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New Crucial Literature: The Science You Need to Know

New Article Suggests Surgeons Should be Antimicrobial Stewards to Reduce Risk of SSI

Miranda D, Mermel LA, Dellinger EP. Perioperative Antibiotic Prophylaxis: Surgeons as Antimicrobial Stewards. J Am Coll Surg. 2020.

This article offers useful perspectives for surgeons to consider when making clinical decisions regarding use of perioperative prophylactic antimicrobial drugs as a means of reducing risk of surgical site infections (SSI). Data relevant to effective use of perioperative prophylaxis are reviewed from the viewpoint of achieving optimal antimicrobial stewardship. The guiding principles of antimicrobial stewardship include use of drugs that are known to be effective, using appropriate dosing and timing of dosing, stopping antimicrobial drug use when the drug is no longer needed or outside of the known effective time interval, and avoiding practices that may increase the risk of microbial resistance to the drug (e.g., prolonged use, late dosing). The authors emphasized data showing that administration of antimicrobials shortly before making the surgical incision is an effective strategy; providing the first dose of antimicrobials at a time after the operation is completed was identified as an ineffective practice for preventing SSI and increases the risk for increasing microbial resistance. Similarly, prolonged use (days beyond completion of the operative procedure) has been shown to increase microbial resistance according to data cited in the report. Convincing data also are available showing that improper use of antimicrobial prophylaxis increases risk for postoperative C. difficile infection. To summarize, the data reviewed showed that optimal antimicrobial stewardship can be achieved in use of perioperative prophylaxis for prevention of SSI if the right drug is administered at the right time, in the right dose, and discontinued at the conclusion of the procedure.

Women with Breast Cancer Treated for DCIS Show Increased Mortality Compared to Those Not: New Studies Analyzes the Data

Giannakeas V, Sopik V, Narod SA. Association of a Diagnosis of Ductal Carcinoma In Situ With Death From Breast Cancer. JAMA Netw Open. 2020;3(9):e2017124.

The authors queried the SEER database in an attempt to determine the risk of death from breast cancer in women diagnosed with ductal carcinoma in situ (DCIS) and treated with conventional measures including surgical excision of the lesion and radiotherapy, if indicated. Follow-up data (median of 9.2 years) were obtained from a cohort of 144,524 women who had no history of cancer at the time DCIS was diagnosed. The data analysis showed that the risk of death from breast cancer in the cohort was threefold higher than the risk in a comparison group of women with no diagnosis of breast cancer or DCIS. The authors concluded that the current treatment methods for DCIS do not eliminate risk of death from breast cancer. These data have important implications for patient counseling and surveillance during long-term follow-up.

Article Suggests Both Immediate Prophylactic Embolization and Surveillance then Embolization Approach to Splenic Trauma Lead to High Rates of Spleen Rescue

Arvieux C, Frandon J, Tidadini F, et al. Effect of Prophylactic Embolization on Patients With Blunt Trauma at High Risk of Splenectomy: A Randomized Clinical Trial. JAMA Surg. 2020.

Dodwad SJ, Wandling MW, Kao LS. How Should the SPLASH Trial Inform the Care of Patients With Blunt Splenic Trauma? JAMA Surg. 2020.

This article presented data from a randomized clinical trial comparing prophylactic splenic embolization (pSAE) with embolization performed for specific indications (SURV). The authors noted that splenic salvage is a worthy goal for management of patients with splenic trauma since complications of splenectomy are significant in both the early and late stages of management (infectious and thromboembolic complications). Since 85 percent of patients with high-risk splenic injury are hemodynamically stable on admission, splenic artery embolization is potentially valuable for reducing the risk of splenectomy and its complications. Whether pSAE or SURV provides the best rate of splenic rescue is unknown. Outcomes data from 117 randomized patients were presented; successful splenic rescue was defined as CT imaging evidence of more than 50 percent functioning spleen at one month following embolization. The data analysis showed that splenic salvage rate was 93 percent with no difference in success rates for pSAE when compared with SURV. Complication rates were comparable in both groups; no serious adverse events were observed. Patients in the SURV group had a higher number of pseudoaneurysms at the time of angiography and experienced longer hospital stays. The need for SURV increased with increasing injury grade. The authors concluded that either strategy was acceptable for management of high-risk splenic injuries in hemodynamically stable patients. In the accompanying editorial, Dodwad and coauthors noted that these data provide an excellent basis for discussions of options with injured patients and their families.

New Study Shows Povidone-Iodine Nasal Solution Effectively Inactivates COVID-19 and Discusses Implications

Frank S, Brown SM, Capriotti JA, Westover JB, Pelletier JS, Tessema B. In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2. JAMA Otolaryngol Head Neck Surg. 2020.

Frank and coauthors performed an in vitro study of the effectiveness of povidone-iodine nasal solution in eliminating the SARS-CoV-2 virus. They studied various concentrations of povidone-iodine; concentrations were chosen because of safety and persistence of antiviral activity in the intranasal environment. The nasal spray inactivated the virus within 15 seconds of contact. The authors concluded that these data suggest potential benefit from administration of povidone-iodine nasal solution for prevention of COVID-19 transmission, particularly for high-risk groups such as health care workers. Additional clinical studies are needed to determine in vivo effectiveness.

Does Wearing Simple Eyeglasses Reduce Risk of Transmission of COVID-19? New Report Examines Data in a Chinese Hospital

Zeng W, Wang X, Li J, et al. Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection. JAMA Ophthalmol. 2020.

Maragakis LL. Eye Protection and the Risk of Coronavirus Disease 2019: Does Wearing Eye Protection Mitigate Risk in Public, Non-Health Care Settings? JAMA Ophthalmol. 2020.

The authors reported observational data from 276 patients with COVID-19 infection admitted to a single hospital in China; 5.8 percent of the group wore eyeglasses for more than eight hours/day. The authors noted that the proportion of patients in the general Chinese population who wore eyeglasses for more than eight hours/day was 31.5 percent. These observations suggested that eyeglass wearing might be associated with some protection from transmission of viral infection by shielding the eyes from airborne viruses and/or reducing the risk of transmission from touching the eyes and surrounding facial surfaces. In the accompanying editorial, Maragakis noted that eye protection is recommended for health care workers caring for patients with COVID-19 infection; she noted that, according to the framework for interpretation of epidemiologic studies proposed by Austin Bradford Hill, the data presented suggest that the observed difference in eyeglass wearing probably did not occur by chance, but causality was not shown. Additional observational and prospective studies are needed to determine if eye protection might be a useful measure to prevent COVID-19 transmission in the general population.