Prevention of Surgical Site Infection in Abdominal Surgery. A Critical Review of the Evidence

Evaluating antibiotic prophylaxis adherence: Implications for surgical site infections and wound care management

AIM

This study aimed to evaluate adherence to an antibiotic prophylaxis protocol and its impact on incidence of surgical site infection (SSI).

MATERIALS AND METHOD

A prospective observational cohort study was conducted at a teaching hospital in São Paulo, Brazil, from September to November 2015. The population were adults who underwent surgery with surgical antibiotic prophylaxis. The main outcomes measured were incidence of SSI at 30-days postoperatively, protocol adherence and surgical wound complications. STROBE guidelines were followed.

RESULTS

Among the 527 participants recruited, a 30-day follow-up was completed by 78.7 % (n = 415). Within this cohort, 57.6 % were females aged over 60 years (36.4 %). The incidence of SSI stood at 9.4 % (n = 39), with dehiscence being the most prevalent complication at 64.1 % (n = 25), followed by increased exudate at 51.3 % (n = 20). Notably, full adherence to the antibiotic prophylaxis protocol was low at 1.7 % (n = 7). The study observed a 60 % increased risk of SSI for every protocol mistake made. Alarmingly, 17.8 % (n = 74) of participants received antibiotic treatment exceeding the stipulated protocol duration. The overall mortality rate stood at 13.5 % (n = 56), with 1 % (n = 4) of these deaths attributed to SSI.

CONCLUSION

There is a pressing global necessity to enhance antibiotic management, as underscored by this study's revelation of low adherence to the antibiotic prophylaxis protocol. This lack of adherence correlated with a notable incidence of SSI and subsequent wound complications. Nearly 20 % of participants received prolonged antibiotic treatment. Adhering strictly to the protocol could substantially impact SSI-related outcomes and enhance global antibiotic management.

Effect of perioperative hypothermia on surgical site infection in abdominal surgery: A prospective cohort study

AIM

To estimate the incidence rates of surgical site infection and identify the independent effect of perioperative hypothermia on the incidence of this type of infection in patients undergoing abdominal surgery.

BACKGROUND

Around the world, surgical site infection is a frequent complication in surgical patients, mainly causing increased morbidity and mortality rates and health service costs.

DESIGN

A prospective cohort study.

METHODS

The 484 patients were recruited from a large private philanthropic hospital in the state of São Paulo, Brazil, from July 2016 to May 2017. Crude and adjusted models were constructed for the hypothermia indicators to assess the effect of this exposure on surgical site infection.

RESULTS

The incidence rate of surgical site infection was 20.25% (n = 98). The attributable fraction to exposed to hypothermia was >40%. A greater probability of developing surgical site infection (relative risk = 1.89) was found for patients who experienced body temperatures <36.0°C (from entry time into the operating room until the end of the surgery) for more than five hypothermic episodes or longer than 75 min.

CONCLUSION

Perioperative hypothermia was an independent risk factor for surgical site infection.

SUMMARY STATEMENT

What is already known about this topic? Around the world, surgical site infection is a complication that leads to damage to the patient and increased costs for the health services. Despite recent advances in surgical techniques, surgical site infection remains one of the most frequent complications in abdominal surgery. Perioperative hypothermia can increase the incidence rates of surgical site infection. There is evidence that perioperative hypothermia is associated with surgical site infection in abdominal surgery, but most studies were conducted in developed countries using retrospective designs. What this paper adds? Perioperative hypothermia was identified as an independent risk factor for surgical site infection in patients undergoing abdominal surgery. The attributable fraction to the exposed indicated that, if the main exposure of interest (perioperative hypothermia) could be prevented during surgical anaesthetic procedures, more than 40% of surgical site infection cases would be avoided. The classification of the American Society of Anaesthesiologists was independently associated with the surgical site infection and presented a dose-response effect among its categories. Spinal anaesthesia served as an independent protective factor for surgical site infection. The implications of this paper: The health service managers need to be aware of potential cost-savings associated with perioperative hypothermia prevention as a measure to reduce the incidence of surgical site infection. During the perioperative period, health professionals need to implement effective measures to maintain patients' normothermia, promoting improved care and surgical patient safety. In this context, the nurse's role is fundamental. Future research projects using a prospective design and developed to address the reality of developing countries can contribute to the strengthening and consistency of the findings with a view to a global understanding of the surgical site infection problem.