Defeating Cancel Culture in Surgical Site Infection Research: A Plea to Include Microbial Cultures and Antibiotic Sensitivity Data

Studies Involving Surgical Site Infections (SSIs) without Culture Results, the Antibiotics Chosen for Prophylaxis and Antibiotic Sensitivity Data. “Are they actionable?”

“…However, here I argue that some mention of the pathogenic organisms involved, the antibiotics chosen for prophylaxis, and their sensitivity data might have been helpful. 2 Although, most SSIs were superficial in this study, without any information regarding how the SSIs were treated or where they occurred (ie, the extraction site since most cases were laparoscopic), leaves one with the presumption that most were treated with antibiotics alone. The authors state "when an SSI was suspected based on the clinical findings, nonblinded investigators collected microbiologic cultures from wounds and recorded the treatment details and wound depth."…”

“…We thank the authors for outlining the limitations of the study and its inherent selection bias. However, here I argue that some mention of the pathogenic organisms involved, the antibiotics chosen for prophylaxis, and their sensitivity data might have been helpful 2 . Although, most SSIs were superficial in this study, without any information regarding how the SSIs were treated or where they occurred (ie, the extraction site since most cases were laparoscopic), leaves one with the presumption that most were treated with antibiotics alone.…”

“…We realize that not all wounds, as suggested by the authors, can be clinically inspected by the index surgeon nor need to be opened and cultured 2 . Yet counting and diagnosing an SSI based on clinical inspection and subsequent treatment alone (i.e., provision of antibiotics) as the CDC criteria has indicated, is problematic for obvious reasons 8 .…”

“…This latter approach will require that we accept that today, as many as 50% of SSIs may be due to organisms resistant to the antibiotic chosen for prophylaxis 14 . The only way to change our practice is to identify the microorganisms that are present in a given SSI and to determine their antibiotic sensitivities 2 …”

“…We realize that not all wounds, as suggested by the authors, can be clinically inspected by the index surgeon nor need to be opened and cultured. 2 Yet counting and diagnosing an SSI based on clinical inspection and subsequent treatment alone (i.e., provision of antibiotics) as the CDC criteria has indicated, is problematic for obvious reasons. 8 Here we posit that in order to design a rational approach to SSI prevention, 2 considerations are needed: first we must consider that mechanisms other than intraoperative contamination of the operative wound site are possible causes of an SSI (ie, Trojan Horse hypothesis of an SSI).…”