A Systematic Review and Meta-Analysis of Intra-Operative Surgical Site Sampling: Culture versus Culture-Independent Techniques in Predicting Downstream Surgical Site Infection

Vishnoi, Veral; Morey, Tristan; Hoedt, Emily C.; Keely, Simon; Pockney, Peter; Smith, Stephen R.

doi:10.1089/sur.2023.012

Cited by 2 publications

(3 citation statements)

References 29 publications

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“…Prior studies examining the role of endogenous bacteria in SSI have used lower-resolution methods of strain comparison [such as pulse-field gel electrophoresis ( 13 , 14 ) or multilocus sequence typing ( 15 )] and have focused on S. aureus, which can readily be isolated from the anterior nares of colonized patients using selective culture media to facilitate strain-level comparison. In contrast, culture-based approaches for the isolation of other common SSI pathogens from the patient microbiome, particularly Gram-negative and anaerobic skin commensals, are comparatively complex and less reproducible ( 12 , 34 ). Other factors complicating the use of culture-based approaches for comparison of colonizing and infecting strains include the coexistence of multiple commensal strains of the same species ( 35 , 36 ), low bacterial abundance in some sample types (for example, skin swabs), and limitations in preserving viable cells from preoperative samples when the species of interest (the subsequent SSI pathogen) is not known in advance.…”

Section: Discussionmentioning

confidence: 99%

“…Future quality improvement in this arena remains limited by a poor fundamental understanding of both the origins of SSI and the high rates of resistance to prophylactic antimicrobial agents observed in these infections ( 7 ). Whereas the potential for surgical wounds to become inoculated with endogenous bacteria may be intuitive for contaminated or “clean-contaminated” procedures involving nonsterile spaces (for example, in colorectal surgery) ( 8 ), the pathogenesis of SSI in procedures involving clean skin incisions in the era of modern surgical antisepsis remains a matter of debate ( 9 – 12 ). Infection prevention strategies, particularly in orthopedic surgery, have historically emphasized the importance of environmental cleaning, sterile processing, and operating room attire, which target “exogenous” sources of infection from nosocomial reservoirs.…”

Section: Introductionmentioning

confidence: 99%

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Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery

Long,

Bryson-Cahn,

Waalkes

et al. 2024

Sci. Transl. Med.

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Despite modern antiseptic techniques, surgical site infection (SSI) remains a leading complication of surgery. However, the origins of SSI and the high rates of antimicrobial resistance observed in these infections are poorly understood. Using instrumented spine surgery as a model of clean (class I) skin incision, we prospectively sampled preoperative microbiomes and postoperative SSI isolates in a cohort of 204 patients. Combining multiple forms of genomic analysis, we correlated the identity, anatomic distribution, and antimicrobial resistance profiles of SSI pathogens with those of preoperative strains obtained from the patient skin microbiome. We found that 86% of SSIs, comprising a broad range of bacterial species, originated endogenously from preoperative strains, with no evidence of common source infection among a superset of 1610 patients. Most SSI isolates (59%) were resistant to the prophylactic antibiotic administered during surgery, and their resistance phenotypes correlated with the patient’s preoperative resistome ( P = 0.0002). These findings indicate the need for SSI prevention strategies tailored to the preoperative microbiome and resistome present in individual patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery

Long,

Bryson-Cahn,

Waalkes

et al. 2024

Sci. Transl. Med.

View full text Add to dashboard Cite

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“…Limited research suggests that a "positive" intraoperative culture identifies a patient who is at higher risk of developing a clinical SSI, but application is limited due to its inability to correctly identify the pathogen(s) involved. [5][6][7] This illustrates the limitation of culture-dependent methods as only certain microorganisms thrive in the preselected nutritional and physiological conditions used in the laboratory to culture and isolate organisms. More recently culture independent techniques, such as DNA sequencing, have challenged the use of culture as the most accurate method.…”

Section: Introductionmentioning

confidence: 99%

A pilot study: intraoperative 16S rRNA sequencing versus culture in predicting colorectal incisional surgical site infection

Vishnoi

Hoedt

Gould

et al. 2023

ANZ Journal of Surgery

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BackgroundSurgical Site Infection (SSI) of the abdominal incision is a dreaded complication following colorectal surgery. Identifying the intraoperative surgical site microbes may provide clarity in the pathogenesis of SSIs. Genomic sequencing has revolutionized the ability to identify microbes from clinical samples. Utilization of 16S rRNA amplicon sequencing to characterize the intraoperative surgical site may provide the critical information required to predict and prevent infection in colorectal surgery.MethodsThis is a pilot, prospective observational study of 50 patients undergoing elective colorectal resection. At completion of surgery, prior to skin closure, swabs were taken from the subcutaneous tissue of the abdominal incision to investigate the microbial profile. Dual swabs were taken to compare standard culture technique and 16S rRNA sequencing to establish if a microbial profile was associated with postoperative SSI.Results8/50 patients developed an SSI, which was more likely in those undergoing open surgery (5/15 33.3% versus 3/35, 8.6%; P = 0.029). 16S rRNA amplicon sequencing was more sensitive in microbial detection compared to traditional culture. Both culture and 16S rRNA demonstrated contamination of the surgical site, predominantly with anaerobes. Culture was not statistically predictive of infection. 16S rRNA amplicon sequencing was not statistically predictive of infection, however, it demonstrated patients with an SSI had an increased biodiversity (not significant) and a greater relative abundance (not significant) of pathogens such as Bacteroidacaea and Enterobacteriaceae within the intraoperative site.Conclusions16S rRNA amplicon sequencing has demonstrated a potential difference in the intraoperative microbial profile of those that develop an infection. These findings require validation through powered experiments to determine the overall clinical significance.

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A Systematic Review and Meta-Analysis of Intra-Operative Surgical Site Sampling: Culture versus Culture-Independent Techniques in Predicting Downstream Surgical Site Infection

Cited by 2 publications

References 29 publications

Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery

Contribution of the patient microbiome to surgical site infection and antibiotic prophylaxis failure in spine surgery

A pilot study: intraoperative 16S rRNA sequencing versus culture in predicting colorectal incisional surgical site infection

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