was irrigated with gentamicin solution before wound closure, and in the saline solution group (placebo), each layer of the abdominal wall was irrigated with normal saline solution. The incidence of SSI and other surgical site complications was compared between both groups, and the presence of adverse effects with the use of topical gentamicin. Data from 146 patients were included for analysis: 74 in the gentamicin group and 72 in the saline solution group. SSI was observed in six patients (8.1%) in the gentamicin group and eight patients (11.1%) in the saline solution group, with no significant differences (p = 0.538) between both groups. No statistically significant differences were observed in the presentation of seroma, hematoma, and surgical wound dehiscence between both groups. No adverse effects were reported from topical application of gentamicin. In this clinical trial, the use of topical gentamicin in incisional hernia repair with mesh did not significantly reduce the incidence of SSI. EU Clinical Trials Register: EudraCT 2018-001860-45 (04/07/2019).

This study aims to examine the adverse events associated with hypoglossal nerve stimulator (HNS) implantation for treating obstructive sleep apnea (OSA), drawing data from the Manufacturer and User Facility Device Experience (MAUDE) database. We aim to provide a comprehensive and updated account of these adverse events.

Retrospective analysis.

MAUDE Database review.

A retrospective analysis was performed on the MAUDE database to collect all HNS-related reports from May 2014 to December 2023. Variables collected included date of event, event description, nature of event, iatrogenic injuries, required interventions, and, if available, root causes. Each event description was analyzed to classify the adverse event, the postevent intervention, and device model number.

Out of 1178 reports fulfilling the inclusion criteria, 1312 adverse events were identified. Common adverse events included infection (24.0%), pain (19.7%), and hematoma/seroma (10.2%). Approximately 83.1% of these adverse events necessitated medical and/or surgical intervention. The most frequent procedures included explantation (29.4%) and device repositioning (15.8%). Pneumothorax was reported in 50 cases, with 41 (82.0%) requiring a chest tube to be inserted. Three adverse events described overstimulation in the setting of magnetic resonance imaging (MRI) despite the implantation of MRI-compatible second-generation internal pulse generators.

While HNS implantation has been established as a reliable intervention for OSA in cases of continuous positive airway pressure failure or intolerance, this study highlights several perioperative and postoperative difficulties and complications. Understanding these challenges is essential for refining surgical practices and enhancing patient consent processes, ultimately aiming to improve therapeutic outcomes.