Surgical site infections (SSIs) affect 160,000 to 300,000 patients annually, increasing postoperative mortality, causing significant complications, and incurring US $3.5 to US $10 billion in excess costs each year. Effective SSI surveillance can inform strategies to mitigate these outcomes. Traditional SSI surveillance methods, primarily manual chart reviews, are costly and labor-intensive. This study aimed to evaluate whether an automated SSI surveillance system built using newer natural language processing methods and deep learning could outperform previous approaches and whether such an approach could enable more efficient infection surveillance. Our dataset comprised approximately 30,000 surgical cases from the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC). Data from UWMC were captured for the National Surgical Quality Improvement Program, and data from HMC were captured for the National Healthcare Safety Network. Electronic health record (EHR) data for each surgical case included structured data pertaining to surgical procedure characteristics, laboratory values, and antibiotic administration, as well as clinical text notes for a surgical case from 7 days before to 90 days after surgery. Using this data, we applied a myriad of machine learning approaches to the task of SSI prediction. We reported the following performance metrics: F1-score, precision (positive predictive value), recall (sensitivity), area under the precision-recall curve, and precision at 0.9 recall for each machine learning approach. In a cohort of 5996 surgical cases, incorporating multimodal EHR information-including contextual information from clinical text and temporal information from laboratory values-improved SSI prediction performance. Models using structured data and clinical text outperformed structured data alone (F1=0.68, 95% CI 0.68-0.69 vs F1=0.55, 95% CI 0.54-0.56; P<.001). Adding temporal features further improved performance (F1=0.70, 95% CI 0.69-0.71; P<.001). Deep learning approaches leveraging large language models also outperformed the state-of-the-art rule-based system (F1=0.70, 95% CI 0.69-0.71 vs F1=0.43; P<.001). The optimal approach combined foundation models for text summarization with deep learning methods for clinical text and temporal data processing. This system achieved a precision of 0.38 at 0.9 recall, demonstrating its potential for efficient, data-driven SSI surveillance. Automated surveillance approaches-particularly deep learning approaches-in combination with voluminous, multimodal data from the EHR, can enable more efficient infection surveillance processes. This has the potential to increase the quantity of SSI surveillance data available to guide interventions aimed at reducing SSI rates.
This study aimed to evaluate the determinants of postoperative complications in pediatric surgical patients and investigate whether the Systemic Immune-Inflammation Index (SII) independently predicts complication type in a predominantly acute abdominal pediatric surgical population. This retrospective study included patients aged 0 to 18 years who underwent surgical procedures between 2017 and 2024. Demographic characteristics, preoperative laboratory parameters, culture results, postoperative complications, and clinical outcomes were recorded. The primary outcome was postoperative complication class (local vs systemic). Secondary outcomes included in-hospital mortality, length of hospital stay, and readmission. Multivariable regression analyses were performed. A total of 307 pediatric patients were included; 64.17% were male. The majority underwent acute abdominal emergency surgery (89.54%). The most frequent culture growth site was the peritoneum (65.47%). Gram-negative microorganisms accounted for 94.46% of isolates, whereas Gram-positive organisms constituted 5.21%; fungal growth was observed in 1.30% of patients. Local complications were observed in 96.42% of patients, whereas systemic complications occurred in 3.58%. Overall mortality was 2.93%. Fever was significantly more common among non-survivors compared to survivors (77.78% vs 12.75%, P < .001), and systemic complications were associated with mortality (P = .040). Although SII values were higher in Gram-negative infections, SII did not independently predict complication type or mortality in this heterogeneous cohort. Gram-negative pathogens predominate in pediatric surgical infections. However, laboratory inflammatory indices, including SII, did not independently predict postoperative complication type or mortality. These findings suggest that clinical and perioperative factors play a more important role in determining outcomes in this predominantly acute abdominal pediatric surgical population.
Background/Objectives: There is no consensus on whether it is possible to preserve implant retention during deep surgical site infections (SSIs), and there is no widely accepted treatment protocol to date for these patients. The aim of this study is to evaluate the efficacy of the debridement, antibiotics, and implant retention (DAIR) protocol in patients who were treated for degenerative thoracolumbar spinal disorder using spinal instrumentation. Methods: This retrospective study describes the 24-month outcomes of deep SSI that developed in 25 of 720 patients (3.5%) who underwent surgery for thoracolumbar degenerative spinal disorders (disc disease, spinal stenosis, and scoliosis) and were treated according to the DAIR protocol. Results: Of these 25 patients, 18 developed early infection (<1 month), 3 developed delayed infection (1-3 months), and 4 developed late-onset deep infection (>3 months). Staphylococcus aureus was isolated in 56% of the patients. The DAIR protocol was successful in 22 (88%) of the patients, while it failed in 3 (12%). Surgical implants were removed in 25% of patients with late-onset SSI, and only 11.1% with early onset and 0% with delayed SSI. All patients who failed DAIR were smokers. A significant association was found between the Charlson Comorbidity Index and the number of surgical interventions (p = 0.022). Conclusions: In this small retrospective cohort, the DAIR protocol appeared to be a feasible treatment option for deep SSI, particularly in early infections. Implant removal may be considered when infection persists after repeat DAIR or when implant loosening is observed.
Surgical site infections (SSIs) remain a major cause of postoperative morbidity, prolonged hospitalization, and increased healthcare costs. To evaluate the incidence, risk factors, microbiological profile, preventive measures, and outcomes of SSIs to inform targeted perioperative strategies. A hospital-based surveillance cohort study included 4,632 patients undergoing 4,860 surgical procedures between January 2022 and December 2024. Multivariate logistic regression identified independent predictors. A total of 382 patients developed SSIs (8.25%), corresponding to an incidence density of 12.4 per 1,000 patient-days. Independent predictors included hypoalbuminemia (OR 2.91), contaminated wounds (OR 2.83), emergency surgery (OR 2.66), operative duration >120 min (OR 2.41), and >20 operating room door openings (OR 1.77). Additional risk was associated with diabetes, anemia, ASA ≥ III status, and perioperative transfusion. Adherence to timely antibiotic prophylaxis and chlorhexidine skin preparation significantly reduced the risk of SSI (OR 0.39-0.51). Staphylococcus aureus accounted for 31.4% of cases, while Gram-negative bacilli exhibited high multidrug resistance. SSIs prolonged hospital stay by 8.9 days, tripled ICU admissions, increased 30-day mortality fourfold, and added approximately USD 2,450 in direct costs. The predictive model demonstrated strong discrimination (AUC 0.84) and good calibration. SSIs impose substantial clinical and economic burdens. Optimized perioperative care, strict adherence to prophylactic protocols, and improved environmental control measures are critical to reducing infection rates and improving surgical outcomes.
Enhanced Recovery After Surgery (ERAS®) is a multimodal perioperative framework designed to mitigate the physiological stress response to major surgery. While ERAS protocols consistently reduce length of hospital stay, overall complication rates, and healthcare costs compared to conventional care, their specific impact on surgical site infections (SSIs) remains poorly defined. This review explores the potential synergistic benefits of integrating ERAS protocols with established infection prevention bundles. By evaluating the current clinical evidence, we analyze how the co-implementation of these two evidence-based strategies can collectively reduce the incidence of SSIs.
Background and Objectives: Surgical site infections (SSIs) remain common after elective colorectal surgery. This systematic review and meta-analysis evaluated whether adding oral antibiotic bowel preparation (OAB) to mechanical bowel preparation (MBP) reduces SSIs compared with MBP alone. Materials and Methods: PubMed, the Cochrane Library, Scopus, and ClinicalTrials.gov were searched for English-language randomized controlled trials published from January 2005 to January 2025. Eligible trials enrolled adults undergoing elective colorectal surgery and compared MBP+OAB versus MBP alone, with standard intravenous prophylaxis in both groups. The primary outcome was overall SSI; secondary outcomes were incisional SSI and organ-space SSI. Risk of bias was assessed with RoB 2, certainty with GRADE, and odds ratios (ORs) were pooled using DerSimonian-Laird random-effects models. The protocol was prespecified but not prospectively registered. Results: Twelve trials including 4073 patients were included (MBP+OAB, n = 2069; MBP, n = 2004). MBP+OAB reduced overall SSI (OR 0.53, 95% CI 0.37-0.75; p < 0.001; I2 = 62.5%; 95% prediction interval 0.17-1.66), incisional SSI (OR 0.52, 95% CI 0.34-0.80; p = 0.003; I2 = 57.5%), and organ-space SSI (OR 0.63, 95% CI 0.45-0.88; p = 0.007; I2 = 8.3%). The effect was preserved in metronidazole-containing regimens (OR 0.46, 95% CI 0.33-0.65), but this subgroup was exploratory. Excluding high-risk-of-bias studies supported the primary result. Publication-bias assessment was underpowered. Overall and organ-space SSI were moderate-certainty outcomes; incisional SSI was low-certainty, and anastomotic leak was very low-certainty. Conclusions: In contemporary elective colorectal surgery when MBP is used, adding preoperative OAB probably reduces SSIs. Findings do not establish whether OAB alone is sufficient or whether MBP is necessary; stewardship-relevant outcomes remain insufficiently reported. Funding was provided by ISCIII grant PI25/01285.
Background: Gram-negative (GN) bacteria are an increasingly recognized cause of prosthetic joint infection (PJI), accounting for 10 %-20 % of cases. However, epidemiological data from European centres remain limited. This study aimed to evaluate the incidence, risk factors, microbiological profile, and treatment outcomes of GN PJI in several European tertiary referral hospitals. Methods: We conducted a retrospective multicentre study including all culture-positive hip and knee PJIs diagnosed between 2014 and 2018 at three tertiary hospitals in Italy, Spain, and Switzerland. Demographic characteristics, comorbidities, surgical management, microbiological data including antimicrobial susceptibility, and treatment outcomes were analysed. Treatment success was defined as absence of persistent or recurrent infection requiring additional surgery, prosthesis removal, infection-related mortality, or long-term suppressive antibiotic therapy. Results: Among 780 confirmed PJIs, 71 (9.1 %) were caused by GN bacteria. The most frequent pathogens were polymicrobial infections (29.6 %), Escherichia coli (25.4 %), and Pseudomonas aeruginosa (19.7 %). GN PJI mainly affected elderly patients (median age 74 years), females (60.6 %), and those with comorbidities such as diabetes mellitus (32.4 %) and those who are overweight/obese (62 %). Hip infections were more common than knee infections (59.2 % vs. 40.8 %). Overall treatment success was 89 %. Two-stage revision showed the highest success rate of 94.8 % compared with one-stage exchange (88 %) and DAIR (81 %). Ciprofloxacin was used in 72 % of cases. Conclusions: GN PJI incidence was comparable to that of previous reports. These infections occur more often in elderly patients with comorbidities. Two-stage revision remains the most effective surgical strategy, and ciprofloxacin continues to be a key component of antimicrobial therapy for susceptible GN infections.
Advanced lower extremity lymphedema is difficult to manage and can lead to significant functional impairment and diminished quality of life. Extirpative (also known as excisional and debulking) surgical procedures offer meaningful volume reduction for patients with advanced disease refractory to conservative management. The objective of this systematic review was to identify the clinical and imaging criteria used to determine candidacy for excisional surgery (i.e. Charles and modified Homan procedures) in adults with lower extremity lymphedema and to report the surgical outcomes observed across the included studies. A systematic search of PubMed, Embase and Cochrane Library was conducted by an expert medical librarian. The search yielded 3,916 articles. Inclusion criteria involved randomized controlled trials, cohort studies, and case series that reported on excisional surgical procedures for adults with lower extremity lymphedema and described clinical or imaging criteria for surgical candidacy. Studies that did not involve lower extremity lymphedema patients were excluded. Screening, full text review, and data extraction were performed using Covidence software with standardized data extraction templates. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Five studies were included in this systematic review. There was a total of 933 patients across all studies. The five included studies were one systematic review, three retrospective cohorts or case series, and one small case series. Five clinical criteria for surgical candidacy were identified in this review: failure of conservative management, advanced clinical staging (ISL III or equivalent), functional impairment, skin changes, and recurrent infections. No imaging was used to determine surgical candidacy for excisional surgery alone in lower extremity lymphedema. The quality of life was not formally measured with validated instruments in any study. This systematic review reveals a fundamental absence of validated, evidence-based selection criteria for extirpative surgery in lower extremity lymphedema. The current selection process is entirely surgeon-dependent, institution-specific, and non-standardized. This represents a critical barrier to the development of clinical guidelines and equitable patient care. No existing evidence supports the superiority of any particular set of selection criteria over another.
Advanced filariasis-induced lymphedema causes irreversible fibrosis, severe disability, recurrent infections, and major psychosocial burden, often with poor response to conservative therapy. Surgical management in this type of lymphedema is rarely addressed. We conducted a PRISMA 2020-guided systematic review evaluating surgical interventions versus conservative management or no intervention in adults with filarial lymphedema, involving various anatomical locations. Of 580 records identified, 29 studies were included for qualitative synthesis. The evidence base predominantly consisted of case reports, with surgical indications frequently involving disabling elephantiasis or diagnostic excision of filarial masses. While ablative procedures (excisional debulking) remained the primary salvage strategy, specific studies documented physiological techniques, including nodovenous shunts and vascularized lymph node transfer (VLNT). Quantitative limb-volume reduction was sparsely reported; however, qualitative assessments demonstrated significant improvements in ambulation, cosmesis, and patient-reported quality of life. Postoperative complications, primarily superficial surgical site infections, were generally low and manageable. Ablative surgical procedures appear to be the most common salvage strategy for advanced filarial lymphedema, but the evidence base remains limited to low-level, heterogeneous observational data. However, with the emergence of physiological lymphatic surgery, a combination of ablative procedures and physiological procedures should be considered. Prospective controlled studies with standardized outcomes are urgently needed.
The inappropriate use of surgical antibiotic prophylaxis (SAP) remains a common issue in Vietnam, posing a significant risk of surgical site infections (SSIs) and other adverse outcomes. This study aimed to evaluate the impact of a pharmacist-led audit-feedback (A&F) intervention, as part of an antimicrobial stewardship (AMS) program, on improving compliance with SAP guidelines. A prospective pre-post interventional study was conducted in the surgical departments of Saint Paul General Hospital. A multidisciplinary team, led primarily by clinical pharmacists, conducted audit-feedback activities on SAP practices from December 2023 to April 2024. The primary outcome was the overall compliance rate with SAP guidelines. Secondary outcomes included compliance with specific components: antibiotic selection, timing of administration, dosing, and duration of use. A total of 162 patients in the pre-intervention group and 147 in the post-intervention group were included. After two audit-feedback phases, overall compliance with SAP guidelines significantly increased from 60.49% to 76.87% (OR: 2.97, 95% CI: 1.71-5.28). Notably, the most significant improvements were observed in the appropriateness of antibiotic selection and duration of use, increasing from 74.69% to 88.44% (OR: 2.57, 95%CI: 1.40-4.89) and 72.84% to 88.44% (OR: 2.82, 95% CI: 1.55-5.36), respectively. Conclusion, the audit-feedback intervention led by clinical pharmacists substantially improved compliance with SAP guidelines across several domains. This study provides pragmatic evidence from a tertiary hospital in Vietnam, demonstrating that audit-feedback is not only feasible but also impactful in resource-limited settings. Importantly, this approach could inform scalable AMS and infection prevention policies in other low-and middle-income countries.
Refractory thoracic infections require targeted antimicrobial combinations, repeated drainage interventions and often staged surgical procedures of varying complexity grades. In necrotizing pneumonia cases, successful treatment is complete removal of destroyed non-functional parenchyma, pleural cavity debridement, and complete pathogen eradication based on culture-based sensitivity-driven antimicrobials. The latter proves challenging in pan-resistant microbial strains where both medical and surgical treatments demonstrate limited effectiveness. We describe a case of persistent thoracic sepsis due to pan-resistant Pseudomonas receiving sequentially thoracoscopic decortication, thoracotomy for lobectomy, and open thoracostomy as the last treatment option to prevent fatal sepsis in view of non-available antibiotics. The immediate source-control effect raised the question of the ideal timing for selecting an aggressive thoracoplastic procedure despite its deforming nature over any other treatment approach.
Introduction: Upper urinary tract infections (UUTIs) are among the most common serious infections during pregnancy and may be associated with maternal and fetal complications. The increasing prevalence of multidrug-resistant pathogens has led to the use of broader-spectrum antibiotics, including meropenem. However, data regarding the safety and efficacy of meropenem in pregnant women remain limited. The aim of this study was to evaluate the indications, efficacy, and safety of meropenem treatment in pregnant women with UUTIs and its impact on maternal and fetal outcomes. Methods: We conducted a retrospective study over a 12-year period including pregnant women hospitalized with UUTIs who received meropenem. The control group consisted of pregnant women with UUTIs who were treated with ceftriaxone during the same period. Results: Pregnant women treated with meropenem were more frequently diagnosed in the third trimester of pregnancy (p = 0.01) and were more often multiparous (p = 0.006). Sepsis and septic shock occurred significantly more frequently in the study group (p < 0.01), and multivariate analysis identified them as the main indications for meropenem administration (OR 10.54, 95% CI 3.30-33.70 for sepsis; OR 3.28, 95% CI 1.01-10.62 for septic shock). Patients in the study group had a higher rate of transfer to the obstetrics clinic (p = 0.032), a longer duration of antibiotic therapy (p = 0.031), and a longer hospital stay (p < 0.01). No maternal deaths were reported in either group. The rate of adverse pregnancy outcomes was similar between the two groups, except for the Apgar score, which was lower in the meropenem group (p = 0.007). Escherichia coli and Klebsiella pneumoniae were the most frequently isolated pathogens in both groups. Conclusions: Meropenem therapy in pregnant women with UUTIs was mainly indicated in cases of sepsis and septic shock and was associated with favorable maternal clinical evolution, even in patients with severe infections. The rate of adverse pregnancy outcomes was similar between the two groups, although a lower Apgar score was observed in the meropenem group; the severity of illness in the meropenem group should be considered when interpreting the lower Apgar scores. Further prospective multicenter studies are needed to better evaluate the safety and clinical effectiveness of meropenem during pregnancy.
Background: Surgical site infection (SSI) is a common complication that increases morbidity, prolongs hospital stays, and raises healthcare costs. Perioperative hypothermia may contribute to its development by altering tissue perfusion, oxygenation, and the immune response. Objective: To evaluate the association between perioperative hypothermia and the risk of SSI in adult patients. Methods: A scoping review was conducted following the methodological framework of Arksey and O'Malley, expanded by Levac, the recommendations of the Joanna Briggs Institute, and the PRISMA-ScR guidelines. A systematic search was performed in PubMed and Scopus through 30 April 2026. We included observational studies and clinical trials in adults undergoing surgery that evaluated the association between perioperative or intraoperative hypothermia and the occurrence of SSI or other postoperative infectious complications. Results: A total of 28 studies were included. Retrospective observational studies were the most common design, comprising 19/28 studies (67.9%), followed by 6/28 prospective cohorts (21.4%) and 4/28 randomized clinical trials (14.3%). The studies were conducted across 12 countries, with the United States contributing the largest proportion (14/28, 50%), followed by China, Turkey, and Japan with two studies each (7.1% per country). Regarding the main findings, 14 studies (50%) reported a positive association between perioperative hypothermia and an increased risk of SSI or other postoperative infections, whereas 11 studies (39.3%) found no statistically significant association. Most studies (15/28, 53.6%) used a fixed temperature threshold of <36 °C, while a smaller proportion applied lower cutoffs such as <35-35.5 °C (3/28, 10.7%); in the remaining studies (10/28, 35.7%), the threshold was not clearly specified. Temperature measurement methods were frequently underreported (21/28, 75.0%). Among studies that did report them, approaches included repeated measurements (3/28, 10.7%), continuous monitoring (2/28, 7.1%), mean intraoperative temperature (1/28, 3.6%), nadir temperature (1/28, 3.6%), and single-point measurements (1/28, 3.6%). Conclusions: Perioperative hypothermia may be associated with an increased risk of SSI; however, the available evidence is inconsistent across surgical settings. Rather than indicating a clear independent effect, the findings suggest that hypothermia could play a context-dependent role within a broader set of perioperative factors influencing infection risk.
Poor outcomes of odontogenic infections usually increase the length of stay (LOS) in hospitals, and the cost of treatment increases substantially. The LOS of patients with odontogenic infections is not set in stone. In clinical practice, it is observed that cost, certain medications and treatments, age and a plethora of factors influence this. However, it is unclear which factors have direct effects on it. As such, evidence-based interventions become difficult. The study utilised a retrospective observational approach and a total population sampling technique to investigate 286 out of the 811 patients admitted at the allied ward of STH from 2021 to 2025. Data was extracted from the Lightwave Health Information Management System and analysed with IBM SPSS 27, Claude (Anthropic, version Sonnet 4.6) and Python (Version 3.12). A total of 286 patients were included, with a mean hospital length of stay (HLOS) of 9.28 ± 4.21 days. Necrotising fasciitis and Ludwig's angina were associated with the longest admissions. On proportional odds ordinal logistic regression, severe infection classification (OR 25.39, 95% CI: 4.21-153.32) and necrotising fasciitis (OR 9.36, 95% CI: 3.87-22.61) were the strongest independent predictors of prolonged HLOS (all p < 0.001). HIV/AIDS, diabetes mellitus, hypertension, Ludwig's angina and male sex were also significant independent predictors. The model demonstrated strong explanatory power (Nagelkerke R2 = 0.686, p < 0.001). All predictor variance inflation factors were below 2.5, indicating no multicollinearity concerns. Infection severity, primary diagnosis, immunocompromising comorbidities and surgical interventions were the principal independent determinants of prolonged HLOS. Multispace involvement showed a crude association with extended HLOS but did not emerge as an independent predictor in the adjusted ordinal regression model. Early diagnosis and prompt, multidisciplinary management are crucial to reducing hospitalisation and improving patient outcomes.
Infections associated with spinal instrumentation represent one of the most complex complications in spine surgery and frequently involve biofilm-forming pathogens that compromise the effectiveness of antimicrobial therapies. Diagnosis-particularly in chronic cases-requires the use of advanced microbiological techniques, such as implant sonication, next-generation metagenomic sequencing, and prolonged culture incubation. Therapeutic strategies depend on the chronicity of the infection and the stability of the implant, ranging from surgical debridement with retention of osteosynthesis material to staged delayed re-instrumentation. Empirical antibiotic therapy should be initiated promptly and subsequently adjusted according to microbiological results. Prevention remains a fundamental pillar and includes strict perioperative optimization. Favorable outcomes rely on early detection, a multidisciplinary team approach, and individualized surgical and antimicrobial management based on accurate clinical and radiological assessment.
Intra-abdominal infections are a common complication of colorectal cancer surgery. Postoperative abdominal infections can cause systemic inflammatory response syndrome, which seriously affects the prognosis of patients. With the widespread application of antibiotics, the detection rate of drug-resistant bacteria has increased annually, resulting in increased pressure on antibiotic treatment selection. To improve the prognosis of postoperative patients with colorectal cancer, it is important to actively search for risk factors leading to postoperative abdominal infection and formulate effective intervention measures according to these risk factors. A comprehensive search was conducted using several databases, including China National Knowledge Infrastructure, Wanfang Data, VIP, CBM, PubMed, Embase, and OVID, until September 2025. Case-control studies focusing on postoperative abdominal infections in colorectal cancer were conducted, and a meta-analysis was performed using the RevMan 5.4 software. A total of 21 case-control studies were included, and 42 risk factors for infection were identified. The results indicated that significant differences (P < .05) existed between the postoperative abdominal infection and non-infection groups concerning various factors, including diabetes mellitus, hypertension, cardiovascular disease, hypoproteinemia, tumor-node-metastasis stage I, tumor location, and several perioperative variables: operation time exceeding 150 minutes, hospital stay of 30 days or more, drainage tube indentation lasting over 10 days, serum albumin levels, preoperative hemoglobin levels, incision length > 15 cm, blood loss exceeding 300 mL, laparoscopic surgery, postoperative fistula, preoperative intestinal obstruction, anemia, anastomotic fistula, combined organ resection, preoperative ASA score, perioperative blood transfusion, and reoperation. Given the multitude of identified risk factors for postoperative abdominal infections in colorectal cancer, medical institutions should prioritize the prevention and control of hospital infections. This includes developing targeted strategies based on identified risk factors, careful assessment of surgical indications for colorectal cancer patients during clinical diagnosis and treatment, strict adherence to surgical protocols, and enhancing organ function support for patients post-surgery to reduce the incidence of postoperative abdominal infections.
Periprosthetic joint infection (PJI) remains one of the most severe and complex complications following joint arthroplasty. With the global increase in primary hip and knee replacements, the clinical and economic burden associated with PJI continues to grow. Although relatively uncommon, PJI is linked to substantial morbidity, elevated mortality, and significantly higher healthcare costs compared to aseptic revision procedures. The challenge is compounded by the intricate pathogenesis of biofilm-forming microorganisms, heterogeneous clinical presentations, and the lack of universally standardised diagnostic criteria. This review provides an integrated overview of current evidence concerning the pathophysiology, risk factors, and microbiological patterns associated with PJI. Contemporary diagnostic pathways based on the Musculoskeletal Infection Society/International Consensus Meeting (MSIS/ICM) criteria are summarised, including the utility and limitations of established serological markers, emerging synovial biomarkers such as alpha-defensin, and the complementary roles of culture techniques, histopathology, and molecular assays. Medical and surgical treatment strategies are outlined, including debridement with implant retention, one-stage and two-stage revision approaches, and organism-directed antimicrobial therapy. Preventive strategies spanning preoperative optimisation, intraoperative protocols, and postoperative risk reduction are also highlighted. Despite significant advances, important gaps persist, particularly in antimicrobial resistance, the management of polymicrobial or culture-negative infections, and the treatment of high-risk or immunocompromised patients. Continued interdisciplinary collaboration and high-quality clinical research are essential to refine diagnostic algorithms, improve therapeutic outcomes, and reduce the incidence of this increasingly consequential complication.
Methicillin-resistant Staphylococcus aureus (MRSA), a leading cause of chronic and post-surgical wound infections, is a hard-to-treat pathogen. In this study, we isolated and characterized a lytic MRSA bacteriophage, vB_SauM-MUHD-1, and evaluated its therapeutic potential in a murine wound infection model. Among 107 clinical wound samples, MRSA was reported in 48.6% of cases. Phage vB_SauM-MUHD-1, isolated from sewage, demonstrated lytic activity against 70.6% of the tested MRSA isolates. The phage exhibited efficient replication kinetics and remained stable under physiologically relevant conditions. Whole-genome sequencing identified a ~ 134 kb dsDNA genome (~ 30.45% GC) lacking detectable lysogeny-associated, virulence, or antimicrobial-resistance genes. In a BALB/c excisional wound model infected with MRSA, topical phage treatment significantly reduced bacterial burden, accelerated wound closure, and improved clinical severity scores compared to untreated controls, performing comparably to phage-linezolid combination therapy and outperforming linezolid monotherapy in bacterial clearance. These findings support that our phage vB_SauM-MUHD-1 has potential for treating MRSA-infected wounds and should be further investigated for efficacy in more challenging chronic or biofilm-rich wound environments. KEY POINTS: • This study provides a newly kayvirus, strictly lytic anti-MRSA phage vB_SauM-MUHD-1. • Phage exhibited favorable replication kinetics, physical stability and genomic safety. • Topical phage therapy reduced bacterial burden and accelerated wound healing.
Background/Objectives: Cefiderocol (FDC) is a siderophore-containing cephalosporin that retains activity against many β-lactamase-producing bacteria, such as New Delhi metallo-β-latamase-producing (NDM) K. pneumoniae. Its use in critically ill patients is still limited, since the recommended dosing regimens are mainly derived from studies on healthy subjects, while critical illness is often associated with critical alterations in drug pharmacokinetics. Therefore, the aim of this study was to investigate FDC pharmacokinetic/pharmacodynamic (PK/PD) parameters in real-life patients based on their body weight and renal function. Methods: Patients with K. pneumoniae infections and indications for FDC were enrolled. Drug quantification in plasma was performed at the steady state at different timings. PK/PD targets of fCmin > 4 mg/L (most common) and more stringent targets of fCmin > 8 and 12 mg/L (4× and 6× the EUCAST breakpoint MIC) were considered in relation to patients' characteristics, 14 days of microbiological eradication and 30-day mortality. Results: Ten patients were enrolled in this study. Mortality, as well as the failure to achieve microbiological eradication, increased with BMI. In a PK/PD point of view, all patients reached the PK/PD targets of fCmin > 4 mg/L and > 8 mg/L, while only 20% reached a fCmin > 12 mg/L, with a key influence of renal function. However, no significant association was found between PK/PD target attainment and treatment outcomes. Conclusions: Our study may be useful for the real-world use of FDC, highlighting the impact of renal function on the achievement of ideal PK/PD thresholds. Nevertheless, the lack of a significant association between PK/PD and outcomes, partially due to the small sample size, highlights the complex impact of patients' clinical conditions other than drug PK.
Mycobacterium chelonae is a rapidly growing nontuberculous mycobacterium (NTM) that can infect both immunocompetent and immunocompromised hosts. Cutaneous and soft tissue infections are the most common manifestations and occur more frequently in individuals with underlying immune dysfunction. Patients with chronic lymphocytic leukemia (CLL), particularly those receiving targeted therapies such as ibrutinib, may be at increased risk of opportunistic infections. The diagnostic workup, microbiological findings, antimicrobial susceptibility testing, and therapeutic approach adopted for a cutaneous M. chelonae infection arising in a CLL patient four months after the introduction of ibrutinib were described. Clinical course and surgical management are also reported. A 60-year-old beekeeper with B-cell CLL developed a progressive cutaneous lesion on the left lower limb within four months of starting ibrutinib. Culture of a skin biopsy identified M. chelonae. Antimicrobial therapy was initiated based on in vitro susceptibility testing, resulting in partial clinical improvement. Complete resolution required surgical excision of the infected tissue followed by skin grafting. The patient's underlying hematologic disease, ongoing immunosuppression, and recent exposure to ibrutinib likely contributed to susceptibility and persistence of infection. This case highlights the increasing recognition of nontuberculous mycobacterial infections in immunocompromised individuals and underscores the importance of early diagnosis and susceptibility- guided therapy. Clinical response may be incomplete, and combined medical and surgical approaches may be required in selected cases. NTM infections should be considered in patients receiving Bruton's tyrosine kinase inhibitors who present with persistent, atypical, or non-healing cutaneous lesions. However, the association between ibrutinib therapy and susceptibility to infection remains uncertain, as multiple predisposing factors may coexist. Increased awareness of this possible association, together with careful clinical evaluation, may facilitate earlier diagnosis and improved management.