Impact of an Infection Control and Antimicrobial Stewardship Program on Solid Organ Transplantation and Hepatobiliary Surgical Site Infections

Abstract

OBJECTIVE The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs). METHODS This study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation were included. Outcomes were compared between a preintervention group (2010-2011) and a postintervention group (2012-2014). RESULTS A total of 1,424 procedures averaged an overall SSI rate of 11.2%. After implementation of the interventions, a decrease of 52.8% in SSI rates from 17.4% to 8.2% was observed (P50% (relative rate; P<.001) was observed in superficial incisional and organ-space infections between pre- and postintervention groups. In addition, a 54.9% decrease from 19.7% to 8.9% (P<.001; OR, 2.2; 95% CI, 1.4-3.5) and a 51.6% decrease from 15.5% to 7.5% (P=.001; OR, 2.2; 95% CI, 1.4-3.5) were observed for SSI rates in hepatobiliary surgery and solid organ transplantation, respectively. The antimicrobial stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 15.2% (absolute rate) from 45.1% to 60.3% (P<.003; 95% CI, 5.4-24.9). CONCLUSIONS A long-term serial infection control and antimicrobial stewardship intervention decreased SSIs among patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation. Infect Control Hosp Epidemiol 2016;1468-1474.

Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single‐center prospective cohort study

“…The reported incidence of surgical site infection (SSI) after a liver transplantation is high owing to the complexity of the surgical procedure, comorbidities, and immunosuppression (4%‐48%) . SSI causes decreased graft survival, prolonged hospital stay, increased costs, morbidity, and mortality . Various risk factors have been described for SSIs: obesity, diabetes mellitus, alcoholism, malnutrition, model for end‐stage liver disease (MELD) score, ABO incompatibility, preoperative anemia, low albumin levels, pretransplant abdominal infection, previous colonization by resistant microorganisms, intraoperative hyperglycemia, intraoperative blood transfusion, presence of vascular grafts, type of biliary anastomosis, retransplantation, cold ischemia time (CIT), biliary leak, and significant immunosuppression .…”

“…The incidence of SSI has not changed in the last 10 years despite the advances in surgical techniques, improvements in postoperative treatments for liver transplant recipients, changes in immunosuppressive therapy, and the fact that organ allocation is performed according to the MELD scoring system . Additionally, variations in the incidence of SSI may stem from the variability in the risk factors at different centers …”

Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review

“…The main characteristics of all 40 included studies are presented in Table 2. Twenty-five studies were performed in the US [36, 37, 39, 45-52, 55, 56, 58-60, 62, 63, 65, 67, 69-73], two each in Australia [34,54], Canada [41,42], the Netherlands [38,44], Spain [40,64], and the UK [35,66], and one each in Germany [68], Saudi Arabia [53], Singapore [57], Switzerland [61], and Qatar [43]. Thirty-six studies were single-center studies, and four studies were performed in more than one hospital [50,65,66,69].…”

“…In some of these studies, the compliance rates were reported in narrative or graphical form only, which made it difficult to determine the exact rates. In addition, from those studies that reported explicit baseline and cohort compliance rates, 13 studies reported rates for individual measures, while 7 presented global rates for all clinical measures [35,38,42,53,54,62,64]; only two studies reported both types of rates [34,63]. Thus, further analyses on the associations between implementation interventions and compliance with clinical interventions are omitted.…”

“…In particular, the compliance rates were incompletely reported. In 8 of 9 studies that explicitly reported global baseline and cohort compliance rates, the global compliance rates increased [34,35,38,42,53,[62][63][64]. Increases ranged from 15.2 to 70% (mean value: 31.7%).…”