Search Results (63)

Background: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCAIs) worldwide. Changes in the functioning of healthcare systems may affect the implementation of SSIs prevention practices, with consequent alterations in the occurrence of HCAIs. The main aims of our study were to analyze specific SSIs prevalence and proportions together with overall HCAIs prevalence in acute care hospitals (ACHs) before and after the COVID-19 pandemic. Additional aims were to identify bacterial causative agents, the use of perioperative antibiotic prophylaxis (PAP), related structural and process quality indicators, and to determine trends between two periods. Methods: The National Reference Centre for HCAIs (University Hospital Centre Zagreb) conducted point prevalence surveys in May 2017 and May 2023 in ACHs throughout Croatia, using the technical protocol developed by the European Centre for Disease Prevention and Control (ECDC). Results: The prevalence of HCAIs in ACHs in Croatia rose from 5.3% (95% CI 4.8–5.7) in 2017 to 7.2% (95% CI 6.6–7.8) in 2023 (p = 9.93 × 10⁻¹⁴). This trend was paralleled with the rising of the HCAIs prevalence in surgical departments from 5.1% to 6.7% (p = 0.0099). The prevalence of overall SSIs across ACHs increased from 0.9% (95% CI 0.7–1.1) in 2017 to 1.2% (95% CI 1.0–1.5) in 2023 (OR 1.36 (1.03–1.80), p = 0.032. While the prevalence of superficial incisional SSIs significantly decreased (OR 0.53 (0.30–0.95), p = 0.028), the share of deep-seated SSIs (deep incisional and organ/space SSIs) among classified SSIs shifted from 48/92 to 77/96; odds ratio (OR) 2.09 (95% CI 1.45–3.01). In 2017, Gram-positive cocci were the most frequently isolated bacterial causative agents (44.6%). By 2023, this shifted, with Enterobacterales species comprising most isolates (42.2%). In 2023, significantly a higher proportion of patients received PAP (χ² = 25.419, df = 1, p  < 0.5). An increase in the positive trend of alcohol-based hand rub antiseptics use in surgical departments (+15.7 L/patient-days, p < 0.001) contrasted with a decrease in infection prevention and control (IPC) nurses and medical doctors per hospital (−0.5, p = 0.041/−0.5, p = 0.003). Conclusions: Findings of the two point prevalence surveys over time indicate the changes in trends in surgical site infections burden, and highlight the need for the implementation and strengthening of preventive measures with the focus on targeted prevention of deep-seated infections. Full article

Background: Alveolar echinococcosis (AE) is a neglected parasitic disease caused by Echinococcus multilocularis that is difficult to diagnose and treat. Methods: This systematic review has gathered articles presenting original data from the past 5 years, from January 2020 to December 2025, with epidemiological data (incidence, prevalence), treatment options, case reports, and other findings relevant to the prevention and control of this disease, representing the inclusion criteria of this study. Three medical databases were searched for the study: PubMed, Web of Science, and ScienceDirect. To improve our understanding of the available data, no spatial or temporal restrictions were imposed on the study’s duration or follow-up period. Results: A total of 248 articles are included in this review, which describe atypical sites and complications owing to Echinococcus multilocularis infection, the heterogeneity of epidemiological studies in different endemic and non-endemic regions, diagnosis techniques based on imaging, histopathology, and molecular techniques, as well as surgical and non-surgical treatment options (and lack thereof regarding the latter). Conclusions: Although advances have been made in the diagnosis, management, and treatment of AE, challenges remain, particularly with regard to misdiagnosis, delayed diagnosis, and limited antiparasitic therapy. Full article

Background and Objectives: The onset of the COVID-19 pandemic posed a new challenge to hospital infection prevention measures and to the antimicrobial therapies adopted. The present study aimed to assess the influence of the COVID-19 pandemic on the dynamics of surgical site infection (SSI) rates and the variations in the microbiological profiles of the SSI. Materials and Methods: A retrospective, single-center study was conducted to examine data from patients who underwent conventional surgical procedures and developed SSI. The study was conducted at the First Surgery Clinic of the “Pius Brinzeu” Clinical Emergency Hospital, Timisoara, Romania. Data from 173 patients were analyzed over six years (from 26 February 2018 to 25 February 2024). The selected time interval was divided into three periods: pre-pandemic, pandemic, and post-pandemic. Results: During the pandemic, the average patient age was significantly lower than in the other periods. The average length of stay decreased consistently over the six-year study period. Among the 173 patients included in the study, 71.1% had a monobacterial infection, while the remaining 28.9% had infections involving at least two different bacteria. The two most commonly identified bacteria in more than 50% of the cases were Pseudomonas aeruginosa and Enterococcus spp. There was a significant decrease in bacterial resistance to levofloxacin and ciprofloxacin over the study period, with resistance dropping from 50% (pre-pandemic) and 53.3% (pandemic) to just 9.1% (post-pandemic). Conclusions: The COVID-19 pandemic substantially altered the SSI profile in our institution. The temporary increase in SSI frequency during the pandemic was likely related to shifts in surgical case mix and care delivery, rather than decreased infection control performance. Post-pandemic restoration of surgical flow coincided with improved antimicrobial susceptibility patterns, particularly for fluoroquinolones. Microbiological surveillance, the use of infection prevention measures, and robust stewardship initiatives remain essential to maintain these favorable trends and mitigate the emergence of future resistance. Full article

Background: Surgical site infections (SSIs) are common postoperative complications. Data on SSIs following breast surgery in Saudi Arabia are limited because these procedures are not included in the national SSI surveillance system. This study determined the SSI incidence rate, identified associated risk factors, and described the microbiological profiles of patients undergoing breast surgery at two tertiary hospitals in Saudi Arabia. Methods: This bicentric retrospective case–control study analyzed 1841 breast surgeries performed at two tertiary hospitals between July 2021 and July 2024. Demographic, surgical, and microbiological data were extracted from electronic medical records. SSIs were defined according to National Healthcare Safety Network criteria. Descriptive statistics summarized patient and surgical characteristics and SSI rates. A matched case–control analysis (1:4 ratio based on age and hospital site) included 172 patients. Multivariable logistic regression was used to identify predictors of SSI. Results: The cumulative SSI incidence was 2.4%, and most infections occurred within 30 days of surgery (69%). Gram-negative organisms were predominant in microbiologically positive cases (53.6%), mainly Klebsiella pneumoniae and Pseudomonas aeruginosa, whereas Staphylococcus aureus (including MRSA) accounted for 25%. Immunocompromised status (OR 3.32, 95% CI 1.35–8.14) and surgical drain use (OR 4.07, 95% CI 1.68–9.87) were independently associated with SSI. Conclusions: The incidence of SSIs after breast surgery in Saudi Arabia was relatively low. The predominance of Gram-negative pathogens and the identification of immunocompromised status and surgical drain use as major risk factors highlight opportunities for targeted infection prevention strategies. Further studies should validate these findings in larger and more diverse populations and healthcare settings. Full article

Surgical site infections (SSIs) are among the most frequent healthcare-associated infections, leading to prolonged hospitalization, increased costs, and impaired recovery. This retrospective cohort study aimed to identify the determinants and microbial patterns of SSIs following hepatobiliary and pancreatic (HPB) surgery to inform preventive strategies and optimize clinical outcomes. The patients undergoing hepatobiliary and pancreatic surgery from 2014 to 2024 in a tertiary university hospital are reviewed. SSI was defined according to Centers for Disease Control and Prevention (CDC) criteria, and microbiological isolates were identified through routine culture methods and susceptibility testing. Clinical, operative, and microbiological data of patients who underwent hepatobiliary and pancreatic surgery were extracted, including demographics, comorbidities, operative characteristics, and postoperative outcomes. Among 553 hepatobiliary and pancreatic surgery patients, SSI occurred in 48.6%. Gram-negative bacteria predominated, with E. coli as the leading pathogen. SSI was linked to open surgery, longer operative time, and higher ASA scores; malignancy, renal insufficiency, anemia, and COPD were independent risk factors. Age by itself was not a reliable predictor of infection, while operative duration demonstrated moderate predictive performance, with a sensitivity of 66%. These findings underscore the multifactorial pathogenesis of SSIs and emphasize the importance of refined perioperative strategies to mitigate postoperative infectious complications. Full article

Background: Irrigation is a key strategy in reducing bioburden, disrupting biofilms, and supporting wound healing. While saline is the standard for its safety and availability, antiseptic and antibiotic solutions are often used in clinical scenarios that require infection control. However, the rise in antibiotic stewardship and concerns regarding cytotoxicity are reshaping current practices. This review identifies recent trends, current controversies, and persistent gaps in knowledge that warrant further investigation and regulatory attention. Methods: A literature review identified irrigation solutions commonly used in plastic surgery; labeling and concentrations were obtained from Devices@FDA, Drugs@FDA, and DailyMed, and PubMed, Cochrane Central, and Embase were searched (January 2022–July 2025) for human studies on acute wounds, chronic wounds, and implant-based breast surgery. Results: In acute wounds, saline and potable tap water effectively prevent infection. In chronic wounds, such as diabetic foot ulcers and pressure injuries, antiseptic agents, including hypochlorous acid, sodium hypochlorite, polyhexanide, and citrate-based solutions, have shown promise in improving healing and reducing infection. In implant-based breast reconstruction and augmentation, data on antiseptics, such as chlorhexidine, and changes in FDA guidance for povidone–iodine and bacitracin have prompted a reevaluation of intraoperative irrigation practices. Conclusion: Despite widespread use, many antiseptics remain off-label, and high-quality clinical studies comparing efficacy and safety are lacking. Full article

Background/Objectives: Surgical site infections (SSIs) are serious complications in orthopedic implant-associated procedures, increasing morbidity, mortality, and hospital costs. The purpose of this study was to evaluate the impact of a structured infection prevention and control (IPC) service on SSI incidence and cost savings across hip arthroplasty (HA), knee arthroplasty (KA), and open reduction and internal fixation (ORIF). Methods: A retrospective analysis included 6930 patients treated between 2019 and 2024, divided into pre-intervention (2019–2022) and post-intervention (2023–2024) cohorts. Preventive methods (PMs) comprised enhanced antibiotic prophylaxis, Staphylococcus aureus screening, chlorhexidine bathing, intraoperative audits, and behavioral interventions. Economic evaluation used literature-based costs, standardized to 2024 US dollars (USD 2024), with sensitivity analyses performed. Results: SSI incidence decreased from 5.6% to 1.1% overall (p < 0.001), with consistent reductions across procedures: ORIF (5.2%→1.0%), HA (9.2%→2.4%), and KA (4.8%→1.2%). In 2023, approximately 31 SSIs and one infection-related death were prevented, avoiding 308 hospital days. Cost savings ranged from USD 209,188 to USD 376,898, with cost saving confirmed in 93% of simulations. Conclusions: Comprehensive infection-prevention protocols, delivered through a structured IPC service, significantly reduced SSIs and generated substantial cost savings. These findings support wider use of these PMs in orthopedic surgery. Full article

Background/Objectives: Tissue expander (TE)-based breast reconstruction is a common procedure, but postoperative infection rates can reach up to 30%. The optimal skin antiseptic solution for minimizing these infections remains uncertain. This retrospective cohort study aimed to compare the impact of chlorhexidine and povidone-iodine for skin antisepsis in preventing surgical site infections in patients who underwent TE-based breast reconstruction. Methods: The TriNetX database was queried to identify patients who underwent TE-based breast reconstruction. Patients were classified into two cohorts: the chlorhexidine group and the povidone-iodine group. A propensity score matching analysis was performed to control infection risk factors. The primary outcome was the occurrence of surgical site infections, while secondary outcomes included wound dehiscence, emergency department visits, debridement, and TE removal. All outcomes were assessed at 30, 60, and 90 days following surgery. Results: After matching of both the chlorhexidine cohort and povidone-iodine cohort, each consisted of 1446 patients. Within 30 days post-surgery, no significant differences were observed between the chlorhexidine and povidone-iodine groups in terms of the risk of surgical site infections (RR 0.62, p = 0.168), wound dehiscence (RR 1.00, p = 1.000), emergency department visits (RR 0.95, p = 0.700), debridement (RR 0.71, p = 0.271), or TE removal (RR 0.84, p = 0.335). Similar results were seen at 60 and 90 days post-surgery. Conclusions: This study suggests that chlorhexidine and povidone-iodine may be equally effective for skin antisepsis in preventing surgical site infections and associated complications in patients undergoing TE-based breast reconstruction. Full article

Background: Surgical site infections (SSIs) are among the most common postoperative complications. Environmental factors, including intraoperative traffic and door openings in the operating room (OR), have been identified as critical contributors to microbial air contamination. Nurses play a pivotal role in managing these factors, directly influencing infection control practices. Methods: An integrative review was conducted to synthesize current evidence on the association between intraoperative traffic, door openings, and SSIs. A structured methodology was employed to identify, assess, and analyze the existing literature, with a specific focus on the nursing role in infection prevention. Results: Findings from a single-center prospective cohort study indicate that ORs with more than 10 personnel present exhibit a threefold increase in SSI risk [Relative Risk (RR) = 3.12; 95% Confidence Interval (CI): 0.71–13.66] compared to ORs with fewer personnel. Additionally, every five door openings per procedure were associated with a significant increase in SSI incidence [Hazard Ratio (HR) = 2.00; 95% CI: 1.24–3.20, p = 0.005]. Conclusions: These findings underscore the importance of strict protocols to limit intraoperative traffic and unnecessary OR access. A multidisciplinary approach plays a crucial role in ensuring surgical safety and preventing SSIs by regulating OR access and adhering to infection control best practices. Full article

Background: Advancements in surgical wound management have led to improved healing and reduced complications. Incisional negative pressure wound therapy (iNPWT) is a technique that applies sub-atmospheric pressure to closed surgical wounds, enhancing blood flow, minimizing edema, and promoting tissue repair. Initially developed for chronic wounds, its use has expanded across multiple surgical specialties, including orthopaedic trauma surgery, to reduce complications such as dehiscence, infection, and prolonged healing. While traditional wound care relies on standard closure methods with simple dressings, iNPWT offers additional mechanical support and may lower the risk of deep surgical site infections (SSIs). This review examines the current evidence on iNPWT’s role in preventing SSIs following surgery for lower extremity fractures to guide clinical decision-making and improve patient outcomes. Methods: A systematic search through PubMed and MEDLINE utilizing our inclusion and exclusion criteria yielded seven randomized controlled trials and randomized prospective cohort studies that were subsequently analyzed to determine iNPWT effectiveness. Results: Of the seven studies, five showed a decreased SSI rate compared to standard wound dressing, with the other two exhibiting an increased infection rate. Conclusions: This review critically examines existing literature on iNPWT, analyzing level I and II studies on deep SSI rates in traumatic fractures. The evidence remains inconclusive on whether iNPWT offers a significant advantage over standard wound dressings, highlighting the need for further research to clarify its efficacy and clinical application. Full article

Background and Objectives: The transoral endoscopic thyroidectomy-vestibular approach (TOETVA) and parathyroidectomy-vestibular approach (TOEPVA) are scar-free alternatives to conventional surgery but are classified as clean-contaminated due to the oral incision, raising concerns about surgical site infections (SSIs). This study evaluates whether perioperative antibiotic prophylaxis (pABX) alone is sufficient compared to extended antibiotic prophylaxis (eABX) in preventing SSIs in TOET/PVA, particularly considering the surgical learning curve. Materials and Methods: A retrospective study analyzed 162 patients undergoing TOET/PVA at a single center from January 2018 to June 2024. Patients were divided into two groups: 82 received eABX (intravenous cefazolin preoperatively plus 7 days of oral amoxicillin/clavulanate), and 80 received pABX alone (intravenous cefazolin). The inclusion criteria included complete postoperative hemogram and C-reactive protein (CRP) records; exclusions comprised other surgical approaches or missing data. Outcomes included postoperative white blood cell (WBC) count, CRP levels, and complications (seroma, cellulitis, and flap perforation), defined using Centers for Disease Control and Prevention (CDC) guidelines. The statistical analysis comprised t-tests, chi-square tests, and logistic regression, adjusting for confounders like age and sex. Results: The postoperative WBC and CRP levels were significantly higher in the pABX group (p = 0.001), but all values remained within the laboratory normal limits. Complications were observed in 14 patients: seroma in 11, cellulitis in 2, and flap perforation in 1. Complications occurred more frequently in the eABX group but without statistical significance (p = 0.103). The duration of surgery was longer in the eABX group (117.93 ± 52.35 vs. 72.44 ± 22.54 min, p = 0.001) and was an independent predictor of complications (OR = 1.018, 95% CI: 1.006–1.031, p = 0.004). Conclusions: Perioperative antibiotic prophylaxis alone does not increase the risk of SSIs compared to extended prophylaxis in TOETVA. However, eABX may be prudent during the learning curve due to longer operative times and higher complication risks. Future prospective, randomized trials are needed to standardize prophylaxis regimens. Full article

Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative Pressure Wound Therapy (NPWT), advanced dressings, irrigation techniques, antibiotic regimens, and innovative therapies, in improving wound healing outcomes and reducing infection rates. Materials and Methods: An exhaustive literature search focused on the use of NPWT, dressings, and antibiotics in the care of chronic wounds was conducted following PRISMA guidelines in the PubMed, Scopus, Web of Science, and CINAHL databases. Eligible studies included randomized controlled trials and prospective cohorts assessing interventions for wound care in trauma, surgical, and chronic wound settings. The risk of bias was assessed using the ROB2 tool. Subgroup analyses were performed to evaluate the relative risk (RR) of infections based on the intervention type. Results: The analysis included 17 studies spanning diverse geographical and clinical settings. NPWT demonstrated significant benefits in reducing infection rates compared to control groups (RR: 0.590, 95% CI: 0.458–0.760, and p < 0.001). Although advanced dressings demonstrated clinically relevant benefits as reported across the included studies, the meta-analysis did not reveal statistically significant differences (RR: 0.516, 95% CI: 0.242–1.100, and p = 0.087). Antibiotic therapies significantly reduced infections when administered within 24 h of injury, while low-pressure irrigation techniques effectively minimized bacterial contamination without causing tissue damage. Growth factors and honey-based treatments exhibited promising results in accelerating wound healing and reducing infection risks in chronic wounds. Conclusions: NPWT emerges as a highly effective intervention for infection prevention and wound healing, supported by robust evidence. Advanced dressings and innovative therapies show potential but require further research for conclusive evidence. These findings underscore the importance of tailoring wound care strategies to the clinical context and patient needs. Future research should focus on long-term outcomes and cost-effectiveness analyses to enhance the integration of these therapies into clinical practice. Full article

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of healthcare-associated infections in Europe. It has become increasingly prevalent in community settings, causing skin and soft tissue infections (SSTIs). Managing community-acquired (CA) MRSA infections is challenging due to its high virulence and resistance to common antibiotics, and prevention outside the hospital setting is complex. Combination therapy has demonstrated efficacy in the treatment of severe MRSA infections. Furthermore, surgical source control is critical in treating CA-MRSA infections, involving removing the primary infection site to interrupt bacterial replication. Timeliness and a correct surgical approach are essential for successful treatment outcomes and improved quality of life. Methods: This report details the case of a 15-year-old athlete who was admitted to the intensive care unit with septic shock caused by CA-MRSA. Results: Despite initial treatment, his condition rapidly worsened. A computed tomography (CT) scan identified multiple abscesses (in the lungs, limbs, thyroid, and subscapular region) along with other complications. To achieve adequate tissue concentrations at all affected sites, a triple-targeted antimicrobial therapy was initiated and adjusted based on therapeutic drug monitoring (TDM). At the same time, daily surgical debridement was performed. The patient responded significantly to this treatment, and blood cultures eventually returned negative. Conclusions: A multidisciplinary approach involving early source control, tailored antimicrobial therapy, and, if monotherapy fails to control infection, combination therapy is advisable to treat life-threatening CA-MRSA infections. Full article

To analyze nursing interventions for preventing healthcare-associated infections (HAIs), major complications in acute care impacting length of stay, costs, morbidity, and mortality, an umbrella review was conducted between 1 February and 26 February 2024, following the Joanna Briggs Institute methodology and PRISMA reporting guidelines, resulting in the inclusion of 22 articles. The 22 final articles obtained addressed the following Centers for Disease Control and Prevention (CDC) categories: surgical site infections (e.g., skin antisepsis, antibiotic prophylaxis), catheter-related bloodstream infections (e.g., taurolidine lock solutions), ventilator-associated pneumonia (e.g., oral hygiene, semi-recumbent positioning), and catheter-associated urinary tract infections (e.g., catheter duration management). Using Neuman’s holistic framework, the review emphasized patient–environment interactions. Further primary research is needed to refine these interventions and enhance interprofessional care. The protocol was registered in PROSPERO (CRD42024506801). Full article

Background/Objectives: Fracture-related infections (FRIs) are a significant complication in maxillofacial trauma, leading to adverse outcomes such as prolonged healing, nonunion, and osteomyelitis. Despite advancements in surgical techniques, the incidence of FRIs remains concerning, particularly for mandibular fractures. This systematic review and meta-analysis aims to evaluate the incidence, risk factors, and management strategies for FRIs in oral and maxillofacial trauma. Methods: A systematic search of Medline and Embase databases was conducted, including studies up to February 2024, adhering to PRISMA guidelines. Eligible studies included randomized controlled trials, cohort studies, and case-control studies focusing on the incidence, risk factors, or treatment outcomes of FRIs. Data on patient demographics, fracture type, infection rates, and management strategies were extracted and analyzed. Statistical analyses included pooled infection rates, stratified by anatomical sites, using fixed and random-effects models. Results: A total of 72 studies were included, with a pooled FRI rate of 5.6%. Mandibular fractures exhibited the highest infection rate at 8.9%, while midface fractures had the lowest at 0.9%. The significant risk factors identified included smoking, substance abuse, and comorbidities such as diabetes. Delayed surgical intervention and poor periodontal health were also associated with higher infection rates. The use of prophylactic antibiotics did not show significant differences in infection prevention. Conclusions: FRIs in maxillofacial trauma are influenced by multifactorial risks, including anatomical, patient-specific, and procedural factors. Mandibular fractures are particularly vulnerable, requiring targeted preventive strategies and timely intervention. Standardized definitions and guidelines are essential for improving consistency in diagnosis and management. Future research should focus on high-quality trials to establish evidence-based approaches for FRI prevention and treatment. Full article