Microbiology of Surgical Site Infections Complicating Breast Surgery

Throckmorton, Alyssa; Baddour, Larry M.; Hoskin, Tanya L.; Boughey, Judy C.; Degnim, Amy C.

doi:10.1089/sur.2009.029

Cited by 25 publications

(22 citation statements)

References 15 publications

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“…These findings are in agreement to another study [18]. This study found more MDR among Gram-negative bacteria than Gram-positive bacteria; of these the proportion of MRSA (37.5%) among S. aureus isolates was more than previously reported (25.0% and 31.5%) from Uganda [9,21] and other countries [8,16,18]. Thus, while β-lactamase-resistant antibiotics such as cloxacillin could still be effective in this setting, they are likely to be ineffective against the 38% of isolates that were confirmed as MRSA.…”

Section: Discussionsupporting

confidence: 92%

“…These infections pose therapeutic challenges and are associated with substantially longer duration of hospital stay, increased hospital cost, higher morbidity and mortality [5,12], particularly when the agents are Methicillin resistant S. aureus (MRSA), Extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae and/or other agents collectively referred to as multidrug-resistant (MDR) [11,13,14]. Studies from developing countries have shown high level of resistance (ranging from 50 to 100%) to the commonly used antibiotics like ampicillin, trimethoprim – sulphamethoxazole, gentamicin, chloramphenicol and third generation cephalosporins among S. aureus, E. coli , and P. aeruginosa [8,15] as opposed to low rates of resistance ranging from 0-50% in developed countries [16]. In both settings however, substantial rates of resistance to oxacillin, erythromycin and clindamycin reported for S. aureus, ranged from 10-60% [8,9,15,16] whereas vancomycin (for S. aureus and other Gram-positive bacteria ), amikacin, piperacillin-tazobactam and imepenem (for E. coli , P. aeruginosa and other Gram-negative bacteria) showed resistant rates of less than 25% [17,18].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda

et al. 2013

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BackgroundSurgical site infections (SSIs) are difficult to treat and are associated with substantially longer hospital stay, higher treatment cost, morbidity and mortality, particularly when the etiological agent is multidrug-resistant (MDR). To address the limited data in Uganda on SSIs, we present the spectrum of bacteria isolated from hospitalized patients, the magnitude and impact of MDR bacterial isolates among patients with SSIs.MethodsA descriptive cross sectional study was conducted from September 2011 through April 2012 involving 314 patients with SSIs in the obstetrics & gynecology, general surgery and orthopedic wards at Mulago National Hospital in Kampala, Uganda. Wound swabs were taken and processed using standard microbiological methods. Clinico-demographic characteristics of patients were obtained using structured questionnaires and patients’ files.ResultsOf the 314 enrolled patients with SSIs (mean age 29.7 ±13.14 years), 239 (76.1%) were female. More than half of the patients were from obstetrics and gynecology (62.1%, 195/314). Of 314 wound swabs taken, 68.8% (216/314) were culture positive aerobically, yielding 304 bacterial isolates; of which 23.7% (72/304) were Escherichia coli and 21.1% (64/304) were Staphylococcus aureus. More than three quarters of Enterobacteriaceae were found to be extended spectrum beta lactamase (ESBL) producers and 37.5% of S. aureus were Methicillin resistant S. aureus (MRSA). MDR occurred in 78.3% (238/304) of the isolates; these were more among Gram-negative bacteria (78.6%, 187/238) compared to Gram-positive bacteria (21.4%, 51/238), (p-value < 0.0001, χ2 = 49.219). Amikacin and imepenem for ESBL-producing Enterobacteriacea and vancomycin for MRSA showed excellent performance except that they remain expensive drugs in Uganda.ConclusionMost SSIs at Mulago National Hospital are due to MDR bacteria. Isolation of MRSA and ESBL-producing Enterobacteriaceae in higher proportions than previously reported calls for laboratory guided SSIs- therapy and strengthening of infection control surveillance in this setting.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Uganda

et al. 2013

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“…Other studies reported the same results [8, 15]. However, Mukhtar et al [16] reported Gram negative bacteria as the most common isolated pathogens.…”

Section: Discussionsupporting

confidence: 58%

Surgical Site Infection Complicating Breast Cancer Surgery in Kuwait

Omar

Al-Mousa

2013

ISRN Preventive Medicine

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Background and Objectives. Surgical site infection (SSI) is the most common postoperative complication associated with breast cancer surgery. The present investigation aimed to determine the SSI rate after breast cancer surgeries and the causative microorganisms. Patients and Methods. All patients who underwent breast surgery in Kuwait Cancer Control Center as a treatment for breast cancer from January 2009–December 2010 were prospectively followed for the development of SSI. Indirect detection was used to identify SSIs through medical record to review and discussion with the treating surgeons. Results. The number of operations was 438. Females represented 434 (99.1%) cases while males constituted only 4 (0.9%) cases. SSIs were diagnosed after 10 operations, all for female cases. Most of the SSIs (8 cases; 80%) were detected after patients were discharged, during outpatient followup. Out of those 5/8; (62.5%) were readmitted for management of SSI. Nine patients (90%) received systemic antibiotic therapy for management of their wound infection. The SSI rate was 2.3%. The main causative organism was Staphylococcus aureus (S. aureus) which was responsible for 40% of infections. Gram negative bacteria were isolated from 40% of the cases. Conclusion. SSI is an important complication following breast cancer surgery. Microbiological diagnosis is an essential tool for proper management of such patients.

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“…Secondly, timing and incidence of infection during the months/years after surgical implantation have been variably studied so far, predominantly with retrospective studies that consider either constrained observation periods or mixed breast implant infections with other surgical infections [4][5][6][7][8]. Accordingly, there are good indications on the factors associated with this occurrence, particularly early after implant insertion.…”

mentioning

confidence: 99%