Epidemiology and risk factors associated with surgical site infection after different types of hepatobiliary and pancreatic surgery

Morikane, Keita

doi:10.1007/s00595-017-1503-0

Cited by 37 publications

(51 citation statements)

References 20 publications

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“…The implementation of such a policy in our practice led to a reduction in the incidence of SSI from 26.4% to 14.8%, and when only patients' adherent to the policy were assessed the rate was only 10.7%. This rate of SSI is less than reported in the NSQIP data (H. Pitt, personal communication, March 18, 2018) and the current surgical literature [4,5] and indicates that intelligent antibiotic prophylaxis targeting bacteria likely to be encountered during PD is critical in preventing SSIs in this cohort.…”

Section: Discussionmentioning

confidence: 60%

“…In the NSQIP database, surgical site infections (SSIs) were the most common cause of morbidity, accounting for 21% of the postoperative complications with two-thirds being organ/space and one-third superficial SSIs (H. Pitt, personal communication, March 18, 2018). Such high rates for SSI are also reported in the recent literature: 17%-28% for PD [4,5] and so it is certain that this is a genuine problem.…”

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confidence: 53%

“…Of note, the incidence of Clostridium difficile infection also reduced after the change in the antibiotic policy from 8.1% to 1.9% (p = 0.006). A further observation was a reduction in the length of post-operative hospital stay from a median and interquartile range of 7 [5-9] to 6 [4][5][6][7] days (p = 0.003).…”

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confidence: 99%

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Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Cengiz

Jarrar

Power

et al. 2020

Surgical Infections

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Background: Surgical site infections (SSIs) remain a major source of morbidity after pancreatoduodenectomy (PD). We noted a higher than anticipated incidence of SSI in our patients undergoing PD, and after an internal audit and detailed analysis of the microflora of SSIs, as well as a multidisciplinary discussion, the local prophylactic antibiotic policy was changed based on sensitivities to the bacteria isolated from post-operative infections. The hypothesis was that a targeted change in antibiotic prophylaxis would reduce the rate of SSIs. The aim of the current study was to analyze the results of a change in prescribing policy on SSI rates, and in addition, on the occurrence and severity of post-operative pancreatic fistulae (POPF) because this complication is often linked to the presence of an organ/space SSI. Methods: After implementing a change of prophylaxis policy from cefalexin to ceftriaxone and metronidazole, and educating staff and residents, a prospectively maintained departmental database was used to identify consecutive patients undergoing PD pre-and post-institution of policy change. Incidence data relating to SSIs and POPF were obtained from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) data set and the details of culture results and organism sensitivity extracted from the electronic medical record, as were details on the severity of fistulae, and verified by the senior author. Results: The pre-and post-implementation cohorts consisted of 111 and 216 patients, respectively, and were matched in terms of all demographic features. After the change in the antibiotic prophylaxis policy, there was a reduction in the overall SSI rate (26.4% vs. 14.8%; p = 0.01) and the organ/space SSI rate (OS-SSI; 15.3% vs. 8.6%; p = 0.03). There were also reductions in the POPF rate (38.2% vs. 19%; p = 0.002) and in the clinically relevant POPF (CR-POPF; 23.4% vs. 6.0%; p = 0.001). The rate of Clostridium difficile infections also decreased (8.1% vs.1.9%; p = 0.006) as did the median length of hospital stay (7 vs. 6 days; p = 0.003). After excluding patients with a penicillin allergy (n = 24) from the post-implementation cohort, cases compliant (158/ 192) and non-compliant (34/192) to the new antibiotic policy were compared. The overall SSI (26.4% vs. 10.7%; p = 0.025), OS-SSI (17.6% vs. 5.1%; p = 0.021), overall POPF (32.4 vs. 14.6; p = 0.023); CR-POPF (10.8% vs. 5.5%; p = 0.047) and Clostridium difficile (8.8% vs. 1.3%; p = 0.040) were all lower in the compliant patient cohort. Conclusions: A change in antibiotic prophylaxis prior to PD based on the local microflora, resulted in reductions in SSI, POPF, and Clostridium difficile rates.

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Section: Discussionmentioning

confidence: 60%

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confidence: 53%

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Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Cengiz

Jarrar

Power

et al. 2020

Surgical Infections

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“…This finding is not novel. 16 Although there is no consensus regarding why male patients are predisposed to SSI, studies have shown that, in laparoscopic cholecystectomy, male sex is a predictor of longer and more difficult operations and has a higher rate of conversion. [17][18][19] In addition, it is known that there are sex differences in skin colonization that may be associated with differences in skin thickness, sebum production and skin pH.…”

Section: Discussionmentioning

confidence: 99%

Surgical site infection following abdominal surgery: a prospective cohort study

Alkaaki

Al‐Radi

Khoja

et al. 2019

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Background: Surgical site infection (SSI) is one of the most common complications of abdominal surgery and is associated with substantial discomfort, morbidity and cost. The goal of this study was to describe the incidence, bacteriology and risk factors associated with SSI in patients undergoing abdominal surgery. Methods: In this prospective cohort study, all patients aged 14 years or more undergoing abdominal surgery between Feb. 1 and July 31, 2016, at a single large academic hospital were included. Patients undergoing vascular, gynecological, urological or plastic procedures were excluded. Patients were followed prospectively for 30 days. Wound assessment was done with the Centers for Disease Control and Prevention definition of SSI. We performed multivariate analysis to identify factors associated with SSI. Results: A total of 337 patients were included. The overall incidence of SSI was 16.3% (55/337); 5 patients (9%) had deep infections, and 25 (45%) had combined superficial and deep infections. The incidence of SSI in open versus laparoscopic operations was 35% versus 4% (p < 0.001). The bacteria most commonly isolated were extended-spectrum β-lactamase-producing Escherichia coli, followed by Enterococcus species. Only 23% of cultured bacteria were sensitive to the prophylactic antibiotic given preoperatively. The independent predictors of SSI were open surgical approach, emergency operation, longed operation duration and male sex. Conclusion: Potentially modifiable independent risk factors for SSI after abdominal surgery including open surgical approach, contaminated wound class and emergency surgery should be addressed systematically. We recommend tailoring the antibiotic prophylactic regimen to target the commonly isolated organisms in patients at higher risk for SSI. Contexte : L'infection de plaie opératoire (IPO) est l'une des plus fréquentes complications de la chirurgie abdominale et elle est associée à un inconfort, une morbidité et des coûts substantiels. L'objectif de cette étude était de décrire l'incidence, les données bactériologiques et les facteurs de risque associés à l'IPO chez les patients soumis à une chirurgie abdominale. Méthodes : Dans cette étude de cohorte, tous les patients de 14 ans ou plus soumis à une chirurgie abdominale entre le 1 er février et le 31 juillet 2016 dans un seul grand établissement hospitalier universitaire ont été inclus. Les chirurgies vasculaires, gynécologiques, urologiques ou plastiques ont été exclues. Les patients ont été suivis de façon prospective pendant 30 jours. L'évaluation des plaies a été effectuée à partir de la définition de l'IPO des Centers for Disease Control and Prevention. Nous avons procédé à une analyse multivariée afin d'identifier les facteurs associés à l'IPO. Résultats : En tout, 337 patients ont été inclus. L'incidence globale des IPO a été de 16,3 % (55/337); 5 patients (9 %) ont présenté des infections profondes, et 25 (45 %) ont présenté des infections superficielles et profondes. L'incidence des IPO lors d'interventions ouvertes ...

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“…Infectious complications are one of the main causes of death. Surgical-site infection rates after HBPS were reported to be about 9.9-23% [8]. Postoperative infectious complication rates for liver resection were reported as 15.6-34% [9][10][11], which adversely affect oncologic outcomes for hepatocellular carcinoma patients [11], potentially resulting in hepatic failure and death.…”

Section: Introductionmentioning

confidence: 99%

A Novel Prediction Model for Bloodstream Infections in Hepatobiliary–Pancreatic Surgery Patients

et al. 2019

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Background Bloodstream infections (BSI) are an important source of postoperative mortality in hepatobiliarypancreatic surgery (HBPS) patients, and no prediction model has been analyzed before. Methods Using big data from the electronic medical records of the administrative and culture databases of MacKay Memorial Hospital, we identified the potential risk factors for community-acquired and healthcare-associated BSI and mortality of patients who received HBPS. Subsequently, we analyzed the microorganisms' profiles and antimicrobial susceptibility patterns for these BSI. Results BSI were found in 6.3% patients (349 of 5513 HBPS patients), and hospital mortality was 1.48% (82 of 5513). Dividing patients into low-, intermediate-, and high-risk groups on the basis of sex, age, status of comorbidity (renal failure, peptic ulcer disease, fluid and electrolyte disorders, and acute cholecystitis), a predictive BSI risk score model was developed. According to this model, BSI risk ranged from 1.43% to 11.95%; AUROC to predict BSI risk was 0.72 (95% CI 0.69-0.75). From this retrospective study, Enterobacteriaceae were the most common microorganisms that were isolated from BSI. For both community-acquired and healthcare-associated BSI, imipenem and colistin are the most successful. Conclusion This novel model can be useful to predict who is at risk of BSI after HBPS, and new prophylactic protocols for these patients are needed.

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Epidemiology and risk factors associated with surgical site infection after different types of hepatobiliary and pancreatic surgery

Abstract: The incidence of and factors associated with SSI after the three types of HBPS analyzed differed significantly. To accurately compare hospital performance in relation to SSI following HBPS, the operative procedure category in the surveillance system must be divided into three types.

Cited by 37 publications

References 20 publications

Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Antimicrobial Stewardship Reduces Surgical Site Infection Rate, as well as Number and Severity of Pancreatic Fistulae after Pancreatoduodenectomy

Surgical site infection following abdominal surgery: a prospective cohort study

A Novel Prediction Model for Bloodstream Infections in Hepatobiliary–Pancreatic Surgery Patients

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