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Motaghi S, Mulazzani F, Karam SG, Fashami FM, Buchan T, Ibrahim S, Langeroodi SMF, Khademioore S, Couban RJ, Mbuagbaw L, Mertz D, Loeb M. Antibiotic prophylaxis for the prevention of surgical site infections following colorectal surgery: protocol for network meta-analysis of randomized trials. Syst Rev 2024; 13:224. [PMID: 39227872 PMCID: PMC11370109 DOI: 10.1186/s13643-024-02639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/19/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Surgical site infections continue to be a significant challenge following colorectal surgery. These can result in extended hospital stays, hospital readmissions, increased treatment costs, and negative effects on patients' quality of life. Antibiotic prophylaxis plays a crucial role in preventing infection during surgery, specifically in preventing surgical site infections after colorectal surgery in adult patients. However, the optimal antibiotic regimen is still unclear based on current evidence. Considering the limitations of existing reviews, our goal is to conduct a comprehensive systematic review and network meta-analysis of randomized controlled trials to evaluate the comparative benefits and harms of available antibiotic prophylaxis regimens for preventing surgical site infections following colorectal surgery in adult patients. METHODS We will search the Medline, EMBASE, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases to identify relevant randomized controlled trials. We will include trials that (1) enrolled adults who underwent colorectal surgeries and (2) randomized them to any systemic administration of antibiotic (single or combined) prophylaxis before surgery compared to an alternative systemic antibiotic (single or combined antibiotic), placebo, control, or no prophylactic treatment. Pairs of reviewers will independently assess the risk of bias among eligible trials using a modified Cochrane risk of bias instrument for randomized trials. Our outcomes of interest include the rate of surgical site infection within 30 days of surgery, hospital length of stay, 30-day mortality, and treatment-related adverse effects. We will perform a contrast-based network meta-analysis using a frequentist random-effects model assuming a common heterogeneity parameter. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be utilized to assess the certainty of evidence for treatment effects. DISCUSSION By synthesizing evidence from available RCTs, this study will provide valuable insight for clinicians, patients, and health policymakers on the most effective antibiotics for preventing surgical site infection. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023434544.
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Affiliation(s)
- Shahrzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Francesca Mulazzani
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Samer G Karam
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote Cochrane Canada and McMaster GRADE Centre, McMaster University, Hamilton, ON, Canada
| | - Fatemeh Mirzayeh Fashami
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tayler Buchan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sara Ibrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Sahar Khademioore
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Rachel J Couban
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit/The Research Institute, St Joseph's Healthcare, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Dominik Mertz
- Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Depuydt M, Van Egmond S, Petersen SM, Muysoms F, Henriksen N, Deerenberg E. Systematic review and meta-analysis comparing surgical site infection in abdominal surgery between triclosan-coated and uncoated sutures. Hernia 2024; 28:1017-1027. [PMID: 38713430 PMCID: PMC11297069 DOI: 10.1007/s10029-024-03045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Surgical site infection (SSI) is a frequent complication after abdominal surgery and impacts morbidity, mortality and medical costs. This systematic review evaluates whether the use of triclosan-coated sutures for closing the fascia during abdominal surgery reduces the rate of SSI compared to uncoated sutures. METHODS A systematic review and meta-analysis were conducted using the PRISMA guidelines. On February 17, 2024, a literature search was performed in Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and Embase. Randomized controlled trials (RCTs) on abdominal fascial closure in human adults, comparing triclosan-coated and uncoated sutures, were included. The risk of bias was assessed using the Cochrane RoB 2 tool. Pooled meta-analysis was performed using RevMan. RESULTS Out of 1523 records, eleven RCTs were included, with a total of 10,234 patients: 5159 in the triclosan-coated group and 5075 in the uncoated group. The incidence of SSI was statistically significantly lower in the triclosan-coated group (14.8% vs. 17.3%) with an odds ratio (OR) of 0.84 (95% CI [0.75, 0.93], p = 0.001). When polydioxanone was evaluated separately (coated N = 3999, uncoated N = 3900), triclosan-coating reduced SSI; 17.5% vs. 20.1%, OR 0.86 (95% CI [0.77; 0.96], p = 0.008). When polyglactin 910 was evaluated (coated N = 1160, uncoated N = 1175), triclosan-coating reduced the incidence of SSI; 5.4% vs. 7.8%, OR 0.67 (95% CI [0.48; 0.94], p = 0.02). CONCLUSION According to the results of this meta-analysis the use of triclosan-coated sutures for fascial closure statistically significantly reduces the incidence of SSI after abdominal surgery with a risk difference of about 2%.
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Affiliation(s)
- Martijn Depuydt
- General Surgery, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium.
- Department of Surgery, University of Ghent, Ghent, Belgium.
| | - Sarah Van Egmond
- Department of Surgery, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | | | - Filip Muysoms
- General Surgery, AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium
| | - Nadia Henriksen
- Hepatic and Digestive Diseases, Herlev University Hospital, Copenhagen, Denmark
| | - Eva Deerenberg
- Department of Surgery, Franciscus Gasthuis and Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
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Wills BW, McGwin G, Ponce BA. Surgical Jacket and Bouffant Use and Surgical Site Infection Risk-Reply. JAMA Surg 2020; 155:997-998. [PMID: 32697309 DOI: 10.1001/jamasurg.2020.2190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bradley W Wills
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham
| | - Brent A Ponce
- Department of Orthopaedic Surgery, University of Alabama at Birmingham
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Bacteriological Profile of Patients with Intra-Abdominal Sepsis and Superficial Surgical Site Infection Following Emergency Abdominal Surgery—Is It Concordant? Indian J Surg 2020. [DOI: 10.1007/s12262-019-01997-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Khan FU, Khan Z, Ahmed N, Rehman A. A General Overview of Incidence, Associated Risk Factors, and Treatment Outcomes of Surgical Site Infections. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Tomita K, Chiba N, Ochiai S, Yokozuka K, Gunji T, Hikita K, Ozawa Y, Okihara M, Sano T, Tsutsui R, Shimazu M, Kawachi S. Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples. J Gastrointest Surg 2018; 22:1385-1393. [PMID: 29633116 DOI: 10.1007/s11605-018-3754-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/20/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery. METHODS Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors. RESULTS A total of 691 patients were included. Patients with skin staple closures (n = 346) were compared with patients with subcuticular suture closures (n = 345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index < 25. CONCLUSIONS Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.
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Affiliation(s)
- Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kosuke Hikita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yosuke Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Masaaki Okihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Rina Tsutsui
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Motohide Shimazu
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
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Li X, Nylander W, Smith T, Han S, Gunnar W. Risk Factors and Predictive Model Development of Thirty-Day Post-Operative Surgical Site Infection in the Veterans Administration Surgical Population. Surg Infect (Larchmt) 2018; 19:278-285. [DOI: 10.1089/sur.2017.283] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Xinli Li
- Veterans Health Administration, National Surgery Office, Washington, DC
| | - William Nylander
- Veterans Health Administration, National Surgery Office, Washington, DC
| | - Tracy Smith
- Veterans Health Administration, National Surgery Office, Washington, DC
| | - Soonhee Han
- Veterans Health Administration, National Surgery Office, Washington, DC
| | - William Gunnar
- Veterans Health Administration, National Surgery Office, Washington, DC
- The George Washington University, Washington, DC
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Sandy-Hodgetts K, Carville K, Leslie GD. Surgical wound dehiscence: a conceptual framework for patient assessment. J Wound Care 2018; 27:119-126. [DOI: 10.12968/jowc.2018.27.3.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kylie Sandy-Hodgetts
- Clinical Trials Coordinator, Joondalup Health Campus, Adjunct Research Fellow, School of Anatomy, Physiology and Human Biology, University of Western Australia
| | - Keryln Carville
- Professor, Primary Health Care and Community, School of Nursing and Midwifery, Curtin University, Silver Chain Group
| | - Gavin D. Leslie
- Professor, Director of Research Training, School of Nursing and Midwifery, Curtin University
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Itani KMF, Dellinger EP, Mazuski J, Solomkin J, Allen G, Blanchard JC, Kelz R, Berríos-Torres SI. Surgical Site Infection Research Opportunities. Surg Infect (Larchmt) 2017; 18:401-408. [PMID: 28541807 DOI: 10.1089/sur.2017.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Much has been done to identify measures and modify risk factors to decrease the rate of surgical site infection (SSI). Development of the Centers for Disease Control and Prevention (CDC) Core recommendations for the prevention of SSI revealed evidence gaps in six areas: Parenteral antimicrobial prophylaxis, glycemic control, normothermia, oxygenation, antiseptic prophylaxis, and non-parenteral antimicrobial prophylaxis. Using a modified Delphi process, seven SSI content experts identified nutritional status, smoking, obesity, surgical technique, and anemia as additional areas for SSI prevention research. Post-modified Delphi process Staphylococcus aureus colonization and SSI definition and surveillance were also deemed important topic areas for inclusion. For each topic, research questions were developed, and 10 were selected as the final SSI research questions.
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Affiliation(s)
- Kamal M F Itani
- 1 VA Boston Health Care System, Boston University and Harvard Medical School , Boston, Massachusetts
| | - E Patchen Dellinger
- 2 Department of Surgery, Division of General Surgery, University of Washington , Seattle, Washington
| | - John Mazuski
- 3 Section of Acute and Critical Care Surgery, Department of Surgery, Washington University School of Medicine , St. Louis, Missouri
| | - Joseph Solomkin
- 4 Department of Surgery, University of Cincinnati , Cincinnati, Ohio
| | - George Allen
- 5 Downstate Medical Center and SUNY College of Health Related Professions , Brooklyn, New York
| | - Joan C Blanchard
- 6 Association of periOperative Registered Nurses, Inc. , Denver, Colorado
| | - Rachel Kelz
- 7 Department of Surgery, Perelman School of Medicine, Leonard Davis Institute of Healthcare Economics, Wharton School, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Sandra I Berríos-Torres
- 8 Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia
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10
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Henriksen NA, Deerenberg EB, Venclauskas L, Fortelny RH, Garcia-Alamino JM, Miserez M, Muysoms FE. Triclosan-coated sutures and surgical site infection in abdominal surgery: the TRISTAN review, meta-analysis and trial sequential analysis. Hernia 2017; 21:833-841. [PMID: 29043582 DOI: 10.1007/s10029-017-1681-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/06/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Surgical site infection (SSI) is a frequent complication of abdominal surgery causing increased morbidity. Triclosan-coated sutures are recommended to reduce SSI. The aim of this systematic review and meta-analysis was to evaluate the evidence from randomized controlled trials (RCT) comparing the rate of SSI in abdominal surgery when using triclosan-coated or uncoated sutures for fascial closure. METHODS A systematic literature search was conducted using Medline, EMBASE, the Cochrane library, CINAHL, Scopus and Web of Science including publications until August 2017. The quality of the RCTs was evaluated using critical appraisal checklists from SIGN. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively. RESULTS Eight RCTs on abdominal wall closure were included in the meta-analysis. In an overall comparison including both triclosan-coated Vicryl and PDS sutures for fascial closure, triclosan-coated sutures were superior in reducing the rate of SSI (OR 0.67; 0.46-0.98). When evaluating PDS sutures separately, there was no effect of triclosan-coating on the rate of SSI (OR 0.85; 0.61-1.17). Trial sequential analysis showed that the required information size (RIS) of 797 patients for triclosan-coated Vicryl sutures was almost reached with an accrued information size (AIS) of 795 patients. For triclosan-coated PDS sutures an AIS of 2707 patients was obtained, but the RIS was estimated to be 18,693 patients. CONCLUSION Triclosan-coated Vicryl sutures for abdominal fascial closure decrease the risk of SSI significantly and based on the trial sequential analysis further RCTs will not change that outcome. There was no effect on SSI rate with the use of triclosan-coated PDS sutures for abdominal fascial closure, and it is unknown whether additional RCTs will change that.
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Affiliation(s)
- N A Henriksen
- Dept. of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark.
| | - E B Deerenberg
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Venclauskas
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - R H Fortelny
- Hernia Center, Wilhelminenspital, Vienna, Austria
| | - J M Garcia-Alamino
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - M Miserez
- University Hospitals, KU Leuven, Leuven, Belgium
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Liu S, Wang M, Wang G, Wu X, Guan W, Ren J. Microbial Characteristics of Nosocomial Infections and Their Association with the Utilization of Hand Hygiene Products: A Hospital-Wide Analysis of 78,344 Cases. Surg Infect (Larchmt) 2017; 18:676-683. [PMID: 28613991 DOI: 10.1089/sur.2017.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Song Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, he Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Meng Wang
- Department of General Surgery, Nanjing Drum Tower Hospital, he Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Gefei Wang
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xiuwen Wu
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Wenxian Guan
- Department of General Surgery, Nanjing Drum Tower Hospital, he Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jianan Ren
- Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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Park HM, Han SS, Lee EC, Lee SD, Yoon HM, Eom BW, Kim SH, Ryu KW, Park SJ, Kim YW, Park B. Randomized clinical trial of preoperative skin antisepsis with chlorhexidine gluconate or povidone–iodine. Br J Surg 2016; 104:e145-e150. [DOI: 10.1002/bjs.10395] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/04/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Skin antiseptic agents are used to prevent surgical-site infection (SSI); few trials have reported the superiority of any specific agent in clean-contaminated abdominal surgery. This RCT was designed to compare the effectiveness of chlorhexidine gluconate and povidone–iodine.
Methods
Consecutive patients who underwent clean-contaminated upper gastrointestinal or hepatobiliary–pancreatic open surgery between 2011 and 2014 were assigned randomly to either chlorhexidine gluconate or povidone–iodine. The primary endpoint was the occurrence of SSI within 30 days of surgery. Secondary endpoints included causative organisms and risk factors for SSI.
Results
A total of 534 patients were randomized; 31 (5·8 per cent) developed an SSI. There was no difference in the overall SSI rate in the chlorhexidine gluconate and povidone–iodine groups: 15 of 267 (5·6 per cent) and 16 of 267 (6·0 per cent) respectively (P = 0·853). The most common causative organism was Enterococcus faecalis. In subgroup analysis, biliary–pancreatic surgery had a higher SSI rate (26 of 127, 20·5 per cent) than upper gastrointestinal (2 of 204, 1·0 per cent) and hepatic (3 of 203, 1·5 per cent) resection. Both age (60 years and over) and type of incision were associated with the risk of SSI.
Conclusion
No difference was detected between chlorhexidine gluconate and povidone–iodine antiseptics for prevention of SSI. Registration number: NCT01495117 (http://www.clinicaltrials.gov).
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Affiliation(s)
- H M Park
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - S-S Han
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - E C Lee
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - S D Lee
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - H M Yoon
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - B W Eom
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - S H Kim
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - K W Ryu
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - S-J Park
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - Y W Kim
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - B Park
- Biometric Research Branch, Research Institute and Hospital, National Cancer Centre, South Korea
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Jonsson A, Azhar N, Hjalmarsson C. Validation of surgical site infection registration in colorectal surgery. Infect Dis (Lond) 2016; 49:55-61. [DOI: 10.1080/23744235.2016.1227473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Purpose of review Despite the application of prophylactic antimicrobial therapy and advanced technologies, infection remains one of the most common causes of morbidity and mortality in surgical patients. Understanding the pathogenesis of surgical infection would offer new insights into the development of biomarkers to predict and stratify infection in patients, and to explore specific strategies to minimize this serious postoperative complication. Recent findings The acute nonspecific inflammatory response triggered by endogenous danger signals evoked by surgical insult is beneficial, while paradoxically associated with reduced resistance to infection. There is growing evidence indicating that primed inflammation by surgical insult exaggerates the dysregulation of the immune-inflammatory response to the invasion of pathogens postoperatively. Innate immune receptors, such as Toll-like receptors (TLRs), contribute to detecting both pathogen-associated molecular patterns and endogenous damage-associated molecular patterns, and to further amplifying inflammatory responses to infection. Current evidence shows the fascinating role of non-TLRs in the process of infection. Non-TLRs, such as membrane-associated triggering receptor expressed on myeloid cells family, cytosolic nucleotide-binding oligomerization domain-like receptors and nuclear receptor nuclear family 4 subgroup A receptors, are also crucial in triggering the immune responses and mounting an effective defense against surgical insults and the second hit of infection. Summary Understanding the pivotal role of non-TLRs in sensing exogenous and endogenous molecules, and the influence of primed systemic inflammation and depressed immune status on the defense against pathogen after surgical insult, would be helpful to fully explore the relevant sophisticated phenomena of surgical infection, and to elucidate the occurrence of heterogeneous constellations of clinical signs and symptoms among this special population.
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Ballus J, Lopez-Delgado JC, Sabater-Riera J, Perez-Fernandez XL, Betbese AJ, Roncal JA. Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes. BMC Infect Dis 2015. [PMID: 26223477 PMCID: PMC4520265 DOI: 10.1186/s12879-015-1050-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Surgical site infection (SSI) remains a significant problem in the postoperative period that can negatively affect clinical outcomes. Microbiology findings are typically similar to other nosocomial infections, with differences dependent on microbiology selection due to antibiotic pressure or the resident flora. However, this is poorly understood in the critical care setting. We therefore aimed to assess the incidence, epidemiology and microbiology of SSI and its association with outcomes in patients with severe peritonitis in the intensive care unit (ICU). Methods We prospectively studied 305 consecutive patients admitted to our surgical ICU from 2010 to 2014 with a diagnosis of secondary or tertiary peritonitis. We collected the following data: SSI diagnosis, demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II score, type of surgery, microbiology, antibiotic treatment and outcomes. Microbiological sampling was done by means of swabs. Results We identified 269 episodes of SSI in 162 patients (53.1 %) aged 64.4 ± 14.3 years, of which 200 episodes occurred in men (64.6 %). The mean APACHE II and SAPS II scores were 19.7 ± 7.8 and 36.5 ± 16.1 respectively. The mean ICU and hospital stays were 19.8 ± 24.8 and 21.7 ± 30 days respectively. Pseudomonas spp. (n = 52, 19.3 %), Escherichia coli (n = 55, 20.4 %) and Candida spp. (n = 46, 17.1 %) were the most frequently isolated microorganisms, but gram-positive cocci (n = 80, 29.7 %) were also frequent. Microorganisms isolated from SSIs were associated with a higher incidence of antibiotic resistance (64.9 %) in ICU patients, but not with higher in-hospital mortality. However, patients who suffered from SSI had longer ICU admissions (odds ratio = 1.024, 95 % confidence interval 1.010–1.039, P = 0.001). Conclusions The incidence of SSI in secondary or tertiary peritonitis requiring ICU admission is very high. Physicians may consider antibiotic-resistant pathogens, gram-positive cocci and fungi when choosing empiric antibiotic treatment for SSI, although more studies are needed to confirm our results due to the inherent limitations of the microbiological sampling with swabs performed in our research. The presence of SSI may be associated with prolonged ICU stays, but without any influence on overall mortality.
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Affiliation(s)
- Josep Ballus
- Intensive Care Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica Bellvitge; Biomedical Investigation Institute of Bellvitge), C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Juan C Lopez-Delgado
- Intensive Care Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica Bellvitge; Biomedical Investigation Institute of Bellvitge), C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Joan Sabater-Riera
- Intensive Care Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica Bellvitge; Biomedical Investigation Institute of Bellvitge), C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Xose L Perez-Fernandez
- Intensive Care Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica Bellvitge; Biomedical Investigation Institute of Bellvitge), C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - A J Betbese
- Intensive Care Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Universitat Autònoma de Barcelona, C/Sant Quintín 89, 08041, Barcelona, Spain.
| | - J A Roncal
- Intensive Care Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Universitat Autònoma de Barcelona, C/Sant Quintín 89, 08041, Barcelona, Spain.
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Bacterial Epidemiology and Antimicrobial Resistance in the Surgery Wards of a Large Teaching Hospital in Southern Italy. Mediterr J Hematol Infect Dis 2015; 7:e2015040. [PMID: 26075047 PMCID: PMC4450648 DOI: 10.4084/mjhid.2015.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/17/2015] [Indexed: 11/09/2022] Open
Abstract
Objectives Surgical infections represent an increasingly important problem for the National Health System. In this study we retrospectively evaluated the bacterial epidemiology and antimicrobial susceptibility of the microorganisms concerned as well as the utilization of antibiotics in the General and Emergency Surgery wards of a large teaching hospital in southern Italy in the period 2011–2013. Methods Data concerning non-duplicate bacterial isolates and antimicrobial susceptibility were retrieved from the Vitek 2 database. The pharmacy provided data about the consumption of antibiotics in the above reported wards. Chi-square or Fisher’s exact test were used. Results In all, 94 Gram-negative were isolated in 2011, 77 in 2012, and 125 in 2013, Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa always being the most frequently isolated microorganisms. A. baumannii showed high rates of resistance to carbapenems (with values of 100% in 2011 and 2012) and low rates of resistance to tigecycline, colistin and amikacin. In the same years, there were respectively 105, 93, and 165 Gram-positive isolated. The rate of MRSA isolates ranged from 66% to 75% during the study period. Conclusions Our results show no significant increase in antimicrobial resistance over the period in question, and a higher rate of both MRSA isolates and resistance to carbapenems in A. baumannii compared with other European data.
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Sandy-Hodgetts K, Carville K, Leslie GD. Determining risk factors for surgical wound dehiscence: a literature review. Int Wound J 2015; 12:265-75. [PMID: 23692188 PMCID: PMC7950784 DOI: 10.1111/iwj.12088] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 03/11/2013] [Accepted: 04/14/2013] [Indexed: 12/21/2022] Open
Abstract
Postoperative wound healing plays a significant role in facilitating a patient's recovery and rehabilitation. Surgical wound dehiscence (SWD) impacts on mortality and morbidity rates and significantly contributes to prolonged hospital stays and associated psychosocial stressors on individuals and their families. A narrative review of SWD was undertaken on English-only studies between 1945 and 2012 using three electronic databases Ovid CINHAL, Ovid Medline and Pubmed. The aim of this review was to identify predisposing factors for SWD and assessment tools to assist in the identification of at-risk patients. Key findings from the included 15 papers out of a search of 1045 revealed the most common risk factors associated with SWD including obesity and wound infection, particularly in the case of abdominal surgery. There is limited reporting of variables associated with SWD across other surgical domains and a lack of risk assessment tools. Furthermore, there was a lack of clarity in the definition of SWD in the literature. This review provides an overview of the available research and provides a basis for more rigorous analysis of factors that contribute to SWD.
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Affiliation(s)
| | - Keryln Carville
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
- Silver Chain Nursing Association, Perth, WA, Australia
| | - Gavin D Leslie
- School of Nursing and Midwifery, Curtin University, Perth, WA, Australia
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Comparison of the efficacy of chlorhexidine gluconate versus povidone iodine as preoperative skin preparation for the prevention of surgical site infections in clean-contaminated upper abdominal surgeries. Surg Today 2014; 45:1378-84. [DOI: 10.1007/s00595-014-1078-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
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Abstract
Age-related changes in skin contribute to impaired wound healing after surgical procedures. Changes in skin with age include decline in thickness and composition, a decrease in the number of most cell types, and diminished microcirculation. The microcirculation provides tissue perfusion, fluid homeostasis, and delivery of oxygen and other nutrients. It also controls temperature and the inflammatory response. Surgical incisions cause further disruption of the microvasculature of aged skin. Perioperative management can be modified to minimize insults to aged tissues. Judicious use of fluids, maintenance of normal body temperature, pain control, and increased tissue oxygen tension are examples of adjustable variables that support the microcirculation. Anesthetic agents influence the microcirculation of a combination of effects on cardiac output, arterial pressure, and local microvascular changes. The authors examined the role of anesthetic management in optimizing the microcirculation and potentially improving postoperative wound repair in older persons.
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Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, Kyaw MH. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One 2013; 8:e83743. [PMID: 24367612 PMCID: PMC3867498 DOI: 10.1371/journal.pone.0083743] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/07/2013] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Surgical site infection (SSI) complicates 2-5% of surgeries in the United States. Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis, and SSIs are responsible for increased morbidity, mortality, and economic burden associated with surgery. Staphylococcus aureus (S. aureus) is a commonly-isolated organism for SSI, and methicillin-resistant S. aureus SSI incidence is increasing globally. OBJECTIVE The objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting. EVIDENCE REVIEW An initial search identified 328 titles published in 2002-2012; 57 were identified as relevant for data extraction. Extracted information included study design and methodology, reported cumulative incidence and post-surgical time until onset of SSI, and odds ratios and associated variability for all factors considered in univariate and/or multivariable analyses. FINDINGS Median SSI incidence was 3.7%, ranging from 0.1% to 50.4%. Incidence of overall SSI and S. aureus SSI were both highest in tumor-related and transplant surgeries. Median time until SSI onset was 17.0 days, with longer time-to-onset for orthopedic and transplant surgeries. Risk factors consistently identified as associated with SSI included co-morbidities, advanced age, risk indices, patient frailty, and surgery complexity. Thirteen studies considered diabetes as a risk factor in multivariable analysis; 85% found a significant association with SSI, with odds ratios ranging from 1.5-24.3. Longer surgeries were associated with increased SSI risk, with a median odds ratio of 2.3 across 11 studies reporting significant results. CONCLUSIONS AND RELEVANCE In a broad review of published literature, risk factors for SSI were characterized as describing reduced fitness, patient frailty, surgery duration, and complexity. Recognition of risk factors frequently associated with SSI allows for identification of such patients with the greatest need for optimal preventive measures to be identified and pre-treatment prior to surgery.
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Affiliation(s)
- Ellen Korol
- Oxford Outcomes, Vancouver, British Columbia, Canada
| | | | | | | | - Hasan S. Jafri
- MedImmune, Gaithersburg, Maryland, United States of America
| | - Mathew Lo
- MedImmune, Gaithersburg, Maryland, United States of America
| | - Moe H. Kyaw
- MedImmune, Gaithersburg, Maryland, United States of America
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Rashiq S, Dick BD. Post-surgical pain syndromes: a review for the non-pain specialist. Can J Anaesth 2013; 61:123-30. [PMID: 24185829 DOI: 10.1007/s12630-013-0072-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 10/24/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This is a selective narrative review of the latest information about the epidemiology, impact, and prevention of chronic post-surgical pain (CPSP), intended primarily for those without a special interest in pain medicine. PRINCIPAL FINDINGS Chronic post-surgical pain is an important problem in terms of personal impact. It has staggering economic implications, exerts powerful negative effects on the quality of life of many of those it afflicts, and places a significant burden on chronic pain treatment services in general. It is well known that surgery at certain body sites is apt to cause CPSP, but emerging evidence shows a strong correlation between CPSP and demographic (young age, obesity, and female sex) and psychological characteristics (anxiety, depression, stress, and catastrophizing). Severe acute pain is a strong risk factor for CPSP, and this adds yet more weight to the argument that acute pain should be controlled effectively. In specific circumstances, CPSP can be reduced by regional anesthetic techniques, infiltration of local anesthetic, or preoperative use of gabapentin. The ability of other known interrupters of afferent nociceptive transmission-commonly used to reduce CPSP when administered at the time of surgery-is currently unproven, as is the hypothesis that the use of remifentanil during surgery worsens CPSP. CONCLUSIONS Reduction of CPSP is a worthy long-term outcome for anesthesia providers to consider as they plan the perioperative care of their patients. More evidence is needed about the effect of currently used analgesics and other perioperative techniques on CPSP.
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Affiliation(s)
- Saifee Rashiq
- Division of Pain Medicine, Department of Anesthesiology & Pain Medicine, University of Alberta, 8-120J Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada,
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Qu X, Diao Y, Zhang Z, Wang S, Jia Y. Evaluation of anti-bacterial and wound healing activity of the fruits of Amorpha fruticosa L. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2013; 10:458-68. [PMID: 24146475 DOI: 10.4314/ajtcam.v10i3.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the traditional Chinese medicine, the fresh fruits of Amorpha fruticosa L. were applied for the treatment of carbuncle, eczema and burn (Das et al., 2007). However, little is known about the functional roles of the fruits of Amorpha fruticosa L. during wound healing progress. In the present study, we evaluated both antimicrobial potential against a wide range of microorganisms and wound healing activity of the seven compounds isolated from the fruits of Amorpha fruticosa L in vitro and in vivo. Our results showed that compounds I (6a,12a-dehydroamorphin), V (dehydrosermundone) and VI (tephrosin) isolated from the fruits of Amorpha fruticosa L. performed dominant antimicrobial potential against microorganisms. Moreover, these compounds significantly enhanced fibroblasts proliferation and migration, leading to promotion of wound healing. Thus, it could be possible for the therapeutic utilization of Amorpha fruticosa L. for wound healing in the future.
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Affiliation(s)
- Xueling Qu
- Department of Pathophysiology, Dalian Medical University, Dalian, Liaoning Province, China 116011
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van Dishoeck AM, Koek MBG, Steyerberg EW, van Benthem BHB, Vos MC, Lingsma HF. Use of surgical-site infection rates to rank hospital performance across several types of surgery. Br J Surg 2013; 100:628-36; discussion 637. [PMID: 23338243 DOI: 10.1002/bjs.9039] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Comparing and ranking hospitals based on health outcomes is becoming increasingly popular, although case-mix differences between hospitals and random variation are known to distort interpretation. The aim of this study was to explore whether surgical-site infection (SSI) rates are suitable for comparing hospitals, taking into account case-mix differences and random variation. METHODS Data from the national surveillance network in the Netherlands, on the eight most frequently registered types of surgery for the year 2009, were used to calculate SSI rates. The variation in SSI rate between hospitals was estimated with multivariable fixed- and random-effects logistic regression models to account for random variation and case mix. 'Rankability' (as the reliability of ranking) of the SSI rates was calculated by relating within-hospital variation to between-hospital variation. RESULTS Thirty-four hospitals reported on 13 629 patients, with overall SSI rates per surgical procedure varying between 0 and 15·1 per cent. Statistically significant differences in SSI rate between hospitals were found for colonic resection, caesarean section and for all operations combined. Rankability was 80 per cent for colonic resection but 0 per cent for caesarean section. Rankability was 8 per cent in all operations combined, as the differences in SSI rates were explained mainly by case mix. CONCLUSION When comparing SSI rates in all operations, differences between hospitals were explained by case mix. For individual types of surgery, case mix varied less between hospitals, and differences were explained largely by random variation. Although SSI rates may be used for monitoring quality improvement within hospitals, they should not be used for ranking hospitals.
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Affiliation(s)
- A M van Dishoeck
- Centre of Medical Decision Making, Department of Public Health, Erasmus MC–University Centre Rotterdam, The Netherlands.
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Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt) 2012; 13:234-7. [PMID: 22913334 DOI: 10.1089/sur.2012.131] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is unequivocally morbid and costly. The estimated 300,000 SSIs annually in the United States represent the second most common infection among surgical patients, prolong hospitalization by 7-10 days, and have an estimated annual incremental cost of $1 billion. The mortality rate associated with SSI is 3%, with about three quarters of deaths being attributable directly to the infection. Prevention is possible for the most part, and concerted effort has been made to limit these infections, arguably to little effect. METHODS Review of pertinent English-language literature. RESULTS Numerous risk factors for SSI and tactics for prevention have been described, but efforts to bundle these tactics into an effective, comprehensive prevention program have been disappointing. Numerous studies now demonstrate that the Surgical Care Improvement Program (SCIP), which focused on process improvement rather than outcomes, has been ineffective despite governmental support, financial penalties for non-compliance, and consequent widespread implementation. CONCLUSION Required reporting has increased awareness of the problem of SSI, but just as the complexity of SSI risk, pathogenesis, and preventions reflects the complexity of the disease, many other factors must be taken into account, including the skill and knowledge of the surgical team and promulgation of a culture of quality and safety in surgical patient care.
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Affiliation(s)
- Samir S Awad
- Section of Surgical Critical Care, Baylor College of Medicine, and Department of Surgery and Surgical Intensive Care Unit, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA.
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Fakhry SM, Montgomery SC. Peri-Operative Oxygen and the Risk of Surgical Infection. Surg Infect (Larchmt) 2012; 13:228-33. [DOI: 10.1089/sur.2012.122] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Samir M. Fakhry
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Fujiwara T, Nishimoto S, Ishise H, Kawai K, Fukuda K, Kakibuchi M. Comparative study of the antibacterial penetrating effects of wound dressings. J Plast Surg Hand Surg 2012; 46:2-7. [DOI: 10.3109/2000656x.2011.644939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Donald E Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Williams N, Sweetland H, Goyal S, Ivins N, Leaper DJ. Randomized trial of antimicrobial-coated sutures to prevent surgical site infection after breast cancer surgery. Surg Infect (Larchmt) 2011; 12:469-74. [PMID: 22142317 DOI: 10.1089/sur.2011.045] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical site infection (SSI) is the fourth commonest healthcare-associated infection and complicates at least 5% of open operations. In a randomized clinical trial, antimicrobial-coated sutures were compared with their conventional counterparts, polyglactin and poliglecaprone, for skin closure after breast cancer surgery to assess their role in reducing the rate of SSI. METHODS Between November 2008 and February 2011, 150 female patients presenting with breast cancer to a single center were randomized to skin closure with antimicrobial-coated or plain sutures. Postoperatively, SSI was defined using the U.S. Centers for Disease Control and Prevention (CDC) definitions and scored using the ASEPSIS or Southampton systems by trained, blinded observers with close post-discharge surveillance and patient diaries. Surgeons and patients were blinded to the type of suture used. RESULTS Using CDC criteria, the overall rate of SSI was 18.9% at six weeks. Six patients (4.7%) needed intervention or readmission for SSI. Skin closure with antimicrobial sutures showed a non-statistically significant reduction in the SSI rate, to 15.2%, compared with conventional sutures (22.9%). A uniform tendency for fewer SSIs in the antimicrobial-coated suture group was found using ASEPSIS and Southampton scores, but again, the difference was not statistically significant. CONCLUSION The previously reported high rate of SSI related to breast surgery was confirmed. Using statistical modeling and earlier reports, the study was powered to show a difference using ASEPSIS scores, but the modification used in this trial failed to find a difference. Finding a statistically significant difference would have needed two to three times the number of patients recruited. Further evaluation of antimicrobial-coated sutures is merited, particularly if used as part of a care bundle to reduce SSI after breast cancer surgery.
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Affiliation(s)
- Nia Williams
- Department of Wound Healing and Dermatology, Cardiff University, Cardiff, United Kingdom
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Hourigan JS. Impact of obesity on surgical site infection in colon and rectal surgery. Clin Colon Rectal Surg 2011; 24:283-90. [PMID: 23204944 PMCID: PMC3311496 DOI: 10.1055/s-0031-1295691] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obesity affects over 30% of the United States population. Over the past 10 years, there has been increased recognition of the prevalence of obesity and its contribution to worse outcomes among medical and surgical patients. In particular, obesity has been validated as a risk factor for surgical site infection (SSI) among patients undergoing major abdominal surgery with some reports demonstrating an increased risk of SSI as high as sixty percent (60%) among obese patients. For patients undergoing elective colon and rectal surgery, a higher incidence of SSI (up to 45%) has been reported in comparison to outcomes of other surgical procedures. Obesity, as well as numerous other variables, have been implicated as a potential source for this increased incidence. Although the pathophysiology of obesity-related SSI has been suggested (decreased wound oxygen tension, impaired tissue antibiotic penetration, altered immune function, etc.), the true effect of obesity has not been clearly described. The purpose of this review is to examine the growing epidemic of obesity and its specific impact on SSI for both general and colorectal surgical patients. The proposed mechanisms for why obesity increases the risk of SSI will be briefly discussed, as well.
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Affiliation(s)
- Jon Stuart Hourigan
- Section of Colon and Rectal Surgery, Department of Surgery, University of Kentucky Medical Center, Lexington, Kentucky
- Division of Colon and Rectal Surgery, Veteran Affairs Medical Center–Lexington, Lexington, Kentucky
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Vasilakis C, Wilson A, Haddad F. Automating the monitoring of surgical site infections using variable life-adjusted display charts. J Hosp Infect 2011; 79:119-24. [DOI: 10.1016/j.jhin.2011.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 05/18/2011] [Indexed: 11/29/2022]
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Abstract
While there is a plethora of clinical and anecdotal evidence on the efficacy of silver dressings, there is no rigorous RCT data to support this. This has led procurement managers to defer the inclusion of silver dressings on wound formularies, despite its clinical popularity. This article gives an overview of the evidence on topical antimicrobials, in order to determine whether there is a case for such a stance.
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