Surgical Infections

Facial fractures account for over 400,000 emergency department visits annually in the United States. They are managed operatively, non-operatively, or via observation with diet and activity modification. Regardless of management, antibiotic agents are commonly prescribed. The Surgical Infection Society (SIS) published the 2020 guidelines limiting antibiotic agent use to the peri-operative period.

We performed a retrospective chart review to evaluate antibiotic agent prescribing practices for patients with isolated facial fractures at an academic level-one trauma center. We assessed potential antibiotic agent days saved by adhering to SIS guidelines. Patients 18 and older presenting to the trauma service with a facial fracture from January 2019 to August 2024 were identified from the trauma registry. Patients with clear antibiotic agent indications (e.g., open fractures) were excluded. Descriptive and chi-square analyses were used.

The number of potentially saved antibiotic agent days was 495. Of 119 patients, 89.1% received antibiotic agents, 57.6% at least twice. A total of 80.2% of antibiotic agents given were against SIS recommendations. The antibiotic agent administration rate for mandibular fractures was 97%. Operative management accounted for 93.2% of cases. Antibiotic agent use did not significantly differ between operative and non-operative management (p = 0.18) or between open and closed operative cases (p = 0.99). In operative cases, appropriate peri-operative antibiotic agents were used 89.9% of the time, with 47.5% pre-operative and 63.6% post-operative non-guideline use. Segmented logistic regression showed no statistically significant reduction in non-guideline antibiotic agent use after the guidelines were published. The 30-day post-operative surgical site infection rate was 3.4%, with no significant difference between guideline and non-guideline use.

There is substantial discordance between real-world antibiotic agent prescribing practices and SIS guideline recommendations for facial fractures. Quantifying excess non-guideline antibiotic agent use highlights an important opportunity for antimicrobial agent stewardship and provides a foundation for future quality improvement initiatives.

Early diagnosis of intracranial bacterial infections following neurosurgical procedures remains challenging because of delayed or inconclusive pathogen identification. This study aimed to develop and validate a predictive model for early detection of post-neurosurgical procedure bacterial infections by integrating clinical features and cerebrospinal fluid (CSF) biomarkers.

We conducted a retrospective study including 429 patients who underwent neurosurgery at Tianjin Huanhu Hospital between November 2018 and December 2024. Patients were randomly divided into training (n = 300) and validation (n = 129) cohorts. Predictive parameters were selected via uni-variable analysis and LASSO regression, followed by multi-variable logistic regression to construct a nomogram. Model performance was evaluated using receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA).

Among 429 patients, 147 (34.3%) had confirmed CSF bacterial infections. Seven independent predictors were identified: CSF time to operation, CSF color, CSF white blood cell count ≥ 2000 × 10⁶/L, CSF glucose < 1.89 mmol/L, CSF lactate concentration, hyperpyrexia, and slower reaction time. The model achieved an area under the ROC curve of 0.822 (95% confidence interval [CI]: 0.771–0.873) in the training cohort and 0.715 (95% CI: 0.604–0.827) in the validation cohort. DCA demonstrated substantial clinical net benefit across a threshold probability range of 0.1–0.25.

This nomogram-based model provides a practical and reliable tool for early risk stratification of post-neurosurgical procedure intracranial bacterial infections, supporting timely diagnostic and therapeutic decision-making in clinical practice.

Breast operations have a surgical site infection rate of <1.5%, a figure that increases to 3% after implant-based reconstructions. We aimed to assess whether contamination occurred before implant insertion and could be related to post-operative infections.

The reconstruction team prepared the surgical field using a betadine solution and standard draping. After the surgical procedures, the antiseptic was re-applied around the incision, the surgical field re-draped, and the gloves changed before implant insertion. Immediately before the betadine application and re-draping, swab cultures were collected from the peri-areolar regions and margins of the exposed field. Any signs of infection were checked during the 2-year follow-up.

A total of 164 cases were included; of these 13 showed positive swab cultures (12 of Staphylococcus epidermidis, and one of Bacillus species). Among them, only one patient developed a post-operative infection necessitating the insertion of a Hemovac drain at 42 days after a surgical procedure. Among the 151 patients with negative swab culture results, 10 patients received a diagnosis of post-operative infections; follow-up cultures primarily identified S. aureus (three methicillin-sensitive cases, four methicillin-resistant cases), whereas two were culture-negative.

Residual contamination may persist despite the initial surgical site sterilization. The re-application of antiseptics and re-draping immediately before implant insertion may help reduce post-operative infections and should be considered an adjunct to comprehensive peri-operative protocols. Some infections may be more closely related to post-operative management than pre-implant field contamination, underscoring the need for meticulous post-operative care. Definitive causal relationships should be tested using rigorously designed and adequately powered studies.

Damage control laparotomy (DCL) rates have declined and remained low. Given DCL’s association with surgical site infections (SSIs), we hypothesize that SSI rates and severity, as per Clavien–Dindo (CD) classification, have decreased concurrently.

A retrospective study was performed on patients (≥16 y) who underwent trauma laparotomy from January 2011 to December 2020. Patients who survived ≤48 hours were excluded. Data were divided into period 1 (January 2011–December 2015, DCL rates declined) and period 2 (January 2016–December 2020, low DCL rates were sustained). SSIs were defined as per the Centers for Disease Control and Prevention, and severity was graded by the CD scale (I–V). SSIs were classified as minor (CD grade I–II) and major (CD grade III–V). Uni-variable and multi-variable analyses were performed (p < 0.05).

In total 1,975 patients met the inclusion criteria. Between periods 1 and 2, there was an increase in injury severity score (ISS); (19 [IQR: 10, 29] vs. 21 [IQR: 12, 34], p ≤ 0.001) and penetrating injuries (426 [44%] vs. 513 [51%], p = 0.002), with a decrease in DCL (283 [29%] vs. 153 [15%], p ≤ 0.001). A total of 355 (18%) patients developed an SSI, 18.5% (179) in period 1 and 17.5% (176) in period 2 (p = 0.5). On multi-variable analysis, after controlling for mechanism of injury, emergency room systolic blood pressure, wound classification, large bowel resection, ISS, splenectomy, and operating-room time at index laparotomy, DCL was associated with major SSIs.

Despite decreases in DCL, SSI rates and severity after trauma laparotomy remain stable, potentially because of increased injury severity and penetrating trauma. Identification of other potential modifiable risk factors is needed to decrease SSI incidence and severity.

Infections involving the aorta are particularly complex, posing unique diagnostic and therapeutic challenges. Aortic infections (AIs) are associated with considerable morbidity and mortality and incur significant healthcare costs. This narrative review examines the current literature and offers guidance on primary and post-operative AIs.

We conducted a search using electronic databases (PubMed, Medline, Scopus, and Cochrane) with a Boolean approach using selected keywords of aorta and infection, aortitis, aortic graft infection, infected aortic aneurysm, and mycotic aneurysm.

AIs are among the most feared complications in vascular surgery. Gram-positive bacteria, such as Staphylococcus aureus, are responsible for about 80% of AIs. These microorganisms produce toxins capable of leading to anastomotic disruption. The common use of broad-spectrum antibiotic agents has resulted in an increasing prevalence of multi-drug-resistant organisms, making the management of AIs even more complex. Clinical presentation is often non-specific, ranging from mild symptoms, such as abdominal pain, malaise, and fever, to sepsis and hemorrhagic shock due to anastomotic rupture. Management of patients with an infected aorta includes antimicrobial therapy and surgical source control, which may include washout and aneurysm repair if a primary aortic infection or graft removal if a post-operative infection. Collaboration with intensive care unit and ID consultation improved long-term outcomes.

AIs are among the most complicated and challenging surgical problems and are potentially life-threatening and require a multi-disciplinary approach to reduce its prevalence and improve clinical outcomes.

Fungal empyema is uncommon and has worse short-term outcomes than bacterial disease, particularly when a bronchopleural fistula (BPF) sustains contamination.

A previously healthy male developed BPF and methicillin-resistant Staphylococcus aureus (MRSA) empyema after right upper lobectomy at age 17, managed by open-window thoracostomy (OWT). An apical residual space persisted and formed a fungus-ball-like nodule. At age 30, he re-presented with fever and nodule growth, with elevated Aspergillus IgG; voriconazole was started.

Computed tomography-guided catheter placement and re-OWT exposed air leaks and recurrent MRSA. Staged fistula control with endobronchial Watanabe spigots, n-butyl-2-cyanoacrylate, and cavity-side suturing achieved cessation.

After irrigation, sterilized cultures, negative-pressure therapy preceded latissimus dorsi flap obliteration. He was discharged on postoperative day 149 without recurrence.

A stepwise plan—source control, fistula control, sterilization, and obliteration—can achieve durable cure in mixed Aspergillus–MRSA empyema with BPF after prior OWT.