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2022 MAY 28 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Data detailed on bacterial infections and mycoses have been presented. According to [...]

BACKGROUND: Interplay between wound resistance factors and bacterial innoculum determines the risk of surgical infection. Since cautery causes more damage than the scalpel, our hypothesis is that lower numbers of bacteria are required to infect wounds made by electric cautery than to infect wounds made with a scalpel. METHODS: Abdominal fascia was incised in 375 rats by cold knife, cutting current, or coagulation current. Wounds were innoculated with increasing numbers of bacteria and histologically scored at 7 days for necrosis, inflammation, and abscess. RESULTS: Coagulation current causes more inflammation, necrosis, and abscesses than the scalpel at all bacterial levels. Electric cutting current is intermediate, causing more damage than the scalpel only after contamination reached [10.sup.5]. Above this threshold most wounds were infected in all groups. CONCLUSIONS: Electric coagulation current should be used only when the need for meticulous hemostasis outweighs the considerably increased risk of infection. Electric cutting current is less destructive but also less hemostatic; indications for its use are difficult to identify. Am J Surg. 1998;175:263--266. [C] 1998 by Excerpta Medica, Inc.

Allowing spontaneous detachment of the placenta during cesarean section appears to reduce the risk of infection compared with manual removal. Researchers randomly assigned 333 women having cesarean sections to either the standard manual removal of the placenta or to spontaneous separation. Fifteen percent of the spontaneous separation group experienced postsurgical infections compared with 27% of women in the manual removal group. Women in the spontaneous separation group were 40% less likely to experience infection. It seems likely that inserting a hand into the uterus introduces infective bacteria from the edges of the surgical incision.

Health care workers have an increased risk of contracting transmissible infections through exposure to infectious diseases at work. Surgeons in particular have an increased risk of contracting blood-borne infections. One study showed that 86 percent of surgeons experienced an injury involving penetration through the skin during the previous year. The rate of injury was estimated at 4.2 injuries per 1,000 operating room hours, and most surgeons experienced at least two injuries per year. The risk of accidental injury during an operation was estimated at 5.6 percent per procedure, with 95.5 percent of injuries due to needlesticks and 56.3 percent of injuries occurring on the index finger. A survey was conducted among 41 dermatologic surgeons to assess their experience with and attitudes about percutaneous injury, or wounds that penetrate the skin. Eight injuries in 6,278 operations performed over a one-month period were caused by needlesticks, recapping of needles, scalpel blades, skin hooks, and transport of an instrument. Injuries tended to occur on the dominant fingers. The percentage of dermatologic surgeons who felt that they should be permitted to operate while infected was 41.5 percent for human immunodeficiency virus (HIV) infections; 40 percent for hepatitis B virus infections; 25 percent for herpetic whitlow, or inflammation of the ends of the fingers or toes; and 20 percent for Staphylococcus aureus-related paronychia, or nail infections. The percentage of physicians who would inform patients of their infection before the operation was 29.4 percent for HIV; 27.8 percent for hepatitis B virus; 28.6 percent for herpetic whitlow; and 33.3 percent for S. aureus-related paronychia. Among patients, 45 percent said in a recent survey that they believed HIV-infected surgeons should not be allowed to operate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infections of the skin and soft tissues commonly occur in hospital patients. The choice of initial antibiotic treatment is made before cultures are available which identify the specific organism causing the infection. The selection of this initial antibiotic is based upon knowledge of those organisms which commonly cause such infections. In order to provide more insight into these organisms, a retrospective study was undertaken of 584 wounds and 676 skin or soft tissue abscesses. The anaerobic and aerobic microbiologic characteristics were correlated with the infection site. Aerobic organisms live and grow in the presence of free oxygen, while anaerobic organisms live in the complete or almost total absence of oxygen. The results indicated that anaerobic bacteria play an important role in skin wounds and abscesses. The location of the wound or abscess was useful in determining which organisms were involved in the infection. Infections located around the oral, rectal and vaginal regions tended to have organisms similar to those that are part of the normal flora at the adjacent mucous membrane. Infections occurring far from these areas usually involved organisms found in the skin. Mixed aerobic and anaerobic infections were more often found in the breast area and fingers and nail beds. Cultures for both aerobic and anaerobic organisms should be obtained. Antibiotics play an important role in the prevention of postoperative infections. The best treatment for skin wounds and abscesses is surgical drainage, and some cases may require systemic administration of antibiotics. (Consumer Summary produced by Reliance Medical Information, Inc.)

The incidence of graft infection in patients undergoing arterial reconstruction has been reported to range from 1 to 6 percent. A mortality of close to 50 percent is associated with these infections. It has been suggested that a source of bacteria may be the arterial wall or the contents of the artery itself. A study was designed to determine the incidence of bacteria in arteries, periarterial adipose tissue (fat tissue near the vascular site), and blood obtained from patients undergoing vascular surgery. Specimens were taken from 84 patients undergoing elective reconstruction of an artery. The procedures included repair of abdominal aortic aneurysms and bypass surgery. All except one patient received preventive antibiotic treatment. Cultures of the tissue samples revealed 32 of 84 patients (38 percent) had bacterial growth in at least one of the samples obtained. Of these 32 patients, five had bacterial growth from two types of tissue, and one had bacterial growth from all three types. There were 152 artery samples cultured; 18 (12 percent) contained bacteria. Out of 139 adipose tissue samples cultured, 19 (14 percent) showed bacteria; only two of the 139 blood samples (2 percent) were positive for bacteria. Short-term follow-up ranging from one to 29 months did not reveal any evidence of artery or graft infection. A possible explanation for the lack of graft infection may involve the fact that 71 percent of the positive cultures grew coagulase-negative staphylococcus, a bacteria that is not as virulent as many other bacteria; low bacterial concentrations were found; and preventive antibiotics were used. It is concluded that acute infectious complications following vascular surgery do not necessarily result from the presence of bacteria in the artery wall and surrounding tissue. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients who have recently undergone heart surgery are at risk for developing postoperative infections, particularly endocarditis from prosthetic valves and surgical wound infections. Staphylococcus epidermidis is a type of bacteria that has been responsible for postoperative epidemics in patients who have had cardiac surgery. The source of one epidemic of postoperative Staphylococcus epidermidis infection was traced to the hands of the operating surgeon. It seemed that a single strain of Staphylococcus epidermidis was responsible for an outbreak of postoperative endocarditis and wound infections. The infections appeared more often when one particular surgeon (surgeon A) performed the cardiac surgery. It seemed that only those patients having surgery performed by surgeon A developed the Staphylococcus epidermis wound infections at the sternum (chest bone) and on artificial valves. Since surgeon A was not responsible for removing saphenous veins in the legs, which are used for bypass grafting, none of the donor sites were infected with the bacteria. The 17 members of the surgical team were tested for the bacteria by culturing the nose, underarms, and groin area. The patients and other environmental sources were investigated and cleared. Hand cultures were performed on eight surgical personnel. The specific Staphylococcus epidermis strain of bacteria found in the infected cardiac patients and in the bypass pump matched the bacteria found on the hands of surgeon A. How the surgeon was able to transfer the bacteria during surgery was not ascertained. Small perforations in surgical gloves have been reported elsewhere. The surgeon recently began using sterile mineral oil on his hands, which might have promoted the bacterial growth. An effective antimicrobial soap scrub used prior to surgery to rid the surgeon's hands of any bacteria eliminated any further contamination. (Consumer Summary produced by Reliance Medical Information, Inc.)

A large city hospital experienced an infestation of mice combated in part by broadcasting poisoned baits. Months later there was an invasion of flies into the hospital, and 2 comatose patients in an intensive care unit contracted nasal maggots. Adult flies were trapped and maggots removed from the nares of the second patient. These were identified as the green blowfly (Phaenicia sericata). Recent downsizing of hospital personnel had led to the unintended and unrecognized loss of housekeeping services in the canteen food storage areas. A mouse infestation of the hospital occurred, with the epicenter in the canteen area. This was initially addressed by scattering poisoned bait and using rodent glue boards. The result of such treatment was the presence of numerous mouse carcasses scattered throughout the building attracting the green blowfly. Adult gravid female flies trapped in the new intensive care unit (where mice were not present) laid eggs in the fetid nasal discharge of 2 comatose patients. Live trapping of mice and removal of carcasses led to an abatement of the fly infestation. The cause-and-effect nature of the mouse carcasses and flies was underscored a year later when an outbreak of P sericata occurred in the operating department and was linked to the presence of mouse carcasses on glue boards not removed the previous fall. Hence, the disruption or loss of 1 vital link in hospital organization (in this case, housekeeping support) may lead to an unintended and bizarre outcome.

A prospective, randomized, blinded clinical trial was conducted to determine whether electrocautery as a means of creating abdominal or thoracic wounds would result in increased wound infection rates. Over a 15-month period, 492 consecutively studied patients were randomly placed into 1 of 2 groups: scalpel or electrocautery. There were no differences in age grouping, use of steroids, incidence of diabetes, number of days preoperative, operative time, use of preoperative antibiotic prophylaxis, use of drains, number of obese patients, or gender ratio. Wound infections developed in 38 of the 250 scalpel patients (15%) and in 30 of the 242 cautery patients (12%). The use of electrocautery to create surgical wounds does not increase wound infection rates.

Background. Methicillin-resistant Staphylococcus aureus (MRSA) isolates are resistant to penicillins and all other [beta]-lactam antibiotics. Nosocomial MRSA are also resistant to a variety of other antibiotic classes. MRSA infections are associated with a high morbidity and mortality in Uganda. There is limited data on the magnitude of MRSA in surgical site infections. The objective of this study was to determine the prevalence of MRSA among S. aureus isolates from surgical site infections in Mulago Hospital, Kampala, Uganda. Methods One hundred eighty eight pus swabs were collected from patients with surgical site infections. Swabs were inoculated for culture at the Microbiology laboratory Faculty of Medicine, Makerere University. S. aurues was identified biochemically. All S. aureus isolates were subjected to oxacillin agar screen and then tested with a polymerase chain reaction (PCR) assay for detection of the mecA gene which codes for oxacillin resistance. Results Out of the 188 specimen cultured, 54 (28.7%) grew S. aureus. Seventeen (31.5%) of the 54 isolates were confirmed as MRSA by PCR. Conclusion. S. aureus is highly (28.7%) prevalent in surgical site infections in Mulago National Referral Hospital, Kampala Uganda. MRSA is highly (31.5%) prevalent among populations of S. aureus isolated from surgical site infections in Mulago National Referral Hospital, Kampala Uganda, Table of Contents Introduction Materials And Methods Identification of S. aureus Introduction Staphylococcus aureus continues to be a major cause of both nosocomial and community-acquired infections. Methicillin was first introduced [...]

The causes, diagnosis, care and treatment of infected wounds is discussed.

The case of a 48-year-old woman is reported who had a hysterectomy to treat endometrial cancer. Six weeks later she developed an abscess at the incision site, which was treated with drainage and antibiotics. Doctors found a bacteria called Pasteurella multocida in the wound. This bacterium is normally found in the mouths of animals. She told the doctors she slept with her cats and that the cats may have licked her incision during the night.

An increasingly frequent complication of surgery is infection with the fungus Candida albicans; these infections are particularly difficult to control. This may be due to the ability of Candida to prevent the activation of the body's immune functions, which could otherwise control the growth of the organism. It appears that the mannan, a polysaccharide (carbohydrate molecule) in the cell wall of Candida, mediates the lack of reaction by the body to the chronic infection; mannan appears to interfere with the body's defense system. In order to identify the mechanism of this action, the effect of isolated mannan on cell immune functions was examined. Oligosaccharides of three sizes derived from the breakdown of mannan were found to inhibit the immune system. It is suggested that catabolites of fungal mannan help suppress immunity in candidiasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

The removal of the pterygium, a triangular piece of tissue that extends from the nasal border to the eye, in two patients who had received radiation treatment was complicated by corneoscleritis, an inflammation of the cornea and sclera, and endophthalmitis, an inflammation of the internal eye, both caused by bacterial infection. These complications came two to six weeks after surgery. Despite therapy, vision remained poor in both subjects. These data demonstrate that, although rare, complications of pterygium extraction can be destructive and visually disabling.

Postoperative surgical-wound infection remains one of the three most common types of nosocomial infection and accounts for considerable patient morbidity and prolonged hospitalization. Staphylococcus aureus remains the most common cause [...]