New silver-containing dressings developed in recent years have brought new and powerful means for the prevention and treatment of wound infection, which promote development and progress of wound therapy. There are many kinds of silver-containing dressings, however, misunderstanding and even misapplication exist in how to choose and use these dressings. Based on literature evidence, we propose this national expert consensus on clinical application of silver-containing dressings, particularly in terms of kinds and mechanisms, indications, contraindications, rational selections in different wounds, and cautions in the clinical application of silver-containing dressings. This consensus would be helpful for medical and nursing personnel to use silver-containing dressings in wound repair field in clinic correctly and professionally.
Administration, Topical ; Bandages ; Burns ; therapy ; Consensus ; Humans ; Silver Compounds ; therapeutic use ; Surgical Wound Infection ; prevention & control ; Wound Healing ; drug effects ; Wound Infection ; prevention & control ; therapy

In case of bezoar removal, pharmacotherapy has been performed within restrictive patients as well as therapeutic endoscopy has been restricted as to the size of bezoar and its hardness. In patients with huge and hard bezoars, that is unable to remove through endoscopy they need surgical removal. But in case of geriatric patient management, we can't overlook the complication of general anethesia and post operative wound infection. Thus we describe two case of geriatric patient that endoscopically removed bezoar through the medium of dissolved by Coca-Cola direct injection and lavage. We injected Coca-Cola directly to bezoar through the spray catheter and then Coca-Cola lavage daily two liters for three days. We could easily destroy dissolved huge bezoars by using of biopsy forcep and snare and than get rid of them endoscopically by use of basket. In case of geriatric patient management of huge gastric bezoar it is considered another choice for bezoar removal.
Bezoars* ; Biopsy ; Catheters ; Drug Therapy ; Endoscopy ; Hardness ; Humans ; SNARE Proteins ; Surgical Instruments ; Therapeutic Irrigation ; Wound Infection

BACKGROUNDWound infection following spinal instrumented surgery is a frequent complication. The optimal treatment of acute deep wound infection following spinal instrumentation fusion remains controversial because of variability in cohort identification, definition of an infection, and the instrument used to measure outcomes. This retrospective study evaluated the clinical curative effect for postoperative spinal infection after instrumented spine fusion with extensive debridement, or implant removal.

METHODSFrom January 2004 to October 2009, 851 patients were identified who underwent surgical treatment of spinal diseases. The medical records of patients who developed infections were reviewed in detail.

RESULTSOf 851 patients, 41 (4.9%) developed an infection. Thirty-three were acute, and eight were delayed. Acute infected cases were managed with antibiotic therapy, and aggressive debridement of the wound and soft tissues leaving all instrumentation in situ in all but one patient. The most common symptoms of acute infection included: posterior incisional drainage (26 of 33 patients), back pain (22 of 33 patients) and fever (13 of 33 patients). Among patients with delayed onset infection, five of eight patients had local pain, four of eight patients had incision drainage, and one patient had a prolonged period of intermittent fever. The most frequent causative organism for postoperative spinal infection following spine surgery is Staphylococcus aureus. Pseudarthrosis was noted in long-term follow-up in four of 41 patients.

CONCLUSIONSWe recommend irrigation and debridement, no instrumentation removal, and, if necessary, repeat debridement followed by delayed primary closure for the treatment of acute deep infection with instrumentation.

Debridement ; Female ; Humans ; Male ; Retrospective Studies ; Surgical Wound Infection ; diagnosis ; drug therapy ; prevention & control ; surgery

For elective surgery of colorectal cancer, current evidence supports preoperative mechanical bowel preparation combined with oral antibiotics. Meanwhile, for patients with varied degrees of intestinal stenosis, individualized protocol is required to avoid adverse events. We hereby summarize recent high-quality evidences and updates of guidelines and consensus, and recommend stratified bowel preparation based on the clinical practice of our institute as follows. (1) For patients with unimpaired oral intake, whose tumor can be passed by colonoscopy, mechanical bowel preparation and oral antibiotics are given. (2) For patients without symptoms of bowel obstruction but with impaired oral intake or incomplete colonoscopy due to tumor-related stenosis, small-dosage laxative is given for several days before surgery, and oral antibiotics the day before surgery. (3) For patients with bowel obstruction, mechanical bowel preparation or enema is not indicated. We proposed this evidence-based, individualized protocol for preoperative bowel preparation for the reference of our colleagues, in the hope of improving perioperative outcomes and reducing adverse events.
Anti-Bacterial Agents/therapeutic use* ; Colorectal Neoplasms/drug therapy* ; Constriction, Pathologic/etiology* ; Elective Surgical Procedures/adverse effects* ; Humans ; Preoperative Care/methods* ; Surgical Wound Infection/etiology*

Scleral necrosis and infection are serious late complications of pterygium treatment and are difficult to manage. We describe a 70-year-old Chinese male who presented with scleral necrosis and Pseudomonas aeruginosa infection 15 years after the excision of a pterygium. The infection was treated early and aggressively with intensive topical and intravenous antibiotics and the thin necrotic sclera was reinforced with a donor scleral patch graft when the scleral infection was clinically controlled. The integrity of the globe was maintained by a thin layer of sclera anterior to the graft after the graft gradually shrunk in size and retracted posteriorly. The eye was saved from possible scleral perforation and endophthalmitis. This case is reported to highlight the importance of early aggressive treatment of infection and the value of prophylactic repair of scleral necrosis in the management of these late complications of pterygium treatment.
Administration, Topical ; Aged ; Anti-Bacterial Agents ; Drug Therapy, Combination ; administration & dosage ; therapeutic use ; Humans ; Injections, Intravenous ; Male ; Necrosis ; Pseudomonas Infections ; drug therapy ; Pseudomonas aeruginosa ; Pterygium ; surgery ; Sclera ; pathology ; transplantation ; Scleral Diseases ; drug therapy ; microbiology ; Surgical Wound Infection ; drug therapy ; etiology

PURPOSETo assess the effects of lipopolysaccharide (LPS) pretreatment on wound infection mouse model and evaluate the biological safety of the optimal pretreatment dose in vivo.

METHODSMice were pretreated with LPS of different doses at 48 and 24 h before femoral medial lon- gitudinal incision was made and infected with different bacteria.

RESULTSIt is showed that 0.5 mg/kg/time of LPS pretreatment can significantly alleviate the inflammation in mouse model infected with methicillin-resistances Staphylococcus aureus, methicillin-sensitive S. aureus, Pseudomonas aeruginosa,or Escherichia coli compared with doses of 0.25 mg/kg/time, 1 mg/ kg/time, and 1.5 mg/kg/time.

CONCLUSIONSLPS pretreatment can alleviate the inflammation in mouse model and the optimal dose is 0.5 mg/kg/time, and meanwhile it does not damage organs' function.

Animals ; Disease Models, Animal ; Female ; Inflammation ; prevention & control ; Lipopolysaccharides ; therapeutic use ; Mice ; Mice, Inbred BALB C ; Surgical Wound Infection ; drug therapy ; Toll-Like Receptor 4 ; physiology

OBJECTIVETo explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation.

METHODSThe clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients, among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs, lab tests, MRI findings, pathology findings, and clinical effects were analyzed.

RESULTSAll four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano, 3 cases obtained excellent results, while 1 poor.

CONCLUSIONSThe incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments, thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate, C-reactive protein level, MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.

Back Pain ; Fracture Fixation, Internal ; Humans ; Kyphosis ; Lumbar Vertebrae ; Lumbosacral Region ; Retrospective Studies ; Spinal Fusion ; Surgical Wound Infection ; drug therapy ; epidemiology ; Treatment Outcome

Objective: To investigate the effect of hypochloric acid on Escherichia coli biofilm and the clinical efficacy of hypochloric acid for wounds with Escherichia coli infection. Methods: One strain of Escherichia coli with the strongest bacterial biofilm forming ability among the strains isolated from specimens in 25 patients (16 males and 9 females, aged 32-67 years) from five clinical departments of the 940^th Hospital of the Joint Logistic Support Force was collected for the experimental study from September to December 2019. The Escherichia coli was cultured with hypochloric acid at 162.96, 81.48, 40.74, 20.37, 10.18, 5.09, 2.55, 1.27, 0.64, and 0.32 μg/mL respectively to screen the minimum bactericidal concentration (MBC) of hypochloric acid. The Escherichia coli was cultured with hypochloric acid at the screened MBC for 2, 5, 10, 20, 30, and 60 min respectively to screen the shortest bactericidal time of hypochloric acid. The biofilm formation of Escherichia coli was observed by scanning electron microscopy at 6, 12, 24, 48, 72, and 96 h of incubation, respectively. After 72 h of culture, hypochloric acid at 1, 2, 4, 8, and 16 times of MBC was respectively added to Escherichia coli to screen the minimum biofilm eradicate concentration (MBEC) of hypochloric acid against Escherichia coli. After hypochloric acid at 1, 2, 4, and 8 times of MBEC and sterile saline were respectively added to Escherichia coli for 10 min, the live/dead bacterial staining kit was used to detect the number of live and dead cells, with the rate of dead bacteria calculated (the number of samples was 5). From January to December 2020, 41 patients with infectious wounds meeting the inclusion criteria and admitted to the Department of Burns and Plastic Surgery of the 940^th Hospital of Joint Logistic Support Force of PLA were included into the prospective randomized controlled trial. The patients were divided into hypochloric acid group with 21 patients (13 males and 8 females, aged (46±14) years) and povidone iodine group with 20 patients (14 males and 6 females, aged (45±19) years) according to the random number table. Patients in the 2 groups were respectively dressed with sterile gauze soaked with hypochloric acid of 100 μg/mL and povidone iodine solution of 50 mg/mL with the dressings changed daily. Before the first dressing change and on the 10^th day of dressing change, tissue was taken from the wound and margin of the wound for culturing bacteria by agar culture method and quantifying the number of bacteria. The amount of wound exudate and granulation tissue growth were observed visually and scored before the first dressing change and on the 3^rd, 7^th, and 10^th days of dressing change. Data were statistically analyzed with one-way analysis of variance, Dunnett-t test, independent sample t test, Mann-Whitney U test, Wilcoxon signed-rank test, chi-square test, or Fisher's exact probability test. Results: The MBC of hypochloric acid against Escherichia coli was 10.18 μg/mL, and the shortest bactericidal time of hypochloric acid with MBC against Escherichia coli was 2 min. Escherichia coli was in a completely free state after 6 and 12 h of culture and gradually aggregated and adhered with the extension of culture time, forming a mature biofilm at 72 h of culture. The MBEC of hypochloric acid against Escherichia coli was 20.36 μg/mL. The Escherichia coli mortality rates after incubation with hypochloric acid at 1, 2, 4, and 8 times of MBEC for 10 min were significantly higher than that after incubation with sterile saline (with t values of 6.11, 25.04, 28.90, and 40.74, respectively, P<0.01). The amount of bacteria in the wound tissue of patients in hypochloric acid group on the 10^th day of dressing change was 2.61 (2.20, 3.30)×10⁴ colony forming unit (CFU)/g, significantly less than 4.77 (2.18, 12.48)×10⁴ CFU/g in povidone iodine group (Z=2.06, P<0.05). The amounts of bacteria in the wound tissue of patients in hypochloric acid group and povidone iodine group on the 10^th day of dressing change were significantly less than 2.97 (2.90, 3.04)×10⁶ and 2.97 (1.90, 7.95)×10⁶ CFU/g before the first dressing change (with Z values of 4.02 and 3.92, respectively, P<0.01). The score of wound exudate amount of patients in hypochloric acid group on the 10^th day of dressing change was significantly lower than that in povidone iodine group (Z=2.07, P<0.05). Compared with those before the first dressing change, the scores of wound exudate amount of patients in hypochloric acid group on the 7^th and 10^th days of dressing change were significantly decreased (with Z values of -3.99 and -4.12, respectively, P<0.01), and the scores of wound exudate amount of patients in povidone iodine group on the 7^th and 10^th days of dressing change were significantly decreased (with Z values of -3.54 and -3.93, respectively, P<0.01). The score of wound granulation tissue growth of patients in hypochloric acid group on the 10^th day of dressing change was significantly higher than that in povidone iodine group (Z=2.02, P<0.05). Compared with those before the first dressing change, the scores of wound granulation tissue growth of patients in hypochloric acid group on the 7^th and 10^th days of dressing change were significantly increased (with Z values of -3.13 and -3.67, respectively, P<0.01), and the scores of wound granulation tissue growth of patients in povidone iodine group on the 7^th and 10^th days of dressing change were significantly increased (with Z values of -3.12 and -3.50, respectively, P<0.01). Conclusions: Hypochloric acid can kill Escherichia coli both in free and biofilm status. Hypochloric acid at a low concentration shows a rapid bactericidal effect on mature Escherichia coli biofilm, and the higher the concentration of hypochloric acid, the better the bactericidal effect. The hypochloric acid of 100 μg/mL is effective in reducing the bacterial load on wounds with Escherichia coli infection in patients, as evidenced by a reduction in wound exudate and indirect promotion of granulation tissue growth, which is more effective than povidone iodine, the traditional topical antimicrobial agent.
Adult ; Aged ; Biofilms ; Escherichia coli ; Escherichia coli Infections/drug therapy* ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Surgical Wound Infection ; Treatment Outcome

PURPOSE: Antibiotic-loaded bone cement (ALBC) was usually used to prevent periprosthetic joint infection (PJI) in primary total knee arthroplasty (PTKA), but whether to use ALBC or plain bone cement in PTKA remains unclear. We aimed to compare the occurrence rate of PJI using two different cements, and to investigate the efficacy of different antibiotic types and doses administered in preventing surgical site infection (SSI) with ALBC. METHODS: The availability of ALBC for preventing PJI was evaluated by using a systematic review and meta-analysis referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Existing articles until December 2021 involving PTKA patients with both ALBC and plain bone cement cohorts were scanned by searching "total knee arthroplasty", "antibiotic-loaded cement", "antibiotic prophylaxis", "antibiotic-impregnated cement" and "antibiotic-laden cement" in the database of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library. Subgroup analysis included the effectiveness of different antibiotic types and doses in preventing SSI with ALBC. The modified Jadad scale was employed to score the qualities of included articles. RESULTS: Eleven quantitative studies were enrolled, including 34,159 knees undergoing PTKA. The meta-analysis results demonstrated that the use of prophylactic ALBC could significantly reduce the prevalence of deep incisional SSI after PTKA, whereas there was no significant reduction in the rate of superficial incisional SSI. Moreover, gentamicin-loaded cement was effective in preventing deep incisional SSI, and the use of high-dose ALBC significantly reduced the rate of deep incisional SSI after PTKA. Besides, no significant adverse reactions and complications were stated during the use of ALBC in PTKA. CONCLUSION The preventive application of ALBC during PTKA could reduce the rates of deep PJI. Furthermore, bone cement containing gentamicin and high-dose ALBC could even better prevent deep infection after PTKA. However, the existing related articles are mostly single-center and retrospective studies, and further high-quality ones are needed for confirmation.
Humans ; Bone Cements ; Arthroplasty, Replacement, Knee/methods* ; Anti-Bacterial Agents/therapeutic use* ; Prosthesis-Related Infections/etiology* ; Retrospective Studies ; Arthritis, Infectious/etiology* ; Gentamicins ; Surgical Wound Infection/drug therapy*

Anti-Bacterial Agents ; therapeutic use ; Antibiotic Prophylaxis ; Dry Socket ; drug therapy ; etiology ; Humans ; Inflammation ; drug therapy ; Mandible ; Molar, Third ; microbiology ; surgery ; Surgical Wound Infection ; drug therapy ; etiology ; Tooth Extraction ; adverse effects ; Tooth, Impacted ; microbiology ; surgery