عفونت زخم

Post-operative infection is one of the most common complications following mandibular fractures. This study aims to assess the prevalence of post-surgical infection between patients with and without opioid abuse.

In this prospective cohort study, the prevalence of post-operation infection was documented in patients who had a mandibular fracture and underwent open reduction with rigid fixation (ORIF). In group1, patients with no opioid abuse, and in group 2, patients with opioid abuse were placed. Age, gender, the time between trauma and operation, plaque index, and white blood cell (WBC) counts of the patients were registered. Fisher's exact test was applied to compare the prevalence of infection between groups.

A total of 150 patients were included in the study, 20 of whom had a history of opioid abuse. In the first group, eight (6.2%) out of 130 patients had signs and symptoms of infection after the operation, and in the second group, 11 people (55%) out of 20 patients experienced infection. There was a statistically significant difference between the two groups regarding the prevalence of postoperative infection (p<0.001).

It seems that opioid abuse along with smoking and poor oral hygiene can lead to postoperative infection in patients with mandibular fracture.

The use of antibiotic prophylaxis in the treatment of burns is a controversial issue. Many specialists start antibiotic treatment after the patient is admitted to prevent infection, while in most cases, antibiotic use is not necessary. The aim of the present study was to determine the relationship between the use of antibiotic prophylaxis on mortality, infection and drug resistance in burn patients without sepsis symptoms admitted to Amir al-Momenin Burn Injury Hospital.

The present analytical-cross-sectional study was conducted in 2020-2021 at Amir al-Momenin Burn Injury Hospital, Shiraz, Iran. 2982 patients were included in the study. Patients' information, results of bacterial culture and antibiotic resistance of isolated isolates were extracted from burn patients' registry system and health information system. Descriptive statistics and the collected data were presented in tabular form. Quantitative data were summarized as mean and standard deviation and qualitative data as frequency and percentage graphs. Statistical analysis was analyzed for the association of results using paired t-test and chi-square. The level of statistical significance in all tests was considered P≤0.05.

Antibiotic resistance in hospitalized patients with prophylaxis treatment was 54.30%. The rate of mortality and re-hospitalization of patients in patients with no antibiotic prophylaxis was zero; In addition, the blood, liver and kidney factors of the patients were within the normal range. There was no significant difference between platelet levels, alkaline phosphatase serum level, alanine aminotransferase, blood urea nitrogen level and its ratio to creatinine (P≥0.05) on the first day of hospitalization and at the time of discharge. On the other hand, there was a significant difference between the levels of white blood cells, neutrophils and albumin (P<0.001) in the first three days of hospitalization and the time of discharge.

The use of prophylactic antibiotics had no effect in the treatment of burn diseases without infection, and in order to reduce microbial resistance, it is better to avoid unnecessary use of antibiotics in burn areas.

Recently, it has been found that tyrosol and farnesol can replace antibiotics due to their known antimicrobial and medicinal effects. Niosomes have been extensively researched for drug delivery during the last few decades, and their efficiency has been proven. The current study aimed to investigate the physical properties and antibacterial effects of niosomes loaded with tyrosol and farnesol.

Nanoniosomes loaded with farnesol and tyrosol were synthesized by the thin-layer hydration method. The physical properties of nanoformulations were measured using dynamic light scattering and scanning electron microscopy (SEM), and the release of farnesol and tyrosol from the nanocarrier was examined using a dialysis bag. In addition, Fourier-transform infrared spectroscopy was used to check the functional groups, and the stability studies of nanoniosomes were performed at temperatures of 25 °C and 4 °C for two months. Finally, its antimicrobial properties against the bacterial pathogens Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), and Pseudomonas aeruginosa (P. aeruginosa) underwent investigation. The cytotoxicity of free and farnesol- and tyrosol-loaded nanoniosomes on human foreskin fibroblast cells was also evaluated by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide method.

The size of nanoniosomes and farnesol- and tyrosol-loaded nanoniosomes was estimated to be 208 nm and 240 nm, respectively. SEM results indicated the spherical structure of niosomes. The slow release of farnesol and tyrosol from niosomes was observed, so that almost half of the drug was released from nanoniosomes after 72 hours. Nanoniosomes loaded with the above-mentioned drugs demonstrated good stability at 4 °C for 60 days. The results of the minimum inhibitory and bactericidal concentrations confirmed the antibacterial effects of both free farnesol and tyrosol and nanoniosomes loaded with farnesol and tyrosol against all three bacterial species, although these effects were more considerable for the nanoniosomes formulation.

Nanoniosomes loaded with farnesol and tyrosol have the potential to be used in the treatment of some common bacterial wound infections. However, clinical studies are needed in this field.

Farnesol- and tyrosol-loaded nanoniosomes had strong inhibitory effects on S. aureus, E. coli, and P. aeruginosa.

Appendectomy due to appendicitis is the most common emergency surgery in the world. Appendicitis occurs mostly in the second to fourth decades of life. The aim of this study was to compare wound infection in skin repair by the two ways of subcuticular and far and near sutures in uncomplicated appendectomies in Imam Khomeini hospital, Urmia, Iran.

This study was an interventional trial that was conducted on 300 patients who underwent appendectomy and the surgical site wound was repaired with two types of subcuticular sutures and distal and proximal sutures. The patients were examined by the attending physician for signs of infection such as purulent discharge, local tenderness, fever, hematoma, redness, and drainage at the site of the surgical wound. The final diagnosis of the infection was made by the attending physician based on the definition of the infection and according to the symptoms.

In this study, 150 people had their skin repaired by the subcuticular method and 150 people by the far and near method. In terms of surgical wound infection, 3 people (2%) had infection and 147 people (98%) had no infection. In the group of skin repair by far and near method, 5 people (3.3%) had infection and 145 people (96.7%) had no infection in skin repair by subcuticular method. In total, 8 people (2.66%) had surgical wound infection and 292 people (97.33%) had no surgical wound infection, and there was no significant difference between post-surgical wound infection in the two treatment groups (P<0.05).

This study showed that there was no significant difference in wound infection in two treatment groups. However, the infection in the subcuticular skin repair group was higher than the far and near skin repair group.

The emergence of Escherichia coli resistance to common antibiotics in burn wound patients has become a controversial problem in Iran trauma and burn hospitals. The emergence of more and more drug resistance by infectious pathogens paves the way for further study of the nature of phages, and phage therapy can significantly address this crisis. In the first phase, this study aimed to isolate and identify the biochemical and molecular nature of antibiotic-resistant E. coli, which causes burn wound infections. The second phase of this study isolated the specific phages of the bacteria in these wounds and then evaluated the morphological characteristics of the phage and the host area.

In this study, 50 bacterial strains were isolated from specialized accident and burn hospitals in Isfahan, Yazd, Tehran, and Rasht. Accurate identification and study of antibiotic resistance profile was performed by disk diffusion method on agar. The 16S rRNA coding gene was amplified using the PCR technique. The PCR product was then sent to "Gene Azma" laboratory for sequencing. In order to isolate the possible phages, a sample was taken from the raw wastewater (entrance of the northern treatment plant) in Isfahan, Iran. Phage morphology was assessed and reported by transmission electron microscopy (TEM); moreover, phage plate count and host range were assessed for this bacteriophage.

Bacterial 16S rRNA sequence was located in NCBI with MW844043 Accession Number. The specific phage PϕBw-Ec01 was significantly able to infect resistant E. coli bacteria. TEM demonstrated that the isolated phage was dsRNA and belonged to the family Cystoviridae with prototype ɸ6. PϕBw-Ec01 lytic phage was highly effective in inhibiting the growth of E. coli strain ADB_66-1 in this study.

The results of this report showed that E. coli isolated from burn wounds of hospitalized patients had high resistance to common antibiotics. The studied phage in this study can be a good choice and a suitable option for controlling and inhibiting these resistant pathogens in the burn wounds of hospitalized patients. It is hoped that with more extensive research on the identity and study of the effectiveness of phages, the rate of bacterial lysis will be investigated. This issue will reduce the microbial load caused by resistant and infectious pathogens and can be used as an effective adjuvant against burn wound infections.

Episiotomy is associated with some complications such as pain, infection and discomfort of perineal sutures for mothers. This study was performed with aim to compare the complications of episiotomy repair in continuous versus interrupted suturing technique in primiparous women.

This single blind randomized clinical trial study was performed in 2017-2018 on 140 primiparous women referred for vaginal delivery in Niknfas maternity hospital in Rafsanjan city. The subjects were randomly divided into two groups (n=70 in each group). Repair of episiotomy was done in one group with interrupted and in another group with continuous suturing technique. The tools were demographic and midwifery characteristics form, visual analog scale and surgical site infection. Pain severity score, analgesia use, wound infection and discomfort stitches were assessed 2 hours, 3-5 days, 2 and 6 weeks after delivery. Data were analyzed using SPSS software (version 22) and Chi-square, Independent-t and Mann-Whitney tests. P<0.05 was considered statistically significant.

The pain severity score and discomfort stitches was lower in continuous group than interrupted group (p<0.05). Use of analgesia at these times was not significantly different between the two groups (p>0.05). Wound infection in 3-5 days and 2 weeks after delivery was lower in continuous group (p<0.05). Also, the repair time, number of threads and lidocaine used ampoules were less in the continuous method (p <0.05).

Pain intensity, discomfort stitches and episiotomy infection were less in continuous method compared to interrupted repair; it seems cost-effective due to less use of threads and analgesia.

Wound infections, as a common nosocomial infection, are contributing factors to mortality. Determining the prevalence of common pathogens causing wound infections and their antibiotic susceptibility patterns plays a key role in the rapid treatment and prevention of such infections. This study aimed to analyze wound infections in hospitalized patients in a university hospital in Tehran and determine the antimicrobial susceptibility patterns of the isolated bacteria.

Data about 563 hospitalized patients from different wards of a university hospital, who had participated in the study from March 2017 to June 2019, were collected, and sample collection from the wounds was carried out. For the identification of pathogens, we used standard bacteriological techniques. The disk diffusion method was used to determine the antimicrobial susceptibility patterns of the isolates. Data were analyzed using SPSS 18.

Among five hundred and sixty-three samples, 382 (67.7%) had positive cultures. The most common isolated pathogens were Staphylococcus aureus (19.2%), Escherichia coli (17.7%), Acinetobacter spp. (14%), Pseudomonas aeruginosa (13.6%) and Klebsiella spp. (12.9%). Fifty percent of the Staphylococcus aureus isolates were resistant to cefoxitin. Escherichia coli and Acinetobacter spp. were resistant to most of the antibiotics.

Our study found that pathogens causing wound infections were highly resistant to commonly prescribed antibiotics. Identifying the etiological agents of wound infection and their antibiotic susceptibility patterns is essential, especially for the treatment of elderly patients and those hospitalized in intensive care. This can assist in designing a therapeutic strategy for these types of infections.

One of the most common infectious diseases in diabetes mellitus is diabetic foot ulcer infection. This study was designed to identify the microorganisms that cause diabetic foot ulcer infection and their antibiotic resistance to improve the rational administration of antibiotics in experimental therapy.

The present descriptive cross-sectional study is retrospective. This study was performed on 200 patients admitted with a diagnosis of diabetic foot ulcer infection in the infectious ward of Razi Hospital in Ahvaz during the years 1394 to 1397. Finally, 126 of them were included in the study. Statistical analyzes were performed using SPSS software (v22) (IBM, USA).

In this study, 61 cases were female (48.4%), and 65 were male (51.6%). 18 cases (14.3%) were PEDIS 2, 71 cases (56.3%) were PEDIS 3, 37 cases (29.4%) were PEDIS 4. In this study, gram-negative bacteria 50.3% and gram-positive bacteria 49.7% were the cause of infection, and the three main strains were Staphylococcus aureus (41.3%), Escherichia coli (27.8%), and Staphylococcus epidermis (24.6%). 9.6% of Staphylococcus aureus were resistant to methicillin, and 5.7% of Escherichia coli were punk resistant. The lowest resistance was observed in gram-negative and positive bacteria to Meropenem and imipenem and the highest resistance to ciprofloxacin and clindamycin antibiotics.

it is necessary to study the causative strains and their antibiotic resistance alternately in each region. Progressive resistance to clindamycin and ciprofloxacin also reduces the effectiveness of these drugs in experimental therapies.

Staphylococcus aureus is an opportunistic pathogenic bacterium that can provide invasive conditions by secreting various toxins. It is involved in the development of skin infections, such as swollen and ulcers. Today, one of the main problems is the treatment of Staphylococcus aureus resistant strains. The aim of the current study was to detect virulence factors and antibiotic resistance among strains isolated from wound infections of children who referred to Tehran Children’s Medical Hospital in 1396-97. A total of 59 strains of Staphylococcus aureus isolated from wound infection were collected during one year. Staphylococcus aureus was detected using biochemical tests. For antibiotic susceptibility test, antibiotic disks (Mast، UK) were used according to the CLSI 2017. For detection of virulance genes, including nuc، mecA، tsst-1، hla، hlb، hld، eta، etb، etc, PCR method was used. Vancomycin and linezolid were sensitives for all isolates and the highest resistance antibiotic was penicillin with 98.3%. The frequency distribution of genes s mecA، tsst-1، hla، hlb، hld، eta، etb، and etd were 59.3%, 37.7%, 71.2%, 57.6%, 96.6%, 100%, 11.9%, 27.1%, respectively. All isolates were sensitive to vancomycin and linezolid, and these antibiotics were the best choices for the first line of treatment for staphylococcus aureus strains. Since all isolates of Staphylococcus aureus were obtained from children wound infections and all of them contained oxfolitic A gene, control and disinfection measures seem to be important among children, because these strains have the potential to spread this gene among hospitalized patients.

Wound infection is not uncommon after cesarean sections. Using a first-generation cephalosporin (cefazolin) has been recommended for antibiotic prophylaxis in patients, but according to few reports, extending the spectrum of antibiotic prophylaxis by adding azithromycin to the standard cephalosporin may lead to extra protection against postcesarean infections. The relevant available data are not enough to draw a solid conclusion. This study aimed to compare the effectiveness of conventional antibiotic prophylaxis using cefazolin with a combination of cefazolin and azithromycin in reducing wound infection.
In this randomized clinical trial, candidates of cesarean section were categorized in two groups; cases (n=85) who received intraoperative cefazolin plus postoperative oral azithromycin (500 gr) and controls (n=86) who received intraoperative cefazolin only. The incidence rate of surgical wound infection by 30 days postoperation was compared between the two groups.
Cesarean sections were emergency in 80% of cases and 89.5% of controls (p=0.08). Postcesarean incisional wound infection developed in 4.7% of controls, whereas no patient in the case group had such infection (p=0.12).
Compared to cefazolin alone, a combination of azithromycin and cefazolin was more effective in preventing postcesarean incisional wound infection, the difference was not significant. Nonetheless, owing to this advantageous clinical consequence using a combination of these two antibiotics instead of cefazolin alone is recommended.

Multiple-drug resistance (MDR) is one of the medical challenges in medicine. The aim of present study was molecular identification of multiple-drug resistant bacterial isolates in wounds of patients in Ahvaz City, Iran, hospitals, and detection of the effect of bee propolis ethanol extract on these bacteria.
120 samples was obtained from bed, burn, and diabetic foot wounds of patients hospitalized in 5 hospitals in Ahwaz City from May to July 2016. Multiple-drug resistant isolates were selected using disk diffusion method and were identified via sequencing 16SrRNA gene. Propolis ethanol extract was prepared using soaking method and its effect as an antibacterial agent was tested on the isolates by well diffusion and microdilution methods.
Findings: 6 multiple-drug resistant isolates including Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis were identified among 25 antibiotic-resistant isolates from different wounds. The concentration of 25 mg/ml of propolis ethanol extract was effective on Gram-positive bacteria in well diffusion method. In microdilution method, the most sensitivity was seen in Staphylococcus aureus with minimum inhibitory concentration (MIC) of 25 mg/ml and minimum bactericidal concentration (MBC) of 50 mg/ml, and then in Enterococcus faecium, and Enterococcus faecalis minimum inhibitory concentration of 100 mg/ml and minimum bactericidal concentration of 200 mg/ml. Gram-negative bacteria were resistant to all concentrations of extract in both methods.
The isolated multiple-drug resistant Gram-positive bacteria which were from problematic agents in treatment of wounds, showed high sensitivity to propolis ethanolic extract.

The selection of incisions for laparotomy depends on a number of factors such as the area that needs to explore, being emergency or elective (non-emergency), and ultimately, surgeon preference. This study aimed to compare the complications of surgical wound in two methods of midline and reverse L. incision in order to recognize the complications and benefits in any circumstances.
This cross-sectional study was performed on 68 patients who underwent laparotomy in Alzahra hospital in Isfahan City, Iran, during the years 2015 and 2016. 34 patients were enrolled in midline incision group, and 34 patients underwent reverse L incision. During the study, the severity of postoperative pain, wound infection, incisional hernia, and dehiscence were compared.
Findings: There was no significant difference between the two groups in terms of incisional hernia, wound infection, and dehiscence (P Due to the similarity of wound complications in the two groups, two different methods can be used in different conditions depending on need.

During surgery, the first and most important part of the body defense, skin barrier broked. Microorganisms can be located easily into the tissues and internal organs. Due to the limited studies in comparing the results and complications of surgical disinfection with or without chlorhexidine-alcohol spray in non-emergency abdominal surgery, this study was conducted.
The patients that undergoing elective abdominal surgery in baqiyatallah hospital (including cholecystectomy, gastrectomy, resection of the small intestine and colectomy) after obtaining informed consent, were recruited into the project. Prior to surgery, chlorhexidine was used as a spray in a cutting site. After the surgery was completed in the abdomen and before the skin was closed, an incision was taken from the edge of the surgical cutting edge with a swab for culture. Samples were transferred to the laboratory and bacterial mass count (Kant's colony) was performed. For the mean quantitative variables, standard deviation was calculated and for qualitative variables, number and percentage were reported. The data were analyzed using SPSS 20 software.
A total of 97 people were disinfected and evaluated. Of the total number, 5 (5.1%) of the cases were developed infection and 5 (5.1%) had a mass of staphylococcus epidermidis.
Due to the low number of infections and the ease of use and rapid disinfection of the site of operation by chlorhexidine, the using of this method in abdominal surgery is recommended.

According to the World Health Organization statistics, about 20 to 25% of patients admitted to the hospital are affected by different types of nosocomial infections. Burn wound infections are the major cause of mortality and morbidity in these patients. So, the aim of this study was to determine the prevalence and types of burn wound infection in burn ward of Tohid Hospital in Sanandaj in 2015.
In this cross- sectional study, all the 198 patients admitted to burn unit of Tohid hospital in Sanandaj city from April 2014 to March 2015 were studied. Variables such as age, sex, hospitalization time (season), burn percentage, location of burn ,and type of infection were studied. Chi-square test was used to analyze the data.
Of all 198 patients, 53% (105 patients) were men. The average and standard deviation of the patient's age was 30.33± 3.82. 33 patients (16.7 %) were affected by nosocomial infection. The most prevalence of burn wound infection was occurred in autumn (23.3 %) and the highest microorganism produced infections (58%) was Staphylococcus aureus. There was a significant relationship between the burn percentage and the burn wound infections (P=0.011), so that the highest rate of infection was in the patients with the burns between 11 to 30%.
Due to the high prevalence of burn wound infections in the haspitalized patients at Sanandaj's Tohid hospital, compliance with control standards of infection in this unit seems to be nessesary.

Bacteria, fungi, and viruses have the ability to colonize in burned lesions. Due to the wide use of antibacterial drugs, this colonization is increasing.These drugs induce impairment of immune system in burn patients, destruction of blood vessels, and presence of fungal agents in environment and body normal flora, colonization of fungi tends to induction of infection. The most common fungi in burn patients are Candida spp., Aspergillus spp., and other molds such as Mucorals. Nowadays, antifungals drugs cause resistance increasing in non-albicans spp., uncommon molds, and yeasts. This study aimed to determine fungal infections in burn patients.
From 111 hospitalized burn patients at Isfahan burn center, Iran, during February 2016 to April 2017, sampling was performed via pus swabs and skin scraping. Each sample divided into two parts; one for direct exam by 10% potassium hydroxide (KOH) and Giemsa staining. The second part cultured on Sabouraud dextrose agar with chloramphenicol (SC); then, incubated at 30°C for 24-48 hours, and after amplification, the polymerase chain reaction (PCR) product was purified and sent for DNA sequencing.
Findings: Out of 111 patients, only one specimen was positive in direct exam, culture criteria, and DNA sequencing, in which, Neurospora sitophila isolated and identified. In the present study, the frequency of fungal species was 0.9%.
Due to the consideration of antifungals at the early phase after burn injury, the low positive rate of fungal cultures is reasonable. This prophylaxis protocol is recommended to be considered in other burn centers.

Currently, considering the advances made in management of traumatic wounds, preventing secondary infections following these accidents is considered a serious challenge. Although using antibiotics for prophylaxis to reduce infection has become less popular, it is still discussed as a method of reducing infection. The aim of the present study is to evaluate the rate and route of antibiotic prophylaxis prescription in traumatic wounds treated in emergency department (ED) and compare it with international standards.
This cross-sectional study was carried out in the ED of Shohadaye-Hafte-Tir Hospital, Tehran, Iran. Patients with simple traumatic wounds were included via easy nonprobability method. Before wound healing, the researcher evaluated the patient’s wound regarding appearance, site, cause of injury, length and depth of the wound, time since occurrence of injury, and presence or absence of evident contamination, and determined presence or absence of indication for prescribing antibiotics based on recommendations of approved references in emergency medicine. The researcher asked the patients questions regarding receiving or not receiving antibiotic prophylaxis and its duration after the healing of the wound. Data were analyzed using SPSS-21 after gathering.
Overall, 296 patients with the mean age of 31.56 ± 14.74 years were evaluated, 816% of which were male. For 268 (90.5%) of the studied patients, antibiotics was prescribed. However, only 58 (19.6%) had indications for prophylaxis prescription. All of the patients who had indications for receiving antibiotics had received antibiotic prophylaxis. According to the results of this study, antibiotic prophylaxis was prescribed without indications in 210 (71%) of the patients. There was a significant difference (p=0.0001) between the duration of antibiotic prophylaxis prescription in this study and the standard duration recommended for simple wounds. Duration of antibiotics prescription was more than 3 days regarding wounds with evident contamination (p=0.018) and wounds with indication of antibiotic prescription (p=0.007). Sex of the patients, wound type, and anatomic site of injury did not have a significant effect on the mean duration of antibiotics prescription compared to the recommended rate (p > 0.05).
Based on the results of the present study, for 71% of the patients with simple traumatic wounds, antibiotic prophylaxis was prescribed without presence of indications and the duration of antibiotic prophylaxis prescription was longer than the standard recommendations.

In the present study, we have tried to isolate an effective lytic bacteriophages on drug-resistant Escherichia coli isolated from diabetic ulcer wounds.
Two E.coli strains were isolated by using standard methods from patients in Razi Hospital of Rasht. Waste water of the same hospital was used as a source for isolation of lytic bacteriophages. Agar layer method was used to isolate and plaque finding. Determination of host range of isolated phages was performed using five standard reference collection of E. coli. Finally, Transmission electron microscopy was used for morphological analysis of the isolated bacteriophages. Morphotype and family of isolated phages were determined based on Bradley recommendation and final version of International Committee on Taxonomy of Viruses (ICTV) report, respectively.
The results showed that the isolated bacteria were highly resistant to the antibiotics tested. Based on morphological characteristics, the separated virus belongs to siphoviridae family. Based on Bradley classification, isolated phage against strains of E.coli belongs to the morphotype B1.
The isolated bacteriophage from waste water efficiently lysed the multiresistant strains of E. coli. Therefore, bacteriophages could potentially be used as an alternative for antibiotics for treating infections by multiresistant E. coli.

Background and Sternal Wound Infection (SWI) is a serious complication of median sternotomy that increases the rate of mortality. We report our experience of managing SWI in a regional cardiothoracic unit in Mazandaran province, Iran.
We prospectively studied 4725 patients who underwent isolated coronary artery bypass grafting between March 2012 and March 2015. Information about age, sex, morbidities, surgical factors and nature of sternal wound infection were recorded. Treatment options were stratified by nature of infection, and timing and nature of management. Data analysis was done using Med calc soft ware and p-values less than 0.5 were considered significant.
Sternal wound infection occurred in 49 (1%) patients. There were 26 (0.55%) superficial and 23 (0.48%) deep SWIs. SWI patients were found to be mainly females, with diabetes or hypertension, high body mass indices and longer aortic cross-clamp time. All patients with superficial SWI were managed by skin debridement and closure. Patients with deep SWI who had surgery within 48 hours of diagnosis were managed using skin and bone debridement and sternal rewiring following mediastinal drain. The mortality rate was found to be high in patients with SWI (12.2%).
Low sternal wound infection can be achieved with an ongoing focus on appropriate infection control. SWI significantly increases the risk of mortality which could be reduced through early intervention.

Some previous studies have shown that in the surgical site infection, sterility of the surgeon’s hands is not so effective, while the other studies have shown the other way. Also some studies believe that most infections come either from pathogens of the patient’s skin or from the pathogens of the environment. This study is designed to compare the pathogens of the surgeon’s hands and surgical site for each patient with the same patient’s pathogens of the wound infection, and recognize the possible infection factor. However, there are some altering factors that make the final conclusion, difficult. Some of these factors are unknown. It is tried to match the conditions for all patients, to reduce the chance of biased results. However, some of them could not be prevented.
Methods and Materials: The current study is designed in the form of prospective cohort. In this study, 122 patients which have undergone cesarean operation in the two hospitals of Rasool Akram and Shahid Akbarabadi in the city of Tehran, are considered for the study. The method of sampling was that after washing the surgeon’s and surgeon assistant’s hands with sterile soap, a culture is taken from the grooves of their hand palms on the sheep blood agar, and after preparation of the operation site and before cutting, a culture is taken from the operation site. After 5 to 7 days, the patients are called by phone to the hospital, and their operation site is investigated. If any sign of infection including stiffness, erythma, and discharge is seen, once more a culture is taken from the operation site, and the type of pathogen of operation site and the surgeon’s and surgeon assistant’s hands and that of the wound site are compared and their relation are investigated. To reduce the chance of biased results, the type of operations are matched and all the known infectious factors, such as immune deficiency, diabetes, history of using immunosuppressor drugs, Corton, and rupture of membrane, are excluded from the study.
In this study, 122 patients have participated, which have undergone cesarean operation in Rasool Akram and Shahid Akbarabadi hospitals in Tehran. From these patients, 57% were from Akbarabadi hospital, 39% were above age of 30, 58% had urgent operation, 57% had repeated cesarean operation, 69% were obese, 9% were illiterate, 14% had hypertension or pre-eclampsy, 12% faced with tearing of operation gloves during operation, for %62 of them povidine iodine is used for washing the surgeon’s hands. The results were that in the 4.9% of cases, the surgeon’s hands culture results were positive, in 16.4% of the cases, the surgical site culture results were positive, and finally, in 6.6% of the cases, the wound infection culture results were positive. For investigation of the relation between the wound infection culture result and the other recorded parameters of the operation, the mean and standard deviation of the different parameters in the presence or absence of the wound infection are measured and compared with each other. Then, the significance of the relation is investigated with the calculation of the P Value, and with the calculation of the Odds Ratio for different parameters, their effects as a risk factor for wound infection positive culture is examined.
This study shows that the wound infection culture result has significant and direct relation with the surgeon’s hand culture result, but it rejects the significant relation between wound infection culture result and the surgical site culture result, that requires more samples and investigations for confirmation, and requires that all the samples are taken from a single hospital to reduce the chance of altering factors. This study also shows that for the wound infection culture result, these are some risk factors: age above 30, being an urgent operation, being a repeated operation, obesity, illiteracy, past medical history, hypertension or pre-eclampsy, type of washing solution (povidine iodine), and surgeon’s hands positive culture result. This study shows, as well, that for the surgeon’s hands positive culture result, being an urgent operation, and type of washing solution (povidine iodine) are some risk factors.

Wound infection treatment, particularly in chronic and bacterial poly cases, is difficult and entails heavy costs. This study was done to determine the prevalence of poly bacterial infection and antimicrobial susceptibility of wound samples from different wards.
In this descriptive study, wound sampling was prepared from 336 patients admitted to different wards of Baqiatallah Hospital in Tehran, Iran. Identification was performed based on biochemical tests including oxidase test, TSI, IMVIC, lysine decarboxylase, phenylalanine deaminase, urea, motility, catalase, coagulase, mannitol fermentation, optochin sensitivity, susceptibility to bacitracin and sulfamethoxazole, growth in Bile esculin and DNase production. Antibiotic resistance pattern of isolates was determined using disk diffusion method for 14 important antibiotics.
294 samples were positive for bacterial culture, from which 364 isolates including 11 different isolates were obtained. Out of 294 positive samples, 245 samples were mono bacterial and 54 were poly bacterial including two-bacterial (45 samples), three-bacterial (7 samples), and four-bacteral (2 samples). S. aureus (29.7%), Enterococci (15.6%), and E. coli (15.6%) were the most prevalent isolates. S. aureus-Enterococci pattern was the most common two-bacterial pattern (33%), and majority of polybacterial patterns belonging to gram negative bacteria was in surgery ward (32.5%). Antibiogram results showed high levels of antibiotic resistance in the isolates. Imipenem and amikacin were the most effective antibiotics against Gram negative isolates, and vancomycin for Gram positive isolates. Also, 71% of S. aureus isolates were resistant to oxacillin.
Variation of bacterial isolates was similar to other studies. Most of poly-bacterial wound infections were due to common nosocomial pathogens and their high rates of antibiotic resistance are extremely alarming.