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Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. Because the medical, economic and social costs of SSI are enormous, any significant reduction in risks will pay dividends. The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a randomly selected group of patients who did not develop this complication in order to identify changeable risk factors. With a case–control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008, we identified 36 cases with deep SSI (CDC criteria). Information regarding patient-level and surgical-level risk factors was derived from standardized but routinely recorded data and compared with those acquired in a random selection of 135 uninfected patients. Univariate analyses and a multivariate logistic regression were performed. The overall rate of infection in 1,615 procedures (1,568 patients) was 2.2%. A positive history of spinal surgery was associated with an almost four times higher infection rate (OR = 3.7, 95% BI = 1.6–8.6). The risk of SSI increased with the number of levels fused, patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI. The most common organism cultured was Staphylococcus aureus . All infected patients underwent at least one reoperation, including an open débridement and received appropriate antibiotics to treat the organism. Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways. High-risk patients should be informed about the increased risk of complications.

Background: Sleeve gastrectomy (SG) has become the predominant bariatric surgery, leading to significant weight loss and reductions in obesity-related complications. However, postoperative gastrointestinal symptoms such as constipation and bloating are common. This study aims to evaluate the impact of probiotic supplementation on postoperative gastrointestinal symptoms in patients undergoing SG. The secondary aim is to analyze laboratory and stool test results. Materials and methods: This prospective, placebo-controlled study included patients undergoing SG at a single center. Participants were adults without specific gastrointestinal diseases. They were randomly assigned to either the Probiotics or Controls group. Gastrointestinal symptoms and laboratory and stool tests were assessed before surgery and one month after. Results: Thirty-one patients participated, with 15 in the Probiotics group and 16 in the Controls group. Probiotic supplementation significantly increased the number of stools per week (p = 0.027) and reduced constipation incidence (p = 0.002). Patients in the Probiotics group reported easier defecation and greater bowel movement completeness (p = 0.015, p = 0.004). No significant differences in weight loss or laboratory tests were observed between the groups. Stool microbiota analysis showed a return to normal levels of Enterococcus faecalis, Enterococcus faecium, and Clostridium perfringens in the Probiotics group and an increase in the Controls group. Conclusions: Probiotic supplementation after SG significantly reduces constipation without adverse effects. These findings suggest that incorporating probiotics into postoperative care protocols can enhance patient comfort and recovery.

A 67 year-old male was admitted in the ICU because of multi-organ failure due to sepsis secondary to Fournier’s gangrene. He had sustained radical prostatectomy in the last 48 hours. Peritoneal fluid and fatty tissue biopsies grew Aspergillus Fumigatus without concomitant pulmonary involvement. Postoperative acquisition via exogenous and endogenous routes is discussed, as this nosocomial entity is very rarely reported apart from peritoneal dialysis, especially in non-immunosuppressed patients.

Staphylococcus epidermidis ( S. epidermidis ) is one of the primary pathogens in postoperative endophthalmitis, which is a devastating complication of cataract surgery and often results in irreversible visual loss and even blindness. Meanwhile, it is the most frequently isolated commensal bacterium in the healthy conjunctiva. In this study, we investigated the differentially expressed genes (DEGs) of S. epidermidis isolated from the patients with postoperative endophthalmitis and the healthy conjunctiva to predict their functions and pathways by Illumina high-throughput RNA sequencing. Using genome-wide transcriptional analysis, 281 genes (142 upregulated and 139 downregulated genes) were found to be differentially expressed (fold change ≥ 2, p  ≤ 0.05) in the strains from endophthalmitis. Ten randomly selected DEGs were further validated by quantitative reverse transcription polymerase chain reaction (qRT-PCR). GO enrichment analysis suggested that more DEGs were associated with the thioredoxin system and iron ion metabolism. KEGG pathway analysis revealed that more DEGs were associated with the pathways of the two-component system and pyruvate metabolism. Moreover, the gene SE1634 code for staphylococcal toxin was significantly upregulated in S. epidermidis strains of the endophthalmitis, which might be directly responsible for the pathogenesis of endophthalmitis. In conclusion, this research is helpful for further investigations on genes or pathways related with the pathogenesis and therapeutic targets of S. epidermidis endophthalmitis.

IntroductionResistant Gram-positive organisms, such as methicillin-resistant staphylococci, account for a significant proportion of infections following joint replacement surgery. Current surgical antimicrobial prophylaxis guidelines recommend the use of first-generation or second-generation cephalosporin antibiotics, such as cefazolin. Cefazolin, however, does not prevent infections due to these resistant organisms; therefore, new prevention strategies need to be examined. One proposed strategy is to combine a glycopeptide antibiotic with cefazolin for prophylaxis. The clinical benefit and cost-effectiveness of this combination therapy compared with usual therapy, however, have not been established.Methods and analysisThis randomised, double-blind, parallel, superiority, placebo-controlled, phase 4 trial will compare the incidence of all surgical site infections (SSIs) including superficial, deep and organ/space (prosthetic joint) infections, safety and cost-effectiveness of surgical prophylaxis with cefazolin plus vancomycin to that with cefazolin plus placebo. The study will be performed in patients undergoing joint replacement surgery. In the microbiological sub-studies, we will examine the incidence of SSIs in participants with preoperative staphylococci colonisation (Sub-Study 1) and incidence of VRE acquisition (Sub-Study 2). The trial will recruit 4450 participants over a 4-year period across 13 orthopaedic centres in Australia. The primary outcome is the incidence of SSI at 90 days post index surgery. Secondary outcomes include the incidence of SSI according to joint and microorganism and other healthcare associated infections. Safety endpoints include the incidence of acute kidney injury, hypersensitivity reactions and all-cause mortality. The primary and secondary analysis will be a modified intention-to-treat analysis consisting of all randomised participants who undergo eligible surgery. We will also perform a per-protocol analysis.Ethics and disseminationThe study protocol was reviewed and approved by The Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/102) on 9 July 2018. Study findings will be disseminated in the printed media, and learnt forums.Trial registration numberACTRN12618000642280

Nasal lavage with mupirocin has the potential to reduce sinonasal morbidity in endoscopic endonasal approaches for skull base surgery. To evaluate the effects of nasal lavage with and without mupirocin after endoscopic endonasal skull base surgery. A pilot randomised, controlled trial was conducted on 20 adult patients who had undergone endoscopic endonasal approaches for skull base lesions. These patients were randomly assigned to cohorts using nasal lavages with mupirocin or without mupirocin. Patients were assessed in the out-patient clinic, one week and one month after surgery, using the 22-item Sino-Nasal Outcome Test questionnaire and nasal endoscopy. Patients in the mupirocin nasal lavage group had lower nasal endoscopy scores post-operatively, and a statistically significant larger difference in nasal endoscopy scores at one month compared to one week. The mupirocin nasal lavage group also showed better Sino-Nasal Outcome Test scores at one month compared to the group without mupirocin. Nasal lavage with mupirocin seems to yield better outcomes regarding patients' symptoms and endoscopic findings.

Trial design: In this blinded randomized study we analyzed patient reported outcome of three different treatments after nail surgery. We compared daily footbath with either alkaline or acidic soap or just a simple bandage of gauze dressing. Method: After partial nail ablation surgery, patients were randomized into three postoperative treatment modalities. Outcome in terms of reduction in pain, improvement of function, reduction of signs of infection and postoperative soothing effect were reported after one and two weeks. A generalized linear mixed model was used to analyze possible statistical differences between the groups. Results: 97 patients, 57% women, mean age 31 years, were included. Men reported significantly less pain and better function than women. Despite a registered lower growth of invasive pathogenic microbes following the use of acidic soaps, this did not lead to less infections than in the groups using either alkaline soap baths or bandaging. On the contrary, patients keeping the bandage on had significantly lower signs of infection after one week. Two patients using soap baths had growth of MRSA. Two weeks postoperatively, all three treatment alternatives had similar patient reported outcome in all parameters, and nobody needed antibiotics. Conclusions: This prospective randomized study was unable to prove that footbath with either acidic or alkaline soap should be preferred to just leave the postoperative bandage on for a week after partial nail ablation. We recommend that postoperative advice should be given on an individual basis, especially since our study did not involve patients with high risk of infections.

Background: The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion. Patients and Methods: The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16. Results: Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123). Conclusion: DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.

[...]of the clear need for enhanced LRTI diagnostics in HCT recipients, we sequentially enrolled 22 adult HCT recipients hospitalized for acute respiratory illnesses who underwent bronchoscopy and BAL between January 25, 2012, and May 20, 2013, under University of Michigan protocol HUM00043287. Standard-of-care BAL microbiologic testing was uniformly performed on all patients and included semiquantitative cultures for bacteria, mycobacteria, fungi, and cytomegalovirus; Aspergillus galactomannan assay; silver stain for Pneumocystis jirovecii; multiplex polymerase chain reaction influenza A/B, respiratory syncytial virus and human metapneumovirus; and human herpesvirus-6 polymerase chain reaction, as detailed in the Methods in the online supplement (4). With respect to potential bacterial pathogens, mNGS identified Streptococcus mitis in patient 13, an oropharyngeal microbe known to cause bacteremia and acute respiratory distress in HCT recipients (6), and Corynebacterium proprinquum, one of the few virulent Corynebacterium species associated with LRTI (7). mNGS identified a diversity of DNA viruses including human herpesvirus-6, cytomegalovirus, herpes simplex virus, Epstein-Barr virus, human papilloma virus, and torque teno viruses; however, only five of these also had well-defined evidence of active replication marked by detectable RNA transcripts (Table 1). mNGS identified microbes of uncertain pathogenicity in nine patients (Table 1) who had coexisting clinical diagnoses of graft-versus-host disease (patients 11, 22, 23, 24, 25, 31, 34, 35, and 37) or bacteremia/sepsis (patient 3), which could have contributed to respiratory symptoms resulting from noninfectious pulmonary inflammation. Because asymptomatic carriage of respiratory pathogens is well described (8), establishing biomarkers of genuine infection is critical for determining the significance of a given microbiologic finding. [...]our limited sequencing depth did not yield the human transcriptome coverage that would be desired for optimal differential gene expression analyses, although we were able to rigorously evaluate a composite metric of immunity genes.

The gut microbiome critically influences diverse aspects of physiology and surgical recovery. Conversely, surgery alters the microbiome, potentially predisposing to complications. We aimed to clarify the bidirectional interaction between surgery and gut dysbiosis. On December 22nd, 2024, a systematic search of the Cochrane Library, PubMed, VHL, and WOS was completed. Relevant studies were assessed for risk of bias using STROBE and CONSORT guidelines. Thirty studies, with 2500+ participants experiencing diverse procedures and complications, were incorporated. Although specifics varied, dysbiosis correlated with surgery and its complications. Patients with complications had more harmful bacteria and fewer beneficial bacteria. In some studies, probiotics reduced complications. Gut dysbiosis is tied to postoperative complications in a complex, bidirectional relationship. Patients with surgical complications may have fewer beneficial and more pathogenic bacteria both before and after surgery. Early identification of dysbiosis and probiotic administration could predict or even reduce postoperative complications. Created in BioRender. Nichols, L. (2025) https://BioRender.com/dnzl1dw. [Display omitted] •Postoperative outcomes affect and are affected by the gut microbiome.•Worse outcomes are associated with more severe dysbiotic alterations.•Probiotics improve some GI and extra-GI postoperative outcomes.•This interplay can be utilized to predict and improve postoperative outcomes.•Preoperative microbiome profiling can be used for risk stratification.