OBJECTIVE: To explore the efficacy and safety of human epidermal growth factor gel in the treatment of pin tract infections after surgery in patients with severe spinal deformity. METHODS: A retrospective case-control study was conducted to analyze the clinical data of 26 patients with pin tract infections after skull-pelvic ring traction for severe spinal deformity admitted from February 2019 to May 2022. Among them, 11 were male and 15 were female;the age ranged from 18 to 31 years, with an average of (24.1±4.3) years;the Cobb angle ranged 80.3° to 120.7°, with an average of (88.6±10.2)°;there were 52 iliac traction pins, 104 pin tract openings, and 38 pin tract infections. According to the Checketts-Otterbum classification, there were 11 infections of gradeⅠ, 13 infections of gradeⅡ, 10 infections of grade Ⅲ, and 4 infections of grade Ⅳ. The patients were divided into the conventional dressing change group (13 cases) and the growth factor group (13 cases) by coin flipping. Clinical efficacy was evaluated by recording the visual analogue scale(VAS) score during dressing change, duration of dressing change, cost of dressing change, positive rate of bacterial culture, wound improvement rate, and wound improvement time. RESULTS: There were no statistically significant differences in VAS or duration of dressing change between the two groups (P>0.05). The cost of dressing change was (800.0±59.5) yuan in the conventional dressing change group and (1 179.5±80.9) yuan in the growth factor group, with a statistically significant difference (P<0.05). There was no statistically significant difference in the positive rate of bacterial culture between the two groups (P>0.05). In the conventional dressing change group, within 20 pin tract infections, 2 infections achieved wound healing, 7 infections showed improvement, and 11 infections were ineffective;in the growth factor group, within 18 pin tract infections 5 infections achieved wound healing, 8 infections showed improvement, and 5 infections were ineffective, with a statistically significant difference between the two groups (P<0.05). The wound healing time was (22.8±4.9) days in the conventional dressing change group and (14.2±2.5) days in the growth factor group, with a statistically significant difference (P<0.05). No complications occurred in either group. CONCLUSION The application of human epidermal growth factor gel in the treatment of pin tract infections after skull-pelvic ring surgery in patients with severe spinal deformity is easy to operate, does not increase patient pain, and has significant efficacy. It shortens wound healing time, effectively promotes wound healing, and has good safety and high cost-effectiveness.
Humans ; Male ; Female ; Adult ; Adolescent ; Retrospective Studies ; Case-Control Studies ; Young Adult ; Epidermal Growth Factor/therapeutic use* ; Traction/adverse effects* ; Gels ; Bone Nails/adverse effects* ; Surgical Wound Infection/drug therapy*

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*

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*

Inflatable penile prostheses are an important tool in the treatment of medically refractory erectile dysfunction. One of the major complications associated with these prostheses is infections, which ultimately require device explanation and placement of a new device. Over the past several decades, significant work has been done to reduce infection rates and optimize treatment strategies to reduce patient morbidity. This article reviews the current state of knowledge surrounding penile prosthesis infections, with attention to the evidence for methods to prevent infection and best practices for device reimplantation.
Anti-Bacterial Agents/therapeutic use* ; Anti-Infective Agents, Local/therapeutic use* ; Antibiotic Prophylaxis/methods* ; Bandages ; Carrier State/drug therapy* ; Chlorhexidine/therapeutic use* ; Coated Materials, Biocompatible ; Device Removal ; Diabetes Mellitus/epidemiology* ; Erectile Dysfunction/surgery* ; Gram-Negative Bacterial Infections/therapy* ; Hair Removal/methods* ; Humans ; Immunocompromised Host/immunology* ; Male ; Penile Implantation/methods* ; Penile Prosthesis ; Preoperative Care/methods* ; Prosthesis-Related Infections/therapy* ; Reoperation ; Risk Factors ; Spinal Cord Injuries/epidemiology* ; Staphylococcal Infections/therapy* ; Staphylococcus aureus ; Staphylococcus epidermidis ; Surgical Drapes ; Surgical Instruments ; Surgical Wound Infection/therapy*

Penile prosthesis implant (PPI) remains an effective and safe treatment option for men with erectile dysfunction (ED). However, PPI surgery can be associated with a higher risk of complications in certain populations. This article provides a critical review of relevant publications pertaining to PPI in men with diabetes, significant corporal fibrosis, spinal cord injury, concurrent continence surgery, and complex salvage cases. The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations. While specific patient populations posed considerable challenges in PPI surgery, strict pre- and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.
Diabetes Complications ; Diabetes Mellitus ; Erectile Dysfunction/surgery* ; Humans ; Male ; Penile Implantation ; Penile Induration/surgery* ; Penile Prosthesis ; Priapism/surgery* ; Prosthesis-Related Infections/prevention & control* ; Salvage Therapy ; Spinal Cord Injuries/complications* ; Suburethral Slings ; Surgical Wound Infection/prevention & control* ; Urinary Incontinence/surgery* ; Urinary Sphincter, Artificial

OBJECTIVE: This study aims to observe the efficacy of vacuum sealing drainage (VSD) by continuous negative pressure drainage and saline irrigation in the treatment of oral and maxillofacial space infection. METHODS: Retrospective analysis was conducted on 116 cases of maxillofacial space infection, and clinical data were collected to compare the therapeutic effects of routine incision with drainage treatment (traditional treatment group, 58 cases) and VSD treatment (VSD group, 58 cases). RESULTS: The length of hospital stay, white blood cell count, scar length, frequency of dressing change, and pain degree of patients in the VSD group were all lower than those in the traditional treatment group. Moreover, the improvement degree of mouth opening in the VSD groups was better than that in the traditional treatment group (P<0.05). CONCLUSIONS VSD is a more effective method for the treatment of oral and maxillofacial space infection.
Body Fluids ; Drainage ; Humans ; Mouth Diseases ; therapy ; Retrospective Studies ; Surgical Wound Infection ; therapy ; Vacuum

The published clinical research in 2018 in surgical infection are changing current opinions in the management of acute appendicitis, antibiotics usage, resuscitation of septic shock, and choice of nutritional therapy in critically ill patients. In the management of uncomplicated acute appendicitis, antibiotic therapy can be successful in selected patients who wish to avoid surgery. Delayed primary wound closure can not reduce superficial surgical site infection rates compared to primary wound closure for complicated appendicitis. Infusion of antibiotics 30 minutes before the start of operation may influence their prophylactic effect on surgical site infection. After adequate source control, long-course antibiotic therapy in critically ill post-operative patients is not associated with any clinical benefit. Although susceptible in the test, piperacillin-tazobactam can not replace carbapenems in patients with Escherichia coli and Klebsiella pneumoniae bloodstream infection that produce extended-spectrum beta-lactamase for definitive treatment. Deresuscitation of critically ill patients is associated with reduced mortality. Hydrocortisone therapy has potential role in the patients with septic shock and worth further evidence. The use of an energy-dense formulation for enteral delivery of nutrition can not improve 90-day survival rate in patients undergoing mechanical ventilation. Compared with early isocaloric parenteral nutrition, early enteral nutrition did not reduce mortality or the risk of secondary infections, but was associated with a greater risk of digestive complications in critically ill adults with septic shock.
Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Appendicitis ; complications ; therapy ; Critical Illness ; Humans ; Nutritional Support ; Shock, Septic ; etiology ; therapy ; Surgical Wound Infection ; etiology ; prevention & control ; therapy

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

Adult ; Aged ; Antifungal Agents ; administration & dosage ; adverse effects ; classification ; Candida ; drug effects ; isolation & purification ; Carcinoma ; pathology ; therapy ; Cross Infection ; microbiology ; therapy ; Drug Resistance, Multiple, Fungal ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Mycoses ; microbiology ; therapy ; Patient Care Management ; methods ; Pulmonary Disease, Chronic Obstructive ; complications ; therapy ; Surgical Wound Infection ; microbiology ; therapy ; Symptom Flare Up ; Treatment Outcome