Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes

Ballús, J.; López-Delgado, Juan Carlos; Sabater-Riera, Joan; Pérez-Fernández, Xosé L.; Betbese, A. J.; Roncal, Joan A

doi:10.1186/s12879-015-1050-5

Cited by 38 publications

(36 citation statements)

References 23 publications

(49 reference statements)

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“…In our study, 2 nd group carbapenems showed the highest in vitro efficacy in both study groups, corresponding to data of other colleagues [29]. Other clinicians call to diminish/ignore the use of any generation cephalosporins due to serious drop of their efficacy with time and strong promotion of antibacterial resistance [26].…”

Section: Discussionsupporting

confidence: 88%

“…Antibiotic resistance to >2 antibiotics Original Research Article: full paper (2017), «EUREKA: Health Sciences» Number 6 occurred in 64,9 % of cases of SP, presented mainly by extended spectrum b-lactamase-producing Enterobacteriaceae spp. and P. aeruginosa in 11,1 % and 11,9 % respectively [26]. In other works, fraction of nosocomial MDR reached 84,8 %, but just 14 % in case of TP [23].…”

Section: Discussionmentioning

confidence: 68%

“…According to reports, it's successful in 9,2-21,2 % [25,26]. Results of hemocultivation differ as well, probably depending on patient's general health condition, severity of surgical disease, characteristics of therapy and accuracy of cultivation.…”

Section: Discussionmentioning

confidence: 99%

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Microbiological Spectre of Tertiary Peritonitis as a Component of Its Diagnostics and Treatment

Fomin

Matviychuk

Korniychuk

2017

EUREKA: Health Sciences

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The aim of the research was to investigate the microbial spectre of tertiary peritonits (TP) and its antibiotic resistance as the way to improve the diagnostics and treatment of TP. Materials and methods. Prospective research enrolled 109 patients with secondary peritonitis. Tertiary peritonitis developed in 18,3 % of cases. Samples of peritoneal exudate had been drawn upon index operation, relaparotomy and on the day of diagnosis of TP. Blood sampling was performed in patients with persistent fever, impaired consciousness, prolonged (>4 days) discharge from drainage tubes and on the 1st day of diagnosis of TP. Antibacterial susceptibility was evaluated using Hinton-Müller media. Results and discussion. Patients were divided into 2 groups: with secondary peritonitis (89) and with TP (20). In TP group, cultivation of 76,2 % of primary specimens resulted in replantable and identifiable growth, presenting a shift towards Gram-negative flora and higher incidence of Candida albicans. Following the development of TP, hemocultures were positive in 15,1 %, presented mainly by Proteus spp. and non-albicans Candida spp. Second-group carbapenems, tigecycline and piperacillin-tazobactam had shown the highest activity in pathogens of TP. Caspofungin proved to be the most potent antifungal agent, especially towards non-albicans Candida spp. Antibiotic resistance in TP group was marked in 63,8 %. Conclusions. Tertiary peritonitis is one of the most severe forms of abdominal sepsis with highest mortality. Causing pathogenic flora in case of TP is mainly Gram-negative and coccal with high rates of antibiotic resistance both in vitro and in vivo. Fungi, presented predominantly by Candida non-albicans substrains, show an increasing content in peritoneal exudate and major effect upon mortality in TP. In case of TP, a significant percent of peritoneal specimens do not provide any culture growth despite of observing stringent sampling, transportation and cultivation rules. Antimicrobial therapy of TP can never be standardized and should always be thoroughly based upon regular and proper peritoneal and blood sampling.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 68%

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Microbiological Spectre of Tertiary Peritonitis as a Component of Its Diagnostics and Treatment

Fomin

Matviychuk

Korniychuk

2017

EUREKA: Health Sciences

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“…complications, however it was not common in other sepsis-related complications; *IQR not calculated because < 5 values in range; †Several patients developed more than one sepsis-related complication.who have undergone abdominal surgery 24. The majority of organisms involve hospital acquired ESKAPE pathogens namely…”

mentioning

confidence: 99%

A review of the complications encountered in a quaternary trauma intensive care unit in South Africa

2019

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Background: Due to the invasive nature required for support and multiple therapeutic interventions, critically ill patients are at high risk of complications unrelated to their underlying illness or injury. This audit aimed to describe the spectrum of complications in a trauma intensive care unit, to identify potential remedial interventions to improve quality of care and reduce morbidity Methods: Complications in the Trauma Intensive Care Unit at Inkosi Albert Luthuli Central Hospital are documented prospectively on a specific proforma. A 12-month audit was performed between 2012-2013. Complications were divided into septic and non-septic adverse events and the relationship to injury severity, time of onset and outcome were analysed. Results: Of 283 patients admitted during the study period, 77 (32.5%) suffered a total of 161 adverse events. Ninety-seven (60.2%) complications were sepsis-related and 64 (39.2%) were unrelated to sespis. Ventilator-associated pneumonia was the commonest septic event (38.1%) and extubation-related events the most frequent non-septic complication (45.3%). The number of complications ranged from one in the majority of patients (49.4%) to 6 (3.9%) in 3 patients. There was no significant difference in mortality between those with (24.7%) or without (17.4%) complications (p = 0.22) however, those with complications had a significantly longer length of ICU stay (p < 0.001). Conclusion: Complications are common in the critically injured who necessitate admission to an intensive care unit. The vast majority arise from infective causes, especially ventilator-associated pneumonia. Adverse events related to the endotracheal tube are the commonest non-infective events. The identification of these adverse events should prompt interventions aimed at reducing the incidence.

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“…Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%) whereas, Acinetobacter baumannii was the commonest organism during phase II (38.5%). In a study published by Ballus et al in 2015 35 E. coli (20.4%) and Candida spp. (17.1%) were the most frequently isolated microorganisms from SSIs and were associated with a higher incidence of antibiotic resistance (64.9%) in ICU patients.…”

Section: Discussionmentioning

confidence: 92%

<p>Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt</p>

Wassef¹,

Mukhtar²,

Nabil³

et al. 2020

IDR

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Introduction: Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance. Purpose: We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University. Patients and Methods: Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection. Results: Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p<0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd's ratio (OR's ratio = 0.3) confidence interval (95% CI 0.14-0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%). Conclusion: Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.

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Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes

Cited by 38 publications

References 23 publications

Microbiological Spectre of Tertiary Peritonitis as a Component of Its Diagnostics and Treatment

Microbiological Spectre of Tertiary Peritonitis as a Component of Its Diagnostics and Treatment

A review of the complications encountered in a quaternary trauma intensive care unit in South Africa

<p>Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt</p>

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