Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study

Gomila-Grange, Aina; Badia, Josep M.; Carratalà, Jordi; Serra‐Aracil, Xavier; Shaw, Evelyn; Diaz-Brito, Vicens; Castro, Antoni; Espejo, Elena; Nicolás, Carmen; Piriz, M; Brugués, M; Obradors, Josefina; Lérida, Ana; Cuquet, Jordi; Cáceres, Enrique Limón; Gudiol, Francesc; Pujol, Miquel

doi:10.1016/j.jinf.2017.03.002

Cited by 16 publications

(17 citation statements)

References 29 publications

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“…However, we did not observe differences in mortality rates between patients with P. aeruginosa SSIs and SSIs caused by other organisms, probably due to our low overall mortality rate, neither did they observe differences, in studies previously cited [ 24 , 26 ]. As reported previously, treatment failure among patients with the most serious SSIs in our cohort was not associated with any microbiological etiology, including P. aeruginosa [ 12 ].…”

Section: Discussionsupporting

confidence: 77%

“…This suggests that the attending physicians might not have considered Pseudomonas as the causative agent. The role of the empiric antibiotic treatment in the outcome of patients with intraabdominal infections has been widely discussed [ 24 , 26 ]; however, as we noted previously [ 12 ], it is generally accepted that the control of the source of infection is the cornerstone of management in severe cases [ 27 , 28 ]. Most patients with P. aeruginosa OS-SSIs in our cohort underwent source control.…”

Section: Discussionmentioning

confidence: 99%

“…Variables included in this study are described elsewhere [ 12 ]. These variables included age, sex, American Society of Anesthesiologists’ (ASA) physical status, administration of mechanical bowel preparation (MBP), oral antibiotic prophylaxis (OAP), surgical risk index category based on the National Nosocomial Infections Surveillance (NNIS) modified system criteria [ 13 ], adequacy of the intravenous antibiotic prophylaxis, length of surgery (prolonged surgery was considered as the duration of surgery ≥75th percentile of the procedure), laparoscopic surgery, wound classification, date of SSI, site of infection (superficial and deep incisional SSI or organ-space (OS)-SSI, underlying disease (including neoplasia, inflammatory bowel disease and others), microbiology, and antibiotic treatment.…”

Section: Methodsmentioning

confidence: 99%

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Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study

et al. 2018

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BackgroundHealthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis.MethodsWe conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011–2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections.ResultsOut of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists’ score III–IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44–4.39), National Nosocomial Infections Surveillance risk index 1–2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01–6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31–3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21–0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10–24] vs 13d [IQR 8–20], p = 0.015, OR 1.1, 95% CI 1.00–1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96–2.99), and longer hospitalization (median 22 days [IQR 15–42] vs 19d [IQR 12–28], p = 0.02, OR 1.1, 95% CI 1.00–1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1–2 (OR 2.3, 95% CI 1.03–5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23–0.90).ConclusionsWe observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study

et al. 2018

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“…The sequelae of these infections can be quite severe. In the short term, patients may develop life‐threatening sepsis, require reoperations or procedures for abscess drainage, suffer from prolonged ileus or prolonged hospital stay and require hospital readmission . Long‐term effects include the need for an ostomy, development of hernias and poor quality of life due to poor bowel function …”

Section: Introductionmentioning

confidence: 99%

Risk of post‐operative surgical site infections after vedolizumab vs anti‐tumour necrosis factor therapy: a propensity score matching analysis in inflammatory bowel disease

Park

Sceats

Dehghan

et al. 2018

Aliment Pharmacol Ther

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“…Snapshot audits of this nature have been shown to collect robust and useful data to guide national guidelines and surgical research priorities, especially in the setting of SSIs in other specialties such as colorectal surgery [24], [25]. Expanding surgical audits internationally has permitted the development of research links between high, middle- and low-income countries [26], [27], and we anticipate that success of the GIVE audit will support further collaboration with trainees globally, supporting the global surgery agenda and promoting good surgical practice with colleagues around the world.…”

Section: Discussionmentioning

confidence: 99%

Study protocol for the groin wound infection after vascular exposure (GIVE) audit and multicentre cohort study

Gwilym

Saratzis

Benson

et al. 2019

International Journal of Surgery Protocols

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IntroductionSurgical site infections (SSIs) following groin incision for arterial exposure are commonplace and a significant cause of morbidity and mortality following major arterial surgery. Published incidence varies considerably. The primary aim of GIVE will be to compare individual units’ practice with established guidelines from The National Institute for Health and Care Excellence (NICE). Secondary aims will be to describe the contemporary rate of SSI in patients undergoing groin incision for arterial exposure, to identify risk factors for groin wound infection, to examine the value of published tools in the prediction of SSI, to identify areas of equipoise which could be examined in future efficacy/effectiveness trials and to compare UK SSI rates with international centres.Methods and analysisThis international, multicentre, prospective observational study will be delivered via the Vascular and Endovascular Research Network (VERN). Participating centres will identify all patients undergoing clean emergency or elective groin incision(s) for arterial intervention during a consecutive 3-month period. Follow up data will be captured at 90 days after surgery. SSIs will be defined according to the Centres for Disease Control and Prevention (CDC) criteria. Data will be gathered centrally using an anonymised electronic data collection tool or secure email transfer.Ethics and disseminationThis study will be registered as a clinical audit at all participating UK centres; research ethics approval is not required. National leads will oversee the appropriate registration and approvals in countries outside the UK as required. Site specific reports of SSI rates will be provided to each participating centre. Study results will be disseminated locally at each site, publicised on social media and submitted for peer-reviewed publication.

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Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study

Cited by 16 publications

References 29 publications

Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study

Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study

Risk of post‐operative surgical site infections after vedolizumab vs anti‐tumour necrosis factor therapy: a propensity score matching analysis in inflammatory bowel disease

Study protocol for the groin wound infection after vascular exposure (GIVE) audit and multicentre cohort study

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