PHILIP S. BARIE, M.D.

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The Surgical Infection Society updated its evidence-based guidelines for preventing and treating intra-abdominal infections in children, covering antibiotic selection, duration, timing, pathogen-specific treatment, and hospital stewardship programs. The update was based on a systematic review of literature from 2016 to 2024 evaluated using the GRADE framework. The resulting recommendations provide the most current guidance for clinicians managing conditions like appendicitis, peritonitis, and intra-abdominal abscess in pediatric patients.

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Researchers reviewed 49 studies on artificial intelligence used in emergency surgery and found that AI tools show promise for predicting surgical risks before operations, but they're not yet ready for widespread use in real hospitals. Most of these AI systems only use basic patient data from electronic health records and haven't been tested outside the single hospital where they were created, and almost none have received regulatory approval or been proven fair across different patient populations. The field needs to move beyond just predicting preoperative risk—AI should help surgeons make real-time decisions during emergency situations—and developers must test their tools in multiple hospitals, include diverse types of patient data (like imaging and lab results together), and design systems that actually fit how surgeons work before deploying them into emergency operating rooms.

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A Surgical Infection Society systematic review and guideline development process evaluated whether triclosan-coated suture reduces surgical site infections after abdominal operations. Across 30 studies involving nearly 98,000 patients, 57% showed a reduction in infection with triclosan suture, and overall evidence quality was rated high. The Society recommends using triclosan-coated suture for wound closure in abdominal surgery based on a small but statistically significant absolute risk reduction.

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A declaration signed by 366 healthcare workers and scientists from 119 countries called for global solidarity to address what they described as an unprecedented convergence of threats to public health — including political interference in science, erosion of trust, inadequate health system preparedness, and growing antimicrobial resistance. The statement emphasized the need for One Health approaches, transparent evidence-based decision-making, and equitable health systems. It reflects a coordinated international response to a perceived crisis in the integrity of global health governance.

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After India passed a Good Samaritan Law in 2016 protecting bystanders who help road accident victims from legal and financial liability, this study compared survey data from before and after the law. Willingness to help jumped by 65% and fear of legal consequences dropped by 81%. The law worked, but awareness remained much higher in smaller cities than in major metros, pointing to a need for targeted public education campaigns.

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This survey of five major Indian hospitals found that programs to track and prevent surgical site infections—which are common but largely preventable—varied widely and had significant gaps in oversight, education, and data infrastructure. Drug-resistant bacteria rates were high across all sites, with one hospital reporting that nearly 58% of certain infections involved resistant organisms. The findings underscore an urgent need for standardized stewardship programs across India.

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Researchers compared 678 patients who had a urinary catheter during appendix surgery to 303 patients who didn't have one, to see whether the catheter prevented bladder injuries and what complications it caused. They found that catheters didn't prevent bladder injuries (none occurred in either group), but patients with catheters had more urinary tract infections and other catheter-related problems, while patients without catheters had no urinary retention or complications. The takeaway: hospitals should stop routinely placing urinary catheters during appendix surgery, since the catheters cause more harm than good without providing any protective benefit.

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Researchers trained artificial intelligence to evaluate whether surgical instructors were giving high-quality feedback to medical students learning a procedure on simulators, and found that students who received better-quality feedback improved their technical skills more than those who received lower-quality feedback. The AI judged feedback based on five standards: whether instructors actually watched the student perform, gave specific comments about the technique, praised what the student did well, suggested exactly what to improve, and gave clear action steps. Students whose instructors used these techniques more often showed significantly greater improvement in their procedure scores. This matters because good feedback is one of the most powerful ways to teach surgical skills, but it's inconsistent and hard to deliver—so using AI to standardize and improve feedback quality could make surgical training more effective across all hospitals and ultimately lead to better patient care.

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A national trauma database study found that firearm injuries increased 31% in 2020 compared to an average annual increase of 2.4% in the preceding decade, with the largest surges at Level I trauma centers that already had high firearm injury volumes. Despite the dramatic increase in injuries, adjusted mortality rates did not change significantly over the 10-year study period. The findings document a public health emergency disproportionately burdening high-volume trauma centers without a corresponding increase in fatality rates.

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Researchers analyzed New York City emergency medical services call volume before and during the first year of the COVID-19 pandemic and found that total EMS calls fell by 22% after the pandemic began in April 2020. Contrary to expectations, both trauma and medical calls declined similarly — not just trauma calls — and the drop was consistent across all five boroughs. The data suggest that fear of infection caused people to avoid seeking emergency care even for urgent non-COVID conditions.

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The Surgical Infection Society surveyed its members about how they evaluate post-operative fever in eight clinical scenarios. The only items achieving consensus were checking a complete blood count and performing a physical exam; there was no agreement on when to culture blood or urine, order imaging, measure inflammatory biomarkers, or start antibiotics. The findings expose a significant lack of standardization in a very common clinical situation and identify specific scenarios where formal guidance is most needed.

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A survey compared nurses who were deployed to temporary intensive care units created during the COVID-19 surge to those deployed to permanent ICUs, and found that temporary ICU nurses reported significantly less improvement in skills like ventilator management and sedation infusions. Nurses in temporary units also felt less prepared to manage critically ill patients overall. The study shows that rapid training programs alone are insufficient for nurses with no critical care background deployed to fully independent practice environments.

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The Global Alliance for Infections in Surgery published a position statement on managing intra-abdominal infections, emphasizing that good outcomes require four components working together: fast and accurate diagnosis, timely and adequate source control, short-course antimicrobial therapy guided by pharmacokinetic principles, and hemodynamic support in severe cases. The statement stressed that a personalized approach must account for the extent of infection, likely pathogens, patient condition, and immune status. It serves as a practical guide for front-line surgeons globally.

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A phase 3 randomized trial tested whether placing a slow-release doxycycline polymer directly into a surgical incision before closure reduced infections after colorectal surgery. The overall rate of the composite endpoint — infection, reoperation, or death — was not significantly different between groups. However, in patients with incisions longer than 20 cm and in those with at least one comorbidity, the treatment did reduce the primary outcome, suggesting potential benefit for higher-risk subgroups.

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The Surgical Infection Society published its 2024 update to its comprehensive guidelines for managing intra-abdominal infections in adults, covering antibiotic selection and duration, source control timing, specific pathogen treatment, and antimicrobial stewardship. The guidelines were based on a systematic review of evidence from 2016 to early 2024, graded using the GRADE system. The document provides clinicians with the most current evidence-based recommendations for one of the most common and serious conditions managed by surgeons.

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Using a national trauma database of over 55,000 patients undergoing hemorrhage control surgery, researchers found a small but statistically significant association between higher operative volume and lower in-hospital mortality. However, the survival benefit disappeared entirely when the top 5% of highest-volume centers were excluded, meaning only a very small number of extraordinarily busy centers drive the relationship. Since centralizing trauma care to that degree is impractical, the study calls for identifying and disseminating the practices that make these centers effective.

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A joint guidance document from the Surgical Infection Society and Alberta Health Services addressed whether the standard recommendation to delay elective surgery for four to twelve weeks after COVID-19 infection should still apply given the emergence of the milder Omicron variant. Multiple knowledge gaps were identified — including the lack of data on Omicron-specific surgical outcomes and how to risk-stratify patients with long COVID — making definitive recommendations impossible at the time. The document frames the outstanding questions that subsequent guidelines will need to address.

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This expert review examined whether uncomplicated acute appendicitis, uncomplicated acute cholecystitis, and mild uncomplicated diverticulitis are truly infectious diseases or primarily inflammatory conditions. The evidence is strongest that mild diverticulitis does not benefit from antibiotics and is not primarily infectious; the data are intermediate for cholecystitis; and evidence is insufficient for appendicitis. The review suggests these conditions may be better understood as manifestations of gut microbiome disruption, which has important implications for antibiotic stewardship.

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A cross-sectional study of 1,557 healthcare workers at a California academic hospital early in the COVID-19 pandemic found that 10.8% were seropositive for SARS-CoV-2, suggesting many infections were missed by daily symptom screening. Among workers not previously screened, additional risk factors for seropositivity included younger age, working in administration, and exposure to COVID-19 outside of work. The data show that asymptomatic and non-clinical workers represent a significant reservoir of undetected infection.

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An expert panel addressed six foundational questions about surgical antibiotic prophylaxis — such as which agents to use, when to give them, and how long to continue them — and produced a set of consensus principles intended for global surgical practice. The guidance reinforces key tenets including administration within 60 minutes before incision, re-dosing for long operations, and stopping prophylaxis within 24 hours after surgery. The document aims to standardize prophylaxis practice across settings and specialties.

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A Surgical Infection Society survey on how members close surgical incisions at the end of different operations found consensus in only a few scenarios — primarily elective splenectomy and hemodynamically unstable trauma patients. Most common and contaminated surgical scenarios showed high practice variability, with the Shannon index quantifying the degree of disagreement. Prospective studies and guidelines are needed to standardize decision-making at wound closure, which directly affects infection rates.

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The Surgical Infection Society surveyed members about how they manage incisions that show signs of surgical site infection, finding that consensus existed only for the most clear-cut scenarios — observation for mild redness, opening for purulence. Most scenarios involving intermediate presentations showed wide variation in whether surgeons would observe, open the wound, or prescribe antibiotics. The variability highlights the need for clearer, evidence-based guidance for a very common postoperative complication.

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A retrospective study of 252 critically ill COVID-19 patients on mechanical ventilation found that 39% developed hypertriglyceridemia from propofol infusions, with obese patients at twice the risk. Triglyceride elevations occurred at lower cumulative propofol doses and earlier than previously described in non-COVID patients. The findings point to the need for more frequent triglyceride monitoring in COVID-19 patients receiving propofol, particularly those who are obese.

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Researchers used rotational thromboelastometry to characterize the clotting profile of 44 critically ill COVID-19 patients and test whether it could predict who would develop blood clots. The test confirmed a hypercoagulable state in all patients, and one specific measure — the maximum clot strength in the fibrinogen assay — added modestly to D-dimer in predicting thrombosis. D-dimer remained the strongest single predictor, and the thromboelastometry test was most useful in a narrow range of intermediate D-dimer values.

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A single-center study of 1,219 trauma patients found that injury severity and mechanism — not insurance status — determined how quickly patients moved from the emergency department to definitive care. However, uninsured patients were significantly less likely to be admitted and more likely to have shorter hospital stays, reflecting outcome disparities that emerge after the initial acute phase. The findings suggest that initial emergency protocols protect equity, but downstream care decisions do not.

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A Surgical Infection Society survey on antimicrobial duration in surgical practice found broad consensus that single-dose prophylaxis is appropriate for most operations, but wide disagreement on how long to treat most infections. Only two of twenty clinical infection scenarios achieved more than 60% consensus despite existing high-quality evidence and published guidelines. The findings expose a persistent disconnect between available evidence and clinical practice regarding antibiotic duration.

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A global survey of 304 healthcare workers across 72 countries assessed infection prevention and antimicrobial stewardship practices in surgical facilities. Most hospitals reported having infection prevention teams and prophylaxis protocols, but nearly a quarter lacked SSI surveillance systems or antibiotic use monitoring. COVID-19 was credited by 80% of respondents with raising awareness of infection prevention, and the survey results informed 15 consensus statements aimed at improving organizational structures for surgical infection control.

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A review of 173 trauma deaths at one Level I center found that 91% of patients died after some form of limitation of care — do-not-resuscitate orders, no escalation, or withdrawal of treatment — rather than failing all resuscitative efforts. Older age and female sex were associated with higher odds of having care limited, while more extensive injuries and complications were associated with lower odds, likely because those patients died before any formal limitation was implemented. Understanding these patterns can help clinicians approach end-of-life discussions more proactively.

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Researchers measured blood levels of ertapenem — an antibiotic commonly used for surgical prophylaxis — in 10 obese patients and used the data to model drug exposure in a simulated population. Standard 1-gram doses achieved adequate coverage against bacteria with low resistance thresholds for surgeries up to four hours. For bacteria with higher minimum inhibitory concentrations, standard dosing may be insufficient, and dose adjustments may be needed for longer operations or more resistant organisms.

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A prospective study of 111 critically ill COVID-19 patients who all received full-dose anticoagulation from admission found that 28% still developed thrombosis and 20% had bleeding complications. Neither thrombosis nor bleeding predicted mortality in multivariable analysis; instead, higher illness severity scores, higher D-dimer concentrations, and a longer activated clotting time were the mortality predictors. The findings support continuing full-dose anticoagulation in COVID-19 critical illness while identifying which markers best predict death.

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Participants watched two instructional videos on hemorrhage control — one explaining the rationale and one demonstrating technique — then completed a standardized skills exam. Confidence in performing direct pressure, wound packing, and tourniquet application rose from baseline rates of 8-29% to 96-100% after the video and skills session. The study describes a scalable video-based model for disseminating Stop the Bleed training more widely than in-person courses alone allow.

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A quality improvement initiative in a 20-bed surgical ICU implemented education, expanded multidisciplinary rounds, and an electronic documentation template to improve nurses' recognition and reporting of clinical deterioration. Since implementation, no patient harm or death related to failure to escalate has occurred, and nurses reported greater confidence in knowing when to call the attending physician directly. The intervention demonstrates how a structured communication program can eliminate preventable adverse outcomes in critical care.

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Comparing firearm purchase and violence data from January 2019 through April 2020, researchers found that firearm purchases surged nationally and even more sharply in New York State in March 2020 as COVID-19 spread. Firearm incidents also increased in New York State during this period. However, by April 2020, both purchases and incidents had partially returned toward baseline, and shelter-in-place orders showed no statistically significant independent effect on firearm violence.

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A review evaluated scientific progress on the 15 priority research questions the Surgical Infection Society identified in 2006. Six of the fifteen questions — 40% — had been definitively answered in the intervening 14 years, while nine remained unresolved, largely due to poor-quality or insufficient studies. The unanswered questions, including empiric antibiotics for hospital-acquired infections and appropriate dosing for obese patients, were identified as still-active priorities warranting a new research agenda from the Society.

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The Surgical Infection Society produced guidance for safely resuming elective surgical services during ongoing COVID-19 infection surges and backlogs of millions of delayed cases globally. The document addressed protecting surgical teams from exposure, operating on COVID-positive patients, managing patient expectations, and using enhanced recovery protocols to conserve resources. The guidance emphasized that institutional commitment and equitable access across patient populations are essential for a successful restoration of surgical services.

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A previously healthy young man with severe COVID-19 developed sudden weakness in all four limbs, and imaging revealed a lesion in his cervical spinal cord consistent with a spinal cord infarction rather than inflammation. He did not improve with high-dose steroids, which are used for inflammatory myelitis. The case adds to an emerging literature on vascular and neurological complications of COVID-19 beyond the lungs and highlights the need to consider spinal cord stroke in COVID-19 patients who develop acute paralysis.

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Researchers developed a method to rapidly expand virus-specific T cells from recovered COVID-19 patients using artificial antigen-presenting cells carrying SARS-CoV-2 peptides, generating large quantities of immune cells in seven days. The expanded cells showed strong virus-specific activity and a memory T cell profile that could support a robust immune response. The approach was also tested with cytomegalovirus as a proof of concept, suggesting it could be adapted for future viral pandemics.

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Using a modified Delphi process involving 124 Surgical Infection Society members over three rounds, researchers identified 15 priority research questions for the field of surgical infections for the next decade. The most common themes were antibiotic prophylaxis, surgical site infection prevention, and improved diagnostics. The top three research priorities were non-antimicrobial treatments for infections, optimal duration of antibiotic therapy for bloodstream infections, and treatment duration for necrotizing soft tissue infections.

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This historical and evidence-based review traced the evolution of appendicitis management from early surgical mortality rates of 10% through the introduction of antibiotics, laparoscopy, and modern imaging, leading to the current era of randomized trials comparing surgery to antibiotics alone. Recent trials show that antibiotic treatment is non-inferior to surgery in some patients, but one-year failure rates are approximately 30% and likely increase with longer follow-up. Laparoscopic appendectomy remains the treatment of choice for most patients, particularly those with a fecalith, while non-operative management is a reasonable patient preference-driven option for selected cases.

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A retrospective review of 64 COVID-19 ICU patients found that 80% developed skin failure — wounds and pressure injuries — with 85% of those reaching stage 3 or higher severity. Patients who developed skin failure had higher levels of inflammatory markers and were more likely to experience longer mechanical ventilation and ICU stays. The study argues that skin failure in COVID-19 reflects systemic disease-related organ dysfunction rather than preventable nursing care failures and should not be categorized as a hospital-acquired condition.

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A study evaluated whether the Stop the Bleed hemorrhage control training program improved participants' self-assessed confidence in performing direct pressure, wound packing, and tourniquet application. Both participants with and without prior emergency training showed significant improvement after the combined video and hands-on session, with the greatest gains in those with no prior experience. Participants universally said the training would be more effective if the training mannequins realistically simulated bleeding, pointing to a clear target for program improvement.

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During the COVID-19 surge in New York, a hospital rapidly expanded ICU capacity from 104 to 283 beds and trained 413 nurses from non-critical care backgrounds in a three-hour curriculum covering ventilator management, shock, pharmacotherapy, and renal replacement therapy. The program was completed within 10 days and the nurses continued practicing in COVID ICUs for months. The experience demonstrates that rapid, tailored training is feasible at scale but notes that non-ICU nurses without prior critical care experience cannot be expected to function independently from a short course alone.

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In a study of 72 COVID-19 ICU patients undergoing duplex ultrasound screening for deep vein thrombosis, 17% were found to have lower extremity clots, and D-dimer concentrations were dramatically higher in affected patients — with a cutoff of 3,000 ng/mL achieving 100% sensitivity and 51% specificity. Standard clinical scoring tools for DVT had no utility in this population. The data support using D-dimer-guided screening and suggest that therapeutic anticoagulation should be considered prophylactically in all critically ill COVID-19 patients.