Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

Sun, Chen; Gao, Hui; Zhang, Yuelun; Pei, Lijian; Huang, Yuguang

doi:10.3389/fonc.2021.705335

Cited by 4 publications

(6 citation statements)

References 19 publications

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“…Many of the previously studied surgical populations have much lower rates of overall and organ/space SSI than PT recipients. 21 Patients with organ/space SSIs often receive prolonged courses of antibiotics, which would likely lead to more CDI than perioperative prophylaxis alone. Additionally, most of the agents used for perioperative prophylaxis in the PT population are targeted at enteric organisms rather than skin flora, which have higher risk for CDI.…”

Section: Discussionmentioning

confidence: 99%

Impact of Perioperative Prophylaxis With Enterococcus Activity on Risk of Surgical-Site Infection After Pancreas Transplantation

Yetmar

McCord

Lahr

et al. 2023

Transplantation Direct

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Background. Surgical-site infection (SSI) is the most common early infectious complication after pancreas transplantation (PT). Although SSI has been shown to worsen outcomes, little data exist to guide optimal choices in perioperative prophylaxis. Methods. We performed a retrospective cohort study of PT recipients from 2010-2020 to examine the effect of perioperative antibiotic prophylaxis with Enterococcus coverage. Enterococcus coverage included antibiotics that would be active for penicillin-susceptible Enterococcus isolates. The primary outcome was SSI within 30 d of transplantation, and secondary outcomes were Clostridioides difficile infection (CDI) and a composite of pancreas allograft failure or death. Outcomes were analyzed by multivariable Cox regression. Results. Of 477 PT recipients, 217 (45.5%) received perioperative prophylaxis with Enterococcus coverage. Eighty-seven recipients (18.2%) developed an SSI after a median of 15 d from transplantation. In multivariable Cox regression analysis, perioperative Enterococcus prophylaxis was associated with reduced risk of SSI (hazard ratio [HR] 0.58; 95% confidence interval [CI], 0.35-0.96; P = 0.034). Anastomotic leak was also significantly associated with elevated risk of SSI (HR 13.95; 95% CI,; P < 0.001). Overall, 90-d CDI was 7.4%, with no difference between prophylaxis groups (P = 0.680). SSI was associated with pancreas allograft failure or death, even after adjusting for clinical factors (HR 1.94; 95% CI, 1.16-3.23; P = 0.011). Conclusions. Perioperative prophylaxis with Enterococcus coverage was associated with reduced risk of 30-d SSI but did not seem to influence risk of 90-d CDI after PT. This difference may be because of the use of beta-lactam/beta-lactamase inhibitor combinations, which provide better activity against enteric organisms such as Enterococcus and anaerobes compared with cephalosporin. Risk of SSI was also related to anastomotic leak from surgery, and SSI itself was associated with subsequent risk of a poor outcome. Measures to mitigate or prevent early complications are warranted.

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Section: Discussionmentioning

confidence: 99%

Impact of Perioperative Prophylaxis With Enterococcus Activity on Risk of Surgical-Site Infection After Pancreas Transplantation

Yetmar

McCord

Lahr

et al. 2023

Transplantation Direct

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“…Emergent surgeries are often a contaminated or infected condition in clinical practice, however, it is controversial whether an emergent surgery is a risk factor of SSI incidence or not. [24][25][26] We placed subcutaneous drain or performed closed incision negative pressure therapy when the operative wound was highly contaminated. These treatments might reduce the SSI incidence in patients with operative wound class III/IV.…”

Section: Discussionmentioning

confidence: 99%

“…Some previous reports revealed that neoadjuvant chemotherapy, radiotherapy, preoperative parenteral nutrition, prolonged intensive care unit stay, disseminated cancer, preoperative sepsis, prevalence of inflammatory bowel syndrome, and bowel obstruction/perforation/ fistula were identified as risk factors of organ/space SSI. 25,26 Furthermore, Gomila et al and Xu et al also clarified that stoma creation in colorectal surgery was the risk factor of organ/space SSI. Although our cohort included the largest number of patients undergoing lower gastrointestinal surgery, previously mentioned risk factors were not considered as adjustment factors.…”

Section: Discussionmentioning

confidence: 99%

“…Subgroup analyses revealed that emergent surgery and operative wound class III/IV did not significantly increase SSI incidence in 10% povidone‐iodine group. Emergent surgeries are often a contaminated or infected condition in clinical practice, however, it is controversial whether an emergent surgery is a risk factor of SSI incidence or not 24–26 . We placed subcutaneous drain or performed closed incision negative pressure therapy when the operative wound was highly contaminated.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of olanexidine versus povidone‐iodine as a preoperative antiseptic for reducing surgical site infection in both scheduled and emergency gastrointestinal surgeries: A single‐center randomized clinical trial

Umemura

Sasaki

Fujiwara³

et al. 2023

Annals of Gastroent Surgery

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AimSurgical site infection (SSI) is one of the most common postoperative complications in gastrointestinal surgery. To clarify the superiority of 1.5% olanexidine, we conducted a randomized prospective clinical trial that enrolled patients undergoing gastrointestinal surgery with operative wound classes II–IV.MethodsTo evaluate the efficacy of 1.5% olanexidine in preventing SSIs relative to 10% povidone‐iodine, we enrolled 298 patients in each group. The primary outcome was a 30‐day SSI, and the secondary outcomes were incidences of superficial and deep incisional SSI and organ/space SSI. In addition, subgroup analyses were performed.ResultsThe primary outcome of the overall 30‐day SSI occurred in 38 cases (12.8%) in the 1.5% olanexidine group and in 53 cases (18.0%) in the 10% povidone‐iodine group (adjusted risk ratio: 0.716, 95% confidence interval: 0.495–1.057, p = 0.083). Organ/space SSI occurred in 18 cases (6.1%) in the 1.5% olanexidine group and in 31 cases (10.5%) in the 10% povidone‐iodine group, with a significant difference (adjusted risk ratio: 0.587, 95% confidence interval: 0.336–0.992, p = 0.049). Subgroup analyses revealed that SSI incidences were comparable in scheduled surgery (relative risk: 0.809, 95% confidence interval: 0.522–1.254) and operative wound class II (relative risk: 0.756, 95% confidence interval: 0.494–1.449) in 1.5% olanexidine group.ConclusionOur study revealed that 1.5% olanexidine reduced the 30‐day overall SSI; however, the result was not significant. Organ/space SSI significantly decreased in the 1.5% olanexidine group. Our results indicate that 1.5% olanexidine has the potential to prevent SSI on behalf of povidone‐iodine.

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“…SSIs affect up to 10–20% of patients undergoing major surgery [ 1 ]. In the USA, SSIs cause over 90,000 readmissions, extend the average length of hospital stay by up to 9.7 days and increase medical costs by $700 millions each year [ 2 ]. Due to their aggressive character, cardiac surgical procedures are associated with an even greater degree of postoperative infection risk.…”

Section: Introductionmentioning

confidence: 99%

Surgical Site Infection in Cardiac Surgery

Żukowska¹,

Żukowski

2022

JCM

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Surgical site infections (SSIs) are one of the most significant complications in surgical patients and are strongly associated with poorer prognosis. Due to their aggressive character, cardiac surgical procedures carry a particular high risk of postoperative infection, with infection incidence rates ranging from a reported 3.5% and 26.8% in cardiac surgery patients. Given the specific nature of cardiac surgical procedures, sternal wound and graft harvesting site infections are the most common SSIs. Undoubtedly, DSWIs, including mediastinitis, in cardiac surgery patients remain a significant clinical problem as they are associated with increased hospital stay, substantial medical costs and high mortality, ranging from 3% to 20%. In SSI prevention, it is important to implement procedures reducing preoperative risk factors, such as: obesity, hypoalbuminemia, abnormal glucose levels, smoking and S. aureus carriage. For decolonisation of S. aureus carriers prior to cardiac surgery, it is recommended to administer nasal mupirocin, together with baths using chlorhexidine-based agents. Perioperative management also involves antibiotic prophylaxis, surgical site preparation, topical antibiotic administration and the maintenance of normal glucose levels. SSI treatment involves surgical intervention, NPWT application and antibiotic therapy

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Risk Stratification for Organ/Space Surgical Site Infection in Advanced Digestive System Cancer

Cited by 4 publications

References 19 publications

Impact of Perioperative Prophylaxis With Enterococcus Activity on Risk of Surgical-Site Infection After Pancreas Transplantation

Impact of Perioperative Prophylaxis With Enterococcus Activity on Risk of Surgical-Site Infection After Pancreas Transplantation

Comparison of olanexidine versus povidone‐iodine as a preoperative antiseptic for reducing surgical site infection in both scheduled and emergency gastrointestinal surgeries: A single‐center randomized clinical trial

Surgical Site Infection in Cardiac Surgery

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