Perioperative Antibiotic Selection and Surgical Site Infection in Elective Colon Surgery

2020 ◽  
Vol 86 (9) ◽  
pp. 1091-1093
Author(s):  
Madiha Aziz ◽  
Jack Beale ◽  
Brynn Sheehan ◽  
Nicholas Bandy ◽  
Michael Martyak
Keyword(s):  
Surgical Site Infection ◽  
Retrospective Review ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Colon Surgery ◽  
Site Infection ◽  
Inclusion Criteria ◽  
Antibiotic Selection ◽  
Elective Colon Surgery ◽  
Elective Colon

Objectives The highest rates of surgical site infections (SSIs) are associated with colorectal operations (up to 30%). A sentinel paper showed that the use of intravenous (IV) cefazolin and metronidazole was associated with decreased rates of SSI compared with cefoxitin (6% vs 13%). We reviewed the association of SSI with prophylactic antibiotic choice. We specifically investigated the regimens of ceftriaxone and metronidazole IV, cefoxitin IV, or ertapenem. Methods We conducted a retrospective review of 532 colon surgeries between 2016 and 2018. Inclusion criteria were patients 18-89 years of age undergoing elective colon surgery who received ceftriaxone/metronidazole, cefoxitin, or ertapenem for prophylaxis. All emergent cases were excluded. This resulted in 241 elective colon cases for review. The primary endpoint was to determine if the use of ceftriaxone/metronidazole decreased the rate of SSI. Results In total, there were 241 elective colon cases with 21 SSI. We compared SSI rates in the ceftriaxone/metronidazole group to those patients receiving either cefoxitin or ertapenem (4.5% vs 12.2%; P = .035). We then compared SSI in ceftriaxone/metronidazole to SSI in cefoxitin (4.5% vs 10%; P = .13). Finally, we compared SSI in the ceftriaxone/metronidazole group to SSI in the ertapenem group (4.5% vs 14%; P = .03). Comorbidities and underlying factors were similar across all antibiotic groups. Conclusion In our experience, the use of ceftriaxone/metronidazole is associated with a decreased SSI rate. Furthermore, ceftriaxone/metronidazole use is superior to the use of ertapenem, with a trend toward superiority over cefoxitin. Based on this study, we recommend ceftriaxone/metronidazole as antibiotic prophylaxis for elective colon surgery.

scholarly journals The Prevention of Surgical Site Infection in Elective Colon Surgery

Scientifica ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-19 ◽  
Author(s):  
Donald E. Fry
Keyword(s):  
Surgical Site Infection ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Local Environment ◽  
Colon Surgery ◽  
Colon Resection ◽  
Oral Antibiotic ◽  
Site Infection ◽  
Elective Colon Surgery ◽  
Elective Colon

Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes.

scholarly journals Incidence of post operative surgical site infection in thyroid surgery following single dose of prophylactic antibiotic

2020 ◽  
Vol 22 (1) ◽  
pp. 15-20
Author(s):  
Md Abul Hossan ◽  
Md Ariful Islam ◽  
Tapas Chakraborty ◽  
Firoz Ahmed Khan ◽  
Md Mozharul Islam
Keyword(s):  
Antibiotic Therapy ◽  
Surgical Site Infection ◽  
Thyroid Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Empirical Antibiotic Therapy ◽  
Site Infection ◽  
Cross Sectional

Surgical site infection after thyroid surgery is a less common incidence. Prophylactic antibiotic before surgery and empirical antibiotic therapy after surgery is a common practice in our country. But international guidelines do not suggest antibiotic in clean surgical procedure. Aim: To compare the incidence of surgical site infection after thyroid surgery with and without empirical antibiotic therapy. Method: It was a cross sectional study, done from July 2010 to December 2010 in 3 medical college hospitals in Dhaka city. Total 100 cases were included in this study, 50 cases for study in which only single prophylactic antibiotic used half an hour before operation, 50 cases for control in which 7 days antibiotic used per orally in addition to prophylaxis. Result: Among 100 cases male were 24 & female 76 (M: F= 1:3.2). Oldest patient was 56 yrs & youngest 21yrs. 47% patient operated for solitary thyroid nodule, 35% multinodular goiter & only 6% diffuse goiter. 47% patient was done hemithyroidectomy & only 7% total thyroidectomy. All the operations were completed within 2 hours where 40% within one hour. No surgical site infections were found in both study and control cases. Conclusion: There is no statistical difference between routine antibiotic use and no use of antibiotic after thyroid surgery. Bangladesh J Otorhinolaryngol; April 2016; 22(1): 15-20

scholarly journals ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

2015 ◽  
Vol 52 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Álvaro Antônio Bandeira FERRAZ ◽  
Luciana Teixeira de SIQUEIRA ◽  
Josemberg Marins CAMPOS ◽  
Guido Correa de ARAÚJO JUNIOR ◽  
Euclides Dias MARTINS FILHO ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Continuous Infusion ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Anesthesia Induction ◽  
Site Infection ◽  
Cross Sectional ◽  
Group I ◽  
Bariatric Patients

Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

Value-based purchasing may unfairly penalize specialty centers performing combined liver–colon multivisceral resections

2018 ◽  
Vol 23 (4) ◽  
pp. 143-148
Author(s):  
Ira L Leeds ◽  
Peter J Pronovost ◽  
J Matthew Austin ◽  
Elliott R Haut
Keyword(s):  
Linear Regression ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Risk Adjustment ◽  
Surgical Site Infections ◽  
Multivisceral Resection ◽  
Colon Surgery ◽  
Site Infection ◽  
Surgical Site Infection Rate ◽  
Value Based Purchasing

Background Some of the measures in value-based purchasing programs may be flawed due to inadequate risk adjustment. The purpose of this study was to examine the effect of the surgical casemix on surgical site infection rates using combined colectomy–hepatectomy resections as a test case. Methods We identified all adult patients undergoing elective colon surgery (2007–2013) in the National Inpatient Sample. We defined patients with a concurrent liver resection as “multivisceral resections.” Cases from each hospital were pooled by hospital identifier. The association between surgical site infection rate and the proportion of multivisceral resections performed was compared statistically. Findings were further tested for independence against hospital-level characteristics similar to risk-adjusted surgical site infection rate reporting. Results We identified 1014 hospitals performing 127,646 colon surgeries including 1168 (0.9%) multivisceral resections. The overall surgical site infection rate for multivisceral resection was 11.3% versus 1.6% for colectomy-only resections (p < 0.001). Simple linear regression demonstrated a 2.3% increase in a hospital’s surgical site infection rate for each 1% increase in the proportion of multivisceral resections performed. Multivariable linear regression demonstrated a preserved association. Conclusion A hospital’s rate of surgical site infections is positively associated with the proportion of multivisceral resections performed. Value-based purchasing programs should assess readily available data for further risk-adjustment inclusion.

scholarly journals Risk Factors for Cesarean Section Surgical Site Infections: A Systematic Review

2020 ◽  
Vol 41 (S1) ◽  
pp. s377-s377
Author(s):  
Feah Visan ◽  
Jenalyn Castro ◽  
Yousra Siam Shahada ◽  
Naser Al Ansari ◽  
Almunzer Zakaria
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Body Mass Index ◽  
Risk Factor ◽  
Cesarean Section ◽  
Surgical Site Infection ◽  
Body Mass ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Inclusion Criteria

Background: According to the CDC NHSN, surgical site infections (SSI) are wound infections that develop within 30 days postoperatively for nonimplanted surgeries such as cesarean sections. SSIs is shown to manifest in a continuum of a purulent discharge from surgical site to severe sepsis. It contributes to rising morbidity, mortality and prolonged length of stay. Objective: To describe risk factors to the development of SSI in cesarean section in descriptive studies. Methods: The Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines is used as method for this systematic review. A PubMed literature search was conducted, limited to published articles in English from 1998 to 2016 using the broad key terms “cesarean section,” “surgical site infection,” and “risk factor.” The following inclusion criteria were applied to all reviews: (1) peer-reviewed journal, (2) computed risk factor for SSI development, and (3) calculated SSI rate. Reviews of references of the include studies were conducted, and 7 studies were appraised, with only 1 accepted. Results: After extracting data from 52 article reviews, 23 were finally accepted based on the inclusion criteria. Most studies were multivariate studies (n = 8) followed by cohort studies (n = 6). Unique numerators and denominators for SSI reviews were mentioned in all 23 studies, of which 22 studies followed the CDC NHSN definitions for SSI. Within the 23 studies, most studies showed that obesity (11.46%) is a common maternal risk factor for the development of postoperative cesarean section SSI. Conclusions: Identifying that obesity is a major contributor of surgical site infection in postoperative cesarean section women is a topic that warrants exploration. The relationship of cesarean section SSI to obesity should be investigated, specifically highlighting the level of obesity based on the WHO international body mass index (BMI) classification and the development of SSI. A correlation between increasing wound infection rates and increasing body mass index should be studied further. Published recommendations for preventing SSIs in this population should be reviewed.Funding: NoneDisclosures: None

scholarly journals A study of pattern of pathogen and their sensitivity isolated from surgical site infections in abdominal surgeries

2019 ◽  
Vol 7 (1) ◽  
pp. 267
Author(s):  
Anilkumar M. S. ◽  
Deepakraj K. R.
Keyword(s):  
Surgical Site Infection ◽  
Open Abdomen ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Descriptive Study ◽  
Prophylactic Therapy ◽  
Cost Burden ◽  
Site Infection ◽  
Inclusion Criteria ◽  
Site Pain

Background: Surgical site infection (SSI) is defined as those infections presenting up to 30 days after a surgical procedure if no prosthetic is placed and up to 1 year if prosthesis is implanted in the patient. SSI contributes to increasing morbidity, mortality and cost related to surgeries and continues to be a major problem even in tertiary care modern hospitals following standard protocols of peri operative preparation and antibiotics prophylaxis. Objective of this study was to study and analyse the pattern of pathogen causing SSI in abdominal surgeries in a tertiary care hospital.Methods: Descriptive study on patients undergoing abdominal surgery in the department of surgery. Patients satisfying inclusion criteria will be assessed on 2nd postoperative day and then daily for surgical site pain, redness, warmth, discharge and swelling of surgical site till the patient gets discharged and followed up after discharge every 7 days up to 1 month. If SSI is detected, swab will be taken and sent for culture and sensitivity.Results: At the end of the study, after analysing the pattern of pathogens and antibiotic susceptibility, we intend to conclude the safe usage of empirical antibiotic prophylaxis to prevent the incidence of SSI’s in our hospital.Conclusions: Appropriate prophylactic therapy for any open abdomen surgeries reduces incidence of surgical site infection thereby reducing morbidity, mortality and cost burden in patients undergoing abdominal surgeries.

scholarly journals Single dose antibiotic prophylaxis for prevention of surgical site infection in elective surgery

2017 ◽  
Vol 5 (1) ◽  
pp. 27 ◽  
Author(s):  
Swaroop V. Borade ◽  
Obaid Syed
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Relevant Information ◽  
Site Infection ◽  
Intraoperative Management ◽  
Clean Contaminated ◽  
A Prospective Study

Background: Surgical site infections are associated with prolonged hospital stays and increased costs. Infection develops when endogenous flora is translocated to a normally sterile site. Seeding of the operative site from a distant site of infection can also occur (especially in patients with prosthesis or another implant). Factors influencing the development of surgical site infections include bacterial inoculums and virulence, host defences, preoperative care and intraoperative management. Hence there is the need for antibiotic prophylaxis to overcome this problem. This study was planned to evaluate the effect of prophylactic antibiotic in clean and clean contaminated cases and to assess the outcome.Methods: A prospective study was conducted which include 100 patients undergoing elective surgery admitted to the department of general surgery IIMSR’s Medical College and Hospital, Warudi, Jalna, relevant information of each patient was collected according to the Performa designed for the study. Cefuroxime was used preoperatively 30 min prior to incision and its impact on postoperative wound infection was studied.Results: We had 100 cases in our study predominantly males with maximum individuals in 31-40 years age group, we had 67% clean and 33% clean contaminated surgeries done and had 3% case of superficial surgical site infection.Conclusions: A single preoperative dose of antibiotic Cefuroxime is effective to prevent surgical site infection in elective case assuming an uncomplicated procedure.

scholarly journals Single dose prophylactic antibiotic before surgery to prevent surgical site infection: a prospective interventional study

2019 ◽  
Vol 6 (3) ◽  
pp. 843
Author(s):  
K. Saravanan ◽  
T. Uma Maheswari
Keyword(s):  
Single Dose ◽  
Surgical Site Infection ◽  
Elective Surgery ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Site Infection ◽  
Nice Guideline ◽  
Surgery Patient ◽  
Hernia Mesh Repair

Background: Surgical site infections (SSI) are one of the most common postoperative complications leading to increased morbidity which also an important factor of increased hospital stays and increased healthcare cost. The use of prophylactic antibiotics may benefit the patients in preventing the surgical site infection. Aim of the study was to study the single dose prophylactic antibiotic use in preventing surgical site infection in elective surgery.Methods: Patients were included from the list of elective surgery. Patient with comorbid was excluded. The patient was handled as per NICE guideline for prevention of surgical site infection and treatment 2017. Prophylactic antibiotic injection cefuroxime 1500mg administered intravenously 30 minutes before surgery, at the site of the incision.Results: In 110 patients included in the study, 46% of patients were in 35 to 45 years, male were higher in number. 20% of patients underwent hernioplasty followed by cholecystectomy 18.3%. 9% of SSI was recorded in this study. 4 cases in cholecystectomy, 3 cases in hernioplasty, each 1 case in appendicectomy, Hydrocele and ventral hernia mesh repair. The most common bacteria isolated from the samples were Staphylococcus aureus.Conclusions: In uncomplicated surgeries, single dose antibiotics before 30 minutes of surgery may benefit in preventing SSI.

Surgical Site Infections - A Hospital Havoc: Retrospective Study of Surgical Site Infections in Tertiary Health Care Centre in North East India

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
V Singh ◽  
A B Khyriem, W V Lyngdoh ◽  
C J Lyngdoh
Keyword(s):  
Surgical Site Infection ◽  
Multiple Drug Resistance ◽  
Surgical Site Infections ◽  
Multidrug Resistant ◽  
Multiple Drug ◽  
Site Infection ◽  
Retrospective Case ◽  
Acinetobacter Baumanii ◽  
Health Care Centre ◽  
North East

Objectives - Surgical site infections (SSI) has turn out to be a major problem even in hospital with most modern facilities and standard protocols of pre -operative preparation and antibiotic prophylaxis. Objective of this study is to know the prevalence of surgical site infection among the postoperative patients and to identify the relationship between SSI and etiological pathogens along with their antimicrobial susceptibility at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. Methods - A retrospective case study conducted at NEIGRIHMS, among patients admitted to the surgical departments during the period between January 1st and December 31st 2016. Swabs from the surgical sites were collected under sterile conditions and standard bacteriological tests were performed for identification and appropriate statistical methods were employed to look for association between SSI and etiological pathogens. Results - Out of the 1284 samples included in the study, 192 samples showed evidence of SSI yielding an infection rate of 14.9%. The most commonly isolated bacteria were: Escherichia coli, Acinetobacter baumanii and Staphylococcus aureus, of the gram negative isolates 6.2% were multidrug resistant of which 19% were carbapenem resistant. Conclusion - SSI with multiple drug resistance strains and polymicrobial etiology reflects therapeutic failure. The outcome of the SSI surveillance in our hospital revealed that in order to decrease the incidence of SSI we would have to: a) incorporate a proper antibiotic stewardship  b) conduct periodic surveillance to keep a check on SSI d) educate medical staffs regarding the prevention of surgical site infection.

58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Mistry ◽  
B Woolner ◽  
A John
Keyword(s):  
Surgical Site Infection ◽  
Open Cholecystectomy ◽  
Surgical Site Infections ◽  
Standard Operating Procedure ◽  
Site Infection ◽  
Infection Rates ◽  
Local Evidence ◽  
Audit Data ◽  
The Impact ◽  
To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

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