Surgical Infections

Surgical site infections (SSIs) and complications (SSCs) following open spine surgery result in substantial added healthcare system cost and reduced quality of care. Closed incision negative pressure therapy (ciNPT) is increasingly used as an adjunctive tactic, for postoperative management of high-risk closed incisions. We developed an economic model to evaluate potential savings from SSI and SSC-associated readmission (SSC-AR) reduction against the incremental acquisition cost of the ciNPT system across different patient risk levels.

Patient risk parameters were derived from published predictive models for SSI and SSC-AR risk, using data from the Premier Healthcare Database of open spine surgeries. The economic model incorporated published average costs of SSIs ($18,899) and SSC-ARs ($22,698) within 90 days post-discharge in orthopedic surgery and an estimated ciNPT effectiveness rate ranging from 20% to 80% in spine surgery. Primary measure was estimated economic impact of preventing SSIs or SSC-ARs using ciNPT.

Cost savings were observed in populations with SSI/SSC-AR rates ≥15.0 when ciNPT was universally applied. ciNPT was not cost-effective for rates ≤0.5%. For rates between 1.0% and 15.0%, savings were observed depending on specific patient risk levels.

Strategic use of ciNPT, guided by patient risk stratification, can provide cost savings for healthcare systems. This model may help surgeons to preoperatively identify spine surgery patients with the highest potential cost benefit from ciNPT.

To analyze the clinical outcomes of linezolid (LZD) blood concentration monitoring in the orthopedic department of our hospital, to explore the risk factors associated with thrombocytopenia caused by LZD, and to establish a prediction model.

We retrospectively analyzed orthopedic patients treated with LZD at the First Affiliated Hospital of Nanchang University from January 2021 to December 2024. Eligible patients had concentration testing and complete platelet count data. Univariate and multivariate logistic regression were used to identify risk factors for thrombocytopenia. A nomogram was developed on the basis of independent predictors to predict the probability of thrombocytopenia.

117 patients were enrolled, of which 18 were evaluated for linezolid-induced thrombocytopenia (LIT). Univariate analysis revealed that age, red blood cell count, albumin, creatinine clearance, and LZD trough concentration were statistically significant in relation to LIT; multifactorial logistic regression analysis indicated that the LZD trough concentration was strongly associated with LIT. On the basis of these risk factors, a nomogram was established using R software, and the area under the curve of the receiver operating characteristic for the subjects in the modeling group was 0.884 (95% confidence interval: 0.800, 0.969). According to the nomogram results, the predicted values of the calibration curves were largely consistent with the actual values.

Age, albumin, red blood cell count, LZD trough concentration, and creatinine clearance are all good predictors of LIT. The construction of a nomogram to predict the risk of LIT has greater clinical value, which can be used to guide individualized treatment in the clinical setting.

Fournier’s gangrene (FG) is a rapidly progressive, life-threatening necrotizing fasciitis with mortality rates ranging from 20% to 50%. Despite advances in management, reliable and readily accessible prognostic markers for early mortality risk stratification remain limited. This study aimed to assess the prognostic utility of red cell distribution width (RDW) and RDW-derived indices in predicting in-hospital mortality in patients undergoing surgical treatment for scrotal FG.

A retrospective cohort analysis was conducted on patients treated surgically for scrotal FG between January 2012 and January 2025. Preoperative laboratory parameters, including RDW, albumin, neutrophil, lymphocyte, and platelet counts, were collected. Derived indices—RDW-to-albumin ratio (RAR), RDW-to-lymphocyte ratio (RLR), and RDW-to-platelet ratio (RPR)—were calculated. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) analyses were performed to evaluate the diagnostic performance of these indices.

Of the 62 patients included, 17.7% died during hospitalization. Although stand-alone RDW levels were not substantially associated with mortality, the RAR exhibited excellent predictive accuracy (area under the curve = 0.955). RLR, RPR, and neutrophil-to-lymphocyte ratio (NLR) also showed substantial prognostic value. Non-survivors had markedly lower serum albumin and hemoglobin concentrations and higher creatinine and NLR values. Post-operative intensive care unit admission and bowel diversion were strongly associated with mortality.

RDW-derived indices, particularly RAR, appear to be robust, easily obtainable biomarkers for early mortality risk prediction in scrotal FG. Their integration into clinical evaluation algorithms may enhance prognostic precision and guide timely interventions. Further multi-center prospective studies are warranted to confirm these findings and support their routine use in clinical practice.

Transperineal prostate biopsy has been widely recommended because of its low post-operative complications. We aim to evaluate the clinical value of routine urine culture in non-febrile patients on transperineal prostate biopsy, particularly in terms of infection-related complications and cancer detection rates.

A retrospective analysis was conducted on patients who met the following inclusion criteria: (a) no fever, and (b) no antimicrobials in the 7-day period prior to transperineal prostate biopsy. Patients were categorized based on urine culture results: negative urine culture group, urine culture contamination group, and positive urine culture group.

Infectious complications were more common in the positive urine culture group (11.8%, p < 0.05) than the others. There were no sepsis or death events. In multi-variable logistic regression analysis, patients in the positive urine culture group had 6.54 times higher the odds of developing infection-related complications compared to those in the negative group (95% confidence interval [CI]: 1.805–23.731, p = 0.004). The cancer detection rate was higher in the negative urine culture group than the positive group (49% vs. 33.8%, p < 0.05). Patients in the negative urine culture group had 2.12 times higher the odds of cancer detection rate than patients in the positive group (95% CI: 1.175–3.83, p = 0.013).

Urine culture prior to prostate biopsy remains clinically relevant. Furthermore, for patients with positive urine culture, who are non-febrile and have not received antibiotic treatment or prophylaxis, it would be meaningful to explore whether attempted antibiotic therapy could improve prostate cancer detection rates or avoid unnecessary prostate biopsies.

There is no consensus on the optimal strategy for surgical site infection (SSI) prevention in anorectal surgery. Pre-operative antibiotic agents and enema are commonly used, but their effectiveness in SSI prevention has not been studied. The objective of this study was to determine the combined effect of antibiotic agents and enema on SSI rates in anorectal surgery for benign disease.

A retrospective study was conducted between July 2015 and June 2024 in an academic institution on adult patients who underwent either elective excisional hemorrhoidectomy, lateral internal sphincterotomy (LIS), or simple fistulotomy. Patients were categorized into four groups on the basis of the pre-operative prophylactic strategy utilized: neither antibiotic agents nor enema, enema only, antibiotic agents only, or both antibiotic agents and enema. The primary outcome measured was the effect of pre-operative prophylactic strategy on reducing SSI rates, analyzed within the overall cohort and stratified by procedure performed. Other outcomes measured were factors associated with SSI development.

During the study period, 555 patients met the inclusion criteria. Of these, 136 (24.5%) patients received neither antibiotic agents nor enema, 65 (11.7%) received enema only, 217 (39.1%) received antibiotic agents only, and 137 (24.7%) received both antibiotic agents and enema. No significant differences were observed between the four groups with regard to age, gender, associated comorbidities, or smoking status. SSI occurred in 40 (7.2%) patients within the cohort; of these 3 (7.5%) patients required incision and drainage, and the remaining 37 (92.5%) patients were managed with antibiotic therapy. There was no difference in the SSI rate on the basis of the pre-operative prophylactic strategy utilized. Similarly, no difference was observed among the four groups when stratified by the procedure performed.

Pre-operative antibiotic agents and enema, whether administered individually or in combination, showed no substantial effect on SSI rate.

This study investigated the clinical characteristics and risk factors for cytomegalovirus (CMV) gastrointestinal (GI) disease in patients with trauma using covariate matching.

This study included immunocompetent patients with trauma who had received a diagnosis of CMV GI disease between 2017 and 2022, confirmed by symptoms and quantitative real-time polymerase chain reaction. Patients were matched 3:1 on the basis of age, gender, mechanism of injury, Injury Severity Score, and Trauma and Injury Severity Score. Matched cases were compared using χ² or Fisher exact test and the Mann-Whitney U test. Significant variables identified during uni-variable analysis were entered into logistic regression.

A total of 23 patients received a diagnosis of CMV GI disease. After matching, 22 CMV-positive and 62 CMV-negative patients were analyzed. CMV-positive patients frequently underwent hollow viscus (HV) organ surgery (p = 0.028) and pre-peritoneal pelvic packing (PPP) (p = 0.012). The disease-positive group also exhibited a greater demand for mechanical ventilation, stress-dose steroids, renal replacement therapy (RRT) (all p < 0.001), and a greater blood product requirement within 24 h (p = 0.007). Logistic regression identified HV organ surgery (OR: 6.65, 95% confidence interval [CI]: 1.34–32.89, p = 0.020), PPP (OR: 12.58, 95% CI: 1.14–139.15, p = 0.039), stress-steroid use (OR: 8.31, 95% CI: 1.15–47.40, p = 0.017), and RRT (OR: 15.72, 95% CI: 3.02–81.81, p = 0.001) as risk factors for the disease.

This study identified HV organ surgery, PPP, steroid usage, and RRT as significant risk factors for CMV GI disease in patients with trauma.

There has been a renewed interest in the use of whole blood (WB) in trauma resuscitation, with studies showing improved mortality rate with WB. However, there is a paucity of studies assessing the impact of WB on infectious complications. The aim of this study was to assess the impact of WB during trauma resuscitation on infectious complications.

A retrospective cohort study utilizing the National Trauma Databank of patients who underwent hemorrhage control laparotomy within one hour was performed. The primary outcome was the impact of receiving WB during trauma resuscitation on surgical infections. Secondary outcome included analysis of a dose–response relation between units of WB and infection. Subgroup analysis was performed on patients undergoing massive transfusion. Multi-variable logistic regression was performed to evaluate outcomes.

A total of 2,151 patients received WB compared with 10,641 patients who did not. Receiving WB was not associated with increased odds of infection (odds ratio [OR] = 1.12, 95% confidence interval [95% CI]: 0.94–1.32, p = 0.22). However, each unit of WB received was associated with a 4% increase in odds of infection (OR = 1.04, 95% CI: 1.00–1.08, p = 0.04). In the massive transfusion subgroup, receiving WB was not associated with increased risk of infection.

Receiving WB during trauma resuscitation was associated with increased odds of infection in a dose-dependent manner, but not in patients undergoing massive transfusion. Further studies evaluating effects beyond mortality are needed to better evaluate the impact of WB use on trauma patients.

Actinomycosis is a chronic inflammatory condition caused by Actinomyces israelii or other Actinomycetes species, with primary abdominopelvic involvement being the most important form of the disease, especially when there is splanchnic infiltration. In cases of colonic involvement, the disease is often misdiagnosed as a neoplasm by imaging studies, and surgery is undertaken.

We report the case of a 48-year-old male living in a rural area in whom a computed tomography (CT) scan showed a large, irregular abdominopelvic mass infiltrating the urinary bladder, the left ureter, and the sigmoid colon with luminal obstruction. He was referred with the presumptive diagnosis of abdominal sarcoma for surgical evaluation and treatment. He underwent a Hartmann’s procedure with resection of the sigmoid colon and formation of an end colostomy. Multiple tissue samples were taken from the mass for histopathological examination. The correct diagnosis was made after pathological examination by detection of actinomycetes colonies. Penicillin-based therapy was commenced and continued for six months, when a CT revealed complete resolution of the pre-operative findings without any evidence of a mass.

Although rare, actinomycosis should be considered in the differential diagnosis of colonic neoplastic lesions. Proper long-term antibiotic treatment is necessary for complete eradication of the infection and resolution of tissue alterations.