Search Results (80)

Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures. Full article

Background: Perioperative antibiotic prophylaxis (PAP) is effective for infection prevention in implant-related surgery, with infections being the most feared complications. A total of 15% of all antibiotics in hospitals are used for surgical prophylaxis but less than 50% of them are used according to the guidelines. International guidelines recommend only a single preoperative dose for all surgical procedures. We have developed and implemented new recommendations for PAP duration in primary hip and knee arthroplasty at the University Department for Orthopaedic Surgery. Methods: The development and implementation of new recommendations regarding PAP duration were performed via the following steps: pre-interventional analysis; identification of barriers and facilitators using the Flottorp framework; analyzing the data and preparation of a tailored implementation strategy based on an educational group meeting with the development of new consented to recommendations; and dissemination; followed by postinterventional analysis of PAP duration compliance 6 months later. Results: Before the intervention, 70% of PAP was used inappropriately (longer than 24 h). The major recognized barriers were fear of prosthetic joint infection (PJI) and a lack of concern regarding global antimicrobial resistance problems. Major facilitators were a low local PJI incidence rate (0.28%), etiology of PJI and existing local experience with a single-dose regime. After implementation of new recommendations regarding the duration of PAP, the postinterventional analysis showed that 80% of PAP was used according to the new recommendations, with a significant reduction in prolonged PAP use (from 70% to 12%), leading to an important decline in antimicrobial consumption. Conclusions: Our study showed that a tailored strategy in the development and implementation of new recommendations is complex and time consuming, although necessary for successful clinical practice change. Full article

Full-arch implant-supported rehabilitations are widely recognized as an effective treatment option for edentulous patients. Nevertheless, clinical decision-making regarding patient selection, surgical planning, prosthetic material choice, and long-term maintenance protocols remains heterogeneous and requires structured evidence-based guidance. A modified Delphi consensus process was conducted involving 29 experts during the Italian Consensus Conference. A systematic literature review covering the period 2015–2024 was performed, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Consensus was predefined as ≥90% agreement. Seven evidence-based consensus statements were developed addressing: (1) periodontal risk assessment using validated tools; (2) guided bone regeneration outcomes with technique-specific indications; (3) comparative survival of four versus six implants in mandibular full-arch rehabilitations; (4) equivalence of tilted and axial implant configurations; (5) prosthetic material selection, with monolithic zirconia showing high survival; (6) risk-stratified supportive maintenance protocols associated with a reduction in peri-implantitis incidence; and (7) systemic risk stratification, including absolute and relative contraindications, medication-related osteonecrosis of the jaw (MRONJ) risk management, and perioperative antibiotic prophylaxis. Full article

The sustained increase in bacterial resistance has driven the search for therapeutic alternatives that may help reduce antibiotic use, particularly in empirical treatments. In this context, topical ophthalmic antiseptics have emerged as effective and safe tools, suitable for both perioperative prophylaxis and the management of mild or superficial ocular diseases. Their broad spectrum of activity—encompassing bacteria, fungi, viruses, and protozoa—together with the low likelihood of inducing resistance, establishes them as valuable partners in daily clinical practice. This article reviews the current evidence on the use of antiseptics in veterinary ophthalmology, focusing on their clinical applications, therapeutic benefits, and limitations. It also highlights the need for further studies to establish species-specific, disease-specific, and context-based protocols. Full article

Background: Kounis syndrome is an allergic acute coronary syndrome precipitated by coronary vasospasm, plaque destabilization, stent thrombosis, or bypass occlusion. Cardiac surgery represents a uniquely high-risk setting due to cardiopulmonary bypass–associated inflammation and exposure to multiple pharmaceutical agents. Importantly, Kounis syndrome remains underrecognized in this context, as classical signs of anaphylaxis may be masked under general anesthesia and cardiopulmonary bypass, while ischemic manifestations may be misattributed to other perioperative conditions. Methods: A narrative review of PubMed-indexed literature was conducted to synthesize current evidence on the pathophysiology, perioperative triggers, clinical presentation, diagnostic strategies, and management of Kounis syndrome in cardiac surgery, with emphasis on intraoperative recognition and surgical decision-making. Published cases were retrieved involving perioperative cardiac surgery patients with a definite diagnosis of Kounis syndrome. Additionally, cases presenting with severe perioperative anaphylaxis and life-threatening cardiovascular involvement (grade III with cardiovascular collapse and grade IV with cardiac arrest) were included as possible Kounis syndrome, reflecting real-world diagnostic uncertainty in the intraoperative setting. Results: The literature review identified five cases of definite Kounis syndrome and ten cases of possible Kounis syndrome, including three cases with cardiovascular collapse and seven cases with cardiac arrest. Recurrent episodes were reported in several patients, particularly due to re-exposure to the triggering agent. In the context of cardiac surgery, Kounis syndrome is most frequently triggered by chlorhexidine, protamine, antibiotic prophylaxis, and anesthetic agents. The clinical presentation is often subtle during cardiopulmonary bypass. Vasoplegia, pulmonary hypertension, ventricular dysfunction, new regional wall-motion abnormalities, and hyperdynamic ventricles on transesophageal echocardiography commonly precede overt electrocardiographic changes. Diagnosis is primarily clinical and relies on intraoperative ultrasound, hemodynamic monitoring, serum tryptase, serum troponin, and, when indicated, coronary angiography. A dual-pathway approach addressing both anaphylaxis and myocardial ischemia is essential; however, one component may predominate, particularly in perioperative patients with limited clinical information, potentially leading to misdiagnosis. A multidisciplinary approach is therefore required for rapid diagnosis and individualized management. In refractory cases, cardiopulmonary bypass or ventricular assist devices may provide lifesaving support. Conclusions: Kounis syndrome remains underrecognized in cardiac surgery but carries significant morbidity. Increased clinical awareness, multidisciplinary collaboration, structured diagnostic approaches, and preventive strategies are essential to improve outcomes and reduce the risk of recurrence during future procedures. Full article

Background: Patients undergoing pancreatoduodenectomy (PD) after preoperative percutaneous transhepatic biliary drainage (PTBD) frequently develop bacterobilia. While bile culture positivity has been variably linked to postoperative infections, the clinical relevance of culture data may be more closely related to perioperative antimicrobial adequacy. We aimed to evaluate whether discordant perioperative antibiotic prophylaxis—defined by mismatch between administered prophylaxis and resistance profiles from preoperative PTBD bile cultures—is independently associated with major postoperative morbidity. Methods: This retrospective cohort study included consecutive patients undergoing PD between January 2020 and October 2025. Major morbidity (primary endpoint) was defined as Clavien–Dindo grade ≥ III. Secondary outcomes included postoperative day 4 inflammatory markers (WBC and CRP), length of stay, and infection-related endpoints. Bile culture findings were categorized by culture status and resistance severity (no growth, low resistance, and high resistance [MDR/XDR/PDR]). Discordant prophylaxis was defined using a predefined coverage-based algorithm incorporating antimicrobial class and susceptibility profiles. Multivariable logistic regression (adjusted for age, dichotomized ASA class, and operative type) and model performance (AUC, DeLong test; Hosmer–Lemeshow calibration) were assessed. Results: A total of 145 patients were analyzed; preoperative bile culture status was no culture (n = 30), culture-negative (n = 59), and culture-positive (n = 56). Bile culture status was not associated with major morbidity (p = 0.406), POD4 inflammatory markers, or length of stay. Resistance severity categories were also not associated with major morbidity (15.3%, 17.4%, and 24.2% across no-growth, low-resistance, and high-resistance groups, respectively; p = 0.77). Discordant prophylaxis occurred in 23 patients (15.9%) and was associated with higher major morbidity compared with concordant coverage (30.4% vs. 18.0%; OR: 1.99, 95% CI: 0.69–5.36; p = 0.25). After adjustment, discordant prophylaxis showed a higher point estimate for major morbidity (adjusted OR: 1.84, 95% CI: 0.63–4.96; p = 0.24), although this did not reach statistical significance. The core clinical model showed poor discrimination (AUC 0.59); adding microbiological variables modestly increased the AUC to 0.63 without significant improvement (DeLong p = 0.46). Model calibration was acceptable (Hosmer–Lemeshow p = 0.88). Conclusions: In this PTBD cohort undergoing PD, bile culture positivity and resistance severity were not independently associated with major postoperative morbidity. Discordant prophylaxis was associated with a numerical increase in major morbidity; however, this finding did not reach statistical significance and should be interpreted cautiously given the limited sample size. These findings support interpreting bile culture data primarily within an antimicrobial stewardship framework to ensure adequate coverage rather than as standalone predictors of severe morbidity and warrant validation in larger prospective cohorts. Full article

Background: Surgical site infections (SSIs) are among the most frequent healthcare-associated infections (HCAIs) worldwide. Changes in the functioning of healthcare systems may affect the implementation of SSIs prevention practices, with consequent alterations in the occurrence of HCAIs. The main aims of our study were to analyze specific SSIs prevalence and proportions together with overall HCAIs prevalence in acute care hospitals (ACHs) before and after the COVID-19 pandemic. Additional aims were to identify bacterial causative agents, the use of perioperative antibiotic prophylaxis (PAP), related structural and process quality indicators, and to determine trends between two periods. Methods: The National Reference Centre for HCAIs (University Hospital Centre Zagreb) conducted point prevalence surveys in May 2017 and May 2023 in ACHs throughout Croatia, using the technical protocol developed by the European Centre for Disease Prevention and Control (ECDC). Results: The prevalence of HCAIs in ACHs in Croatia rose from 5.3% (95% CI 4.8–5.7) in 2017 to 7.2% (95% CI 6.6–7.8) in 2023 (p = 9.93 × 10⁻¹⁴). This trend was paralleled with the rising of the HCAIs prevalence in surgical departments from 5.1% to 6.7% (p = 0.0099). The prevalence of overall SSIs across ACHs increased from 0.9% (95% CI 0.7–1.1) in 2017 to 1.2% (95% CI 1.0–1.5) in 2023 (OR 1.36 (1.03–1.80), p = 0.032. While the prevalence of superficial incisional SSIs significantly decreased (OR 0.53 (0.30–0.95), p = 0.028), the share of deep-seated SSIs (deep incisional and organ/space SSIs) among classified SSIs shifted from 48/92 to 77/96; odds ratio (OR) 2.09 (95% CI 1.45–3.01). In 2017, Gram-positive cocci were the most frequently isolated bacterial causative agents (44.6%). By 2023, this shifted, with Enterobacterales species comprising most isolates (42.2%). In 2023, significantly a higher proportion of patients received PAP (χ² = 25.419, df = 1, p  < 0.5). An increase in the positive trend of alcohol-based hand rub antiseptics use in surgical departments (+15.7 L/patient-days, p < 0.001) contrasted with a decrease in infection prevention and control (IPC) nurses and medical doctors per hospital (−0.5, p = 0.041/−0.5, p = 0.003). Conclusions: Findings of the two point prevalence surveys over time indicate the changes in trends in surgical site infections burden, and highlight the need for the implementation and strengthening of preventive measures with the focus on targeted prevention of deep-seated infections. Full article

Background/Objectives: The role, timing, and duration of antibiotic therapy in hypospadias repair remain controversial, with substantial variability in clinical practice and a lack of evidence-based guidelines. This systematic review and meta-analysis aimed to evaluate whether preoperative, postoperative, or combined perioperative antibiotic regimens influence postoperative outcomes after hypospadias repair. Methods: A systematic literature search of PubMed, MEDLINE, Scopus, Embase, and Web of Science was conducted in accordance with PRISMA guidelines to identify studies published between 2000 and 2025 that reported on perioperative antibiotic administration in pediatric patients undergoing hypospadias surgery. Three comparisons were assessed: (i) postoperative antibiotics versus no antibiotics, (ii) preoperative antibiotics versus no antibiotics, and (iii) combined pre- and postoperative antibiotics versus no antibiotics. Outcomes included infectious complications, wound dehiscence, urethrocutaneous fistula, meatal or urethral stenosis, and other postoperative complications. Random-effects meta-analyses were performed, with pooled odds ratios reported together with 95% confidence intervals. Results: Ten studies comprising a total of 9493 patients were included. Perioperative antibiotic use was not associated with a significant reduction in infectious complications (OR 0.95, 95% CI 0.63–1.44; p = 0.81), urethrocutaneous fistula (OR 1.89, 95% CI 0.87–4.12; p = 0.10), or wound dehiscence (OR 1.52, 95% CI 0.98–2.35; p = 0.06) compared with no antibiotic use. Preoperative antibiotic prophylaxis alone did not result in a reduction in infectious complications or wound dehiscence. Combined pre- and postoperative antibiotic therapy did not demonstrate a clear benefit over no antibiotics in terms of infectious complications, although available data were very limited. Conclusions: Routine perioperative antibiotic therapy does not significantly reduce postoperative complications after hypospadias repair. These findings support a selective, risk-based approach to antibiotic use rather than routine administration in hypospadias surgery. Further well-designed prospective studies are needed to establish evidence-based perioperative antibiotic protocols in pediatric hypospadias surgery. Full article

Background: Pancreatoduodenectomy (PD) remains the fundamental treatment for periampullary malignancies but is associated with considerable morbidity (20–50%) and mortality (2–7%). Bacteriobilia contributes to unfavourable postoperative outcomes. Current antibiotic prophylaxis recommendations endorse first-generation cephalosporins, which often fail to adequately target pathogens most frequently isolated from bile. To date, no specific guidelines for preoperative targeted antibiotic therapy have been established, although tailoring such strategies to the bile microbiome may improve surgical outcomes. This study aimed to characterize bile microbiology in patients undergoing PD for pancreatic ductal adenocarcinoma (PDAC), evaluating potential antibiotherapy regimens that provide effective coverage against the most frequently isolated pathogens. Methods: A retrospective cohort analysis of 725 patients surgically treated for pancreatic tumours at a high-volume pancreatic surgery center between 2017 and 2022 was performed. To minimize heterogeneity, study was restricted to 138 patients who underwent PD with histopathological confirmed PDAC. Intraoperative bile cultures were assessed. Results: Patients with bacteriobilia likewise experienced worse outcomes: higher 5-year mortality (OR 3.01, p = 0.007), greater overall postoperative pancreatic fistula (POPF) occurrence (OR 2.54, p = 0.044) and wound infections (OR 2.90, p = 0.038). Among bile microbiome the highest susceptibility rates were observed for combination of amoxicillin/clavulanic acid with gentamicin, while the lowest were noted for cephalosporin–metronidazole regimen (93.6% vs. 30.2%, respectively). Conclusions: Bacteriobilia contributes to postoperative complications and serves as a predictor of poorer survival after PD. Standard perioperative antibiotic prophylaxis in PD is insufficient. Based on our findings, perioperative antibiotic therapy with amoxicillin/clavulanic acid and gentamicin combination appears to provide superior coverage and may improve postoperative morbidity and overall survival following PD. Full article

Background: Elastic stable intramedullary nailing (ESIN) is widely used in pediatric trauma surgery for benefits such as early limb loading, short hospital stays, and easy implant removal. Perioperative antibiotic prophylaxis (PAP) is used to reduce surgical site infections (SSIs). However, the necessity of PAP in minimally invasive pediatric procedures like ESIN remains unclear. Methods: This retrospective analysis reviewed all pediatric fractures treated with ESIN osteosynthesis at a pediatric trauma center over a time span of 10 years. Focus was set on the use of PAP during implantation and complications in the period between osteosynthesis and implant removal, which was used as follow-up. Results: Between January 2013 and December 2023, a total of 979 ESIN osteosyntheses were performed. In total, 4.1% were lost to follow-up resulting in 939 eligible cases. Complications occurred in 14.7% of all cases. However, complications such as wound healing disorders, wound infections, and osteomyelitis were rare, at 1.7%. Between the different subgroups regarding the application of PAP, type of reduction, openness of the fractures, or localization, no significant differences were found. Conclusions: Besides the most minor complications, ESIN osteosynthesis in children and adolescents is safe treatment. No increased risk for complications was observed when closed reduction was performed without the administration of PAP. Full article

Objective: The emergence and spread of multi-drug-resistant (MDR) bacteria pose a growing threat in veterinary medicine, particularly in equine hospitals. This study investigated the colonization and infection dynamics of horses undergoing emergency laparotomy with two distinct antibiotic protocols (single-shot versus 5-day protocol) during hospitalization. Methods: Nasal swabs and fecal samples were collected from 67 horses undergoing emergency laparotomy at clinic admission as well as on postoperative days 3 and 10. These were screened for multi-drug-resistant indicator pathogens. As multi-drug-resistant indicator pathogens, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E), and bacteria belonging to the Acinetobacter baumannii complex were defined. Results: Preoperatively, 6.2% of horses tested positive for MRSA and 13% for ESBL-E. An increase in colonization was observed on day 3 postoperatively, with 62.1% of nasal swabs and 86.4% of fecal samples testing positive for MDR organisms. On day 10, 53.4% of nasal swabs and 62.5% of fecal samples tested positive for indicator pathogens. Surgical site infection developed in five horses, two of which tested positive for MRSA in both nasal and wound samples during hospitalization, supporting the potential role of nasal carriage as a source of infection. Furthermore, all horses tested positive for ESBL-E during at least one time-point during hospitalization, and Enterobacterales (MDR in two surgical site infections (SSI)) were involved in all surgical site infections. No significant differences were observed between the two antibiotic treatment groups regarding colonization rates with indicator pathogens during hospitalization. However, the results indicate that hospitalization itself contributes to increased colonization with resistant bacteria. A clear limitation of the study is the restricted number of sampled horses and the lack of environmental contamination data. Non-sampled hospitalized horses with and without antibiotic treatment may have acted as reservoirs for MDR bacteria. Conclusion: The findings emphasize the need for routine environmental monitoring and strict adherence to hygiene protocols in equine clinics to reduce the risk of nosocomial transmission. Ongoing surveillance and infection control strategies are essential to mitigate the spread of MDR pathogens in veterinary settings. Full article

Background/Objectives: Cleft lip and/or palate are common craniofacial anomalies whose surgical repair is classified as clean-contaminated and may be complicated by surgical site infection or palatal fistula. Despite widespread perioperative antibiotic use, there are no standardized, evidence-based recommendations, and rising antimicrobial resistance underlines the need for rational prescribing. This systematic scoping review aimed to map current evidence on prophylactic antibiotic therapy and related perioperative measures in cleft surgery. Methods: A scoping review was conducted using the Arksey and O’Malley framework and reported in line with PRISMA 2020. PubMed, Mendeley and Google Scholar were searched (January 2015–10 February 2025) for English-language retrospective studies, clinical trials, survey studies and systematic reviews concerning prophylactic antibiotics, bone grafting procedures, mouthwash use or oral microbiota in patients undergoing cleft lip and/or palate surgery. Six reviewers independently screened records; two experienced clinicians extracted data on study characteristics, antimicrobial regimens and infectious or microbiological outcomes. Given heterogeneity and the scoping aim, no formal risk-of-bias assessment or meta-analysis was performed. Results: A total of 40 studies met the inclusion criteria, including 21 original research articles. Considerable variation in antibiotic choice, timing and duration was observed, with no clear superiority of any regimen. Single-dose perioperative prophylaxis appeared non-inferior to prolonged courses in several settings. Oral microbiota studies highlighted colonization by resistant and opportunistic pathogens in cleft patients. Conclusions: Current evidence supports individualized, often short-course perioperative antibiotic strategies rather than routine prolonged therapy. High-quality randomized and microbiological studies are required to develop standardized, resistance-conscious guidelines. Full article

Early bacterial infections (EBI) remain a major cause of morbidity and mortality after liver transplantation (LT). This study aimed to characterize their incidence, microbiological spectrum, risk factors, and clinical impact in an Eastern European cohort. We retrospectively analyzed 64 adult LT recipients from a tertiary center, focusing on perioperative parameters, infection profiles, and postoperative outcomes. EBI, defined as infections occurring within 30 days after transplantation and diagnosed according to CDC/NHSN criteria, occurred in 48.4% of patients. Gram-negative bacilli predominated (73.7%), mainly Pseudomonas aeruginosa (34.2%) and Klebsiella pneumoniae (15.8%), while Clostridioides difficile (CDI) accounted for 18.4% of confirmed cases diagnosed by stool toxin assay. Infected patients had greater intraoperative blood loss (median 6500 mL vs. 5000 mL, p = 0.036) and required more transfusions. The higher infection rate in our cohort may also be related to longer surgical duration. All deaths within the first postoperative year occurred among infected recipients, yet overall 30-day (7.8%) and 1-year (14.1%) mortality rates remained within the range reported internationally, suggesting that timely diagnosis and adequate management limited the impact of infections on survival. These findings emphasize the importance of infection prevention, optimized transfusion and bleeding control, and tailored antibiotic prophylaxis based on local microbiological patterns after LT. Full article

Background: Preventing postoperative infections in hand surgery is an important factor for achieving sustainable results of surgical procedures. To prevent infections, especially when implants are used, preoperative prophylactic antibiotics are applied in adherence to predominantly national guidelines, which are not specifically tailored to hand surgery. However, several studies related to elective soft tissue hand surgery indicate that the preoperative use of antibiotics does not reduce the incidence of postoperative infections. Evidence regarding their efficacy in osteosynthesis of the hand and wrist remains limited. Methods: In this retrospective study, we analyzed 542 adult patients who underwent hand or wrist osteosynthesis between 2016 and 2019 at our university center. They were enrolled in an antibiotic treatment group and a control group without antibiotic treatment. The prophylaxis group (P) underwent surgery in the main operating theater under intravenous anesthesia, whereas the non-prophylaxis group (NP) was treated under WALANT (Wide Awake Local Anesthetic No Tourniquet) in an outpatient operating theater without receiving preoperative antibiotics. Theater construction and installation were otherwise similar, and both were classified as grade 1 theaters. We applied propensity modeling and inverse probability of treatment weighting (IPTW) to achieve balanced treatment groups with respect to risk factors for infection, and we calculated the odds ratio of prophylaxis and infection. Inclusion factors for risk of infection were age, female sex, smoking, diabetes, metabolic disease, inflammatory disease, substance abuse, cardiovascular disease, hepatopathy, renal disease, polytrauma, open fracture, being a manual worker, and occupational accidents. To assess the severity of the cases, we considered whether the fractures were intraarticular, multi-fragmentary, or open, and we collected data on the types of surgical implants that were used. Results: No significant association was found between antibiotic prophylaxis and postoperative infection rate (infection rate P: 3.86%; NP: 3.27%; unadjusted OR: 1.19; adjusted OR after IPTW: 1.09). In terms of risk factors, there was an insignificant trend of higher infection rates in the subgroups smoking, cardiovascular disease, open fracture, occupational accident, and open fixations. Conclusions: In this cohort, routine use of preoperative antibiotics in hand osteosynthesis did not reduce infection rates. The effectiveness of the widespread standardized application of prophylactic antibiotics to reduce the risk of postoperative infections in osteosynthesis of the hand and wrist remains debatable. Our findings set the basis for further prospective studies aiming at clearer guidelines for evidence-based perioperative patient care. Full article

Background/Objectives: Surgical Site Infections (SSIs) are among the most common complications of Posterior Spinal Fusion (PSF) in children and adolescents. The rate of SSIs after PSF varies from 0.9% to 3% for idiopathic scoliosis and can be as high as 8.7% for neuromuscular scoliosis due to cerebral palsy. Major factors associated with SSIs include patient’s underlying pathology and comorbidities, the complexity of the procedure, and many extrinsic factors such as the expertise of the surgeon, perioperative antibiotic prophylaxis, length of hospitalisation, and perhaps environmental factors in the operating theatre and the hospital infections rates of the centre at which the procedure is being performed. We sought to identify the overall rate of SSI and possible modifiable risk factors for SSI in children and adolescents treated with PSF in Penteli Children’s Hospital. Methods: A total of 46 consecutive patients accounting for 67 surgeries performed between 2019 and 2024 were included in this retrospective observational study. Inclusion criteria were as follows: patient’s age at the time of surgery less than 22 years, patients treated with PSF only, and more than 9 months postoperative observation. SSI was defined as infection occurring within 90 days of the index procedure. Results: The rate of deep SSI in our department was 6.0%. Older age at the time of surgery and a history of previous spine surgery were risk factors for developing an SSI. Conclusions: Between 2019 and 2024 four cases of deep SSI occurred in our institution, leading to a rate of 6.0% among all PSF cases for this specific time period. Higher age and a history of previous spine surgery were risk factors for SSI in this cohort of patients. Full article