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A few comments on "Association of serum and fat tissue antibiotic concentrations with surgical site infections in lower gastrointestinal surgery" by Yoko Takayama et al

Dadhwal US

Surgery, 2023 Feb;173(2):558-559.
PMID: 35965145 DOI: 10.1016/j.surg.2022.07.004
Matched MeSH terms: Surgical Wound Infection/drug therapy; Surgical Wound Infection/etiology; Surgical Wound Infection/prevention & control
Fulltext Best practices for managing malodorous and infected wounds in advanced cervical cancer

Hamid HA, Lin X, Qin YK, Akim AM, Zhang L, Wang J, et al.

Int Wound J, 2024 Feb;21(2):e14574.
PMID: 38379231 DOI: 10.1111/iwj.14574

This cross-sectional study was conducted to examine the most effective strategies for managing malodorous and infected wounds in patients who have been diagnosed with advanced cervical cancer. The research was conducted in Liupanshui, China. The study specifically examined demographic profiles, wound characteristics and effectiveness of wound management approaches. The study incorporated the heterogeneous sample of 289 participants who fulfilled the inclusion criteria. Data collection was conducted via structured questionnaires and medical record evaluations. Descriptive statistics and statistical analyses, such as regression analysis, were utilized to evaluate demographic attributes, wound profiles and effects of different approaches to wound management. The findings unveiled the heterogeneous demographic composition of patients, encompassing differences in socioeconomic standing, educational attainment and age. A wide range of wound characteristics were observed, as 65.7% of lesions during the acute phase with diameter between 2 and 5 centimetres, while 41.5% of lesions had this range. The most prevalent types of infections were those caused by fungi (48.4%), followed by bacterial infections lacking resistance (38.1%). A moderate degree of odour intensity was prevalent, affecting 45.0% of the cases. With maximal odour reduction of 80%, a mean healing time of 25 days and patient satisfaction rating of 4.5 out of 5, Negative Pressure Wound Therapy demonstrated itself to be the most efficacious treatment method. Additional approaches, such as photodynamic therapy and topical antibiotic therapy, demonstrated significant effectiveness, as evidenced by odour reductions of 70% and 75%, respectively, and patient satisfaction ratings of 4.3 and 4.2. Thus, the study determined challenges associated with management of malodorous and infected lesions among patients with advanced cervical cancer. The results underscored the significance of individualized care approaches, drew attention to efficacious wound management techniques and identified critical determinants that impacted patient recuperation. The findings of this study hold potential for advancing palliative care for individuals diagnosed with advanced cervical cancer.

Matched MeSH terms: Wound Infection*
Fulltext APSIC guidelines for the prevention of surgical site infections

Ling ML, Apisarnthanarak A, Abbas A, Morikane K, Lee KY, Warrier A, et al.

Antimicrob Resist Infect Control, 2019;8:174.
PMID: 31749962 DOI: 10.1186/s13756-019-0638-8

Background: The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices.
Method: The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section.
Results: It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions.
Conclusions: Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.

Matched MeSH terms: Surgical Wound Infection/diagnosis; Surgical Wound Infection/etiology*; Surgical Wound Infection/epidemiology; Surgical Wound Infection/prevention & control*
Fulltext Orthopaedic infections

Choon DSK

Med J Malaysia, 2004 Dec;59(5):571-2.
PMID: 15889556
Matched MeSH terms: Surgical Wound Infection/etiology*; Surgical Wound Infection/therapy*
Validation of Harikrishna Periwound Skin Classification for wound assessment

Nair HKR, Chong SS, Othman AM

J Wound Care, 2020 Apr 01;29(Sup4):S44-S48.
PMID: 32279612 DOI: 10.12968/jowc.2020.29.Sup4.S44

OBJECTIVE: To validate the accuracy and reliability of Harikrishna Periwound Skin Classification (HPSC) for wound assessment.
METHOD: Post-basic students (staff nurses and medical assistants) were given real life pictures showing the wound and periwound area. The students were asked to classify all pictures according to the HPSC at zero months (before attachment) and after two months of attachment. The images were the same but the answers were never given or discussed after the first test.
RESULTS: A total of 30 post-basic students participated in the study, assessing wound 30 images. The results showed that there was an increase of 25.42% in accuracy of wound assessment using the HSPC after two months of clinical attachment compared to pre-attachment. The reliability of the HPSC in wound assessment 79.87%.
CONCLUSION: Health professionals have to be able to assess and classify wounds accurately to be able to manage them accordingly. Assessment and classifications of the periwound skin are important and need to be validated and integrated as a part of a full wound assessment. With experience and adequate training, health professionals are able to comprehensively assess wounds using the validated tool, to enable effective wound management and treatment, accelerating wound healing and improving the quality of life for patients.

Matched MeSH terms: Surgical Wound Infection/diagnosis*; Surgical Wound Infection/nursing
The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

Jin J, Akau Ola S, Yip CH, Nthumba P, Ameh EA, de Jonge S, et al.

World J Surg, 2021 10;45(10):2993-3006.
PMID: 34218314 DOI: 10.1007/s00268-021-06208-y

BACKGROUND: Morbidity and mortality in surgical systems in low- and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to improve peri-operative outcomes.
METHODS: A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542.
RESULT: Of 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46-1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48-0.93).
CONCLUSION: There is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.

Matched MeSH terms: Surgical Wound Infection/epidemiology; Surgical Wound Infection/prevention & control
Perforated appendicitis--the Malaysian experience

Lee CM, Teoh MK

J R Coll Surg Edinb, 1990 Apr;35(2):83-7.
PMID: 2355382

Perforated appendicitis, with its increased complication rate, today still poses a formidable problem in the Kuala Lumpur General Hospital. Out of 1694 emergency operations performed by our unit in 1987, there were 927 appendicectomies. A retrospective study of these cases showed 126 cases of perforated appendicitis, which were then subjected to detailed analysis. We have a diagnostic accuracy of 81% and perforation rate of 18%. In addition, it is interesting to note the racial differences in the relationship of diagnostic accuracy to perforation rate. Perforation is associated with an increased wound infection rate. Transperitoneal drainage in perforated appendicitis did not lead to a lower incidence of wound infection or improve postoperative performance. Distinguishing between perforated and non-perforated appendicitis may be difficult. Perforation could occur while awaiting operation. We recommend the early administration of systemic antibiotics should appendicectomy be delayed and the cautious use of drains in cases of perforated appendicitis.

Matched MeSH terms: Surgical Wound Infection/microbiology; Surgical Wound Infection/epidemiology; Surgical Wound Infection/therapy
Identifying Risk Factors for Surgical Site Infection After Stoma Closure in Infants for Targeted Implementation of Surgical Site Infection Reduction Bundle

Nwachukwu I, Visa A, Holbrook C, Tan YW

Surg Infect (Larchmt), 2024 Apr;25(3):185-191.
PMID: 38394295 DOI: 10.1089/sur.2023.248

Background: To determine risk factors for surgical site infection (SSI) in infants after stoma closure, to identify at-risk patients, plan timing of surgery, and implement SSI-reduction strategies. Patients and Methods: A single center retrospective comparison study of all children less than one year of age who underwent enterostomy closure (2018-2020) with SSI diagnosed through a prospective surveillance program, using criteria from Public Health England (PHE). Demographics and risk factors, types of SSI, systemic sepsis, mortality and length of stay were compared between SSI and non-SSI. Significant factors associated with SSI were analyzed in a multivariate binomial logistic regression model. Results: Eighty-nine stoma closures were performed, most commonly for necrotizing enterocolitis (NEC) and anorectal malformation. Fourteen had SSI (16%): 12 superficial and two deep; three developed systemic sepsis, but no 30-day mortality. Surgical site infection was associated with NEC (12/14 vs. 32/75; p = 0.003), younger age (median 76 vs. 89 days; p = 0.014), lower corrected gestation (cutoff: 39 weeks gestation; 11/14 vs. 27/75; p = 0.004) and lower weight (cutoff: 2.2 kg; 7/14 vs. 16/75; p = 0.032), compared with non-SSI. After correcting for age, gestation, and weight, logistic regression showed NEC was an independent predictor for SSI (odds ratio [OR], 12; 95% confidence interval [CI],1.2-125). The at-risk cohort (n = 56; 63%) had seven-fold increased risk of SSI and four-fold longer hospital stay, which may be the target for SSI-reduction strategies. Conclusions: Necrotizing enterocolitis-related stoma closure is at increased risk for SSI. Considerations for delaying stoma closure until achieving 39 weeks gestation or 2.2 kg in weight may further reduce SSI. Targeting SSI-reduction strategies using these criteria may improve resource-rationalization.

Matched MeSH terms: Surgical Wound Infection/etiology; Surgical Wound Infection/epidemiology; Surgical Wound Infection/prevention & control
Honey use in burn management: potentials and limitations

Boukraâ L, Sulaiman SA

Forsch Komplementmed, 2010 Apr;17(2):74-80.
PMID: 20484914 DOI: 10.1159/000297213

Management of the burn wound still remains a matter of debate, and an ideal dressing for burn wounds has not yet been discovered. Naturally occurring substances such as honey have been found to be useful as a wound cover for burns. Unlike most conventional local chemotherapeutics, honey does not lead to the development of antibiotic-resistant bacteria, and it may be used continuously. Among the challenging problems of using honey for medical purposes are dosage, safety, and formulation. Many approaches have been suggested to overcome such problems. With the increased availability of licensed medical products containing honey, clinical use is expected to increase and further evidence will become available. Honey seems to have the potential to clear infection as well as to be an effective prophylactic agent that may contribute to reducing the risks of cross-infection. A better understanding of the therapeutic and chemical properties of honey is needed to optimise the use of this product in the clinical management of burns. Its use in professional care centres should be limited to those with certified healing activities. The potentials and limitations of using honey as burn dressing are discussed in this review.

Matched MeSH terms: Wound Infection/therapy*
Fulltext Childhood burns at the Paediatric Institute Kuala Lumpur

Ibrahim SB, Omar MB, Gan EC, Rauf A, Johari NB, Yusof HB

Med J Malaysia, 1995 Sep;50(3):221-5.
PMID: 8926898

A prospective study of 94 burned children was carried out from January 1993 to October 1994. Scalding was the predominant cause of injury affecting mainly toddlers between 1 and 3 years old. Ninety-six per cent of the injuries occurred at home. There was 1 death following an 81% flame burns. An intense campaign to make parents aware of the hazards is required as almost all the injuries were preventable.

Matched MeSH terms: Wound Infection/epidemiology
Fulltext Aeromonas hydrophila hand infection complicating an open Rolando fracture: a case report

Sambandan S

Med J Malaysia, 1985 Mar;40(1):38-40.
PMID: 3831733

A case of Aeromonas hydrophila infection complicating an open Rolando's fracture of the hand is reported. Only two cases, both complicating open tibial fractures have been reported in the literature previously.' ,2 The organism was resistant to the usual antimicrobial (ampicillin and cloxacillin) used in the management of open fractures at University Hospital, Kuala Lumpur. The severity of the infection is largely dependent on the resistance of the host, and could vary from a locally spreading necrotizing cellulitis without systemic signs to a frank septicaemia with serious consequences. Early diagnosis with adequate debridement of the wound and appropriate antimicrobial to which the organisms are sensitive, are essential for effective control.

Matched MeSH terms: Wound Infection/etiology*
Fulltext The use of cefotaxime in serious and problem surgical infections

Balasegaram M, Devanand MR, Singh B

Med J Malaysia, 1980 Sep;35(1):68-72.
PMID: 6265744

Cefotaxime [HR 756], a third generation cephalosporin with pronounced antibacterial activity
against the Enterobacteriaceae, was assessed in serious and problem antibiotic resistant infection. Good clinical success was achieved without observed untoward effects. The study suggests that due to its properties, cefotaxime could be used as a first-line antibiotic provided that the clinical situation warrants the use of a cephalosporin or aminoglycoside.
Key words - cefotaxime [HR 756], serious surgical infection, antibiotic resistant infection.

Matched MeSH terms: Surgical Wound Infection/drug therapy*
Wound infection

Hussein bin Mohamed Sal

Med J Malaysia, 1973 Jun;27(4):262-70.
PMID: 4270783
Matched MeSH terms: Surgical Wound Infection/epidemiology*
Fulltext Antibiotic Prophylaxis In Oral Surgery For Prevention Of Surgical Site Infection, Second Edition

Citation: Antibiotic In Oral Surgery For Prevention Of Surgical Site Infection, Second Edition. Putrajaya: Ministry of Health, Malaysia; 2015.

Matched MeSH terms: Surgical Wound Infection
Diabetic Hand Infection: An Emerging Challenge

Bahar Moni AS, Hoque M, Mollah RA, Ivy RS, Mujib I

J Hand Surg Asian Pac Vol, 2019 Sep;24(3):317-322.
PMID: 31438802 DOI: 10.1142/S2424835519500401

Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.

Matched MeSH terms: Wound Infection/diagnosis; Wound Infection/etiology*; Wound Infection/therapy*
Fulltext Risk factors for neurosurgical site infections after a neurosurgical procedure: a prospective observational study at Hospital Kuala Lumpur

Buang SS, Haspani MS

Med J Malaysia, 2012 Aug;67(4):393-8.
PMID: 23082448

Surgical site infection (SSI) after craniotomy even though rare, poses a real risk of surgery and represents a substantial burden of disease for both patients and healthcare services in terms of morbidity, mortality and economic cost. The knowledge of risk factor for surgical site infection after craniotomy will allow the authority to implement specific preventive measures to reduce the infection rate. Therefore, the objectives of this study are to determine the incidence and the risk factors of surgical site infection after craniotomy.

Matched MeSH terms: Surgical Wound Infection/microbiology; Surgical Wound Infection/epidemiology*
Fulltext Bacteriological study and its role in the management of open tibial fracture

Faisham WI, Nordin S, Aidura M

Med J Malaysia, 2001 Jun;56(2):201-6.
PMID: 11771081

Sixty percent of open fracture wounds are contaminated at the time of injury. Despite that, the necessity for sequential multiple cultures and sensitivity studies for open fractures and their interpretation are still controversial. Predebridement, intraoperative, postoperative swabs and swabs in established infection for culture and sensitivity study were taken in 33 open tibial fractures over a 6 months period. 39.3% of predebridement swabs grew bacteria with the majority yielding gram-positive organism. None of the patients developed infection with similar organisms. 24.2% of the postoperative swabs grew bacteria, of which 75% were gram-negative. 50% of the patients with positive postoperative swabs developed infection. Thus, the role of sequential multiple cultures and sensitivity studies are not helpful in management of open fracture.

Matched MeSH terms: Wound Infection/microbiology*; Wound Infection/therapy*
Fulltext Necrotizing fasciitis

Zubaidah AW, Lim VKE

Med J Malaysia, 1996 Mar;51(1):134-6.
PMID: 10967993

A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.

Matched MeSH terms: Surgical Wound Infection/complications*; Surgical Wound Infection/surgery
Fulltext The incidence of post-operative wound infection in orthopaedic surgery

Dhillon KS, Kok CS

Med J Malaysia, 1995 Sep;50(3):237-40.
PMID: 8926901

With the increase in the number of orthopaedic surgeons and the aggressive marketing by manufacturing companies, high technology orthopaedic surgery is being more frequently carried out in Malaysia. Post-operative sepsis complicating this type of surgery can have disastrous consequences. No data is available in this country on the incidence of post-operative infection in Orthopaedic Surgery. The aim of this study was to determine the incidence of post-operative infection. A retrospective survey of 703 patients undergoing elective Orthopaedic Surgery in the year 1991 was carried out. We found an overall post-operative infection rate of 6.8% and a deep infection rate of 3.3%. This figure of 3.3% is higher than the internationally accepted figure of less than 2%. A need for ongoing surveillance and concerned effort to reduce the infection rate is stressed.

Matched MeSH terms: Surgical Wound Infection/epidemiology*; Surgical Wound Infection/prevention & control
Fulltext Risk factors for infection in total knee replacement surgery at Hospital Kuala Lumpur

Syahrizal AB, Kareem BA, Anbanadan S, Harwant S

Med J Malaysia, 2001 Dec;56 Suppl D:5-8.
PMID: 14569758 MyJurnal

One hundred primary TKR surgeries done between January 1994 and December 1999 were reviewed after a mean follow-up of 37.4 months. The rate of superficial and deep wound infection were 2% and 9% respectively. The most common organism in wound infection was Staphylococcus aureus. The factors that were significantly associated with superficial wound infection were diabetes mellitus (p = 0.005) and rheumatoid arthritis (p = 0.0000). The factors that were significantly associated with deep wound infection were diabetes mellitus (p = 0.000). There was no significant difference between duration of surgery, and the mean age among patients with and without wound infections.

Matched MeSH terms: Surgical Wound Infection/etiology*; Surgical Wound Infection/epidemiology

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