Ehrlichiosis and Anaplasmosis Infections in Solid Organ Transplant Recipients: A Single-Center Series

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Ehrlichiosis and Anaplasmosis Infections in Solid Organ Transplant Recipients: A Single-Center Series

Authors:
Benjamin Fisher, Pravin Meshram, Michael Megaly, Rubeena Naaz, Anmol Nigam, Anna Sachdeva, Jo-Anne Young, Michael Park, Raja Kandaswamy, James Harmon

Body of Abstract:
Introduction

Ehrlichiosis and anaplasmosis are emerging tick-borne rickettsial infections in the bacterial family of Anaplasmataceae. This series describes three cases of ehrlichiosis and four cases of anaplasmosis after organ transplantation at a single center. We report the time between transplant and infection diagnosis, laboratory values, and comorbidities.

Methods

We conducted a 13-year (2011-2024) retrospective cohort study using data from our institutional database. Demographic characteristics, transplant history, comorbidities, medications, and laboratory data were analyzed using R. Relevant laboratory measures and antibiotic usage were identified using pattern-based searches chronologically to characterize trends for each recipient. 

Results

We identified a total of 727 patients who were diagnosed with ehrlichiosis or anaplasmosis at our center. The median age was 66 years and 65% of these patients were male. Seven infections occurred in solid organ transplant (SOT) recipients. The median age of the 7 recipients was 65 years, and all were white. Six of 7 were male, and outdoor hobbies and occupations will be assessed with a later chart review. The dates of organ transplantation ranged from 1982 to 2022. Ehrlichiosis was diagnosed in 3 patients following kidney transplantation. Anaplasmosis was diagnosed in 4 recipients, 3 of whom were heart transplant recipients, and 1 of whom was a liver transplant recipient. One patient was diagnosed using cell-free DNA testing. Three of 7 were diagnosed during a hospital stay. Infections were diagnosed between June and November, consistent with the typical exposure season. The median time between transplant and diagnosis of ehrlichiosis was 4 years (range, 2-5), and anaplasmosis was 8 years (range, 2-31). The liver transplant recipient died 5 months after anaplasmosis infection. All recipients were chronically immunosuppressed with agents including tacrolimus, mycophenolate mofetil, everolimus, cyclosporine, and/or azathioprine. Recipient comorbidities included systemic hypertension in 7, chronic kidney disease in 6, coronary artery disease in 5, heart failure in 2, and diabetes in 1. CRP was elevated in all recipients in whom it was measured (4 out of 7, ehrlichiosis 3, anaplasmosis 1). Leukopenia, anemia, thrombocytopenia (5 out of 7, all less than 100,000), hyponatremia, and elevated creatinine were noted in 5 out of 7 transplant recipients. Aspartate aminotransferase was elevated in 5 of 7 recipients (range, 46-920; upper limit normal 33 U/L), and total bilirubin was elevated in 1 recipient. All recipients were treated with 100mg Doxycycline BID for 9-15 days.

Conclusion

We report 7 transplant recipients who were diagnosed with ehrlichiosis or anaplasmosis at a single center. Immune-suppressed transplant recipients are typically at increased risk of poor outcomes following infection. Our report highlights the features of ehrlichiosis and anaplasmosis infection in SOT recipients.

Evaluation of ASEPSIS Score as a Secondary Endpoint in the Phase 3 SHIELD II Trial of D-PLEX100 in Colorectal Surgery

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Evaluation of ASEPSIS Score as a Secondary Endpoint in the Phase 3 SHIELD II Trial of D-PLEX100 in Colorectal Surgery

Authors:
Robert Sawyer, Livnat Levy, Elena Zafirovikj

Body of Abstract:
Background: D-PLEX100 is a novel extended-release doxycycline delivery system applied as a single dose to the surgical site prior to incision closure. D-PLEX100 was evaluated in SHIELD II, a randomized, double-blind, controlled trial in patients undergoing abdominal colorectal surgery. The study met its primary endpoint, demonstrating a significantly lower rate of treatment failure (defined as occurrence of any of the following: surgical site infection (SSI) in the target incision, re-intervention, or death) in the D-PLEX100 arm compared with standard of care (SoC). ASEPSIS score was used as a post-operative wound surveillance tool to standardize the assessment and grading of surgical site infections based on observable clinical criteria. The score is determined based on the following characteristics: Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissue, Isolation of bacteria, Stay duration as inpatient. It provides an objective and standardized approach to wound assessment, offering a quantitative measure of SSI severity derived from specific, predefined clinical findings. Herein, we report on key secondary endpoints related to ASEPSIS scoring.     

Methods: Abdominal colorectal surgery patients were randomized to receive D-PLEX100 plus SoC systemic antibiotics or SoC alone. The primary outcome was treatment failure defined as a composite of any one of the following: adjudicated incision SSI, re-intervention at the target incision site, and mortality. One of the three key secondary endpoints was determining ASEPSIS scores at each study visit as part of the surgical site assessment. Number of subjects with at least one ASEPSIS score of >20 within 30 days post abdominal (index) surgery were compared between both study arms in the intention-to-treat (ITT) population. The averages of cumulative ASEPSIS assessment scores were also reported for those who experienced adjudicated SSI within 30 days post index surgery. 

Results: SHIELD II had 798 subjects [n = 405 (D-PLEX arm) n = 393 (SOC arm)] in the ITT population. There was a 38% relative risk reduction in the primary outcome in the D-PLEX100 arm compared to SoC [44 (10.9%) vs 71 (18.1%); difference -7.2 (95% CI, -12.1 to -2.3), p = 0.0039]. The proportion of subjects with at least one ASEPSIS score >20 was lower in the D-PLEX100 arm [8/391 (2.0%)] compared to the SoC arm [21/377 (5.6%)]. The stratified risk difference was -3.5 (95% CI -6.2 to ‑0.8; p = 0.0103). The median cumulative ASEPSIS score was 175 in the D-PLEX arm and 216.25 in the SoC arm. The median cumulative ASEPSIS score within the SSI period was 110 in the D-PLEX arm and 160 in the SoC arm. 

Conclusions: The use of D-PLEX100 resulted in improved outcomes for abdominal colorectal surgery patients, specifically demonstrating reduction in treatment failures compared to SoC antibiotics. D-PLEX100 was also associated with lower rates of wound infections as determined by ASEPSIS scoring.

Experience with infections involving the rare non-fermenter Alcaligines faecalis

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Experience with infections involving the rare non-fermenter Alcaligines faecalis

Authors:
Pooja Ajith, Saron Araya, Sridha Gona, Aaron George, Hugo Bonatti

Body of Abstract:
Background: Alcaligines faecalis is a rare non-fermentative Gram-negative rod found in water and soil and decaying material. Other previous Alcaligines spp recently underwent reclassification within the Burkholderiales order such as Achromobacter xyloxidans. Up to 25% of humans are colonized with the organism and only a limited number of infections have been published with the majority diagnosed in immunocompromised individuals.

Methods: Our institutional database was searched for all infections caused by Alcaligines faecalis during a 4-year period. Two isolates initially reported as Alcaligines xyloxidans were excluded from the study.

Results: In total 38 isolates in 33 patients were identified. Median age was 60 (range 35.3-95.6) years; 63.6% were male. Rates of comorbid conditions were DM 46%, hypertension 399%, hyperlipidemia 36%, COPD 21%, CAD 18%, and malignancies 15%. 46% of individuals were obese and 61% were active smokers. Demographic, clinical, and microbiology data are shown in table 1. Bacterial growth pattern based on streak appearance for surgical specimens was reported light in 30%, moderate in 13% and heavy in 57%; 70% of infections were polymicrobial with staphylococci in 43%, streptococci in 13%, Gram-negative rods in 28%, and anaerobes in 18% as co-pathogens. Blood cultures accounted for 6%, drainage fluids/tissue specimens for 42% and wound cultures for 42% of specimens, 9% came from drained abscesses. Only 6% of isolates came from blood cultures. Alcaligines faecalis was predominantly isolated in lower extremity soft tissue infections (88%), upper extremities were involved in 3% and another 3% were intraabdominal infections. Surgical services submitted 33% of specimens, medical services including infectious diseases 27% and the emergency department 27%; 12% of specimens came from primary care physicians. Treatment for surgical infection included incision and drainage, debridement and amputation as indicated together with antibiotics according to sensitivity testing considering the high rate of mixed infections. 

Conclusion: Alcaligines faecalis in this series was predominantly isolated in patients with chronic lower extremity infections such as diabetic foot syndrome. Whereas the majority of these infections were treated successfully, patients with Alcaligines faecalis infections had a survival of only 73% after a 2-year follow-up reflecting the high rates of comorbidities in these individuals.

Female Sex is an Independent Risk Factor for Mortality Following Post-Burn Sepsis

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Female Sex is an Independent Risk Factor for Mortality Following Post-Burn Sepsis

Authors:
Diana Julia Tedesco, Maria Fernanda Hutter, Fadi Khalaf, Marc Jeschke

Body of Abstract:
Background: Sepsis is the leading cause of morbidity and mortality among burn patients, affecting approximately 1 in 5 adults. Previous research has shown that adult female burn patients face an increased risk of mortality after injury compared to their male counterparts. However, the underlying reasons for this disparity remain unclear. It is uncertain whether the increased mortality in females is due to differences in sepsis risk, distinct physiological responses to sepsis, or variations in the timing of sepsis onset. Thus, in this study, we aim to clarify whether sex-based differences in post-burn mortality emerge primarily after sepsis develops, rather than through differential incidence of sepsis.

Methods: We conducted a cohort study at two provincial burn centres between 2006 and 2025. Patients ≥18 years with acute burn injuries covering ≥5% of total body surface area were included and stratified based on biological sex recorded on admission and sepsis diagnosis using the Sepsis-3 and ABA guidelines. Multivariable logistic regression was used to evaluate (1) the association between sex and mortality, (2) the association between sex and sepsis incidence, and (3) sex differences in 30-day mortality among patients with sepsis, adjusting for age, burn size, inhalation injury, and sepsis onset timing. 

Results: A total of 1483 burn patients were included, including 223 males diagnosed with sepsis, 844 male controls, 82 females diagnosed with sepsis, and 334 female controls. At admission, female patients were older (median (IQR) 48 (36-62) vs. 46 (22-59) years, p=0.020), had similar burn size (median (IQR) 11 (7-19) vs 12 (8-21) %, p=0.068), and similar incidence of inhalation injury (26% vs 20%, p=0.462) compared to all male patients. Overall 30-day mortality was higher in females than males (8% vs 4%, p=0.002), an association that persisted after adjustment (adjusted OR 2.20, 95% CI 1.29–3.74). Sepsis incidence (20% vs 21%, p=0.668) and the timing of sepsis onset (median (IQR) 9.5 (5-15) vs 10 (6-15) days post-injury, p=0.503) did not differ between sexes. However, among sepsis patients, females had higher 30-day mortality compared to males (20% vs 10%, p=0.031) and female sex remained independently associated with mortality after adjustment for age, burn size, inhalation injury, and sepsis onset (adjusted OR 2.97, 95% CI 1.27–6.95).

Conclusion: Female burn patients experienced higher mortality overall, and this disparity became more pronounced following sepsis. These differences were not attributable to differential sepsis incidence or timing, suggesting sex-specific biological responses to infection rather than differential exposure risk.

Hospital Trauma Volume and the Risk of Post-Injury Sepsis in Blunt Intestinal Injury: A Nationwide Analysis

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Hospital Trauma Volume and the Risk of Post-Injury Sepsis in Blunt Intestinal Injury: A Nationwide Analysis

Authors:
Yasmin Arda, Ioannis Karikis, John Hwabejire, Michael DeWane, Charudutt Paranjape, Joshua Ng-Kamstra, Lydia Maurer, Matthew Bartek, Jonathan Parks, Ali Salim, George Velmahos, Haytham Kaafarani

Body of Abstract:
Background: Blunt intestinal injury (BInI) is rare and often difficult to diagnose, resulting in delay in intervention and worse outcomes. This study aimed to evaluate whether hospital BInI volume influences the risk of post-injury sepsis in patients with BInI.

Methods: The 2017-2020 ACS-TQIP database was used to identify patients ≥18 years of age with full-thickness ileal, jejunal, or colonic perforation secondary to blunt trauma. Hospitals were stratified into tertiles by annual BInI volume. Multivariable logistic regression adjusting for demographics, comorbidities, and injury characteristics/severity was used to assess the impact of hospital volume on the risk of post-injury sepsis. To examine the potential role of delayed recognition, sensitivity analyses were conducted by stratifying patients undergoing early versus delayed (>24 hours) surgical intervention.

Results: Of 4,005,762 trauma patients, 3,954 were included: 1,397 (35.3%) in low BInI volume, 1,373 (34.7%) in medium BInI volume, and 1,184 (30%) in high BInI volume hospitals. The mean age was 41±18 years, 37% were females, the mean injury severity score was 19±10, and the most common injury was jejunal or ileal perforation (66%). On multivariable analyses, high BInI volume was independently associated with a 45% lower risk of post-injury sepsis (aOR 0.55, 95% CI 0.36-0.86) compared to low BInI volume. This association was not statistically observed in sensitivity analyses stratified by timing of surgery.

Conclusions: High trauma hospital volume of BInI is independently associated with decreased risk of post-injury sepsis. The attenuation of this effect after stratifying by operative timing may partially be related to earlier surgical intervention at high volume hospitals.

Immune cell temporal specific signatures clock track recovery status of critical injury patients

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Immune cell temporal specific signatures clock track recovery status of critical injury patients

Authors:
TeDing Chang

Body of Abstract:
BACKGROUND

Despite major advances in resuscitation and supportive care, trauma remains a leading cause of death and disability worldwide, particularly among young adults. Critical illness following severe trauma represents one of the most complex and dynamic immunological conditions encountered in modern intensive care. Survivors frequently experience prolonged recovery characterized by immune dysregulation, secondary infections, and MODS. These adverse outcomes highlight the need to understand not only the magnitude but also the temporal dynamics of immune responses during recovery from critical injury.

METHODS

We conducted a large, prospective, multicenter study enrolling 243 critically injured trauma patients and 57 healthy volunteers. Using sorted immune cell populations including T cells, monocytes, and PMNs, we constructed a comprehensive, time-resolved transcriptomic cohort of immune responses from injury onset through clinical recovery or death.

We applied three complementary analytical approaches: DEGs, WGCNA, and SLIDE to select the recovery related gene signature. From these analyses, we identified nine gene signatures associated with complicated recovery and used them to train an immune recovery clock.

We developed a novel framework, termed Temporal Gap (TempoGap), to quantify the deviation between the predicted and actual post-injury time, thereby providing a metric of immune recovery delay or acceleration. To model temporal progression, we employed the LASSO regression, optimized through 5-fold cross-validation. Model stability and performance variability were estimated via 500 bootstrapped iterations, aggregated into an ensemble of LASSO-based temporal predictors.

RESULTS

All TempoGap models showed significant associations with recovery duration. Notably, the T cell latent factor–based TempoGap demonstrated the strongest predictive effect (HR = 1.5, p < 0.001), indicating that higher expression of this temporal module was associated with faster recovery. Given the importance of early prognostication, we further evaluated model performance within the first week post-injury. The models retained substantial predictive power during this period, with the monocyte complicated recovery gene TempoGap model showing the best performance on day six (HR = 2.0, p < 0.05). Importantly, TempoGap scores exhibited only weak correlations with conventional clinical indicators, suggesting that TempoGap captures unique biological dimensions of immune recovery not reflected by traditional scoring systems. CONCLUSIONS In summary, we established an immune recovery clock model and introduced TempoGap, a novel temporal deviation metric that predicts recovery status in critically injured patients. This approach offers a conceptual and analytical foundation for precision monitoring of immune recovery, enabling early outcome prediction and guiding targeted interventions to promote recovery after critical injury.

Immunomodulatory Effect of Phospholipid Nanoparticle, VBI-S for Treatment of Sepsis.

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Immunomodulatory Effect of Phospholipid Nanoparticle, VBI-S for Treatment of Sepsis.

Authors:
Gracy Rosario, Gelilla Daniel, Benjamin Edwards, Cuthbert Simpkins

Body of Abstract:
Background: 

Sepsis, a leading cause of morbidity and mortality in humans, is an inflammatory disease caused by a dysregulated host response to an infection. Increased antibiotic resistance and lack of FDA approved drugs significantly limits treatment options for sepsis. Recently, VBI-S, a phospholipid nanoparticle colloid, has proven effective in Phase 2a clinical trial for septic shock1. Efficacy of VBI-S for septic shock is currently being evaluated in Phase III open-label randomized controlled clinical trial. 

In sepsis, macrophages play an important role in inflammation, which is one of the causes of multi-organ damage. As preliminary evidence indicates that VBI-S is effective in sepsis, we hypothesized that VBI-S is immunomodulatory in nature, and capable of reducing inflammation in septic patients. Hence, the present study initially evaluated the immunomodulatory potential of VBI-S on pro-inflammatory macrophage functions. The study analyzed the effect of VBI-S on pro-inflammatory gene expression by M1 macrophages in an in-vitro culture model. 

Methods: 

Human THP-1 monocytes were differentiated to M0 macrophages by treatment with 25nM phorbol-myristate-acetate (PMA) for 48h and then to M1 macrophages by treatment with 100 ng/ml lipopolysaccharide (LPS) and 20 ng/ml interferon gamma (IFN-γ) for 48h. Subsequently, the M1 cells were treated with different concentrations of VBI-S, (1%, 0.1%, 0.01%, 0.01%) for 24h in presence of LPS and IFN-γ for 24h. Control included M1 cells cultured in media with or without the aqueous phase. Expression of pro-inflammatory genes (CXCL10, CCR7 and IL-1b) were analyzed by quantitative SYBR Green RT-PCR. Viability of the VBI-S treated adherent M1 cells were studied by MTT assay and non-adherent floating M1 cells evaluated by Trypan blue staining. Statistical analysis was performed by Brown-Forsythe and Welsch ANOVA, nonparametric t-test and Mann Whitney U test (Graph Prism Software). 

Results: 

VBI-S significantly decreased the levels of candidate pro-inflammatory CXCL10, CCR7 and IL-1b genes in M1 cells at 1%, 0.1%, and 0.01% concentrations (P<0.05). Furthermore, the number of viable adherent or non-adherent dead cells were unaltered at 1%, 0.1%, 0.01% and 0.001% VBI-S as compared to the respective controls.  Conclusion:  VBI-S has immunomodulatory properties as it reduces pro-inflammatory cytokine/chemokine gene expression by M1 macrophages. This study points towards immunomodulation being a key mechanistic function of VBI-S in treatment of sepsis. Futuristic studies are aimed at assessing VBI-S uptake by M1 macrophages, and subsequent mechanistic actions on pro-inflammatory signaling events. 1 Simpkins C, et al., 2024: Efficacy and safety of phospholipid nanoparticles (VBI-S) in reversing intractable hypotension in patients with septic shock: a multicentre, open-label, repeated measures, phase 2a clinical pilot trial. EClinicalMedicine 68:102430.

Impact of Thoracic Irrigation on Empyema Patterns in Trauma Patients

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Impact of Thoracic Irrigation on Empyema Patterns in Trauma Patients

Authors:
Katherine Russo, Joshua Preston, Wen Yang, Randi Smith, Jonathan Nguyen, Jason Sciarretta

Body of Abstract:
Background:

Empyema is a significant complication following traumatic hemothorax, contributing to prolonged hospitalization, increased morbidity, and the need for invasive interventions. Thoracic irrigation (TI) has emerged as a minimally invasive strategy for managing retained hemothorax, yet its influence on the development and microbiologic profile of subsequent empyema remains unclear. 

Methods:

A retrospective review was performed of trauma patients who underwent TI for retained hemothorax at an urban Level I trauma center between 8/2023 and 8/2025, identifying those who subsequently developed empyema. A historical comparison cohort included all traumatic empyema cases over a four-year period (1/2019 – 7/2023) preceding TI protocol implementation. Empyema was defined by the presence of positive pleural cultures. Data collected included demographics, injury patterns, pleural microbiology, ICU length of stay (LOS), and mortality. Continuous and ordinal variables were summarized as median [IQR] and compared using the Wilcoxon rank-sum test. Categorical variables were summarized as n (%) and compared using Fisher’s exact test.

Results:

Among 124 patients who underwent TI during the study period, the overall empyema rate was 2.4%. A total of 35 culture-proven empyemas were identified: 3 post-TI patients and 32 historical controls without TI. Patients who developed empyema after TI had a significantly longer time to diagnosis compared with those without TI (30 days [29.5-33] vs. 13 days [9.8-19.5], p=0.031). Polymicrobial empyema occurred less frequently in the TI group (33% vs. 72%), though this difference did not reach statistical significance. Rates of anaerobic infection were similar between cohorts (33% vs. 41%). No significant differences were observed in demographics, injury mechanism, ISS, thoracic AIS, ICU LOS, or mortality between groups (Table 1).

Conclusion:

In trauma patients who developed empyema, those who underwent prior thoracic irrigation demonstrated delayed onset of empyema and a lower observed rate of polymicrobial infection compared with patients who did not undergo TI. Although limited by the small number of post-TI empyemas, these findings suggest that TI may influence the microbiologic profile or temporal development of pleural space infection. Larger studies are needed to clarify the impact of TI on empyema pathophysiology and clinical outcomes following traumatic hemothorax.

Age-Dependent Remodeling of Splenic Immune Responses in Murine Sepsis Revealed by Single-Cell Transcriptomics

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Age-Dependent Remodeling of Splenic Immune Responses in Murine Sepsis Revealed by Single-Cell Transcriptomics

Authors:
Christine Rodhouse, Dayuan Wang, Hongru Tang, Miguel Hernandez-Rios, Whitman Wiggins, Xuanxuan Yu, Leandro Balzano-Nogueira, Angel Charles, Larissa Langhi Prata, Tyler Loftus, Letitia Bible, Alicia Mohr, Robert Maile, Guoshuai Cai, Shawn Larson, Philip Efron, Jaimar Rincon

Body of Abstract:
Background: Decades of sepsis research have yet to produce an effective immune-therapeutic to improve patient outcomes. This is in part due to a failure to apply precision medicine to sepsis research, which includes accounting for the age of the host as the disease tends to affect the very young and older adults the most. Our goal is to delineate the transcriptomic patterns of leukocytes early after sepsis in key age (neonate, young adult, older adult) groups using a polymicrobial model of murine abdominal sepsis, allowing for comparisons of similarities and differences.

Methods: Neonatal (7-day-old), young adult (3-4 months), and older adult (18-24 months) C57BL/6 (B6) mice were challenged with 1.1 – 1.3 mg/g BW of cecal slurry (CS) to induce polymicrobial sepsis. Spleens were harvested prior to challenge (naive) and 18 hours post-sepsis (CS18h). Single-cell gene expression libraries were generated using the 10X Genomics platform and sequenced on an Illumina HiSeq® system (scRNAseq).  Data was processed with CellRanger and analyzed in Seurat.  Differentially expressed genes (DEGs) were identified using an adjusted Wilcoxon’s rank-sum test. IPA was used for functional enrichment, with significance assessed by Fisher’s exact test. Pseudotime trajectory analysis was inferred based on transcriptional dynamics. 

Results: Following sepsis, neonates showed expansion of HSPCs, PMNs, and mast cells; young adults exhibited reductions in HSPCs and mast cells, while older adults displayed increased DCs with otherwise stable myeloid proportions. Monocyte transcriptional responses differed markedly by age. Neonatal monocytes showed dysregulated activation and impaired maturation with induction of IL-10, Th2, TLR, LPS/IL-1, iNOS, IL-17, and IL-1 pathways and suppression of LXR/RXR and MAPK. Young adults mounted a balanced response, upregulating IL-10, IL-17, and PD-1/PD-L1 while downregulating Th1, HGF, and IL-4. Aged monocytes exhibited profound dysregulation with activation of cytokine-storm, IL-10, ID3, and sirtuin pathways and loss of PPAR/RXR, TRIM21, and communication signaling, reflecting a hyperinflammatory, metabolically compromised state. Pseudotime trajectory analysis revealed pronounced alterations suggesting perturbations in hematopoietic differentiation dynamics across the ages. In young adult mice, myeloid differentiation skewed towards inflammatory effector cells (e.g. monocytes, DCs). In contrast, in neonates and aged mice there were disrupted trajectories and reduced progression to the terminal macrophage branches, indicative of impaired myeloid maturation. 

Conclusions: scRNAseq analysis of splenic leukocytes revealed that host age results in tremendous differences in cell proportions, DEGs, and cell differentiation early after sepsis. Translation efforts in sepsis can be improved by applying precision medicine to research, including preclinical rodent sepsis models needed for FDA approval of therapies.

Comparing efficacy of preoperative antiseptic agents in preventing SSI after urgent and emergency cesarean section

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Comparing efficacy of preoperative antiseptic agents in preventing SSI after urgent and emergency cesarean section

Authors:
Gabriela Cortese, Robyn Bronshtein, Alex Kaizer, Cameron Maidenberg, Stefka Fabbri, Daniel Yeh

Body of Abstract:
Background: Preoperative skin antisepsis is a well-established method of reducing rates of

postoperative surgical site infection (SSI). The aim of this descriptive study was to assess SSI

rates following emergent cesarean section (e-CS) using different preoperative skin antiseptic

agents.

Methods: This retrospective study included adults undergoing e-CS at our institution between

5/16-12/23. E-CS after trauma and in correctional care patients were excluded. Maternal

demographic information, operative characteristics, and postoperative outcomes were collected.

Two abdominal preparation types were assessed: chlorohexidine gluconate with alcohol (CHG)

for “priority 1” (decision-to-incision < 15 minutes) and povidone-iodine (PVP-I) for “priority 2” (decision-to-incision < 30 minutes). The primary outcome was SSI rate. Additional major co- variates included timeliness of preoperative antibiotics within 60 min before incision (SCIP compliance), appropriateness of antibiotics spectrum (CDC compliance), and postoperative antibiotics treatment and duration. Logistic regression models were used to estimate odds ratios between abdominal preparation types. Results: A total 665 patients were included in the study: CHG=488 (73%) and PVP-I=177 (27%) (Table). Significant differences were seen between groups regarding indication for e-CS, preoperative antibiotics administration, timeliness of preoperative antibiotics, post-operative antibiotics prescription, and duration of postoperative antibiotics. However, the overall SSI rate was 4.2% and SSI rates were not significantly different between groups (3.9% vs. 5.1%, p=.164). Adjusted logistic regression demonstrated that PVP-I vs. CHG was not associated with increased risk of SSI (OR 1.18, 95% CI 0.48-2.88, p=.712). Conclusion: The choice of preoperative skin antisepsis agent at our institution is variable and may depend upon factors such as indication for e-CS. We did not detect a meaningful difference in SSI rates between different antiseptic agents. These findings indicate that SSI rates may not be impacted by type of preoperative skin antiseptic agent.