Surveillance of Surgical Site Infection after Cholecystectomy Using the Hospital in Europe Link for Infection Control through Surveillance Protocol

Abstract

Background: The third most common healthcare-associated infection is surgical site infection (SSI), accounting for 14%-16% of infections. These SSIs are associated with high morbidity, numerous deaths, and greater cost. Methods: A prospective study was conducted to assess the incidence of SSI in a single university hospital in Croatia. We used the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol for surveillance. The SSIs were classified using the standard definition of the National Nosocomial Infections Surveillance (NNIS) system. Results: The overall incidence of SSI was 1.44%. The incidence of infection in the open cholecystectomy group was 6.06%, whereas in the laparoscopic group, it was only 0.60%. The incidence density of in-hospital SSIs per 1,000 post-operative days was 5.76. Patients who underwent a laparoscopic cholecystectomy were significantly younger (53.65 -14.65 vs. 64.42 -14.17 years; p < 0.001), spent roughly one-third as many days in the hospital (2.40 -1.72 vs. 8.13 -4.78; p < 0.001), and had significantly shorter operations by nearly 26 min (60.34 -28.34 vs. 85.80 -37.17 min; p < 0.001). Procedures that started as laparoscopic cholecystectomies and were converted to open procedures (n = 28) were reviewed separately. The incidence of SSI in this group was 17.9%. The majority of converted procedures (71.4%) were elective, and the operating time was significantly longer than in other two groups (109.64 -85.36 min). Conclusion: The HELICS protocol has a good concept for the monitoring of SSI, but in the case of cholecystectomy, additional factors such as antibiotic appropriateness, gallbladder entry, empyema of the gallbladder, and obstructive jaundice must be considered.

Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis

“…This particular measure mainly prevents from postoperative pneumonia, so it does not influence the prevention of incisional SSI. Finally, as in parallel to other series reviewed (9,11,13), the microorganisms isolated in our study were the most often identified in such kind of surgical procedures, including Escherichia coli (47.8%), Klebsiella pneumoniae (13.1%) and Enterococcus faecium (13.1%).…”

“…Antibiotic choice should be based on the spectrum of microorganisms most frequently involved in each surgical location, opting for the safer, cheaper and less likely to favor the emergence of drug-resistance bacteria. In order to ensure the effectiveness of antibiotic prophylaxis, its administration is usually protocolized, being not indicated in the case of a low risk gallbladder surgery (9). These interventions have an overall incidence of SSI of 1% to 3%, which range from 0.5% in laparoscopic to 6% in open surgery.…”

Role of antibiotics on surgical site infection in cases of open and laparoscopic cholecystectomy: A comparative observational study

“…So, we can conclude that endoscopic surgeries are associated with low SSI in gallbladder surgeries as compared to the open gallbladder surgeries. [12627]…”

“…[1] There are evidence of postoperative morbidity due to SSI. So it is needed to improve the outcome of surgical procedures and hence advised to give antibiotic prophylaxis.…”

Surgical Site Infection

“…1 Bile may contain multiple aerobic as well as anaerobic bacteria thus increasing the risk of SSI. 2 Some newly developed guidelines do not support the use of prophylactic antibiotics in routine laparoscopic cholecystectomy (LC).…”