Six Years of Surgical Wound Infection Surveillance at a Tertiary Care Center

Weiss, Carl A.; Statz, Catherine L.; Dahms, Rachel A.; Remucal, Michael J.; Dünn, David L.; Beilman, Greg J.

doi:10.1001/archsurg.134.10.1041

Cited by 112 publications

(32 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is likely related to bacterial proliferation evoking an immune response and altering normal collagen synthesis and wound healing. With underlying organ dysfunction and immunosuppressive medications, transplant patients are at increased risk for SSI [28] and, subsequently, incisional hernias. Thus efforts to 1) recognize and aggressively treat SSI and 2) reduce infections would likely have secondary benefits of reducing the risk of hernia formation.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of incisional hernia formation following abdominal organ transplantation

et al. 2014

View full text Add to dashboard Cite

Background Hernia formation is common following abdominal operations and transplant patients are at increased risk due to their need for postoperative immunosuppression. The purpose of this study is to estimate the incidence of incisional hernia formation following primary abdominal solid organ transplantation and identify clinical risk factors for hernia formation. Methods We performed a single-institution retrospective review of a prospectively collected database to evaluate all patients who underwent primary liver, kidney, or pancreas transplantation between 2000 and 2011. The primary outcome measure was hernia formation at the transplant incision. Univariate and multivariate Cox proportional hazards models were used to identify risk factors for incisional hernia formation. Results 3460 transplants were performed during the study period: 2247 kidney only, 718 liver only, and 495 pancreas or simultaneous pancreas and kidney (pancreas group). The overall incisional hernia rate was 7.5%. The Kaplan-Meier rates of hernia formation at 1, 5, and 10 years were 2.5%, 4.9%, and 7.0% for kidney; 4.5%, 13.6%, and 19.0% for liver; and 2.5%, 12.7%, and 21.8% for the pancreas groups. On univariate analysis, surgical site infection (SSI), body mass index (BMI) >25, delayed graft function (DGF), and absence of a calcineurin inhibitor or mycophenolic acid (MMF) were associated with hernia formation in the kidney group. SSI and BMI>25 were associated with hernia formation in the liver group. In the pancreas group, SSI, the use of cyclosporine, and lack of MMF were all associated with hernia formation. On multivariate analysis, SSI was strongly associated with hernia formation in all groups (Hazard Ratio (HR): Kidney = 24.71, p<0.001; Liver = 12.0, p<0.001, Pancreas = 12.95, p=0.001). Conclusion Incisional hernias are common following abdominal organ transplant with nearly one in five patients developing an incisional hernia five years after liver of pancreas transplantation. Strategies focusing on prevention and early treatment of SSI may help to decrease the risk of incisional hernia formation following abdominal organ transplantation.

show abstract

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of incisional hernia formation following abdominal organ transplantation

et al. 2014

View full text Add to dashboard Cite

show abstract

“…whether cellulitis cases are included or excluded), 20 and differences in surveillance methods to ascertain SSI cases. 9, 21 …”

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains After Breast and Axillary Operations

Degnim¹,

Scow²,

Hoskin³

et al. 2013

Annals of Surgery

View full text Add to dashboard Cite

Objective To determine if bacterial colonization of drains can be reduced by local antiseptic interventions. Summary Background Drains are a potential source of bacterial entry into surgical wounds and may contribute to surgical site infection (SSI) after breast surgery. Methods Following IRB approval, patients undergoing total mastectomy and/or axillary lymph node dissection were randomized to standard drain care (control) or drain antisepsis (treated). Standard drain care comprised twice daily cleansing with alcohol swabs. Antisepsis drain care included 1) a chlorhexidine disc at the drain exit site and 2) irrigation of the drain bulb twice daily with dilute sodium hypochlorite (Dakin’s) solution. Cultures results of drain fluid and tubing were compared between control and antisepsis groups. Results Overall, 100 patients with 125 drains completed the study with 48 patients (58 drains) in the control group and 52 patients (67 drains) in the antisepsis group. Cultures of drain bulb fluid at one week were positive (1+ or greater growth) in 66% (38/58) of control drains compared to 21% of antisepsis drains (14/67), (p=0.0001). Drain tubing cultures demonstrated >50 CFU in 19% (8/43) of control drains versus 0% (0/53) of treated drains (p=0.004). SSI was diagnosed in 6 patients (6%) - 5 patients in the control group and 1 patient in the antisepsis group (p=0.06). Conclusions Simple and inexpensive local antiseptic interventions with a chlorhexidine disc and hypochlorite solution reduce bacterial colonization of drains. Based on these data, further study of drain antisepsis and its potential impact on SSI rate is warranted.

show abstract

“…Indeed, one published study found an inpatient SSI rate of 0.4% and an outpatient SSI rate of 2.4% within 30 days after breast surgeries. 18 Another found that the rate of SSI after breast biopsy doubled when a post-discharge surveillance program was instituted. 19 …”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infection after Breast Surgery: Impact of 2010 CDC Reporting Guidelines

et al. 2012

View full text Add to dashboard Cite

Introduction Reported surgical site infection (SSI) rates after breast operations range from 0.8–26% in the literature. Aims of the present study were to characterize SSI after breast/axillary operations and determine the impact on the SSI rate of the 2010 Centers for Disease Control and Prevention (CDC) reporting guidelines that now specifically exclude cellulitis. Methods Retrospective chart review identified 368 patients, with 449 operated sides, between 07/2004 and 6/2006. SSI was defined using CDC criteria: purulent drainage (CDC #1), positive aseptically collected culture (CDC #2), signs of inflammation with opening of incision and absence of negative culture (CDC#3), or physician diagnosis of infection (CDC #4). The impact of excluding cellulitis was assessed. Results Using prior CDC reporting guidelines, among 368 patients, 32 (8.7%) experienced SSI in 33/449 (7.3%) operated sides. Of these, 11 (33%) met CDC criteria 1–3, while 22 (67%) met CDC criterion 4. Excluding cellulitis cases per 2010 CDC SSI reporting guidelines eliminates 21 of the 22 infections previously meeting CDC criterion 4. Under the new reporting guidelines, the SSI rate is 12/449 (2.7%) operated sides. SSI rates varied by procedure but these differences were not statistically significant. Conclusions Cellulitis after breast and axillary surgery is much more common than other criteria for SSI, and SSI rates are reduced almost three-fold if cellulitis cases are excluded. Recently revised CDC reporting guidelines may result in underestimates of the clinical burden of SSI after breast/axillary surgery.

show abstract

Six Years of Surgical Wound Infection Surveillance at a Tertiary Care Center

Abstract: Hypotheses: (1) Antibiotic restriction policies result in alteration of microbiologic features of surgical site infections (SSIs) and (2) reported SSI rates are underestimated when postdischarge surveillance is not included in SSI surveillance efforts.

Cited by 112 publications

References 39 publications

Incidence and risk factors of incisional hernia formation following abdominal organ transplantation

Incidence and risk factors of incisional hernia formation following abdominal organ transplantation

Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains After Breast and Axillary Operations

Surgical Site Infection after Breast Surgery: Impact of 2010 CDC Reporting Guidelines

Contact Info

Product

Resources

About