Early recognition and response to increases in surgical site infections using optimised statistical process control charts—The early 2RIS trial: A multicentre stepped wedge cluster randomised controlled trial

Baker, Arthur W.; Ilieş, Iulian; Benneyan, James C.; Lokhnygina, Yuliya; Foy, Katherine; Lewis, Sarah S.; Wood, Brittain; Baker, Esther; Crane, Linda H; Crawford, Kathryn L.; Cromer, Andrea; Padgette, Polly; Roach, Linda; Adcock, Linda; Nehls, Nicole; Salem, Joseph; Bratzler, Dale W.; Dellinger, E. Patchen; Greene, Linda; Huang, Susan S.; Mantyh, Christopher R.; Anderson, Deverick J.

doi:10.1016/j.eclinm.2022.101698

Cited by 8 publications

(4 citation statements)

References 39 publications

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“…Maintenance of established targets for normothermia and euglycemia, both strongly associated with reduction in SSI risk, remains inconsistent across a wide range of practice settings and procedure types . The association between perioperative hyperglycemia and SSIs appears to be similar for both patients with diabetes and those without diabetes, indicating that broader screening for hyperglycemia in surgical patients may be beneficial.…”

Section: Discussion and Observationsmentioning

confidence: 99%

Preventing Surgical Site Infections in the Era of Escalating Antibiotic Resistance and Antibiotic Stewardship

Long,

Cifu,

Salipante

et al. 2024

JAMA Surg

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ImportanceAccording to the Centers for Disease Control and Prevention and governing bodies within the American College of Surgeons, the administration of antibiotics as prophylaxis against infection prior to a planned elective procedure is, with rare exception, routinely recommended. The goal of “getting to zero” infections remains a high priority for policymakers, practitioners, and certainly for patients.ObservationsDespite the many advances in surgical technique, skin decontamination, sterile procedure, and enhanced recovery programs, surgical site infections continue to adversely affect procedures as diverse as dental implant surgery, joint arthroplasty, and major abdominal surgery. Although surgical site infection rates are at historically low levels, progress has stalled in recent reporting periods and such infections remain disabling, costly, and occasionally lethal. Stakeholders in the field, including surgeons, infectious diseases specialists, and industry, advocate for strategies emphasizing greater levels of intraoperative sterility or broader-spectrum antibiotic coverage as the most appropriate path forward.Conclusions and RelevanceThe current emphasis on ever-increasing levels of intraoperative sterility and extended-spectrum antibiotic use are not sustainable long-term solutions. Continuing to escalate these approaches may contribute to unintended consequences including antimicrobial resistance. Principles of antimicrobial stewardship and microbiome sciences can be applied to inform a more effective and sustainable approach to infection prevention in the field of surgery.

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Section: Discussion and Observationsmentioning

confidence: 99%

Preventing Surgical Site Infections in the Era of Escalating Antibiotic Resistance and Antibiotic Stewardship

Long,

Cifu,

Salipante

et al. 2024

JAMA Surg

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“…Additionally, almost all SSIs resulting in readmission occur after patient discharge [ 19 ], and delays in detection and treatment can result in serious consequences. Moreover, patients at high-risk for SSI are excellent candidates to receive more intensive prevention such as the use of negative pressure wound therapy [ 20 ] as well as enhanced post-operative monitoring to enable early SSI detection and treatment [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

A Practical Approach to Predicting Surgical Site Infection Risk Among Patients Before Leaving the Operating Room

Woods,

Ekstrom,

Darer

et al. 2023

Cureus

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A surgical site infection (SSI) prediction model that identifies at-risk patients before leaving the operating room can support efforts to improve patient safety. In this study, eight pre-operative and five perioperative patient- and procedure-specific characteristics were tested with two scoring algorithms: 1) count of positive factors (manual), and 2) logistic regression model (automated). Models were developed and validated using data from 3,440 general and oncologic surgical patients. In the automated algorithm, two pre-operative (procedure urgency, odds ratio [OR]: 1.7; and antibiotic administration >2 hours before incision, OR: 1.6) and three intraoperative risk factors (open surgery [OR: 3.7], high-risk procedure [OR: 3.5], and operative time OR: [2.6]) were associated with SSI risk. The manual score achieved an area under the curve (AUC) of 0.831 and the automated algorithm achieved AUC of 0.868. Open surgery had the greatest impact on prediction, followed by procedure risk, operative time, and procedure urgency. At 80% sensitivity, the manual and automated scores achieved a positive predictive value of 16.3% and 22.0%, respectively. Both the manual and automated SSI risk prediction algorithms accurately identified at-risk populations. Use of either model before the patient leaves the operating room can provide the clinical team with evidence-based guidance to consider proactive intervention to prevent SSIs.

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“…Compared with other hospital-acquired conditions, SSI rates have seen little improvement over recent reporting periods ( 2 – 4 ) despite wide adherence to standard infection prevention measures ( 4 , 5 ). Moreover, focused efforts to identify and correct deficiencies in established best practices for SSI prevention have not translated to reduced rates of infection ( 6 ), suggesting both the limited potential of current strategies to drive substantial further reductions in SSI and the need for new data to guide development of preventative approaches.…”

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.

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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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Early recognition and response to increases in surgical site infections using optimised statistical process control charts—The early 2RIS trial: A multicentre stepped wedge cluster randomised controlled trial

Cited by 8 publications

References 39 publications

Preventing Surgical Site Infections in the Era of Escalating Antibiotic Resistance and Antibiotic Stewardship

Preventing Surgical Site Infections in the Era of Escalating Antibiotic Resistance and Antibiotic Stewardship

A Practical Approach to Predicting Surgical Site Infection Risk Among Patients Before Leaving the Operating Room

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

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