Invasive group A Streptococcal (iGAS) outbreaks have been linked to Community Healthcare Services Delivered at Home (CHSDH). There is, however, very limited evidence describing the epidemiology and mortality of iGAS cases associated with CHSDH. We used routine data to describe iGAS cases in adults who had received CHSDH prior to onset and compare characteristics between CHSDH-outbreak and non-outbreak CHSDH cases, in South East England between December 2021 and December 2023. There were 80/898 (8.9%) iGAS case episodes with CHSDH prior to onset; cases were in elderly people (50% aged 85 and over), and had primarily received wound or ulcer care (93.8%), with almost all care delivered by community nurses (98.8%). The 30-day all-cause case fatality was 26.3%. Emm 1.0 was the most common type (17.5%). In this period, 5/11 iGAS outbreaks (45.4%) were CHSDH-associated, and 25 cases with receipt of CHSDH prior to onset (31.3%, Confidence Interval [CI] 21.3–42.6%) were linked to these outbreaks. On univariate analysis, CHSDH-outbreak case episodes were more likely to be associated with emm pattern genotype E (OR 6.1 95% CI 1.8–20.9), and skin or soft tissue infection clinical presentation (OR 3.6, 95% CI 1.1–12.0) than non-outbreak CHSDH cases. There may be an increased risk of propagation of iGAS outbreaks in patients receiving CHSDH, emphasizing the need for rigorous early infection prevention and control, and outbreak surveillance.

Surgical site infection (SSI) after vascular surgery is a serious complication increasing morbidity, mortality, and costs for healthcare systems. A 4-year retrospective cohort study was performed in a university hospital with patients who had undergone arterial vascular surgery below the aortic arch. Investigated variables included demographics and clinical data. Forty-four of 756 patients experienced SSI, 29 of which were superficial, five were deep, and 10 had organ/space infections. Coagulase-negative staphylococci (22%), enterococci (20%), and Staphylococcus aureus (18%) were the most common pathogens. Independent risk factors for SSIs were femoral grafting [odds ratio (OR) 6·7], peripheral atherosclerotic disease, Fontaine stages III–IV (OR 4·1), postoperative drainage >5 days (OR 3·6), immunosuppression (OR 2·8), duration of operation >214 min (OR 2·8), and body mass index >29 (OR 2·6). The application of perioperative antibiotic prophylaxis was an independent protective factor (OR 0·2). Patients with certain risk factors for SSIs warrant special attention for infection prevention.

The aim of this study was to investigate whether an extended course of prophylactic antibiotic could reduce the wound infection rate in a subtropical country. Fifty-three consecutive cases scheduled to receive major head and neck operations were randomised into one-day or three-day prophylactic antibiotic groups. Thirteen cases (24.5 per cent) developed wound infections after operations. The duration of prophylactic antibiotic was not related to the surgical wound infection. However, pre-operative haemoglobulin less than 10.5 g/dl (odds ratio: 7.24, 95 per cent confidence interval: 1.28–41.0) and reconstruction with a free flap or pectoris major myocutaneous flap during the operation (odds ratio: 11.04, 95 per cent confidence interval: 1.17–104.7) were associated factors significantly influencing post-operative wound infection. Therefore, one day of prophylactic antibiotic was effective in major head and neck procedures but should not be substituted for proper aseptic and meticulous surgical techniques.

This study was designed to evaluate the effects of a prophylactic antibiotic regimen on the incidence of wound infection after clean neck dissections. A prospective series of 57 patients undergoing clean neck dissections with the use of perioperative ampicillin-sulbactam for 24 hours was compared with an historical control group of 51 patients undergoing clean neck dissections with no perioperative antibiotic use. The outcome variable was the incidence of post-operative wound infection. The two groups were similar for factors reported to influence the rate of post-operative wound infection. Wound infection occurred in one patient (1.7 per cent) in the study group and in seven patients (13.3 per cent) in the control group, the difference was statistically significant (p = 0.02). These data suggest that the use of a perioperative antibiotic for 24 hours in patients undergoing clean neck dissection results in significant reduction in the incidence of post-operative wound infection.

Experience with a straight, vertical incision for cochlear implantation in 168 patients of all ages is reported and comparison made with previous experience using a 'C' shaped incision in 173 patients with regard to complications encountered. With the straight incision the only complication was a wound infection which settled in one week; this is in contrast to the 'C'shaped incision, which was associated with a number of serious complications. The straight incision also compared favourably with the other incisions commonly used for cochlear implantation and appears to offer advantages over them.

A seven-day course of cephazolin and metronidazole chemoprophylaxis for clean-contaminated head and neck oncological procedures is compared to results with previously published antibiotic regimens. Aetiological factors associated with increased rates of wound complications are analyzed. Retrospective analysis of procedures over asix-year period was performed. The overall wound complication rate was 28.1 per cent, comparing favourably with previously published results. A major fistula was the most common complication with a rate of 9.2 per cent. Factors statistically associated with increased rates of wound complications included: radical neck dissection, extended surgical procedures requiring flap reconstruction, previous tracheotomy, and race. This is the largest single institutional study to show thata seven-day course of cephazolin and metronidazole is an effective chemoprophylactic regimen in head and neck surgery.

A straight, vertical post-aural incision for the ‘Cochlear’ multichannel cochlear implants has been evaluated in 52 patients (20 adults and 32 children). Nineteen of the children were under three years of age and five of these were under two years of age.

The 7cm long incision is placed approximately 3 mm behind the post-auricular crease and runs from the tip of the mastoid to a point 3 cm above the superior attachment of the pinna. The incision heals within several days.

Because the incision is straight interruption of the blood supply to the flaps raised is the least possible. This also minimizes the possiblity of scalp necrosis and impaltn exrusion. The likelihood of infection is reduced by the small size of the incision, minimal soft tissue dissection and small amount of dead space. Rapid healing has occurred in all cases despite infection in one.